Board of Directors 26 November 2014

Board of Directors

26 November 2014

Board of Directors 26 November 2014

Document Page

1 Board Agenda 26 Nov 14 32 Item 3-Board Minutes 29 Oct 2014 73 Item 4-Chairman's Report Nov 2014 194 Item 5-Chief Executive's Report 255 Item 8.1-Integrated Performance Report 316 Item 8.2-EPRR Assurance Report 897 Item 8.2-Attach 1 to EPRR Assurance 978 Item 8.2-Attach 2 to EPRR Assurance 1019 Item 8.3-Review of Appraisal 10310 Item 8.4-Sickness Absence Report 11111 Item 9.1-BAF Report 13312 Item 9.1-Attach 1 to BAF Report 13913 Item 9.1-Attach 2 to BAF Report 15714 Item 9.2-VRP 16115 Item 9.2-Attach 1 to VRP 16716 Item 9.2-Attach 2 to VRP 19317 Item 9.2-Attach 3 to VRP 22518 Item 9.3-CF Report 25119 Item 9.3-Attach 1 to CF Report 25720 Item 9.3-Attach 2 to CF Report 26121 Item 9.3-Attach 3 to CF Report 26922 Item 9.3-Attach 4 to CF Report 27923 Item 9.3-Attach 5 to CF Report 29524 Item 9.3-Attach 6 to CF Report 29925 Item 9.4-Committees Report 30126 Item 9.4-Attach to Committees Report 30927 Item 9.5-Compliance Report 315

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1. Board Agenda 26 Nov 14

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Page 1 of 2

Meeting of the Board of Directors

Wednesday 26 November 2014 Held at Ladybridge Hall, 399 Chorley New Road, Bolton, BL1 5DD

10.00am

AGENDA

Time Encl. Presenting

1. Apologies for absence

2. Declaration of interests

3. Minutes of previous meeting: 29 October 2014 Ⓐ

10.00am

4. Chairman and Non-Executives’ Communications Ⓝ

10.05am M Whyham

5. Chief Executive’s Report Ⓝ

10.10am B Williams

6. Items of urgent business notified to the Chairman

7. STRATEGIC DISCUSSION

7.1 Finance, Performance & Quality - Achieving the Balance 10.15am B Williams

8. PERFORMANCE & PATIENT SAFETY

8.1 Integrated Performance Report Ⓐ 11.00am S Faulkner

8.2 Emergency Preparedness, Resilience & Response Report Ⓐ 11.20am D Cartwright

8.3 Review of Appraisal Process Ⓐ 11.25am M Forrest

8.4 Quarterly Sickness Absence Report Ⓝ 11.35am M Forrest

Break for Refreshments

9. GOVERNANCE

9.1 Board Assurance Framework Ⓐ 11.45am S Faulkner

9.2 Vehicle Replacement Programme 2015-16 Ⓐ 12.00pm D Cartwright

9.3 Charitable Funds Annual Report & Accounts 2013/14 Ⓐ 12.10pm A Stuttard

9.4 Report of Board Committees 12.15pm Committee Chairs

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9.5 Compliance Statements Report Ⓐ 12.25pm P Buckingham

10. DATE, TIME & VENUE OF NEXT MEETING

10.1 28 January 2015, 10.00am, at Ladybridge Hall, Bolton

11. EXCLUSION OF PRESS AND PUBLIC

The Board will meet in private session to consider the following confidential matters:

111 Service – Market Testing Preparations (Commercially Sensitive)

Board Assurance Framework Part 2 (Commercially Sensitive)

High Risk Events Report (Patient Identifiable)

KEY

Ⓐ = For Approval

Ⓓ = For Discussion

Ⓝ = For Noting

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2. Item 3-Board Minutes 29 Oct 2014

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NORTH WEST AMBULANCE SERVICE NHS TRUST Minutes of a meeting of the Board of Directors

Held on Wednesday 29 October 2014 10.00am at Ladybridge Hall, 399 Chorley New Road, Heaton, Bolton. BL1 5DD

Present: Mrs M Whyham MBE Chairman Mr A Slater Non-Executive Director Mr P White Non-Executive Director Mr M O’Connor Non-Executive Director Mr J Townsend Non-Executive Director Prof I Singh Non-Executive Director Mr B Williams Chief Executive Mr A Stuttard Director of Finance Mr D Cartwright Director of Operations Mr M Forrest Director of Organisational Development Ms S Faulkner Director of Quality Prof K Mackway-Jones Medical Director In attendance: Mr P Buckingham Corporate Secretary Miss H Thornton Corporate Governance Officer 267/14 Chairman and quorum

The Chairman noted that due notice of the meeting had been given to each Board member and that a quorum was present. Accordingly, the Chairman declared the meeting duly convened and constituted. She welcomed Mrs R Dorsky, Head of Technical Accounts, Mr P Graham, Health Intelligence Analyst, Mr R Selby, Lead Governor, Mrs J Pitman, Public Governor, Mrs P Dyson, Public Governor and Ms S Stephenson from Deloitte.

268/14 Apologies for absence

There were no apologies for absence.

269/14 Declaration of interests

There were no declarations of interests in any items on the agenda. 270/14 Minutes of the previous meeting

The Board reviewed the minutes of the previous meeting held on 24 September 2014 and the Medical Director noted minute ref 242/14 and advised that the Deputy Medical Director had left the meeting after the following agenda item. Subject to this amendment, it was agreed that the minutes could be duly signed by the Chairman as a true and accurate record of proceedings. The action tracking log was reviewed and annotated as follows:

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Ref. Annotation

9/14 The Medical Director advised that the presentation from Advanced Paramedics had been deferred due to REAP Level 4 operations.

11/14 The Corporate Secretary advised that outcomes of the operational modelling work would be incorporated in the Board Strategy meeting on 18 December 2014.

Mr M O’Connor joined the meeting.

271/14 Chairman and Non-Executive Directors’ Communications

The Chairman presented a report which detailed her activities, and those of the Non-Executive Directors, during September and October 2014. She provided the Board with an overview of her report and noted in particular her attendance at a Collaboration event in Cheshire on 22 October 2014 which involved representatives from other emergency services in the county. At the request of the Chairman, Mr P White provided the Board with an overview of his recent attendance at a Hot Topics event facilitated by the Foundation Trust Network. He noted in particular a recurring theme during the event associated with the need to ensure that focus was maintained on the delivery of performance targets. Prof I Singh advised the Board that he had attended a meeting hosted by Sir Robert Francis on 28 October 2014 and noted that the meeting had focused on the ‘Freedom to Speak’ concept and how this would be reflected in the regulatory framework. Mr A Slater congratulated the Trust’s procurement team on their success in being short-listed for an Excellence in Procurement award. The Board:

Received and noted the content of the report.

272/14 Chief Executive’s report

The Chief Executive presented a report which provided information on a number of key areas since his previous report to the Board on 24 September 2014. He highlighted s2 of his report relating to PES operational pressures and also s3 which related to industrial action. He noted that further industrial action was anticipated but advised that dates for any further action had yet to be confirmed. He also highlighted s4, noting the various collaborations which are currently ongoing and s5.3 relating to the one year anniversary of the Trust’s delivery of the NHS 111 service. He noted that since NWAS had assumed the role of stability partner, the service has handled three quarters of a million calls. He noted that market testing of the service had now commenced and advised that the Invitation to Tender document was included as an Annex to his report. The Chief Executive concluded his report by offering the Trust’s condolences to the family of Dr John Harrison who sadly passed away earlier in the month. Dr Harrison had previously worked as an Assistant Medical Director for the Trust and had been a

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guiding force in Paramedic development and clinical governance processes for the Cheshire and Mersey area for many years. In response to a question from Mr P White, the Chief Executive acknowledged that details of comparative ambulance trust performance would be helpful for the Board and the Director of Quality advised that relevant information would be incorporated in future Integrated Performance Reports. In response to a question from the Director of Finance regarding the impact of 12 trust staff volunteering as part of the NHS response to the Ebola crisis, Mr B Williams advised that it was a direct request to staff from the Secretary of State and it would there not be appropriate for the Trust to prevent release of such staff. The Director of Operations noted that the Trust was yet to receive confirmation of the names of the individuals who had volunteered, and consequently the actual impact was difficult to judge. There followed a discussion regarding the safeguarding assurances for the staff on their return from West Africa and the Director of Quality assured the Board that the directive would come from Public Health England. Both the Chairman and Mr I Singh took the opportunity to congratulate the staff for their wider contribution to the NHS. In relation to s5.5 regarding procedures and processes for Ebola, Mr I Singh requested assurances around the planning arrangements for NWAS. The Director of Operations advised that the HART team had been involved with planning arrangements for the Trust and the transfer of patients with processes ongoing for refresh of PPE stock and FFP3 masks. He also noted that the national training programme had been rolled out to Advanced Paramedics. In response to a question from Mr A Slater regarding approaching CFRs to help alleviate performance pressures, the Director of Operations advised that the Trust had not broadened the scope to mobilise CFRs to other types of calls, although the CFR team had been responding to calls outside the usual geographical footprint wherever possible. He also noted that the Trust had been reviewing the coding set. The Director of Quality reminded the Board that the CFRs are volunteers and the Trust must also be satisfied that they are fully competent for any additional call category’s they may get asked to respond to. The Medical Director endorsed the comments and added that the Trust must consider the CFRs physical and physiological wellbeing. The Board:

Received the report and noted the content.

273/14 Items of Urgent Business No items of urgent business had been notified to the Chairman. 274/14 Integrated Performance Report The Director of Quality presented the Integrated Performance Report (IPR) which

detailed performance for September 2014. She briefed the Board on the content of the report and noted that following on from a previous suggestion, the right hand columns of the dashboard had now been populated with risk and Datix information. There followed a discussion regarding the inclusion of Trust complaint and STEIS

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information and it was agreed that an update would be incorporated into the Quality Report for future Board meetings.

In response to a question regarding a recent paramedic visit to West Midlands

Ambulance Service NHS Foundation Trust (WMAS), the Chief Executive advised that the visit was interesting learning and there would be a briefing document to share. In response to a question from Mr J Townsend regarding the impact of the Trust not achieving trajectories in September, the Chief Executive advised that there has been no impact to date and financially there had been no indication of intent to invoke fines on the Trust. In response to a question from Prof I Singh regarding action plans for the clinical performance care bundle indicators, the Medical Director noted that the Trust would be aiming to hit trajectories of 95% with detailed information on the issues with pre-alerts included in the narrative. He noted that nationally the Trust performs significantly higher than other ambulance services and reports as such are presented to the Quality Committee.

In response to a question from Mr P White regarding the call pickup time, the

Director of Operations assured the Board that the Trust was working hard to get the Call takers/Emergency Medical Dispatchers (EMD) over-established by January 2015. There followed a discussion regarding the impact of REAP level 4 on training and sickness levels. The Director of Organisational Development assured the Board that mandatory training and Performance Appraisal Development Reviews (PADR) were still ongoing with a schedule in place and although there had been a sickness spike in August, the Trust had seen three/four months of improvement previously. He noted that the Workforce Committee was monitoring the sickness levels.

In response to a question from Mr J Townsend regarding the use of CQUIN monies,

the Director of Finance advised that the overall profile has been calculated to the end of the month and a financial summary had been included in the report. He noted that the Trust had received an additional £1.1m for winter pressures and based on the current plans in place, the Trust would remain in budget. In response to a question from the Chairman regarding potential fines, the Director of Finance advised that ultimately if the Trust was fined, it would break the current financial position. He assured the Board the Trust was working with the Commissioners and if the Trust were to receive a performance improvement notice, action plans would be put into place before any financial penalty was applied. He advised the Board that the Trust had held continuing discussions with Commissioners at the Strategic Partnership Board, with the vast majority of CCGs recognising that the unprecedented activity increase had been beyond the Trust’s control and would be supporting the service.

There followed a discussion regarding the inclusion of a breakdown of race, gender

and ethnicity within the Workforce dashboard. The Director of Organisational Development advised that a report is presented at the Workforce and Communities Committee. The Chairman noted that she was pleased with refresh of the dashboard and focus on these matters.

With regard to the REAP level, the Chief Executive advised that the EMT review the

current situation on a weekly basis and to date, there had not been enough evidence to change from the current position of REAP level 4. He noted that while improvements had been made through operating at REAP level 4, premature de-escalation could result in a consequent dip in performance levels. In response to a

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query from Prof I Singh regarding the potential implications on quality, the Chief Executive assured the Board that it remains a focus of the EMT and if there were any concerns regarding quality, the issues would be raised and addressed immediately. The Chairman advised that she felt assured that the Trust should remain at REAP level 4 with weekly monitoring by the EMT and further discussions to follow at the November Board meeting.

The Board:

Received and noted the report and attached appendices Noted the assurances given regarding compliance with agreed targets.

275/14 Patient Experience Integrated Report – Quarter 2

The Director of Quality presented a report to provide an update on the integrated patient experience report 2014/15 at the end of quarter 2. She briefed the Board on the content of the report and noted that there had been detailed discussions regarding the report at the Board development session on 28 October 2014. She highlighted the key themes at s3 of the report and provided a brief overview of the family and friends test progress and service improvement plan. She noted that included in the report were detailed appendices and the report will be presented to the Board on a quarterly basis. The Chairman noted that the report was also presented to the Quality and Patient Experience Sub-Group. Prof I Singh endorsed the report and suggested that the complaints in relation to staff conduct could be presented in a way which enabled identification of complaints arising from particular demographic groups such as vulnerable adults. The Director of Quality welcomed the comments and noted that herself and the Director of Organisational Development had already begun work regarding staff conduct and staff behaviours. The Chief Executive suggested that future reports could include historical data to indicate movements in complaint numbers year on year. Prof I Singh endorsed the comments and noted that it would be helpful to see trend information. The Board:

Received the report and noted the assurance report Agreed to receive Patient Experience reports on a quarterly basis Noted the identified areas of service improvement.

276/14 Strategic Plan – Quarter 2 Progress Report

The Director of Organisational Development presented a report to provide details of progress against the 2014/15 objectives as at the end of Quarter 2 and to provide assurance following review by the Finance, Investment and Planning Committee (FIP) on 24 October 2014. He briefed the Board on the content of the report and noted that the Finance, Investment and Planning Committee had conducted an in-depth review of progress against PTS objectives at its meeting on 24 October 2014. The Chairman advised the Board that she felt assured that the FIP Committee was considering the objectives in detail and that assurances were being sought on any red- rated areas.

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The Board:

Received the report and noted the assurance that the Finance, Investment and

Planning Committee had reviewed the detail of the progress associated with the Directorate objectives as at the end of quarter 2.

277/14 Integrated Business Plan - Quarterly Update

The Director of Finance presented a report to provide an update on the changes to the Integrated Business Plan (IBP) and request approval for sign off as the most recent version of the ‘Current IBP’. He advised the Board that the table in s3.3 of the report summarised the changes which had been agreed by the FT Steering Group. The Board:

Approved the updated version of the Current IBP as presented.

278/14 Organisation Performance & Financial Planning

The Chief Executive and Director of Operations delivered a presentation which provided an overview on ‘Organisation Planning’ and covered the following areas for discussion:

Simon Stevens 5 year forward view Recap previous 5 year plan Commissioning model Progress on new 5 year model Finance position for 2015/16

In response to a question from the Chairman regarding the model, the Chief Executive advised that in principle, there would be one flexible model that could be used across the Trust. The Director of Operations provided the Board with a detailed overview of the progress to develop a new 5 year plan, highlighting area performance issues, resource requirements, demand and capacity analysis, rurality factors, health service reconfigurations, seasonal variants and the dynamics of changing transport needs. He advised the Board that test scenarios and gap analysis would be completed and assured the Board that the first draft of the modelling was expected to be finished by the end of November with further refinements to follow. He advised that the modelling had been based on the Trust-defined areas, rather than by CCG, which could vary in the future, and was based on resources necessary to deliver performance rather than resources required to meet the financial envelope. The Director of Finance provided the Board with an overview of the finance position and CIP targets including the shortfalls, noting that there were underlying cost pressures. He summarised the overarching financial cost pressures and assured the Board that the problem is a national issue. In response to questions from the Chairman, the Chief Executive advised that finances are part of the current debate to incite discussion about changes within the system and advised the Board that the current modelling will then inform CIP planning for 2015/16.

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Mr P White endorsed the impressive work involved in the planning of the new model and queried how all of the Directorates would be involved to work together collaboratively. The Director of Operations assured the Board the all Directorates have been engaged with conversations ongoing to ensure all involved are interlinked. He noted that staff side have also been considered. There followed a discussion regarding the trajectories and Mr P White advised that the figures have to be achievable before the Trust presents the new model to the Commissioners. The Director of Operations assured the Board that the trajectories would be balanced and pitched correctly. He noted that there was still ongoing work with the urgent care systems and the Trust would require a capacity review. The Chief Executive endorsed the comments and noted that the Trust had completed a capacity review previously in 2010 and that a request to Commissioners earlier in the year for a further review had not been agreed. There followed a discussion in response to a question from Mr M O’Connor regarding the appetite to consider income generation. The Director of Finance advised that the Trust would have to be mindful of CIPs and becoming reliant on finances from income generation. He noted that there was scope for further efficiencies. The Chairman expressed concern regarding the CIPs and budgets for the Trust in 2015/16 and Prof I Singh noted that following the overview of Simon Stevens’ 5 year forward view, it was important to recognise the need to inject funds into the NHS with the whole system moving towards a new model and understand the impact on organisations such as NWAS. The Chief Executive endorsed the comments and noted that the Trust had based the 5 year plan as such. Mr J Townsend endorsed the planning and presentation and noted that the costing is critical and the Trust must look five years forward for business plans. The Director of Quality highlighted the current difficulties in support for some of the core projects while staff continued to conduct core business. The Chairman summarised the discussion and was pleased with the positive work so far. She noted that the potential for income generation merited further discussion and the requirement to develop CIP plans for 2015/16.

279/14 Board Assurance Framework

The Director of Quality presented the Board Assurance Framework (BAF) 2014/15 for review and approval. She briefed the Board on recent BAF activity as detailed at s3 of the report and advised that two risk areas had been identified as a result of horizon scanning. The Board completed a review of each risk within the BAF and discussed risk 1264 in detail and the need to progress development of CIP plans for 2015/16. The Director of Finance expressed concerns with developing plans which would be at the expense of quality. Following comments from Mr J Townsend, who suggested a need to model a variety of CIP planning scenarios, the Director of Finance agreed that such an approach could be helpful. The Chairman requested the Board consider the discussions which had been held during the Board meeting for new potential risks. The Director of Quality noted that there could be a need for a risk around the outcomes of the operational modelling work. In response to a suggestion from Mr A Slater, the Director of Operations

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agreed to consider the level of risk associated with the capacity limitations of current third party providers. The Board then completed a review of risks with a residual risk score of 12 by exception and commented as follows: Risk ID 1009 – The Director of Operations noted that the risk was due to be closed. Risk ID 1147 – In response to a question from Mr P White regarding the inclusion of Hub & Spoke concept in the new modelling, the Director of Operations noted that it would be aligned during the development of plans. The Board:

Approved the Board Assurance Framework 2014/15 Considered potential risks from discussions held Reviewed and commented on the risks with a residual risk rating of 12

included at Annex 2 of the report. 280/14 Duty of Candour Report

The Director of Quality presented a report to outline the Health and Social Care Act 2008 (Duty of Candour) Regulations 2014. She provided the Board with an overview of the report and noted that the report also provided assurance on the current position of the Trust meeting the requirement and recommended actions taken in preparation for the Regulations to be fully implemented. In response to a question from Prof I Singh, the Director of Quality advised that numbers which have been acknowledged would relate to STEIS incidents reported. The Board:

Acknowledged that identified risks have been/are being mitigated Acknowledged significant levels of assurance the Trust is adhering to

requirements of the Health and Social Act 208 (Duty of Candour) Regulations 2014

Acknowledged that where gaps in assurance have been identified, actions to address the gaps are being taken.

281/14 Reports of the Board Committees

Due to the publication of the Board papers preceding the Committee meeting date for the Finance, Investment and Planning Committee, Mr A Slater provided the Board of Directors with a verbal update on matters considered at the Committee meeting held on 24 October 2014. He noted that the Committee considered progress reports on both the Cost Improvement Programme (CIP) and the Capital Programme for 2014/15 and could assure the Board that good progress was being made against both programmes. He also noted that the Committee had reviewed high level financial-related risks.

The Board:

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Received and noted the tabled report of the Finance, Investment and Planning Committee.

282/14 Consent Agenda

The Board noted the Consent Agenda items and agreed the following action:

Noted the Good to Great Engagement Programme – Progress Report Noted the Climate Change Risk Assessment and Adaption Action Plan

The Director of Quality noted that the Board should acknowledge the work relating to Sustainable Development (Climate Change) with the Trust making excellent progress against the Good Corporate Citizenship model.

283/14 Compliance Statements Report

The Director of Quality presented a report seeking approval for submission of compliant assurance statements to the NHS Trust Development Authority (TDA). She provided the Board with an overview of the report and highlighted the monthly self-certification requirements detailed in s2.2 of the report.

The Board:

Approved sign-off and submission of full compliance assurance statements for September 2014.

284/14 Date, time and venue of next meeting

The next meeting of the Board of Directors will be held on 26 November 2014, 10.00am, at Ladybridge Hall, 399 Chorley New Road, Heaton, Bolton, BL1 5DD.

285/14 Exclusion of press and public

In accordance with s.1(2) Public Bodies (Admission to Meetings) Act 1960, the Board resolved that representatives of the press and other members of the public be excluded from the remainder of the meeting, having regard to the confidential nature of the business to be transacted; publicity on which would be prejudicial to the public interest.

Signed: ______________________________ Date: ______________________________

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BOARD OF DIRECTORS: ACTION TRACKING LOG

Ref. Meeting Minute

Ref Subject Action Responsible

9/14 28 May 14 140/14 Integrated

Performance Report

Presentation on the quality improvement work being undertaken by Advanced Paramedics in relation to clinical performance care bundles to be arranged for a future Board meeting. Update 25/05/14 - The Medical Director advised that he would liaise with the Corporate Secretary and a date for the presentation would be provided at the next Board of Directors meeting. Update 30/7/14 - The Corporate Secretary advised that a presentation on quality improvement work being undertaken by Advanced Paramedics was scheduled for the Board of Directors meeting on 24 September 2014. Update 24/09/14 - The Corporate Secretary noted the absence of the Medical Director and advised that a presentation on quality improvement work being undertaken by Advanced Paramedics would be re-scheduled for the October 2014 Board of Directors meeting. Update 29/10/14 - The Medical Director advised that the presentation from Advanced Paramedics had been deferred due to REAP Level 4 operations.

Medical Director

11/14 24 Sep 14 241/14 Financial Strategy

Development

An away day session for Board members to be arranged on completion of current operational modelling work. Update 29/10/14 - The Corporate Secretary advised that outcomes of the operational modelling work would be incorporated in the Board Strategy meeting on 18 December 2014.

Corporate Secretary

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3. Item 4-Chairman's Report Nov 2014

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Report to: Board of Directors Date: 26 November 2014

Subject: Chairman's Report

Report of: Chairman Prepared by: Mary Whyham

PAPER FOR NOTING

Corporate objective ref:

-----

NHS Constitution This paper supports the following principles that guide the NHS:

The NHS provides a comprehensive service to all

Access to NHS services is based on clinical need, not an individual’s ability to pay

The NHS aspires to the highest standards of excellence and professionalism

NHS services reflect the needs and preferences of patients, local communities and the wider population

The NHS works across organisational boundaries and in

partnership with other organisations in the interest of

patients, local communities and wider population

The NHS is committed to providing best value for taxpayers’

money and the most effective, fair and sustainable use of

finite resources

The NHS is accountable to the public, communities and

patients that it serves

Board Assurance Framework ref:

-----

CQC Registration Standards ref:

-----

Equality Impact Assessment:

Completed

Not required

Attachments:

This paper has previously been

presented to:

Board of Directors

Council of Governors

Audit Committee

Executive Management

Team

Quality Committee

Finance & Investment

Committee

Workforce Committee

Communities Committee

Charitable Funds Committee

Nominations Committee

Remuneration Committee

Joint Partnership Council

Service Development

Committee

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- THIS PAGE IS INTENTIONALLY BLANK -

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1. INTRODUCTION

1.1

The purpose of this report is to advise members of matters of importance and my activities

on behalf of the Trust since the previous Board meeting and those of my Non Executive

colleagues.

2. BACKGROUND

2.1 The attached report provides details of my activities since the previous Board meeting.

3. CHAIRMAN’S ENGAGEMENTS

3.1

31/10/14 Visit to Middlebrook for 111 birthday celebrations

3-10/11/14 Annual Leave

12/11/14 Visit to Parkway Manchester

13/11/14 Shadow Governor Council Leyland

18/11/14 Visit to Elm House Merseyside

19/11/14 North West Leadership Academy Awards Ceremony

21/11/14 Meeting with Non-Executive Directors

25/11/14 CQC Quality Summit

25/11/14 Board Development

26/11/14 Board Meeting

3.2 NON EXECUTIVE DIRECTORS’ ENGAGEMENTS

Alan Slater

4-5/11/14 F & I committee chairs meeting, Stratford Upon Avon

11/11/14 Audit committee, LBH

13/11/14 Council of Governors, Leyland

18/11/14 AACE meetings, Leeds

19/11/14 Ambulance Learning Forum, Leeds

21/11/14 NED Meeting and Finance, Investment and Planning Committee, LBH

25/11/14 CQC Quality Summit, Manchester

26/11/14 Board Meeting, LBH

Peter White

4/11/14 Workforce and Communities Committee

18-19/11/14 Ambulance Leadership Forum, Leeds



John Townsend

4/11/14 NHS Audit Chairs Event, London

13/11/14 Council of Governors, Leyland



Michael O’Connor

4/11/14 NWAS national Meeting in Stratford upon Avon - attended all day

including meal and overnight

21/11/14 NED and Governor meeting with Mary Whyam

21/11/14 NWAS meeting with Steve Barnard - 1:30pm - 2pm

26/11/14 Board of Directors meeting 10am - 4pm 22 of 324

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Prof Iqbal Singh

Leave

4. MATTERS TO NOTE

4.1 As this will be my final report to the NWAS Board, I wanted to take the opportunity to

reflect a little on the past eight and a half years.

4.2 I am now in the process of visiting key centres across the region and am heartened by the

commitment, enthusiasm and care that our staff demonstrate. This was a key factor

highlighted by the CQC Inspectors when they provided their initial feedback to the Chief

Executive Officer.

4.3 The merger of four large and very complex ambulance organisations was always going to be

a very challenging task, but I am extremely proud of what we have achieved and thank all

Board members past and present who have supported me. Without the support of our

stakeholders and partners, in particular our Commissioners, this would not have been

possible.

4.4 As NWAS moves forward with the Urgent Care agenda and Safe Care Closer to home there

is still much to do. Market testing I am sure is here to stay, and it is my hope that my

successor will have the business and commercial skills and experience to help the Board

with this task. We can be justly proud of the progress that we have made with our four PTS

contracts. This is encouraging for the future. Our stewardship of 111 has gone well as we

bid for the future contract with confidence and pride.

4.5 The Shadow Governor Council meeting on November 13th 2014 demonstrated that our

Members can be confident in a Shadow Council that is getting to grips with its role and

function in terms of holding to account, whilst acquiring knowledge and expertise.

4.6 Our patients in the North West remain our major focus. I have confidence in the

composition of the Board- both executives and non-executives. Their experience, skills and

healthy respect for one another provide an ideal platform from which NWAS can address

the challenges of finance, performance and quality. There is a very real need for a new

commissioning framework and I know that this is something that the Board are pursuing.

And finally, as a Member of NWAS, I look forward to the day when Foundation Trust status

will be achieved.

5. LEGAL IMPLICATIONS

5.1 There are no legal implications associated with the content of this report.

6. RECOMMENDATION(S)

6.1 The Board of Directors is recommended to:

Note the content of the report.

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4. Item 5-Chief Executive's Report

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Subject: Chief Executive’s Report

Report of: Chief Executive Prepared by: Bob Williams

PAPER FOR NOTING


-----











finite resources




1258/1259/1274


-----


Completed

Not required

Attachments:


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1 The purpose of this report is to provide members with information on a number of key areas

since my last report to the Trust Board on 29 October 2014.

2.

Organisational Pressure

2.1 As can be seen from the detail in the Integrated Performance Report on the Trust Board

Agenda, NWAS is continuing to struggle towards achieving the headline PES performance

targets.

2.2

The key factor which is affecting our performance delivery, the service to patients and the

pressure on our staff is the continuing levels of activity. We are having ongoing dialogue

with the commissioners over the activity levels and what additional mitigation can be

obtained.

2.4

The concern is that with the focus and attention placed on delivery of the headline

performance targets, the adverse effect on staff, managers and supporting quality aspects of

the service are being stretched further than is sustainable.

3. INDUSTRIAL ACTION

3.1 NHS staff are taking further national action during the week commencing 24th November.

Robust contingency planning arrangements have been put in place and a verbal update of

the impact will be supplied by the Director of Operations at the Board meeting.

4.

CQC update

4.1

The Trust has received the draft Inspection Report for factual accuracy and at the time of

writing this report is in the process of responding to that. The Quality summit is scheduled

for the 25th November and an update will be given at the Trust Board meeting.

5. ITEMS OF NOTE

5.1

Tripartite summit: A regional event for all provider Chief Executives and commissioning

Accountable Officers was held in Leeds on 4th November. At this event, NHSE CEO Simon

Stevens, Monitor CEO David Bennett and Trust Development Agency CEO David Flory

presented the NHS 5 year Forward View (5FV) as the NHS offer to the public and the next

government. The headline message was that the NHS has improved dramatically over the

last 15 years, but the tactics to save money seen over the last 5 years are not sustainable

and we need to make 3 big changes – a) reduce avoidable illnesses that generate most of

the activity increase, b) change the way care is delivered to more integrated solutions with

local flexibility, c) the funding gap can be reduced by efficiency and change but @£8b needs

central funding. They were also very clear that “We will not get chance to have this

conversation [5FV] with the next government if we do not deliver the headline targets over

the next four months because that is where the focus will be”.

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5.2

Association of Ambulance Chief Executives (AACE) video: In line with the NHS 5 year

Forward View and the development of ambulance services for their role in transforming

Urgent and Emergency Care, AACE have released a video outlining some of the change in

practices across the ambulance services recently. It demonstrates the wide-ranging

capabilities we now have and identifies the potential for us to be at the heart of the changes

required for integration in the proposed new urgent and emergency care system. It can be

found at http://aace.org.uk/ambulance-services-in-transforming-urgent-emergency-care/


6.1

There are no legal implications associated with the content of this report.

7.

RECOMMENDATION(S)

7.1

The Board of Directors is recommended to:

Receive the report and note the items

Be assured that the necessary contingency arrangements are in place for the

industrial action

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http://aace.org.uk/ambulance-services-in-transforming-urgent-emergency-care/


5. Item 8.1-Integrated Performance Report

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Subject: Integrated Performance Report

Report of: Director of Quality Prepared by: Health Intelligence Analyst

PAPER FOR NOTING/APPROVAL


All











finite resources




-----


All


Completed

Not required

Attachments:

Appendix 1: Operational Delivery Report

Appendix 2: Quality Report

Appendix 3: Finance Report

Appendix 4: Workforce Report


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1

The purpose of this report is to provide the Board of Directors with a report on all aspects of performance for the month of October. The report details any significant areas of concern and identifies corrective action being already taken or planned.

2. REPORT STRUCTURE

2.1 2.2

The report is supported by the following appendices, which have been amended to give more focus on exceptions and risk areas:

Appendix 1: Operational Delivery Report Page 13 Appendix 2: Quality Report Page 26 Appendix 3: Finance Report Page 42 Appendix 4: Workforce Report Page 54

A brief summary of the main issues in each appendix is included in the main report at section 4.

3. CORPORATE DASHBOARD

3.1 3.2 3.3 3.4

The dashboard provides an update on performance against key indicators covering the main functions of the organisation. Where appropriate, indicators are RAG rated. The definitions used for the current position are: ● On track to deliver ● Off track but will deliver with mitigating action ● Off track and unlikely to deliver For the PES Clinical Performance Indicators and the PTS quality indicators an alternative approach is used: ● Meeting target ● Within 5% of target ● Over 5% below target As requested by the Board of Directors, indicators 34, 35, 39, 40, 44 and 45, which related to Complaints and Serious Untoward Incidents (SUI’s) for PES, 111 and PTS respectively, have been removed from the Corporate Dashboard. Information on these areas can be found in the Quality Appendix. Also requested by Board, was the addition of benchmarking data around the Trust’s Ambulance Quality Indicators. This information has been included in the Operational Delivery Appendix.

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CORPORATE DASHBOARD OCTOBER 2014

No. LI/NI Service Line Indicator Lead

Director Target Aug-14 Sep-14 Oct-14 YTD

Risk rating Datix Ref

Data source C L Total

OPERATIONAL DELIVERY - PARAMEDIC EMERGENCY SERVICE

1 NI PES Red 1&2 calls responded to within 19 minutes against target

DC 95% 95.3% 95.1% 93.6% 95.0% 2 4 8 1269 1

2 NI PES Red 1 calls responded to within 8 minutes

DC 75% 72.7% 71.5% 71.2% 72.0% 4 5 20 1274 1

3 NI PES Red 2 calls responded to within 8 minutes

DC 75% 72.1% 73.3% 73.7% 73.1% 4 5 20 1274 1

4 LI PES 999 calls answered within 5 Seconds DC 95% 87.6% 84.6% 85.6% 84.7% 3 3 9 1270 3

5 NI PES Percentage of Incidents managed without the need for transport to A&E

DC * 27.6%* 27.2%* 27.6%* 27.4%* 2 4 8 1332 1

6 NI PES Calls closed with telephone advice where re-contact occurs within 24h

DC * 10.5%* 11.2%* 11.6%* 11.1%* 1

7 LI PES Ambulance calls closed with telephone advice

DC * 3.3% 3.3%* 3.4%* 3.5%* 2 4 8 1266 1

OPERATIONAL DELIVERY - NHS 111

8 LI 111 Percentage of 111 calls will be answered in 60 seconds

DC 95% 96.7% 95.6% 95.0% 95.7% 2 4 8 1363 4

9 LI 111 Percentage of 111 calls abandoned DC <5% 0.6% 0.7% 0.8% 0.7% 2 4 8 1363 4

10 LI 111 Warm transfer to an NHS 111 Nurse Advisor when required

DC 98% 75.6%† 70.3%† 67.4%† 70.0%† 2 4 8 1363 4

11 LI 111 Time taken for 111 call back < 10 mins

DC 75% 75.9% 74.3% 71.9% 72.7% 2 4 8 1363 4

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No. LI/NI Service Line Indicator Lead


Risk rating Datix Ref

Data source C L Total

OPERATIONAL DELIVERY - PATIENT TRANSPORT SERVICE

12 LI PTS Arrival to Appointment: -45 minutes to +15 minutes

AS 90% 88.5% 86.8% 87.5% 88.2%

4

4

4

4

2

2

2

1

8

8

8

8

1322 (Cu) 323 (Ch) 1324 (Me) 1325 (La)

2

13 LI PTS Time on vehicle – No greater than 60 minutes

AS 80% 92.1% 91.6% 92.5% 92.1% 2

14 LI PTS Collection after treatment within 60 minutes

AS 80% 84.3% 83.8% 84.7% 84.5% 2

15 LI PTS Collection after treatment within 90 minutes

AS 90% 93.9% 93.2% 93.6% 93.7% 2

16 LI PTS Arrival to Appointment: Within 30 minutes - Enhanced Priority Service

AS 90% 86.3% 86.1% 86.8% 86.9% 2

17 LI PTS Time on vehicle – No greater than 40 minutes - Enhanced Priority Service

AS 85% 74.5% 72.9% 73.9% 73.5% 2

18 LI PTS Collection after treatment within 60 minutes- Enhanced Priority Service

AS 85% 91.4% 90.2% 91.6% 91.5% 2

19 LI PTS Collection after treatment within 90 minutes- Enhanced Priority Service

AS 90% 97.7% 97.2% 97.8% 97.7% 2

20 LI PTS PTS Calls Answered AS 90% 98.7% 90.0% 99.0% 97.4% 2

21 LI PTS PTS Calls answered in 20 Seconds AS 75% 81.40% 82.10% 85.1% 85.0% 2

22 LI PTS PTS Average Answer Delay AS 1 min 00:15 00:14 00:11 00:12 2

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No. LI/NI Service

Line Indicator

Lead


Risk rating Datix

Ref

Data

source C L Total

QUALITY - PES

23 LI PES Asthma Care Bundle Performance SF 93.10% 91.9% 95.7% 85.4% 90.7% 7

24 LI PES Cardiac Chest Pain Care Bundle

Performance SF 84.70% 82.6% 83.2% 84.8% 83.0% 7

25 LI PES Pain Care Bundle Performance SF 95.00% 94.4% 94.2% 95.4% 94.1% 7

26 LI PES PRF Completion Care Bundle

Performance SF 95.00% 93.2% 93.5% 93.2% 93.1% 7

27 LI PES Patient Pathway Care Bundle

Performance SF 83.90% 80.6% 81.3% 80.7% 80.3% 7

28 LI PES Paediatric Febrile Convulsion Care

Bundle Performance SF 83.00% 80.9% 66.0% 82.8% 71.8% 7

29 LI PES Trauma - Below Knee Fracture Care

Bundle Performance SF 73.80% 68.5% 75.3% 70.7% 69.6% 7

30 LI PES Stroke Care Bundle Performance SF 95.00% 92.6% 93.8% 91.8% 92.2% 7

PATIENT EXPERIENCE - PARAMEDIC EMERGENCY SERVICE

31 LI PES Overall service received (% patients surveyed who rated the service very

good/fairly good) SF 90% 97.00% 97.00% 100% 97.1% 8

32 LI PES Recommendation of our Ambulance

Service to friends and family (% patients

surveyed who said extremely likely/ likely)

SF 90% 95.00% 94.00% 92.9% 94.4% 8

33 LI PES Overall Patient Experience Results (the cumulative score from all survey questions

asked) ** SF 90 93.0 93.0 93.0 92.9 8

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No. LI/NI Service

Line Indicator

Lead Director

Target Aug-14 Sep-14 Oct-14 YTD Risk rating Datix

Ref Data

source C L Total

PATIENT EXPERIENCE – NHS 111

36 LI 111

Overall satisfaction with the way NHS 111 handled the whole process (%

patients surveyed who rated the service very good/fairly good)

SF 90% 92.00% 91.00% 94.00% 94.50% 8

37 LI 111 Recommendation of our Ambulance Service to friends and family (% patients

surveyed who said extremely likely/ likely) SF 90% 90.00% 91.00% 94.00% 91.10% 8

38 LI 111 Overall Patient Experience Results (The cumulative score from all survey questions asked) **

SF 90 90.0 92.0 94.0 92.4 8

PATIENT EXPERIENCE - PATIENT TRANSPORT SERVICE

41 LI PTS Overall service received (% patients

surveyed who rated the service very good or fairly good)

SF 90% 97.00% 95.00% 97.00% 96.30% 8

42 LI PTS Recommendation of our Ambulance Service to friends and family (% patients

surveyed who said extremely likely/ likely) SF 90% 92.00% 92.00% 93.00% 92.60% 8

43 LI PTS Overall Patient Experience Results (The cumulative score from all survey questions asked) **

SF 90 87.0 85.0 87.0 85.9 8

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No. LI/NI Service

Line Indicator

Lead Director

Target Aug-14 Sep-14 Oct-14 YTD Risk rating Datix

Ref Data

source C L Total

FINANCE

46 NI Trust Revenue Budget Position AS -£500k (£236k) (£126k) £125k (£1,239k) 4 5

3 3

12 15

1334 1312

5

47 NI Trust Capital Resource Limit AS £10,137k £165k £358k £187k £1076k 5

48 NI Trust Cash Flow AS £34,125k £35,738k £37,380k £36,794k £36,794k 5

49 NI Trust Better Payment Practice Code AS 95% 97.52% 97.34% 95.66% 97.22% 5

50 LI Trust Cost Improvement Programme vs trajectory

AS £13,863k (£276k) £777k (£105k) (£756k) 4 3 12 988 5

WORKFORCE

51 LI Trust NWAS Current KSF Appraisal MF 85.00% (±.5%)

49% 49% 46% 3 5 15 1035 6

52 LI Trust Staff sickness (one month behind) MF 5.00% (±.5%)

7.19% 6.98% 4 3 12 1094 6

53 LI Trust Mandatory Training (PES) MF 94% 82% 85% 86% 4 4 16 1036 6

54 LI Trust Mandatory Training (PTS) MF 90% 91% 93% 95% 6

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Data Sources:

1. NWAS Ambulance Quality Indicator (AQI) Returns 2. NWAS PTS Business Intelligence Systems 3. Real Time Operational Dashboard 4. NWAS 111 Business Intelligence Systems 5. NWAS Financial systems 6. NWAS ESR 7. NWAS PRF Audit Sample data (as at 17.10.14) 8. Patient Experience Surveys - Meridian System

Notes:

* (Indicators 5, 6 and 7). These targets are shown as green as the figures exceed 2014/15 Hear & Treat and See & Treat targets

** (Indicators 33, 36 & 39). The score is made up of the cumulative ‘weighted responses’ for that given question out of a 100, (i.e. Strongly Agree = 100,

Agree = 75, Neither Agree nor Disagree = 50, Disagree = 25 and Strongly Disagree = 0).

† (Indicator 10). These targets are shown as amber despite being less than the target by more than 5% at the recommendation of the Executive team.

NB: Indicators 34, 35, 39, 40, 44 and 45, which related to Complaints and Serious Untoward Incidents (SUI’s) for PES, 111 and PTS respectively, have been

removed from the Corporate Dashboard at the request of the Board. Information on these areas can be found in the commentary appendices.

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http://ehbisql02.northwestambulance.nhs.uk/ReportServer_EHBISQL02/Pages/ReportViewer.aspx?%2fWallboard%2fPES%2fPESOPD&rs:Command=Render&rc:Toolbar=true&rc:Zoom=100&Type=Area

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4. SUMMARY OF APPENDICES – MAIN ISSUES

4.1

4.2 4.2.1

4.2.2

4.2.3 4.2.4 4.2.5

4.2.6

4.2.7

4.2.8

Appendix 1: Operational Delivery During the month of October 2014 the Trust delivered the following headline performance; Red 1 71.24%,

Red 2 73.63% and A19 93.57%. The activity for the month of October has remained high with 8.0%

increase in emergency calls; the year to date position is up 8.8%. For Red 1 & 2 combined, activity has

increased by 9.7% for October.

Appendix 2: Quality

SIREN Report: October 2014

Red 1 and Red 2 activity has increased since August 2014. 35,756 calls were received in October 2014 compared to 32,603 received during the same period last year. There was an increase in prolonged waits for ambulances to 45 Red 2 calls from the 24 Red 2 calls reported during September. There were 4 incidents where an RRV had to wait for ambulance back up compared to the 1 reported during September. There were no (0) recorded Red 1 incidents with prolonged attendance times. Safeguarding: October 2014

There has been an increase in both child and adult referrals received during October. Compliance levels for Adults and Child referrals have remained above the NWAS standard. Complaints Received: 58 complaints were noted as received during October, less than half the 144 received the previous month. The top 3 primary complaint category, in order of frequency are emergency response, PTS transport and staff conduct. Incident Reporting: 253 incidents were reported during October. The top three incident types in order of frequency were 111 Data protection, manual handling and abuse/inappropriate use of service. Medicine Management Quality Indicators:

The Medicine Management Quality Improvement indicator (MMQI) bundle performance at October 2014 general medicines is 72.0%, and controlled medicines 82.9%. Quality Improvement targets have been set against these indicators for 2014/15. Infection Prevention Control Bundle Indicators:

PES vehicles - Two bundles have shown an increase in compliance (Management of equipment and management of Waste and Linen). Four IPC PES vehicle bundles perform with compliance above quality improvement target. PTS vehicles –The ‘Bare Below elbow/Hand Hygiene’ bundle is performing at more than 5% away from the agreed quality improvement target. Station- The ‘Cleanliness and Management of Waste and Linen’ bundle is performing at more than 5% away from the agreed quality improvement target. Clinical Performance Care Bundle Indicators

Asthma management whilst generally performing at a high overall standard is more than 5% away from

the quality improvement target set for this year.

National Ambulance Clinical Quality Indicators

NWAS is generally stable/ consistent in its management of the ACQI clinical conditions in comparison to

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4.3

4.4 4.4.1

4.4.2

4.4.3

other ambulance trusts.

Appendix 3: Finance The Trust has a surplus position of £1,239.4k, which is £7.9k below the planned surplus of £1,247.3k and

therefore the Board of Directors can be assured that the Trust is currently on track to achieve the planned

£500.0k surplus at the end of the financial year. Income is over recovered by £3,805.6k, pay is overspent by

£2,852.3k and non-pay is overspent by £961.2k. There have been some technical accounting adjustments

relating to the impairment of fixed assets and depreciation on donated assets which do not impact on the

planned surplus. The accounts will show a deficit of £622.2k, however the value of the technical accounting

adjustments is £614.3k and when this is added back the underlying financial performance position is

reported as £7.9k below the planned surplus.

There are a number of risks with mitigation which are influencing the M7 position:

Some of the schemes in the Trust’s Cost Improvement Plan have been slow to start, however there

are clear mitigation plans.

Activity in the first half of the year has fluctuated and there have been significant increases in red

activity and pressures across the hospitals.

