FINAL VERSION FOR BOARD JUNE 2007

Annual Report 2006 – 2007

FINAL VERSION FOR BOARD JUNE 2007

Contents Page

The Trust 1 Chief Executive’s foreword 2 Chairman’s review 3 Reconfiguration Trust Overview 4 Board Members 5&6 Register of Interests 7 Management Appointments Human Resources 8 Introduction 9 Staff Employed Recruitment and retention Agenda for change and performance management 10 Health and welfare 11&12 Equal opportunities and diversity/equality 13 Staff Involvement Support for keyworkers 14 Education, training and development Workforce Development 15 Commercial Training Clinical Governance 16 Medical Director’s review 17 Clinical governance explained 18 Clinical developments and Effectiveness Clinical guidelines Cardiac care 19 Spearheading new treatments Stoke Care 20 Mental Health Safeguarding 21 Infection prevention and control Clinical Audit improvements Influencing the National Clinical Effectiveness Agenda 22 Find out more Public Health Improving Patient Care 23 Patient and Public Involvement Complaints Patient, Advice and Liaison Service (PALS) 24 Appreciations Personal Injury Claims Clinical Negligence Scheme for Trusts (CNST) for

South Western Ambulance Service NHS Trust Risk management 25 Clinical developments Increased confidence in risk management systems Commercial training 26 Next steps Operations 27 Introduction Vision for ambulance services 28 Focus on 5 key areas Welcome challenges 29 999 Communications Centres 30 Calling Line Identity (CLI) Improvements in Exeter 999 Communication Centre 30 Improvements in St Leonards, Dorset 999

Communication Centre 31 Investment in specialist clinical advice Operational resources Intermediate Care

FINAL VERSION FOR BOARD JUNE 2007

Contents

Page

32 Falls 33 Fallers Hotline Maximising potential workforce Air Ambulances Spearheading new Out of Hours healthcare services 34 Operational Initiatives Innovations Group Devon 35 PROMIS software rota system 36 Newquay Safe Bus 37 Activity and Performance 38 Achievements Summary 39 Improvements in clinical practice New responsibilities Out of Hours care Improving working lives of staff Supported by Logistics, Medical Transport, Vehicle

Maintenance and Fleet units 40 Patient Focused 41 Planned patient care Proud to serve the community Emergency Planning Rapid Response Vehicle 42 Patient Transport Services (PTS) 43 Voluntary Hospital Car Service (HCS) Fleet, logistics and equipment 44 First Responders 45 Responder Training services and management Groups and number of schemes 46 Updated Resuscitation Council guidelines New Responder Schemes National Defibrillator Programme 47 Inappropriate use of ambulance services Ambulance Care Assistants (ACAs) Urgent Care Service (UCS) 48 Somerset Integration 48&49 Palliative Care 50&51 Activity and Performance – Call Profile 52 Dental Service Nurse Triage Remodelling 53 Dental Calls Workforce Development Reorganisation 51 Future Developments Finance 52 Introduction Remuneration for Dorset Ambulance NHS Trust 53 Remuneration for Westcountry Ambulance Services

NHS Trust Remuneration for South Western Ambulance Service

NHS Trust 54 Pension Benefits 55 Auditors Remuneration Committees Statements of Responsibilities

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Chief Executive’s foreword I am delighted to introduce the 12 month annual report for the newly formed modern South Western Ambulance Service NHS Trust. This report spans the period from 1 April 2006 to 31 March 2007. The report has been written and produced in a format that has been influenced by staff and members of the public. In October 2006 a major consultation day was held by the ambulance, fire and police services with over 80 stakeholders from a variety of ‘hard to reach’ groups in attendance who provided ideas for improving annual report productions. I hope you agree that this cost effective, yet fully informative and very detailed report is much more user friendly than perhaps previous annual reports have been in the past. During this reporting period I was pleased to undertake the role of transitional lead officer for former Dorset Ambulance NHS Trust and Westcountry Ambulance Services NHS Trust. Both of these trusts now make up South Western Ambulance Service NHS Trust which covers the four counties of Cornwall and the Isles of Scilly, Devon, Dorset and Somerset. I would like to thank and congratulate all staff for their unstinting hard work and enthusiasm in the establishment of the new trust. This dedication and commitment to the people of the South West enabled solid building blocks to be put into place which helped the smooth merger of two very successful ambulance services into the South Western Ambulance Service NHS Trust on 1 July 2006. I strongly urge you to visit our website on www.swast.nhs.uk and view the supplementary 3 month reports for both Dorset Ambulance NHS Trust and Westcountry Ambulance Services NHS Trust who worked tremendously well together during the first 3 months of the financial year. Although the launch of the new trust was 1 July 2006, the 12 month annual report covers the whole period of 1 April 2006 to 31 March 2007. I am very proud of the achievements of everyone involved in the transition and subsequent reconfiguration of the trust and would like to take this opportunity to personally thank all of the staff who are part of this ongoing success. Well done to everyone. Ken Wenman Chief Executive South Western Ambulance Service NHS Trust

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Chairman’s review I am delighted to have been appointed as Chairman of the newly formed South Western Ambulance Service NHS Trust. I am very pleased to report on how well the trust has established itself and performed during its first year. This time was not without its challenges but the trust responded well and continued to perform strongly and consistently achieved high quality patient care. This level of achievement was only possible because of the skills, professionalism and commitment of all staff. I should like to thank everyone on behalf of the Board for the excellent service that has been delivered to patients in the Isles of Scilly and Cornwall, Devon, Dorset and Somerset. As a trust, I believe that we are also very fortunate to have appointed an enthusiastic and committed Board. I should like to thank them for working together so well in helping the trust establish a sound base to build upon and in developing a positive culture to bring improved services to patients and the public in the future. Board members, both Executive and Non Executive, have a variety of backgrounds and a rich wealth of knowledge that will be extremely beneficial to the trust and I welcome their expertise. Many of the trust’s achievements are based on growing partnerships, both internally and externally. By working together, sharing resources, skills and expertise, we can achieve a higher standard of care for the patient; a standard that is more appropriately focused on their needs whilst ensuring that our resources are being used most effectively and efficiently. I look forward to seeing the continued and dynamic developments of our services to the patient and to the trust playing a wider role within the health community as a whole.

Heather Strawbridge Chairman South Western Ambulance Service NHS Trust

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Reconfiguration On 1 July 2006 South Western Ambulance Service NHS Trust was established as the new trust covering the 4 counties of Cornwall and the Isles of Scilly, Devon, Dorset and Somerset. By the end of July, the first Board meeting had taken place and by the end of August, the full Board had been appointed. A new organisational structure was developed in consultation with staff which was designed to meet the requirements of the new organisation whilst minimising disruption to existing staff as far as possible. Every effort was made to find roles for displaced staff within the trust, or within the wider NHS. The new structure was finalised in October 2006 but will be reviewed again at the start of the new financial year (2007/08) to measure whether it fulfils the requirements of each of the trust’s functions and remains fit for purpose. A Strategic Direction has been developed for the next 5 years, in consultation with staff and stakeholders, and the trust Board will continue to review this dynamic document as the new trust evolves and develops. The process of building a new trust has been challenging but rewarding: challenging in the sense that performance targets remained unchanged throughout and because of the need to ensure that patients continued to receive the highest quality service; and rewarding in that it provided an opportunity to construct an organisation in a new mould which could meet the requirements of a modern, patient-centred NHS. The operation of this new trust will be continually reviewed over the forthcoming years to build upon the excellent developmental work achieved in its successful foundation year. Trust overview South Western Ambulance Service NHS Trust is a complex organisation dealing with a wide range of healthcare needs and services. It has a duty to ensure the continuous improvement of all services for which it is responsible. The trust has an income of £104 million per annum and employs a total workforce of 2204 whole time equivalents for the year 2006/07. The busy Communication Control Centres receive 302,279 emergency 999 calls each year, 50,094 urgent requests from health professionals to transport a patient to hospital, 551,042 non urgent medical transport journeys, and 217,516 calls from out of hours urgent care patients (including advice/assessment, dental services, and home visits). The newly formed trust for the South West is proud to serve a resident population of almost 3 million people living in a mainly dispersed rural area throughout Dorset, Somerset, Devon, Cornwall and the Isles of Scilly. However, it also caters for a large influx of holidaymakers and other visitors estimated to be in the order of 16.5 million people each year.

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Cover is provided for an area of 18,000 square kilometres including 32,000 kilometres of road and 1300 kilometres of coastline. The trust faces a considerable challenge in terms of health inequalities in its operational area. Geographic variations in health, a report from the Office for National Statistics (ONS) (geographic variations in Health www.statistics.gov.uk) has shown marked evidence of significant health inequalities by social class in the South West. In addition, the South West has the highest incidence of malignant melanoma in England; death rates from suicide and undetermined injury are rising in young males; drug misuse is on the increase; and teenage pregnancy rates are very high. The South West has the oldest age structure of all English regions. In 2004, 38% were aged 50 or over and it is forecast that the number of residents aged over 50 will rise by 300,000 over the next ten years, raising its share of the total population to 41%. These factors will require the trust, in partnership with health and social care providers and local authorities, to focus increasingly on the promotion of good health, wellbeing and independence. Estates A full review of the trust estate requirement will be undertaken in 2007/8 as part of the trust’s Estate Strategy which was presented to the Board in May 2007. This estates review will be commissioned and completed in 2007/8 resulting in recommendations for the trust’s future estate. Environment A new Environmental Policy demonstrating the trust’s commitment to the environment is being developed by the trust and will be complete by the end of September 2007. A steering group will be established to drive this work forward. Board members for Dorset Ambulance NHS Trust - 1 April 2006 to 30 June 2006 Mr T Jones OBE Chairman Sir B Kenny Non Executive Director Mr T Ware Non Executive Director Mrs P Rushton Non Executive Director Mr K Wenman Chief Executive Mr C Launchbury Director of Finance Mr R Ferre Deputy Chief Executive

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Ms J Liggett Associate Director of Corporate Affairs Mr T James Associate Director of Operations Mrs N Lane Associate Director of Urgent Care Service Dorset

and Somerset Board members for Westcountry Ambulance Services NHS Trust - 1 April 2006 to 30 June 2006 Mrs H Strawbridge Chairman Mr B Evans Non Executive Director Mr B Lewis Non Executive Director Mrs C Russell Non Executive Director Mrs J Cowdery Non Executive Director Mr K Burrows Non Executive Director Mr M Willis OBE Chief Executive Mr S Davies Director of Finance Mr S Pryor Director of Operations Ms G Bryce Medical Director Ms K Nethercott Director of Corporate Affairs Board members for South Western Ambulance Services NHS Trust - 1 July 2006 to 31 March 2007 Mrs H Strawbridge Chairman Mr T Ware Non Executive Director & Vice Chairman Prof M Watkins Non Executive Director Mrs C Russell Non Executive Director Mr R Lock Non Executive Director Mr Bjorn Howard Non Executive Director Mr K Wenman Chief Executive Mr S Davies Director of Finance Ms G Bryce Medical Director Ms J Liggett Director of Human Resources & Workforce Development Mr S Pryor Director of Operations Associate Director Mrs N Lane Clinical Director Register of interests for Dorset Ambulance NHS Trust - 1 April 2006 to 30 June 2006 Mr T Jones OBE Member of West Dorset District Council Member of Dorchester Town Council Vice Chairman Scrutiny Panel Local Government

Association Member Local Government Pensions Committee Member Dorset Fire Authority

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Chairman Dorset County Council Audit & Scrutiny Committee

Peer Member Peer Clearing House Improvement and Development Agency Chairman Dorset Film Touring Ltd