PTS performance pressures resulting in an increase in the cost of PTS third party provision.

As previously reported resources to mitigate the overspend have now been brought in to the M7 position totalling £3,029.8k Appendix 4: Workforce Sickness The August sickness absence level has reduced from the figure reported last month as a result of late

changes to sickness being notified to Payroll. The revised August rate is 7.00%.

The overall sickness absence rate is 6.98% for the month of September and represents a reduction of

0.02% on the previous month. The overall cumulative sickness absence rate for 14/15 is 6.74%.

Appraisals The Trust has approved revised appraisal targets for 2014/15. Appraisal reporting has now changed to a 1

year cycle, rather than a 2 year cycle. Overall 46% of appraisals are up to date, i.e. were completed less

than 12 months ago which remains unchanged from last month. The move to REAP level 4 has led to a

temporary suspension of appraisals within PES until January 2015.

Mandatory training PTS have achieved 95% completion and PES are currently at 86%. REAP level 4 has led to a suspension of

mandatory training within PES until January, although new entrants to the Trust will continue to complete

all mandatory training elements which will have a positive impact on the figures. The position has

improved by 1% since September as 41 new entrants completed mandatory training.


5.1 Failure to ensure on-going compliance with national targets and registration standards could render the

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Trust open to the loss of its registration, prosecution and other penalties.

6. CONCLUSION

6.1 The report demonstrates to the Board of Directors the following assurances:

The Trust did not achieve the two 8 minute PES national response time targets in October 2014. The Trust has identified a significant risk to the achievement of national targets for the full year.

The Board of Directors can be assured the Trust is identifying areas of potential clinical risk and is monitoring the level of performance against specific measures such as the CPIs, CSIs, IPC and Medicines Management.

Overall the Trust can be assured that the financial position at month 7 has not shown any significant variance to plan overall due to the implementation of the mitigating resources. However the Trust is facing financial challenges in 2014/15 in terms of balancing the financial position against the significant increase in activity whilst looking to maintain/improve performance and quality

7. RECOMMENDATIONS


Receive and note this report and its attached appendices Note the assurances given regarding compliance with agreed targets

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Appendix 1: Operational Delivery

1. Paramedic Emergency Service

1.1 1.2 1.3

During the month of October 2014 the Trust delivered the following headline performance; Red 1

71.24%, Red 2 73.63% and A19 93.57%.

The activity for the month of October has remained high with 8.0% increase in emergency calls; the

year to date position is up 8.8%. For Red 1 & 2 combined, activity has increased by 9.7% for October.

The full breakdown is below.

Over recent months British Telecom (BT) have raised concerns regarding the length of time they have

had callers on the line and been unable to pass the call to an NWAS call taker due to high activity. The

delay in NWAS answering their call impacts on BTs ability to answer other 999 calls. To mitigate the

risk, NWAS has introduced a system, whereby a delay of 20 seconds or more and if a caller agrees the

call can be put in a waiting queue and a pre-recorded script is played explaining we are experiencing

high call volume and we answer their call as soon as possible. The scripts were introduced in early

October and the impact can be seen in the graph below. A better understanding of the impact will be

known once a complete month of data is available. This situation will also be improved with the

APR - OCT Comparison 13/14 - 14/15

2013/14 2014/15 (*YTD var is vs YTD LYr)

Oct OCT YTD Oct OCT YTD

EmergencyCalls (includes 111 direct entries) 99792 678636 107801 738051

As % variance from this month last year +8.0% +8.8%

R1 Incidents 2392 17434 2229 16813

As % variance from this month last year -6.8% -3.6%

R2 Incidents 30205 203814 33527 224550


G1 Incidents 5741 39761 4673 35266


G2 Incidents 21306 147848 23388 164162


G3 Incidents 6557 47358 8235 58385


G4 Incidents 15449 103671 12543 83625


All Emergency Incidents 81650 559886 84595 582364


Note: Emergency calls measured from CAD and includes 111 direct entries.

Incidents' are Incidents with at least one response attending scene.

Checked for agreement with RTO.

Figures taken from BI cube and can differ from Commissioning Volumes.

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1.4

1.5

1.6

increased numbers of call taking staff.

Commencing the 11th November the Trust is moving from ‘Interflow’ to a true virtualised switch. This

means that wherever you make a 999 call within the regional footprint the call will be answered by the

next available call taker, as opposed to the nearest geographical call centre. The change will allow the

Trust to make more efficient use of the call taking suites and improve call pick up and handling time.

During October the first of a number of national pay dispute actions took place. The action was a 4

hour strike from 07:00 to 11:00 on Monday 13th October, and then followed by an overtime ban until

Friday 17th October. The Trust put in place a number of actions to mitigate the risks as previously

mentioned in last month’s board report.

The impact on operational resources and EOC was:

DMA`s NWAS CAL CM GM

Planned 736.5 246.5 247.0 243

Actual Available 461 208.5 118.0 134.5

% of Resource 62.6% 84.6% 47.8% 55.3%

EOC 68% 80% 50% 75%

The next date identified date for action in 24th November. We currently don’t know the actions to be

taken by the three trade unions but it is anticipated to be similar to the previous action. Planning has

already taken place to deal the potential problems.

Hospital turnarounds have this month increased to an average of 29 minutes and 20 seconds per

incident. This is indicative of the pressures hospitals are experiencing due to the increased demand.

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1.7

1.8

Below sets out the numbers of patients triaged as Red 1 & 2 (highest acuity) each week in comparison

to the equivalent week last year. It can be clearly seen that the activity is consistently higher than last

year.

The following information display the Trust’s performance against Green 1-4 locally agreed targets.

The targets for Green responses are below.

Green 1 Green 2 Green 3 Green 4

20 minute response

time in 95% of cases

30 minute response


180 minute response


240 minute

response time in

95% of cases

The descriptors for the categories are:

Green 1 – 2 are deemed as serious but non-life threatening.

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1.9

2.0

Green 3 – 4 are deemed non serious and non-life threatening.

Between 01/10/14 and 31/10/14

Area G1 Perf Up to 20 Minutes

G2 Perf Up to 30 Minutes



G 69.97% 67.98% 98.07% 97.37%

L 79.25% 80.65% 98.85% 97.41%

M 80.61% 79.85% 97.66% 93.02%

The following table illustrates the April and the year to date position for the Commissioning Clusters.

Table 1 – Commissioning Area headline performance (data source – NWAS Informatics)

The national performance picture is below.

PES Performance & Trajectories MONTHLY OCT YEAR TO DATE APR-OCT

R1 in 8 mins

%

R2 in 8 mins

%

R1/R2 in 19

mins %R1 in 8 mins %

R2 in 8 mins

%

R1/R2 in 19

mins %

Cluster Cumbria Cluster 69.0% 73.4% 87.1% 68.0% 67.7% 86.6%

Cluster Lancashire Cluster 68.9% 75.6% 93.0% 71.3% 72.6% 93.8%

Cluster Cheshire Warrington and Wirral Cluster 66.9% 70.5% 94.0% 68.8% 69.6% 95.5%

Cluster Merseyside Cluster 76.1% 76.6% 94.8% 76.3% 77.2% 96.0%

Cluster Greater Manchester Cluster 72.2% 72.5% 94.1% 72.4% 73.9% 96.4%

CCG Unknown / Out of Area #DIV/0! 44.4% 81.5% 55.6% 38.6% 75.2%

Trust NWAS 71.2% 73.7% 93.6% 72.1% 73.2% 95.1%

Source: PES CCG Commissioning Sheets (from CAD through interim warehouse)

Note Unknown/Out of Area work not included within any cluster, however is included within NWAS trust total

We expect a portion of Unknown/Out of Area work to repatriate into known clusters upon introduction of Polygon reporting.

NOTE: PES commissioning CCG's are now calculated using polygon boundaries directly within the trust's CAD system.

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URGENT CARE

2. Hear and Treat (Clinical Support Desk)

2.1 2.2 2.3

The Hear and Treat target for October has been achieved. Total H&T for the month was 2622 against a trajectory of 2459, taking the year to date figure to 18248. This is 8.6% up against trajectory and meeting CQUIN metrics for planned reward income in Q3. Whilst Hear and Treat performance is above contracted levels and continues to exceed the planned trajectory for achieving CQUIN targets, a significant element of the telephone triage resource has been focused on Red Ring Back during the REAP 4 period. As a result, the overall AQI remains at circa 3.4% for the month of October (Up 0.1% on September). The Board should note that work is ongoing to improve the AQI contribution of the CSD, against the context of performance recovery. The overall number of H&T exceeds the trajectory, however telephone triage of activity not included in the AQI measures are not reflected in the AQI i.e. 111 activity. There are no H&T exceptions to report for October.

3. 111

3.1 3.2

The NWAS NHS 111 activity levels have been unpredictable during October. We witnessed two Saturdays where activity exceeded 3300 against projected activity of 2800. In total call activity for October was 7% above anticipated levels and as a result calls answered within 60 seconds, fell below the KPI standard of 95% by 0.03% to 94.97%. This is classed as green for KPI rolling scorecard purposes. Short notice cancellation and high attrition rates by agency staff remained a significant issue. This is

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3.3

3.4

managed daily by the senior management team. Recruitment of 39 additional heads should help to alleviate this pressure. We will continue to monitor agency staff attendance. *uplift applied based on activity levels two months in arrears. The following table demonstrates activity against projected and uplifted plans: 12 month post transition projections not available.

Monthly Performance Figures

There has been a significant increase in overall monthly activity during October, the activity has increased during weekends and surges have been unpredictable. Against an increase of 7% against predicted activity achievement of 94.97% represents a good performance.

Month May Jun Jul August Sept October

Planned 58498 51084 51252 51943 48265 N/A

Actual 67687 63674 62050 60609 56086 64776

Variance 15.71% 24.65% 21.07% 16.68% 16.2% N/A

Revised Plan 68221 61176 59191 62667 58434 60538

Variance to

uplift

(0.8%) 0.7% 4.8% (3.3%) (4.2%) 7%

KPI

May June July August Sept Oct

Number of Calls Answered

67687 61131 62050 60609 56,086 64,776

95% of calls will be answered in 60 seconds

64103 94.7%

59230 (96.1%)

59128 (95.3%)

58589 (96.7%)

53609 (95.6%)

61,519 (94.97%)

Total number of calls abandoned < 5%

531 <1%

345 <1%

535 <1%

366 <1%

420 (<1%)

522 (<1%)

Warm Transfer to an NHS 111 Nurse Advisor required 90% (reduced form 98%)

68%

70 % 68% 75.6%

70.% 68%

Patient call back < 10 minutes Target 75%

73.2% 72.9% 70% 75.96% 74% 72%

4. See and Treat (Safe Care Closer to Home)

4.1 4.2

4.3

See and Treat See and Treat Activity in October amounted to 17469 against a target of 15738. The following table provides an overview of the in-month See and Treat and Hear and Treat against contract and CQUIN trajectory:

Measure Contract Trajectory Actual

Hear and Treat 1630 2459 2622 (+163)

See and Treat 14869 15738 17469 (+1731)

Total Non-conveyance 16499 18197 20091 (+1894)

The figures continue to demonstrate our increasing use of alternative services and represent an

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4.4 4.5

exceptional achievement against trajectory. However, GP/Acute Visiting Services can be used more frequently and the Pathfinder team continues to work to maximise the overall percentage of SCCTH. There are no exceptions to report within See and Treat for October. Summary Each of the key Urgent Care metrics is being achieved and the Q3 CQUIN metrics are on target. A separate report has been forwarded to EMT relating to the delay in implementation of three key CQUIN projects. Agreement has been reached to delay staff release until Q4 in the context of REAP 4. The increase in H&T and S&T achievement is encouraging as we enter the peak winter period. 111 produced stable performance but there are further signs of winter pressure which we will continue to monitor. We are also, as a Trust about, to advertise 111 as an alternative to 999. Commissioners support this action as positive. However any activity increases seen in 111 must be absorbed within existing financial restrictions.

5

Resilience

5.1 5.2 5.3 5.4 5.5

Work to ensure a safe and proportional response to any case of Ebola Virus Disease (EVD) in the UK is continuing with Resilience Team (RT) specialists supporting the compilation of national protocols for high-risk transfers by HART Operatives, low-risk protocols in conjunction with Trust Infection Prevention and Control experts and information releases to our staff. Planning and exercising activity around EDV is high in all areas and RT members are also participating in local exercises, planning meetings and discussion events across many organisations in the health sector. Internal training events have been run to ensure that Clinical and Operational Managers together with Tactical Advisors are all familiar with current versions of protocols and the correct use of various levels of PPE. Ongoing Industrial Action by both Fire & Rescue and National Health Service staff again requires careful planning and the RT continues to provide support to the Trust to ensure that the effects of NHS staff abstractions or reduction in Fire & Rescue cover are mitigated as far as possible. In addition to detailed planning activities, individual members of the Resilience Team have been offering their clinical/operational management skills, administrative abilities/logging and C1 driving skills to help ensure provision of front-line cover. To further support PES and Level 4, Operational Managers have been released from exercise participation wherever possible and replaced by members of the RT. Although this reduces the opportunities for testing commanders and building their National Occupational Standards portfolios, it does lessen the pressure on the Operational Management Teams whilst continuing to support the exercises and our multi-agency partners. Resilience related content on the 2015/16 Mandatory Training Programme is being updated and revised to fit the new timetable. Work is underway to complete two significant pieces of national work. The first is the Emergency Preparedness, Resilience and Response (EPRR) assurance process for 2014 which is the subject of a separate paper to this meeting. The second is the completion of the Cabinet Office sponsored National Capabilities Survey (NCS) which is a biennial questionnaire devised to gauge the level of resilience of a wide range of organisations and thus gain a picture of the levels of preparedness of the UK to a range of hazards and threats. The NCS is hosted on the ‘Resilience Direct’ secure web-portal and consists of an extensive set of questions tailored to individual organisation (or groups in the case of Local

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5.6

Resilience Fora, and NHS England structures) which measure the depth and breadth of resilience arrangements across a range of activities and functions. The broad results aggregated for each sector and subject, should be available towards the end of the calendar year and will be circulated in a fashion appropriate to their ultimate security classification. The review of Trust BCM arrangements is continuing and recent progress means that we can now report a status of ‘Amber’ for the current validity of plans. Some plans still require updating however but this work to bring all plans up to date and representative of recent, internal movements is underway. Some directorates are at a point where their revised plans are ready to be stress tested and where this is the case, table-top exercises have been arranged. The recent national Pandemic Influenza exercise, ‘Cygnus’ although scaled down by the Government, was highly beneficial within NWAS as the external injects were used to run an internal BC exercise of our own. A number of departments embraced this opportunity fully and tested their own plans and processes over a period of weeks as the national exercise unfolded and the scenario worsened. Such activity is proving invaluable in ensuring that our BC arrangements remain robust and workable.

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6

AQI Benchmarking

6.1

The following table is taken from the NHS England AQI Publication page and provides a comparison of Ambulance Trust AQI and ACQI data for the month of September. October comparisons are not yet available. The data is available at the following link

6.2 The following graphs, created from the same published data, give a comparative view of NWAS performance on a trend basis for the AQI’s for the period October 2013 to October 2014.

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

90.0%

95.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

R1 in 8minutes % East Midlands Ambulance Service NHS Trust

East of England Ambulance Service NHS Trust

Isle of Wight Healthcare NHS Trust (Ambulance)

London Ambulance Service NHS Trust

North East Ambulance Service NHS Trust

South Central Ambulance Service NHS Trust

South East Coast Ambulance Service NHS Foundation Trust

South Western Ambulance Service NHS Foundation Trust

West Midlands Ambulance Service NHS Trust

Yorkshire Ambulance Service NHS Trust

North West Ambulance Service NHS Trust

ENGLAND

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http://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/Ambulance_CQI_Dashboard_v_3_18_2-Apr11-to-Sep14.xls

- 22 -

6.00

11.00

16.00

21.00

26.00

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Seco

nd

s

R1 95th Percentile Response Time East Midlands Ambulance Service NHS Trust











50.0%

55.0%

60.0%

65.0%

70.0%

75.0%

80.0%

85.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

R2 in 8minutes % East Midlands Ambulance Service NHS Trust











ENGLAND

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

100.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

A19 Transportation % East Midlands Ambulance Service NHS Trust











ENGLAND

0.0%

2.0%

4.0%

6.0%

8.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Call Abandonment Rate East Midlands Ambulance Service NHS Trust











ENGLAND

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0.0%

5.0%

10.0%

15.0%

20.0%

25.0%O

ct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Recontact Rate Following Discharge of Care by Telephone Advice East Midlands Ambulance Service NHS Trust











ENGLAND

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

14.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Recontact Rate Following Treatment at Scene East Midlands Ambulance Service NHS Trust











ENGLAND

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Recontact Rate - Frequent Callers East Midlands Ambulance Service NHS Trust











ENGLAND (Trusts that identify Frequent Callers Only)

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0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0O

ct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Time to Call Answer - 95th & 99th Percentiles East Midlands Ambulance Service 95th percentile

East Midlands Ambulance Service 99th percentile

East of England Ambulance Service 95th percentile


Isle of Wight Healthcare 95th percentile


London Ambulance Service 95th percentile


North East Ambulance Service 95th percentile


South Central Ambulance Service 95th percentile


South East Coast Ambulance Service 95th percentile


South Western Ambulance Service 95th percentile


West Midlands Ambulance Service 95th percentile


Yorkshire Ambulance Service 95th percentile


North West Ambulance Service 95th percentile


0.0

10.0

20.0

30.0

40.0

50.0

60.0

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Time to Call Answer - 95th & 99th Percentiles























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0.0%

5.0%

10.0%

15.0%

20.0%O

ct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Proportion of Calls Closed with Telephone Advice East Midlands Ambulance Service NHS Trust











ENGLAND

0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Proportion of Calls Closed without Transport to a Type 1 or 2 Facility East Midlands Ambulance Service NHS Trust











ENGLAND

-

20,000

40,000

60,000

80,000

Oct

No

v

De

c

Jan

Feb

Mar

Ap

r

May Jun

Jul

Au

g

Sep

Oct

No

v

De

c

Jan

Feb

Mar

Volume of Transports to a Type 1 or 2 Facility East Midlands Ambulance Service NHS Trust











56 of 324

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Appendix 2 – Quality Report 1. Quality Risks

1.1.

SIREN Report: October 2014 data: charts located in appendix 2.1 The Trust has experienced an increase in activity in the number of Red 1 and Red 2 incidents by 2,343 in comparison with the previous month. The total number of Red incidents in October 2014 was 35,756.

R1 R2 Spilt by Area October 2014

Greater Manchester Cheshire & Merseyside Cumbria & Lancashire Out of Area

41.1% 31.8% 27.1% 0% Table 1: R1R2 split

1.2

Red 1 and 2 incidents with no paramedic attendance: September 14 data A total of 57 (2.6%) Red 1 incidents with no paramedic attendance and 1,428 (47.3%) Red 2 incidents. September 14 data was: 63 (2.6%) for Red 1 and 1,199 (3.9%) Red 2.

R1 No Paramedic in attendance October 2014


11 (1.2%) 29 (4.1%) 17 (2.8%) 0(0%) Table 2: R1 No paramedic attendance

R2 No Paramedic in attendance October 2014


553 (4.0 %) 483 (4.5%) 392 (4.3%) 0(0%) Table 3: R2 no paramedic attendance

1.3 Red 1 incidents with excess attendance time > 60 minutes: October 2014 data No Red 1 incidents resulted in prolonged attendance time in excess of 60 minutes.

1.4

Red 2 incidents with excess attendance time > 60 minutes: October 2014 data There were 45 (0.1%) Red 2 incidents resulting in an excess attendance time of 60 minutes; of these there were 6 incidents that had receiving unit pre-alerts.

R2 Prolonged calls >60 minutes October 2014


14 (0.1 %) 24 (0.2%) 7 (0.1%) 0(0%) Table 4: R2 prolonged calls

1.5 Green 1 and Green 2 incidents with excess attendance time > 60 minutes: October 2014 data 185 (4.0%) Green 1 incidents with an excess attendance time of 60 minutes. (September 2014, 184 (3.7%)). 373 (1.6%) Green 2 incidents with an excess attendance time of 80 minutes. (September 2014, 277 (1.2%)).

1.6 Red 1 Red 2 prolonged journey time over 60 minutes: October 2014 In this month on 3 occasions a Red 1 response had a prolonged journey time of over 60 minutes. There were 104 (0.3%) Red 2 responses with a prolonged journey time of over 60 minutes. This is double the numbers reported for September 2014.

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1.7 Re-attendance at the same address within 24 hours: October 014 Re-attendance at NWAS level to the same address has seen an increase in October to 7.8 % (2,801) compared to the September figures of 8.7 % (2,902).

Re-attendance at the same address October 2014


1,291 (8.8%) 897 (7.9%) 613 (6.3%) 0(0%) Table 5: Re attendance <24hours

1.8

Red 1 prolonged CFR or RRV unsupported: October 2014 data There were no occasions were a Community First Responder was waiting on scene in excess of 55 minutes for an RRV/ambulance with a Red 1 patient. There were 5 occasions when a RRV had to wait on scene in excess of 65 minutes for an ambulance.

2. Safeguarding: Appendix 2.3 illustrates the bundle compliance scores for adult and child safeguarding as well as the main failures for each of the bundles. The majority of referrals originate from PES however some are from PTS and increasing numbers from 111.

2.1

Safeguarding Adult referrals: The table below provides a comparison breakdown of the number of adult safeguarding referrals made in October 2014 in comparison with previous month.

Clinician Group NWAS Overall GM CAM CAL

Sept

2014

Oct

2014

Sept

2014

Oct

2014

Sept

2014

Oct

2014

Sept

2014

Oct

2014

PES 734 737 341 315 167 185 266 237

PTS 2 5 2 2 0 1 0 2

EOC & 111 45 77 20 26 18 30 7 21

Out of area 3 6 3 3 0 0 0 3

Total Number

of referrals

784 825 366 346 185 216 233 263

Table 6: Breakdown of Adult safeguarding referrals made by Area and by Clinician group.

2.2 Care Bundle – Adult Referrals

The bundle compliance score for NWAS adult safeguarding referrals is 96.4% which is a reduction on the

figure reported in September (98.2%). The main metrics for non-compliance are the recording of the

patient’s ethnicity.

2.3

Safeguarding Children referrals:

The table below provides a comparison breakdown of the number of adult safeguarding referrals made

in September 2014 in comparison with previous month.

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- 28 -

Clinician Group

NWAS Overall GM CAM CAL

Sept

2014

Oct

2014

Sept

2014

Oct

2014

Sept

2014

Oct

2014

Sept

2014

Oct

2014

PES 217 216 105 108 57 43 55 65

PTS 1 0 0 0 0 0 1 0

EOC & 111 27 37 16 22 8 9 3 6

Frequent Caller

Team 3 0 2 0 0 0 1 0

Total Number of

referrals 248 253 123 130 65 52 60 71

Table 7: Breakdown of Child safeguarding referrals made by Area and by Clinician group.

2.4 Care Bundle – Child Referrals

The bundle compliance score for NWAS children safeguarding referrals is 96.1% which is the same as

reported in September.

3.

Complaints: 58 complaints were received during November 2014. The table below illustrates the risk

score associated with those complaints – year to date.

Complaints Received Apr

2014 May 2014

Jun 2014

Jul 2014

Aug 2014

Sep 2014

Oct 2014

Nov 2014 Total

1 - Insignificant 39 34 38 28 9 18 22 7 195

2 - Minor 61 113 101 106 93 91 88 40 693

3 - Moderate 29 13 26 57 23 33 28 8 217

4 - Major 6 8 11 8 11 8 6 2 60

Total 135 169 176 200 138 151 144 58 1171 Table 8: Complaints received to date

3.1

The top 3 primary category complaints received have no changed during the year and these are

illustrated in table below.

Complaint Category

Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

Sep 2014

Oct 2014

Nov 2014 Total

PTS Transport 43 53 53 45 51 48 52 17 362

Emergency Response 36 47 54 75 41 45 33 18 349

Staff Conduct 24 27 21 24 15 25 24 14 174

Total 103 127 128 144 107 118 109 49 885 Table 9: Top 3 primary complaint categories

4. Incidents: 253 incidents were reported during November 2014. The table below illustrates the risk score

associated with those reported incidents – year to date.

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Incidents reported Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

Sep 2014

Oct 2014

Nov 2014 Total

1 - Insignificant 194 186 245 266 253 243 204 90 1681

2 - Minor 468 497 465 523 489 430 361 134 3367

3 - Moderate 103 94 103 105 83 77 92 26 683

4 - Major 0 3 9 11 5 3 3 3 37

Total 765 780 822 905 830 753 660 253 5768 Table 10: Reported incidents to date

4.1

Incident Category Apr 2014

May 2014

Jun 2014

Jul 2014

Aug 2014

Sep 2014

Oct 2014

Nov 2014 Total

111 Data Protection 100 82 117 111 83 103 119 64 779

Abuse/Inappropriate Use of Service 79 86 78 72 101 97 100 30 643

Manual Handling 55 77 71 72 67 81 58 36 517

Total 234 245 266 255 251 281 277 130 1939 Table 11: Top 3 reported Incident category

5. Medicine Management: data extracted 10/11/14

5.1 Management of general medicines bundle is 72.0%.

Chart 1: General medicines compliance to date

60%

70%

80%

90%

100%

Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14

Pe

rfo

rman

ce

NWAS: Medicines Management - General Medicines Performance12 months to date

General Medicines End of year 2013/14 performance Q4 2014/15 QI target

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5.2

Management of controlled drugs bundle is 82.9%.

Chart 2: Controlled drug compliance to date

6. Infection Prevention and Control: data extracted 10/11/14

6.1

Paramedic Emergency Service: 56.0% (197) of the vehicles in the PES fleet (not including RRVs) were audited in October 2014. This is a decrease on the September figures of 239 (67.9%) at the same point during the month.

Table 12 IPC Bundle Compliance: PES Vehicles October 2014

Management of equipment has shown an increase in compliance during October, bringing it to within 5% of the quality improvement target.

IPC Bundle Topic

PES Vehicles

Oct

%

Sept

%

Stretch

target

2014-15

Variance

from target

(%)

Primary Reason for failing an IPC bundle

Audited

Oct

2014

Audit Controls 98.5 99.6 95.0

%

+3.5 IPC folder not up to date 197

Bare Below Elbow 95.9 97.0 95.0 +0.9 In date hand gel and emollient moisturiser not

available in a fixed bracket 197

Cleanliness 91.4 92.3 93.8 -2.4 Vehicle deep clean sticker in date 197

Crew Competence 99.5 100 95.0 +4.5 No issues reported 197

Management of Equipment 89.9 83.8 93.7 -3.8 Seat covers in saloon with rips/tears 197

Management of Sharps 93.9 94.0 95.0 -1.1 Sharps boxes do not meet service requirements 197

Management of Waste and

linen 95.9 94.9 95.0

+0.9

Clear/white linen bags available for used

laundry 197

Met or exceeded target cumulative

performance

Up to 5% away from target

cumulative performance

Over 5% away from target cumulative

performance

6.2 Patient Transport Service: 151 (61.6%) of the vehicle audits for October within the PTS fleet were available for analysis on 11 October. This is a decrease on the September figures of 179 (73.1%) at the same point last month. Bare Below elbow/Hand Hygiene bundle has had a decrease in compliance bringing it over 5% away from the quality improvement target.

80%

85%

90%

95%

100%


Pe

rfo

rman

ceNWAS: Medicines Management Controlled Drugs Performance

12 months to date

Controlled Drugs End of year 2013/14 performance Q4 2014/15 QI target

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Table 13 IPC Bundle Compliance: PTS Vehicles October 2014

Care Bundle Topic

PTS Vehicles

Oct

%

Sept

%

Stretch

Target

2014-15

Variance

from target

(%)

Primary Reason for failing an IPC bundle

Audited

Oct

2014

Audit Controls 90.7 93.9 90.0 +0.7 IPC folder not up to date 151

Bare Below Elbow 86.8 93.9 95.0 -8.2 In date emollient moisturiser availabe 151

Cleanliness 96.7 96.6 87.6 +9.1 Ambulance cab and saloon being clean and

deep clean sticker. 151

Crew Competence 94.7 98.9 95.0 -0.3 Staff not adhereing to dress code policy 151

Management of Equipment 92.7 83.2 92.5 +0.2 Rip/tears in seat covers 151


linen 96.0 96.6 95.0 +1.0

Waste not being stored correctly on

vehicles. 151


performance



Over 5% away from target


6.3

64.5% (71) of all stations were audited by Service Delivery during October which is a decrease on September figures of 71.8% (79). The proportions of audits across the 3 areas are: Cumbria and Lancashire 32.4% (23), Cheshire and Mersey 46.5% (33), and Greater Manchester 21.1% (15). ‘Cleanliness’ and ‘Management of Waste and Linen’ bundles compliance are over 5% away from the quality improvement target.

Table 14 IPC Bundle Compliance: Stations October 2014

IPC Bundle Topic

Stations

Oct

%

Sept

%

Stretch

Target

2014-15

Variance

From target

Primary Reason for failing a care

bundle

Audited

Oct

2014

Audit Controls 98.6 100 95.0 +3.6 No issues reported 71

Bare Below Elbow 94.4 97.5 95.0 -0.6 Hand wash posters displayed at sinks 71

Cleanliness 69.0 70.9 81.3 -12.3 Food not being labelled 71

Management of Equipment 85.9 68.4 83.3 +2.6 Mop change record not up to date 71

Management of Sharps 95.8 96.2 95.0 +0.8 Sharps boxes being disposed of

incorrectly

71


linen 85.9 92.4 94.3 -0.9 Clinical waste not being marked with

station of origin 71


performance



Over 5% away from target


7. Quality Improvement: Clinical Care: data extracted 10th November 2014

7.1. Clinical Performance Indicators (CPI) care bundles are used to indicate the quality of care that a patient

receives. The indicator bundles are made up of measures that every patient experiencing a particular

condition should expect to receive in terms of intervention and assessment. The CPI care bundles are

measured monthly and each year a quality improvement (QI) target is set. The charts below describe the

month on month care bundle achievement against the quality improvement achieved at the end of

2013/14 and QI target for 2014/15.

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7.2

CPI Care bundles: longitudinal data

7.3

7.4

76%

80%

84%

88%

92%

96%

100%


Perf

orm

ance

Asthma Management Care Bundle Clinical Performance 12 months to date

Asthma End of year performance Q4 QI target

64%

68%

72%

76%

80%

84%

88%


Perf

orm

ance

Cardiac Chest Pain Care Bundle Clinical Performance12 months to date

Cardiac Chest pain End of year performance Q4 QI target

50%

60%

70%

80%

90%

Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14

Perf

orm

ance

Paediatric Care: Febrile Convulsion Care Bundle Clinical Performance 12 months to date

Paediatric care: Febrile End of year performance Q4 QI target

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7.5

7.6

7.7

7.8

89%

91%

93%

95%

97%


Perf

orm

ance

Pain Management Care Bundle Clinical Performance12 months to date

Pain End of year performance Q4 QI target

84%

86%

88%

90%

92%

94%

96%


Perf

orm

ance

Stroke Management Care Bundle Clinical Performance 12 months to date

Stroke End of year performance Q4 QI target

30%

40%

50%

60%

70%

80%


Perf

orm

ance

Trauma Care: Single Limb Care Bundle Clinical Performance 12 months to date

Trauma Care: Single Limb End of year performance Q4 QI target

86%

88%

90%

92%

94%

96%


Perf

orm

amnc

e

PRF Bundle Performance12 months to date

PRF End of year performance Q4 QI target

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7.9

8. National Ambulance Clinical Quality Indicators

8.1 NWAS performance remains reasonably consistent in performance across all indicators. It should be

noted NWAS performs the national average for both the stroke indicators. Funnel charts for the ACQI are

located in appendix 2.2 illustrate the most recent month’s position in comparison to other English

ambulance trusts.

ASCQI Indicator

Sample Size

(Current Month)

June 14 Performance

(%)

May 14 Performance

(%)

May 14 Rank

position

Rank movement

Performance Range %

(national mean)

Cardiac Arrest ROSC

Overall 280 28.6 27.6 6 ↓ 14.2 – 58.3 (26.5)

Utstein 34 41.2 43.6 10 ↓ 24.0 – 100 (51.4)

Cardiac Arrest Survival to

Discharge

Overall 221 6.8 7.4 8 ↓ 3.9 – 16.7 (8.5)

Utstein 24 8.3 7.0 10 ↓ 4.9 – 66.7 (23.2)

Acute STEMI PPCI 113 81.4 88.4 11 ↓ 81.4 – 100 (89.0)

Care Bundle 186 93.0 82.4 2 ↑ 66.0 – 93.4 (79.8)

Stroke Hyper-acute 409 76.0 68.2 1 ↑ 48.4 – 76.0 (63.0)

Care Bundle 1081 99.4 97.1 2 ↔ 92.9 – 100 (97.1)

Table 15: ACQI most recent published performance

8.2 The last column in the table above describes the performance range and national mean. It should be

noted that some ambulance Trusts will perform at the extremes of the performance range due to their

small sample sizes.

8.3 Exception: Stroke hyper-acute with 60 minutes, stroke care bundle, STEMI care bundle

It is observed that NWAS performance against thee indicators is outside the upper control limits. NWAS

performs highly in terms of reaching a hyper-acute within the time frame due to the configuration of

stroke services within the North West. It should be noted that NWAS has followed the network

designation in identifying hyper-acute centres in the North West which is not always the methodology

adopted by other services.

65%

69%

73%

77%

81%

85%


Perf

orm

ance

Patient Pathway Bundle Performance 12 months to date

Patient Pathway End of year performance Q4 QI target

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Care bundle performance improvement is supported by internal NWAS CPI programme. The NWAS CPI

care bundles for stroke and Cardiac Chest pain is slightly more complicated than that of the equivalent

AQI (whilst encompassing all elements of the AQI requirements) an as a consequence the Trust performs

well.

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APPENDIX 2.1: SIRENS

Appendix 2.1 SIRENS Charts:

0%

1%

2%

3%

4%

5%

6%


Pro

po

rtio

n o

f to

tal N

WA

S re

spo

nse

s

NWAS: Red 1 & Red 2 with no Paramedic attendance 12 months to date

Red 1 Red 2

0

50

100

150

200


Nu

mb

er

of

calls

NWAS: Prolonged (over 60 minutes) Red 1 & Red 2 attendance times 12 months to date

Red 1 Red 2

185

373

0

100

200

300

400

500

600

700


Nu

mb

er

of

calls

NWAS: Prolonged Green1 (>60mins); Green 2 (>80mins) attendance times 12 months to date

Green 1 Green 2

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0

1

2

3

4

5


Nu

mb

er

of

calls

NWAS: Solo Responder (CFR) at scene Red 1 responses (>55mins); (>25 mins) Amber 12 months to date

Red Amber

0

5

10

15

20

25

30

35


Nu

mb

er

of

calls

NWAS: Solo responder (RRV) at scene Red 1 responses (>65 mins); (>35mins) Amber 12 months to date

Red Amber

3

104

12

10

0

20

40

60

80

100

120


Nu

mb

er

of

Jou

rne

ys

NWAS: Red1, Red2, Green 1, Green 2 responses Prolonged Journey times to hospital 12 months to date

Red 1 Red 2 Green 1 Green 2

68 of 324

- 38 -

Appendix 2.2: ACQI Charts:

NEASFT33.9%

SCASFT47.1%

SECAmbFT33.2%

EMAS15.2%

YAS14.2%

EEAST21.1%

SWAFT25.0%

NWAS28.6%

WMASFT24.1%

LAS32.8%

10%

15%

20%

25%

30%

35%

40%

45%

50%

100 125 150 175 200 225 250 275 300 325 350 375 400

Pe

rce

nta

ge

Trust Sample Size

ROSC Rate: Overall June 2014 data

National compliance rate Upper & Lower Control Limits

NEASFT83.3%

EEAST56.5%

EMAS24.0%

SECAmbFT61.8%

YAS41.9%

SCASFT65.9%

NWAS41.2%

WMASFT43.6%

LAS58.3%

SWASFT42.2%

0%

20%

40%

60%

80%

100%

15 20 25 30 35 40 45 50

Pe

rce

nta

ge

Trust Sample Size

ROSC rate: Utstein GroupJune 2014 data


69 of 324

- 39 -

NEASFT3.9%

SCASFT15.3%

EMAS5.2%

YAS12.6%

SECAmbFT11.0%

NWAS6.8%

EEAST8.4%

SWASFT10.2%

WMASFT6.9%

LAS5.7%

0%

2%

4%

6%

8%

10%

12%

14%

16%

70 120 170 220 270 320 370

Pe

rce

nta

ge

Trust Sample Size

Survival to Discharge: OverallJune 2014 data


NEASFT25.0%

YAS51.6%

EMAS4.8%

NWAS8.3%

SECAmbFT24.2%

EEAST19.1%

LAS14.3%

SCASFT24.4%

WMASFT20.5%

SWASFT25.0%

0%

10%

20%

30%

40%

50%

60%

5 10 15 20 25 30 35 40 45

Pe

rce

nta

ge

Trust Sample Size

Survival to Discharge: Utstein GroupJune 2014 data


70 of 324

- 40 -

LAS93.3%

SCASFT95.7%

NEASFT89.9%

EMAS92.0%

SECAmbFT88.1%

SWASFT88.1%

WMASFT89.7%

YAS84.8%

EEAST92.0%

NWAS81.4%

75%

80%

85%

90%

95%

100%

40 50 60 70 80 90 100 110 120

Pe

rce

nta

ge

Trust Sample Size

PPCI Pathway ComplianceJune 2014 data


NEASFT93.4%

EMAS76.6%

YAS84.0%

SCASFT66.0%

SECAmbFT76.2%

WMASFT68.8%

EEAST85.3% SWASFT

85.1%

LAS71.8%

NWAS93.0%

60%

65%

70%

75%

80%

85%

90%

95%

100%

50 100 150 200 250

Pe

rce

nta

ge

Trust Sample Size

STEMI Care Bundle ComplianceJune 2014 data


71 of 324

- 41 -

EMAS62.3%

NEASFT74.3%

SCASFT55.1%

NWAS76.0%

WMASFT48.4%

SWASFT57.8%

EEAST60.1%

YAS58.8%

SECAmbFT69.4%

LAS61.4%

40%

45%

50%

55%

60%

65%

70%

75%

80%

70 120 170 220 270 320 370 420 470 520 570

Pe

rce

nta

ge

Trust Sample Size

Call to Stroke Centre within 60 minutesJune 2014 data


NEASFT98.3%

SCASFT100%

EEAST96.2%

NWAS99.4%

YAS97.7%

WMASFT95.6%

SWASFT96.6%

SECAmbFT92.9%

EMAS99.3%

LAS96.3%

90%

92%

94%

96%

98%

100%

240 340 440 540 640 740 840 940 1,040 1,140

Pe

rce

nta

ge

Trust Sample Size

Stroke Care Bundle PerformanceJune 2014 data


72 of 324

- 42 -

Appendix 3 – Finance Report 1. PURPOSE OF REPORT

1.1 The purpose of this report is to assure and inform the Board of Directors of the financial

performance to Month 7 and the achievement of the financial duties for 2014/15.

2.

OVERALL POSITION

2.1 The Trust has a surplus position of £1,239.4k, which is £7.9k below the planned surplus of

£1,247.3k and therefore the Board of Directors can be assured that the Trust is currently on

track to achieve the planned £500.0k surplus at the end of the financial year. Income is over

recovered by £3,805.6k, pay is overspent by £2,852.3k and non-pay is overspent by

£961.2k. There have been some technical accounting adjustments relating to the

impairment of fixed assets and depreciation on donated assets which do not impact on the

planned surplus. The accounts will show a deficit of £622.2k, however the value of the

technical accounting adjustments is £614.3k and when this is added back the underlying

financial performance position is reported as £7.9k below the planned surplus.

There are a number of risks with mitigation which are influencing the M7 position:

Some of the schemes in the Trust’s Cost Improvement Plan have been slow to start,

however there are clear mitigation plans.

Activity in the first half of the year has fluctuated and there have been significant

increases in red activity and pressures across the hospitals.

PTS performance pressures resulting in an increase in the cost of PTS third party

provision.

As previously reported resources to mitigate the overspend have now been brought in to

the M7 position totalling £3,029.8k (for details please see the table in 3.1).

The detailed financial analysis is set out in the tables and graphs in Appendix 1 and

Appendix 2 reflects the Directors new portfolios.

3. RESOURCES

3.1 In order to support the requirement to improve operational performance whilst at the

same time managing the overall financial resources the Executive Management Team

reviewed the financial assumptions for the current financial year. The following resources

were identified and subsequently agreed by the Board of Directors:

73 of 324

- 43 -

Funding Utilised Remaining

£’000 £’000 £’000

CQUIN (See Note 2)

Contingency (0.5%) (See Note 3)

Provisions (See Note 4)

Operational Resilience (See Note 5)

A&E Resilience (See Note 5)

2,882.9

1,238.0

2,229.1

2,635.3

1,120.4

1,681.7

722.2

0

439.2

186.7

1,201.2

515.8

2,229.1

2,196.1

933.7

10,105.7 3,029.8 7,075.9

Notes

1. Committed Resources - £3,029.8k has been committed in the financial position at M7.

2. CQUIN - related to Hear and Treat and See and Treat non-recurrently in 2014-15. At

M7 the Trust is on target of achieving and 7/12ths of the £2.9m is in the position.

3. Contingency - the budget setting process identified a contingency of £1,238.00k (0.5%)

and 7/12ths of the £1.2m is in the position.

4. Provisions - a review of all the general provisions have identified £2,229.1k that can be

released.

5. Operational Resilience (Winter Pressures) - the Trust has received an allocation of

£2,635.30k in this financial year and 1/6th of the funding is in the position. The Trust has

received notification that 111 will receive a separate allocation of £472.0k.

6. A&E Resilience (Winter Pressures) - the Trust has received notification of an

additional allocation of £1,120.4k in this financial year and 1/6th of the funding is in the

position.

3.2 The Director of Operations is looking at a range of options with regard to how the £7.4m,

allocated to PES from the 10.1m in the above table, is to be used. However this funding

must mitigate by covering any overspending/shortfall in the CIP’s and overall PES financial

position.

3.3 With regard to PTS the £1.5m will be earmarked to cover the overspend on the PTS budget.

3.4 There are a number of risks associated with the approach being proposed. These include:-

The Trust will not have any resources to cover any unforeseen costs arising over the

remainder of the year.

74 of 324

- 44 -

Given the level of activity the Trust may still not achieve the required performance

levels.

Releasing the provisions and utilising the funds will reduce the amount of cash held

by the Trust impacting on the Trust’s working capital.

The money is only available non-recurrently for 2014/15.

4.

SERVICE LINE REPORTING

4.1 In April 2014 the Executive Directors were allocated new portfolios and this section will

highlight areas of focus. For an analysis of the Director portfolios please refer to Appendix

2.

4.2

PARAMEDIC EMERGENCY SERVICES

PES has an overspend position of £1,910.1k. There is an over recovery on income of

£1,054.4k relating to 1/6th of the Operational and A&E Resilience monies being released in

to the position, events income and contracted income above the plan. Pay is £2,764.4k

overspent which relates to overtime expenditure incurred above the plan, slippage on the

CIP implementation and Winter pressure expenditure. The overtime relates to extended

overtime (eg. end of shift) and general overtime to cover absences. Non-pay is £200.1k

overspent and is mainly due to the overspend on Voluntary Ambulance Service (VAS)

(£811.0k), offset with underspends on fuel (£315.6k), uniforms (£79.5k), drugs and medical

& surgical (£141.3k) and utilities (£135.8k). Whilst PES is overspending, the position is being

managed through the use of the additional £10,105.7k and the overspend will not impact

on the Trust achieving financial balance.

4.3

111

The 111 service has an overspend position of £11.4k. There is an over recovery on income

of £305.3k due to an increase in activity above the contracted value. Pay is overspent by

£356.6k and non-pay is underspent by £39.9k.

4.4

PTS

The PTS service line has an overspend position of £1,743.5k.

4.5

ACTIVITY

Overall PES activity (incidents) in month 7 is 3.1% above plan. However of particular note is

that red activity is 8.0% above plan for October (7.1% cumulative) indicating significantly

higher acuity of the patients. The cumulative position for the year to date is 3.0% above

plan for all incidents.

In terms of the cumulative position regarding contract currencies, calls are 2.2% above plan,

Hear and Treat is 64.3% above plan, See and Treat is 14.3% above plan and See and Convey

is 0.9% below plan. These levels are in line with the Trust’s strategy to increase Hear and

Treat / See and Treat through the increased use of the Urgent Care Desk and the work with

75 of 324

- 45 -

the Clinical Commissioning Groups to increase care closer to home and reduce hospital

admissions.

In financial terms the PES overspend is linked to excessive activity but the PES contract for

2014/15 is a block contract, therefore there is no additional resource for the growth within

the contract mechanism.

5. BALANCE SHEET

5.1

5.2

5.3

The month 7 report includes a fully accrued balance sheet and follows International

Financial Reporting Standards (IFRS).

The technical adjustments referred to in section 2.1 are in relation to the impairment of

fixed assets (£131.5k engine replacements, £4.0k sale of Newton-Le-Willows, £470.0k

Darwen, Clitheroe, Preston and Birkenhead held for sale) and depreciation on donated

assets (£8.8k Neo natal vehicle).

The Trust has a healthy working capital and balance sheet position at month 7 please see

Appendix 1.