Trustee Dorchester Community Nursery School

Sir B Kenny Governor Canford School Trustee – Dorset and Somerset Air Ambulance Charity King of Arms – Order of the Bath Mr T Ware Non Executive Director Southern Fruits Ltd Non Executive Director Baxters Food Group Director Auld Smokehouse Originals Ltd Mrs P Rushton East Dorset Magistrates Christchurch Borough Council Standards Committee Mr K Wenman Board Director (unpaid) – Ambulance Service Association Register of interests for Westcountry Ambulance Services NHS Trust - 1 April 2006 to 30 June 2006 Mrs H Strawbridge Chairman – Connexions Somerset Ltd Governor – Bridgwater College of Further Education Mr K Burrows Director, Chairman and Chief Executive of Somerset

Chamber of Commerce Director – South West Chambers of Commerce Director – South West Industrial Development Board Chairman – Somerset 4 Business

Chairman – South West Regional Assembly Remuneration Panel

Mrs J Cowdery Director and Company Secretary– Athene Engineering Ltd

Mr B Evans Governor – Maple Grove Primary School Mr M Willis OBE Honorary Treasurer - Joint Royal Colleges Ambulance

Liaison Committee (JRCALC) Ms G Bryce Accident and Emergency Consultant – Musgrove Park

Hospital Taunton and Somerset NHS Trust Mr S Davies Treasurer – Ambulance Service Association (ASA) Director – Polarglow Ltd

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Register of interests for South Western Ambulance Services NHS Trust - 1 July 2006 to 31 March 2007 Mrs H Strawbridge Chairman - Connexions Somerset Ltd Governor - Bridgwater College of Further Education Mr T Ware Non Executive Director Southern Fruits Ltd Non Executive Director Baxters Food Group Director Auld Smokehouse Originals Ltd Mr K Wenman Board Director (unpaid) – Ambulance Service Association Mr S Davies Treasurer – Ambulance Service Association (ASA) Director – Polarglow Ltd Ms G Bryce Accident and Emergency Consultant – Musgrove Park

Hospital,Taunton and Somerset NHS Trust Mr B Howard Executive Director, Coastline Housing Ltd

Executive Director, Coastline Services Ltd Non Executive Director, Teign Housing Association Ltd

Prof M Watkins Deputy Vice Chancellor, University of Plymouth Trustee, Burdett Trust for Nursing Managing Director, Plymouth Healthcare Education Ltd Governor, Plymouth College

Mr R Lock General Advisor, Citizens Advice, Sedgemoor Training Advisor, Citizens Advice, Sedgemoor Mentor, Prince’s Trust Vice Chair of Governors, Burnham Infants School

Management appointments for Dorset Ambulance NHS Trust - 1 April 2006 to 30 June 2006 The Executive Directors comprised the Chief Executive, Director of Finance and the Deputy Chief Executive. Three other Associate Directors, Operations, Urgent Care and Human Resources were appointed by external advertisement with the exception of the Associate Director of Operations who was appointed as a result of organisational change in 2003. Termination procedures are within individual contracts/staff policies/procedures. The Medical Director was employed on an open contract which may be terminated and/or renewed by the Board. The Chairman was re-appointed by the Secretary of State at the end of 2002 for four years. The other Non Executive Board members were appointed for 4 years by the NHS Appointments Commission on behalf of the Secretary of State for Health.

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Management appointments for Westcountry Ambulance Services NHS Trust - 1 April 2006 to 30 June 2006 The Executive Directors comprised the Chief Executive, Director of Operations, Director of Finance and Director of Corporate Affairs, all were appointed following external advertisement and were not for set periods. Termination procedures are within individual contracts/staff policies/procedures. The Medical Director was employed on an open contract which may be terminated/renewed by the Board. The Chairman was re-appointed by the Secretary of State in 1 July 2004 for 4 years. The other Non Executive Board members were appointed for 4 years by the NHS Appointments Commission on behalf of the Secretary of State for Health. Management appointments for South Western Ambulance Service NHS Trust - 1 July 2006 to 31 March 2007 The Executive Directors comprised the Chief Executive, Director of Operations, Director of Finance, Director of Human Resources and Workforce Development and Clinical Director; the latter does not hold an executive position. All were appointed following external advertisement and were not for set periods. Termination procedures are within individual contracts/staff policies/procedures. The Medical Director was employed on an open contract which may be terminated/renewed by the Board. The Chairman, Mrs Heather Strawbridge, was re-appointed by the Secretary of State on 1 July 2006 for 4 years. The other Non Executive Board members were appointed by the NHS Appointments Commission on behalf of the Secretary of State for Health. The appointees were given the following contracts; Mrs Charlotte Russell and Mr Trevor Ware have been appointed for a 3 year term from 1 July 2006 to 30 June 2009. Mr Raymond Lock has been appointed for a 3 year term from 1 August 2006 to 31 July 2009. Professor Mrs Mary Watkins and Mr Bjorn Howard have been appointed for a 2 year term from 1 August 2006 to 31 July 2008.

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Human Resources Top quality services to patients depend on high calibre staff. The success of merging staff from both former ambulance services has created a strengthened and unified workforce. The new workforce is, not only highly skilled and professional, but totally committed to improving the patient experience and delivering optimum standards of care for patients in the twenty first century. The trust intends to build on the previous work of both former trusts and harmonise all working practices. For example, the county of Dorset had achieved practice plus status under the NHS Improving Working Lives (IWL) initiative. This intense focus on working conditions for all NHS staff has seen exciting and positive benefits for the workforce eg improved flexible working. Rolling out this pioneering work across the trust’s 4 counties will ensure all staff are fully supported in achieving their optimum performance whilst maintaining a healthy work-life balance. A strong focus on the implementation of the new electronic staff record (ESR) which is already in place for those staff who work in the Isles of Scilly and Cornwall, Devon and Somerset, will also be a top priority. Equality and Diversity has seen a much needed investment in resources with the recruitment of a dedicated specialist business manager to take this work forward. In line with current legislation, the trust has produced and published an Equality and Diversity Strategy with Race, Gender and Disability Schemes. A new task group has been set up to champion this work and drive numerous projects forward to maintain the trust’s ongoing commitment and dedication to this important work. The trust aims to be an organisation that appreciates and benefits from the diversity of all staff and values their individual contribution. We treat all patients and employees with dignity and respect in accordance with our philosophy of improving working lives, promoting an open culture and providing a working environment that endorses the positive management of diversity, free from discrimination, bullying, victimisation or harassment. Staff employed At 31 March 2007, South Western Ambulance Services NHS Trust had been operational for 9 months, with the initial 3 months of operational activity seeing both former trusts working in harmony to maintain full service levels for patients. Westcountry Ambulance Services NHS Trust employed 1540 staff for the first 3 months of the 06/07 financial year and Dorset Ambulance NHS Trust employed 617 staff for the same period.

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From the 1 July 2006 until 31 March 2007, South Western Ambulance Service NHS Trust employed a total of 2204 staff across the four counties. Recruitment and retention From 1 April until 30 June 2006, Westcountry Ambulance Services NHS Trust recorded 36 staff leaving the trust which was a turnover of 1.3%. During the same period, Dorset Ambulance NHS Trust recorded 13 staff leaving the trust which was a turnover of 1.1%. These figures were less than the staff turnover in the previous 3 month periods for both trusts. Westcountry Ambulance Services and Dorset Ambulance Trust had 39 and 29 new starters respectively and development opportunities remained high with 36 staff being promoted in the West Country and a further 18 in Dorset. From the 1 July 2006 until 31 March 2007, South Western Ambulance Service NHS Trust recorded a staff turnover of 4.84% in the West Country and 2.45% in Dorset with 91 staff leaving trust over this period. There were 95 new starters and 104 staff were promoted in the West Country alone. A further 63 members of staff successfully qualified as ambulance technicians following their year of student technician status. Agenda for Change and performance management The year continued to embed the pioneering NHS new pay and conditions initiative known as Agenda for Change. This brought about a fairer system of pay that supports the government’s reforms and modernised working practices to ensure the NHS is fit for purpose for the needs of all patients in the twenty first century. These changes are underpinned by an environment of important partnership working with Staff Side representatives. The trust has applied this principle to all aspects of organisational development which has helped with the successful transition of two ambulance services into one. The Knowledge and Skills Framework (KSF) that forms part of Agenda for Change to promote and enhance development opportunities within the trust continues to be rolled out, with individual personal development plans further helping employees and managers identify and meet training needs in order to assist with career progression. Numerous awards have been won and received by a variety of staff across the 4 counties which is a positive accolade of the high calibre staff working within the trust. Well done to everyone for this fantastic team work that is accelerating positive changes within the much welcomed modernisation of emergency and urgent care services in the South West. Showcasing innovations and projects in the national, regional and local media has been a major part of the proactive work of the press office to ensure staff are fully supported and to illuminate best practice across the UK.

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Health and welfare Before the successful merger, sickness rates were 4.37% for Dorset Ambulance Trust and 4.62% for Westcountry Ambulance Services. These statistics demonstrate the continuing downward trend from the previous 3 month periods for each trust. After the 1 July 2006, South Western Ambulance Trust recorded a staff sickness rate of 5.65% in the 3 counties of Isles of Scilly and Cornwall, Devon and Somerset and 5.47% in the county of Dorset. Investment in the support offered to staff includes reimbursement of chiropractor costs, free welfare calls during periods of sickness, regular review where individuals have ongoing health problems, referral to occupational health and a 24/7 advice and counselling helpline which is also available to the families of staff. In total, 85 staff and/or their families received help and advice from the helpline within this period. The high profile zero tolerance of violence towards staff initiative continued to gather pace. Before the merger, there were 21 violent incidents from patients/public towards staff in Dorset, of which 10 were physical, and 157 in the West Country (the Westcountry figure was skewed due to a frequent caller who has since sadly passed away) including 12 physical incidents. The ambulance service has seen a total of 71 violent incidents since 1 July 2006 of which 29 were physical. The trust will continue to work with the police to press charges against those who attack ambulance personnel, whether physically or verbally. Further work will ensure a consistent approach in reviewing all serious adverse incidents with the provision of support and feedback to staff on the outcome of each reported incident. The rationale for the enforcing the trust’s policy so stringently and taking subsequent actions against assailants is two fold. The measures act as a deterrent and help to boost staff morale. Equally important is for assailants to be prepared to pay the price for disrespecting health personnel who play an integral role in serving their communities. For frontline and support staff involved in particularly difficult incidents the trust has continued to provide ‘hot’ and ‘cold’ debriefs which have been shown to help staff deal with their feelings afterwards and which also highlight lessons for the future aimed at improving patient care. Reported accidents/injuries from staff before the merger were 21 for Dorset Ambulance Trust and 71 for Westcountry Ambulance Services. Two hundred and eighty seven accidents/injuries were reported for South Western Ambulance Service Trust from 1 July 2006 to 31 March 2007. A proactive and determined attitude has been adopted by staff to drive forward and pursue a programme of continuous improvement in raising

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awareness and understanding of health, safety and security issues. This has culminated in the delivery of ongoing training programmes and the provision of comprehensive information and instruction. Equal Opportunities, Equality and Diversity As a public body the trust is concerned with the well being of people who use its services and those who provide trust services. The trust recognises that diversity is inclusive and based on valuing everyone as an individual. The trust aims to ensure that equality and quality is at the centre of its work and is integral to all our functions, policies, strategies and procedures as a means of eliminating institutional and individual discrimination. The trust’s policies can be viewed on www.swast.nhs.uk. South Western Ambulance Service NHS Trust has developed an Equalities and Diversity Strategy that meets its legal obligations under the Race Relations (Amendment) Act 2000, the Disability Discrimination Act 2005 and the Equality Act 2006. This demonstrates due regard to the requirements as laid down in the Race Equality Duty, The Disability Equality Duty and the Gender Equality Duty. The trust wishes to emphasise that a single Equality Strategy will not diminish the high importance of carrying out its individual statutory duties in respect of Race, Disability and Gender but these will be given equal respect and consideration. We live in a changing world and people’s expectations are changing too. Our communities are increasingly multi ethnic and multi faith. People with physical or learning disabilities are living much longer than in the past. A greater percentage of the population are living longer – into their 80s and 90s. Same sex couples have the same legal partnership rights as married couples. The majority of lower paid people are women. These are not mutually exclusive. The trust appreciates exclusion and discrimination can compound inequity of opportunity and our objective as an organisation is to be all encompassing. Through the Equalities and Diversity Strategy the trust wishes to demonstrate its commitment to ensuring equality and fair treatment for all staff and service users. The proposed arrangements set out in the Strategy are about being inclusive; they are about developing, supporting and sustaining a diverse workforce and creating a working environment where staff are able to do their job to the best of their ability without having to face discrimination, bullying or harassment on the grounds of their age, belief, disability, ethnicity, gender, race, religion or sexual orientation. Equally it is about providing a healthcare service that recognises, respects and responds to the diversity of the local communities we serve. Steps have been taken to ensure the workforce is representative of the local community and efforts continue to target prospective applicants from the

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Black and Minority Ethnic (BME) population which is currently under-represented among staff. The proportion of BME staff employed before the merger was 1.75% for Dorset Ambulance Trust and 0.58% for Westcountry Ambulance Service. After 1 July 2006, South Western Ambulance Service NHS Trust recorded no variance to these statistics. The ratio of women employed compared with men before the merger was 1:2 for former Westcountry Ambulance Service and 2:3 for Dorset Ambulance Trust. These statistics remained unchanged since the reconfiguration of the trusts. The tables below are a breakdown of the age and gender of staff. Evidence of reconciliation of statistics are included in the full set of Annual Accounts. Dorset Ambulance NHS Trust April 2006 to June 2006 Men Women Age 18 – 24 3 0 25 – 35 89 81 36 – 45 115 69 46 – 55 95 56 56 – 65 69 19 66+ 7 3 Total 378 228

Westcountry Ambulance Services NHS Trust April 2006 to June 2006 Men Women Age 18 – 24 54 55 25 – 35 245 226 36 – 45 341 152 46 – 55 266 56 56 – 65 124 21 66+ 0 0 Total 1030 510

South Western Ambulance Service NHS Trust July 2006 to March 2007 Men Women Age 18 – 24 37 55 25 – 35 346 301 36 – 45 468 256 46 – 55 376 119 56 – 65 188 48 66+ 7 3 Total 1422 782

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Staff involvement Staff involvement continues to be achieved through the various committees and forums set up by the trust. In addition to the trust’s Recognition Agreement with Trade Unions, it has a Partnership Agreement with recognised Staff Side organisations. The latter aims to foster an environment that encourages involvement, co-operation, high standards and appropriate levels of support for staff. Support for keyworkers All staff are designated as keyworkers which makes them eligible for a number of schemes to assist with affordable housing. For the past 5 years, the former Dorset Ambulance NHS Trust worked in partnership with Western Challenge Housing Association to secure equity loans for some staff to assist with the purchase of a home. This positive scheme will be rolled out across the new trust area to ensure all staff have the opportunity to reap the benefits of this supportive initiative. Education, training and development

The Head of Education and Professional Development has been working with the University of Bournemouth to accredit the Emergency Care Practitioner (ECP) course. The programme is being accredited at 120 Degree level points and has been designed to follow on from a foundation degree. Successful students will achieve a BSc in Emergency and Urgent Care Practice.

Developments continue with other higher education pathways, including a foundation degree in Paramedic Science and a BSc (Hons), both of which aim to be accredited in the future. The national move towards higher education for ambulance staff will mean this will form the only recruitment route/career path in future years.

National liaison with the British Paramedic Association about alternative routes to registration, including regular meetings with the Health Professions Council and Open University, is ongoing to reduce the implications of the move to higher education. This will see workforce planning issues being encountered by all ambulance services until the higher education pathways are embedded.

Workforce development The trust has a multi-disciplinary workforce with GPs, Emergency Care Practitioners (ECPs), Nurse Practitioners, Triage Nurses, drivers, receptionists, administrative staff and Communications Hub staff all working together as a team. Doctors deal with 90% of patient calls and in the future as staff develop additional skills there will be less reliance on doctors and more effective use of ECPs, Triage Nurses and Nurse Practitioners.

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The Communication Hub is the name of the Communication Control Centre for the busy Urgent Care Service based in St Leonard’s, Dorset. This service co-ordinates and supports the operational staff in the delivery of Out of Hours (OOHs)/Urgent Care Services (UCSs), in the counties of Dorset and Somerset. Urgent Care Services are delivered by Serco (known as Kernow Urgent Care) in Cornwall and the Isles of Scilly and by D Doc (Devon Doctors) in the county of Devon. For the counties of Dorset and Somerset, an increase in activity levels has led to the Communications Hub expanding with ever increasing numbers of staff occupied with receiving and dispatching calls. Supervisors have to deal with more complex operational issues and so their capacity has been increased. To ensure effective operations and clinical prioritisation of calls, further training, support and development is planned for the Hub staff. Considerable development has taken place this year in the area of management of palliative care patients. A jointly funded position by the Dorset PCT has supported patient records to be added to the out of hours systems so that the GPs are aware of special clinical needs set out by the patients own GPs should difficulties arise out of hours. The development of the workforce and enhancement of skills has required significant progress in the trusts overall medicines management procedures with an increased emphasis on medicines related to dealing with minor ailments/ illness. Somerset Clinical Governance continues to grow with the introduction of additional Clinical Advisors. The management structure has been strengthened with the appointments of a Hub and Communications Manager, 2 Field Operations Managers, one for Dorset and one for Somerset, plus a General Manager. The work of the Urgent Care Service (UCS) being delivered by the ambulance service is continuing to stimulate national interest with a positive article published in the nationally respected publication called the Health Service Journal (HJS). The trust was reported upon as a successful model of delivery for urgent care and showcased as a best practice model for patients. Norma Lane, Clinical Director continues to drive forward the innovative reform programme set by the new trust by securing the contract for the delivery of urgent care in prisons for the county of Dorset. This adds to the existing portfolio of patients which include the army and naval bases in Dorset and Somerset. Commercial Training The Commercial Training Department which former Dorset Trust established is being taken forward in the new trust to maximise income generation opportunities. This service has been in existence for approximately 18 years,

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initially supplying the Health & Safety Executive (HSE) First Aid at Work training to customers and businesses of the county of Dorset. The ambulance service’s commercial training is delivered at Dorchester and Bournemouth Ambulance Stations where fully fitted training suites are able to offer first class facilities. The trust also provides on-site training to optimise business opportunity and provide a tailored service for customers. For the past 4 years the Commercial Training Department has successfully supplied supplementary training courses which include

• Advisory external defibrillation/refresher • Oxygen therapy/entinox • Basic Life Support/Anaphylaxis • Special Hazards (for companies with life threatening chemicals) • Venepuncture • Cannulation • Sharps awareness

Two members of staff recently completed the First Aid Instructor course and have successfully achieved additional qualifications in chainsaw and suspension trauma. A unique partnership with Streetwise Safety Centre in Bournemouth delivers an interactive HSE First Aid at Work and Emergency First Aid course. The trust is currently embarking on establishing a similar team of ambulance ‘Bank’ First Aid Instructors in the counties of Isles of Scilly and Cornwall, Devon and Somerset, as former Westcountry Ambulance Services had not set up a Commercial Training department. Clinical Governance - Medical Director’s review Clinical Governance is now fully embedded within the NHS and continues to maintain momentum with full integration in all areas of the new ambulance trust for the South West. The concept of risk awareness and the management of risk are well understood and each directorate has its own Risk Register which contributes to the trust’s overall Risk Register. An increasing number of reported adverse incidents and near misses has helped the trust to manage all areas of risk. Just as importantly, the system has allowed the trust to learn important lessons in practice to instigate continuous improvements and create more patient focused services. A new web based reporting system introduced within this period encountered initial implementation problems for staff as a result of some IT issues. Appropriate levels of training were swiftly put into place to ensure improvements were secured. The new electronic system is now enjoying much success and enabling staff to exploit modern technology which is ultimately providing patients with a better service.

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This high level of risk management within both former trusts was confirmed when they both achieved the top level 3 in the NHS Litigation Authority’s (NHSLA) Risk Management Standard for the Provision of Pre-Hospital Care in the Ambulance Service. As part of the reconfiguration new trusts were required to take on the lowest level last achieved by the previous trusts, this has meant that South Western Ambulance Service is the only ambulance trust to currently be at level 3. All front line Paramedics can now administer thrombolysis, ie clot busting drugs, for patients suffering a heart attack. In some areas work is ongoing to transfer appropriate patients directly to hospital units which provide primary angioplasty, an alternative form of treatment for such patients. An important development is the rapid access arrangements for patients suffering from an acute stroke. This service has been in place for over 2 years in Dorset but is now being introduced across the trust. The provision of appropriate care on arrival at hospital is critical to this development. Clinical audit has been highlighted below but one notable achievement within this period is the successful introduction of oral morphine to ensure patients receive the optimum level of pain relief and comfort. This exciting preliminary work will ensure the new trust is well placed to achieve Level 1 of the proposed new NHS Litigation Authority (NHSLA) Risk Management standards due to be piloted later in the year. Finally, I am honoured to have been reappointed as the Medical Director for the new trust. The timely and positive progress of the new team who are taking forward the successful work of both former trusts is noteworthy. Of prime importance is the continued provision of high quality patient focussed care delivered by our frontline staff. I am confident that with the support of the management teams our clinicians will move forward with further developments and innovations to ensure continuous improvements for patients in the future. Gillian Bryce Medical Director Clinical Governance explained Clinical Governance is a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. Implementing Clinical Governance is helping the transformation of culture, of ways of working, of attitudes and of systems within the NHS. It has become truly embedded within the NHS and the way in which is plans, implements, monitors and reviews its services.

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The ambulance service, alongside all other NHS organisations, is duty bound to involve staff and patients in finding better ways to do things and must continuously seek to do this. Clinical Governance has changed the way people work, demonstrating that leadership, teamwork and communication are as important to high quality care as risk management and clinical effectiveness. All levels of staff have continued to embrace change as the new trust settles down and begins to take forward the commitment of both former trusts to constantly strive to improve the services provided to the population of the Isles of Scilly and Cornwall, Devon, Somerset and Dorset. The new contract to provide out of hours primary care services to Dorset and Somerset has provided a fresh perspective to the ambulance service. This new facet of patient care is embedding the improvement of the patient experience into everyday practice regardless of the discipline in which staff work. This refreshing and much welcomed departure from being “just a transport service”, has been widely acclaimed throughout numerous articles and features written about the former trusts and the new trust with the spotlight firmly shining down on the South West. This is showcased on the trust’s website on www.swast.nhs.uk under communications, press. Clinical developments and effectiveness Clinical effectiveness has been defined as ‘applying the best available knowledge, derived from research, clinical expertise and patient preferences, to achieve optimum processes and outcomes of care for patients’. Clinical effectiveness encompasses the setting of clinical standards, implementation of guidelines, clinical audit and other quality improvement measures. Successful clinical effectiveness initiatives not only identify the best information about those interventions which work but also make that information available to clinicians in an accessible and understandable format and ensure that it is used in practice. These principles will underpin the trust’s current and future clinical effectiveness activity. Clinical guidelines All clinical staff within the trust practice to standards developed and published by the Joint Royal Colleges Ambulance Liaison Committee (JRCALC) and the National Institute for Health and Clinical Excellence (NICE). This provides assurance that care is based on the best available evidence where it exists. Where robust research evidence is lacking a consensus on practice standards is reached by the JRCALC guidelines development group.