6. CASH / TREASURY MANAGEMENT

6.1

6.2

6.3

The cash held in the Bank at the end of October 2014 is £36,794.2k which is £1,854.2k

above the planned cash balance of £34,940.0k.

The Trust’s Better Payment Practice target is to pay 95% of its suppliers within 30 days. The

Trust has achieved 97.22% of invoices by number and 96.39% by value. This assures the

Board of Directors that the Trust has the required performance in paying its suppliers.

The Trust has a Cost Improvement Programme target of £13,863.0k recurrently. At the end

of October 2014, the actual achievement is £7,142.0k against a target of £7,898.4k and

represents an achievement of 90.42%. With mitigation schemes the Trust forecasts CIP will

be achieved for 2014/15.

7.

FT METRICS

7.1 Risk Ratings

Continuity of Service Risk Ratings have been calculated for NWAS and the results are in the

table below.

The rating categories ranging from 1, which represents the most serious risk, to 4,

representing the least. NWAS has the highest possible score and is highlighting a risk.

October rating on the new version - Continuity of Service Risk Rating (CSRR)

76 of 324

- 46 -

Indicator Year to

Date

Liquidity ratio score 4

Capital Servicing capacity score 4

OVERALL Continuity of Service Risk Rating (CSRR) 4

8.

CONCLUSION

8.1

Overall the Trust can be assured that the financial position at month 7 has not shown any

significant variance to plan overall due to the implementation of the mitigating resources.

However the Trust is facing financial challenges in 2014/15 in terms of balancing the

financial position against the significant increase in activity whilst looking to

maintain/improve performance and quality.

9. RECOMMENDATION


Review the financial performance for month 7.

Receive the assurance regarding the overall financial position and the achievement

of the financial duties for 2014/15.

77 of 324

- 47 -

Aged Debt Analysis for 2014-15

Better Payment Practice Code

APPENDIX 3.1

NORTH WEST AMBULANCE SERVICE NHS TRUST

Actual and projected cash flowCash flow Month 7

Trust Performance Against Revenue Plan

-2,000

-1,500

-1,000

-500

0

500

Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15

£'0

00

s

Plan Surplus Actual Surplus

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

No

v-1

4

De

c-14

Jan

-15

Feb

-15

Mar

-15

£'000s

Planned Cash Actual

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000


£'00

0s

0-30 days 31-60 days 61-90 days 91-180 days over 180 days

80%

85%

90%

95%

100%


%Monthly No. 30 Days % Monthly Value 30 Days %

Cumulative No 30 days. % Cumulative Value 30 days%

The Trust has a surplus position of £1,239.4k, which is £7.9k below the planned surplus of £1,247.3k and therefore the Board of Directors can be assured that the Trust is currently on track to achieve the planned £500.0k surplus at the end of the financial year. Income is over recovered by £3,805.6k, pay is overspentby £2,852.3k and non-pay is overspent by £961.2k. There have been some technical accounting adjustments relating to the impairment of fixed assets and depreciation on donated assets which do not impact on the planned surplus. The accounts will show a deficit of £622.2k, however the value of the technical accounting adjustments is £614.3k and when this is added back the underlying financial performance position is reported as £7.9k below the planned surplus.

Total aged debt at the end of October 2014 is £3,596.6k, of which £2,999.7k (83.40%) was raised in Month 7.

Outstanding debt greater than 90 days is £126.4k.

The Trust is actively progressing this debt and will review the appropriateness of bad debt provisions on a quarterly basis. The Trust's Corporate Commissioning Group considers outstanding NHS Debt on a monthly basis and actively reviews any major issues.

The Trust's Better Payment Practice target is to pay 95% of its suppliers within 30 days. This is monitored based on both number and value of invoices paid each month.

At the end of October 2014 the Trust has achieved a position of 97.22% for the number of invoices paid and 96.39% for the value of invoices paid within the target set.

The closing cash balance at the end of October 2014 is £36,794.2k which is £1,854.2kabove the planned cash balance. of £34,940.0k.

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

Oct

-14

No

v-1

4

De

c-14

Jan

-15

Feb

-15

Ma

r-15

Ap

r-1

5

Ma

y-1

5

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

£'000s

Actual Cash Projected Cash Cash in Cash out

The graph shows the current month's actual cash balance and a cash flow forecast for the next 12 months. The movement in the cash balances are illustrated by cash in and out.

78 of 324

- 48 -

Income Budgetary Variance

Pay Budgetary Variance

Non Pay Budgetary Variance

Cost Improvement Programme

-4,000

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

0

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

No

v-1

4

De

c-14

Jan

-15

Feb

-15

Mar

-15

Var

ian

ce £

'00

0

In Month Variance Cumulative Variance

0

500

1,000

1,500

2,000

2,500

3,000

Apr

-14

May

-14

Jun

-14

Jul-

14

Aug

-14

Sep

-14

Oct

-14

No

v-1

4

De

c-14

Jan

-15

Feb

-15

Mar

-15

Var

ian

ce £

'00

0


-600

-400

-200

0

200

400

600

800

1,000

1,200


Va

ria

nce

£'0

00


0500

1000150020002500300035004000450050005500600065007000750080008500

Cor

pora

te S

ervi

ces

Rev

iew

Cor

pora

te G

over

nan

ce

Faci

litie

s &

Fle

et

Res

ilien

ce

Fin

ance

& P

rocu

rem

ent

Hu

man

Re

sou

rces

/ W

ork

forc

e

IM&

T

PPE

Me

dica

l

Tru

st W

ide

PES

PTS

Res

erve

s

Tota

l

£'00

0

CIP Plan Year to Date CIP Achieved Year to Date

The Trust has a CIP target of £13,863.0k for the financial year 2014-15.

At the end of October 2014, the CIP is £756.3k below target. The Trust has achieved 90.42% of its month 7 CIP target.

The overall non-pay has an overspend position of £961.2k at the end of October 2014.

Pay has an overspend of £2,852.3k at the end of October 2014.

Income is over recovered by £3,805.6k at the end of October 2014.

79 of 324

- 49 -

Paramedic Emergency Services Performance

-1,500

-1,000

-500

0

500

1,000

1,500

2,000

2,500

3,000

Ap

r-1

4

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-14

Jan

-15

Feb

-15

Ma

r-15

£'0

00

Emergency Services Income & Expenditure -Cumulative Variances

YTD Income Variance YTD Pay Variance

YTD Non Pay Variance YTD Combined Variance

-500

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

0

50,000

100,000

150,000

200,000

250,000A

pr-

14

Ma

y-1

4

Jun

-14

Jul-

14

Au

g-1

4

Sep

-14

Oct

-14

No

v-1

4

De

c-14

Jan

-15

Feb

-15

Ma

r-15

Fin

an

cia

l Im

pa

ct -

£'0

00

Act

ivit

y (A

ll) -

00

0s

Emergency Services Activity and Financial Impact

Profiled PES Activity (All) Actual PES Activity (All) Cumulative Financial Impact

PES has an overspend position of £1,910.1k. There is an over recovery on income of

£1,054.4k relating to 1/6th of the Operational and A&E Resilience monies being

released in to the position, events income and contracted income above the plan. Pay

is £2,764.4k overspent which relates to overtime expenditure incurred above the

plan, slippage on the CIP implementation and Winter pressure expenditure. The

overtime relates to extended overtime (eg. end of shift) and general overtime to

cover absences. Non-pay is £200.1k overspent and is mainly due to the overspend on

Voluntary Ambulance Service (VAS) (£811.0k), offset with underspends on fuel

(£315.6k), uniforms (£79.5k), drugs and medical & surgical (£141.3k) and utilities

(£135.8k). Whilst PES is overspending, the position is being managed through the use

of the additional £10,105.7k and the overspend will not impact on the Trust achieving

financial balance.

Overall PES activity (incidents) in month 7 is 3.1% above plan. However of particular note is that red activity is 8.0% above plan for October (7.1% cumulative) indicating significantly higher acuity of the patients. The cumulative position for the year to date is 3.0% above plan for all incidents.

In terms of the cumulative position regarding contract currencies, calls are 2.2% above plan, Hear and Treat is 64.3% above plan, See and Treat is 14.3% above plan and See and Convey is 0.9% below plan. These levels are in line with the Trust’s strategy to increase Hear and Treat / See and Treat through the increased use of the Urgent Care Desk and the work with the Clinical Commissioning Groups to increase care closer to home and reduce hospital admissions.

80 of 324

- 50 -

Capital Programme Progress

Key Budgetary Variance AnalysisVacancy and Overtime Analysis

6.98%

Jan Feb

7.19%

Sickness AnalysisJun Jul Aug Sep Dec Mar

Target

Period

5% 5%

May Oct NovApr

5% 5%5%5% 5% 5%5%5%

6.47%

5%5%

6.54%14-15 Actual 6.99% 6.62%

0

2,000

4,000

6,000

8,000

10,000


£'0

00

Baseline Cumulative Plan Revised Cumulative Plan Actual

-50%

-30%

-10%

10%

30%

50%

70%

90%

110%

130%

-1,000,000

-500,000

0

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

PES

Pa

y

PTS

Pa

y

PTS

Tax

i - V

CS

Fue

l

Me

dic

al G

as

Veh

icle

Le

ase

s

£'0

00

s

Cumulative Variance % Variance

0

1

2

3

4

5

6

7

8


%

Budget % 13-14 Actual Sickness

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

Ap

r-1

3

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Sep

-13

Oct

-13

No

v-1

3

De

c-13

Jan

-14

Feb

-14

Ma

r-14

PES Vacancies % PES Overtime % PTS Vacancies % PTS Overtime %

Details relating to sickness / absence are set out in Section 4 of the Integrated Performance Report. October figures are not available at present.

The graph identifies the capital programme on a cumulative basis for the financial year 2014-15.

The total capital expenditure at the end of October 2014 is £1,076.0k and is below the plan of £3,580.0k by £2,504.0k.

The PES pay variance is £2,764.4k above the budget and this equates to 3.32% the pay budget.

In October 2014, PES overtime was £1,249.0K which is 10.51% of the in month pay budget. At the end of October 2014 PES are under establishment by 1.51%.

PTS overtime was £153.3k, which is 13.17% of the in month pay budget. At the end of

81 of 324

- 51 -


Period Ending 31 October 2014

STATEMENT OF FINANCIAL POSITION Actual Actual

31 March 2014 31 October 2014

£000 £000

Non-current assets

Property, plant and equipment 68,964 63,591

Intangible assets 358 286

Trade and other receivables 1,116 931

Total non-current assets 70,438 64,808

Current assets

Inventories 1,241 1,097

Trade and other receivables 8,306 13,536

Cash and cash equivalents 34,576 36,794

Total current assets 44,123 51,427 Non-Current Assets Held For Sale 265 470

Total assets 114,826 116,705

Current liabilities

Trade and other payables (21,504) (23,627)

Provisions (9,012) (7,889)

Net current assets 13,872 20,381

Total assets less current liabilities 84,310 85,189

Non-current liabilitiesBorrowings (80) (80)

Provisions (15,906) (16,281)

Total assets employed 68,324 68,828

Financed by taxpayers' equity:

Public dividend capital 92,538 92,538

Retained earnings (26,365) (25,739)

Revaluation reserve 2,151 2,029

Donated asset reserve

Total Taxpayers' Equity 68,324 68,828

82 of 324

- 52 -

Budget

£'000

Actual

£'000

Variance

£'000

Budget

£'000

Actual

£'000

Variance

£'000

DIRECTOR OF OPERATIONS

PES

Income (17,759.8) (18,403.1) (643.3) (124,280.2) (125,334.6) (1,054.4)Pay Expenditure 11,885.7 12,578.8 693.1 83,288.4 86,052.7 2,764.4

Non Pay Expenditure 1,590.5 1,873.0 282.5 11,092.2 11,292.3 200.1

Total (4,283.6) (3,951.3) 332.3 (29,899.7) (27,989.6) 1,910.1

111

Income (819.5) (880.1) (60.6) (5,736.2) (6,041.5) (305.3)

Pay Expenditure 634.5 702.7 68.2 4,491.4 4,848.0 356.6

Non Pay Expenditure 125.7 116.9 (8.8) 879.9 840.0 (39.9)

Total (59.3) (60.5) (1.2) (364.9) (353.5) 11.4

Resilience

Income (641.7) (673.3) (31.6) (4,493.2) (4,729.2) (236.0)

Pay Expenditure 441.6 431.3 (10.3) 3,117.9 2,812.2 (305.7)

Non Pay Expenditure 127.7 125.5 (2.2) 897.0 916.7 19.7

Total (72.4) (116.5) (44.1) (478.3) (1,000.3) (522.0)

Fleet & Estates

Income (103.0) (88.4) 14.6 (720.6) (705.0) 15.6

Pay Expenditure 395.7 353.9 (41.8) 2,766.6 2,434.5 (332.1)


Total 1,458.8 1,468.2 9.4 10,092.4 10,121.1 28.6

Director of Operations Total

Income (19,324.0) (20,044.9) (720.9) (135,230.2) (136,810.2) (1,580.0)

Pay Expenditure 13,357.5 14,066.7 709.2 93,664.3 96,147.3 2,483.1


Total (2,956.5) (2,660.1) 296.4 (20,650.5) (19,222.3) 1,428.1

DEPUTY CEO/DIRECTOR OF FINANCE

PTS

Income (1,845.2) (2,108.1) (262.9) (12,920.4) (14,847.7) (1,927.3)

Pay Expenditure 1,163.4 1,166.9 3.5 8,140.2 8,429.0 288.8

Non Pay Expenditure 459.2 1,011.3 552.1 3,167.0 6,549.0 3,382.0

Total (222.6) 70.1 292.7 (1,613.2) 130.3 1,743.5

Corporate

Income (171.6) (155.7) 15.9 (1,196.3) (1,137.5) 58.8

Pay Expenditure 204.3 267.6 63.3 1,678.5 2,023.7 345.2

Non Pay Expenditure 2,087.2 1,752.3 (334.9) 13,311.3 11,019.0 (2,292.3)

Total 2,119.9 1,864.2 (255.7) 13,793.5 11,905.2 (1,888.3)

Deputy CEO/Director of Finance Total

Income (2,016.8) (2,263.8) (247.0) (14,116.7) (15,985.2) (1,868.5)

Pay Expenditure 1,367.6 1,434.4 66.8 9,818.7 10,452.7 634.0

Non Pay Expenditure 2,546.5 2,763.6 217.2 16,478.3 17,568.0 1,089.8

Total 1,897.3 1,934.3 37.0 12,180.3 12,035.5 (144.8)

DIRECTOR OF QUALITY

Quality

Income 0.0 (2.0) (2.0) 0.0 (10.6) (10.6)

Pay Expenditure 270.9 270.9 (0.0) 1,881.7 1,848.3 (33.4)

Non Pay Expenditure 205.7 195.4 (10.3) 1,118.7 1,041.5 (77.2)

Total 476.6 464.3 (12.3) 3,000.4 2,879.1 (121.2)

Summary Service Line Reporting - As at 31st October 2014 - M07 2014/15

Month 07 Year to date

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DIRECTOR OF ORGANISATIONAL DEVELOPMENT

Organisational Development

Income (58.9) (109.1) (50.2) (412.3) (727.5) (315.2)

Pay Expenditure 372.7 350.7 (22.0) 2,536.5 2,426.1 (110.4)

Non Pay Expenditure 153.1 187.3 34.2 1,062.9 1,119.4 56.5

Total 466.9 428.9 (38.0) 3,187.1 2,818.0 (369.1)

CHIEF EXECUTIVE

Chief Executive

Income 0.0 (3.6) (3.6) 0.0 (14.6) (14.6)

Pay Expenditure 101.8 90.8 (11.0) 715.2 633.1 (82.2)


Total 120.5 104.9 (15.6) 846.6 733.8 (112.8)

MEDICAL DIRECTOR

Medical

Income 0.0 0.0 0.0 0.0 (16.7) (16.7)

Pay Expenditure 55.7 20.7 (35.0) 179.9 141.1 (38.8)


Total 57.0 21.5 (35.5) 188.9 130.8 (58.1)

NWAS (inc Technical Adjustments)

NWAS Total

Income (21,399.7) (22,423.3) (1,023.6) (149,759.2) (153,564.8) (3,805.6)

Pay Expenditure 15,526.2 16,234.1 707.9 108,796.3 111,648.6 2,852.3

Non Pay Expenditure 5,935.3 6,483.0 547.7 39,715.6 41,291.1 1,575.5

Total 61.8 293.8 232.0 (1,247.3) (625.1) 622.2

NWAS (exc Technical Adjustments)

NWAS Total

Income (21,399.7) (22,423.3) (1,023.6) (149,759.2) (153,564.8) (3,805.6)

Pay Expenditure 15,526.2 16,234.1 707.9 108,796.3 111,648.6 2,852.3


Total 61.8 124.6 62.8 (1,247.3) (1,239.4) 7.9

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Appendix 4 – Workforce Report 1. INTRODUCTION

1.1

The purpose of this report is to provide the Board of Directors with key workforce information

to provide assurance and highlight risks with regards to workforce issues.

2. BACKGROUND

2.1

2.2

The Workforce data has been summarised into a new headline dashboard provided to the

Board of Directors, however, further detailed dashboards to support effective workforce

management and benchmarking throughout the service lines is also produced and circulated

on a monthly basis.

The Level 1 Dashboard has been developed in order to be more visual and provide context to

the workforce data. Further developments around the presentation of appraisal and

mandatory training data will continue throughout the year.

3. CURRENT SITUATION

3.1

Workforce Profile

In previous dashboards the establishment used has been the April 2014 establishment for the

Trust. Due to changes to the intermediate tier plans and performance pressures it was agreed

that the operational CIPs that were removed from the establishment at the beginning of the

year should be added back into the baseline establishment. Operations have for some time

been working towards the adjusted establishment figures for recruitment purposes and in

order to more accurately reflect the pressures that operations are under the establishment

has been changed in the dashboard. Corporate establishments have not yet been adjusted

following the Corporate Services Review.

The dashboard shows current headcount of 4985 and WTE of 4736 against a revised against

the adjusted base line establishment data of 4950. This represents a vacancy gap of 4.32%

across all Directorates. This position is particularly inflated by the high vacancy gaps in PTS

(Director of Finance) where it is not planned to recruit up to full establishment. Recruitment is

underway, however, for 36 permanent and 12 bank staff to commence in December and

January.

The current vacancy gap for Operations (including 111) is 2.85% equating to 116.42 vacancies.

This is an improvement on the same position last month when the equivalent vacancy gap was

3.42%. The position for the frontline PES operational posts is 2.33% vacancy gap against newly

adjusted establishment. Frontline operational deployment peaks around this time of the year

and we anticipate deployment of 137 new staff in front line position during November and

December as follows:

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3.2

3.3

Month Nov Dec

Paramedics 23.00 14.00

EMT1 10.00 46.00

UCS 9.00 14.00

EMD 16.00 7.00

Total 56.00 81

This is supplemented by the anticipated registration of an additional 67 internal staff as

Paramedics prior to Christmas which will impact positively on the current Paramedic vacancy

gap of 3.2%.

Further operational recruitment is being profiled through the first six months of 2015 to

ensure that establishment levels are maintained and to help to offset any residual Paramedic

vacancy gap, which at the present time is predicted to be approximately -51.64 posts at the

end of March. Planning has also commenced for the impact of any potential investment

arising from activity levels and the capacity review.

The Trust has a detailed workforce, recruitment and training plan which is being regularly

reviewed with service lines to ensure it remains fit for purpose and is able to respond to

changing demands.

Appraisals

The Trust has approved revised appraisal targets for 2014/15. Appraisal reporting has now

changed to a 1 year cycle, rather than a 2 year cycle. Overall 46% of appraisals are up to date,

i.e. were completed less than 12 months ago which remains unchanged from last month.

The move to REAP level 4 has led to a temporary suspension of appraisals within PES until

January 2015. Operations up to date currently stand at 46% but this is expected to reduce by a

maximum of 12.8% as appraisals expire between November and January. Appraisals will be

completed for new staff completing induction during this period which will offset some of the

impact and this is reflected in the October figures for PES.

Appraisals will continue in other areas of the service. Work will be conducted with the service

lines to support their progress. A more detailed report on the position relating to appraisals

and recommendations for the approach to be taken to improving the position has been

presented to the Workforce and Communities Committee and is also being presented to

Board.

Mandatory Training

PTS have achieved 95% completion and PES are currently at 86%. REAP level 4 has led to a

suspension of mandatory training within PES until January, although new entrants to the Trust

will continue to complete all mandatory training elements which will have a positive impact on

the figures. The position has improved by 1% since September as 41 new entrants completed

mandatory training.

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3.4

It is intended to bring all mandatory training programmes into the same cycle (to aid

reporting); we are currently modelling each of the programmes to identify the critical point at

which we can finalise the current cycle end date. Consideration is being given to bridging

arrangements between the old and new cycles and proposals were presented and approved at

the Workforce and Communities Committee.

Sickness Absence

The August sickness absence level has reduced from the figure reported last month as a result

of late changes to sickness being notified to Payroll. The revised August rate is 7.00%.

The overall sickness absence rate is 6.98% for the month of September and represents a

reduction of 0.02% on the previous month. The overall cumulative sickness absence rate for

14/15 is 6.74%.

PES had shown a steady improvement in sickness with a reduction of 0.82% from April through

to July. This rose suddenly by 0.84% for the month of August but has reduced again for

September by 0.30%. The reduction in the overall September position has come largely from

the EOC reducing by 1.60% and GM who reduced by 0.86%.

PTS has shown an increase in September of 0.78% from the amended August position. This has

been influenced by large increases in sickness levels for both Lancashire (3.04%,

predominately made up of long term sickness) and Cumbria (2.41%). All other areas of PTS

reduced in the month.

There is a separate report to Board this month offering further analysis on sickness.


4.1 There are no legal implications associated with this report.



Note the contents of the report

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88 of 324

6. Item 8.2-EPRR Assurance Report

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Subject: Emergency Preparedness, Resilience and Response (EPRR) Assurance

Report of: Director of Operations Prepared by: Mr D Winchester

PAPER FOR APPROVAL


SD4 SD5 SD8











finite resources




-----


6D


Completed

Not required

Attachments: NWAS EPRR Action Plan, EPRR Statement of Compliance.


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1

The purpose of this report is to brief the Board of Directors on the NHS England Emergency

Preparedness, Resilience and Response (EPRR) assurance process for 2014/15. It also

requests support for a formal statement of compliance to be made to the five NHS England

Area Teams (AT) in terms of the current situation regarding NWAS resilience. This will fulfil

the Trust obligations under the NHS England EPRR Core Standards and also aid

demonstration of compliance against sections of the Civil Contingencies Act (2004) and CQC

requirements.

2. BACKGROUND

2.1 The NHS needs to plan for, and respond to, a wide range of incidents and emergencies that

could affect patient care or public health. The manifestations of this could be precipitated

by a wide range of triggers from severe weather, transport emergencies, industrial

incidents/action, infrastructure failures or infectious disease outbreaks. The Civil

Contingencies Act (2004) requires all NHS organisations and providers of NHS-funded care,

to demonstrate that they can effectively respond to such incidents whilst maintaining core

services.

2.2 The Emergency Preparedness, Resilience and Response team at NHS England have

produced a number of pieces of guidance aimed at all providers of NHS commissioned care

with the expectation that they are adopted and localised as appropriate for each

organisation type and configuration.

2.3

2.4

2.5

2.6

Under the EPRR arrangements, all NHS Trusts which are also designated Category 1

Responders under the Civil Contingencies Act (2004), are required to undertake a self-

assessment process in order to determine the level of compliance of resilience

arrangements against the NHS England core standards.

This process is supported by an extensive self-assessment checklist which has been

designed to allow comparisons to be made between all of the core standards and the

prevailing resilience arrangements pertaining to that particular standard. Suggestions of the

types of evidence which would satisfy that standard are also included in the checklist.

Completion of this checklist is not mandatory and it is offered only as a tool to assist in

determining the level of compliance against the core standards. At this stage it is not a

requirement to describe or provide any evidence in support of any of the core standards

regardless of whether the Trust believes that resilience measures are fully met or shortfalls

identified. This may however, be requested at a later time and formal inspections

undertaken.

NHS England anticipates that the assurance exercise will identify any areas of limited or no

compliance (as well as highlighting areas of complete compliance) of resilience

arrangements against the EPRR core standards and any deficiencies in particular areas will

inform an individual improvement plan. This plan will demonstrate the intention of each

Trust to address any outstanding issues and give an indication of priority and timescale for

resolution.

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2.7

2.8

2.9

NHS England also require a statement of compliance from each Trust based on the findings

from the self-assessment process and taking into account those core standards which

require additional attention through the improvement plan. This statement must ultimately

be ratified by the Trust Board of Directors (BoD).

For those Trusts where it is not possible to provide a statement of compliance immediately

(due to time pressures or meeting schedules for example), it is acceptable for an interim

statement to be provided on behalf of the Trust and its Accountable Emergency Officer

(Derek Cartwright) and for the improvement plan and any draft submissions to the BoD,

also to be submitted for scrutiny.

The Area Team and the Local Health Resilience Partnership (LHRP) will review all

documentation for each Trust and if necessary, meet with the Accountable Emergency

Officer or other delegated officers of the Trust, in order to discuss any outstanding issues.

This review will form part of the Area Team assurances on EPRR to the NHS England Board

and the Department of Health. This process is aimed to demonstrate that robust and

resilient arrangements are established across all NHS organisations, that they are aligned to

the NHS England EPRR core standards and adequately maintained.


3.1

In April 2013, the Business Plan of the NWAS Resilience Team was revised to encompass all

of the NHS England EPRR core standards. This move ensured that the ongoing activities of

the Resilience Team were informed by and conducted within, the required regulatory

framework from a health perspective. This successful format has continued with a 2014/15

version in order to focus activities on the requirements of NHS England to maintain robust

EPRR arrangements. In light of revised Core Standards issued since then, this document is

due for a further revision and this is reflected in the NWAS Improvement Plan.

3.2 NWAS engages with five Area Teams and LHRPs within the NWAS geographical footprint.

The LHRPs are broadly concomitant with the appropriate County areas. The ATs have a

similar geographical coverage with the exception of Cumbria, which also encompasses

Northumberland and Tyne & Wear.

3.3

Each AT is required to undertake this EPRR assurance for the Trusts which fall within their

area of responsibility, however the exact timescale over which they conduct this is not

formally prescribed apart from the ultimate reporting date back to the NHS England Board

and the Department of Health. The date for formal assurance sign off by each AT is 31st

December 2014, with regional assurance required by the NHS England Board by 31st

January 2015 so that final assurance can then be offered to the Secretary of State by 31st

March 2015.

3.4 As the timetables for each of the NHS England Area Teams is different, interim statements

of ‘Substantial Compliance’ have already been issued to Cumbria, Cheshire and Merseyside

ATs with the understanding that amended documents or formal ratification (as appropriate)

will follow in due course. Other deadlines have not been reached yet so there is no

requirement for ‘holding statements’.

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3.5 The NWAS Resilience Team has comprehensively assessed NWAS resilience arrangements

against the EPRR core standards and found that almost all criteria are currently being met.

An improvement (action) plan has been constructed to deal with those issues that are not

fully compliant at this point in time. This document is attached. It should be noted that for

some of these matters identified, the issue of partial or non-compliance resultant of the

constraints of the nature of NWAS structure, size or complexity and could be considered in

terms of strict adherence to the defined standard/timescales and not as an omission of

preparations or arrangements.

3.6

It should also be noted that some matters are unlikely to achieve resolution and therefore

may never attain full compliance with the relevant EPRR core standard. These items will be

discussed directly with each AT but are not considered by the Resilience Team to pose

significant threat to the resilience, core business or reputation of NWAS.

4.

PROPOSAL

4.1

4.2

It is proposed that the Board of Directors agree to endorse the statement that;

‘The NWAS Resilience Team has examined NWAS arrangements, policies and procedures

pertaining to the NHS England EPRR Core Standards template and their compliance with

these standards duly assessed. The outcome of this process is that nearly all of the

standards were assessed as fully compliant and therefore the NWAS Board of Directors is

confident that this Trust is almost completely compliant with all necessary criteria and can

produce appropriate supporting evidence, if requested. Those few items which require

further attention have been included on the an improvement plan and progress will be

made to ensure full compliance where possible and within agreed timescales’.

It is further proposed that the BoD minute this endorsement and support the attached

‘Statement of Compliance EPRR 2014/15’ with the indication of a compliance level of

‘Substantial’. This statement will then require the signature of the Trust Accountable

Emergency Officer (Derek Cartwright), before being returned to the Head of Contingency

Planning for circulation to the AT EPRR Leads.

5.

LEGAL IMPLICATIONS

5.1

5.2

The Trust’s contingency planning arrangements and capabilities assist in providing evidence

of compliance with our duties under the Civil Contingencies Act 2004, the Health and Social

Care Act 2008 (Regulated Activities) Regulations 2010 together with other legislation such

as the Corporate Manslaughter and Corporate Homicide Act 2007 and the Human Rights

Act 1998.

Full compliance with the EPRR assessment process should be considered to be mandatory

and will ensure that appropriate assurances are provided to NHS England that NWAS is

meeting or working towards the requirements for EPRR, particularly those as set out in the

NHS England Core Standards Matrix, the NHS England planning framework, Everyone

Counts: Planning for Patients 2013/14, and the 2013/14 NHS standard contract (Service

Condition 30, page 25).

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6. CONCLUSION

6.1 The EPRR scrutiny process is an essential part of providing appropriate assurances to the

NHS England Board and ultimately the Department of Health via our AT partners, that

NWAS resilience arrangements are robust, appropriate, scaleable and fit for purpose. This

exercise has also provided a useful opportunity to conduct an internal confidence check on

NWAS arrangements and generate actions that will further enhance the resilience of the

Trust.



Endorse the statement of compliance and give approval for the Improvement Plan

to be submitted to each Area Team for purposes of providing assurance of NWAS

compliance with the requirements of EPRR Core Standards.

Sanction the signing of the statement of compliance by the Trust Accountable

Emergency Officer.

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7. Item 8.2-Attach 1 to EPRR Assurance

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EPRR Core Standards Improvement Plan 2014/15

v2.0 Page 1 of 2

Trust: North West Ambulance Service NHST

Core standard reference

Core standard description Improvement required to achieve compliance Action to deliver improvement Deadline

3

Organisations have an overarching framework or policy which sets out expectations of emergency preparedness, resilience and response.

Review and revision of current NWAS ‘Resilience Business Plan’ which encompasses revised EPRR Core Standards.

Complete plan review/revision and circulate updated document. Capture recent internal personnel and departmental structure changes and ensure the 2014 version of the EPRR Core Standards are reflected in the narrative.

31/12/14

12 Arrangements explain how VIPs and/or high profile patients will be managed.

Augment existing clinical arrangements (restricted circulation) with consideration of media/communications strategy for VIP patients.

Internal plans are in place to deal with the HAZMAT/CBRNE (clinical and security) management of VIPs. Review required, adding detail on media/communications management. Planning for specific, high risk events will also encompass this detail.

01/02/15

33 Arrangements are in place to ensure attendance at Local Health Resilience Partnerships at an Executive Level.

Compliance not achievable.

Due to the regional footprint of NWAS and internal ‘Area’ structures which are larger than most LHRP coverage, the LHRPs are attended by the Head of Service for each locality. Whilst not an executive level post, each Head of Service is a Strategic Commander with the authority to commit finances and resources on behalf of the Trust.

N/A

41 Rotas are planned to ensure that there is adequate and appropriate decontamination capability 24/7.

Compliance will be difficult to achieve.

NWAS-wide operational rotas are based on a rotating shift system where most individuals occupy a designated shift line, with a predictable pattern and usually with a regular partner. Decontamination responders are drawn from a pool of volunteers in each County and the numbers and their distribution varies with shift rotations. Numbers of trained volunteers are monitored and maintained. HART Teams are on duty 24/7/365 and can provide an initial decontamination response in the Manchester/Liverpool areas. However, a more regular audit of responder availability will be instigated to monitor any potential gaps or patterns of lower numbers and drive any need for additional capacity.

01/02/15

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EPRR Core Standards Improvement Plan 2014/15

v2.0 Page 2 of 2

44

The organisation has the expected numbers of PRPS suits (sealed and in date) available for immediate deployment should they be required. (n=24 for a hospital and as NHS England published guidance (May 2014) for an ambulance provider).

NWAS holds 120 PRPS suits for immediate deployment against the recommended level of 336.

Current stock levels are based on a formal risk assessment of the ability of NWAS to provide and sustain a response predicated around 7 (Decon) Incident Support Unit vehicles, located strategically around the NW. Each can maintain a 2 hours of patient decontamination and can be supported by adjacent units or a further NWAS deployable reserve of 12 suits. Mutual aid in the form of suits and equipment can also be requested from neighbouring Ambulance Services. The National Ambulance Resilience Unit (NARU) holds a tactical reserve of 100 suits and if the incident is protracted, a larger National reserve can be accessed. For large numbers of contaminated people, Fire and Rescue Service will provide Mass Decontamination facilities. The introduction of Initial Operational Response (IOR) for staff will reduce the likelihood of ‘wet’ decontamination being required. This approach has been underwritten by NHSE (North) based on adequate risk assessment. Directive from awaited from NARU.

TBC

51

Staff that are most likely to come into first contact with a patient requiring decontamination understand the requirement to isolate the patient to stop the spread of contaminant.

Although this issue is covered in internal Mandatory Training, the Initial Operational Response (IOR) package of training will reinforce this message and ensure that it is embedded.

Continue with roll-out of IOR package to NWAS staff. Reinforce ‘STEP 1-2-3’ procedures as outlined in staff Major Incident and CBRNe Pocket Guide and requirement to escalate such incidents to an Emergency Operations Centre so that an NWAS National Inter-Agency Liaison Officer (Tactical Advisor) can be alerted to provide additional guidance.

31/03/15

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8. Item 8.2-Attach 2 to EPRR Assurance

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STATEMENT OF COMPLIANCE EPRR 2014/15

The North West Ambulance Service NHST has undertaken a self-assessment against required areas of the NHS England Core Standards for EPRR v2.0).

Following assessment, the organisation has been self-assessed as demonstrating the Substantial compliance level (from the four options in the table below) against the core standards.

Compliance Level Evaluation and Testing Conclusion

Full The plans and work programme in place appropriately address all the core standards that the organisation is expected to achieve.

Substantial The plans and work programme in place do not appropriately address one or more the core standard themes, resulting in the organisation being exposed to unnecessary risk.

Partial The plans and work programme in place do not adequately address multiple core standard themes; resulting in the organisational exposure to a high level of risk.

Non-compliant The plans and work programme in place do not appropriately address several core standard themes leaving the organisation open to significant error in response and /or an unacceptably high level of risk.

Where areas require further action, this is detailed in the attached core standards improvement plan and will be reviewed in line with the Organisation’s EPRR

governance arrangements.

I confirm that the above level of compliance with the core standards has been or will be confirmed to the organisation’s board / governing body.

________________________________________________________________

Signed by the organisation’s Accountable Emergency Officer

____________________________ ____________________________ Date of Board of Directors meeting Date signed

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9. Item 8.3-Review of Appraisal

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Report to: Board of Directors Date: 26th November 2014

Subject: Review of Appraisal

Report of: Director of OD Prepared by: C. Offer

PAPER – FOR REVIEW AND APPROVAL


Quality Performance Good employer











finite resources




1030 &1036


14A 14C


Completed

Not required

Attachments: -----


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1

1.2

The purpose of this report is to provide the Board of Directors with an update on the Trust’s current

position relating to Appraisals and to provide feedback on the Workforce & Communities Committee’s

review of this position.

The November Workforce & Communities Committee agreed that a position on this matter would need to

be determined by the Board of Directors.

2. BACKGROUND

2.1

2.2

2.3

The Trust made the decision to move from a two year cycle of appraisal to an annual cycle in 2014/15,

setting a target of 85% to be achieved by the end of the financial year. The driver for the timing of this was

the change to Agenda for Change which enabled closer management of annual pay progression linked to

appraisal cycles.

Additionally, best practice evidence indicates that a robust appraisal process makes a positive contribution

to staff motivation, staff engagement and improved communications, all of which contribute to the stated

Trust objective of being an organisation where staff want to work.

The NHS Staff Council, in 2010, set out for the NHS, the need for high quality performance appraisal;

stating;

“The delivery of high quality patient care within the NHS critically depends on every member of staff:

having a clear understanding of their role and the part they play in their team and organisation

having an agreed set of priorities and objectives for their work

possessing and applying the knowledge and skills they need to perform that role effectively and to

achieve their objectives.

Research studies show strong and positive relationships between lower patient mortality rates and the

incidence and quality of performance appraisals and development reviews. See Reducing patient

mortality in hospitals: the role of human resource management (Carol Borrill and Michael West, Aston

Business School, 2003), and Silence Kills: the Seven Crucial Conversations for Healthcare (David

Maxfield, Joseph Grenny, Ron McMillan, Kerry Patterson, Al Switzler, 2005).

But current practice across the NHS is mixed at best. A recent review (Review of the NHS Knowledge and

Skills Framework, Institute for Employment Studies, NHS Employers 2010) found that annual

performance appraisal and development reviews cover fewer than half of the staff in around a third of

trusts and were only applied to three-quarters of staff in a similar proportion of Trusts.”

3. APPRAISAL POSITION

3.1

The position at the start of the year was that overall 53% of staff had received an appraisal in the previous

12 months.

The position for PES was 55%.

PTS and 111 were at a much lower point 33% and 3% respectively.

The Board had accepted that the focus within PTS was on improving performance and a recovery

trajectory during 2014-15 was agreed for this service line. Their start position was in line with this

trajectory.

111 had transferred into the Trust with no appraisal mechanism in place and with no funding within

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3.2

their relief structures to support regular appraisals; a recovery trajectory was also agreed but this

was not maintained.

Again progress towards the agreed target in PES has been impacted by the implementation of Reap

Level 3 in June and the decision to suspend further appraisals until January 2015, with the

implementation of Reap Level 4.

The appraisal compliance over the last 6 months (reporting format was different prior to this) is outlined in the table below

NWAS Appraisal 31 May

2014

30 Jun

2014

31 Jul

2014

31 Aug

2014

30 Sep

2014

31 Oct

2014

NWAS 50% 48% 47% 49% 49% 46%

Chief Executive 81% 92% 83% 100% 87% 86%

Director of Operations 52% 49% 48% 48% 46% 44%

Director of Finance/Deputy CEO 34% 37% 36% 43% 53% 51%

Director of Quality 71% 74% 71% 76% 82% 79%

Director of Organisational Dev’t 82% 91% 88% 86% 86% 86%

4. CURRENT POSITION

4.1

4.2

4.3

NWAS Position

The overall NWAS position at the end of October 2014 was that 46% of staff had had an appraisal in the

previous 12 months. This figure has dropped by 3% from the end of September 2014 figure of 49%.

NWAS Appraisal Reviews in month % up to date Previous month

%

NWAS 149 46% 49%

Chief Executive 1 86% 87%

Director of Operations 116 44% 46%

Director of Finance/Deputy CEO 23 51% 53%

Director of Quality 0 79% 82%

Director of Organisational Dev’t 9 86% 86%

Corporate Position

The overall position for corporate directorates has fallen outside of the target compliance, with 78% of

corporate staff having a recorded appraisal in the previous 12 month period.

Corporate Directorates Appraisal

Reviews in month

% up to date Previous month % % Target

Corporate - All 10 78% 83% 85±5%

Chief Executive 1 86% 87% 85±5%

Finance ~ Corporate 0 65% 78% 85±5%

Quality 0 79% 82% 85±5%

Organisational Dev’t 9 86% 86% 85±5%

PTS Position

The position in PTS (at 50% compliance) is that they are behind their recovery trajectory but this month

they have only maintained their position. It is anticipated that PTS will continue with the recovery positon

and achieve the Trust compliance target of 85±5% by 31st March 2015.

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4.4

4.5

Finance ~ PTS Appraisal Reviews in

month % up to date Previous month %

% Target (Recover

y)

Finance ~ PTS - All 23 50% 50% 60%

Lancashire 10 26% 25% 60%

Cumbria 13 31% 16% 60%

Cheshire 0 71% 76% 60%

Merseyside 0 93% 93% 60%

PTS CC & Mgt 0 10% 9% 60%

111 Position

The position in the 111 service is that no reviews were recorded as taking place in October (nor were any

recorded in September), this has seen compliance reduced, with only 1% of staff having a recorded

appraisal in the previous 12 month period.

Operations ~ 111 Appraisal Reviews in

month % up to date Previous month %

% Target (Recover

y)

111 - All 0 1% 4% 45%

Carlisle 0 0% 0% 45%

Middlebrook 0 1% 2% 45%

Clinical Service 0 50% 50% 45%

Management 0 0% 17% 45%

Parkway 0 22% 22% 45%

Operations Position

The position in the Operations Service line is that they have been unable to maintain their start of year

position, with 43% of staff having a recorded appraisal in the previous 12 month period.

Operations Appraisal Reviews in

month % up to date Previous month % % Target

Operations (Excluding 111) 116 46% 48% 85±5%

Operations ~ PES 62 44% 48% 85±5%

Cumbria & Lancashire 15 43% 46% 85±5%

Cheshire & Mersey 20 37% 41% 85±5%

Greater Manchester 27 53% 55% 85±5%

Operations ~ EOC 25 38% 39% 85±5%

Operations ~ Resilience 0 80% 87% 85±5%

Operations ~ Fleet & Estates 29 77% 66% 85±5%

Trust Wide 0 47% 48% 85±5%

The following table shows the likely impact on the compliance level of 46% during the Reap Level 4 period.

It indicates that the position is likely to worsen to 35% across PES Operations if appraisals cease until

January 2015. If the suspension continues until the end of March 2015, the position would be closer to

23% compliance. Given that the position in Operations has a significant impact on the overall Trust position

it is highly unlikely that the Board approved target of 85% will be met.

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Operations: Appraisals Due to Expire in Month 2014/15

Department No Recorded

Appraisal Nov - Dec Jan-March

Operations 7% (289) 9% (343) 11% (457)

PES 3% (86) 9% (275) 12% (383)

EOC 10% (47) 8% (37) 11% (52)

111 94% (150) 0% (0) 0% (0)

Resilience 0% (0) 1% (1) 5% (5)

Fleet & Estates 2% (3) 23% (30) 6% (8)

Trust Wide 6% (3) 0% (0) 19% (9)

The table also shows the figures for staff who have had no recorded appraisal.

5. ORGANISATIONAL RISKS

5.1

5.2

There are currently two appraisal related risks on the Trust’s risk register.

ID Lead(s) Directorate Risk Description Likelihood

(current)

Consequence

(current)

Rating

(current)

1036 Mr Derek Cartwright

Service Delivery Directorate:

Failure to have an engaged workforce and ability to highlight potential development opportunities due to non delivery of KSF appraisal process across the organisation resulting in demotivated staff.

5 3 15

1030 Mrs Kelly Jackson

Finance Directorate (inc PTS)

Failure to embed principles of KSF appraisal across the organisation and manage conflict with operational performance; which will result in failure to meet Trust objectives and potential failure of CQC assessment.

2 3 6

Appraisal was also an area highlighted by CQC on their recent visit so a focused plan for recovery will be

required. The current levels of appraisal will also mean that the Agenda for Change incremental pay

progression arrangements cannot be fully implemented (whereby incremental pay is linked to performance

appraisal).

6. REVIEW AND DISCUSSION

6.1

6.2

6.3

Work has already been undertaken as part of the policy and procedure review to simplify the paperwork

associated with appraisal and this will support service lines in the delivery of effective appraisals.

PTS and corporate services are not directly affected by the implementation of Reap Level 4 and as a result

both these areas will be expected to meet the target of 85% ±5% by the 31st March 2015 and will be

supported to do so through the OD Directorate.

There are limited interventions which can be undertaken during the period of Reap level 4 to mitigate the

worsening position in PES Operations but the following activities are taking place:

A review of those staff on light duties/maternity is being undertaken to see whether these

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6.4

6.5

appraisals can be completed using corporate managers but the impact of these numbers is likely to

be small.

Appraisals and Personal Development Plans for new entrants will be undertaken during their core

induction programmes. This could have an impact of up to 5% on the overall figures for PES

Operations.

The Workforce and Communities Committee received a proposal to agree a longer term recovery trajectory

for PES Operations to achieve the required target over the 12 months following the recommencement of

appraisals. For 111, a proposal was also received to agree a revised trajectory; however, 111 have not been

able to sustain the previous trajectory and the expectations on this function will need to be confirmed.

Both recovery trajectories would extend beyond 31st March 2015.

The Committee considered the importance of the appraisal process in terms of service quality and staff

development and the risk that the process could be devalued by what would effectively be a deferment.

The Committee agreed that a position on this matter would need to be determined by the Board and that

the subject should form a separate agenda item for the meeting on 26 November 2014.


7.1

7.2

7.3

The Health and Social Care Act (assessed by CQC) requires that NHS organisations ‘Have a regular system of

appraisal that is being delivered’

Appraisal compliance is subject to assessment by the CQC.

Appraisal compliance has previously been area of compliance within tender submissions.



Determine the Board’s expectation for appraisal compliance given the current operating

environment.