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Cardiac care The trust continued its strong working relationship with partner organisations to further improve services to patients with heart attacks. Due to the investment in equipment, more patients are now being assessed with a 12 lead ECG machine and more patients than ever before receive aspirin, oxygen therapy and GTN in line with national clinical guidelines. The early delivery of clot dissolving thrombolysis treatment, vital in reducing mortality from heart attack, continued with a further 259 patients treated by trust crews in the period, 90% of whom received their treatment within 60 minutes of dialling 999. Heart attack patients also benefited from improved prehospital pain relief. Trust clinicians administered intravenous pain relief to 68% of eligible patients, 39% more than the national average. This is in addition to those whose pain was successfully controlled with oxygen, nitrate and other therapies. A range of additional pain management medications is being introduced to provide ambulance clinicians and patients with increased analgesia options for other clinical conditions. Spearheading new treatments The trust has also been developing alternative reperfusion options for heart attack patients. Working in partnership with the Royal Bournemouth Hospital and the Royal Devon and Exeter Hospital, trust clinicians are now referring certain patients directly to the Cardiac Care Unit for Primary Angioplasty instead of administering thrombolysis. In primary angioplasty, a catheter with a balloon at its tip is inserted through an artery in the groin or arm and guided into the blocked artery. The balloon is then inflated, squashing the fatty deposit which is blocking the artery, increasing the size of the vessel and restoring the blood flow to the heart. A small rigid support called a stent is then left in place to ensure that the artery remains open. The trust is immensely proud to be only the second area in the UK to offer patients both thrombolysis and primary angioplasty. Stroke care Clot dissolving treatment can improve outcomes in some patients, although it is most effective if given very soon after onset of symptoms. During the past two years, the Trust has been working in partnership with three hospitals in Dorset to develop an innovative new system to improve the care of patients experiencing a stroke. Stroke patients now receive a faster response from the ambulance service. They are assessed to establish whether they would benefit from early specialist stroke care, and if deemed suitable, they are rushed to a hospital with a specialist stroke service.

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The treatment has been a fantastic success story for many patients. It has enabled a number of patients to walk out of hospital without any lasting effects after just 36 hours, instead of requiring weeks or months of rehabilitation and long term care. The scheme received the highest accolade of recognition by winning two prestigious awards from the then Dorset and Somerset Strategic Health Authority (1 July 2006 merged with South West Strategic Peninsula Health Authority to become NHS South West). Dorset continues to rank top in stroke care, as it is the only area in the UK with an organised county-wide system of acute stroke care. Stroke services in Devon are also being developed, and the trust continues to work with acute trust partners in South Devon to fast track stroke patients to Accident and Emergency (A&E) departments, so more people are benefiting from early thrombolysis. These new approaches are expected to reduce the number of patients who die or become disabled and similar ways of working will be rolled out in other areas of the trust. Mental health The trust has been instrumental in improving the care of patients with mental health problems. The result is that ambulance staff across the 4 counties now have 24/7 access to advice from mental health specialists who are able to provide support to clinicians, and arrange a further assessment or direct admission to a mental health unit where appropriate. A full time safe-guarding manager has been appointed alongside front line operational staff who have dedicated hours set aside to lead the trust’s work for vulnerable adults and child protection. This work is being managed in parallel with the mental health work for the trust with the additional investment and recruitment of 8 clinically trained staff, 6 are based in the busy Communications Control Centre in Exeter and 2 in the Dorset Communications Control room in St Leonards. These highly skilled clinicians who consist of paramedics, nurses and Emergency Care Practitioners (ECPs) will provide individual support to those patients who call the 999 emergency service and require support with mental health issues. This pioneering approach will build upon the former experience and solid evidence base provided by an initial trial within the Communication Control Centre based in St Leonards, Dorset. Safeguarding Safeguarding is defined as ‘The protection of members of society who may be more vulnerable due to age, illness, capacity or position in society. It incorporates children, vulnerable adults, those with mental health issues and those suffering domestic violence.’

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All these areas have statutory requirements for the trust, including:

• Referrals • Vulnerable adult inquiries • Serious case reviews • Child death reviews • Domestic homicide reviews • Drug related death reviews

The trust is fully engaged with the setting up and implementation of these reviews which provide opportunities to review process and practice so that patients receive the very best patient care. In the 6 months from 1 July 2006 until 31 December 2006, staff completed 359 referrals. This represents an approximate 40% increase in referral rate from the same period in 2005. These statistics demonstrate and reinforce the dedication and commitment by staff to continually improve frontline services. Infection prevention and control Commitment to infection prevention and control remains top priority, with a continued emphasis on hand hygiene during the annual training program. To improve a weak area recognised by the trust in the counties of Isles of Scilly and Cornwall, Devon and Somerset, regular cleaning schedules by front-line staff continues to be supported by a dedicated team of vehicle cleaners. A recent audit of performance demonstrated considerable improvements, with the number of stations achieving full compliance with nationally acceptable standards increasing from an unacceptable 50% to an impressive 92.35%. All staff deserve recognition and thanks for this outstanding continued effort to improve cleanliness. Clinical Audit improvements Clinical Audit is a process by which performance is measured against agreed standards and improvement is made where necessary. The trust contributes to national audit programmes as required and in addition the trust’s Clinical Governance Committee agrees an annual programme of audits which this period included

• Treatment of patients with heart attacks, including thrombolysis • Treatment of severe meningococcal disease with antibiotics • Referrals in cases of suspected child abuse and for vulnerable adult

protection • Identifying suitable care pathways for those making frequent

inappropriate 999 calls • Morphine administration • Evaluation of the Mucosal Atomisation Device • Care of patients who self-harm

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A review was also undertaken of temperature variations in ambulances which may affect the stability of medicines and sensitive medical devices. Further research is planned in the next year. Continued emphasis is placed on empowering clinical staff to participate in local audit programmes. Influencing the National Clinical Effectiveness Agenda The trust actively supports the development of best clinical practice through participation in national forums including the Ambulance Service Association’s Clinical Effectiveness Committee. The trust is represented on the JRCALC Clinical Guidelines Development Committee and contributed to the development of the NHS Integrated Care Record Service, part of the NHS National Programme for Information Technology. Find out more The Trust has numerous ongoing clinical developments and reports on clinical effectiveness but space within the annual report does not permit reflection of all of these. More information is available at www.swast.nhs.uk. Public Health The trust Board of both former services agreed Public Health Strategies in 2005 to take forward the Government’s national strategy ‘Choosing Health: Making Healthier Choices – November 2004’. The aim of the Strategy is to establish a 5 year framework of actions to improve access and contribute to the reduction in health inequalities. The Strategy identified 4 priorities for the future

ü Tackle the social, economic and environmental determinants of health

ü Support and promote healthy lifestyles ü Protect health ü Improve provision of and access to local health and health

related services

This strategy will be taken forward by the newly emerging South Western Ambulance Services NHS Trust from 1 July 2006 and led by the Medical Director. Improving patient care The Trust continues to support staff to undertake a variety of training to enhance skills eg 15 week training course to become an Emergency Care Practitioner (ECP). These new skills enable staff to deliver more patient care out of the hospital setting and in the heart of the community.

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Developments continue with other higher education pathways, including a foundation degree in Paramedic Science and a BSc (Hons) in Paramedic Science, both of which aim to be accredited in the future. The National move towards higher education for ambulance staff will mean this will form the only recruitment route/career path in future years.

National liaison with the British Paramedic Association about alternative routes to registration, including regular meetings with the Health Professions Council and Open University is ongoing to reduce the implications of the move to higher education which will see workforce planning issues being encountered by all ambulance services until the higher education pathways are embedded. Patient and Public Involvement (PPI) The trust’s Patient and Public Involvement Strategy has been rewritten and agreed by the new Board. This Strategy explicitly states the trust’s intention of enabling and empowering patients, members of the public and stakeholders to contribute to the development, organisation and evaluation of services. An important aspect of patient and public involvement is feedback via appreciations, complaints and the Patient Advice and Liaison Service (PALS). The latter is a service that provides on the spot advice and help for those who do not wish to make a formal complaint but prefer to raise matters as a concern. All of these services provide very important opportunities to learn from everyone’s experience of the ambulance service and help to inform service developments by the trust responding to patient led suggestions. Complaints During the last year the trust received a total of 224 complaints, which is a slight decrease of 11% on the combined figures for former Westcountry and Dorset Ambulance Services, compared with the same period in 2005. The trust responded to 84% of complaints within the Healthcare Commission’s defined timescale for the year. This timescale for responses changed from 20 working days to 25 working days on 1 September 2006. Therefore 87% of complaints were finalised within the 20 working days response target during 1 April 2006 to 31 August 2006 and 81% of complaints were finalised within 25 working days during 1 September 2006 to 31 March 2007. Patient, Advice and Liaison Services (PALS) PALS finalised 1,181 enquiries for the financial year 1 April 2006 to 31 March 2007, compared to a combined total from former Westcountry and Dorset

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Ambulance Services of 1,001 within the previous 12 month period. This is an increase of 15%. 85% of enquiries received a response within the timescales set by the trust. As with complaints, these timescales were 20 working days from the 1 April 2006 to 31 August 2006, and 25 working days from 1 September 2006 onward. These timescales were introduced by both former trusts to ensure patients and carers were dealt with promptly and have been retained for the new trust. Appreciations The trust was delighted to receive 816 appreciations in the past year. This total figure is a culmination of 181 for former Westcountry Ambulance Service and 81 for former Dorset Ambulance Service for the period April to June 2006, alongside the new South Western Ambulance Service for the period July 2006 to March 2007. Personal injury claims NHS Litigation Authority’s Liabilities to Third Parties Scheme (LTPS) is the employee personal Injuries claims for the ambulance service. The trust received 7 Personal Injury Claims in the last 12 month period which is a decrease of 3 from the same period in 2005/06. 6 of these claims related to injuries sustained through manual handling and/or moving. The trust also closed 12 Personal Injury Claims in the last 12 month period which is an increase of 4 on the 8 closed for the same period in 2005/06. Clinical Negligence Scheme for Trusts (CNST) for South Western Ambulance Service NHS Trust The trust’s claims are covered by the NHS Litigation Authority’s Clinical Negligence Scheme for Trusts (CNST). The Trust currently has 2 ongoing clinical negligence claims which have been carried over from the former trusts. Risk management The NHS Litigation Authority (NHSLA) Risk Management Standard for the Provision of Pre Hospital Care in the ambulance service was introduced in 2004/05 and brought together organisational, clinical and non-clinical risks, including risks specific to those providing ambulance services. Examples of these requirements include the need for clear systems for managing ‘first responders’, clinical guidelines for pre-hospital care, and obstetric training which reflects national guidelines.

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All NHS trusts are assessed against risk management standards with level 3 being the highest by an independent assessor working on behalf of the NHSLA. Of the existing 13 ambulance trusts in the country during this period, only one maintained this top level. South Western Ambulance Services NHS Trust were delighted to be the trust that ranked top. This impressive achievement and experience will be taken forward into the new ambulance service for the South West to ensure the trust meets all future criteria for achieving the new risk management standards currently being developed by the NHS Litigation Authority and which the trust will be piloting later in the year. Clinical developments The trust has numerous ongoing clinical developments and space within this report is limited. Why not view the trust’s website on www.swast.nhs.uk and find out more. Increased confidence in risk management systems The trust actively encourages staff to report incidents in order that the organisation can identify trends and manage risks to staff, patients and the public. Staff demonstrated an increased confidence in the trust’s incident reporting procedure by reporting 727 incidents since the formation of South Western Ambulance Service. The trust is also pleased to note that the results of the Healthcare Commission’s NHS National Staff Survey indicated that the percentage of staff reporting adverse incidents is above average for ambulance trusts. The trust introduced on line reporting and rolled out a training programme across the trust. Considerable development has taken place this year in the area of management of palliative care patients. A jointly funded position by the Dorset PCT has supported patient records to be added to the out of hours systems so that the GPs are aware of special clinical needs set out by the patients own GPs should difficulties arise out of hours. The development of the workforce and enhancement of skills has required significant progress in the trusts overall medicines management procedures with an increased emphasis on medicines related to dealing with minor ailments/ illness. To ensure that managers and supervisors felt confident in using the new system. The new system was also well publicised throughout the trust and guidance material was produced for all staff. The new system is now gathering momentum and staff are able to exploit modern technology to assist with the process of accurate and timely reporting.

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Commercial training The reporting period saw the commercial team achieve an income of approximately £100,000. The product range was expanded and includes many more police, medic courses. Work with primary care continues to grow. First aid at work training continues at a steady pace and the commercial team now offer Resuscitation Council UK courses as well as those accredited by the Health & Safety Executive. Rolling out this work across the trust’s new area in the future will be at the top of the agenda for the training team in the future. Next steps The Healthcare Commission have introduced a new system of performance monitoring called Standards for Better Health and this was put into place for 2005/2006. This replaces the previous star rating systems for NHS Trusts. The new system is known as the ‘Annual Health Check’. The trust welcomes this relatively new and far reaching performance monitoring system that now enables ‘what matters most to patients’ to be measured and for all NHS trusts to be rated upon that key aspiration of patients. In addition, this new reporting enables stakeholders to comment upon trust performance. Local authority led Overview and Scrutiny committees (OSCs) and Patient and Public Involvement Forums (PPIF) which are soon to evolve into Local Information Networks {LINks} are given an opportunity to provide annual commentary on NHS trust performance. This highly valuable feedback contributes into the performance report published by the Healthcare Commission. The 7 domains below will continue to form a strong patient led focus for the new trust in 2006/07 and beyond:

• Safety • Clinical and cost effectiveness • Governance • Patient focus • Accessible and responsive care • Care and environment amenities • Public health

Both former trusts were required to submit self assessments of compliance with the core standards to the Healthcare Commission and both were pleased to report full compliance with each of the core standards for 2005/06. During the period the new trust has begun the extensive and thorough process of harmonising its strategies and policies to maintain compliance with each of the core standards for the year 2006/2007. The trust welcomes the opportunity to be scrutinised by an external organisation and believes this crucial feedback is helping with the ongoing modernisation, improvement and reform programmes.

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Operations The major part of the Operations Directorate comprises of staff which are recognised, by the public, as the face of the ambulance service. The Ambulance Care Assistants (ACAs), Urgent Transfer Care Assistants, Technicians, Paramedics and Emergency Care Practitioners (ECPs) are all well respected by both the public and their health service colleagues throughout the four counties which we serve. Their role is often a difficult one, but one where they continue to deliver a service which is second to none. Within the Operations Directorate are other key functions; the Communications Centres, Unscheduled Care Services, Patient Transport Services (PTS), Community Engagement and Resilience (formerly Emergency Planning). These all work closely to provide a framework which supports those on the front line; again the trust is extremely proud of the commitment shown by the various teams. The Operations Directorate was extremely pleased with the progress made in all areas during 2006/2007, especially with the improvements to key performance targets. The commitment to the delivery of the highest quality patient care by motivated professionals has never been stronger. Staff continue to work in partnership with their NHS colleagues to transform the way pre-hospital care is made available to the population. In doing this it has also enabled staff to work closely with those responsible for primary, secondary and unscheduled care resulting in an improved integration of services. The direction underpinning the key strategies for the Operations Directorate were a reflection of Taking Health Care to the Patient: Transforming NHS Ambulance Services’ (The Bradley Report) which was launched in July 2005. The Bradley Report outlined a clear national strategic vision for the future of ambulance services which became the guiding principles and values for the South Western Ambulance Service over the past year. “An ambulance service that provides both high quality call handling

and clinical advice (hear and treat), and safe and effective mobile healthcare (see and treat)”.

The Operations Directorate took the recommendations of the Bradley Report as a route map towards a more proactive, efficient and dynamic provision of local ambulance services through delivering high quality care that meets the needs of patients. During 2006/2007 the operational arm of the service began to undertake a transformation, a focus on five key areas;

• Leadership to deliver the cultural change, • Improved quality and consistency of care for patients, • Improved efficiency and effectiveness of our systems, • Supporting performance improvement, and • Developing an empowered professional, self regulating workforce.

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The Bradley Report posed some key challenges in the delivery of ambulance services which we have started to address in collaboration with our partners. Operationally during 2006/2007 we delivered improved services for patients and pressed forward with organisational reform, to deliver substantial and lasting improvements for the future, while returning robust financial health. In addressing all aspects of operational delivery a strong emphasis was placed on the quality and safety of care, ensuring that local clinical governance arrangements were robust, that systems were geared to reducing the risks of care and enhancing patient safety. The patient’s experience was central to the day-to-day running of services. The standards-based approach to delivery was very important within ambulance operations and was intended to give patients and the public confidence in the fact that services were quality assured and fit for purpose. The Communications Centre The Bradley Report asserted that:

“Ambulance services need to improve the speed with which 999 calls are answered and the quality of call handling”.

Automatic Call Distribution (ACD) which is widely used in commercial call centres was implemented within the Exeter Communication Centre in August 2006 to ensure improved productivity, as the caller is simply presented in the earpiece of the Control Assistant, announced only by an alert tone. Following the introduction of this innovation the speed with which 999 calls are answered has improved dramatically with over 84% of emergency calls now answered within 5 seconds.

EMERGENCY LINE CALL ANSWERING PERFORMANCE MARCH 2007

8%3% 2% 1% 1% 1%

84%92%

95%97% 98% 99% 100%

84%

TARGET 95% IN 5S

0%

25%

50%

75%

100%

0-5 SECS 5-10 SECS 10-15 SECS 15-20 SECS 20-25 SECS 25-30 SECS > 30 SECS75%

80%

85%

90%

95%

100%

105%

Calling Line Identity (CLI) services are a feature of modern telephone networks; this transmits the number of the caller as each call is set up. CLI has long been used in modern phone systems to allow the phone company to trace malicious or nuisance calls and it also forms an important part of the 999 emergency services, allowing the emergency operator to see, on their display, the caller's number and the location from which the call is being made. On

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accepting the call in the Communications Centre the Control Assistant can see the number on their display along with the telephones location (the address from which the call is being made). During 2006/2007 the telephone system in the Exeter Communication Centre was interfaced with the Command and Control system (CAD) so the address information, once confirmed, no longer had to be manually typed into the dispatch record, thus saving vital seconds when activating an ambulance response. An independent report strongly asserted that the St Leonard’s Communications Centre would derive significant benefit from additional dispatchers in the evening period from 17:00 hours (5pm) until 01:00 hours (1am). Additional dispatchers were added to the establishment during 2006/2007 to facilitate this requirement and to allow the current dispatchers to take their evening break without being disturbed thus improving their working lives. The Bradley Report asserts that:

“Ambulance services need to deliver significantly more clinical telephone advice, with higher levels of clinical expertise”.

The decision was taken during 2006/2007 to provide a mixture of in-house and outsourced clinical advice to increase the number of 999 callers safely provided with advice and/or passed to other health agencies. The in-house provision of clinical advice was consolidated and strengthened in 2006-2007 through the provision of:

• Additional Clinical Supervisors providing advice 24 hours a day throughout the year

• Enhanced computer decision support software with appropriate audit

facilities

• Procurement and implementation of Advanced Medical Priority Dispatch Systems (AMPDS), the nationally agreed software for managing emergency and urgent calls.

Operational Resources During 2006/2007 there were significant changes to operational resource levels in many areas of the trust. These changes included the introduction of new and innovative resources, the addition of traditional front line vehicles and the re-profiling of rosters on several stations. Falls staff were introduced to Truro, Plymouth, Torquay, Exeter, Yeovil and Bournemouth; having received additional training in manual handling techniques and referral pathways they were targeted at mainly elderly patients who have fallen. This new service was provided (in general) between the hours of 06:00 (6am) and 14:00 (2pm) in urban areas. The service provision

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was networked and integrated with Primary / Community / Social / Urgent Care response teams and has provided more than a ‘pick up’ or ‘lift and shift’ service through collaborative and partnership approach. As well as carrying out this valuable level of care for a more vulnerable group of patients the staff involved are also used to conveying the more basic GP urgent admissions to hospital. Additional resources were introduced during 2006/2007 to Helston, Dartmouth and Frome following extensive staff consultation and engagement. The key objectives, which were, to maximize staff down time, to improve the service we deliver to our patients and to provide the best possible service within the levels of affordability were achieved on each occasion. As well as the introduction of additional resources, rosters were reviewed and improvements made to service delivery, by matching demand patterns to availability of crews at the following locations; Tavistock, Brixham, Paignton, Torquay, Okehampton, Cullompton, and Glastonbury. Aircrew at the four Air Ambulance bases (1 in Cornwall, 2 in Devon and 1 shared between Somerset and Dorset) across the trust area continue to provide a crucial service to residents and visitors in the four counties within our boundaries. It has long been recognised by the trust, other health care workers and the public that the Air Ambulance operations are an integral part of providing top quality pre-hospital care. The level of Air Ambulance cover was stabilized following agreement with the Devon Air Ambulance Trust the air ambulance based in North Devon five days per week, ten hours per day was consolidated and operated to significant effect throughout 2006/2007. The main source of revenue for all the operations continues to come from the efforts of those working within and for the Air Ambulance Charities. Their unstinting efforts ensure this remarkable initiative continues to provide for those who may be in need, for this the South Western Ambulance Service is extremely grateful. Operational Initiatives In line with recommendations made within the Bradley Report, which suggested the need for better collaboration between health care workers, leading to partnership working the Innovations Group was established during 2006/2007. This brought together like minded health professionals with a ‘can do’ attitude who wanted to make progress and affect change to improve the services provided to patients. Members of the Innovation Group include senior ambulance managers, General Practitioners and the Lead Manager from Devon Doctors. The group made a real difference in transforming unscheduled care through dynamically tackling the niches that emergency care networks had currently not been addressing. Areas on which the Innovation Group made significant progress during 2006/2007 included:

• With patient consent ambulance crews are notifying Devon Doctors (OOH service) across Devon when patients are either treated at home

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or not conveyed to hospital. This information is then passed to the patients GP, normally within 24 hours, so as they have a record of the contact made by the ambulance service. It is anticipated that this initiative will improve patient outcomes by allowing General Practitioners to further facilitate the needs of their patients and importantly will also assist in managing clinical risks when ambulance clinicians do not convey 999 patients to hospital. This information is also used to better manage patients within the community, it is anticipated this initiative will be adopted by other counties.

• Emergency Care Practitioners (ECPs) are working from the Response

Care Hub at North Devon District Hospital to integrate their practice with the other health care professionals. The ECPs in North Devon are also working towards carrying out home visits on behalf of Devon Doctors and GPs within the town.

• Paramedics within the Okehampton area are working within the local

Minor Injury Unit (MIU) to make better use of the down time between calls. This initiative will enable them to work with other health workers with differing skills which will in turn enhance their own abilities.

• ECPs and Paramedics working within health care facilities were also

introduced to Paignton MIU, Honiton MIU, and St Thomas Health Centre in Exeter.

Other initiatives which are not as a direct result of the Innovations group include;

• In Plymouth ECPs are working in partnership with the police to help manage the numbers of calls which can originate from what is a busy night time community. They have set up what is practically a MIU within a few hundred yards of the nucleus of the clubs and have successfully reduced the numbers of patients presenting at the acute hospital.