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10. Item 8.4-Sickness Absence Report

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Report to: Board of Directors Date: 26th November2014

Subject: Quarterly Workforce Report - Sickness Absence

Report of: Director of Organisational Development

Prepared by: L. Ward

PAPER FOR NOTING












finite resources





-----


Completed

Not required

Attachments:

Appendix 1: NWAS & NHS Absence Data Tables

Appendix 2: Age & Sickness Absence Analysis

Appendix 3: Long Term/Short Term Absence Analysis

Appendix 4: Causes of Absence

Appendix 5: Level 3 Absence Reports ~ PES & PTS


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1 1.2

As part of the review of Workforce Information presented to the Board of Directors it was decided to reduce the content of the monthly Workforce Compliance Dashboard and to provide a quarterly report with more in-depth analysis of workforce metrics. The purpose of this report is :

to provide information and more detailed root cause analysis of sickness trends

to provide assurance on actions being taken to improve attendance levels

to make additional recommendations for further work

2. BACKGROUND

2.1 2.2

The current budgeted level of sickness absence for the Trust is 5% however the current cumulative sickness absence rate for 2013-14 was 6.6%. High levels of sickness absence, therefore, place the Trust’s financial position under pressure as well as impacting on the resourcing levels available to deliver patient care. This impact is particularly evident when combined with a vacancy position. The sickness absence levels are recognised by the Board as a critical workforce indicator and are highlighted every month in the Workforce Dashboard. In addition, sickness absence levels have also been identified to the TDA as an area of improvement for the Trust.


3.1 3.1.1 3.1.2 3.1.3 3.1.4

Absence Patterns and Context Reviewing data over the last four years identifies very similar patterns of absence across the year [Appendix 1 – Table 1]. Sickness absence patterns from April to September have been variable with some years showing decreasing trends over this period and others showing more variability. The period September to March, however, shows a consistent pattern of rising absence. These peaks in absence correlate with the time of the year when environmental factors have the greatest effect on staff and sickness often increases during this period of time with winter pressures also creating higher levels of fatigue. This absence pattern is mirrored in other Ambulance Trusts [Appendix 1 – Table 2] A review of cumulative sickness absence back to 2006-7 indicates that the cumulative absence rate in NWAS has only once fallen below 6% [Appendix 1 – Table 4]. This was a year in which data reliability was affected by issues with the Payroll provider at the time. The last two years have been at a higher level of 6.6%, but the average sickness level for the last 5 years is 6.24%. This position indicates that a budgeted absence level of 5% is aspirational and the target set for this year, of individual areas and service lines aiming to reduce their absence rates by 1%, is challenging but a more realistic approach to target setting. Compared to other Ambulance Trusts across the UK NWAS has the second highest absence rate [Appendix 1 – Table 2] with a cumulative absence rate of 6.59% between the periods July 2013 to June 2014. With the exception of West Midlands, the remaining urban services have rates of around 6% or above indicating that this is a challenge which is shared across the sector. It should also be noted that reported rates can be affected by the approach taken in individual Trusts to the management of sickness, for example, a more extensive use of alternative duties could reduce absence figures but would not

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3.1.5 3.2 3.2.1 3.2.2 3.2.3 3.3 3.3.1 3.3.2 3.3.3 3.3.4

necessarily mean that resourcing levels are improved. Generally the North West as a region has higher levels of absence compared to other regions across the NHS. NHS Data analysed by HEE region (over 5 year period) confirms that the North West has the second highest cumulative sickness absence rate of 4.66% and North Central and East London HEE region had the lowest cumulative rate at 3.41% [Appendix 1 – Table 3]. Current Sickness Absence Position Sickness absence has fallen slightly over the last 2 financial years [Appendix 1 – Table 1] and has followed a similar pattern of absence. The cumulative sickness absence rate for 14/15 is currently 6.74% [Appendix 1 – Table 4] but this has been heavily affected by a spike in absence rates for August. Over a 9 year period the average sickness absence percentage for the Trust is 6.3%. For 2014/15 all service lines have been set a target of a 1% sickness absence reduction which is being monitored through the Level 2 and Level 3 dashboards. PES are on track to achieve this target and have achieved a 0.33% reduction, over the period April to August 2014, and PTS are over the target by 0.13% for the same period [Appendix 1 – Table 5]. The FY14/15 absence rates were showing a decreasing trend for the year with the exception of August 2014. This increase is largely due to an increase in long term absence of 0.5% from the previous month and a 0.2% increase in the short term absence rate. Historical evidence indicates that a rise in sickness during August is expected but the increase this year is more pronounced and the downward trend for September has already commenced. Further investigation to try to identify causes for the higher than expected peak in August is underway. Age and Sickness There is a clear correlation between age and attendance within PES which includes a sharp rise in sickness levels in the 55-64 age groups. This increase compared with other grades is largely attributable to increases in long term sickness in this age group as levels of short term sickness are fairly stable across the age groups. However, this age related pattern is not reflected in other areas of the business such as PTS which shows a low level of sickness for the same age group. Given that both roles involve a high level of manual handling, it is clear that the factors influencing this are complex. Other service lines do not necessarily show significant age related trends with the exception of EOC, where the spike in absence is for the younger age groups and is short term sickness. This is not untypical of call centre environments and requires a different approach to tackling it than the position in PES Operations. There is a spike in long term sickness in the 25-34 age group in PTS but this is a very small group of only 57 staff. The age related sickness pattern in PES remains the largest area of concern, and potential future risk for the Trust, as there are other factors which could see this position worsening or having further impact in future years. With the move to graduate Paramedic recruitment, the recruitment age profile is now younger so by the time staff reach the 55-64 age group their working lives will have been longer and the impact of an aging workforce may be more pronounced. In addition, the working longer review being undertaken nationally has not accepted that the working environment of Paramedics/Ambulance workers impacts on their ability to work longer prior to

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3.4 3.4.1 3.4.2 3.4.3 4.0 4.1 4.2 4.2.1 4.2.2 4.2.3

retirement. This leads to a situation where pension changes may require staff to work for longer financially. The knock on effect would be that we may see a rise in the number of people in the older age categories which in turn may have a detrimental effect on absence levels across the Trust. Reasons for Absence Analysis of reasons for absence has been undertaken for absence recorded between April and August this year within PES. Appendix 4 details the top six causes of absence for each age group. The top six causes of absence typically account for 70.9% of total sickness for PES (calculated over rolling 12 month period Sep13 to Aug14). This analysis indicates that causes generally linked with short term sickness such as gastrointestinal problems feature at a high rate amongst the younger age groups, whereas there is a clear upward trend in muscular skeletal related absence as staff get older. Stress related absence increases as a proportion of the top six causes with age but appears to peak in the middle years perhaps when family pressures could be an additional factor. It is currently difficult to clearly analyse the links between industrial injury and absence as the information is recorded on two different systems which are difficult to correlate effectively and this is an area which requires further work to enable Health and Safety preventative work to be effectively focused to maximise impact. PROPOSALS The analysis undertaken to date indicates that historic levels of absence within NWAS and the wider health service within the North West, are higher than in other parts of the country. This suggests that there are external cultural factors at play. Policy improvement and management of absence alone may not have the long term desired effect on overall absence levels. The strategy being pursued is to explore the cultural and organisational root causes of absence alongside the more traditional approaches of targeted absence management. The following section outlines those actions already in progress and additional areas of work identified as a result of this analysis. Current Policies and Practices There is evidence that a consistent application of policies does have an impact on short term absence levels. Appendix 1 – Table 6 shows the percentage absence levels for the GM Central sector in 2013-14 which had traditionally higher than average levels of sickness absence. The Sector Manager here had focused on consistent and rigorous application of the procedure and, although there were peaks in some months, there were months where sickness was consistently below the 5% target. The results indicate that with consistent application of the policy it is possible to impact positively on absence levels, particularly in areas of the Trust (EOC for example) where short term absence has a particular impact. The procedure has been reviewed with particular focus on amendments to trigger points and resolving anomalies or barriers which managers felt hampered their application of the procedure. The revised procedure was implemented on 1st July but evaluation of its impact is being affected by the application of reap Level 4 which is felt to be affecting the consistent application of the management arrangements. HR Managers use the Workforce Dashboards to analyse both the areas of good practice

and areas of concern. This data enables focussed meetings to take place with HR

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4.2.4 4.2.5 4.3 4.3.1 4.3.2 4.3.3 4.3.4 4.3.5 4.4 4.4.1

Managers and Sector Managers to share best practice and also review problem areas. As

a result of this data analysis, coupled with discussion on a local level, the HR Advisers then

assess the need for training for groups of Managers or 1:1 sessions dependant on need

and the issues emerging. The data is also used to action plan individual cases with

managers to ensure that the most effective approach to management of individual cases

is being taken.

The dashboard data is also supplemented by quarterly audits of the sickness absence

process which are undertaken by HR within each sector. The data for analysis is randomly

selected and the HRAs undertake the local audit which acts as a prompt for assessing gaps

in understanding, knowledge and enables any problems to be rectified quickly. This

particularly focuses on issues of recording and the first stage interventions undertaken by

managers and helps to assure or address gaps in Return to Work interviews, local

recording processes and that triggers of the policy are being acted on promptly.

Although the responsibility for managing the absence of staff clearly lies with line

managers the current pressures and high levels of absence suggest that options for a

more targeted approach in the short term using more dedicated resources may need to

be considered. This option will be kept under review.

Occupational Health Contract Following a competitive tender process in later 2013, the Trust renewed the Occupational Health Service contract to Stockport NHS Foundation Trust, commencing on 1 April 2014. A key requirement of the Occupational Health contract is to ensure that the service is of both high quality and value for money for the Trust. As with the previous contract, Occupational Health Services will be provided via a ‘hub and spoke’ model throughout the North West. One of the main changes with the contract is a shift to a nurse led service and this represents a significant change from the previous physician led service. To support managers with this transition a series of management workshops run by the Occupational Health consultants, took place in May and June. The workshops focused on how managers can use the service to support attendance management and overall health and wellbeing amongst staff. The contract also has a renewed focus on the health and wellbeing of staff. Alongside the provision of the basic Occupational Health Service the new contract includes the launch of an online health and wellbeing resource. The changes should enable managers to gain greater benefit from the service and will support the Trust to focus Health and Well-Being initiatives more effectively on areas of concern. There will be an ongoing cycle of evaluation and feedback through the contract management process. Organisational and Cultural Analysis NWAS has already commissioned a project with Zeal Solutions which aims to assess the cultural health of the organisation. This aims to support the Trust in identifying organisational factors which may contribute to motivation, absence and performance within the Trust, thus seeking to address some of the underlying or root causes of why our absence is consistently higher than other parts of the sector.

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4.4.2 4.5 4.5.1 4.6 4.6.1 4.7 4.7.1 4.7.2 4.7.3

The project is being managed through the Health and Well Being group. A survey is currently being undertaken which, to date, has a 23% return rate. Responses will continue to be sought before Christmas. Results will then be analysed and key themes and outcomes explored in more detail and supplemented through focus groups. The planning and timing of these was due in the last three months of the financial year with the expectation of a report to Board in March 2015 but these timescales will be considered in light of current performance pressures. Data Improvement From the analysis undertaken, there is a requirement to improve the links between data held relating to injury at work and sickness levels. Currently the system for recording accidents at work does not link with, or give person identifiable data that could be linked with ESR systems that allow us to marry that data with sickness absence data. Options for resolving this issue and improving data analysis are being pursued. Working Longer Review The Working Longer Review has been extended nationally and the Ambulance Services continue to be engaged in the review led by LAS. NWAS will continue to contribute to this review. In addition, a longitudinal study (approx. 4-5 years) of older staff in LAS and SCAS has been commissioned and will be undertaken by Bath University to help inform the national picture. Age Issues – PES Clearly the issues associated with an ageing workforce, particularly in PES, are an area for concern. Further work will be undertaken to understand the problem more fully but also to explore interventions which may enable improvements to the position. The work will incorporate outcomes from Zeal but will also engage with Occupational Health, both to seek their support in a more detailed understanding of the health related factors affecting older age groups and to consider more targeted Health and Wellbeing interventions that could reduce absence in particular around the Muscular Skeletal issues within the PES service line. A more detailed analysis of the root causes of absence for older age groups may result in us needing to consider more flexible options for the operational deployment of older staff or more flexible working arrangements, utilising part time, shorter shift lengths or a mix of reduced manual handling options to try to maximise attendance amongst this group. We may also want to consider health promotion and health/well-being options targeted at this group of staff to try to support this group and the 45-54 age groups to maintain their health.


5.1 There are no legal implications arising from this report.

6. 6.1

CONCLUSION The more in depth analysis of sickness information provided in this report highlights the challenges posed in tackling what are historically higher levels of sickness absence in NWAS and the wider North West. There are also more detailed concerns regarding sickness absence in older age groups within PES which will be explored in more detail.

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6.2

Approaches in the past have focused primarily on sickness absence management and the efficacy of the policy/procedure framework. Evidence suggests that the procedure is appropriate to manage absenteeism and, when applied consistently, can have an overall impact on improving sickness levels. However, the strategy being pursued also identifies that for a step change to take place, a focus on organisational and cultural causes is required and this is being pursued through the Zeal Project. In addition, a review of the approach to Health and Well Being will support a more proactive approach.


7.1 The Trust Board is recommended to:

Continue to monitor sickness levels across the Trust on a monthly basis via the Workforce Dashboard incorporated into the monthly board reports

Support the conclusions of this report

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Appendix 1

Table 1

NB: The trend lines use on the graph use a two month moving average for the years FY12/13 and FY13/14. This approach is used to smooth out peaks and troughs in trend data. Ambulance Sickness Absence Rates

Ambulance Trust Jul-13 Aug-

13 Sep-

13 Oct-

13 Nov-

13 Dec-

13 Jan-

14 Feb-

14 Mar-

14 Apr-

14 May-

14 Jun-

14 Cum Ave

West Mids Amb F 4.97% 5.22% 4.85% 4.83% 4.76% 5.43% 6.15% 6.15% 5.73% 5.73% 5.23% 4.65% 5.31%

South East Coast Amb 5.00% 5.36% 5.06% 5.05% 4.77% 6.15% 6.05% 5.96% 5.56% 5.25% 5.31% 4.72% 5.35%

South Central Amb F 5.13% 4.78% 4.63% 4.93% 5.07% 6.19% 6.06% 5.80% 5.69% 5.62% 5.44% 5.27% 5.38%

South West Amb F 4.88% 5.16% 5.10% 4.73% 5.15% 5.92% 5.71% 5.95% 5.67% 5.74% 5.85% 5.91% 5.48%

East Mids Amb 5.37% 5.28% 5.44% 5.34% 5.35% 6.73% 6.96% 6.70% 6.26% 5.86% 6.15% 6.13% 5.96%

London Amb 5.58% 5.61% 5.56% 6.25% 6.23% 6.01% 5.82% 6.15% 5.78% 6.03% 6.20% 6.41% 5.97%

North East Amb F 5.73% 5.84% 5.33% 5.16% 5.46% 6.71% 6.44% 6.13% 6.84% 6.18% 5.95% 6.49% 6.02%

Yorkshire Amb 5.55% 5.67% 5.62% 5.48% 5.50% 6.20% 6.54% 6.58% 6.69% 6.59% 6.05% 6.12% 6.05%

East of Eng Amb 5.81% 5.64% 5.66% 5.86% 5.89% 7.39% 7.32% 6.72% 6.54% 6.54% 6.57% 6.18% 6.34%

North West Amb 6.57% 6.68% 5.96% 5.70% 5.82% 6.85% 7.26% 7.31% 6.94% 6.97% 6.57% 6.49% 6.59%

Welsh Amb Services 7.45% 7.61% 7.31% 7.40% 7.41% 8.57% 8.82% 8.17% 7.64% 7.54% 7.63% 8.62% 7.85%

Table 2

Annual Sickness Absence Rates by Health Education England Region

NHS England 4.40% 4.16% 4.12% 4.24% 4.06%

Year 2009-10 2010-11 2011-12 2012-13 2013-14 Average

Health Education North East 4.98% 4.60% 4.55% 4.74% 4.52% 4.68%

Health Education North West 4.86% 4.60% 4.52% 4.69% 4.60% 4.66%

Health Education Yorkshire and the Humber 4.72% 4.53% 4.45% 4.57% 4.36% 4.53%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

2012/13 6.75% 6.73% 6.20% 6.43% 6.60% 6.20% 6.00% 6.30% 7.30% 7.40% 7.00% 6.52%

2013/14 6.48% 6.70% 6.84% 6.64% 6.68% 5.99% 5.71% 5.86% 6.93% 7.18% 7.21% 6.84%

2014/15 6.99% 6.59% 6.49% 6.39% 7.00% 6.98%

Amb. Nat. Ave. 12/13 6.01% 5.87% 5.72% 5.64% 5.73% 5.52% 5.54% 5.60% 6.51% 6.62% 6.53% 6.29%

Amb. Nat. Ave. 13/14 6.21% 6.09% 6.06% 6.14%

4.00%

4.50%

5.00%

5.50%

6.00%

6.50%

7.00%

7.50%

8.00%

NWAS 3 Year Sickness Absence Data

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Health Education West Midlands 4.70% 4.47% 4.31% 4.43% 4.21% 4.43%

Health Education East Midlands 4.68% 4.42% 4.33% 4.47% 4.22% 4.42%

Health Education South West 4.41% 4.13% 4.11% 4.28% 4.12% 4.21%

Health Education East of England 4.31% 4.02% 4.03% 4.20% 3.95% 4.10%

Health Education Kent, Surrey and Sussex 4.12% 3.86% 3.87% 3.96% 3.84% 3.93%

Health Education Wessex 4.04% 3.79% 3.74% 3.92% 3.81% 3.86%

Health Education Thames Valley 3.79% 3.69% 3.75% 3.79% 3.63% 3.73%

Health Education South London 3.92% 3.63% 3.67% 3.62% 3.58% 3.68%

Special Health Authorities and other statutory bodies 3.93% 3.69% 3.47% 3.56% 3.13% 3.56%

Health Education North West London 3.50% 3.47% 3.48% 3.50% 3.47% 3.48%

Health Education North Central and East London 3.50% 3.32% 3.39% 3.45% 3.36% 3.41%

Source: Health & Social Care Information Centre - NHS Sickness Absence Rates, Annual Summary Tables, 2009-10 to 2013-14 Table 3

NWAS Cumulative Sickness Absence Percentages

Financial Year % Absence

2006 07 6.0%

2007 08 6.7%

2008 09 6.4%

2009 10 6.3%

2010 11 5.2%

2011 12 6.0%

2012 13 6.6%

2013 14 6.6%

2014 15 (April-Aug) 6.7%

Average Over All Years 6.3%

Table 4

Achievement against 1% reduction (April-August 2014)

Service Line Apr May Jun Jul Aug Cum. Ave. (Apr-Aug)*

% Reduction (Apr-Aug)**

PES 7.58% 7.17% 6.93% 6.84% 7.74% 7.25% -0.33%

Cumbria & Lancashire 7.63% 6.92% 7.32% 7.15% 7.66% 7.34% -0.30%

Cheshire & Mersey 7.59% 7.81% 8.18% 7.99% 7.69% 7.85% 0.26%

Greater Manchester 6.92% 6.80% 5.60% 5.91% 7.98% 6.64% -0.28%

EOC 8.80% 7.16% 6.63% 6.04% 7.50% 7.23% -1.57%

PTS 6.59% 6.28% 6.38% 6.92% 7.43% 6.72% 0.13%

Cheshire 6.67% 4.37% 6.44% 9.96% 9.66% 7.42% 0.75%

Cumbria 6.90% 6.80% 7.84% 6.98% 6.18% 6.94% 0.04%

Lancashire 7.00% 5.52% 5.34% 5.34% 6.94% 6.03% -0.97%

Merseyside 8.69% 9.56% 7.74% 7.78% 7.47% 8.25% -0.44%

PTS CC 1.99% 4.06% 4.97% 4.71% 6.35% 4.41% 2.43%

*Cum. Ave. based on % average during period **Reduction is calculated using April 2014 as start figure and deducting the Cum. Ave. to give a % reduction over period Table 5

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Example of area where sickness absence policy consistently applied:

Table 6

3.00%

3.50%

4.00%

4.50%

5.00%

5.50%

6.00%

6.50%

7.00%

3.00%

3.50%

4.00%

4.50%

5.00%

5.50%

6.00%

6.50%

7.00%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

PES GMA - Central - Sickness Absence FY13/14

% Absence Target

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- 12 -

Appendix 2 – Age and Sickness Analysis The first set of graphs shows the analysis undertaken for the month of August 2014 calculated by age group for each service line. The data is shown graphically with the percentage absence for each age group shown against headcount. Very low headcount can mean a disproportionate impact on absence levels. The analysis undertaken for August identified a correlation between age and sickness absence in PES and EOC. As a result more in depth analysis was undertaken into these areas. This analysis is presented graphically as follows:

Sickness percentage for each age group is shown graphically by month

The graphs below show the headcount and the cumulative average for each age group compared with the average for the service line

August Data Observations PES The data for PES is a cause for concern as it does appear to show a clear correlation between age and attendance. This is particularly marked with a sharp rise in sickness levels in the 55-64 age group. Whilst this group is very small it has a high percentage absence rate which has been on the increase over the last 2 months [Chart 2].

Data Extracted from ESR 01-31Aug 2014. Absence % based on sickness calculated over a 31 day period irrespective of staff working patterns.

Chart 1

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

0

200

400

600

800

1000

1200

1400

18-24 25-34 35-44 45-54 55-64 65-69

%

A

b

s

e

n

c

e

H

e

a

d

c

o

u

n

t

PES Age & Absence % ~ August 2014

Sum of H/C % Absence Current Absence

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- 13 -


Chart 2

The age group 45-54 had seen a steady reduction in absence levels since the beginning of the fiscal year however; this has seen a sharp rise for the month of August. Other groups impacting a higher than expected August sickness percentage are the 35-44 age group, which is our largest headcount age group and to a lesser extent the 25-34 age group which has the third largest headcount. EOC The pattern for EOC shows that the younger age groups are contributing the highest levels of absence.


Chart 3

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Apr May Jun Jul Aug

%

A

b

s

e

n

c

e

PES - Age and Percentage Absence

18-24

25-34

35-44

45-54

55-64

65-69

70+

Age Band 18-24 25-34 35-44 45-54 55-64 65-69 70+ Grand Total

Headcount 119 690 1185 941 266 10 0 3211

Cumulative Absence 4.18% 6.32% 6.96% 7.71% 8.13% 0.82% 0.00% 7.03%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

0

50

100

150

200

250

18-24 25-34 35-44 45-54 55-64 65-69

%

A

b

s

e

n

c

e

H

e

a

d

c

o

u

n

t

EOC Age & Absence % ~ August 2014


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- 14 -


Chart 4

All of those three groups have seen an increase in sickness level for the month of August, only the 25-34 age group and the over 65’s have seen a reduction in sickness for the month of August. PTS Sickness absence rates across the age groups are fairly consistent with the exception of the small group of staff between the ages of 25-34 who have high levels of absence. Data in Appendix 4 will show us which area of work these staff may be working in.


Chart 5

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

Apr May Jun Jul Aug

%

A

b

s

e

n

c

e

EOC - Age and Percentage Absence

18-24

25-34

35-44

45-54

55-64

65-69

70+


Headcount 54 234 152 125 36 4 0 605


0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

0

50

100

150

200

250

18-24 25-34 35-44 45-54 55-64 65-69

%

A

b

s

e

n

c

e

H

e

a

d

c

o

u

n

t

PTS Age & Absence % ~ August 2014


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- 15 -


Chart 6

The over 65’s are also a small headcount group that are showing a hike in sickness levels. Data shown in Appendix 3 reveals that this increase is not the expected increase in long term sickness most closely associated with absence levels in the higher age ranges.

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

Apr May Jun Jul Aug

%

A

b

s

e

n

c

e

PTS - Age and Percentage Absence

18-24

25-34

35-44

45-54

55-64

65-69

70+


Headcount 14 66 101 209 203 21 0 614


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- 16 -

Appendix 3 Long Term & Short Term Split in Sickness Absence The charts shown below show the long term and short term split in percentage absence for the period of August 2014.

Based on absence data for period August 2014

Table 1

PES shows a steady and proportionate split in short term versus long term absence percentage for August with the exception is the 55-64 age groups where there is a noticeable difference in long term sickness percentage for the age group. This is of particular concern given that this is a relatively small age group of approx. 260 staff. Further work would allow us to analyse whether this is just a one off spike in activity with a number of people being off long term sick or whether or not this is a predictable pattern. If this is a more sustained absence occurrence then further analysis would allow us to see whether or not more occupational health intervention for this group would be appropriate. The split in absence in EOC is markedly different to that of PES. There is a much higher proportion of short term absence compared to long term absence levels. To some extent this is a predictable pattern within calls centres across the UK, however, it is also the type of sickness absence where early management intervention has been shown to be very effective.

18-24 25-34 35-44 45-54 55-64 65-69 70+

LT % 0.22% 1.15% 1.80% 1.67% 3.89% 0.00% 0.00%

ST % 4.02% 5.69% 6.00% 6.30% 6.64% 0.00% 0.00%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

%

A

b

s

e

n

c

e

PES Sickness Absence ~ Short/Long Term Split by Age

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- 17 -


Table 2

PTS have a higher than average short term absence rates and relatively small percentages of long term sickness absence; given the high proportion of older employees within the service line this is unexpected. Further work to review this split across other months will show if this trend is typical.


Table 3

Whilst the data provides only a snap short in time (August 2014) it is clear to see the majority of sickness absence across all services lines appears to be short term sickness absence.

18-24 25-34 35-44 45-54 55-64 65-69 70+

LT % 0.00% 0.54% 1.14% 1.63% 1.00% 0.00% 0.00%

ST % 2.07% 6.23% 8.30% 6.91% 5.01% 0.00% 0.00%

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

%

A

b

s

e

n

c

e

EOC Sickness Absence ~ Short/Long Term Split by Age

18-24 25-34 35-44 45-54 55-64 65-69 70+

LT % 0.00% 5.18% 0.80% 1.55% 1.09% 0.00% 0.00%

ST % 0.92% 8.29% 6.00% 4.13% 6.55% 6.17% 0.00%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

%

A

b

s

e

n

c

e

PTS Sickness Absence ~ Short/Long Term Split by Age

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- 18 -

It would be fair to assume that given the data time period, i.e. August, being the height of summer and that we always traditionally have a spike in absence activity around this time of year, that it is largely related to short term absence, we are not able to draw any other conclusions from this data about activity at other times of the year. Further analysis of short term versus long term absence in other months across the year could help model trends for the fiscal year.

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- 19 -

Appendix 4

Causes of Absence The pie charts below show the top six reasons for absence for each age group but the percentages are only as a proportion of the top six (based on rolling 12 months data September 13 to August 2014). The top six absence reasons accounts for 70.9% of sickness for the PES service line. The following tables show an extract of those sickness reasons which vary across age groups. The percentage is a proportion of the total sickness for each age group.

8% 7%

46%

16%

11%

12%

PES Top 6 Absence Causes ~ 18-24 12 month period Sep 13 - Aug 14

S10Anxiety/stress/depression/other psychiatric illnesses

S11 Back Problems

S25 Gastrointestinalproblems

S26 Genitourinary &gynaecological disorders

S28 Injury, fracture

8%

16%

12%

10% 40%

14%



S11 Back Problems

S13 Cold, Cough, Flu -Influenza

S16 Headache / migraine



10%

16%

9%

15%

33%

17%



S11 Back Problems

S12 Other musculoskeletalproblems




11%

18%

10%

13%

31%

17%



S11 Back Problems





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- 20 -

By far the most common reason for absence across all age ranges is that of ‘Gastrointestinal Illness’ ranging from 26% in the 45-54 age group to 41% in the 25-34 age group. Stress and anxiety also appears in the majority of age groups with the highest percentage in the age ranges 35- 54. The table below shows sickness reasons which increase as a proportion of sickness with age:

Absence Reason Age

18-24 25-34 35-44 45-54 55-64 65-69

S10 Anxiety/stress/depression/other psychiatric illnesses 5.97% 5.72% 7.29% 8.39%

S11 Back Problems 5.22% 11.63% 11.19% 13.28% 12.21%

S28 Injury, fracture 7.46% 10.53% 12.28% 12.06% 12.21%

S12 Other musculoskeletal problems 6.32% 7.66% 7.26%

S15 Chest & respiratory problems 6.93% 9.09%

S13 Cold, Cough, Flu - Influenza 8.43% 10.46% 9.37% 6.93% 9.09%

NB: Percentages shown are % sickness reason as a % of all sickness for the age group. Data period Sept 13 to Aug 14.

It would be possible to extract further information and make further assumptions around the reasons for absence using data from the occupational health teams and to also increase the search parameters above to a period that spans a number of years thus providing a more comprehensive set of data.

16%

10%

9%

9% 30%

16%

10%


S11 Back Problems



S15 Chest & respiratoryproblems



S99 Unknown causes / Notspecified

15%

14%

14%

14%

29%

14%



S14 Asthma

S15 Chest & respiratoryproblems

S22 Dental and oralproblems


S26 Genitourinary &gynaecological disorders

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- 21 of 21 -

Appendix 5 Level 3 Dashboard Data

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

NWAS A&E 6.29% 5.80% 5.92% 7.31% 7.33% 7.43% 7.39% 7.58% 7.17% 6.93% 6.84% 7.74%

C&L 6.19% 6.03% 6.13% 7.21% 6.92% 7.15% 7.04% 7.63% 6.92% 7.32% 7.15% 7.66%

C&M 6.88% 6.24% 6.68% 8.56% 9.05% 9.25% 8.27% 7.59% 7.81% 8.18% 7.99% 7.69%

GM 6.40% 6.27% 5.39% 6.28% 5.95% 5.92% 6.20% 6.92% 6.80% 5.60% 5.91% 7.98%

EOC 5.13% 3.71% 5.25% 7.28% 7.73% 7.63% 8.77% 8.80% 7.16% 6.63% 6.04% 7.50%

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%

10.00%

% s

ickn

ess

PES Sickness Absence Rolling 12 Months

Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug

NWAS PTS 7.62% 7.61% 7.47% 8.34% 9.54% 10.05% 7.17% 6.59% 6.28% 6.38% 6.92% 7.43%

Cheshire 12.92% 14.33% 13.40% 12.01% 11.06% 11.89% 9.41% 6.67% 4.37% 6.44% 9.96% 9.66%

Cumbria 6.39% 4.38% 6.22% 11.82% 14.63% 10.10% 9.16% 6.90% 6.80% 7.84% 6.98% 6.18%

Lancashire 4.95% 5.34% 4.46% 4.86% 5.94% 6.49% 4.51% 7.00% 5.52% 5.34% 5.34% 6.94%

Merseyside 7.40% 8.04% 8.41% 8.92% 11.76% 12.24% 10.42% 8.69% 9.56% 7.74% 7.78% 7.47%

PTS CC 7.82% 5.35% 4.88% 7.94% 7.89% 11.42% 2.74% 1.99% 4.06% 4.97% 4.71% 6.35%

0.00%2.00%4.00%6.00%8.00%

10.00%12.00%14.00%16.00%

% S

ickn

ess

PTS Sickness Rolling 12 Months

132 of 324

11. Item 9.1-BAF Report

133 of 324

- 1 of 4 -


Subject: Board Assurance Framework 2014/15

Report of: Director of Quality Prepared by: Deputy Director of Quality

PAPER FOR APPROVAL


Not Applicable











finite resources




All Board Assurance Framework risks


Outcome 16


Completed

Not required

Attachments: Annex 1 - Board Assurance Framework 2014/15

Annex 2- Risks with a residual risk score of 12


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

134 of 324

- 2 -


135 of 324

- 3 of 4 -

1. INTRODUCTION

1.1

The purpose of this report is to present the Board of Directors with the latest Board Assurance

Framework (BAF) 2014/15, for review and approval.

2. BACKGROUND

2.1

2.2

2.3

The aim of giving this assurance is to provide confidence that the Trust is delivering high quality

care in a safe environment for patients by staff who have received the appropriate training; that

it is complying with legal and regulatory requirements and that it is meeting its strategic

objectives.

Historically, the BAF has been presented each month to the Risk Moderation Management Group

and Executive Management Team for moderation and to the Board of Directors at each of their

meetings for approval.

The BAF is also presented on a regular basis to the Audit Committee for review, challenge and

scrutinisation of the effectiveness of identified high level risk key controls.


3.1

3.2

3.3

3.4

As a result of escalating the residual risk score from 12 to 15, the following risk has been added

to the BAF by the Director of Operations;

Datix ID; 1036 Failure to have an engaged workforce and ability to highlight potential

development opportunities due to non delivery of KSF appraisal process

across the organisation resulting in demotivated staff.

Residual risk score increased from 12 to 15

As a result of escalating the residual risk score from 12 to 15, the following risk has been added

to the BAF by the Director of Finance;

Datix ID; 1260 Failure to achieve A19 target resulting in 2% PES Contract Financial

penalty in 2014/15 causing failure of financial duty.

Residual risk score increased from 12 to 15

Therefore, there are currently 12 moderated risks identified on the BAF 2014/15 (at Annex 1) of

which, 5 are owned by the Finance Director, 1 by the Medical Director, 4 by the Director of

Operations and 2 by the Director of Organisational Development.

There are currently 9 non sensitive risk with a residual risk score of 12 (at Annex 2) and the table below shows ownership and current alignment of these risks;

Linked Committee Service Delivery

Finance PTS

Quality Directorate

Finance Directorate

OD Directorate

Quality 2 0 0 0 0 Finance & Investment 2 0 0 2 0 Workforce & Communities 1 0 1 0 1 No Match 0 0 0 0 0 Total 5 0 1 2 1

136 of 324

- 4 -


4.1

4.2

There are legal implications to exposing the Trust to statutory and common law legislation and

prosecutions, if identified risks are not being managed appropriately.

The Assurance Framework process is an integral part of the Trust’s Statutory Risk Management

arrangements which in turn informs the Trust’s future Business planning process and Annual

Governance Statement in managing risk appropriately.

5. CONCLUSION

5.1

5.2

The Trust’s BAF 2014/15 will continue to be reviewed and approved by the Board of Directors in

line with National Guidance and the Trust’s Risk Management Policy.

The Risk Moderation Management Group, Executive Management Team and Audit Committee

will also continue to receive, moderate and reviews all ‘high level’ risks, on a regular basis.


6.1 It is recommended that the Board of Directors;

Review and comment on the contents of this Report and its Annexes.

Approve the BAF 2014/15 at Annex 1.

Review and comment on the risks with a residual risk rating of 12, at Annex 2, identifying

any risk that should be escalated or reduced.

137 of 324


12. Item 9.1-Attach 1 to BAF Report

139 of 324

North West Ambulance Service NHS Trust Board Assurance Framework 2014/15

Page 1 of 16

Unmitigated Risk Score = * Residual Risk Score = Target Risk/Risk Appetite Threshold

Datix ID:- 1375 Description:- Inability to get to patients in a timely manner and meet and sustain Category Red 2 performance target across NW Counties due to significant increases in demand and acute pressures which results in delays to patient care

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-13

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-15

Risk opened:-

Oct-2014 Expected risk closure:-

Mar-2015 25 20

Datix ID:- 1274 Description:- Inability to get to patients in a timely manner and meet and sustain Category Red 1 performance target across NW Counties due to significant increases in demand and acute pressures which results in delays to patient care

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Apr-2014 Expected risk closure:-

Mar-2015 20 20 20 20 20 20 20 20

Datix ID:- 1264 Description:- Failure to achieve financial duties due to lack of developed detailed plans for 2015/16 CIPs.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-13

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-15

Risk opened:-


Mar-2015 20 20 20 20 20 20 20 20

Datix ID:- 1035 Description:- Failure to deliver statutory and mandatory training needs of organisation and staff, due to potential conflict with operational performance and staff not allocated to attend or insufficient instructors being available to deliver. Risk of staff not being fully competent and potential impact on patient care.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

< *

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Jun-13 Expected risk closure:-

Mar-2015 12 12 12 12 15 15 15 15 15

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Page 2 of 16

Datix ID:- 709 Description:- Failure to accurately assess patients in the pre-hospital environment may result in inappropriate non-conveyance decisions

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Jan-2011 Expected risk closure:-

Dec-2015 15 15 15 15 15 15 15 15 15

Datix ID:- 1036 Description:- Failure to have an engaged workforce and ability to highlight potential development opportunities due to non-delivery of KSF appraisal process across the organisation resulting in demotivated staff.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Jun-2013 Expected risk closure:-

Mar-2015 12 12 12 12 12 12 12 12 15

Datix ID:- 1171 Description:- Potential of major reconfiguration to alter journey times may result in additional cost which will impact on the Trust CIP and call cycle times

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Jan-2014 Expected risk closure:-

Mar-2016 15 15 15 15 15 15 15 15 15

Datix ID:- 1258 Description:- Failure to achieve Red 1 (8 minute) target resulting in 2% PES Contract Financial penalty in 2014/15 causing failure of financial duty.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

< *

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-


Mar-2015 10 10 10 15 15 15 15 15

141 of 324


Page 3 of 16

Unmoderated risks

Datix ID:- 1259 Description:- Failure to achieve Red 2 (8 minute) target resulting in 2% PES Contract Financial penalty in 2014/15 causing failure of financial duty.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

< *

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-


Mar-2015 10 10 10 15 15 15 15 15

Datix ID:- 884 Description:- Potential financial risk to the Trust following the pending Paramedic banding decision, which is outstanding from the 2004 AfC banding review. The banding review will be undertaken outside of the Trust by an external panel of trained JE practitioners selected by the National Job Evaluation working Group.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

< *

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

May-2012 Expected risk closure:-

Nov-2014 10 10 10 10 10 10 15 15 15

Datix ID:- 1260 Description:-

Failure to achieve A19 target resulting in 2% PES Contract Financial penalty in 2014/15 causing failure of financial duty.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

< *

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-


TBC 10 10 10 10 10 10 10 15

Datix ID:- 1374 Description:- Severe organisational pressures and or cessation of key services due to potential national Public sector workers industrial action/strikes, arising out of failure of government union negotiations.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Oct-2014 Expected risk closure:-

May-2015 20

142 of 324


Page 4 of 16

Guide for Board Assurance Framework entries;

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing

Key Controls Mitigating actions in Place

Internal Assurance

External Assurances

Gaps in Control/ Mitigating Actions

Re

sid

ual

ris

k sc

ore

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al r

isk

sco

re

Must be high level potential risks that are unlikely to be

fully resolved and require on-going

control

Systems or processes in place and operating to

mitigate the risk

Internal evidence that the risk is being

effectively managed (i.e. Board reporting,

committees)

External evidence that the risk is

being effectively managed (e.g.

received external audit reviews)

Additional actions

required to mitigate/control the risk further

Where the Directorate

lead is failing to gain

evidence that the controls/

system on which we

place reliance are effective

143 of 324


Page 5 of 16

Strategic Objective:- Quality Reporting to the:- Quality Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing


Internal Assurance External Assurances


Re

sid

ual

ris

k sc

ore

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al r

isk

sco

re

1375

Mr

Der

ek C

artw

righ

t

Inability to get to patients in a

timely manner and meet and

sustain Category Red 2

performance target across NW Counties due to

significant increases in demand and

acute pressures which results in

delays to patient care

25

KEY ASSURANCE - Utilisation of Overtime - funding identified & resources identified. Funding agreed to implement operational model to meet demand (UCS). Workforce Plan agreed for 2014/15. Review of EOC Management Structure. Additional Paramedics recruited to date. Second or subsequent Procedure implemented. UCS demand reviewed against vehicle and staff availability. Additional funding identified to support performance recovery plan. Additional resources in place (VAS, UCS, EA. Agreement to increase workshop capacity. Extended operating hours in the ROCC to relieve regional pressures. Accelerated recruitment programme in place. Trust escalated to REAP Level 4. Trajectories agreed with TDA. Performance Recovery meeting established and chaired by the CEO. Demand Analysis project established.

P1 and P2 Reports

HAS Reporting

National Performance

Targets

Monthly Performance

Reports

AQI reports

Introduction of Community

Paramedics across NWAS – October

14

Introduce across ‘Green Car’ across NWAS – October

14

Recruit additional PES & EOC Staff

Ongoing

Carry out a full demand analysis

to ensure resources are

aligned to high areas of

activity/demand – November 14

20 No assurances

currently required

31/

03/2

01

5

10

144 of 324


Page 6 of 16

Strategic Objective :- Quality Reporting to the:- Quality Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing Key Controls

Mitigating actions in Place

Internal Assurance External Assurances Gaps in Control/

Mitigating Actions

Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e

of

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1274

Mr

Der

ek C

artw

righ

t

Inability to get to patients in a

timely manner and meet and

sustain Category Red 1

performance target across NW Counties due to

significant increases in demand and

acute pressures which results in

delays to patient care

25

Utilisation of Overtime - funding identified & resources identified. Funding agreed to implement operational model to meet demand (UCS). Workforce Plan agreed for 2014/15. Review of EOC Management Structure. Additional Paramedics recruited to date. Second or subsequent Procedure implemented. UCS demand reviewed against vehicle and staff availability. Additional funding identified to support performance recovery plan. Additional resources in place (VAS, UCS, EA. Agreement to increase workshop capacity. Extended operating hours in the ROCC to relieve regional pressures. Accelerated recruitment programme in place. Trust escalated to REAP Level 4. Trajectories agreed with TDA. Performance Recovery meeting established and chaired by the CEO. Demand Analysis project established.

Key Performance Indicators

(internal assurance)

P1 and P2 reports

Internal Benchmarking

Reports (internal assurance)

HAS Reporting

External Benchmarking

Reports (External

Assurance)

National Performance

Targets

Commissioner Feedback (External

Assurance)

Monthly Commissioner

Reports

AQI reports

Introduction of Community

Paramedics across NWAS –

September 14

Introduce across 'Green Car' across

NWAS - September 14

Recruit additional PES & EOC staff –

Ongoing

Carry out a full demand analysis

to ensure resources are

aligned to high areas of

activity/demand - November 14

20 No Gaps in Assurance Identified

31/

03/2

01

5

10

145 of 324


Page 7 of 16

Strategic Objective :- Finance Reporting to the:- Finance and Investment Committee Level of Assurance:- High

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing


Internal Assurance

External Assurances


Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1264

Mr

Ala

n S

tutt

ard

Failure to achieve financial duties due to lack of developed detailed plans for 2015/16 CIPs.

20 Outline plan included in the

TDA return

Approved Board and/ or Committee Reports

(internal assurance) TDA returns

Trust Development

Returns (external

assurance)

TDA returns

No PIDs, QIAs, detailed plans

20

Approved Board and/or

Committee Reports.

15/16 CIP

Implementation Plan Approved by Trust Board.

Detailed QIAs

developed and evaluated.

31

/03

/20

15

10

146 of 324


Page 8 of 16

Corporate Objective :- Great Place to Work Reporting to the:- Workforce and Communities Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1035

Mr

Der

ek C

artw

righ

t

Failure to deliver statutory and

mandatory training needs of organisation and

staff, due to potential conflict with operational performance and staff not allocated

to attend or insufficient

instructors being available to

deliver. Risk of staff not being

fully competent and potential

impact on patient care.

16

All staff attendance on course profiled in. Progress reporting process in place. Upto and including July 2014, 70% against a target of 97%. Consideration to operational demand is factored in when scheduling in training. New training plan developed and agreement to achieve target.

Training Records (internal assurance)

Individual staff

training records.

Complaints Reports (internal assurance)

Monthly

Complaints report

No Assurances Identified

Deliver training to all Staff

16

Training Records (internal

assurance)

Completed Training Records

31

-Mar

ch-2

01

5

4

147 of 324


Page 9 of 16

Strategic Objective:- Quality Reporting to the:- Quality Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing


Internal Assurance

External Assurances


Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

709

Pro

fess

or

Kev

in M

ackw

ay-J

on

es

Failure to accurately assess

patients in the pre-hospital

environment may result in

inappropriate non-conveyance

decisions

20

Clinical leadership structure in place 24/7/ clinical advice from advance paramedics Clinical advice also available through specialist Paramedics in UCD

PRIMARY ASSURANCE Non- conveyance data

reported to SMT/CGMG Siren data reported to

Quality Committee /EMT and Board. Incident. Management/StEIS

reported to CG/H&S MGs Quality Com/Board.

Audit process for refusal

Clinical Audit Reports

(CPI Reports)

Complaints Reports (Non Conveyance data

reviews

CQC Quality and Risk Profile

CQC reports

2013/14

. Audit process for all patient refusals

ERISS now being implemented and referral pathways being introduced.

15

Audit process for all patient

refusals

The Board has accepted that

the level of this risk will not reduce any further

Review of

referral pathways with embedding of

ERISS

31/

12/2

01

5

15

UCD audit undertaken including balanced score card. Clinical education strategy which widens knowledge and skills and enhances assessment skills.

Complaints and Incidents Management process looks at incidents of non-conveyance and take appropriate action UCPI on Pathfinder.

Weighted Balance Scorecard audit for each SP within UCD. UCD peer reviews.

Reports to SMT bi-monthly. Senior Paramedic performance framework now approved.

On Line' clinical advice from urgent care desks, Urgent Care Desk audit undertaken, revised PRF contains non-conveyance guidance

148 of 324


Page 10 of 16

Strategic Objective:- Great place to work Reporting to the:- Workforce and Communities Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1036

Mrs

Der

ek C

artw

righ

t

Failure to have an engaged

workforce and ability to highlight

potential development

opportunities due to non-delivery of

KSF appraisal process across

the organisation resulting in

demotivated staff.

12

All Senior Management and Team Leaders trained in the KSF process. Majority of staff reviews scheduled in. Progress reporting process in place. New arrangements in place to carry out initial appraisal at induction stage. New paperwork implemented to simplify process.

Workforce Committee reports

re KSF Reporting

Individual staff training records

None identified

Achieve KSF trajectories by ensuring staff

reviews take place

15

Completed training records

demonstrating KSF reviews for all staff.

31

/03

/20

15

6

149 of 324


Page 11 of 16

Strategic Objective:- Finance Reporting to the:- Finance and Investment Committee Level of Assurance:- Limited

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k sc

ore

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al r

isk

sco

re

1171

Mr

Ala

n S

tutt

ard

Potential of major reconfiguration to

alter journey times may result in additional cost which will impact on the Trust CIP

and call cycle times.

20

Governance framework ensures that the Trust is informed at an early stage of the Commissioner’s intentions. The Trust is actively engaged with service reconfiguration planning and implementation groups. Reconfiguration register established and used to inform formal Commissioner meetings. Periodic management reports to F&I Committee supported by production of monthly reconfiguration register.

Approved Board and/or Committee Reports (internal assurance)

Board and Committee

Reports

Commissioner Feedback

Meetings with Commissioners

Lack of understanding of the impact that

future reconfiguration

may have.


31/

03

/20

16

10

150 of 324


Page 12 of 16

Strategic Objective:-Finance Reporting to the:- Finance and Investment Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1258

Mr

Ala

n S

tutt

ard

Failure to achieve Red 1 (8 minute)

target resulting in 2% PES Contract Financial penalty

in 2014/15 causing failure of

financial duty.

20

2014/15 Revenue Budgets and recruitment plans in place. Performance dashboard established to monitor performance. REAP escalation processes in place. Discussion with commissioners has taken place regarding penalties and the fact that growth was not funded and therefore penalties should not be applied. Regular discussion at SPB with commissioners. Regular update to FIP Committee.

Approved Board and/or Committee


Board and

Committee Reports

Trust Development Authority (external

assurance)

TDA Returns

Evidence that target has been

delivered for 2014/15


31

-Mar

ch-2

01

4

10

151 of 324


Page 13 of 16

Strategic Objective:- Finance Reporting to the:- Finance & Investment Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1259

Mr

Ala

n S

tutt

ard

Failure to achieve Red 2 (8 minute)

target resulting in 2% PES Contract Financial penalty

in 2014/15 causing failure of

financial duty.

20

2014/15 Revenue Budgets and recruitment plans in place. Performance dashboard established to monitor performance. REAP escalation processes in place. Discussion with commissioners has taken place


Reports (Internal assurance)

Board and

Committee Reports


Assurance)

TDA Return

Evidence that target has been

delivered for 2014/15


31

-Mar

ch-2

01

5

10

152 of 324


Page 14 of 16

Strategic Objective:- Finance Reporting to the:- Workforce and Investment Committee Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

884

Mr

Mic

k Fo

rres

t

Potential financial risk to the Trust

following the pending

Paramedic banding decision,

which is outstanding from

the 2004 AfC banding review.

The banding review will be undertaken

outside of the Trust by an

external panel of trained JE

practitioners selected by the

National Job Evaluation

working Group.

20

National JE profile for paramedics Job Evaluation guidance memorandum of understanding drawn up with SHA assistance. Four separate Paramedic JE reviews to be undertaken with four separate consistency reviews. Staff Side JE analysis taken place for each JAQ and Management side commented with discrepancies to JE analysts for evidence based review. Terms of Reference agreed. Panel members identified by JEWG and review of the 4 Job Analysis Questionnaires took place on 29 & 30 September 2014. Panel to inform the national JEWG lead of the outcome and a Consistency panel will be convened by national JEWG lead by 28 November 2014.



Board report

20/2/14


The Review is being undertaken

outside of the 15

No Gaps in Assurance Identified

31

-Dec

emb

er-2

014

5

153 of 324


Page 15 of 16

Strategic Objective:- Great place to work Reporting to the:- Workforce and Communities Committee Level of Assurance:-

Dat

ix I

D

Re

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nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1374

Mr

Mic

k Fo

rres

t

Severe organisational

pressures and or cessation of key services due to

potential national Public sector

workers industrial action/strikes, arising out of

failure of government

union negotiations

25

Robust contingency planning including additional external support, leave cancellation etc. Agreed exemptions with TUs and ongoing dialogue Identification of internal resources to support Public campaign to reduce activity Internal communications

Trust has applied for exemptions

from the relevant unions.

Staff side

engagement up to chief Executive

Level


Differences in local and regional interpretation of

exemptions.

Effective training and allocation of

internal resources.

Limited options to mitigate loss of overtime cover

20

lack of commitment from Unions

to give sufficient notice of details of

strike

May

-20

15

6

154 of 324


Page 16 of 16

Strategic Objective:- Finance Reporting to the:- Finance & Investment Level of Assurance:- Significant

Dat

ix I

D

Re

spo

nsi

ble

Exe

c D

ire

cto

r

Risk Description

Init

ial R

isk

Rat

ing




Re

sid

ual

ris

k

sco

re

Gaps in Assurance

Exp

ect

ed

dat

e o

f

risk

clo

sure

Targ

et

resi

du

al

risk

sco

re

1260

Mr

Ala

n S

tutt

ard

Failure to achieve A19 target

resulting in 2% PES Contract

Financial penalty in 2014/15

causing failure of financial duty.

20

2014/15 Revenue Budgets and recruitment plans in place. Performance dashboard established to monitor performance. REAP escalation processes in place

Approved Board and / or Committee

Reports (internal assurance) Board

reports and committee reports


assurance) Trust Development

Authority

Evidence that target has been delivered

for 2014/15 15

No gaps identified

6

155 of 324


13. Item 9.1-Attach 2 to BAF Report

157 of 324

North West Ambulance Service Risks with a residual score of 12

Page 1 of 3

Unmitigated Risk Score = *

Residual Risk Score =

Target Risk Score/ Risk Appetite Threshold

Datix ID:- 1009 Description:- Lack of application of single approved Trust wide flagging system, resulting in delayed response and/or failure to comply with the data protection act, resulting in adverse publicity and potential detrimental patient care

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

<

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-


Oct-14 12 12 12 12 12 12 12 12 12

Datix ID:- 1094 Description:- Failure to effectively support the organisation in the management of sickness absence and identifying the causes of sickness absence (including stress) ; which will lead to reduced resources capacity, impacting on ability to meet operational performance and provide effective patient care. Failure to meet the Trust objectives and cost improvement target.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Sept-13 Expected risk closure:-

Mar-15 12 12 12 12 12 12 12 12 12

Datix ID:- 1334 Description:- Failure to achieve financial duties due to the cost of delivering the PES agreed performance exceeds contract price and budget including the £7.4m additional resource causing overspend.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

July-14 Expected risk closure:-

April-15 16 16 16 12 12

Datix ID:- 1286 Description:- Inability to deliver a standalone NW service due to loss of the Middlebrook site through physical loss of premises leading to poor performance, reputational damage to NWAS and adverse patient outcomes and reputational damage The Middlebrook site is a shared premises, hence there is risk from the operation of other parties in the same building.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-


Oct-14 12 12 12 12 12 12

158 of 324


Page 2 of 3

Datix ID:-783 Description:- Inadequate Trust Business Continuity arrangements through lack of Business Impact Assessment or plan compilation by individual Departments/Directorates, reducing the resilience of the Trust in the event of a disruptive challenge, thus compromising delivery of core functions and affecting Trust reputation.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

<

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-


Mar-15 6 6 6 6 6 12 12 12 12

Datix ID:- 988 Description:- Failure to show sufficient progress against CIP implementation plans for 2014/15 plans which have been put on hold non-recurrently in 2014/15 but are required for recurrent impact from the 1 April 2015.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Mar-13 Expected risk closure:-

Mar-15 15 15 15 15 15 12 12 12 12

Datix ID:- 1348 Description:- Failure to ensure the Trust adequately prepares for the impact of climate change due to insufficient Trust wide focus resulting in detrimental patient care and increased expenditure

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Sept-14 Expected risk closure:-

Sept-20 12 12 12

Datix ID:- 951 Description:- inability to train all staff in the PREVENT (wrap2 counter terrorism) awareness in a timely manner due to limited trainers and allocation of allotted training time during 2013/14 and 2014/15 leading to failure to achieve DH requirements and commissioning contract. Greater risk to radicalisation due to ongoing increase in security threats.

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Nov-12 Expected risk closure:-

Aug-15 8 8 8 8 8 8 8 12 12

159 of 324


Page 3 of 3

Datix ID:- 1403 Description:- Inability to deliver Hub and Spoke concept into NWAS resulting in failure to deliver identified efficiencies due to capital and revenue budgetary constraints

Low Risk

Medium Risk

High Risk

6 8 9 10 12 15 16 20 25

*

Mar-14

Apr-14

May-14

Jun-14

Jul-14

Aug-14

Sept-14

Oct-14

Nov-14

Risk opened:-

Nov-14 Expected risk closure:-

Mar-15 12

160 of 324

14. Item 9.2-VRP

161 of 324

- 1 of 5 -

Report to: Trust Board Date: 26 November 2014

Subject: Vehicle Replacement Programme 2015.16

Report of: Director Of Operations Prepared by: Assistant Director of Estates and Fleet

PAPER FOR RECOMMENDATION


-----











finite resources




-----


-----


Completed

Not required

Attachments:

RRV vehicle replacement programme

2015/16

PES vehicle replacement programme

2015/16

Urgent Care vehicle replacement

programme 2015/16


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

162 of 324

- 2 -


163 of 324

- 3 of 5 -

1. INTRODUCTION

1.1

The purpose of this report is to seek approval from the Trust Board for three business cases

covering the RRV, PES and Urgent care vehicle replacement programmes for 2015/16. The

papers have been submitted to the EMT 12.11.14 and both the Urgent Care and RRV were

supported. The PES VRP was supported in principle with a requirement to explore the option of

retaining and extending the life of some vehicles for up to 12 months. The papers are also due

at the Finance and Investment Committee Friday 21st November.

2. BACKGROUND

2.1 The Trust’s Fleet Strategy was approved by the Board in May 2013. The strategy proposes

having annual replacement programmes and that these programmes will be drawn up to take

into account the changing fleet profile in line with the service modernisation, and that

replacement programmes will be supported by robust business cases targeted to each service

delivery core vehicle type.


3.1

Ideally any Vehicle Replacement Strategy should not only capture the short term needs but also

the projected medium to long term needs but they must also be affordable in both capital and

revenue financial terms.

4.

4.1

PROPOSALS

RRV OPTIONS Option Number

of

Vehicles

Recurrent Revenue

Shortfall / (Saving)

Non-Recurrent

Revenue Shortfall

2 – Skoda Estate SE (2WD) 12 (£9,275) £35,295

3 – Skoda Scout (4WD) 12 (£8,022) £35,295

4 – Mixture of Skoda Estate SE (2WD) & Skoda

Scout (4WD) 12 (£8,648) £35,295

Option 2 provides the best value for money (VFM) as this has the highest recurrent revenue

saving of £9,275. The 12 vehicles scheduled to be replaced are all Skoda Estates SE (2WD). This

would mean purchasing all Skoda Estates SE (2WD) which is the current preferred choice of the

Trust for RRV’s.

164 of 324

- 4 -

4.2 PES OPTIONS

Option Number

of Vehicles

Capital Shortfall /

(Over Provision)

Recurrent Revenue

Shortfall / (Over Provision)

2 – All Modular Vehicles 50 £1,980,873 £756,637

3 – All Van Derived Vehicles 50 (£227,470) £355,067

4 – Mixture of Modular & Van Derived Vehicles

50 £876,702 £551,542

Option 3 to replace with all Van Derived Vehicles would provide the Trust with the best VFM

solution in terms of recurrent revenue and capital expenditure. There would be saving of

£227k against the capital programme and would create the lowest recurrent revenue cost

pressure against the existing capital charges budgets. The recurrent revenue pressure is

already built in to the Trust financial plans, this is demonstrated below.

The current IBP and LTFM make the following assumptions regarding capital and revenue spend

associated with vehicles:

• 2015/16 Capital Spend of £7,211k (£1,106k for UCS Ambulances see Business Case).

• 2016/17 Onwards depreciation £1,030k (£183k) for UCS Ambulances see Business Case)

Option 3 in the business case means spend as follows:

• 2015/16 Capital Spend A&E Ambulances £5,160k

• 2016/17 Depreciation A&E Ambulances £355k

This outlines a scenario where the projected capital spend (£5,160k) is within the current LTFM

plan (£7,211k) and the projected depreciation charge (£355k) is within the current LTFM plan

(£1,030k).

4.3 URGENT CARE SERVICE OPTIONS

Option No. of

Vehicles

Capital Shortfall /

(Over Provision)

Recurrent Revenue

Shortfall / (Over

Provision)

2 – Renault Master Vans 15 (£46,806) £183,049

There is a high recurrent revenue shortfall because the majority of these vehicles are fully

depreciated on the asset register. This means that there isn’t an existing depreciation or Public

Dividend Capital budget for these vehicles. However, the recurrent revenue pressure is already

built in to the Trusts financial plans. (See PES Options)

165 of 324

- 5 -


5.1 The replacement programme has considered and adheres to:

European whole vehicle type approval (2012)

The road vehicle (construction and use) regulation 1986

Road vehicle lighting regulation(1989)

4th EU Motor Insurance Directive

European Whole Vehicle Type Approval 2012 (EWVTA)

The Trust is a member of the Freight Transport Association which is a professional body who

represent the interest of the end user in operational and legislative matters pertaining to the

use of a Motor vehicle.

The Head of Fleet Services provides and also has access to expert opinion and receives regular

updates in regard to vehicle operation and legislative matters.

6.

RECOMMENDATION

6.1

The Trust Board is asked to approve the following options:

1. RRV – VRP Option 2 of this business case.

It is recommended that option 2 be approved based on the current assumptions on finance for

2015/16, as this is the most cost effective option and would give the Trust a lower level of risk.

There is a non-recurrent cost pressure on all options of £35,295; this is to fund the de-

installation and re-installation of the Airwave Kit and the Satellite Navigation System.

The non-recurrent cost pressures will be considered as part of the Trusts annual budget setting

process.

2. PES – VRP Option 3 of this business case

It is recommended that option 3 be approved based on the current assumptions on finance for

2015/16, as this would give the Trust the new fleet required within the affordability envelope,

and generate recurrent savings against the available revenue budgets.

3. Urgent Care Service – VRP Option 2 of this business case

Option 2 provides the solution that balances risk, vehicle replacement numbers and VFM to

serve essential replacements.

166 of 324

15. Item 9.2-Attach 1 to VRP

167 of 324

RRV Replacement Programme 2015-16 Page: 1 of 24

Author: Project Manager Fleet Version: 0.4

Date of Approval: Status:

Date of Issue: Date of Review

Rapid Response Vehicle Replacement Programme

2015-2016

Reference: EF.NM. 042C

168 of 324


Author: Head of Fleet Version: 0.2



Recommended by

Approved by

Approval Date

Version Number 0.4

Review Date Nov 15

Responsible Director Director of Operations

Responsible Manager (Sponsor) Assistant Director Fleet and Estates

For use by Service Delivery, Fleet, Supplies, Finance

This policy is available in alternative formats upon

request. Please contact Fleet on 0161 743 9164.

169 of 324





CHANGE RECORD FORM

Version Date of change Date of release Changed by Reason for change

0.1 06.08.13 K Bamford 1st draft

0.2 10.09.14 Finance, procurement, medical

0.3 22.10.14 Finance update.

0.4 03.11.14 Neil Maher edits

Abbreviation/term

Description

NWAS A&E BAU PES PTS RRV HDV Ops VRP VFM

PASA PES GVW DWP

NWCCA TBC

North West Ambulance Service NHS TRUST Accident & Emergency Business As Usual Paramedic Emergency Service Patient Transport Services Rapid Response Vehicles High Dependency Vehicle Operations Vehicle Replacement Programme Value For Money Purchase and Supply Agency Paramedic Emergency Service Gross Vehicle Weight Department of Work and Pensions North West Commercial Collaborative Agency To be confirmed

170 of 324





Table of Contents

1 INTRODUCTION ...................................................................................................................... 5

2 BACKGROUND ........................................................................................................................ 5

3 CURRENT SITUATION ............................................................................................................ 5

4 VEHICLE REPLACEMENT PROGRAMME (VRP) & WORKFORCE MODEL ........................ 6

5 VEHICLE OPTIONS ................................................................................................................. 6

5.1 SCOPE ........................................................................................................................... 7 5.2 MEDICAL & IT EQUIPMENT (SR) ...................................................................................... 7 5.3 ALTERNATIVE FUELS/VEHICLE EMISSIONS (MS ADD STOP START) ...................................... 8

6 OPTIONS .................................................................................................................................. 9

6.1 OPTION 1 - REPLACE NO VEHICLES DURING THE FINANCIAL YEAR ....................................... 9 6.2 OPTION 2 – REPLACE 12 VEHICLES LIKE FOR LIKE WITH SKODA SE (2WD) ......................... 9 6.3 OPTION 3 – REPLACE 12 VEHICLES WITH SKODA SCOUT ................................................... 9 6.4 OPTION 4 – REPLACE 12 VEHICLES WITH 6 SKODA SE (2WD) AND 6 SKODA SCOUT.......... 10

7 PROCUREMENT .................................................................................................................... 10

8 RISK ....................................................................................................................................... 11

9 FINANCE ...................................................................... ERROR! BOOKMARK NOT DEFINED.

9.1 FINANCIAL ASSUMPTIONS .............................................. ERROR! BOOKMARK NOT DEFINED. 9.1 OPTION 2 – REPLACE 12 VEHICLES WITH SKODA ESTATE SE (2WD)ERROR! BOOKMARK NOT

DEFINED. 9.2 OPTION 3 – REPLACE 12 VEHICLES WITH SKODA SCOUT (4WD) .... ERROR! BOOKMARK NOT

DEFINED. 9.3 OPTION 4 – REPLACE 12 VEHICLES - 6 WITH SKODA ESTATE SE (2WD) AND 6 WITH SKODA

SCOUT (4WD) .......................................................................... ERROR! BOOKMARK NOT DEFINED.

10 FINANCIAL SUMMARY ............................................... ERROR! BOOKMARK NOT DEFINED.

11 EQUALITY IMPACT ASSESSMENT ..................................................................................... 15

12 DELIVERY AND IMPLEMENTATION PLAN ......................................................................... 15

13 CONCLUSION (TBC) ............................................................................................................. 16

14 RECOMMENDATIONS (TBC) ................................................................................................ 16

List of Appendices

APPENDIX A – EQUIPMENT FORMING PART OF VRP ................................................................................. 17

APPENDIX B – EQUALITY IMPACT ASSESSMENT REPORT .......................................................................... 18

APPENDIX C – VEHICLES TO BE REPLACED .............................................................................................. 24

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1 INTRODUCTION

The purpose of this business case is to present the annual Rapid Response Vehicle Replacement Programme (VRP) for 2015/16 as defined in the Board approved Fleet Strategy, May 2013. Option 2 provides the solution that balances risk, vehicle replacement numbers and VFM to secure essential replacements of the Trust’s fleet and maintain business continuity. The timeline for replacement would normally be six months. Therefore the business case aims to secure approval at the earliest opportunity to enable the replacement of vehicles.

2 BACKGROUND

The Trust’s Fleet Strategy was approved by the Board in May 2013. The strategy proposes having annual replacement programmes and that these programmes will be drawn up to take into account the changing fleet profile in line with the service modernisation. Annual vehicle replacement programmes will be supported by robust business cases targeted to each Service Delivery core vehicle type. The replacement programme covers the “in-service” fleet only. Additions and special projects will be covered under separate business cases. Further, a key objective of the strategy is to achieve a 4 year replacement cycle for RRV cars. The Trust’s Integrated Business Plan sets out the future direction of the service in response to Taking Healthcare to the Patient. The key elements of this vision and strategy are the redesign of ambulance responses to more appropriately meet the needs of the patient. In considering the proposals for 2015/16 there are several key factors affecting the replacement programme that have to be considered:

The time taken to deliver into the service the vehicles from orders being placed, (purchase and conversion).

Supplier capacity to deliver and convert the number of vehicles required

Revenue funding available

Future workforce model

Vehicle pool resource requirements

Experience of operating RRV’s in both urban and rural areas

Improved maintenance of vehicles

Extended life of vehicles

3 CURRENT SITUATION

Ideally any Vehicle Replacement Strategy should not only capture the short term needs but also all projected medium to long term needs and must be affordable in a financial context in revenue terms.

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The present size of the “Blue Light” RRV fleet is 150 vehicles. One of the stated objectives of the Fleet Strategy was to achieve a 4 year replacement cycle which has been met, (the target was achieved in 2010). To maintain a consistent 4 year replacement program 12 vehicles would need to be replaced in 2015-16.

4 VEHICLE REPLACEMENT PROGRAMME (VRP) & WORKFORCE MODEL

The Fleet Strategy proposes having annual replacement programmes and that these programmes will be drawn up to take into account the changing fleet profile in line with the service modernisation. This business case is a RRV age replacement programme. The strategy for Rapid Response cars identifies an estate type of vehicle. However, consideration for the future could involve vehicles that provide not only rapid response but, respond and treat and respond treat and convey, this would involve different types of vehicles.

5 VEHICLE OPTIONS

Ambulance Service Chief Executives have signed up to national vehicle designs for frontline vehicles. However, agreed national designs for a Rapid Response type vehicle (RRV) are still under development and are unlikely to be available for this replacement programme. To keep abreast of new developments aligned with the changing needs of the service there is a requirement to maintain flexibility in the area of review, development and trialling new vehicle types. Where opportunities arise these should be addressed via a supplementary paper to the Executive Management Team. Potential supply issues with our current model of vehicle resulted in the Trust having to identify alternatives to the current model. Although the supply issues were resolved quickly, it highlighted the fact that the Trust would have been at risk if it could not provide a suitable alternative. Several vehicles were evaluated; the result was that the Volkswagen Passat met the service criteria. Therefore, three vehicles were ordered in the 2013-14 Business Case (one being the Passat All Track all-wheel drive vehicle). These were introduced into the RRV fleet in 2014 and will be field evaluated for use. The vehicle is not dissimilar to the Trust’s current model. The strategy for Rapid Response cars currently identifies an estate type of vehicle and this will continue for this Business case (2015-2016). The Vehicle and Equipment design group will continue to look at different Health Care models and react to changes in appropriate time frames. The Trust currently has 40% of its fleet with all-wheel drive technology; this has been possible due to favourable purchase prices to include this facility at a very affordable cost. However all-wheel drive vehicles are not as efficient as the two wheel drive versions, both in carbon emissions and fuel returns, (see table 1). These are factors in consideration of the Trusts Sustainable Development Management Plan. In addition to the all-wheel drive facility in 2013 the Trust took a decision to fit all weather tyres to all its RRV vehicles.

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Therefore, future consideration of how effective this has been needs to be incorporated into the development the next business case. 4x4 vehicle will be considered only where there is an indefinable need.

Model Average fuel consumption CO2 Emissions

Skoda 2.0 Tdi 57.6 129

Skoda all-wheel 50.0 148

Skoda Scout 47.9 155

VW Passat (all track)

49.6 149

Table 1: Vehicle efficiency comparisons

5.1 SCOPE

This paper specifically addresses RRV of the “in service fleet”. The business case does not cover specialist vehicles and one off procurements, for which a separate business case would be required.

5.2 MEDICAL & IT EQUIPMENT

During 2007/08 a vehicle equipment task group was established to determine standard requirements for the Trust. New vehicles are procured and equipped to this standard. The Trust’s Paramedic Consultant maintains the standard list of medical equipment. The medical equipment does not lend itself to the age profiling of the vehicles. Some equipment will last longer than the 4 year vehicle replacement programme and will still be serviceable after the vehicle has been replaced. Therefore, the Business Case takes into consideration the needs of the medical/clinical equipment replacement programme. In general, the medical equipment will be transferred from decommissioned vehicles to the newly commissioned vehicles for this Business case. For new vehicles a complete set of IT equipment will be procured. For replacement vehicles, as is the case in this VRP, only the following will be procured (the remaining equipment will be transferred from the replaced vehicles):

Fixed mobile phone.

Tracker recoding unit system and forward and rear facing camera’s (Part of RTC procedures/management)

Existing kit will be transferred from old vehicles to new vehicles, including costs.

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Airwave sacrificial items packs.

Satnavs – o Any additional vehicles will require a full system purchase. o Any vehicle to be replaced which has a VDO5200PRO unit

installed will receive a de-install and re-install of the existing and still serviceable unit. A VDO ‘sacrificial items’ pack will be purchased and supplied for an in-build during production, and in order to facilitate a ‘plug-and-play’ re-install of equipment into the replacement vehicle. A full system purchase will not be required.

o Any vehicle scheduled for replacement which is installed with an end-of-life disc drive satellite navigation system will receive a new Garmin Dezl 560 Fleet unit during production. A full system purchase will be required.

Appendix A lists the medical and IT equipment to be delivered within this programme. Note that revised equipment costs impacting Airwave communications equipment purchases for additional vehicles has been issued to NWAS Finance to assist with business planning. The costs of NWAS de-installations and re-installations for existing systems remains unchanged, these revisions impact orders for additional voice and mobile data equipment only.

5.3 ALTERNATIVE FUELS/VEHICLE EMISSIONS

The Trust seeks wherever possible to act in a socially responsible manner and recognises its responsibility to minimise any adverse impact of its activities on the environment. The two main alternative fuels presently adopted for use on commercial vehicles are LPG (Liquefied Petroleum Gas) and CNG (Compressed Natural Gas) the latter being used mainly on larger commercial vehicles. For reasons of practicality LPG vehicles use duo-fuel which means they are designed to run on either LPG Gas or petrol. A litre of LPG is approx 50% less in cost than its fossil fuel alternative. The CO levels between LPG and Diesel fuels are comparable. The main disadvantage is the requirement to carry an additional LPG tank which adds to the overall vehicle weight and reduces the overall payloads This would severely restrict the boot space to allow for the fitment of an equipment rack . The limit mileage range of a litre of LPG will provide the same as 75% of a litre of diesel. This would increase the maintenance costs of the vehicles. Presently Volvo, Skoda and Ford, the preferred vehicle manufacturers on the PASA framework agreement, do not offer an LPG alternative fuel vehicle. However, the Fleet Engineers regularly review the market and changes in technology that may provide an opportunity for the Trust are evaluated with a view to incorporating into future VRPs. The Trust is aware and will be monitoring the new technologies, such as solar panels, being trialled by other Ambulance Trusts.

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Several electric vehicles have been considered, unfortunately due to these vehicles requiring batteries etc to support emergency audible and visual warning batteries the manufacturers are not keen to allow any interference with their sophisticated systems.

6 OPTIONS

Due to the arduous working environment the planned replacement for Rapid Response Vehicles is 4 years.

6.1 OPTION 1 - REPLACE NO VEHICLES DURING THE FINANCIAL YEAR

This option would require extending vehicle leases and retain owned vehicles and make no new procurements.

Advantage/Benefits Disadvantage/Risks

Cheapest solution.

Maintains a level of status quo.

Increasing maintenance costs and reliability and availability issues.

Risk of lease companies not extending leases.

Adverse impact on the age profile of the fleet.

Building future costs.

Poor image.

6.2 OPTION 2 – REPLACE 12 VEHICLES LIKE FOR LIKE WITH SKODA SE (2WD)


Supports a modern fleet of vehicles aligned to the Trust’s future workforce model.

Lower cost CO2 rating than a 50% Scout solution.

Most cost effective solution.

Does not include all wheel drive capability.

6.3 OPTION 3 – REPLACE 12 VEHICLES WITH SKODA SCOUT


Supports a modern fleet of vehicles aligned to the Trust’s future workforce model.

Increased capability in dealing

MPG increase

Environmental issues with higher CO2 rating

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with adverse winter driving conditions.

All wheel tyres are now supplied for all vehicle making winter driving condition easier and a cheaper solution, (no adverse vehicle working as seen in earlier years reported in 2012-13).

Not as cost effective as option 2.

6.4 OPTION 4 – REPLACE 12 VEHICLES WITH 6 SKODA SE (2WD) AND 6 SKODA

SCOUT


Lower cost CO2 rating than an all Scout solution.

Environmental issues with higher CO2 rating.

Not as cost effective as option 2.

7 PROCUREMENT

The Trust must comply with EU procurement legislation due to the value of the vehicles and the numbers required. To do this the Trust must purchase the vehicles from a national or regional contract which has been awarded following an appropriate tender process, via a national or regional procurement agency - for example the Crown Commercial Service (CCS) or a regional procurement agency such as the Shared Business Services Commercial Procurement Solutions (SBS). Alternatively the Trust could undertake its own EU compliant tender process using the appropriate timescales (an OJEU process can usually take between 4 to 6 months). Historically, the Trust has fulfilled its requirements for response vehicles via an operating lease route. However, the decision to purchase or lease will be made based on both the Value for Money and Transfer of Risk tests. Again to comply with EU procurement legislation the Trust must either use a national contract, noted above, or tender independently. The operating lease provider will be selected following a mini competition under either the Sector Treasury Service Operating Lease framework agreement or the pan government lease framework established by the Crown Commercial Service (CCS), formally the Government Procurement Solutions (GPS).

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Once selected, the lease provider will procure the base vehicles from the CCS pan government vehicle purchase framework (RM859). The base vehicles will be converted to the Trusts specification by the Trust’s preferred converter. The conversion will be facilitated by the operating lease provider. The preferred converter is Wilker UK Limited, who were selected by the Trust following a mini competition using the CCS framework for Vehicle Conversions (RM 956).

8 RISK

The main risk connected with these recommendations is the service/business continuity risk associated with not replacing ageing vehicles. The timescale to build and deliver an RRV to the Trust takes six-seven months from the placement of the order. Therefore, there is real risk to the Trust of:

Expired leases incurring additional lease and maintenance costs, at worse lease companies recovering their vehicles.

Vehicle manufacturers changing their product range could result in compromising the Trust’s supply of replacement vehicles if procured from a single source.

The business case is based upon the current indicative costs, which could change when true costs are realised at the point of procurement, and this risk could increase the longer the timescale from business case development to actual procurement.

9 FINANCE

With regards to insurance and maintenance costs the business case assumes a status quo. This is because vehicles are replacements; therefore insurance will transfer from old to new at no additional cost. The following financial analysis of the options in section 6 has been costed by the finance department. The completion of VFM tests has indicated that the most cost effective solution, for all models, is to lease the vehicles, therefore quotes have been obtained for leasing each type of vehicle to be considered. A further financial test has then been completed to ensure that if the Trust decided to lease the vehicles they still qualify under IFRS operating lease requirements. In addition the Trust does not have the capacity to purchase the vehicles from the Capital Programme.

9.1 FINANCIAL ASSUMPTIONS

A number of assumptions have been included in the financial section of this Business Case. These are outlined below:

Quotations have been obtained by the Fleet Department. These are subject to change once the order is placed and the quotation is verified.

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The lease cost includes maintenance but does not include tyre replacement.

All prices include VAT at 20% and it is assumed that VAT cannot be

reclaimed.

All medical equipment will be swapped out from existing to replacement vehicles.

The recurrent and non-recurrent revenue elements for the three types of car being considered are shown below:

Revenue Cost Analysis for an A&E Rapid Response Vehicle

Vehicle Med Equip IMT Total

£ £ £ £

Octavia Elegance 2.0 Estate SE with RRV conversion (2WD)

Recurrent Revenue Cost: Annual Lease 8,463 8,463

Recurrent Revenue Cost: VUE Tracking 173 173

RECURRENT REVENUE 8,463 0 173 8,635

Non-Recurrent Revenue Cost: Ai rwave / Sat Nav Swap Out 0 1,431 1,431

Non-Recurrent Revenue Cost: VUE Tracking 1,490 1,490

Non-Recurrent Revenue Cost: Crests 20 20

NON-RECURRENT REVENUE 0 0 2,941 2,941

Total Revenue 8,463 0 3,114 11,577

Vehicle Med Equip IMT Total

£ £ £ £

0

Recurrent Revenue Cost: Annual Lease 8,567 8,567

Recurrent Revenue Cost: VUE Tracking 173 173

RECURRENT REVENUE 8,567 0 173 8,740

Non-Recurrent Revenue Cost: Ai rwave / Sat Nav Swap Out 0 1,431 1,431

Non-Recurrent Revenue Cost: VUE Tracking 1,490 1,490

Non-Recurrent Revenue Cost: Crests 20 20

NON-RECURRENT REVENUE 0 0 2,941 2,941

Total Revenue 8,567 0 3,114 11,681

N.B. Al l costs include VAT at 20%

Revenue Cost Analysis for an A&E RRV - Skoda Estate SE (2WD)

Revenue Cost Analysis for an A&E RRV - Skoda Scout

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9.1 OPTION 2 – REPLACE 12 VEHICLES WITH SKODA ESTATE SE (2WD)

9.2 OPTION 3 – REPLACE 12 VEHICLES WITH SKODA SCOUT (4WD)

9.3 OPTION 4 – REPLACE 12 VEHICLES - 6 WITH SKODA ESTATE SE (2WD) AND 6

WITH SKODA SCOUT (4WD)

OPTION 2 Annual Budget Projected Cost Cost Pressure

Number £ £ £

RECURRENT REVENUE

SKODA ESTATE SE 12 103,625

12 112,900 103,625 (9,275)

NON-RECURRENT REVENUE


Total 12 0 35,295 35,295

2015/16


Number £ £ £

RECURRENT REVENUE

SKODA SCOUT 12 104,878

12 112,900 104,878 (8,022)



Total 12 0 35,295 35,295

2015/16


Number £ £ £

RECURRENT REVENUE



12 112,900 104,252 (8,648)




Total 12 0 35,295 35,295

2015/16

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10 FINANCIAL SUMMARY

The financial information identifies that the differences between the budget being carried for the vehicles being disposed of and the cost of replacing them is as follows:

Option Number of Vehicles

Recurrent Revenue Shortfall / (Saving)

Non-Recurrent Revenue Shortfall

2 – Skoda Estate SE (2WD) 12 (£9,275) £35,295

3 – Skoda Scout (4WD) 12 (£8,022) £35,295

4 – Mixture of Skoda Estate SE (2WD) & 12Skoda Scout (4WD)

(£8,648) £35,295

Option 2 provides the best value for money (VFM) as this has the highest recurrent revenue saving of £9,275. The 12 vehicles scheduled to be replaced are all Skoda Estates SE (2WD). This would mean purchasing all Skoda Estates SE (2WD) replacements which is the current preferred choice of the Trust for RRV’s. It is therefore recommended that option 2 be approved based on the current assumptions on finance for 2015/16, as this is the cheapest option and would give the Trust a lower level of risk. There is a non-recurrent cost pressure on all options of £35,295, this is to fund the de-installation and re-installation of the Airwave Kit and the Satellite Navigation System. The non-recurrent cost pressures will be considered as part of the Trusts annual budget setting process. A full list of the registrations to be replaced can be found at Appendix C.

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11 EQUALITY IMPACT ASSESSMENT

All new vehicle specifications will have the potential to impact both staff and services with regards to equality. The Equality Impact Assessment for the VRP is shown at Appendix B.

12 DELIVERY AND IMPLEMENTATION PLAN

The project plans will follow the same format as established for the 2010/11 VRP. The main phases of the plans are:

Business Case development and approval.

Procurement process

Agree factory scheduling and delivery

Build

Delivery into Operations Project roles and responsibilities:

Assistant Director Fleet and Estates – Business Case sponsor.

Head of Fleet Engineering Services – Overall lead for business case development and delivery, vehicle procurement, specification, production plan, quality and delivery. Maintenance specification and planning, commissioning, de-commissioning and handover. Vehicle leases and insurance management associated with the business case.

Vehicle Equipment Manager - key customer interface: operational requirement; medical equipment specification, procurement and management; handover and deployment.

Head of Procurement – direct support and lead for the over procurement process associated with the business case.

Head of Finance – direct support and financial evaluation of the business case.

IM&T Project Manager (vice Airwave Business Contract Manager) – responsible for the communications and Airwaves aspects of the business case, procurement, installation and commissioning.

Project Manager (Fleet) – overall project management from business case approval to handover into operations.

Corporate Risk Manager – to assess the business case’s risk assessment.

E&D Coordinator – to assess the business case’s EIA.

Capital Management Group – Oversight and monitoring.

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13 CONCLUSION

The Trust’s Fleet Strategy was approved by the Board in May 2013. The strategy required that annual replacement programmes were to be drawn up taking into account the changing fleet profile in line with service modernisation. The main risk connected with these recommendations is the service/business continuity risk associated with not replacing aging vehicles. There is a very high demand from other ambulance services for RRV’s. The timescale to build and deliver an RRV to the Trust takes 6-7 months from the placement of the order. The Trust currently has 40% of its fleet with all-wheel drive technology. However, all-wheel drive vehicles are not as efficient as the two wheel drive versions, both in carbon emissions and fuel returns. These are factors in consideration of the Trusts Sustainable Development Management Plan. In 2013 the Trust took a decision to fit all weather tyres to all its RRV vehicles therefore, future consideration of how effective this has been needs to be incorporated into the development the next business case. Option 2 provides the best value for money (VFM) as this has the highest recurrent revenue saving of £9,275. This would mean purchasing all Skoda Estates SE (2WD) which is the current preferred choice of the Trust for RRV’s. It is therefore recommended that option 2 be approved based on the current assumptions on finance for 2015/16, as this would give the Trust a lower level of risk as this option maintains the current vehicles. To ensure that the Trust stays on track with its replacement programme for RRV Vehicles the optimum solution is option 2.

14 RECOMMENDATIONS

Option 2 for the RRV business case provides the solutions that balances risk, vehicle replacement numbers and VFM to secure essential replacements of the Trust’s fleet and maintain business continuity. The option also provides a cost effective solution towards achieving and sustaining a four year replacement programme for the fleet and gives a flexible approach to match the fleet to future requirements.

It is recommended that option 2 is approved.

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APPENDIX A – EQUIPMENT FORMING PART OF VRP

Medical Equipment – This will be swapped from the existing vehicle

ICT equipment

Type of Equipment

Process / Kit

RRV Ambulance Communications Equipment – Replacement Vehicle

NWAS de-installation and re-installation

Trust de & re-installation voice and mobile data

Sacrificial items voice restock tetra|/GPS Antenna for Mobile Data

Sacrificial items Thorcom restock

Bury car kit

Mobile Phone

Call Sign Decals Satellite Sacrificial Re-stock (This is only required if the Trust carry on doing a De/Re install of the Siemens) New Garmin SatNav Vue equipment

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APPENDIX B – EQUALITY IMPACT ASSESSMENT REPORT

Name of Policy, Service or Function NWAS RRV AMBULANCES VEHICLE REPLACEMENT PROGRAMME 2015/16

Equality Impact Assessment carried out by Mick Sweetmore, Fleet Engineer Operations/Yunus Mogra, E&D Manager

Date of Equality Impact Assessment September 2014

Step 1: Description and Aims of Policy, Service or Function

Overall aims The purpose of this business case is to present the annual RRV replacement programme as defined in the Trust’s Fleet Strategy. Key elements of policy, service, process Vehicle (RRV) replacement programmes will be determined by: • Organisational strategy • Resource profile model • Patient needs • Vehicle age profile • Pool allocation • Funding availability (VFM) • Legislation • Suppliers production capacity Who does the policy, service or function affect? Vehicles in this case RRV have been designed in accordance to statutory regulations and CEN compliance, which takes into account where required patient and staff security and comfort. The document sets out Operational procurement requirements for procurement by Fleet and Supplies. How do you intend to implement the policy or service change (if applicable)? The business case will be implemented within the framework of the Fleet Strategy.

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Step 2: Data Gathering

Summary of data available and considered Key data assessed and reviewed: construction and use regulations, CEN compliance, lighting regulations, feedback from staff side and complaints, knowledge of specific representative of the working group. Outcomes of data analysis

Equality Group Evidence of Impact

Gender No impact, affects all genders equally

Race/Ethnicity Potential for language barriers.

Disability No impact, (not a patient carrying vehicle)

Sexual Orientation

No impact, affects all sexual orientation groups equally

Religion or belief

No impact, as the procedure affects all religions and beliefs equally

Age No impact, (not a patient carrying vehicle)

General (Human Rights)

No impact on areas covered by the Human Rights Act Where RRV’s are required to transport patients i.e. in exceptional circumstances REAP Level 4 then access considerations must also be considered prior to conveyance with respect to physical disability, children etc

Step 3: Consultation

Summary of consultation methods

Vehicle (RRV) design and specifications is the outcome of a working group consisting of representatives from: H&S, Operational (member of specific patient forums), engineering, staff side, Risk Management, Training, Clinical Governance and Supplies. The process involves approval to comply with construction and use regulations and is risk assessed corporately.

A copy of the draft policy was circulated to all Heads of Services, Finance, Fleet and Supplies as a consultation group.

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Outcomes of consultation





Sexual Orientation


Religion or belief


Age No impact, (not a patient carrying vehicle)


No impact on areas covered by the Human Rights Act

In exceptional circumstances, where RRV’s are required to transport patients i.e. REAP Level 4 then access considerations with re physical disability, children etc

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Page 21 of 24

Step 4 & 5: Impact Grid

Relevant Equality Area Areas of impact identified

Is the impact positive or negative?

Key issues for action Will form basis of action plan]

Gender No impact, affects all genders equally ----- -----

Race/Ethnicity Replacement vehicles can aid potential for meeting

patient and staff concerns on language barriers.

Positive Consideration to availability on all replacement vehicles:

PES Pictorial Handbooks

Multilingual Phrasebooks.


-----

-----

Sexual Orientation No impact, affects all sexual orientation groups equally ----- ----

Religion or belief No impact, as the procedure affects all religions and beliefs equally

----- -----

Age No impact, (not a patient carrying vehicle).

-----

-----


No impact on areas covered by the Human Rights Act Where RRV’s are required to transport patients i.e. in exceptional circumstances REAP Level 4 then access considerations with re physical disability, children etc

-----

Consideration to car seat/s that assist with meeting requirements

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Page 22 of 24

Step 6: Action Plan

Name of Policy or Service: Procedure for ensuring compliance with legislation and regulation

Issue identified and equalities group or communities affected

Action to be taken By When Who By Expected outcome Progress

Language barrier Ensure PES Pictorial Communication Handbook or multilingual phrase books are available on all vehicles.

Sept 2011 Ops Sector Managers

Alleviate the issue Books designed and in use on A&E vehicles

Where RRV’s are required to transport patients i.e. in exceptional circumstances REAP Level 4 then access considerations with re physical disability, children etc

Consideration to car seat/s that assist with meeting requirements

April 2012 Head of H&S and Consultant Paramedic

Meet with legal and DDA access requirements

Vehicle (RRV) design and specifications process involves a Trust working group approval to comply with construction and use regulations and is risk assessed corporately

Summary of decisions and recommendations

1. Ensure PES Pictorial Communication Handbook and or multilingual phase books availability on all replacement vehicles and communicate to staff 2. Consideration to car seat/s that assist with meeting patient disability requirements 3. Consideration to car seat/s that assist with meeting children legal requirements

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Step 7: Monitoring arrangements

On the date of the next equality impact assessment, and monitored through the Equality and Diversity Steering group.

Step 8: Date of next Equality Impact Assessment

This equality impact assessment will be reviewed and a subsequent assessment carried out at the first of the following occasions:

- On review and development of the 2016/17 Vehicle Replacement Programme.

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APPENDIX C – VEHICLES TO BE REPLACED

Count

IndexVehicle Registration Make Model Area Owned / Leased 2WD / 4WD

1 MX11 OJA VOLVO V50 GMA LEASED 2WD

2 MX11 OJB VOLVO V50 GMA LEASED 2WD

3 MX11 OJC VOLVO V50 GMA LEASED 2WD

4 MX11 OJD VOLVO V50 GMA LEASED 2WD

5 MX11 OJE VOLVO V50 GMA LEASED 2WD

6 MX11 OJF VOLVO V50 GMA LEASED 2WD

7 MX11 OJM VOLVO V50 GMA LEASED 2WD

8 MX11 OJN VOLVO V50 GMA LEASED 2WD

9 MX11 OJO VOLVO V50 GMA LEASED 2WD

10 MX11 OJP VOLVO V50 GMA LEASED 2WD

11 MX11 OJR VOLVO V50 GMA LEASED 2WD

12 MX11 OJS VOLVO V50 GMA LEASED 2WD

Appendix C

Vehicles to be Replaced All Options

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Fleet PES Ambulance Replacement Programme 2015-16 Page: 1 of 30


Date of Approval: Status: Draft

Date of Issue: Date of Review August 2015

North West Ambulance Service

PES Ambulances Vehicle Replacement Programme

2015-2016

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Author: Assistant Director Fleet and Estates Version: 0.5



Recommended by

Approved by

Approval Date

Version Number 0.5

Review Date August 2015




This policy is available in alternative formats upon request.

Please contact the Fleet Department, on 0161 743 9164.