Software rota system known as Promis Dorset Promis is a software rota system which has helped the trust manage its complex shifts required for a 24/7 healthcare service. However, this is only available in the county of Dorset. The system first commenced in April 2005 at former Dorset Ambulance Trust with a phased implementation to embed the rota system, for both A&E and Patient Transport Services (PTS) personnel, into the trust working procedures. The new trust will continue to expand and maintain the access for all staff in Dorset to PROMIS from the web in their own homes by ensuring the appropriate IT support. Continued expansion plans for PROMIS include ongoing opportunities for all staff to attend training on the successful system, adding Urgent Care Systems (UCS) to the system and moving to the new sophisticated control suite being

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built at St Leonard’s in Dorset which will be phased into operation late 2007 and onward. Rolling this system out to the staff across Isles of Scilly and Cornwall, Devon and Somerset will be considered in the next financial year. In Plymouth ECPs are working in partnership with the police to help manage the numbers of calls which can originate from what is a busy night time community. They have set up what is practically a MIU within a few hundred yards of the nucleus of the clubs and have successfully reduced the numbers of patients presenting at the acute hospital. Newquay Safe Bus A new Mobile Treatment Centre, which operates predominantly throughout Newquay in Cornwall, was highly commended at an awards ceremony held within this period. The prestigious Cornwall Partnership Awards run annually, and shortlisted partnerships were invited to showcase their projects before the official ceremony and presentation of certificates and awards in 2006. The trust were delighted to be invited and receive a coveted award for innovation in partnership. The Mobile Treatment Centre, which is taking healthcare to the patient as recommended in the Bradley Report, began operating officially as a pilot project in 2005. It was commissioned in conjunction with Cornish charity FLEET (Front Line Emergency Equipment Trust) who put a lot of hard work and effort into refurbishing and kitting out the bus before it made its debut at the famous ‘Run to the Sun’ event, where it was operational for 3 nights and treated a total of 74 patients. The majority of these people were treated on scene and therefore did not need to be conveyed to the nearest Accident & Emergency department 17 miles away. It has since been utilised in Newquay town centre throughout the summer and at weekends. The centre will also assist FLEET in raising charitable funds and educate the public. Approximately 2000 children passed through the vehicle in June over a two week period, where they were taught basic life saving skills and resuscitation techniques. The rationale behind the introduction of the Mobile Treatment Centre is two-fold. Firstly, it stops people calling 999 unnecessarily, therefore freeing up resources for genuine emergencies. Secondly, the on scene treatment prevents many people from heading straight to A&E departments, thus freeing up beds and staff time. The staff who crew the centre, which is a converted bus, can perform minor wound care to advanced life support skills. Similar initiatives are in operation across the trust’s vast geographical operational area and some of these are showcased at www.swast.nhs.uk.

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Activity and Performance The Operational Directorate is proud of the progress made throughout 2006/2007 on performance levels and in particular the number of patients suffering from life threatening conditions who receive a response within 8 minutes of the initial call. An improvement in performance has still been achieved despite the ongoing increase in demand across the entire trust area. During the past year the trust activated to 352373 A&E and Urgent calls which was an increase of 11.23% specifically on 999 calls, with an increase 6.33% on all calls over the previous year. In line with Government prioritization procedures all calls are classified as either;

• Category A - immediately life threatening • Category B - serious but not life threatening • Category C - not serious

Each call is responded to in the most appropriate way which can include a traditional front line vehicle, a rapid response vehicle, an ECP vehicle, a falls/urgent transfer vehicle, the air ambulance or telephone advice. Achievements Summary All staff across the entire Operations Directorate and those in support have worked extremely hard to provide the highest levels of patient care which is delivered in a timely way.

• Activated to 352373 A&E and Urgent calls which was an increase of 6.33% on the previous year

• Category A - 74.10 were responded to within 8 minutes • Category B - 93.49 were responded to within 19 minutes • Category C - were responded to within 60 minutes.

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SWAST Emergency and Urgent Activityand Category A 8 Minute Performance

March 2006 to March 2007

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20.00

30.00

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100.00

Mar Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar

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%

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10000

15000

20000

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35000

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ber

Cat A Cat B Cat C Urgent Response % within 8 Min (75%)

Improvements in clinical practice have continued to progress patient care

• Introduction of new clinical skills such as the FAST track Stroke Project • Numerous paramedic staff have gained additional skills to become

Emergency Care Practitioners • Award wining projects launched such as TAPP • Improved intravenous pain relief for heart attack patients • Continuing work under the auspices of the Clinical Negligence Scheme

for Trusts (CNST) in preparation of the new pilot for achieving level 1 • Continuing to develop treatments including thrombolysis and, in

partnership with acute trusts, primary angioplasty • Harmonisation of both former ambulance service working policies and

practices to capture the best of both trusts and continue to develop and enhance front line staff skills

• Developmental work led by the Head of Training and Development toward the implementation of a new training programme for staff

• Launched a new Clinical Governance Committee to lead the continuation of the robust strategic work of the Clinical Directorate and wider trust

Committed to the professionalism and Improving the Working Lives (IWL) of staff

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• Successfully took forward the transitional and preparatory work of the trust from both former Dorset Ambulance NHS Trust and Westcountry Ambulance Services NHS Trust

• Successfully took forward the introduction of the new NHS pay modernisation (Agenda for Change) assimilating 98.3% staff across to these new terms and conditions

• The sickness rate continued its downward trend for the first 3 months of the financial year with a slight increase in the past 9 months

• Continued the investment in the staff 24/7 helpline • Commenced on work to harmonise the work practices of both trusts • Commenced and progressing work on the harmonisation of trust policies • Recruited a Business Manager to take forward the Equality and Diversity work • Wrote and published an Equality and Diversity Strategy with subsequent Race,

Gender and Disability Schemes Supported by Logistics, Medical Transport, Vehicle Maintenance and Fleet units The figures in the 3 month Dorset Ambulance NHS Trust and Westcountry Ambulance Services NHS Trust to not reconcile with these below when added together for the new trust. Evidence from FAR and additions testing have been agreed by the trust with the Audit Commission to secure reconciliation. • 200 Front-line A&E Ambulances • 108 Patient Transport Ambulances • 109 Paramedic Response Cars (15 Operational and 2 Reserve) • 7 Rapid Response Cars • 24 Resilience Vehicles • 16 Urgent Care Service (UCS) cars • 5 First Responder Vehicles • 71 Support Vehicles • 1 Boat (Star of Life – Isles of Scilly) Patient Focused

• Successfully implemented a new trust wide quarterly newsletter called

‘twentyfourseven’ • Designed and implemented a new weekly staff bulletin that features a

regular patient focused article • Developed a new redesign mechanism for new patient information

leaflets which can be used by Emergency Care Practitioners (ECPs) in the event of a patient being treated at home

• Developed a new in-house service for the publication of leaflets for all the services

• Developed and launched a new trust website with an interactive feedback section

• Worked in partnership with the Police and Fire Services to host and manage an interactive consultation day with 80 ‘hard to reach’ members

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• Rolled out the new public relations and health promotion vehicle; participating in numerous community and multi agency events

• Managed a proactive media function to drive forward a campaign calendar that supports the government’s public health strategy ‘Choosing Health’ ; these were based on social marketing techniques

• Redesigned and agreed the Patient and Public Involvement Forum (PPIF) working agreement based on national best practice

• Dedicated officer attendance at the trust’s Patient and Public Involvement Forum (PPIF) public meetings which are held bi monthly

• Hosted and managed the Patient and Public Involvement Forum (PPIF) monthly face to face briefings

• Devised and produced a new Corporate Communication Guide for all staff that is tailored around the needs of the public for clear, timely and accurate information

• Developed a projects database to inform members of the public of the work that the trust is driving forward

• Mapped the trust’s strategic partnerships and developed a database of evidence

• Joined the early adopter site project (EAP) group in Dorset for the preparatory work of feeding into the Department of Health’s project to establish the Local Involvement Networks (LINks) that are due to be launched in 2008 to take the place of the current Patient and Public Involvement Forums (PPIFs)

• Dedicated officer support to attend a variety of the 9 Overview and Scrutiny Committee (OSC) public meetings and pre briefings across the 4 counties to foster good relations and develop robust scrutiny arrangements

• Worked in partnership with the newly formed Cornwall and Isles of Scilly Primary Care Trust on their consultation of their Strategic Review by attending a series of public meetings that provided opportunities for audience participation via questions and answers

Planned patient care

• Patient Transport Service (PTS) carried out 170,617 patient journeys • Voluntary Hospital Car Service undertook 380,425 patient journeys Emergency Planning The trust continues to play a key role, whilst taking part in inter-agency collaborations, such as Local Resilience Forums (LRFs), in emergency planning across the local, regional and national structures to protect the public. The Civil Contingencies Act 2004 and subsequent Emergency Planning Guidance 2005 placed a statutory duty on the Trust to liaise and exercise with other organisations. All activity throughout the year has been aimed at ensuring an appropriate response to any perceived challenges. The focus of work has centred around four key areas:

• Emergency Planning

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• Risk Assessment • Business Continuity Planning • Warning and informing (Local Resilience Forums) Emergency preparedness The definition of an emergency has been defined by the trust as ‘any incident requiring prompt action by a premises licence holder and/or emergency services’. Whilst the definition of a major incident has been defined by the trust as ‘any emergency which involves a large number of people and which requires the implementation of special arrangements by one or more of the emergency services, the NHS or the local authority or other agencies for

• the initial treatment, rescue and transport of a large number of casualties

• the involvement either directly or indirectly of large numbers of people

• the handling of a large number of enquiries likely to be generated both

from the public and the news media, usually to the Police

• the need for a large scale combined resources of 2 or more of the emergency services

• the mobilisation and organisation of the emergency services and

supporting organisations, for example a local authority, to cater for the threat of death, serious injury or homelessness to a large number of people.

A major incident for one of the emergency services would not necessarily be a major incident for the others. A health major incident may involve the ambulance service or other agencies within the NHS but not the Police or the fire service. The trust has a major incident plan in place and continuously takes part in numerous multi agency preparedness planning events throughout the 4 counties. These valuable live and table top exercises ensure the trust is able to fully practice its procedures and plans, alongside partner agencies which in turn enable the pinpointing of areas for improvement. These important multi agency events are assisting with the continual improvement of the trust’s state of preparedness for any potential emergency or threat. Planning for the future The 2012 Games will see Dorset hosting the only major Olympic sporting events outside of London.

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The trust is pleased to be actively involved in the preparatory work and will take a lead role on providing an assessment of the required medical provision throughout the events. The trust received recognition for co-writing the first multi agency Local Resilience Forum (LRF) Communications and Media Strategy for the South West. This fulfils the trust’s legal duty to jointly prepare for potential major incidents in terms of ensuring there are joined up mechanisms for early ‘warning and informing’ of the public. Rapid Response Vehicles Ambulance resources are deployed to an incident in most cases whilst the call is being taken. The severity of the call will reflect the type of vehicle sent to the scene. The Category ‘A’ life-threatening calls may, in addition to an ambulance, receive a response from a Rapid Response Vehicle (RRV). These vehicles are staffed with one Paramedic and work across Dorset.