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CHANGE RECORD FORM


0.1 13.08.14 K Bamford Initial draft

0.2 10.10.14 Finance and Procurement, medical

0.3 25.09.14 Group

0.4 22.14.14 Finance update

0.5 03.11.14 Neil Maher - edits

Abbreviation/term

Description

NWAS BAU PES PTS RRV UCS Ops VRP VFM

PASA GVW DWP

SBSCPS

CCS

North West Ambulance Service NHS TRUST Business As Usual Paramedic Emergency Service Patient Transport Services Rapid Response Vehicles Urgent Care Service Operations Vehicle Replacement Programme Value For Money Purchase and Supply Agency Gross Vehicle Weight Department of Work and Pensions Shared Business Services Commercial Procurement Solutions Crown Commercial Services

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Table of Contents

1 INTRODUCTION ...................................................................................................................... 5

2 BACKGROUND ........................................................................................................................ 5



5 VEHICLE OPTIONS ................................................................................................................. 6

5.1 SCOPE ........................................................................................................................... 7 5.2 MEDICAL & IT EQUIPMENT ............................................................................................... 7 5.3 ALTERNATIVE FUELS/VEHICLE EMISSIONS ........................................................................ 8

6 OPTIONS .................................................................................................................................. 8

6.1 OPTION 1 - REPLACE NO VEHICLES DURING THE FINANCIAL YEAR ....................................... 9 6.2 OPTION 2 – REPLACE 50 VEHICLES – WITH 50 MODULAR ................................................... 9 6.3 OPTION 3 – REPLACE 50 VEHICLES WITH 50 VANS .......................................................... 10 6.4 OPTION 4 – REPLACE 50 VEHICLES WITH 25 MODULAR AND 25 VANS ............................... 10

7 PROCUREMENT .................................................................................................................... 10

8 RISK ....................................................................................................................................... 11


9.1 FINANCIAL ASSUMPTIONS ...................................... ERROR! BOOKMARK NOT DEFINED. 9.2 OPTION 2 – MAINTAIN MODULAR VEHICLES ......... ERROR! BOOKMARK NOT DEFINED. 9.3 OPTION 3 – VAN ONLY ............................................. ERROR! BOOKMARK NOT DEFINED. 9.4 OPTION 4 – REDUCTION IN MODULAR ................... ERROR! BOOKMARK NOT DEFINED.

11 EQUALITY IMPACT ASSESSMENT (YM) .......................................................................... 16


13 CONCLUSION ............................................................................................................................... 17

14 RECOMMENDATIONS .......................................................................................................... 18

List of Appendices

APPENDIX A – RISK ASSESSMENTS ..................................................................................................... 19

APPENDIX B – EQUIPMENT FORMING PART OF VRP ............................................................................. 20

APPENDIX C – EQUALITY IMPACT ASSESSMENT REPORT ...................................................................... 22

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1 INTRODUCTION

The purpose of this business case is to present the annual PES Ambulance Vehicle Replacement Programme (VRP) for 2015/16 as defined in the Board approved Fleet Strategy, May 2013. The timeline for replacement would normally be nine months. Therefore the business case aims to secure approval at the earliest opportunity to enable the replacement of vehicles.

2 BACKGROUND

The Trust’s Fleet Strategy was approved by the Board on 29 May 2013. The strategy proposes having annual replacement programmes and that these programmes will be drawn up to take into account the changing fleet profile in line with the service modernisation. Annual vehicle replacement programmes will be supported by robust business cases targeted to each Service Delivery core vehicle type. The replacement programme covers the “in-service” fleet only. Additions and special projects will be covered under separate business cases. Further, a key objective of the strategy is to achieve a 7 year replacement cycle for ambulances. The Trust’s Integrated Business Plan sets out the future direction of the service in response to Taking Healthcare to the Patient. The key elements of this vision and strategy are the redesign of ambulance responses to more appropriately meet the needs of patients and a differentiation of service and response models appropriate to urban, rural and remote areas of the North West. Both of these elements will require a review of the operational fleet, and in so doing the fleet mix is already changing from its former modular and sitter vehicle base with the following procurements identified in the fleet strategy. In considering the proposals for 2015/16 there are several key factors affecting the replacement programme that have been considered:

The time taken to deliver into the service the vehicles from orders being placed, (purchase and conversion).


Capital and revenue funding available



Experience of operating A&E ambulances in both urban and rural areas


Limited historical operational maintenance data for van derived ambulances

CIP Project Initiation document proposing all new PES Ambulances to be replaced by van conversions.

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3 CURRENT SITUATION

Ideally any Vehicle Replacement Strategy should not only capture the short term needs but also all projected medium to long term needs and must be affordable in a financial context both in capital and revenue terms. The present size of the “Blue Light” emergency ambulance fleet is 361 vehicles. To maintain a consistent seven year replacement program in line with the Fleet Strategy a minimum of 51 vehicles would need to be replaced annually. The present fleet of emergency ambulances has been procured by capital with variations of numbers changed each fiscal year. This has produced a “Peaks and Troughs” replacement programme. To replace the present fleet by registration date of 7 years of age would continue this process. The current fleet of 361 vehicles is made of 227 modular and 133 van conversions (plus 1 welfare vehicle, Iveco).


The Fleet Strategy proposes having annual replacement programmes and that these programmes will be drawn up to take into account the changing fleet profile in line with the service modernisation. For many reasons such as cost, operational application, and sustaining quality of service it is impractical to achieve that change in one year.

5 VEHICLE OPTIONS

Ambulance Service Chief Executives have signed up for national vehicle designs for frontline vehicles. The National Strategic Fleet Group has produced a base national design for Modular type emergency ambulances. The design allows for variations in equipment carried by the Ambulance Trusts. There is a two year plan when results of the national specification will be released this will be looked at in further detail after the assessment in 2016/17. A Vehicle Design and Equipment Group (VDEG), led by the Head of Emergency Services and consisting of membership from Service Delivery, Fleet, Medical Directorate, IM&T, Finance, PES staff and staff side representatives review all equipment, (medical, health and safety and IT), existing vehicles and alternative vehicles to meet the evolving needs of the Trust. In 2010 the Trust introduced Van Conversions – based on the Fiat Ducato Multijet The main limiting factors on van conversions are:

Gross vehicle limitation normally operating at 4.25 tonnes gross vehicle weight.

Due to ride height and additional weight difficult to accommodate a Tail Lift.

The advantages are: Cost

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Simplicity Size in relation to estate available space They can operate in rural areas more effectively.

The rural road networks, especially in the Cumbria area, are very narrow with small bridges and access to some properties is restricted. Again it is becoming increasingly difficult for these large vehicles to negotiate these areas. Rural areas require a different approach to vehicle design and van conversations are more suitable for the rural area. The Trust now has 133 van conversions in the fleet which has built up over the last 3 years. It was felt appropriate to undertake a review of the van/modular mix and the overall performance of the van conversion of the future replacement options. An evaluation appraisal was carried out in December 2012 and presented to the EMT on the van derived vehicle to ensure the Trust options for a van derived PES variant are substantive and demonstrate overall value for money. As part of the CIP for this year the trust proposed of a scheme to deliver savings against the PES operational fleet in order to achieve this it is proposed that all new ambulances be replaced by van conversations and not modular.

5.1 SCOPE

This paper specifically addresses PES Ambulance replacements and the associated pool reserve of the “in service” fleet. Due to increased activities and staffing levels there may be a need to add further vehicles, however, this will be done as a separate business case as they will be additions to the fleet.


The necessary medial kit will be ordered as part of this business case on the items deemed necessary. This is itemised in the appendix B. Sacrificial IT items will be procured, for replacement vehicles, as is the case in this VRP, a minimum of new phone and sat navs will be procured if required as part of IT replacement programmes. It is the intention, over the coming years, to equip all front line vehicles with information technology equipment to assist clinicians in the execution of their duties. The equipment will enable, in real time, front line staff to access a range of functions which are currently unavailable to them such as:

Toxbase Medicines Management PathFinder Manchester Triage System

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In addition to this, the Trust would be in a position to roll out an Electronic Patient Report Form (ePRF) and hopefully integrate a future Mobile Data System (MDT) into a single unit. 20 vehicles will be trialled for this purpose in this business case. Appendix B lists the medical and IT equipment to be delivered within this programme.


The Trust seeks wherever possible to act in a socially responsible manner and recognises its responsibility to minimise any adverse impact of its activities on the environment. The two main alternative fuels presently adopted for use on commercial vehicles are LPG (Liquefied Petroleum Gas) and CNG (Compressed Natural Gas) the latter being used mainly on larger commercial vehicles. For reasons of practicality LPG vehicles use bio-fuel which means they are designed to run on either LPG Gas or petrol. A litre of LPG is approx 50% less in cost than its fossil fuel alternative. The CO levels between LPG and Diesel fuels are comparable. The main disadvantage is the requirement to carry an additional fuel tank which adds to the overall vehicle weight and reduces the overall payloads and space. The limit mileage range of a litre of LPG will provide the same as 75% of a litre of diesel. This will increase the maintenance and capital costs of the vehicles. These vehicles would not at present be suitable for PES Ambulances. However, the Fleet Engineering team regularly review the market and changes in technology that may provide an opportunity for the Trust are evaluated with a view to incorporating into future VRPs.

6 OPTIONS

There are currently 50 vehicles due for replacement in the financial year 2015/16 this includes the 6 vehicles that were retained. The overall mix within the fleet arising from each of the options (when added to the existing fleet profile) is demonstrated in the diagram below:

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Retaining owned vehicles and make no capital purchases.


Cheapest capital solution.



Adverse impact on the age profile of the fleet and contradicts the Fleet Strategy.


Poor image.

6.2 OPTION 2 – REPLACE 50 VEHICLES – WITH 50 MODULAR

Replace all 50 vehicles due for replacement as proposed in the Fleet Strategy with modular type vehicles.


Provides the more robust solution to match the fleet to future requirements.

Allows greater scope to change mix of fleet to match future

Would not be able to achieve CIP.

Biggest cost pressure on capital and revenue.

Option 2 Vans 133

Modular 227 50

Option 3 Vans 183 50

Modular 177

Option 4 Vans 158 25

Modular 202 25

2014

133 Vans

227 Modular

Van/Modular ratio on optionsBased on 361 vehicles after

delivery of new vehicles (inc add

6) (exc 1 welfare)

Vans37%

Modular63%

Option 2

Vans 51%

Modular49%

Option 3

Vans44%

Modular56%

Option 4

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resource requirements and potential for future refurbishment options and extension of operational asset life.

6.3 OPTION 3 – REPLACE 50 VEHICLES WITH 50 VANS

The following option identifies a van derived only option. Replace all 50 vehicles with all vans with a reduction in the modular vehicles.


More affordable and deliverable solution than option 2.

Savings on both capital and revenue costs.

Provides proven operational models of vehicle.

Would achieve almost 50% split of vehicle type.

A reduction in the modular type vehicle.

The short life of the van conversion provides a limited service history of only 4 years at present.

6.4 OPTION 4 – REPLACE 50 VEHICLES WITH 25 MODULAR AND 25 VANS

To procure a mixture of vehicle types.


The Modular variant of vehicle has the potential for refurbishment and life extension beyond the 7 years expected operational life, whereas the van variant will be restricted to a finite 7 year operation life.

High capital cost pressure

Unable to meet CIP

7 PROCUREMENT

The Trust must comply with EU procurement legislation due to the value of the vehicles and the numbers required. To do this the Trust must purchase the vehicles from a national or regional contract which has been awarded following an appropriate tender process, via a national or regional procurement agency - for example the Crown Commercial Service (CCS) or a regional agency such

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as Shared Business Services (SBS). Alternatively the Trust could undertake its own EU compliant tender process using the appropriate timescales (an OJEU process can usually take between 4 to 6 months). Consequently the Trust has identified the following preferred procurement routes to fulfil its operational vehicle requirements:

Modular Requirement - There is a CCS pan government framework agreement for the procurement of various vehicle types including chassis. The framework is for Vehicle Purchase (RM859). The intention is to continue with the Mercedes chassis using this framework which is fully compliant with the procurement rules. Once the business case has been approved, the vehicles can ordered at the earliest opportunity. The Trust will undertake a mini competition, under the CCS National Framework Agreement for Vehicle Conversions and Reconditioning Services framework (RM956) to identify a suitable converter.

Van Requirement –

Again, the Trust will use the CCS pan government framework agreement for Vehicle Purchases for the procurement of commercial vans. The Trust in 2009/2010 identified the Fiat Ducato as the preferred base van following an evaluation. The intention is to continue with the Fiat Ducato using this framework which is fully compliant with the procurement rules.

The Trust will undertake a mini competition, under the CCS National Framework Agreement for Vehicle Conversions and Reconditioning Services framework (RM956) to identify a suitable converter.

8 RISK

The main risk connected with these recommendations is the service/business continuity risk associated with not replacing ageing vehicles. The assessment of the risk is contained within Appendix A of this business case. The timescale to build and deliver an ambulance to the Trust takes 6-9 months from the placement of the order. Therefore, there is real risk to the Trust of:

Not all vehicles ordered being delivered within the financial year.

The above would add adversely to the backlog of replacement vehicles.


As with the introduction of any new vehicle type into the fleet it has the potential to be received negatively by some sections of staff.

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9 FINANCE

With regards to insurance and maintenance costs the business case assumes a status quo. This is because vehicles are replacements, therefore insurance will transfer from old to new at no additional cost. With regards to maintenance, if new vehicle types are introduced, maintenance will run on existing lines which will be reviewed after 12 months service to determine any variances in costs/savings. The following financial analysis of Options 2, 3, and 4 has been costed by the Finance Department. The new vehicles coming into service will have improved reliability and performance, therefore the depreciation of the asset will be over a 7 year time period. Within the capital programme for 2015/16 there is an allocation of £6.54m of capital to replace ambulances and their equipment. £1.15m of this provision has been used for the Urgent Care Service Business Case, therefore there is £5.39m for the replacement of PES ambulances. The vehicles that are proposed for purchase are Mercedes Modular Vehicles and Fiat Van Vehicles.



Mercedes Modular & Fiat Van Vehicle prices have been based on the 2013/14 purchase costs with an increase of 3%.

All prices include VAT at 20%.

Medical Equipment has been based on current prices plus a 5%

increase.

New Stretchers have been included for all vehicles. It is the intention, over the coming years, to equip all front line vehicles with information technology equipment to assist clinicians in the execution of their duties. The equipment will enable, in real time, front line staff to access a range of functions which are currently unavailable to them such as:

Toxbase Medicines Management PathFinder Manchester Triage System

In addition to this, the Trust would be in a position to roll out an Electronic Patient Report Form (ePRF) and hopefully integrate a future Mobile Data System (MDT) into a single unit.

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The cost of a tablet device has been included in the vehicle costings for 20 vehicles as a trial. The capital and recurrent revenue elements for the two types of ambulance being considered are shown below:

NB. The IT/Comms costs included above include the cost of a new Satellite Navigation system and the cost of Tablet Device for use on the vehicles.

9.2 OPTION 2 – MAINTAIN MODULAR VEHICLES

Replace 50 Vehicles – 50 Modular The revenue and capital requirement and affordability gap for the replacement of 50 vehicles with modular ambulances is set out in the table below:

Capital and Revenue Cost Analysis for an PES Ambulance, modular derived

Vehicle IT/Comm's Med Equip Total

£ £ £ £

Capital:

Mercedes 121,449 4,607 22,102 148,159

Revenue:

Depreciation 3 years 440 440

Depreciation 7 years 17,350 470 3,157 20,977

Depreciation 10 years 2,210 2,210

Dividend 3.5% 4,251 161 774 5,186

Tracking Equipment Annual Charge 0 173 0 173

Total Revenue 21,601 804 6,141 28,546

Capital and Revenue Cost Analysis for an PES Ambulance, van derived


£ £ £ £

Capital:

Capital 77,282 4,607 22,102 103,992

Revenue:

Depreciation 3 years 440 440


Depreciation 10 years 2,210 2,210

Dividend 3.5% 2,705 161 774 3,640

Tracking Equipment Annual Charge 0 173 0 173

Total Revenue 13,745 804 6,141 20,690

Capital / Revenue Cost Analysis for an PES Ambulance, modular derived

Capital / Revenue Cost Analysis for an PES Ambulance, van derived

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9.3 OPTION 3 – VAN ONLY

Replace 50 Vehicles – 50 Van Derived Ambulances The revenue and capital requirement and affordability gap for the replacement of 50 vehicles with van derived ambulances is set out in the table below:

9.4 OPTION 4 – MODULAR AND VAN MIX

Replace 50 Vehicles – 25 Modular and 25 Van Derived Ambulances The revenue and capital requirement and affordability gap for the replacement of 50 vehicles with modular and van derived ambulances is set out in the table below:

OPTION 2

Annual

Budget

Projected

Cost Cost Pressure

Number £ £ £

CAPITAL

Modular 50 7,368,345

Total 50 5,387,472 7,368,345 1,980,873

REVENUE

Modular 50 1,436,251

Total 50 679,614 1,436,251 756,637

2015/16

OPTION 3

Annual

Budget

Projected

Cost Cost Pressure

Number £ £ £

CAPITAL

Van 50 5,160,002

Total 50 5,387,472 5,160,002 (227,470)

REVENUE

Van 50 1,034,681

Total 50 679,614 1,034,681 355,067

2015/16

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The financial information identifies includes all relevant costs for bringing a replacement vehicle in to use. A breakdown of how funding is used is shown below: Capital expenditure includes:

Purchase of new vehicles Purchase of replacement equipment where necessary Re/de-installation of Airwave Installation of Tracking Device Installation of Tablet Device on 20 vehicles as a trial Fire suppression units

Additional recurrent revenue is made up of two elements: Capital Charges Vue Tracking Equipment Annual Charge

The table below demonstrates the differences between the budget being carried for the vehicles being disposed of and the cost of replacing them in terms of capital and revenue.

OPTION 4

Annual

Budget

Projected

Cost Cost Pressure

Number £ £ £

CAPITAL

Modular 25 3,697,373

Van 25 2,566,801

Total 50 5,387,472 6,264,174 876,702

REVENUE

Modular 25 713,725

Van 25 517,341

Total 50 679,614 1,231,066 551,452

2015/16

Option Number

of Vehicles

Capital Shortfall /

(Over Provision)

Recurrent Revenue

Shortfall / (Over Provision)

2 – All Modular Vehicles 50 £1,980,873 £756,637

3 – All Van Derived Vehicles 50 (£227,470) £355,067

4 – Mixture of Modular & Van Derived Vehicles

50 £876,702 £551,542

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Option 3 to replace with all Van Derived Vehicles would provide the Trust with the best VFM solution in terms of recurrent revenue and capital expenditure. There would be saving of £227k against the capital programme and would create the lowest recurrent revenue cost pressure against the existing capital charges budgets. The recurrent revenue pressure is already built in to the Trust financial plans, this is demonstrated below. The Trust has had Van Derived Vehicles in the fleet since 2010 and has built up a history of performance of these vehicles and they have proved to be reliable. Therefore, it would be acceptable to reduce the number of modular vehicles being replaced. The current IBP and LTFM make the following assumptions regarding capital and revenue spend associated with vehicles:

• 2015/16 Capital Spend of £7,211k (£1,106k for UCS Ambulances see Business Case).

• 2016/17 Onwards depreciation £1,030k (£183k) for UCS Ambulances see Business Case)

Option 3 in the business case means spend as follows: • 2015/16 Capital Spend A&E Ambulances £5,160k • 2016/17 Depreciation A&E Ambulances £355k

This outlines a scenario where the projected capital spend (£5,160k) is within the current LTFM plan (£7,211k) and the projected depreciation charge (£355k) is within the current LTFM plan (£1,030k). It is therefore recommended that option 3 be approved based on the current assumptions on finance for 2015/16, as this would give the Trust the new fleet required within the affordability envelope, and generate recurrent savings against the available revenue budgets. A list of vehicle registrations to be replaced under option 3 is included at Appendix D.


All new vehicle specifications will have the potential to impact both staff and services with regards to equality. The Equality Impact Assessment for the VRP is shown at Appendix C.


The project plans will follow the same established format. The main phases of the plans are:


Procurement process


Build

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Assistant Director Fleet and Estates – Sponsoring AD.

Head of Engineering Services – Overall lead for business case development and delivery.

Fleet Engineer (Support) – vehicle procurement, specification, production plan, quality and delivery. Vehicle leases and insurance management associated with the business case – maintenance specification and planning, commissioning, de-commissioning and handover.









13 CONCLUSION

The main risk connected with the business case is the service/business continuity risk associated with not replacing aging vehicles. There is a high demand from other ambulance services for both the modular and van derived ambulances. The timescale to build and deliver an ambulance to the Trust takes 6-9 months from the placement of the order, and therefore any slippage would have adverse effects on capital and delivery within the financial year. Operational experience is showing a need for flexibility within the fleet to deal with a variety of medical and geographical challenges. The Van Derived Vehicles have been seen to be more adept at operating in more restricted and rural areas than the modular. Option 3 is van derived vehicles and overall provides a balance of risk, vehicle replacement numbers and VFM.

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14 RECOMMENDATIONS

Option 3 to replace with all Van Derived Vehicles would provide the Trust with the best VFM solution in terms of recurrent revenue and capital expenditure. There would be saving of £227k against the capital programme and would create the lowest recurrent revenue cost pressure against the existing capital charges budgets. The recurrent revenue pressure is already built in to the Trust financial plans.

It is recommended that option 3 is approved.

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APPENDIX A – Risk Assessments

Datix ID

Description

Initial Risk Score

Key Controls/Assurance (including internal and/or external assurance for every key

control)

Residual Risk Gaps in Control

Assurance level

Risk Owner

C L R C L R

The main risk connected with the RRV/PES/Urgent care vehicle business case is the service/business continuity risk associated with not replacing ageing vehicles.

3 3 9 Vehicle replacement programme business cases produced and approved annually. 3 2 6

No guarantee that the Trust Board will all sign and agree with the business cases.

Mick Sweetmore

Risk Descriptor

Principal objectives

Last Reviewed

RRV‘s - this could also incur additional charges on extending leases and maintenance costs, at worse lease companies recovering their vehicles.

3 3 9 Vehicle replacement programme business cases produced and approved annually. 3 2 6

No guarantee that the Trust Board will all sign and agree with the business cases

Mick Sweetmore

As a result of the Vehicle

replacement programme business cases not being signed off by the Board of Directors for 2015/16 there will be an increased demand on fleet maintenance additional costs and a drop in VoR availability resulting in detrimental patient care and negative publicity.

3 3 9

Vehicle replacement programme business cases produced and approved annually 3 2 6

No guarantee that the Trust Board will all sign and agree with the business cases.

Mick Sweetmore

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APPENDIX B – Equipment forming part of VRP

Product / Item descriptionPegasus Stretcher, Including 4 point harness Millennia Extrication Board Scoop Stretcher EXL (yellow) Kendrick Extrication Device (KED) Wheelchair Mangar Elk complete with charger Pedi-pac (Model 78) Turntable 380mm Pedi - mate child harness Winch harness attachment

Millennia Spinal board biosafe speed clip straps

Scoop stretcher straps

Combi Head Immobiliser including strapsFracture Immobiliser - 5 Strap (Adult)Fracture Immobiliser - 4 StrapFracture Immobiliser - 2 Strap (Child)Para Pac Laerdal Ambulance Suction UnitFluid Warmers, Emergo 3 Thermo Bag (Green)Basic Life Support BagAdvanced Life Support BagPaediatric Life Support BagMedicines Bag with 2 hinged boards Nitronox analgesic Set + Carry CaseManual Handling Bag Curve BoardLarge Manual Handling BeltMedium Manual Handling BeltSmall Manual Handling BeltPara Pac Quick Release Mounting Bracket Suction Unit Wall Mounting BracketsFluid Warmers, Mounting BracketsDefibrillator Bracket (Dlouhy)Morphine Safe including mounting plateFinger SPO2 probe (proact)

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IT costs

Airwave Costs A&E Trust De-Re Installation £101.55 NWAS Specific Sacrificial Kit £203.13 Thorcom Sacrificial Kit £161.90 Hands free Mobile Phone Kit £63 Garmin Satellite Navigation £542.97 Total A&E - £1072.55

Tablet type IT device for use with PathFinder etc, including a car charging kit. (x20 trial)

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APPENDIX C – Equality Impact Assessment Report

Name of Policy, Service or Function NWAS A&E AMBULANCES VEHICLE REPLACEMENT PROGRAMME 2015-2016

Equality Impact Assessment carried out by Mick Sweetmore, Fleet Engineer Operations/Yunus Mogra, E&D coordinator



Overall aims The purpose of this business case is to present the annual replacement programme as defined in the Trust’s Fleet Strategy. Key elements of policy, service, process Vehicle replacement programmes will be determined by: • Organisational strategy • Resource profile model • Patient needs • Vehicle age profile • Pool allocation • Funding availability (VFM) • Legislation • Suppliers production capacity Who does the policy, service or function affect? Vehicles have been designed in accordance to statutory regulations and CEN compliance, which takes into account patient and staff security and comfort. The document sets out Operational procurement requirements for procurement by Fleet and Supplies. How do you intend to implement the policy or service change (if applicable)? The business case will be implemented within the framework of the Fleet Strategy.

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Disability Access from infirmed, bariatric patients and those requiring the use of wheel chairs.

Sexual Orientation


Religion or belief


Age Specific requirements for the carriage of children and infants.





Vehicle design and specifications is the outcome of a working group consisting of representatives from: H&S, Operational (member of specific patient forums), engineering, staff side, Risk Management, Training, Clinical Governance and Supplies. The process involves approval to comply with construction and use regulations and is risk assessed corporately.


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Condideration for spec Sexual Orientation


Religion or belief





Not withstanding the above, additional work should be undertaken, with the assistance of the comms team, to identify specific groups such as disability and faith groups for targeted consultation.

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Religion may require the observance of certain practices.

negative Signage using pictograms used. Multilingual phase books available on all vehicles.

Failure to consider cultural/racial issues.


Positive

Lifts fitted chairs and stretchers supplies to meet latest standards. Lifting equipment supplied and Bariatric vehicles deployed for use. Target specific group to confirm requirements met.



----- -----


Positive Fittings as standard for incubator transfers. ISO fix mounts and EVS child seats pumps fitted,

General (Human Rights) No impact on areas covered by the Human Rights Act -----

-----

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Step 6: Action Plan




Target specific group (i.e. faith, disability groups) to confirm requirements met. Transportation patients using personal issue wheelchairs (i.e motor powered) Induction loops in vehicles for deaf/hard of hearing groups. Bariatric vehicles.

Additional work should be undertaken, with the assistance of the comms team, to identify specific groups and seek involvement and feedback. Needs to be referred to the vehicle Equipment and design group for discussion and consideration. Needs to be referred to the vehicle Equipment and design group for discussion and consideration Data on bariatric patients is currently being measured and will determine the number of these specialist vehicles required for the future.

Prior to final specification Prior to final specification. Prior to final specification Next vehicle business case

M. Sweetmore VD&E group VD&E group VD&E group

confirm requirements met Confirm outcome or any specification changes Confirm outcome or any specification changes

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Summary of decisions and recommendations 1. Target specific group (i.e. faith, disability groups) to confirm requirements met.

2. Ensure PES Pictorial Communication Handbook and or multilingual phase books availability on all replacement vehicles and communicate to staff

3. Induction Loop and Powered wheelchair transport needs to be referred to the vehicle design and equipment groups.

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APPENDIX D – Vehicles to be replaced

Count

IndexVehicle Registration Make Model Location Owned / Leased

1 DK56 KNC Mercedes 416 MANCHESTER OWNED

2 DK56 KNE Mercedes 416 MANCHESTER OWNED

3 DK56 KNF Mercedes 416 MANCHESTER OWNED

4 DK56 KNH Mercedes 416 MANCHESTER OWNED

5 DK56 KNJ Mercedes 416 MANCHESTER OWNED

6 PX07 GWJ Mercedes 515 CUMBRIA OWNED

7 PX07 GWK Mercedes 515 CUMBRIA OWNED

8 DK08 GXD Mercedes 515 MANCHESTER OWNED

9 DK08 GXE Mercedes 515 MANCHESTER OWNED

10 DK08 GXF Mercedes 515 MANCHESTER OWNED

11 DK08 GXJ Mercedes 515 MANCHESTER OWNED

12 DK08 GXL Mercedes 515 MANCHESTER OWNED

13 DK08 GXM Mercedes 515 MANCHESTER OWNED

14 DK08 GXN Mercedes 515 MANCHESTER OWNED

15 DK08 GXO Mercedes 515 MANCHESTER OWNED

16 DK08 GXP Mercedes 515 CHESHIRE OWNED

17 DK08 GXR Mercedes 515 MERSEY OWNED

18 DK08 GXS Mercedes 515 CHESHIRE OWNED

19 DK08 GXT Mercedes 515 MERSEY OWNED

20 DK08 GXU Mercedes 515 CHESHIRE OWNED

21 DK08 GXV Mercedes 515 CHESHIRE OWNED

22 DK08 GXW Mercedes 515 MERSEY OWNED

23 DK08 GXY Mercedes 515 MERSEY OWNED

24 DK08 GXZ Mercedes 515 CHESHIRE OWNED

25 DK08 GYA Mercedes 515 CHESHIRE OWNED

26 DK08 GYB Mercedes 515 MERSEY OWNED

27 DK08 GYC Mercedes 515 MERSEY OWNED

28 DK08 GYD Mercedes 515 CUMBRIA OWNED

29 DK08 GYE Mercedes 515 CUMBRIA OWNED

30 DK08 GYH Mercedes 515 LANCASHIRE OWNED

31 DK08 GYJ Mercedes 515 LANCASHIRE OWNED

32 DK08 GYN Mercedes 515 ???? OWNED

33 DK08 GYV Mercedes 515 LANCASHIRE OWNED

34 DK08 GYW Mercedes 515 LANCASHIRE OWNED

35 DK08 GYX Mercedes 515 CHESHIRE OWNED

36 DK57 MDF Mercedes 515 MERSEY OWNED

37 DK57 MDJ Mercedes 515 MANCHESTER OWNED

38 DK57 MDN Mercedes 515 MANCHESTER OWNED

39 DK57 MDO Mercedes 515 MANCHESTER OWNED

40 DK57 MDU Mercedes 515 CHESHIRE OWNED

41 DK57 MDY Mercedes 515 MERSEY OWNED

42 DK57 MEU Mercedes 515 CHESHIRE OWNED

43 DK57 MEV Mercedes 515 MANCHESTER OWNED

44 DK57 MFA Mercedes 515 MANCHESTER OWNED

45 DK57 MFU Mercedes 515 MANCHESTER OWNED

46 DK57 MFV Mercedes 515 MERSEY OWNED

47 DK57 MFY Mercedes 515 CHESHIRE OWNED

48 DK57 MGX Mercedes 515 MERSEY OWNED

49 DK57 MGY Mercedes 515 LANCASHIRE OWNED

50 DK57 MHE Mercedes 515 LANCASHIRE OWNED

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Fleet UCS Ambulance Replacement Programme 2015-16 Page: 1 of 25

Author: Project Manager Fleet Version: 0.5 Date of Approval:

Status: Draft


North West Ambulance Service UCS Ambulances

Vehicle Replacement Programme

2015-2016

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Recommended by

Approved by

Approval Date

Version Number 0.5

Review Date Nov 15




This policy is available in alternative formats upon request. Please contact Fleet Office, on 0161 743 4849

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CHANGE RECORD FORM


0.1 14.08.14 Kirsty Bamford 1st draft

0.2 09.09.14 Finance, Procurement, medical

0.3 25.09.14 Group

0.4 22.10.14 Finance update

0.5 03.11.14 N Maher - edits

Abbreviation/term

Description

NWAS BAU PES PTS RRV UCS Ops VRP VFM GVW DWP

SBSCPS

CCS

North West Ambulance Service NHS TRUST Business As Usual Paramedic Emergency Service Patient Transport Services Rapid Response Vehicles Urgent Care Service Operations Vehicle Replacement Programme Value For Money Gross Vehicle Weight Department of Work and Pensions Shared Business Services Commercial Procurement Solutions Crown Commercial Services

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Table of Contents

1 INTRODUCTION ...................................................................................................................... 5

2 BACKGROUND ........................................................................................................................ 5



5 VEHICLE OPTIONS ................................................................................................................. 6

5.1 SCOPE ........................................................................................................................... 7 5.2 MEDICAL & IT EQUIPMENT ............................................................................................... 7 5.3 ALTERNATIVE FUELS/VEHICLE EMISSIONS ........................................................................ 8

6 OPTIONS .................................................................................................................................. 8

6.1 OPTION 1 - REPLACE NO VEHICLES DURING THE FINANCIAL YEAR ....................................... 8 6.2 OPTION 2 – REPLACE 14 VEHICLES .................................................................................. 9

7 PROCUREMENT ...................................................................................................................... 9

8 RISK ....................................................................................................................................... 10


9.1 FINANCIAL ASSUMPTIONS ...................................... ERROR! BOOKMARK NOT DEFINED. 9.2 OPTION 2 – REPLACE 15 VEHICLES – CAPITAL PURCHASEERROR! BOOKMARK NOT

DEFINED.

10 FINANCIAL SUMMARY ............................................... ERROR! BOOKMARK NOT DEFINED.

11 EQUALITY IMPACT ASSESSMENT ..................................................................................... 13


13 CONCLUSION ........................................................................................................................ 14

14 RECOMMENDATIONS .......................................................................................................... 15

List of Appendices

APPENDIX A – EQUIPMENT FORMING PART OF VRP ............................................................................. 16

APPENDIX B – EQUALITY IMPACT ASSESSMENT REPORT .......................................................................... 18

APPENDIXC– VEHICLES TO BE REPLACED ........................................................................................... 24

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1 INTRODUCTION

The purpose of this business case is to present the Urgent Care Service Ambulance Vehicle Replacement Programme (VRP) for 2014/15 as defined in the Board approved Fleet Strategy. The business case identifies option 2 as the preferred option. The timeline for replacement would be nine months. Therefore the business case aims to secure approval at the earliest opportunity to enable the replacement of the vehicles.

2 BACKGROUND

The Trust’s Fleet Strategy was approved by the Board in May 2013. The strategy proposes having annual replacement programmes and that these programmes will be drawn up to take into account the changing fleet profile in line with the service modernisation. Annual vehicle replacement programmes will be supported by robust business cases targeted to each Service Delivery core vehicle type. The replacement programme covers the “in-service” fleet only. Additions and special projects will be covered under separate business cases. Further, a key objective of the strategy is to achieve a 7 year replacement cycle for ambulances. The Trust’s Integrated Business Plan sets out the future direction of the service. The key elements of the vision and strategy are the redesign of ambulance responses to more appropriately meet the needs of patients and a differentiation of service and response models appropriate to urban, rural and remote areas of the North West. In considering the proposals for 2014/15 there are several key factors affecting the replacement programme that have been considered:

The time taken to deliver into the service the vehicles from orders being placed, (purchase and conversion)


Capital and revenue funding available



Experience of operating Urgent Care Ambulances in both urban and rural areas


Extended life of vehicles

3 CURRENT SITUATION

Ideally any Vehicle Replacement Strategy should not only capture the short term needs but also all projected medium to long term needs and must be affordable in a financial context both in capital and revenue terms.

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The present size of the Urgent Care Service Ambulance fleet is 54 vehicles. The present fleet of urgent care service ambulances was procured through legacy Trust arrangements in each fiscal year. This has led to an ageing fleet, made up of mainly former PES front line ambulance or specially converted HDS vehicles in order to provide an operational fleet. To replace the present fleet by registration date and maintain a 7 year age profile would require a defined and planned business model to meet with operational and financial objectives. The table below shows the number of vehicles by registration year that have been replaced or are due to be replaced over four years, fifteen were replaced in this financial year.

REGISTRATION YEAR No. OF

VEHICLES

REPLACEMENT YEAR

5 x 52 plates, 2 x 03,53 plates, 2 x 54 and 1 x 06 plate 10 2013/14

15 x 06 plates 15 2014/15

11 x 06 plate, 3 x 56 plate 14 2015/16

2 x 08 plate, 4 x 58 plate and 9 x 09 plate 15 2016/17

Table 1. Vehicle Replacement Profile


The Fleet Strategy proposes having annual replacement programmes and that these programmes will be drawn up to take into account the changing fleet profile in line with the service modernisation. For many reasons such as cost, operational application and sustaining quality of service, it is impractical to achieve that change in one year. Therefore, this VRP should be viewed as a transition step to the service delivery model, and will be reviewed annually to ensure it matches the requirements of the evolving workforce model such as Urgent Care vehicles. Because of the likely impact that these vehicles may have on the PES, the use and application of vehicles will be monitored over a 12-24 month period to determine if there are further efficiency gains that could be achieved within the Urgent Care/PES fleet.

5 VEHICLE OPTIONS

A Vehicle Design and Equipment Group, led by the Head of Operational Services and consisting of membership from Service Delivery, Fleet, Medical Directorate, IM&T, Finance, PES staff and staff side representatives review all

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equipment, (medical, health and safety and IT), existing vehicles and alternative vehicles to meet the evolving needs of the Trust. The future of the urgent care service regarding the fitting of blue lights remains undecided at this moment in time. However, vehicles will be pre-wired to accommodate both options until the decision is made. The Renault Master is currently in operation within the urgent care service. The Renault Master has a history of 7 years proven track record for this level of urgent care service provision and operation. Fleet and workshops are also well equipped and trained to maintain and support this type of vehicle and this is underpinned by a comprehensive manufacturer aftermarket support service. Therefore, the business case proposes to continue to use Renault Master chassis for conversion to UCS Ambulance.

5.1 SCOPE

This paper specifically addresses UCS Ambulance replacements and the associated pool reserve of the “in service” fleet.


New vehicles will be procured and equipped to UCS standard. The Trust’s Paramedic Consultant maintains the standard list of medical equipment. The medical equipment does not lend itself to the age profiling of the vehicles. Some equipment will last longer than the 7 year vehicle replacement programme and will still be serviceable after the vehicle has been replaced. Therefore, the Business Case takes into consideration the needs of the medical/clinical equipment replacement programme. As vehicles are replaced, as is the case in this VRP, only the following IT equipment will be procured (a swap from old vehicles will take place on certain items):

Hand held mobile and hands free kit.

Cost of swapping the existing communications equipment from the old to the new vehicle.

Airwave sacrificial items packs.

Any vehicle to be replaced which has a satellite navigation system unit installed will receive a de-install and re-install of the existing and still serviceable unit. A VDO ‘sacrificial items’ pack will be purchased and supplied for an in-build during production, and in order to facilitate a ‘plug-and-play’ re-install of equipment into the replacement vehicle.

These vehicles are to be fitted with vehicle tracking / monitoring equipment.

Appendix A lists the medical and IT equipment to be delivered within this programme.

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The Trust seeks wherever possible to act in a socially responsible manner and recognises its responsibility to minimise any adverse impact of its activities on the environment. The two main alternative fuels presently adopted for use on commercial vehicles are LPG (Liquefied Petroleum Gas) and CNG (Compressed Natural Gas) the latter being used mainly on larger commercial vehicles. For reasons of practicality LPG vehicles use bio-fuel which means they are designed to run on either LPG Gas or petrol. A litre of LPG is approx 50% less in cost than its fossil fuel alternative. The CO levels between LPG and Diesel fuels are comparable. The main disadvantage is the requirement to carry an additional fuel tank which adds to the overall vehicle weight and reduces the overall payloads and space. The limit mileage range of a litre of LPG will provide the same as 75% of a litre of diesel. This will increase the maintenance and capital costs of the vehicles. These vehicles would not at present be suitable for UCS Ambulances. However, the Fleet Engineering Team regularly review the market and changes in technology that may provide an opportunity for the Trust to evaluate with a view to incorporating into future VRPs. The Trust is also aware and will be monitoring the new technologies, such as solar panels, being trialled by other Ambulance Trusts.

6 OPTIONS

The Trust has inherited a backlog of vehicles requiring replacement due to the service modernisation and development of an Urgent Care Service model. There are currently 14 vehicles due for replacement in the financial year 2015/16. The financial calculation will determine whether the vehicles are procured via capital or lease revenue streams. In order to provide the North West Ambulance service with a robust replacement programme, a range of options have been explored and are presented below for consideration:


This option would require extending vehicle life span beyond 7 years and retain owned vehicles and make no capital / lease purchases.


Cheapest solution.



Adverse impact on the age profile of the fleet.


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Poor image.

6.2 OPTION 2 – REPLACE 14 VEHICLES

Replace all 14 vehicles due for replacement as proposed in the Fleet Strategy.


Long term solution to lead into a 7 year replacement programme within four years.

Provides the more robust solution to match the fleet to future requirements.

More reliable and efficient vehicles.

A more affordable and deliverable solution.

There would be capital pressure associated with the purchase of the profile of UCS Vehicles.

Potential recurrent revenue pressure.

7 PROCUREMENT

The Trust must comply with EU procurement legislation due to the value of the vehicles and the numbers required. To do this the Trust must purchase the vehicles from a national or regional contract which has been awarded following an appropriate tender process, via a national or regional procurement agency - for example the Crown Commercial Service (CCS) or a regional procurement agency such as the Shared Business Services Commercial Procurement Solutions (SBS). Alternatively the Trust would undertake its own EU compliant tender process using the appropriate timescales (an OJEU process can usually take between 4 to 6 months). Consequently the Trust has identified the following procurement routes to fulfil its operational vehicle requirements:

The Trust will use the Pan Government Framework Agreement for Vehicle Purchases (RM859), awarded by the CCS, for the procurement of commercial vans. The Trust will undertake a mini competition, under the CCS National Framework Agreement for Vehicle Conversions and Reconditioning Services framework (RM956) to identify a suitable converter. Although capital funding has been allocated for this business case, previously the Trust has fulfilled its requirements for UCS vehicles (excluding 2013/2014) via an operating lease. However, the decision to purchase or lease will be made based on both the Value for Money and Transfer of Risk tests. The operating lease provider will be selected following a mini competition under either the Sector Treasury Service Operating Lease framework agreement or the pan government lease framework (RM858) established by the Government Procurement Solutions (CCS).

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Once selected, the lease provider will procure the base vehicles from the pan government vehicle framework. The base vehicles will be converted to the Trust’s specification by the Trust’s preferred converter. The conversion will be facilitated by the operating lease provider.

8 RISK

The main risk connected with these recommendations is the service/business continuity risk associated with not replacing ageing vehicles. The timescale to build and deliver an ambulance to the Trust takes 6-9 months from the placement of the order. Therefore, there is real risk to the Trust of:

Not all vehicles ordered being delivered within the financial year.

The above would add adversely to the backlog of replacement vehicles.


As with the introduction of any new vehicle type into the fleet it has the potential to be received negatively by some sections of staff. Any enhancements and design changes identified through experience in use will be fed back through the engineering process and incorporated into future procurements.

9 FINANCE

With regards to insurance and maintenance costs the business case assumes a status quo. This is because vehicles are replacements; therefore insurance will transfer from old to new at no additional cost. With regards to maintenance, maintenance will run on existing lines which will be reviewed after 12 months service to determine any variances in costs/savings.

The following financial analysis of Option 2 has been costed by the Finance Department. The new vehicles coming into service will have improved reliability and performance, therefore the depreciation of the asset will be over a 7 year time period.

The proposal is to purchase Renault Master base Vehicles as these have proved to be reliable over the last two years replacement programme and they provide best value for money.

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Vehicle prices – the costs for the Chassis and the Conversion have been based on the price the Trust has recently received for the 2014/15 replacements.

All prices include VAT at 20%. Medical Equipment has been included at current prices. IT equipment has been included for re/de-installation of Satellite

Navigation System and Airwave Communication Equipment. It is assumed that new satellite navigation system will not be required.

Costs have been assessed for the purchase and lease of the vehicles. A Value for Money (VFM) test has been completed and this has shown that leasing the vehicles on a 7 year lease fails both of the criteria, in terms of VFM and the transfer of risk. Based on the VFM results the purchase of Renault Master van has been included:

9.2 OPTION 2 – REPLACE 14 VEHICLES – CAPITAL PURCHASE

The capital and recurrent revenue requirements and affordability gap for the replacement of 14 vehicles is set out in the table below:

Capital and Revenue Cost Analysis for an UCS Ambulance, Renault Master


£ £ £ £

Capital:

Renault Master 60,116 1,457 17,473 79,047

Recurrent Revenue:


Depreciation 10 years (Stretcher) 0 0 823 823

Dividend 3.5% 1,954 47 574 2,575

VUE Tracking Rental 173 0 0 173

Total Revenue 10,715 256 2,718 13,688

Capital / Revenue Cost Analysis for an UCS Ambulance, purchased

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The financial information identifies that there is a difference between the existing budget for the vehicles and the cost of disposing and replacing them as follows:

Option No. of

Vehicles Capital Shortfall / (Over Provision)

Recurrent Revenue Shortfall / (Over

Provision)

2 – Renault Master Vans 15 (£46,806) £183,049

There is a high recurrent revenue shortfall because the majority of these vehicles are fully depreciated on the asset register. This means that there isn’t an existing depreciation or Public Dividend Capital budget for these

vehicles. This shortfall will be assessed as a Budget Setting cost pressure for 2015/16. (See below).

It is therefore recommended that option 2 be approved based on the current assumptions on finance for 2015/16.

The current IBP and LTFM make the following assumptions regarding capital and revenue spend associated with vehicles:

2015/16 Capital Spend of £7,211k (£5,160k for A&E Ambulances see Business Case).

2016/17 Onwards depreciation £1,030k (£355k for A&E Ambulances see Business Case)


2015/16 Capital Spend UCS Ambulances £1,106k 2016/17 Depreciation UCS Ambulances £183k

OPTION 2

Annual

Budget

Projected

Cost Cost Pressure

Number £ £ £

CAPITAL

Renault Master 14 1,106,652

Total 14 1,153,458 1,106,652 (46,806)

RECURRENT REVENUE

Renault Master 14 191,629

Total 14 8,580 191,629 183,049

2015/16

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This outlines a scenario where the projected capital spend (£1,106k) is within the current LTFM plan (£7,211k) and the projected depreciation charge (£192k) is within the current LTFM plan (£1,030k)

A list of vehicle registrations to be replaced under option 2 is included at Appendix C.


All new vehicle specifications will have the potential to impact both staff and services with regards to equality. The Equality Impact Assessment for the VRP is shown at Appendix B.


The project plans will follow the same format as established Trust VRP. The main phases of the plans are:


Procurement process


Build


Assistant Director Fleet and Estates – Overall accountability for VRP’s and the Fleet Strategy.

Head of Engineering Services – Overall lead for business case development and delivery, vehicle procurement and specification

Fleet Engineer (Support) – maintenance specification and planning, commissioning, de-commissioning and handover. Production plan, quality and delivery. Vehicle leases and insurance management associated with the business case.





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13 CONCLUSION

The main risk connected with the business case is the service/business continuity risk associated with not replacing ageing vehicles. There is a high demand from other ambulance services for van derived ambulances. The timescale to build and deliver an ambulance to the Trust takes 6-9 months from the placement of the order, and therefore any slippage would have adverse effects on any capital and delivery within the financial year. The Renault Master has a proven track record for this level of urgent care service provision. Fleet and workshops are also well equipped and trained to maintain and support this type of vehicle. Option 2 provides the solution that balances risk, vehicle replacement numbers and VFM to secure essential replacements of the Trust’s fleet and maintain business continuity. There is a high recurrent revenue shortfall because these vehicles are fully depreciated on the asset register. This means that there isn’t an existing depreciation or Public Dividend Capital budget for these vehicles. The current IBP and LTFM make the following assumptions regarding capital and revenue spend associated with vehicles:

2015/16 Capital Spend of £7,211k (£5,160k for A&E Ambulances see Business Case).

2016/17 Onwards depreciation £1,030k (£355k for A&E Ambulances see Business Case)


2015/16 Capital Spend UCS Ambulances £1,106k 2016/17 Depreciation UCS Ambulances £183k This outlines a scenario where the projected capital spend (£1,106k) is

within the current LTFM plan (£7,211k) and the projected depreciation charge (£192k) is within the current LTFM plan (£1,030k)

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14 RECOMMENDATIONS

Option 2 provides the solution that balances risk, vehicle replacement numbers and VFM to secure essential replacements of the Trust’s fleet and maintain business continuity. The option also provides a cost effective solution towards achieving and sustaining a seven year replacement programme for the UCS fleet, and gives a flexible approach to match the fleet to future requirements

It is therefore recommended that option 2 be approved based on the current assumptions on finance for 2015/16.

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APPENDIX A – Equipment forming part of VRP

Product / Item description

Pegasus Stretcher, Including 4 point harness Safe working Load 200Kg/31

stone

Tracked chair Safe working load 200kg/31 stone

Scoop Stretcher EXL (yellow) Safe working load 159Kg/25

stoneWheelchair Safe working load 127Kg/20

stoneMangar Elk complete with charger Safe working load 445Kg/70

stoneTurntable 380mm Safe working load 230Kg/36

stonePedi - mate child harness Safe working load 18.1Kg/2.8

stoneWinch harness attachment Breaking strain 2700Kg/424

stone

Scoop stretcher straps

Combi Head Immobiliser including straps

Fracture Immobiliser - 5 Strap (Adult)

Fracture Immobiliser - 4 Strap

Fracture Immobiliser - 2 Strap (Child)

Laerdal Ambulance Suction Unit

Immediate response bag

Lifepak 1000 Automated External Defibrillator (AED)

Nitronox analgesic Set + Carry Case

Tympanic Thermometer (Braun Thermoscan)

Glucometer express meter

Sphygmomanometer

Manual Handling Bag

Curve Board

Large Manual Handling Belt

Medium Manual Handling Belt

Small Manual Handling Belt

Finger probe SPO2

Spider Straps

O2 Flowmeter Bobbin Type

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Type of Equipment

Process / Kit

Communications Equipment – Replacement Vehicle

NWAS de-installation and re-installation

Trust de & re-installation voice and mobile data

Sacrificial items voice restock tetra|/GPS Antenna for Mobile Data

Sacrificial items Thorcom restock

Bury car kit purchase ( Install carried out by the vehicle builders)

Mobile Phone

Call Sign Decals

Satellite Sacrificial Re-stock ( This is only required if we carry on doing a De/Re install of the Seimens)

New Garmin SatNav ( This is the replacement for the Seimens VDO5200PRO) if ordered.

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Appendix B – Equality Impact Assessment Report

Name of Policy, Service or Function NWAS URGENT CARE REPLACEMENT PROGRAMME 2015-2016

Equality Impact Assessment carried out by Mick Sweetmore, Fleet Engineer Operations/Yunus Mogra, E&D coordinator



Overall aims The purpose of this business case is to present the annual replacement programme as defined in the Trust’s Fleet Strategy. Key elements of policy, service, process Vehicle replacement programmes will be determined by: • Organisational strategy • Resource profile model • Patient needs • Vehicle age profile • Pool allocation • Funding availability (VFM) • Legislation • Suppliers production capacity Who does the policy, service or function affect? Vehicles have been designed in accordance to statutory regulations and CEN compliance, which takes into account patient and staff security and comfort. The document sets out Operational procurement requirements for procurement by Fleet and Supplies. How do you intend to implement the policy or service change (if applicable)? The business case will be implemented within the framework of the Fleet Strategy.

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Sexual Orientation


Religion or belief







Vehicle design and specifications is the outcome of a working group consisting of representatives from: H&S, Operational (member of specific patient forums), engineering, staff side, Risk Management, Training, Clinical Governance and Supplies. The process involves approval to comply with construction and use regulations and is risk assessed corporately.


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Condideration for spec Sexual Orientation


Religion or belief





Not withstanding the above, additional work should be undertaken, with the assistance of the comms team, to identify specific groups such as disability and faith groups for targeted consultation.

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Page 21 of 25







Religion may require the observance of certain practices.

negative Signage using pictograms used. Multilingual phase books available on all vehicles.

Failure to consider cultural/racial issues.


Positive

Lifts fitted chairs and stretchers supplies to meet latest standards. Lifting equipment supplied and Bariatric vehicles deployed for use. Target specific group to confirm requirements met.



----- -----


Positive Fittings as standard for incubator transfers. ISO fix mounts and EVS child seats pumps fitted,

General (Human Rights) No impact on areas covered by the Human Rights Act -----

-----

Step 6: Action Plan

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Page 22 of 25




Target specific group (i.e. faith, disability groups) to confirm requirements met. Transportation patients using personal issue wheelchairs (i.e motor powered) Induction loops in vehicles for deaf/hard of hearing groups.

Additional work should be undertaken, with the assistance of the comms team, to identify specific groups and seek involvement and feedback. Needs to be referred to the vehicle Equipment and design group for discussion and consideration. Needs to be referred to the vehicle Equipment and design group for discussion and consideration

Prior to final specification Prior to final specification. Prior to final specification

M. Sweetmore VD&E group VD&E group

confirm requirements met Confirm outcome or any specification changes Confirm outcome or any specification changes




Summary of decisions and recommendations 1. Target specific group (i.e. faith, disability groups) to confirm requirements met.

2. Ensure Pictorial Communication Handbook and or multilingual phase books availability on all replacement vehicles and communicate to staff

3. Induction Loop and Powered wheelchair transport needs to be referred to the vehicle design and equipment groups.

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APPENDIX C – Vehicles To Be Replaced

Count

IndexVehicle Registration Make Model Location Owned / Leased

1 DK56 KNA Renault Master LANCS Owned

2 DK56 KNB Renault Master LANCS Owned

3 DK56 KNM Renault Master LANCS Owned

4 PF06 EHC Renault Master CMA Owned

5 PF06 EHE Renault Master CMA Owned

6 PF06 EHG Renault Master GMA Owned

7 PF06 EHH Renault Master CMA Owned

8 PF06 EHM Renault Master CMA Owned

9 PF06 EHS Renault Master GMA Owned

10 PF06 EHV Renault Master CMA Owned

11 PF06 EHY Renault Master CMA Owned

12 PF06 EJG Renault Master GMA Owned

13 PF06 EJO Renault Master CMA Owned

14 PL06 RZZ Renault Master GMA Owned

Vehicles to be Replaced under Option 2

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Page 25 of 25

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18. Item 9.3-CF Report

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- 1 of 4 -

Report to: Board of Directors Date: 26th November 2014

Subject: Charitable Funds Annual Report and Accounts 2013/14

Report of: Director of Finance Prepared by: Head of Technical Accounts

PAPER FOR DECISION


-----











finite resources




-----


-----


Completed

Not required

Attachments:

1. Letter of representation

2. Trustee’s Annual Report for 2013-14

3. Charitable Trust Accounts 2013-14 4. Audit Highlights Memorandum

5. Auditors Report 6. Trustees Statement


presented to:`

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1

The purpose of this report is for the Board of Directors to review and sign off the (‘NWAS’)

NHS Trust Charitable Fund Annual Report and Accounts for the twelve months ended 31st

March 2014. The Annual Report and Accounts have been reviewed recommended for sign

off of by the Charitable Funds Committee on 29th October 2014.

2. BACKGROUND

2.1 The Annual Report and Accounts are prepared in accordance with guidance issued by both

the Audit and Charity Commissions. The Board of Directors are the Corporate Trustee for

Charitable Fund purposes.


3.1

4.

4.1

4.2

4.3

4.4

5.

5.1

The attached Annual Report and Accounts were audited by the external auditors KPMG LLP.

The audit was undertaken in August 2014. The Charitable Funds Committee reviewed

Accounts and Annual report and is recommending it for sign of to the Board of Directors.

The deadline for submission of the Annual Report and Accounts is the 31st January 2015.

SUMMARY OF FINANCIAL PERFORMANCE 2013/14 In summary the income of the charitable funds in 2013/14 amounted to £55k out of which £40k was for restricted funds and the remaining £15k was for unrestricted funds. Expenditure in 2013/14 amounted to £101k of which £93k was from restricted funds and £8k from unrestricted funds.

The overall available resource in 2013/14 has decreased by £46k compared to 2012/13 with £101k in restricted funds and £146k in unrestricted funds. The Trustee is required to sign the Letter of Representation (Appendix 1). The Annual Report of the Trustee is attached at Appendix 2 and the Annual Accounts can be found at Appendix 3. Audit The audit of the Charitable Funds accounts for 2013/14 was undertaken by the external auditors KPMG in August 2014. An unqualified audit opinion was given to the accounts. The audit memorandum can be found at Appendix 4 and the Auditors report at Appendix 5.

6. RECOMMENDATIONS


Review, agree and sign off the Trust Charitable Funds Annual Report & Accounts

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- 4 -

Note the Audit Highlight Memorandum (Appendix 4) and the Audit Report

(Appendix 5).

Review and agree for approval the Trustees Statement (Appendix 6) and

Management Representation Letter (Appendix 1).

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19. Item 9.3-Attach 1 to CF Report

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Headquarters

Ladybridge Hall 399 Chorley New Road

Heaton, Bolton BL1 5DD

Tel: 01204 498400

Fax: 01204 498423

www.nwas.nhs.uk

Headquarters: Ladybridge Hall, 399 Chorley New Road, Bolton. BL1 5DD

Chairman: Mrs M Whyham MBE Chief Executive: Mr B Williams

KPMG LLP St James Square Manchester M2 6DS [Date] To the Auditors, This representation letter is provided in connection with your audit of the financial statements of North West Ambulance Service NHS Trust Charitable Fund (“the Charity”), for the year ended 31st March 2014, for the purpose of expressing an opinion:

i. as to whether these financial statements give a true and fair view of the state of the Charity’s affairs as at 31st March 2014 and of its surplus or deficit for the financial year then ended;

ii. whether the financial statements have been properly prepared in accordance with UK Generally Accepted Accounting Practice; and

iii. whether the financial statements have been prepared in accordance with the Charities Act 2011.

These financial statements comprise the Balance Sheet, the Statement of Financial Activities and notes, comprising a summary of significant accounting policies and other explanatory notes. The Corporate Trustee confirms that the representations they make in this letter are in accordance with the definitions set out in the Appendix to this letter. The Corporate Trustee confirms that, to the best of their knowledge and belief, having made such inquiries as it considered necessary for the purpose of appropriately informing themselves: Financial statements 1. The Corporate Trustee has fulfilled their responsibilities for the preparation of financial

statements that:

i. give a true and fair view of the state of the Charity’s affairs as at the end of its financial year and of its surplus or deficit for that financial year;

ii. have been properly prepared in accordance with UK Generally Accepted Accounting Practice (“UK GAAP”); and

iii. have been prepared in accordance with the Charities Act 2011.

OUR REF:

YOUR REF:

DIRECT TEL:

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The financial statements have been prepared on a going concern basis. 2. Measurement methods and significant assumptions used by the Corporate Trustee in making

accounting estimates, including those measured at fair value, are reasonable. 3. All events subsequent to the date of the financial statements and for which FRS 21 Events after

the balance sheet date requires adjustment or disclosure, have been adjusted or disclosed. 4. The effects of uncorrected misstatements are immaterial, both individually and in aggregate,

to the financial statements as a whole. A list of the uncorrected misstatements is attached to this representation letter.

Information provided 5. The Corporate Trustee has provided you with:

access to all information of which it is aware, that is relevant to the preparation of the financial statements, such as records, documentation and other matters;

additional information that you have requested from the Trustee for the purpose of the audit; and

unrestricted access to persons within the Charity from whom you determined it necessary to obtain audit evidence.

6. All transactions have been recorded in the accounting records and are reflected in the financial

statements. 7. The Corporate Trustee acknowledges their responsibility for such internal control as it

determines necessary for the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In particular, the Corporate Trustee acknowledges their responsibility for the design, implementation and maintenance of internal control to prevent and detect fraud and error.

The Corporate Trustee has disclosed to you the results of their assessment of the risk that the financial statements may be materially misstated as a result of fraud.

8. The Corporate Trustee has disclosed to you all information in relation to:

a) Fraud or suspected fraud that it is aware of and that affects the Charity and involves:

management;

employees who have significant roles in internal control; or

others where the fraud could have a material effect on the financial statements; and

b) allegations of fraud, or suspected fraud, affecting the Charity’s financial statements communicated by employees, former employees, analysts, regulators or others.

9. The Corporate Trustee has disclosed to you all known instances of non-compliance or

suspected non-compliance with laws and regulations whose effects should be considered when preparing the financial statements.

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10. The Corporate Trustee has disclosed to you and have appropriately accounted for and/or disclosed in the financial statements, in accordance with FRS 12 Provisions, Contingent Liabilities and Contingent Assets, all known actual or possible litigation and claims whose effects should be considered when preparing the financial statements.

11. The Corporate Trustee has disclosed to you the identity of the Charity’s related parties and all

the related party relationships and transactions of which it is aware. All related party relationships and transactions have been appropriately accounted for and disclosed in accordance with FRS 8 Related Party Disclosures.

12. The Corporate Trustee confirms that:

a) The financial statements disclose all of the key risk factors, assumptions made and uncertainties surrounding the charity’s ability to continue as a going concern as required to provide a true and fair view.

b) Any uncertainties disclosed are not considered to be material and therefore do not cast significant doubt on the ability of the Charity to continue as a going concern.

This letter was tabled and agreed at the meeting of the Charitable Fund Committee on 29 October 2014.

Yours faithfully [Chair of Trustees] [Trustee] Optional cc: Audit Committee

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Trustee’s Report for North West Ambulance Service NHS Trust Charitable Fund for the 12 months ended 31st March 2014

Foreword The Corporate Trustee presents the Charitable Funds Report together with the Financial Statements for the 12 months ended 31 March 2014. The Charity’s report and accounts have been prepared by the Corporate Trustee in accordance with Part VI of the Charities Act 2011 and the Charities (Accounts & Reports) Regulations 2008. The Charity’s report and accounts include all the separately established funds for which the North West Ambulance Service NHS Trust is the sole beneficiary. The Charity has a corporate trustee: the North West Ambulance Service NHS Trust. The members of the NHS Trust Board who served during the 12 months were as follows: Mary Whyham MBE Chair Darren Hurrell Chief Executive (to 10th September 2013) Bob Williams Chief Executive (Acting from 1st April 2013 to 15 October 2013, substantive from 16 October 2013) Alan Stuttard Director of Finance / Deputy Chief executive (Deputy CEO from 1st February 2014) Kevin Mackway – Jones Medical Director Sarah Byrom Director of Quality Derek Cartwright Director of Operations (Acting from 1st April 2013 to 27th March 2014, substantive from 28th March 2014) Eddie Pope Non Executive Director Alan Slater Non Executive Director David Peat OBE Non Executive Director (resigned from 31st December 2013) Gary Parker Non Executive Director (resigned from 31st December 2013) Ruth Roberts Non Executive Director (resigned from 31st December 2013) The Charitable funds were established by the Trust deed at 31st January 2007. The Charitable Funds were registered with the Charity Commission (No. 1122470) on 25th January 2008 in accordance with the Charities Act 1993. Reference and Administrative details The charity comprises 4 individual funds at March 2014, namely: Unrestricted Funds: North West Ambulance Service NHS Trust General Fund. Within unrestricted funds there are designated funds for specific areas and purposes.

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Restricted Funds: First Responders Community Fund Mayor of Wigan Rapid Response Vehicle Fund Lancashire First Responders Fund Charitable funds received by the charity are accepted, held and administered as funds and property held on trust for purposes relating to the Health Service in accordance with the National Health Service Act 1977 and the National Health Service and Community Care Act 1990 and these funds are held on trust by the corporate body. Trustees The North West Ambulance Service NHS Trust has been the Corporate Trustee of the charitable fund and its four predecessor charitable funds since 1 July 2006 and is governed by the law applicable to Trusts, principally the Charities Regulations 2008 and the Charities Act 2011. The NHS Trust Board devolved responsibility for the on-going management of funds to the Charitable Funds Committee which administers the funds on behalf of the Corporate Trustee. This committee was formed on 1 July 2006. The names of those people who served as members of the Charitable Funds Committee, as permitted under regulation 16 of the NHS Trusts (Membership and Procedures) Regulations 1990 were as follows: David Peat, OBE Non Executive Director (Chair) Alan Stuttard Director of Finance Mick Forest Director of Organisational Development and HR (Acting

from 1st April 2013 to 27th March 2014, substantive from 28th March 2014)

Derek Cartwright Director of Emergency Services (Acting from 1st April 2013 to 27th March 2014, substantive from 28th March 2014)

Staff representatives are also invited to attend the Committee meetings. Principal Office The principal office for the charity is: North West Ambulance Service NHS Trust Charitable Fund Ladybridge Hall Chorley New Road Bolton BL1 5DD

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Principal Professional Advisers: Bankers Solicitors National Westminster Bank PLC Hempsons Preston Branch The Exchange 35 Fishergate Station Parade Preston Harrogate PR1 3BH HG1 1DY Auditors KPMG St James’s Square Manchester Greater Manchester M2 6DS Structure, Governance and Management The charity’s unrestricted fund was established using the model declaration of trust and all funds held on trust as at the date of registration were either part of this unrestricted fund or registered as separate restricted funds under the main charity. Subsequent donations and gifts received by the charity that are attributable to the original funds are added to those fund balances within the existing charity. The Corporate Trustee fulfils its legal duty by ensuring that funds are spent in accordance with the objects of each fund and by designating funds the Trustee respects the wishes of the donors to benefit patient care and the good health and welfare of staff. Where funds have been received, which have specific restrictions set by the donor, a restricted fund has been established. The charitable funds available for spending during the 12 months reporting period have been allocated to a general fund managed in accordance with the North West Ambulance Service NHS Trust Scheme of Delegation – Charitable Funds. Expenditure up to £999 can be authorised by the Deputy Director of Finance / Heads of Departments, whilst this limit is extended to £1,999 with regards to the Chief Executive and Director of Finance. Any larger requests up to £9,999 and over are approved by the Charitable Fund Committee and Board of Directors respectively. All members of staff are encouraged to approach the Chief Executive as to the use of the charitable funds. Non-Executive Directors of the Trust Board are appointed by the NHS Appointments Commission and Executive Directors of the Board are subject to recruitment by the NHS Trust Board. The charity has adopted the Institute of Chartered Secretaries and Administrators guidance for the production of an induction pack for the newly appointed members of the NHS Trust Board and Charitable Funds Committee. This pack provides information

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about the charity, including the governing document, the Charitable Funds Committee terms of reference, trustees’ annual report and accounts, policies and minutes and information about trusteeship, including Charity Commission booklet CC3, The Essential Trustee. The Chair gives new members of both the NHS Trust Board and the Charitable Funds Committee a briefing on the current policies and priorities for the charitable funds. A guided tour of the beneficiary NHS Trust’s facilities and any additional training that their role(s) may require is also offered. Acting for the Corporate Trustee, the Charitable Funds Committee is responsible for the overall management of the Charitable Fund. The Committee is required to:

- Control, manage and monitor the use of the fund’s resources. - Provide support, guidance and encouragement for all its income raising

activities whilst managing and monitoring the receipt of income. - Ensure that ‘best practice’ is followed in the conduct of all its affairs fulfilling

all of its legal responsibilities.

- Ensure that the approved Investment Policy approved by the NHS Trust Board as Corporate Trustee is adhered to and that performance is continually reviewed whilst being aware of ethical considerations.

- Keep the Trust Board fully informed on the activity, performance and risks of

the charity. The accounting records and the day to day administration of the funds are dealt with by the Finance Department located at Lancashire office, 449 – 451 Garstang Road, Preston, Lancashire, PR3 5LN. Risk Management The major risks to which the charity is exposed have been identified and considered. The main risk that the funds are exposed to is the potential reduction in donations which will result in the funds being depleted. To manage this risk the decision was taken to maintain the reserve of six months’ worth of expenditure. The Charitable Funds Committee continues to monitor carefully how charitable funds are to be spent on a quarterly basis as part of the risk management process to avoid unforeseen calls on reserves. Partnership Working and Networks North West Ambulance Service NHS Trust is the main beneficiary of the charity and is a related party by virtue of being corporate trustee of the charity. By working in partnership with the Trust, the charitable funds are used to best effect. When deciding upon the most beneficial way to use charitable funds, the corporate trustee has regard to the main activities, objectives, strategies and plans of the Trust. The Trust’s Charitable Fund includes the Lancashire First Responders whose aim is to reduce the number of deaths arising from coronary heart disease in the County of

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Lancashire. This objective is being achieved through the establishment of training and education of the public and other personnel in basic emergency life support including cardio pulmonary resuscitation. This, along with a further objective of providing fast response paramedic units and the equipping of such units has dovetailed well with existing services provided by the North West Ambulance Service NHS Trust and with similar work performed by the Community First Responders Teams has proved invaluable in achieving response targets within remote rural areas. Objectives and Strategy The objectives of the Charitable Fund are defined in the Trust Deed as:

“For the general or specific purposes of North West Ambulance Service NHS Trust or for a charitable purpose or purposes relating to the National Health Service”

In other words the overall objective of the fund is to increase the resources available to be used by NWAS staff and patients. During the year the Charity continued to further its main objective and delivered a deficit of £46k. The Charity relies on the goodwill of its patients and of the general public. Nearly all income received in 2013-14 was through donations and legacies. The main items of expenditure by the Charity were for the benefit of the staff or the patients through purchase of necessary medical equipment as per the Deed. Policies, procedures and reserves strategies are regularly reviewed as the charitable trust remains committed to ensuring that there are sufficient funds to secure its objectives. Annual Review: Our Activities Charitable Funds continue to depend on donations received from the public and through fund raising activities held by the First Responder groups. The excellent work of our staff continues to generate support and thanks from the general public which has been appreciated. The General Fund continues to support staff retirement gifts and functions along with training and recreational activities. The continued recruitment of volunteers to the Lancashire First Responders has seen them actively involved in more community based lifesaving schemes. Projects have included both private and public bodies to heighten the awareness of the use defibrillators in public places. In support of these projects there has been a substantial investment in equipment, medical sundries and staff uniforms funded by a steady flow of donations through local fund raising events and the generous support of the public. Reserves Policy

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A recommended policy of having the equivalent of six months worth of expenditure retained in reserves has been agreed by the Charitable Fund Committee. In the normal course of events expenditure within one year does not exceed £40k which means that the reserves to be kept should be around £20k. Current available funds stand at £247k which exceeds the required minimum quite comfortably. Our Future Plans In the absence of any active fund raising the General Funds remain dependent on the support and generosity of the general public in acknowledging the services performed by ambulance staff. The Lancashire First Responders continue to be recognised and supported by the public and fund raising organisations in providing training and support for the use of defibrillators in public places and the recruitment and training of volunteers. This popular policy will continue to be rolled out in future financial years with the aim of improving the use of communication and medical equipment used by First Responders. The Charitable Funds Committee will continue to actively ensure that all funds are maximised for both the benefit of staff and the communities for which they serve. A Review of our Finances, Achievements and Performance The net assets of the Charitable Funds as at 31 March 2014 were £247,000, (£293,000, 31 March 2013). Overall net assets decreased by £46,000, (increase £63,000, March 2013) being the excess of expenditure £101,000, (£40,000, 31 March 2013) over income £55,000, (£103,000, 31 March 2013). Total expenditure of £100,000 (£38,000, 31 March 2013) was spent on direct charitable activity with a further £1,000 (£2,000 to 31 March 2013) spent on governance costs. Direct charitable activity expenditure included: 1. Purchase of New Equipment Total expenditure of £90,000, (£32,000, 31 March 2013) was spent on equipping the Lancashire First Responders with medical equipment and sundries as part of their training and paramedic support services. This has been done in conjunction with several local community schemes in providing both access to and training in the use of defibrillators. Successful recruitment drives during 2013/14 and the previous financial year has seen an increase in First Responder numbers which has generated an increased usage in staff uniform and medical sundries / equipment. 2. Staff Education and Welfare Total expenditure of £7,000, (£8,000, 31 March 2013) was spent on a variety of items including:

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2013/14 2012/13 Retirement Functions £2,900 £3,500 Flowers £500 £500 Miscellaneous £2,500 £1,300 Support Costs £1,100 £2,700 Total £7,000 £8,000 Costs continue to be monitored closely and it is pleasing to see costs reduced when compared with expenditure incurred in 2013/14. The Charitable Funds Committee remains committed to ensuring that all donations are used for the benefit of North West Ambulance Service NHS staff and the communities in which it serves. Approved on behalf of the Corporate Trustee Bob Williams, Chief Executive – North West Ambulance Service NHS Trust Date ……………………………………………

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Organisation

Page 1

CHARITABLE TRUST ACCOUNT - NORTH WEST AMBULANCE SERVICE NHS TRUST

Data entered below will be used throughout the workbook:

This year 2013-14Last year 2012-13This year ended 31st March 2014Last year ended 31st March 2013This year beginning 1 April 2014This year name 31 March 2014Last year name 31 March 2013

5 71

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Statement of Trustees responsibilities for the 12 months ended 31st March 2014

In preparing these financial statements, the Trustees are required to:

* Select suitable accounting policies and then apply them consistently.

* Make judgements and estimates that are reasonable and prudent.

*

*

*

*

These financial statements were approved by the Trustees and signed on its behalf by:

Chairman: ……………………………………………………. Date: ………………………………

Trustee: ……………………………………………………. Date: ………………………………

Under the Trust deed of the Charity and the Charity law, the Trustees are required to prepare financialstatements for each accounting period which show a true and fair view of the state of the affairs of theCharity and of its financial position.

The Trustees are required to act in accordance with the Trust deed of the Charity, within the framework ofTrust law. They are responsible for keeping proper accounting records, sufficient to disclose at any time,with reasonable accuracy, the financial position of the Charity at that time and enable the Trustees to ensurethat any statements of accounts comply with the requirements of regulations under that provision. Theyhave general responsibility for taking such steps as are reasonably open to them to safeguard the assets ofthe Charity and to prevent and detect fraud and other irregularities.

State whether the recommendations of the Statement of Recommended Practice ("Accountingand Reporting by Charities: Recommended Practice (SORP 2005)") have been followed, subjectto any material departures disclosed and explained in the financial statements.

State whether the financial statements comply with the Trust deed, subject to any materialdepartures disclosed and explained in the financial statements.

Prepare the financial statements on the on going basis unless it is inappropriate to presume thatthe Charity will continue its activities.

Ensure the accounts comply with the statutory requirements, the requirements of the Charity'sgoverning document and the requirements of the Charity SORP.

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Page 2


12 months to 12 months to31 March 2014 31 March 2013

Note Unrestricted Restricted Total TotalFunds Funds Funds Funds

£000 £000 £000 £000Incoming resourcesIncoming resources from generated funds:Voluntary income: 3 Donations 6 30 36 76

Legacies 9 10 19 27

Total incoming resources 15 40 55 103

Resources expendedCharitable activities: 5

Purchase of New Equipment - 90 90 32 Staff Education and Welfare 5 2 7 8 Patient Education and Welfare 2 1 3 (2)

Direct charitable expenditure 7 93 100 38

Governance costs 4 1 - 1 2

Total resources expended 8 93 101 40

Net incoming resources before transfersand other recognised gains and losses. 7 (53) (46) 63

Net incoming resources before otherrecognised gains and losses 7 (53) (46) 63

Net Movement in funds 7 (53) (46) 63

Reconciliation of Funds

Total Funds brought forward 1 April 2013 139 154 293 230

Total Funds carried forward 31 March 2013 146 101 247 293

North West Ambulance Service NHS Trust Charitable FundStatement of Financial Activities and Income & Expenditure for the 12 months ended 31st March 2014

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Page 3


Notes Unrestricted Restricted Total TotalFunds Funds Funds Funds

31 Mar 2014 31 March 2013£000 £000 £000 £000

Current Assets: 7 Stock - - - 1 Cash at bank and in hand 147 103 250 297

Total Current Assets 147 103 250 298

Creditors: Amounts falling duewithin one year 8 (1) (2) (3) (5)

Net Current Assets 146 101 247 293

Total Assets less Current Liabilities 146 101 247 293

Total Net Assets 146 101 247 293

Funds of the Charity 9

Restricted income funds 101 101 154 Unrestricted income funds 146 146 139

Total Charity Funds 146 101 247 293

Notes 1 to 8 form part of these accounts.

Signed ……………………………………………………………………

Bob Williams, Chief Executive of North West Ambulance Service NHS Trust

Date:

North West Ambulance Service NHS Trust Charitable Fund Balance Sheet as at 31 March 2014

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Page 5


Notes on the Accounts

1 Accounting Policies

(a) Basis of preparation

The financial statements have been prepared under the historic cost convention, with the exception of investments which are included atmarket value. The financial statements have been prepared in accordance with Accounting and Reporting by Charities: Statement ofRecommended Practice (SORP 2005) issued in March 2005 and applicable UK Accounting Standards and the Charities Act 2011.

(b) Funds structure

Restricted funds are funds which are to be used in accordance with specific restrictions imposed by the donor. Where the restrictionrequires the gift to be invested to produce income but the Trustees have the power to spend the capital, it is classed as expendableendowment. There are no expendable endowments at 31 March 2014.

Unrestricted income funds comprise those funds which the Trustee is free to use for any purpose in furtherance of the charitable objects.Unrestricted funds include designated funds where the donor has made known their non binding wishes or where Trustees, at theirdiscretion, have created a fund for a specific purpose. The Trustee ring fences designated funds within the unrestricted and unsures thatthe funds are used in a way that is consistent with the wishes of the donor.

The Charity has no endowment funds. The major funds held in both the restricted and unrestricted categories are disclosed in note 9.

(c ) Incoming resources

All incoming resources are recognised once the Charity has entitlement to the resources, it is certain that the resources will be receivedand the monetary value of incoming resources can be measured with sufficient reliability.

(d) Incoming Resources from Legacies

Legacies are accounted for as incoming resources either upon receipt or where the receipt is virtually certain; this will be onceconfirmation has been received from the representatives of the estate(s) that payment of the legacy will be made or property transferredand once all conditions attached to the legacy have been fulfilled.

(e) Resources expended

Expenditure is recognised when a liability is incurred. Contractual arrangements are recognised as goods and services are supplied.

(f) Irrecoverable VAT

Irrecoverable VAT is charged against the category of resources expended for which it was incurred.

(g) Charitable Activities

Costs of charitable activities comprise all costs incurred in the pursuit of the charitable objects of the Charity. These costs comprisedirect costs and an apportionment of support costs as shown in note 5.

(h) Governance cost

Governance costs comprise all costs incurred in the governance of the Charity. These costs include costs related to the independentexamination of the accounts together with an apportionment of support costs.

Assets give Assets give entitlemen Gifts made In all cases the amount at which gifts in kind are brought into account is either a reasonable estimate of their value to the funds or the amount actually Depreciation is charged on each main class of tangible asset as follows: The cost of employer pension contributions to the NHS Superannuation and other schemes is charged to the income and expenditure account.The main source of funding for the FHS Appeal Authority is income allocations from the Department of Health within an approved cash limit. Since 1 A The only class of tangible asset held is equipment, comprising office and information technology equipment, depreciated over its estimated life of 5 yeavaluations equipment Intangible income (eg the provision of free accommodation) is included in the accounts with an equivalent amount in outgoing resources, if there is a fin

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Page 5


(j) Fixed asset investments

(k) Realised gains and losses

(l) Change in the Basis of Accounting

(m) Stocks

2 Related Party Transactions

3 Analysis of voluntary income 12 months to 12 months to

Unrestricted Restricted 31 March 2014 31 March 2013Funds Funds Total Total

£000 £000 £000 £000

Donations from individuals and organisations 6 30 36 73 9 10 19 27

15 40 55 100

In unrestricted funds - £3,000 was received from the estate of Mrs Marie Germaine Calvin, £1,000 was reveived from the estate of Irene McGregor, £3,000 was received from the estate of Mrs Margaret Nichol.

In restricted funds - £10,000 was received from the estate of Alice Hesketh for Lancashire CFRs.

Legacies:

The Trustee is the North West Ambulance Service NHS Trust. All expenditure made from the Charitable Funds are for thebenefit of the North West Ambulance Service NHS Trust. During 2013 / 14 none of the members of the NHS Trust Boardor senior NHS Trust staff or parties related to them were beneficiaries of the Charity. NWAS is the creditor in the CharitableFunds Accounts.

The North West Ambulance Service NHS Charitable Trust has held no fixed asset investments in the financial year ended31 March 2014.

All gains and losses are taken to the Statement of Financial Activities as they arise. Realised gains and losses oninvestments are calculated as the difference between sales proceeds and opening market value (purchase date if later).Unrealised gains and losses are calculated as the difference between the market value at the period end and openingmarket value (purchase date if later).

Stocks are valued at the lower of cost and net realisable value.

The Accounts of the Charitable Trust have been prepared on a going concern basis.

Legacies

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4 Allocation of support costs

12 months to Allocated to 12 months to31 March 2014 Governance 31 March 2013

Total £000 £000 £000

Financial Services - - 4Independent Examination of Accounts 1 1 1

Total 1 1 5

5 Analysis of charitable expenditure

Activities 12 months to 12 months toundertaken 31 March 2014 31 March 2013

directly Total£000 £000 £000

Staff Education and Welfare 7 7 8Purchase of New Equipment 90 90 32Patient Education and Welfare 3 3 2-

Total 100 100 38

6 Independent Examiner's Remuneration12 months to 12 months to

31 March 2014 31 March 2013Total£000 £000

Independent examination charges 1 1

Total Cost 1 1

7 Analysis of current assets

(a) Stocks12 months to 12 months to

31 March 2014 31 March 2013Total £000 £000

Raw materials and consumables 0 1

Stocks relate to medical and surgical equipment and sundries held by the Lancashire First Responders.

(b) Analysis of cash and deposits 12 months to 12 months to

31 March 2014 31 March 2013 Total Total £000 £000

National Westminster Deposit Account 250 297

Total 250 297

Once the allocation of support costs has been made to Governance Costs, the balance is allocated to Charitable Activities.

The Charity undertook direct charitable activities mainly on the provision of staff welfare and the purchase of medical and surgical equipmentand sundries with regards to the First Responder Funds. The directors of North West Ambulance Service NHS Trust do not recieve anyremuneration or reimbursement of expenses from the Charity. In 2012/13 Patient Education and Welfare costs show a credit balance due to arebate issued on a vehicle leasing contract on a community vehicle which expired in 2012/13.

and were apportioned on time whilst in 2013-14 these costs were not recharged as due to its size and activity the charge was waived. In 2012-13 Financial Services costs were recharges from North West Ambulance Service NHS Trust for staff employed by the Trust

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8 Analysis of current liabilities and long term creditors

Creditors under 1 year31 March 31 March

2014 2013Total Total£000 £000

Other creditors 3 5

Total 3 5

9 Analysis of charitable fundsBalance Balance

31 March 1 April2014 2013

c/fwd b/fwd£000 £000

Type of FundsUnrestricted - General Purpose Funds 47 38Unrestricted - Designated Funds 99 101Restricted Funds 101 154

247 293

(a) Restricted funds Balance Resources Incoming Balance1 April expended resources 31 March

2013 2014b/fwd c/fwd£000 £000 £000 £000

Mayor of Wigan 45 - - 45 First Responders Community Fund 1 - - 1 Lancashire First Responders 108 (93) 40 55

Grand Total 154 (93) 40 101

Name of Fund Description, nature and purpose of the fund

First Responders Community Fund

Lancashire First Responders Fund

Mayor of Wigan RRV Fund

(b) Unrestricted funds Balance Resources Incoming Balance 1 April expended resources 31 March

2013 2014 b/fwd c/fwd £000 £000 £000 £000

Unrestricted - General Purpose Funds 38 (6) 15 47 Unrestricted - Designated Funds 101 (2) 99

139 (8) 15 146

Name of Fund Description, nature and purpose of the fund

This general fund represents the merger of general funds from the previous fourAmbulance Trusts. This fund has general objects for any charitable purposerelating to the North West Ambulance Service NHS Trust or purposes relating tothe National Health Service.

North West Ambulance ServiceGeneral Fund

Other creditors represent sums owed at the year end by the charity to a related party, North West Ambulance Service NHSTrust, for costs incurred by the NHS Trust on behalf of the charity in the furtherance of the charity's objects.

The objects of this restricted fund are to promote and support volunteer FirstResponder Teams operating in the Mersey & Cheshire area through fund raisingand access to training and medical equipment.

The objects of this restricted fund are to promote and support volunteer FirstResponder Teams operating in the Lancashire area through fund raising andaccess to training and medical equipment.

This restricted fund was established to purchase and maintain a Rapid Responsevehicle operating in the Wigan area.

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9 (b) - ContinuedDesignated Funds

31 March

2014

31 March 2013

£000 £000Nelson Ambulance Station 1 1Cumbria - Penrith area 4 4Cumbria Area - for the purchase of equipment 69 69Cumbria Ambulance Service 25 27

99 101

10 Post Balance Sheet Events

The designated funds are the funds the general designated for a specific purpose or an area.

The detailed funds below are all Designated Funds in that there are usually particular objective to be achieved.

There were no post Balance Sheet events.

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North West Ambulance Service NHS Trust Charitable Funds

Audit highlights memorandum and management letter

Year ended 31st March 2014

October 2014

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1© 2014 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.

North West Ambulance Service NHS Trust Charitable FundsImportant notice

This report is presented under the terms of our audit engagement letter.

■ Circulation of this report is restricted.

■ The content of this report is based solely on the procedures necessary for our audit.

Basis of preparationWe have prepared this Audit Committee Report (Report) in accordance with our audit engagement letter.Purpose of this reportThis Report is made to the Company’s Charitable Funds Committee in order to communicate matters of interest as required by ISAs (UK and Ireland), and other matters coming to our attention during our audit work that we consider might be of interest, and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone (beyond that which we may have as auditors) for this Report, or for the opinions we have formed in respect of this Report. Restrictions on distributionThis Report is subject to disclosure restrictions as set out in our Engagement Letter. Limitations on work performedThis Report is separate from our audit report and does not provide an additional opinion on the Charity’s financial statements, nor does it add to or extend or alter our duties and responsibilities as auditors reporting to the Charity’s members in accordance with the Charity Act 2011.We have not designed or performed procedures outside those required of us as auditors for the purpose of identifying or communicating any of the matters covered by this Report.Our responsibility for other information in the Charity‘s Annual Report and Financial Statements does not extend beyond the financial information identified in our auditor’s report. We have no obligation to perform any procedures to corroborate other information contained in those documents. However, prior to approval and signing we will continue to read the other information included in the Corporate Trustee‘s Report, and confirm that the information given, and the manner of its presentation, is materially consistent with the information, and its manner of presentation, with the financial statements.The matters reported are based on the knowledge gained as a result of being your auditors. We have not verified the accuracy or completeness of any such information other than in connection with and to the extent required for the purposes of our audit.Status of our auditOur audit is not yet complete and matters communicated in this Report may change pending signature of our audit report.

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Contents

The contacts at KPMG in connection with this report are:

Amanda LathamDirector Tel: +44(0) 1772473623 [email protected]

Debra ChamberlainSenior ManagerTel: +44(0) 161 2464189 [email protected]

Jessica BoothroydManager Tel: +44 (0)161 8388370 [email protected]

This report is made solely to the Corporate Trustee of North West Ambulance Service NHS Trust Charitable Fund, in accordance with the terms of our engagement. It has been released to the Corporate Trustee on the basis that this report shall not be copied, referred to or disclosed, in whole (save for the Trustee’s own internal purposes) or in part, without our prior written consent.Matters coming to our attention during our audit work have been considered so that we might state to the Corporate Trustee those matters we are required to state to the Corporate Trustee in this report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than the Charity and its Corporate Trustee, for our work referable to this report, for this report, or for the opinions we have formed.

Please note that that this report is confidential between the Corporate Trustee and this firm. Any disclosure of this report beyond what is permitted above will prejudice this firm’s commercial interests. A request for our consent to any such wider disclosure may result in our agreement to these disclosure restrictions being lifted in part. If the Corporate Trustee receive a request for disclosure of this report under the Freedom of Information Act 2000, having regard to these actionable disclosure restrictions you must let us know and you must not make a disclosure in response to any such request without our prior written consent.

Page

Executive summary 3

Appendices

Appendix 1: Mandatory communicationsAppendix 2: Unadjusted and Adjusted Audit DifferencesAppendix 3: Follow up of prior year recommendations.Appendix 4: Accounting developmentsAppendix 5: Tax legislation updateAppendix 6: UK Chancellor's Budget 2014 – An Overview

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mailto:[email protected]




Executive summary

Audit conclusions

■ Unqualified audit opinion proposed on financial statements. Our Mandatory Communications in relation to our audit are set out in Appendix 1.

Accounting matters

■ No significant accounting issues arose during the course of our audit.

■ Accounting policies appropriate for the annual report and the financial statements are in accordance with disclosure requirements of relevant charitieslegislation, UK GAAP and the Statement of Recommended Practice.

■ We have summarised future accounting developments relevant to the Charitable Fund at Appendix 4. We have also included for information a Tax Legislation update at Appendix 5, and an overview of the UK Chancellor’s Budget 2014 at Appendix 6.

Auditing matters

■ No significant audit issues arose during the course of our audit of the North West Ambulance Service NHS Trust Charitable Fund.

■ No instances of fraud or of management override of controls have been identified during our audit work.

Systems and controls

■ No major weaknesses in the financial systems were identified.

■ A summary of unadjusted and adjusted audit differences is included at Appendix 2.

■ We have followed up on the recommendations we made in previous years at Appendix 3.

Regulatory and tax matters

■ No significant regulatory or tax matters came to our attention during the course of our normal audit work.

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Appendix 1Mandatory communications

Area Key content

Adjusted audit differences

Adjustments made as a result of our audit

There was one adjusted audit difference, which was a reclassification of income between Restricted and Unrestricted Funds. There was no impact on the Net Movement in Funds.

A summary of unadjusted and adjusted audit differences is included at Appendix 2.

Unadjusted audit differences

Audit differences identified that we do not consider material to our audit opinion

There are no unadjusted audit differences which we are required to request that you adjust for under ISA 450.

A summary of unadjusted and adjusted audit differences is included at Appendix 2.

Draft management representation letter

Proposed draft of letter to be issued by the Company to KPMG prior to audit sign-off

We have not requested any specific representations in addition to those areas normally covered by our standard representation letter for the year ended 31st March 2014.

Related parties There were no significant matters that arose during the audit in connection with the entity's related parties. (Not required where all those charged with governance are involved in managing the entity),

Other matters warranting attention by those charged with governance

There were no matters to report in respect of material weaknesses or questions of management integrity or fraud involving management.

Disagreement with management There have been no disagreements with management on financial accounting and reporting matters that, if not satisfactorily resolved, would have caused a modification of our auditors’ report on the Charity‘s financial statements. We encountered no fundamental difficulties in dealing with management in performing the audit.

Consultation with other accountants To the best of our knowledge, management has not consulted with or obtained opinions, written or oral, from other independent accountants during the past year that were subject to the requirements of Statement 1.213 of the Institute of Chartered Accountants in England and Wales Guide of Professional Ethics.

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Under UK auditing standards (ISA (UK&I) 260) we are required to provide the Charitable Funds Committee with a summary of unadjusted audit differences identified during the course of our audit, other than those which are ‘clearly trivial’, which are not reflected in the financial statements. ISA (UK&I) 450 requires us to request that you correct uncorrected misstatements. However, they will have no effect on the opinion in our auditor’s report, individually or in aggregate. Details of all unadjusted differences greater than £100 are shown below:

Unadjusted audit differences (£)

No unadjusted audit differences were noted from the audit.