Patient Transport Service (PTS) Patient Transport Service (PTS) is the non-emergency medical transport arm of the trust providing a service for patients who need to access health services and are unable to use public transport. This includes transport to and from hospitals for appointments, day units and treatment centres. The service is accessed and booked for patients by doctors and healthcare professionals. There is a move to centralise the way patients access the service with the introduction of Single Point of Contact Centres (SPOCs). Some SPOCs are operated by health professionals with the remainder contracted to voluntary agencies. There are 4 Patient Transport Service (PTS) Controls located in Plymouth, Exeter, Taunton and St Leonards in Dorset with a satellite unit in each of the 6 District General Hospitals within Cornwall, Devon and Somerset. These centres control all PTS and Voluntary Hospital Ambulance Car (VACs) journeys across the trust as well as those travelling to more distant locations. The total number of journeys undertaken this 12 month period is 170,617 for Patient Transport Services and 380,425 Voluntary Ambulance Cars. This will drop significantly over the rest of this year as changes (described below) take effect. PTS Controls assist the Accident and Emergency (A&E) Control where appropriate by facilitating transport for suitable urgent patients to hospital and

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also in incidents that involve large numbers of walking wounded patients. A total of 118 patients were passed from the A&E Service to PTS in former Westcountry Ambulance Services area throughout the year. This joint partnership releases A&E resources and so improves overall performance. Anticipated changes in VACs and PTS during year will lead to a review of PTS Controls and its relationship with the A&E Control. The Lead Manager for PTS development and commissioning continues to work to implement this and to liaise with commissioners in their review of PTS and VACs. A medical tier PTS is planned for the future in some areas; this will concentrate on patients needing medical interventions. Those patients with mobility needs will transfer to a new supported travel operated service managed by local authority and voluntary agencies. Voluntary Hospital Ambulance Car Service (VACs) The Voluntary Hospital Ambulance Car Service (VACs) consists of recruited volunteers who give up their time to transport walking patients to and from health clinics and wards across the trust area and beyond. They use their own cars for which they receive a mileage allowance. The service operates a dynamic service 5 days a week with a limited service available at weekends. Patients access this service through their GP or other health professional or in some cases a booking service which applies criteria for its use. These patients are generally not well enough to access their health needs by other means but do not have the need for an ambulance as with the Patient Transport Service (PTS). VACs are recruited, trained, planned and controlled by the PTS Offices in Plymouth, Exeter and Taunton. PTS Supervisors provide an on-call facility for out of hours issues involving VACs and PTS. A review of the VACs is being undertaken by the South West Strategic Peninsula Health Authority which covers Isles of Scilly, Cornwall and Devon (merged with Dorset and Somerset Strategic Health Authority on 1 July 2006 and became NHS South West). VACs in Cornwall passed to the voluntary sector operated by Transport Access Patients (TAPs) in June 2006. An unusually high volume of enquiries and concerns were received during the first month of operation coupled with a few initial unforeseen difficulties implementing TAP. The trust worked alongside TAP during these ‘teething problems’ to help resolve the initial unforeseen difficulties to ensure a successful transition was completed. VACs in Devon is planned to pass to the voluntary sector during 2007 to 2008. Somerset VACs future has yet to be determined and meanwhile will remain within the ambulance service. Fleet, logistics and equipment

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The trust’s dedicated fleet of Accident and Emergency (A&E) vehicles and patient transport vehicles have been designed to comply with legislative and best practice requirements. Vehicles are procured, designed and maintained to meet the highest possible operational standard delivering efficient patient care. The trust is committed to improve the patient experience by ensuring it has an up to date and modern fleet of vehicles and is continuing its investment programme throughout 2006 and beyond. Investment in Fleet during the period saw the arrival of 23 new A&E vehicles and 15 rapid response vehicles. Building on the success of the Urgent Care Service (UCS) provided to Somerset and Dorset residents, the trust is proud of its achievement of providing 15 rapid response cars specially designed for Emergency Care Practitioners (ECPs) and Paramedics. To meet the changing needs of our patients and maintain our impressive safety record, 2 emergency ambulances have been designed specifically for the purpose of transporting bariatric (obese) patients, with more investment planned for the future. This forward thinking design is relatively unique to ambulance services as they are multi-functioning. They offer the ability to transport this particular group of patients, as well as the space to carry life saving equipment such as incubators and aeortic balloon pumps (vital equipment to assist with the opening of arteries as required for some patients). First Responders A First Responder is a generic term that may be applied to any form of responder utilised by the trust to respond on its behalf. Co-responder’s are predominately Fire Co-responders within the trust area and Community Responders are normally volunteer lay persons.

The Resuscitation Council UK has defined the terms as follows

First Responder is ‘a person, trained as a minimum in basic life support and the use of a defibrillator, who attends a potentially life-threatening emergency. This response may be by the statutory ambulance service or complementary to it.’

Examples of first responders include ‘co-responder’ (police or fire service), members of staff of a shopping mall or other public place, members of a first aid organisation, lifeguards, community first responders and others who have been trained to act in this capacity. Members of the statutory ambulance services may also act as first responders.

A Community First Responder is ‘a first responder, usually (but not exclusively) a lay person, who makes himself or herself available to be dispatched by the ambulance control to attend an incident.‘

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Public Access Defibrillation is the ‘use of an Automated External Defibrillator (AED) that is made available to members of the local workforce or members of the public or both.’

A Responder Scheme is made up of volunteers who, within the community in which they live or work, have been trained to attend emergency calls received by the NHS Ambulance Service, providing first aid and general assistance until an emergency ambulance arrives. Responder Services training and equipment Each different type of responder compare favourably in their capacity to deal with different types of emergencies. The Fire Co-responders only attend life threatening emergency incidents, however Community and off duty staff responders attend a wider range of types of emergency following initial evaluation and prioritisation by ambulance Control staff.

Responders that have no previous clinical experience undertake a 3 day course which covers all the necessary training requirements for them to be proficient in the types of incident to which they are dispatched. The Fire Co-responders receive additional training as they carry some specialist equipment as a natural part of their normal role such as attending Road Traffic Collisions (RTCs). Community Responders are not dispatched to Road Traffic Collisions and are not trained to operate within this environment. The only variance between Fire Co-responders and Community Responders is that the Fire Co-responders carry entinox (a pain relieving gas) and cervical collars to immobilise a patient’s neck following incidents such as Road Traffic Collisions. Other forms of First Responders, such as paramedics, may carry out other procedures in line with their clinical scope of practice.

Fire Co-responders receive refresher training on a 3 monthly basis and Community Responders on a monthly basis.

Nationally responders usually carry out Basic Life Support and Automated External Defibrillation. However within our trust we train and equip all responders with oxygen, bag-valve-masks (to aid ventilation of patients) and basic airways. The trust supplies the equipment for all responders, and funds any additional costs associated with the rental of oxygen, pagers, and telephones. All training is supplied by the trust both for the initial setup and the ongoing training.

Extensive advice is given to Community Responders in respect to all aspects of responding, this is through their training and also contained in a Handbook. First Responders who use their car to respond to an emergency call are required to drive within the requirements of the law and have no special exclusions. They are advised to inform their insurers that they are using the vehicle for this purpose but it would not be anticipated that the vehicle is being used for anything other than normal driving.

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Groups and number of schemes The trust has the following number of responder schemes:

• 83 Community Responder groups • 19 Fire Co-responder stations • 138 other First Responder resources

Updated Resuscitation Council guidelines During the past year, the trust’s community responders enthusiastically completed a new programme to receive Automated External Defibrillators (AEDs) which were programmed with the updated Resuscitation Council guidelines. This was complemented with the appropriate training and assessments required and included Fire Co-responders and Static Site responder AEDs located in public access areas. A revised call sign and personal identification number plan has also been introduced. Hundreds of Responders volunteered at local events throughout the region, offering training in an introduction to Basic Life Support to the public. During the 12 months responders attended 133,24 emergency incidents in the Isles of Scilly and Cornwall, Devon and Somerset, continuing to offer early intervention to patients suffering from life threatening conditions until the arrival of an ambulance. New Responder Schemes A number of successful Community Responder Schemes have been established across the 4 counties. The past year saw the ongoing development of those at Polzeath, Tregadillet in Cornwall, Tavistock in Devon, Lulworth and Weymouth, both in Dorset The trust has a variety of Co-Responder Schemes which include static sites at places such as Plymouth Railway Station, Drake Circus shopping mall in Plymouth. In addition, there are some military Co-Responders eg Royal Marine Base (RMB) at Chivenor, as well as the Royal Air Force (RAF), in St Mawgan, Cornwall. Community Responder Schemes are also in place at Bournemouth Airport and Monkey World. More schemes have been implemented in collaboration with St John Ambulance in Shaftesbury and Portland. National Defibrillator Programme Collaboration with the National Defibrillator Programme continues which is providing a comprehensive network of lifesaving community defibrillators.

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There are held at hundreds of locations throughout the 4 counties such as, Police Traffic Units, Police Custody Suites and on site at football clubs The trust would like to sincerely thank all the staff and volunteers who make these schemes so successful. Inappropriate use of ambulance services The Department of Health has confirmed that despite increasing investment in ambulance services in the UK and implementation of new ways of working, keeping up with increasing demand was a real challenge. The clock times for calculation of calls will change in 2008 and this will bring additional pressures. Whilst patients and the public have a right to expect an appropriate and effective emergency response, they equally have a duty to use the service responsibly. The trust has implemented a modern and cutting edge decision support software called Advanced Medical Priority Dispatch System (AMPDS). Dorset Communication Control centre had implemented this system early within the year 2004 and this valuable learning experience has helped the smooth transitional period for the Exeter Communication Control centre. This nationally acclaimed system is complemented with fully trained paramedics in both the Control Centres to enable clinically safer decisions when grading 999 emergency calls to allow the most appropriate resource to be assigned to each incident. This is helping to reduce some of the burden of inappropriate calls for ambulances from non life threatening injuries, whilst at the same time supporting patients in ensuring they receive the most appropriate response. Ambulance Care Assistants (ACAs) The role of an Ambulance Care Assistant (ACA) has changed greatly over the last 12 months, with more and more opportunities for staff to learn extra skills. In line with the Bradley Report, these important members of staff have been specially trained in additional clinical skills to enable them to deal with a more dependant category of patient. This developmental training is realising the vision for ambulance services to deliver more urgent care in the community and out of the hospital setting. The range of supplementary skills include; defibrillation, analgesic gases, pulse oximitary, blood pressure monitoring, and care of fractures.

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Urgent Care Service (UCS) in Dorset and Somerset, previously Dorset Emergency Care Service (DECS) Somerset Integration Easter 2006 was the first ‘peak’ bank holiday period for the integrated Dorset and Somerset Out of Hours (OOH) service with nearly 6000 calls being answered in a 4 day period. Despite the phenomenal levels of demand and the challenges this brought, reasonable performance was maintained. Medicines management in Somerset is improving within the new trust with work progressing well toward agreeing a consistent OOH formulary, achieving consistent stock control and ordering and improving access to controlled drugs for palliative care patients. Palliative Care The Urgent Care Service is proud to be working in partnership with the Dorset Cancer Care Network and Primary Care Trusts (PCTs) in an important area to support best practice in the OOHs care setting. A pioneering new project has been set up within this period to help those patients who are sadly at the end of their life. The project aims to provide continuity of care between in and out of hours for palliative care patients that fosters respect and dignity for this small group of patients.

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Project leaders are spearheading the integration of the government’s ‘Gold Standards Framework’ in the OOHs setting for GPs and Emergency Care Practitioners (ECPs) working within the trust when managing the palliate care needs of the patients in the community who contact the Urgent Care Service (UCS). The trust has jointly produced a special patient information templates for local GPs to complete and send into the service for flagging of patients on the UCS Adastra OOHs software system. In addition, the production of patient information leaflets has been completed to support easy access and advice for patients on ‘who’ and ‘how’ to access appropriate help and advice. The publication of a specially prepared document has complemented this partnership initiative. This crucial information supports practitioners and staff working within the OOHs setting on how to provide adequate and dignified support, as well as information on how to access services in support of palliative care. Joint working within the ambulance service area is also seeing a strengthening of relationships and communications with Devon Docs who manage the same service for those patients who live in Devon. Both services are now sharing special messages in order to avoid inappropriate admissions for patients or carers who contact the 999 service. The trust has also appointed a Pharmacy Advisor to the service to support our strategic developments around medicines management and in particular palliative care drugs. This ongoing improvement work is being taken forward with the new trust to ensure patients receive the optimum care available. Dental Service Immediately after the integration of the Somerset Out of Hour (OOHs) calls, the Dorset Primary Care Trust’s (PCTs) commissioned the former Dorset Ambulance Trust to operate the call handling and overnight triage for the OOHs Dorset Urgent Dental service from 1 April 2006. This development was as a result of changes in the national Dental services contracts, which handed over responsibility to PCT’s for the OOHs provision of Urgent Dental Care. During the past year the trust answered an equally high volume of calls totalling 9,988. Nurse Triage Further to the existing Swanage Nurse Triage which continues to provide dedicated Triage for all the OOHs periods, the trust also has a bank of Hub Triage Nurses and this new approach proved very effective cover over the Easter period for patients. Triage is the term used for managing the categorisation of calls.