Appendix 2Unadjusted and Adjusted audit differences

Under UK auditing standards (ISA UK&I 260) we are required to provide the Audit Committee with a summary of adjusted audit differences identified during the course of our audit. The adjustments below have been included in the financial statements for the North West Ambulance Service NHT Trust Charitable Funds for the year ended 31 March 2014.

Adjusted audit differences (£)

No. Detail

Statement of Financial Activities

and Income & Expenditure Dr/(Cr)

Balance sheetDr/(Cr) Comments

1 Dr Unrestricted Funds Incoming Resources (Donations)Cr Restricted Funds Incoming Resources (Donations)

Dr Restricted Funds Cash at Bank and in HandCr Unrestricted Funds Cash at Bank and in Hand

£3,000(£3,000)

£3,000(£3,000)

Reclassification of Incoming Resources, relating to one donation to the Restricted Funds which had been incorrectly classified as relating to the Unrestricted Funds.

Total - -

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Appendix 3Follow up of Prior Year Recommendations

In our report for 12/13 we raised two recommendations as follows:

Grade A – These are particularly significant matters for the organisation, such as those relating to factors critical to the successful running of the scheme and regulatory environment. We have identified one grade A observation in the current year.

Grade B – These include observations on non-critical control systems, one-off items subsequently corrected, improvements to the efficiency of effectiveness of controls and matters that could be significant in the future. We have identified one grade B observation in the current year.

Grade C – These are less significant than those graded A and B but we nevertheless consider that they merit attention by Management. We have not identified any grade C observations in the current year.

Grade Observation Risk Observation & Recommendation Managements response Implemented

Classification of income

Distinction between restricted and unrestricted funds

The controls in relation to the classification of income are not operating effectively and as a result we have not been able to obtain evidence as to whether the income received in year has been correctly classified as restricted or unrestricted

The Trust does not have formal controls in place on receipt of income to provide an audit trail as to whether the income should be restricted or unrestricted.

We recommend that the Trust should establish a policy to help rectify this problem for the future. For example, all donors could complete a form and tick a box if they want the donation to be used for a specific purpose and the form can could have a list of established restricted funds to choose from. If a specific fund is not identified, the donation could be assigned to the general fund.

Agreed. A procedure being developed to include the backup documentation to enable capture of necessary information on the nature of donation.

Head of Technical Accounts 31 October 2013.

Fully Implemented. There is now a procedure in place at the Trust where back up data is retained in order to evidence that income is restricted or unrestricted on receipt.

Income cut-off

Classification of income within the appropriate financial period

Charity income is generated throughout the financial year. Receipts around the start or end of the financial year risk being classified within the wrong financial period.

As noted in Appendix two we identified one material adjusted audit difference relating to the classification of incoming resources.The Trust should review income received to ensure that it has been classified within the correct financial year.

Agreed. All income around year end will reviewed to establish correct period of accounting.

Head of Technical Accounts 31 October 2013.

Fully Implemented. Income was found to be recorded in the correct period in our audit testing; due to back up documentation now being retained for income, the correct accounting period is evident for all income.

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Appendix 4Accounting developments

New UK GAAP In March 2013, the Financial Report Council (FRC) issued FRS102, the Financial Reporting Standard applicable in the UK and Republic of Ireland. This is the main part of the new UK GAAP regime and follows the issue in November 2012 of FRS 100 (overview of the framework) and FRS 101 (reduced disclosure framework that is not applicable to charities).

Charities will apply FRS 102, or, if eligible the FRSSE. They are not allowed to apply EU-IFRS or FRS 101. FRS 102 is based on the IFRS for Small and Medium Sized Enterprises (IFRS for SMEs) although amendments were made specifically for the UK market. There is a reduced disclosure framework under FRS 102 which, if certain criteria are met, exempts a charity’s subsidiaries from preparing a cash flow statement, and certain other disclosures. The current draft of the Charity SORP Exposure Draft does not allow charitable subsidiaries to adopt this reduced disclosure framework.

New UK GAAP is applicable for accounting periods beginning on or after 1 January 2015. This will require a transition balance sheet for the North West Ambulance Service NHS Trust Charitable Fund to be prepared as at 1 April 2014. Early adoption is permitted for periods ending on or after 31 December 2012 once the Charities SORP has been issued.

Accounting regime Applicable to: Example:

FRS 102 ■ Large and medium sized entities ■ Large and medium private companies

■ Larger charities

FRS 102 with reduced disclosures ■ Individual accounts of qualifying parent and subsidiary entities*

■ Parent company and subsidiaries in a group

■ Company subsidiaries in a charitable group

FRSSE ■ Eligible small entities ■ Small** private companies

■ Small** charities

* A qualifying parent or subsidiary is a member of a group that prepares publicly available financial statements intended to give a true and fair view, in which it is consolidated. Fewer exemptions are available for financial institutions.

* * As defined by company law

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Appendix 4Accounting developments (continued)

Selected GAAP differences

Current UK GAAP FRS 102 EU-IFRS*

Defined benefit pension plans

■ Multi-employer plans (including group) off balance sheet in individual accounts

■ Expected return on assets reflects returns expected on assets held

■ Group plans must be on at least one balance sheet. For non-group multi-employer plans, provision is made for agreed deficit funding

■ One net interest charge/credit based on net balance sheet asset/liability i.e., return on asset element calculated using liability discount rate

■ Group plans must be on at least one balance sheet. For non-group multi-employer plans, provision is made for agreed deficit funding

■ One net interest charge/credit based on net balance sheet asset/liability i.e., return on asset element calculated using liability discount rate (for periods commencing 1 January 2013)

Goodwill ■ Rebuttable presumption that amortised over maximum life of 20 years

■ Intangibles generally subsumed within goodwill

■ Amortised over a presumed life of five years unless has longer life

■ Intangibles recognised separately

■ No amortisation, but reviewed annually for impairment

■ Intangibles recognised separately

Derivatives ■ Generally off balance sheet (non-FRS 26) ■ On balance sheet ■ On balance sheet

Intercompany payables and receivables

■ Recognised at face value (non-FRS 26) ■ Recognised at fair value

■ If the loan is for a fixed term and not at a commercial rate then fair value will not equal face value.

■ Recognised at fair value

■ If the loan is for a fixed term and not at a commercial rate then fair value will not equal face value.

Borrowing / Development costs

■ May capitalise when criteria met ■ May capitalise when criteria met ■ Must capitalise when criteria met

* Under company and charity law a charity cannot apply EU-IFRS. The accounting treatment is given here for completeness.

FRS 102 GAAP differencesDifferences between FRS 102 and current UK GAAP that may impact charities include:

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FRS 102 Public benefit entity requirementsUnder FRS 102 charities are public benefit entities (PBEs) and therefore follow the PBE requirements given for:

Statement Of Recommended Practice (SORP)In July 2014, the SORP Committee issued the new Charity SORPs to reflect the new UK accounting framework and to provide guidance on the application of FRS 102. The new SORPs provide a comprehensive framework for charity accounting that all charities that prepare accrual accounts must follow. The new SORPs apply to financial years beginning on or after 1 January 2015. The new SORPs were needed due to changes in UK accounting following the new Financial Reporting Standard (FRS102) that was issued by the Financial Reporting Council in March 2013. In their joint role as the SORP-making body for UK charities, the regulators have been working closely with the sector-based SORP committee to write the new SORPs, which included a public consultation held from July to November 2013.

Responding to sector feedback the new framework provides a SORP to support each of the accounting standards from which charities can choose, depending on their size. Broadly speaking, in order to use the FRSSE, charities must meet two out of three of the following criteria: an annual income of less than £6.5million; total assets of less than £3.26million; or fewer than 50 employees. FRS 102 may be followed by any charity. Charities following FRS 102 are often required to provide more information in the notes to the accounts and must provide a Statement of Cash-flows irrespective of their level of income.

It is essential for a charity to make the correct choice before downloading, customising or selecting SORP modules. Although the two SORPS have the same structure and order of modules, the requirements differ significantly due to underlying differences in terminology, accounting policies and disclosures required by the FRSSE and FRS 102. The FRSSE SORP and FRS 102 SORP share the same requirements for the form and contents of the Corporate Trustee‘s annual report, fund accounting and common formats for the balance sheet, however there are many areas of difference including a different treatment for realised and unrealised gains and losses on investments in the statement of financial activities.

The new SORPs can be viewed on the SORP microsite http://www.charitysorp.org/ along with a help sheet http://www.charitysorp.org/about-the-sorp/helpsheets/ to assist charities in making their decision about which accounting framework to follow.

■ Property held for the provision of social benefits

■ Funding commitments

■ Concessionary loans – loans between a PBE and a third party at below market rate that are not repayable on demand

■ Incoming resources from non-exchange transactions – donated goods & services

■ Public benefit entity combinations – combinations that are in substance a gift, or are a merger

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http://www.charitysorp.org/download-a-full-sorp/

http://www.charitysorp.org/customise-your-sorp/

http://www.charitysorp.org/choose-sorp-modules/

http://www.charitysorp.org/

http://www.charitysorp.org/about-the-sorp/helpsheets/


Summary of key differences

New SORP

Trustee’s Report ■ Risk management - expanded for larger charities to include an explanation of the principal risks and uncertainties faced by the charity and how these risks are managed.

■ Achievements and performance – the Corporate Trustee must provide a balanced picture and should identify the effect or impact of results on beneficiaries and wider society.

■ Going concern – nature of any uncertainties must be explained.

■ Reserves policy – the Corporate Trustee must disclose if there is no reserves policy and give reasons for this.

■ Pension liability – disclose the impact of any material pension liability.

■ Trustee names – the concession allowing only 50 trustee names to be given has been removed so that now all trustee names must be reported.

SoFA ■ The number of headings within the SoFA has been reduced and a “plain English” style adopted to describe the nature of the income or expenditure included within each heading of the SoFA.

■ The treatment of investment gains and losses has changed to reflect FRS 102 requirements. These will be recognised within the “Income and Expenditure” part of the SoFA instead of the “STRGL” part where they currently sit.

Income recognition ■ Income is recognised when it is probable (previously virtually certain). The SORP ED includes guidance as to when legacies are recognised (on probate).

■ Income from pledges is recognised when it is probable and can be measured.

■ Income from goods donated for sale or distribution is recognised at time of receipt at fair value where practicable. Otherwise it is recognised as income when the goods are sold or distributed.

Cash flow statement ■ The statement of cash flows required by FRS 102 is different to the current format. The new SORP gives more guidance than the current SORP with examples of cash flows that fall within the mandatory headings.

Trustee and management remuneration ■ More guidance is given for where a trustee has a dual role as a trustee and employee.

■ Must disclose the total amount paid to key management personnel and any benefits paid to trustees on an individual basis.

SORP Exposure Draft – summary of key changes from current SORP (2005)


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Appendix 5Tax legislation update

Auto-enrolmentAll charities must “auto-enrol” eligible jobholders into either:

a) National Employment Savings Trust (“NEST”); or

b) Their own qualifying workplace scheme

Requirements phased in between October 2012 and October 2017 for all eligible Jobholders, those between the age of 22 and the State Pension Age. When the scheme is fully inforce employers will have to pay a minimum of 3% of qualifying earnings. Employees can only opt out after 1 month in the scheme, but, crucially, must be auto-enrolled again after 3years. There may be opportunity to offset the additional cost to employers through salary sacrifice.

Employment AllowanceFrom April 2014 all UK employers (businesses and charities) will be eligible for a new £2,000 Employment Allowance. The effect of this allowance is that it will reduce the overall amount of Employer’s NIC payable to HMRC each year.

Each business will be able to employ one individual on an annual salary of £22,400, or four staff on the National Minimum Wage (£12,070 per annum), without having to pay any Employer’s NIC at all.

The scheme will be administered through payroll reporting and Real Time Information and employers will be required to opt in to confirm eligibility for the allowance. It is not yet known how the new Employment Allowance will operate in relation to companies with multiple payrolls, more than one PAYE scheme reference or Group structures.

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Appendix 6UK Chancellor's Budget 2014 – An Overview

We have set out below a summary of the key elements of the UK Chancellor’s Budget which may impact the charity:

Corporation TaxThe following announcements made in the Budget will be applicable to non-charitable subsidiary companies:

Rate of corporation taxThe current main rate of corporation tax is 23 per cent, falling to 21 per cent from 1 April 2014 and 20 per cent from 1 April 2015. The small companies’ rate of corporation tax will remain at 20 per cent.

Capital allowancesThere will be an increase in the Annual Investment Allowance limit from £250,000 to £500,000 for all qualifying investments in plant and machinery made between 1 April 2014 to 31 December 2015.

Stamp Duty Land Tax (SDLT)

Charity reliefAs announced at Autumn Statement 2013, the Government will introduce legislation to extend the SDLT relief available to charities purchasing land jointly with a non-charity. The effect will be that where two or more purchasers acquire land as tenants-in-common, where at least one of them is a charity, and one is not, then the charity may claim relief on its share, subject to the land being held for qualifying charitable purposes. The changes follow the Court of Appeal judgment in the case of The Pollen Estate Trustee Company Limited & Kings College London v HMRC Comrs. The Court held in that case that where a charity is buying land jointly with a non-charity then SDLT relief may be claimed by the charity on its share of the land interest. The legislation will come into effect from the date of Royal Assent to the Finance Bill 2014 and will provide welcome clarification to the SDLT rules.

Extension of the 15 per cent rate of SDLT to property purchases over £500,000The 15 per cent rate of SDLT has been extended to companies (and other corporate vehicles) buying residential property with a value over £500,000. This will apply to land transactions where the effective date is on or after 20 March 2014.

Employment Tax

Rates, thresholds and allowancesRates of income tax will remain the same for 2014/15 at 20 per cent, 40 per cent and 45 per cent. As widely speculated in the run up to today’s Budget, the Chancellor has announced an increase of the threshold at which the 40 per cent tax rate will apply from 6 April 2014 to £41,865, increasing to £42,285 from 6 April 2015. The 45 per cent rate will continue to apply on income above £150,000 per annum.From April, most employers will be able to claim an Employment Allowance to reduce their employer’s Class 1 National Insurance contributions (NIC) by up to £2,000 each year. The previously announced NIC rates and thresholds for 2014/15 remain unchanged.Employer’s NICs for under-21 year olds paid up to the Upper Earnings Limit (£805 per week for 2014/15) will be abolished with effect from 6 April 2015.

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Appendix 6UK Chancellor's Budget 2014 – An Overview

Employment Tax (continued)

Beneficial loansAs announced in last year’s Budget, the statutory exemption threshold for employment-related loans will increase with effect from April 2014 from £5,000 to £10,000.

Childcare costs Following a recent consultation on tax free childcare, yesterday HM Treasury released the Government’s response to the consultation in which it was confirmed that a new scheme will be introduced from autumn 2015 to replace the current tax relief available via relief at source on employment income. From autumn 2015 when the new scheme is introduced, existing employer-supported childcare arrangements will be closed to new entrants.To be eligible, both parents must work (or one parent in the case of single parent families), with each earning more than approximately £50 per week and less than £150,000 a year, and not already receiving support through tax credits (and Universal Credit). There have been several key changes to the original proposals announced last year, including:The original childcare costs limit of £6,000 has now been increased to £10,000, with the Government contributing 20 per cent up to this limit (i.e. maximum £2,000 Government contribution) for each eligible child (not per parent). The age limit will increase over the first year the scheme is introduced to include all children up to age 12 by autumn 2016.Accounts will be required to be opened with National Savings & Investments (NS&I) via online accounts with top-ups of up to £500 per child made each quarter. Parents can then arrange for payments to be made to formally registered or approved childcare provider(s) directly from their NS&I account.

Contacts

If you have any queries regarding any of the announcements in the 2014 Budget Report please contact one of the Charities Tax team below or your local KPMG contact.

Direct Tax Jasmin Bryan [email protected] 652149

Value Added TaxCarolyn [email protected] 7311 5565

Employment tax Stephen Baker [email protected] 694 1908

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mailto:[email protected]?subject=UK%20Chancellor's%20Budget%202014%20%E2%80%93%20Charities

mailto:[email protected]?subject=UK%20Chancellor's%20Budget%202014%20%E2%80%93%20Charities

© 2014 KPMG LLP, a UK limited liability partnership, is a subsidiary of KPMG Europe LLP and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative, a Swiss entity. All rights reserved.

The KPMG name, logo and ‘cutting through complexity’ are registered trademarks or trademarks of KPMG International Cooperative (KPMG International).

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Independent auditor’s report to the Corporate Trustee of North West Ambulance

Service NHS Trust Charitable Fund

We have audited the group and charity financial statements (the ‘financial statements’) of

North West Ambulance Service NHS Trust Charitable Fund for the year ended 31st

March 2014. The financial reporting framework that has been applied in their preparation

is applicable law and UK Accounting Standards (UK Generally Accepted Accounting

Practice), including FRS 102.

This report is made solely to the charity’s Corporate Trustee, in accordance with section

145 of the Charities Act 2011 (or its predecessors) and regulations made under section

154 of that Act. Our audit work has been undertaken so that we might state to the

charity’s Corporate Trustee those matters we are required to state to them in an auditor’s

report and for no other purpose. To the fullest extent permitted by law, we do not accept

or assume responsibility to anyone other than the charity and its Corporate Trustee for our

audit work, for this report, or for the opinions we have formed.

Respective responsibilities of trustee and auditor

As explained more fully in the Statement of Trustee’s Responsibilities set out on page

[number] the trustee is responsible for the preparation of financial statements which give

a true and fair view.

We have been appointed as auditor under section 145 of the Charities Act 2011 (or its

predecessors) and report in accordance with regulations made under section 154 of that

Act. Our responsibility is to audit, and express an opinion on, the financial statements in

accordance with applicable law and International Standards on Auditing (UK and

Ireland). Those standards require us to comply with the Auditing Practices Board’s

Ethical Standards for Auditors.

Scope of the audit of the financial statements

A description of the scope of an audit of financial statements is provided on the Financial

Reporting Council’s website at www.frc.org.uk/auditscopeukprivate.

Opinion on financial statements

In our opinion the financial statements:

give a true and fair view of the state of the group’s and of the charity’s affairs as at

31st March 2014 and of the charity’s incoming resources and application of resources

for the year then ended;

have been properly prepared in accordance with UK Generally Accepted Accounting

Practice; and

have been properly prepared in accordance with the requirements of the Charities Act

2011.

Matters on which we are required to report by exception

We have nothing to report in respect of the following matters where the Charities Act

2011 requires us to report to you if, in our opinion:

the information given in the Trustee’s Annual Report is inconsistent in any material

respect with the financial statements; or

the charity has not kept sufficient accounting records; or

the financial statements are not in agreement with the accounting records and

returns; or

we have not received all the information and explanations we require for our audit.

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http://www.frc.org.uk/auditscopeukprivate

Amanda Latham

for and on behalf of KPMG LLP, Statutory Auditor

Chartered Accountants

St James Square, Manchester, M2 6DS

[Date]

KPMG LLP is eligible to act as an auditor in terms of section 1212 of the Companies Act

2006

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Statement of Trustee’s responsibilities in respect of the Trustee’s annual report and

the financial statements

Under charity law, the Corporate Trustee is responsible for preparing the Trustee’s

Annual Report and the financial statements in accordance with applicable law and

regulations.

Charity law requires the trustees to prepare financial statements for each financial year.

The charity’s financial statements are required by law to give a true and fair view of the

state of affairs of the charity and of the charity’s excess of expenditure over income for

that period.

In preparing these financial statements, generally accepted accounting practice entails that

the trustee:

selects suitable accounting policies and then applies them consistently;

makes judgements and estimates that are reasonable and prudent;

states whether applicable UK Accounting Standards and the Statement of

Recommended Practice have been followed, subject to any material departures

disclosed and explained in the financial statements;

states whether the financial statements comply with the trust deed and rules, subject

to any material departures disclosed and explained in the financial statements; and

prepares the financial statements on the going concern basis unless it is inappropriate

to presume that the charity will continue in business.

The Corporate Trustee is required to act in accordance with the trust deed and the rules of

the charity, within the framework of trust law. They are responsible for keeping proper

accounting records, sufficient to disclose at any time, with reasonable accuracy, the

financial position of the charity at that time, and to enable the trustees to ensure that,

where any statements of accounts are prepared by them under section 132(1) of the

Charities Act 2011, those statements of accounts comply with the requirements of

regulations under that provision. They have general responsibility for taking such steps as

are reasonably open to them to safeguard the assets of the charity and to prevent and

detect fraud and other irregularities.

The Corporate Trustee is responsible for the maintenance and integrity of the financial

and other information included on the charity’s website. Legislation in the UK governing

the preparation and dissemination of financial statements may differ from legislation in

other jurisdictions.

Signed on behalf of the Corporate Trustee

………………………………....... Date:

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25. Item 9.4-Committees Report

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- 1 of 7 -


Subject: Report of Board Committees

Report of: Committee Chairs Prepared by: Corporate Secretary

PAPER FOR APPROVAL


-----

NHS Constitution This paper supports the following principles that guide the NHS: The NHS provides a comprehensive service to all







X The NHS is committed to providing best value for taxpayers’


finite resources

X The NHS is accountable to the public, communities and



-----


-----


Completed

Not required

Attachments: Annex A: Terms of Reference - Charitable Funds Committee


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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- 3 of 7 -

1. INTRODUCTION

1.1

The purpose of this report is to inform the Board of Directors of matters discussed at recent

meetings of Board Committees.

2. CHARITABLE FUNDS COMMITTEE – CHAIR, MR J TOWNSEND

2.1

2.2

2.3

2.4

The Charitable Funds Committee met on 29 October 2014 and considered an agenda which

included the following items:

Annual Report & Accounts 2013/14

Charitable Funds Progress Report 2014/15

Terms of Reference – Annual Review

With regard to matters to bring to the attention of the Board, the Committee reviewed the

Annual Report & Accounts for 2013/14 and noted that the audit of the financial statements

by KPMG LLP had resulted in an unqualified opinion. The Committee subsequently

recommended the Annual Report & Accounts to the Board of Directors for approval and

this subject will form a separate agenda item for the meeting on 26 November 2014.

Approval by the Board will facilitate submission of the accounts to the Charities

Commission in advance of the deadline date of 31 January 2015.

The Committee considered a progress report relating to Charitable Funds during 2014/15

and noted receipt of a legacy of some £132k for specific use in the Runcorn area.

Expenditure proposals are currently being formulated by operational teams in this area.

The Committee considered proposed expenditure of funds from an earlier legacy which

specified use in the Cumbria area. The proposal related to procurement of medical training

equipment and, following a detailed debate, the Committee recommended the proposal to

the Board of Directors for approval.

Finally, the Committee completed the annual review of its Terms of Reference and agreed

that the membership and frequency of meetings remained valid. One amendment to the

Terms of Reference was proposed which relates to an updated reference to the Charities

Act in s2.1. The Board of Directors is recommended to approve the reviewed Terms of

Reference included at Annex A.

3. WORKFORCE & COMMUNITIES COMMITTEE – CHAIR, MR P WHITE

3.1

The Workforce & Communities Committee met on 4 November 2014 and considered an

agenda which included the following items:

Workforce Dashboard Report

Mandatory Training & Appraisal Report

HCPC Registration Checks Report

Industrial Action Review

Library & Knowledge Service Report Communities Strategy - Progress Report Communication & Engagement Strategy - Progress Report Sustainable Development Update Report

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3.2

3.3

3.4

3.5

With regard to matters to bring to the attention of the Board, the Committee considered a

Workforce Dashboard Report which provided details on progress against key workforce

indicators of; Workforce Profile & Recruitment, Appraisals, Mandatory Training, Payroll and

Sickness Absence. The Committee noted in particular the development of benchmark data

which facilitated performance comparison with other clients of the Trust’s payroll provider.

The Committee was able to take positive assurance from this data, which showed that the

Trust’s payroll performance was consistent with the performance of other clients, and

noted work to develop similar benchmark data in relation to overpayments.

The Committee noted recruitment activities currently being undertaken for PES, and the

consequent effect on vacancy factors across various staff grades, and discussed the use of

‘what if’ scenarios to inform future workforce planning and the potential need for a risk-

based approach to over-recruitment. The Committee noted the current position against

mandatory training and appraisals, both of which have been impacted by REAP Level

operations. Proposals relating to both of these indicators were the subject of a separate

report. With regard to sickness absence, the Committee noted an increased absence rate

during August 2014 and the likelihood of a similar increase in September 2014. The

Committee discussed the initiatives being taken to address absence levels and noted that,

while any success of such initiatives was likely to be in the longer term, there had been

limited impact to date. The Chair of the Committee suggested that consideration may need

to be given to introduction of a dedicated team and adoption a more interventionist

approach to support managers.

The Committee considered a detailed report which set out the current position for

mandatory training and appraisals together with a proposed future management approach

for each key indicator. The Committee endorsed the proposal relating to mandatory

training which will result in the cycles for training in PES, PTS and Corporate being

synchronised with training being delivered on an annual basis, as opposed to the previous

2-year cycle, from January 2015. With regard to appraisals, Board members will be aware

of the transition from a 2-year programme to an annual programme in 2014/15 with a

target for the current year of 85% completion by 31 March 2015. The report considered by

the Committee advised that the target would not be achieved (PES appraisals have

currently been suspended until January 2015 due to REAP Level 4) and proposed a recovery

trajectory for completion of appraisals for PES, PTS and 111 staff groups which would

extend beyond 31 March 2015. The Committee considered the importance of the appraisal

process in terms of service quality and staff development and the risk that the process

could be devalued by what would effectively be a deferment. The Committee agreed that a

position on this matter would need to be determined by the Board and the subject will

form a separate agenda item for the meeting on 26 November 2014.

The Committee then reviewed a report which provided positive assurance on the bi-annual

check of Paramedic registration, which was completed in September 2014, and the

Committee noted assurance that robust arrangements are in place for checking the

registration status of nurses employed in the 111 service. The Committee also considered a

report which provided assurance on how the Trust’s Library & Knowledge Service supports

delivery of the Trust’s strategic objectives. The Director of Organisational Development

then briefed the Committee on the impact and lessons learned from industrial action taken

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3.6

during October 2014 and preparatory work in advance of further industrial action

scheduled to commence on 24 November 2014.

Finally, the Committee reviewed a report which detailed good progress being made against

each of the five aims in the Trust’s Communities Strategy and noted in particular the

positive outcome of the Trust’s most recent self-assessment against the Good Corporate

Citizenship Model with targets for 2015 already being achieved. A similar level of positive

assurance can be reported following the Committee’s consideration of a progress report on

the Year 2 delivery plan for the Communication & Engagement Strategy. The Committee

completed the meeting by consideration of a report that provided assurance on the

project-based approach which was adopted for production of the Climate Change

Adaptation Plan.

4. AUDIT COMMITTEE – CHAIR, MR J TOWNSEND

4.1

4.2

4.3

The Audit Committee met on 11 November 2014 and considered an agenda which included

the following items:

Internal Audit Progress Report

Internal Audit Follow-Up on Audit Recommendations

Anti-Fraud Progress Report

MIAA Briefing Notes

External Audit Technical Update

Board Assurance Framework Management Report – Follow-Up on Audit Recommendations Anti-Fraud, Bribery & Corruption Policy Waivers of Standing Orders

With regard to matters to bring to the attention of the Board, the Chairman opened the

meeting by providing an overview of a recent seminar he had attended which had been

facilitated by the NHS Trust Development Authority. He noted that the seminar had

included an interesting presentation by PriceWaterhouseCooper which covered the role of

Audit Committees in relation to risk, governance and assurance. Mr A Slater also provided

an overview of matters discussed at a meeting of the Chairs of Finance & Audit Committees

in the ambulance trust sector.

The Committee reviewed the Internal Audit Progress Report which detailed the outcomes

of audit work completed since the previous Committee meeting. This work, and the

outcomes, were as follows:

Board Reporting - Significant Assurance

111 Service Governance - Significant Assurance

Cost Improvement Programmes - Significant Assurance

IT Service Management - Significant Assurance

The Committee also considered a report from Internal Audit on their follow-up on the

implementation of audit recommendations. The report provided the Committee with

positive assurance that recommendations arising from audit work were being implemented

and could be evidenced with appropriate documentation. This report complimented a

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4.4

4.5

4.6

management report on the same subject which provided a similarly strong level of

assurance.

The Committee considered an Anti-Fraud Progress Report and noted that good progress

was being made against the Anti-Fraud plan for 2014/15. The Committee also noted the

involvement of the Local Counter Fraud Specialist (LCFS) in the Trust’s review of the Anti-

Fraud, Bribery & Corruption Policy and the Committee subsequently approved the revised

policy. The Board of Directors is requested to ratify this policy approval. The Committee

also reviewed briefing papers prepared for information by Mersey Internal Audit Agency on

the following subjects:

Sustainable, Resilient, Healthy People & Places

Human Factors - Improving Patient Safety

These briefing papers provide a useful summary of the relevant topics and Board members

are encouraged to read the papers which can be accessed via the Audit Committee meeting

pack. Similarly, Board members are also encouraged to read the Technical Update

prepared by External Audit which was considered by the Committee and provides a helpful

aide memoire on a variety of subjects at a national level.

The Committee reviewed the Board Assurance Framework (BAF) and Board members

should note that the Committee has adopted a fresh approach to such reviews and the

emphasis of the Committee’s work is now firmly on seeking assurance on the relevance and

effectiveness of the controls applied to the BAF content in order to mitigate risks. This

revised emphasis will result in more focused analysis and will involve the attendance of

relevant management representatives to brief the Committee on control measures and

sources of internal / external assurance. With regard to the BAF content itself the

Committee noted escalation of Risk ID 1374, which relates to the impact of industrial

action, and this particular risk will feature in the BAF to be considered by the Board on 26

November 2014.

Finally, the Committee completed its periodic review of the Register of Waivers of Standing

Orders and considered the minutes of recent Quality Committee and Information

Governance Management Group meetings. As a result of the latter, the Committee has

scheduled an assurance briefing from the Head of Health Informatics for its next meeting in

February 2015.

5. FINANCE, INVESTMENT & PLANNING COMMITTEE – CHAIR, MR A SLATER

5.1

The Finance, Investment & Planning Committee is scheduled to meet on 21 November 2014

and will consider an agenda which includes the following items:

Cost Improvement Programme 2014/15

Contract Performance Report

Strategic Planning Update Report

Value for Money Risks

Financial Strategy

Reimbursement for Urgent & Emergency Care

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As publication of the Board papers will precede the Committee meeting date, the Chair of

the Committee will provide a verbal briefing on matters arising at the Board of Directors

meeting on 26 November 2014.


6.1 There are no legal implications arising from the subject matter of this report.



Receive the report and note the assurances provided on matters considered at the

relevant Committee meetings

Ratify the Audit Committee decision to approve a revised Anti-Fraud, Bribery &

Corruption Policy

Approve Terms of Reference for the Charitable Funds Committee included at Annex

A

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26. Item 9.4-Attach to Committees Report

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Charitable Funds Committee Approved: Draft | Review date: Draft Page 1 of 4

NORTH WEST AMBULANCE SERVICE NHS TRUST

CHARITABLE FUNDS COMMITTEE

TERMS OF REFERENCE

1. CONSTITUTION

1.1 The Board of Directors hereby resolves to establish a Committee of the Board, to be

known as the Charitable Funds Committee (hereinafter referred to as ‘the

Committee’). The Committee is a non-executive Committee of the Board and has no

executive powers, other than those specifically delegated within these terms of

reference.

2. REMIT AND FUNCTIONS OF THE COMMITTEE

2.1 The Committee is established to manage, monitor and review the charitable funds of

the Trust, as required by the Charities Act 2011. 1993. The Committee will work in

accordance with relevant guidance published by the Charities Commission and/or

the Department of Health.

2.2. Charitable funds may be given to the Trust with a specific purpose in mind and the

Committee shall ensure that this purpose is met wherever possible. In

circumstances where the Committee considers that it would be inappropriate or

impossible to meet the stated purpose, the Committee will identify suitable

alternative purposes and, where possible, obtain the agreement of the original

donor(s). Funds donated for general purposes will be used for the welfare of staff

and patients of the Trust. The Committee shall ensure that funds are equally

accessible to all individuals and groups of staff within the Trust.

2.3 The main functions of the Committee are:

i. prepare the policy on the appropriate use of funds for approval by the Board

of Directors

ii. establish an appropriate limit on expenditure for each financial year

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iii. establish and maintain a bidding process against the agreed limits

iv. monitor the income to the charitable funds and ensure that the best possible

income from interest is achieved

v. monitor the use and viability of special purpose funds

vi. liaise with the Charity Commission’s NHS team, where appropriate, to ensure

that administrative and registration processes achieve legal compliance and

practical workability

vii. ensure that donated funds or other resources are managed separately from

exchequer funds

3. COMPOSITION AND CONDUCT OF THE COMMITTEE

3.1 The Committee shall comprise the following membership:

- Non-Executive Director (Chair)

- Director of Finance (Deputy Chair)

- Director of Organisational Development

- Director of Emergency Services

- Head of Patient Transport Services

- Staff-side representative

There is an expectation that members will endeavour to attend all scheduled

Committee meetings.

3.2 Nominated deputies shall attend in the event of absence of any member; however

this shall be in an advisory capacity only.

3.3 Other Officers of the Trust shall attend at the request of the Committee in order to

present and provide clarification on issues, and with the consent of the Chair will be

permitted to participate in the debate. However, only members of the Committee

are permitted to vote.

3.4 Quorum. No business shall be transacted unless at least three members are present.

3.5 Notice of meeting. Before each meeting, a notice of the meeting specifying the

business proposed to be transacted shall be sent by post or electronic mail to the

usual place of business or residence of each member, so as to be available at least

three clear days before the meeting.

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3.6 Frequency of meetings. The Committee will normally meet on a 6-monthly basis.

The Chair may, however, call a meeting at any time provided that notice of the

meeting is given as specified in s. 3.5 above.

3.7 Minutes. The minutes of meetings shall be formally recorded by a member of the

Corporate Governance Department, checked by the Chair and submitted for

agreement at the next ensuing meeting, whereupon they will be signed by the

person presiding at it. The minutes of meetings shall also be submitted to the Board

of Directors, and the Chair of the Committee shall draw to the attention of the Board

any issues that require disclosure or require executive action.

3.8 Emergency powers. The Chair and Director of Finance may, in an emergency,

exercise the functions of the Committee jointly. A full report shall be prepared as for

the Committee and a signed authorisation appended. The exercise of such powers,

together with the report, shall be submitted to the next formal meeting for

ratification.

3.9 Administration. The Committee shall be supported administratively by the

Corporate Governance Department, whose duties shall include: agreement of the

agenda with the Chair and collation of papers; producing the minutes of the meeting

and advising the Committee on pertinent areas.

4. DELEGATED AUTHORITY

4.1 The Committee is authorised by the Board to:

i. approve individual items of expenditure with a value between £2,000 and

£9,999. The Chief Executive and the Director of Finance individually have the

authority to approve items of expenditure with a value between £1,000 and

£1,999, and Service Line Directors have authority to approve items of

expenditure with a value between £0 and £999. However, in these

circumstances, a report of expenditure will be provided to the Committee

ii. investigate any activity within its terms of reference

iii. seek any information it requires from any employee and all employees are

directed to co-operate with any request made by the Committee

5. RELATIONSHIP WITH THE BOARD OF DIRECTORS AND ITS COMMITTEES

5.1 The Committee will report in writing to the Board of Directors the basis for its

recommendations. The Board will use that report as the basis for their decisions, but

would remain accountable for taking the decision. Minutes of the meetings of the

Board of Directors will record such decisions.

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6. REVIEW

6.1 The Committee will evaluation its own membership and review the effectiveness and

performance of the Committee on an annual basis. The Committee must review its

terms of reference annually and recommend any changes to the Board of Directors

for approval.

6.2 Compliance with the Terms of Reference will be monitored on an ongoing basis by

the member of the Corporate Governance Department providing administrative

support to the Committee. Any concerns in relation to compliance will be reported

to the Chair of the Committee and the Corporate Secretary. In addition, the annual

review described in s6.1 will include a summary on compliance with the Terms of

Reference.

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27. Item 9.5-Compliance Report

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Subject: Board Assurance Statements

Report of: Corporate Secretary Prepared by: Corporate Secretary

PAPER FOR APPROVAL


All











finite resources




-----


All


Completed

Not required

Attachments: Appendix 1: Board Assurance Statements


presented to:

Board of Directors


Audit Committee


Team

Quality Committee


Committee

Workforce Committee






Service Development

Committee

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1. INTRODUCTION

1.1

The purpose of this report is to seek Board of Directors approval for completion of the assurance statements which are required to be submitted to the NHS Trust Development Authority (NHS TDA) each month.

2. BACKGROUND

2.1 2.2

The TDA requires two self-certification declarations to be made by the last day of each month. These are the Self-certification of Compliance with the new NHS Provider Licence, produced by Monitor and the Self-certification Board Statement. Since June 2013 the Trust has declared full compliance with both sets of declarations The declarations required cover the following statements: Monthly self-certification requirements - Compliance with Monitor Licence Conditions 1. General Condition 4: Fit and proper persons This licence condition prevents licensees from allowing unfit persons to become or continue as governors or directors (or those performing similar or equivalent functions). In exceptional circumstances and at Monitor's discretion we may issue a licence without the licensee having met this requirement. 2. General Condition 7: Registration with the Care Quality Commission This licence condition requires providers to be registered with the CQC (if required to do so by law) and to notify us if their registration is cancelled. 3. General Condition 8: Patient eligibility and selection criteria This condition requires licence holders to set transparent eligibility and selection criteria for patients and to apply these in a transparent manner. 4. Pricing Condition 1: Recording of information Under this licence condition, Monitor may oblige licensees to record information, particularly information about their costs, in line with guidance to be published by Monitor. 5. Pricing Condition 2: Provision of information Having recorded the information in line with Pricing condition 1 above, licensees can then be required to submit this information to Monitor. 6. Pricing Condition 3: Assurance report on submissions to Monitor When collecting information for price setting, it will be important that the information submitted is accurate. This condition allows Monitor to oblige licensees to submit an assurance report confirming that the information they have provided is accurate. 7. Pricing Condition 4: Compliance with the National Tariff The Health and Social Care Act 2012 requires commissioners to pay providers a price which complies with, or is determined in accordance with, the National Tariff for NHS health care services. This licence condition imposes a similar obligation on licensees, i.e. the obligation to charge for NHS health care services in line with the National Tariff.

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2.3

8. Pricing Condition 5: Constructive engagement concerning local tariff modifications The Act allows for local modifications to prices. This licence condition requires licence holders to engage constructively with commissioners, and to try to reach agreement locally, before applying to Monitor for a modification. 9. Choice and Competition Condition 1: Patient choice This condition protects patients’ rights to choose between providers by obliging providers to make information available and act in a fair way where patients have a choice of provider. This condition applies wherever patients have a choice of provider under the NHS Constitution, or where a choice has been conferred locally by commissioners. 10. Choice and Competition Condition 2: Competition oversight This condition prevents providers from entering into or maintaining agreements that have the object or effect of preventing, restricting or distorting competition to the extent that it is against the interests of health care users. It also prohibits licensees from engaging in other conduct which has the effect of preventing, restricting or distorting competition to the extent that it is against the interests of health care users. 11. The Integrated Care Condition The Integrated Care Condition is a broadly defined prohibition: the licensee shall not do anything that could reasonably be regarded as detrimental to enabling integrated care. It also includes a patient interest test. The patient interest test means that the obligations only apply to the extent that they are in the interests of people who use health care services Monthly self-certification requirements – Board Statement CLINICAL QUALITY 1. The Board is satisfied that, to the best of its knowledge and using its own processes and having had regard to the TDA’s oversight supported by Care Quality Commission information, its own information on serious incidents, patterns of complaints, and including any further metrics it chooses to adopt), the trust has, and will keep in place, effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients. 2. The board is satisfied that plans in place are sufficient to ensure ongoing compliance with the Care Quality Commission’s registration requirements. 3. The board is satisfied that processes and procedures are in place to ensure all medical practitioners providing care on behalf of the trust have met the relevant registration and revalidation requirements. FINANCE 4. The board is satisfied that the trust shall at all times remain a going concern, as defined by relevant accounting standards in force from time to time. GOVERNANCE 5. The board will ensure that the trust remains at all times compliant with has regard to the NHS Constitution.

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6. All current key risks have been identified (raised either internally or by external audit and assessment bodies) and addressed – or there are appropriate action plans in place. 7. The board has considered all likely future risks and has reviewed appropriate evidence regarding the level of severity, likelihood of it occurring and the plans. 8. The necessary planning, performance management and corporate and clinical risk management processes and mitigation plans are in place to deliver the annual operating plan, including that all audit committee recommendations accepted by the board are implemented satisfactorily. 9. An Annual Governance Statement is in place, and the trust is compliant with the risk management and assurance framework requirements that support the Statement pursuant to the most up to date guidance from HM Treasury 10. The board is satisfied that plans in place are sufficient to ensure ongoing compliance with all existing targets (after the application of thresholds) as set out in the relevant TDA quality and governance indicators; and a commitment to comply with all known targets going forwards. 11. The trust has achieved a minimum of Level 2 performance against the requirements of the Information Governance Toolkit. 12. The board will ensure that the trust will at all times operate effectively. This includes maintaining its register of interests, ensuring that there are no material conflicts of interest in the board of directors; and that all board positions are filled, or plans are in place to fill any vacancies. 13. The board is satisfied that all executive and non-executive directors have the appropriate qualifications, experience and skills to discharge their functions effectively, including setting strategy, monitoring and managing performance and risks, and ensuring management capacity and capability. 14. The board is satisfied that: the management team has the capacity, capability and experience necessary to deliver the annual operating plan; and the management structure in place is adequate to deliver the annual operating plan.

3. PROPOSAL

3.1 3.2

The Board of Directors is asked to review the levels of assurance provided to it through the agenda papers and content of the current meeting, and agree a position to be reported to the NHS TDA by the end of November 2014. The format of the return is shown in Appendix 1. In view of the current circumstances relating to operational performance, the Board of Directors is specifically requested to consider whether it remains appropriate to declare compliance with Board Statement 10, which relates to ongoing compliance with existing targets.


4.1 There are no direct legal implications of this report. However, it is a requirement of the NHS TDA that the submission is made each month.

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Receive and note the report, and agree a position for reporting to NHS TDA for October 2014.

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Appendix 1: Compliance with Monitor licence requirements for NHS Trusts Licence Condition Compliance Comment where non-compliant or at risk of

non-compliance

1

Condition G4 – Fit and proper persons as Governors and Directors

(also applicable to those performing equivalent or similar functions)

2

Condition G7 – Registration with the Care Quality Commission

3

Condition G8 – Patient eligibility and selection criteria

4

Condition P1 – Recording of information

5

Condition P2 – Provision of information

6

Condition P3 – Assurance report on submissions to Monitor

7

Condition P4 – Compliance with the National Tariff

8

Condition P5 – Constructive engagement concerning local tariff

modifications

9

Condition C1 – The right of patients to make choices

10

Condition C2 – Competition oversight

11

Condition IC1 – Provision of integrated care

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Board statements For each statement the Board is asked to confirm the following:

For CLINICAL QUALITY, that Response

1

The Board is satisfied that, to the best of its knowledge and using its own processes and having had regard to the TDA’s oversight (supported by Care Quality Commission information, its own information on serious incidents, patterns of complaints, and including any further metrics it chooses to adopt), the trust has, and will keep in place, effective arrangements for the purpose of monitoring and continually improving the quality of healthcare provided to its patients.

2

The board is satisfied that plans in place are sufficient to ensure ongoing compliance with the Care Quality Commission’s registration requirements.

3

The board is satisfied that processes and procedures are in place to ensure all medical practitioners providing care on behalf of the trust have met the relevant registration and revalidation requirements

For FINANCE, that Response

4

The board is satisfied that the trust shall at all times remain a going concern, as defined by relevant accounting standards in force from time to time.

For GOVERNANCE, that Response

5

The board will ensure that the trust remains at all times compliant with has regard to the NHS Constitution.

6

All current key risks have been identified (raised either internally or by external audit and assessment bodies) and addressed – or there are appropriate action plans in place to address the issues – in a timely manner.

7

The board has considered all likely future risks and has reviewed appropriate evidence regarding the level of severity, likelihood of it occurring and the plans for mitigation of these risks.

8

The necessary planning, performance management and corporate and clinical risk management processes and mitigation plans are in place to deliver the annual operating plan, including that all audit committee recommendations accepted by the board are implemented satisfactorily.

9

An Annual Governance Statement is in place, and the trust is compliant with the risk management and assurance framework requirements that support the Statement pursuant to the most up to date guidance from HM Treasury (www.hm-treasury.gov.uk).

10

The board is satisfied that plans in place are sufficient to ensure ongoing compliance with all existing targets (after the application of thresholds) as set out in the relevant GRR; and a commitment to comply with all known targets going forwards.

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11

The trust has achieved a minimum of Level 2 performance against the requirements of the Information Governance Toolkit.

12

The board will ensure that the trust will at all times operate effectively. This includes maintaining its register of interests, ensuring that there are no material conflicts of interest in the board of directors; and that all board positions are filled, or plans are in place to fill any vacancies.

13

The board is satisfied that all executive and non-executive directors have the appropriate qualifications, experience and skills to discharge their functions effectively, including setting strategy, monitoring and managing performance and risks, and ensuring management capacity and capability.

14

The board is satisfied that: the management team has the capacity, capability and experience necessary to deliver the annual operating plan; and the management structure in place is adequate to deliver the annual operating

Signed on behalf of the Trust: Print Name Date

CEO

Chair

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Documents

Board of Directors 26 November 2014