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Remodelling Implementation of the strategic review of OOHs services for Dorset and Somerset commenced on 2 May 2006. As a result, some treatment centres with minimal activity have been developed to support a more appropriate skill mix where GPs are based in centres where activity is high. Other units continue to be staffed by either Nurse Practitioners or Emergency Care Practitioners (ECPs) and GPs providing assistance as required. The overnight mobile cover in Yeovil has been reduced on Mondays to Thursdays and a reduction in the second St Leonards evening mobile cover for Sundays to Fridays. During peak periods additional capacity is put in place to meet demand. Adapting cover to demand has proven very successful in meeting the needs of patients. Workforce Development The Urgent Care Service (UCS) is fully integrated with the Somerset OOHs GP workforce with the transition of their management and leadership from 1 April 2006 to the new trust. Integration of the Somerset Emergency Care Practitioner’s (ECPs) commenced in May which resulted in the increase of mobile resources available in Somerset. These ECPs base themselves in 3 of the main treatment centres and work in collaboration with the doctors. Three Somerset clinical advisors have been appointed and they are also supporting the ECP’ ongoing development to ensure patients’ needs are met. The management of the Minor Injuries Units (MIUs) in Weymouth and Portland have now been successfully taken over by the trust and this will see further improved joint working with an impressive skill mix of practitioners able to help the patients who access the service. Reorganisation During the past year the Urgent Care Service (UCS) structure remained unaffected by the reorganisation of former Westcountry and Dorset ambulance services. Future Developments The building of the new integrated Control Centre at St Leonard’s is well advanced, the Information Technology (IT), communications and operational support infrastructure will host state of the art technology with capability for further expansion if required. The new facility has a phased implementation

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programme which will commence in the latter part of 2006 and carry on into 2007. A computer update has taken place to a more effective windows based call handling module which includes supplementary improvements to enhance ongoing developments. The system used is called Adastra. Triage capacity and effectiveness continues to be a challenge for the service, as this is not the most popular role amongst Doctors. To deliver improvements the trust will consider developing and putting in place call streaming processes to attract more doctors to the role. The prison service has expressed an interest in the trust providing Out of Hours (OOHs) medical care for the prisons in Dorset. The trust is currently exploring the numerous issues involved in such a pioneering development for an ambulance service.

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12 Month Financial Annual Report

South Western Ambulance Service NHS Trust was formed on the 1July 2006 following the merger of Dorset Ambulance NHS Trust and Westcountry Ambulance Services NHS Trust. A full set of accounts including the Statement of Internal Control (SIC) is provided in Annex A. The additional information within this section covers the 12 month period from 1 April 2006 to 31 March 2007. Financial summary The accounts for the 12 months to 31 March 2007 comprise the 3 months to the 30 June 2006 for the predecessor trusts of Dorset and Westcountry and the initial 9 months of the South Western Ambulance Service NHS Trust, the successor trust. In the financial year 1 April 2006 to 31March 2007 the trust had income of £104.6m and achieved a surplus at the end of the year of £1.012m. This surplus will be carried forward into the next year to assist the trust in achieving its performance targets. Income received Of the £104.6m we received £100.3m was because of patient activity. The remaining income of £4.3m related to charitable income of £4.2m and training income of £0.1m. Money spent Over the last year the trust spent £102.7 on running costs. The majority of this money (71%) was spent on staff employment costs of £72.9m. Capital investment The trust invested £6.9m in its fleet of vehicles, a new control room, Information Technology, buildings and other equipment. In summary Our financial results demonstrate that both former trusts and its successor had a very successful year. This could not have been achieved without the effort and commitment of all staff. Well done to everyone for contributing to this combined success. The full set of Annual Accounts can be found at Appendix A of the Annual Report.

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Financial targets and performance The trust had an excellent financial year and all financial targets were achieved:

• A retained surplus of £1.012m on a turnover of £104.6m; • Capital expenditure was within the Capital Resource Limit;

• The cash position was successfully managed (called the External

Finance Limit);

• The required return on assets used by the trust (called the Capital Cost Absorption Rate) was within the range set by the Department of Health.

The Annual Accounts have been prepared in accordance with accounting standards and policies. They have been audited by the Audit Commission who confirmed they give a true and fair view of the trust’s financial position at 31 March 2007 and for the income and expenditure for the year. The 4 financial targets that the trust is required to achieve are: 1. To breakeven on income and expenditure (to operate within the

money received).

The trust achieved a surplus of £1.012m for the 2006 to 2007 financial year and this represented a 0.96% of turnover. The table below demonstrates that the trust (and its predecessor trusts) have successfully operated within the available resources for each of the last 3 years. Annual Surpluses

Year Dorset Westcountry

South Western

combined £000 £000 £000 2004/2005 0 35 35 2005/2006 250 32 282 2006/2007 1,012

2. To stay within the Capital Resource Limit (to keep capital

expenditure within a set limit).

The Trust was set a limit of £6.933m, which it is not permitted to overspend. The net expenditure on capital projects during the year was £6.814m.

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3. To remain within the External Financing Limit (EFL) which is a control on the cash usage of the trust.

This is the net limit on borrowing allowed by the trust and is mainly due to finance capital expenditure and national initiatives. For 2006 to 2007 the trust was set a positive External Financing Limit (EFL) of £3.638m, which means that additional cash of £3.638m could be obtained from the Department of Health. A positive EFL of £3.615m was achieved, an undershoot of just £0.023m.

4. Achieve a Capital Cost Absorption return of 3.5% on relevant net

assets (to make best use of trust assets).

The trust achieved a return of 3.1%, the variance from 3.5% is within the Department of Health’s materiality range of 3.00% to 4.00%. The rate is calculated by expressing the trust’s dividend payment of £0.978m as a percentage of the average of the opening and closing relevant net assets of £m. **Pam – couldn’t calculate the relevant net assets – are you able to email Lynne with the number otherwise take out “of £0.978m” and “of £m” eg that marked in pink above.

Income The total operating income received by the trust for the year was £104.6m which is an increase of £6.4m (6.5%) over the previous year. In 2006 to 2007 the trust provided the Out of Hours service in Somerset for a full year (6 months previous year). The income from activities totalled £100.245m of which £99.153m was received from NHS bodies. Income received is analysed across the service as follows: Amount £000 % Primary Care Trusts 91,615 87.6 NHS Trusts 5,748 5.5 Foundation Trusts 1,438 1.4 Other NHS income 352 0.3 Other patient related income 1,092 1.0 Total Patient Activities 100,245 95.8 Other operating income Charitable and other contributions 3,984 3.8 Transfers from donated asset reserve 266 0.3

Education and training 107 0.1 Total Income 104,602 100.0

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Expenditure During the year the trust spent £102.7m on operating expenses, which is an increase of £5.7m (5.9%) over 2005 to 2006. The total cost of employment for 2,091 whole time equivalent staff, which includes permanent, temporary and agency staff, amounted to £72.9m (71%) of operating expenses with the balance of £29.8m relating to non pay and depreciation costs. A summarised analysis of the Trust’s expenditure is set out in the table below: Amount £000 %

Staff and Directors 72,924 71.0 Transport 9,187 9.0 Depreciation 4,605 4.5 Premises 3,094 3.0 Supplies and services 2,884 2.8 Establishment 2,786 2.7 Other costs 7,225 7.0 Total operating expenses

102,705 100.0

Capital Investment At the 31 March 2007 the trust had fixed assets with a net book value of £38.6m (31 March 2006 £34.7m). The trust spent £6.963m on capital projects; a summary of the main projects is shown below:

Amount £000 Fleet 3,811 New Control Room 1,295 IT 1,070 Estates 591 Medical Equipment 131 Other 65 Total Capital Expenditure

6,963

Less: Disposal of Assets 149 Net Capital Expenditure

6,814

Better Payments Practice Code

The trust’s details of compliance with the Better Payments Practice Code are given in note 1.7 to the full set of accounts.

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Salary and Pension entitlements of senior managers - Remuneration

An indication of how the pension liabilities are treated in the accounts and statements of the relevant pension schemes can be cross referenced to the accounting policy note in the accounts and the remuneration report.

Remuneration for former Dorset Ambulance NHS Trust Name and Title

2006 / 2007 (3 Months to 30

June 2006)

2005 / 2006

Sala

ry

(ban

ds o

f £50

00)

Oth

er

Rem

uner

atio

n (b

ands

of £

5000

)

Ben

efits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

Sala

ry

(ban

ds o

f £50

00)

Oth

er

Rem

uner

atio

n (b

ands

of £

5000

)

Ben

efits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

£000 £000 £ £000 £000 £

T Jones (Chairman) 0-5 15-20 400 T Ware (Non Executive Director)

0-5 100 5-10 200

Sir B Kenny (Non Executive Director)

0-5 5-10 200

P Rushton (Non Executive Director) 0-5

5-10

100

J Knowles (Non Executive Director) until 31/1/06

0-5 0

K Wenman (Chief Executive)

20-25 700 80-85 2,900

R Ferre (Deputy Chief Executive)

10-15

700 50-55 2,700

C Launchbury (Director of Finance)

10-15

900 55-60 3,700

J Liggett (Associate Director of Corporate Affairs)

10-15

600 50-55 2,500

T James (Associate Director of Operations)

10-15 500 45-50 2,000

N Lane (Associate Director of Urgent Care Service Dorset and Somerset)

10-15 500 45-50 2,100

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Remuneration for former Westcountry Ambulance Services NHS Trust Name and Title

2006 / 2007 (3 Months to 30

June 2006)

2005 / 2006

Sala

ry

(ban

ds o

f £50

00)

Oth

er

Rem

uner

atio

n (b

ands

of £

5000

)

Ben

efits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

Sala

ry

(ban

ds o

f £50

00)

Oth

er

Rem

uner

atio

n (b

ands

of £

5000

)

Ben

efits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

£000 £000 £ £000 £000 £

H Strawbridge (Chairman) 0-5 15-20 K Burrows (Non Executive Director)

0-5 5-10

C Russell (Non Executive Director)

0-5 5-10

B Lewis (Non Executive Director)

0-5 5-10

J Cowdrey (Non Executive Director)

0-5 5-10

B Evans (Non Executive Director)

0-5 5-10

M Willis OBE (Chief Executive)*

30-35 265-270 100-105

S Pryor (Director of Operations)

20-25 80-85

S Davies (Director of Finance)

15-20 1,800 70-75 7,200

K Nethercott (Director of Corporate Affairs)

15-20 1,100

65-70 6,400

B Newmarch (Associate Medical Director (until 18/9/05))

20-25 1,400

G Bryce (Medical Director) 5-10

30-35

* Compensation for loss of office under an approved compensation scheme was made to M Willis OBE.

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Remuneration for South Western Ambulance Services NHS Trust (1 July 2006 onward) Name and Title

2006 / 2007 (9 months to 31 March 2007)

Sala

ry

(ban

ds o

f £50

00)

Oth

er

Rem

uner

atio

n (b

ands

of £

5000

)

Ben

efits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

£000 £000 £

H Strawbridge (Chairman) 10-15 B Howard {Non Executive Director (appointed 1 August 2006)}

0-5

R Lock (Non Executive Director (appointed 1 August 2006))

0-5

C Russell (Non Executive Director)

0-5

T Ware (Non Executive Director)

5-19 0-5

M Watkins {Non Executive Director (appointed 1 August 2006)}

0-5

K Wenman (Chief Executive) 100-105 80-85 3,000 G Bryce (Medical Director) 25-30 S Davies (Director of Finance) 60-65 6,000 J Liggett (Director of Human Resources and Workforce Development)

50-55 1,800

S Pryor (Director of Operations)

60-65 300

N Lane (Clinical Director) 40-45 1,800 Benefits in kind are car and fuel benefits. The trust does not have any performance related pay scheme for senior managers. This statement applies to all the remuneration tables.

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Pension Benefits at 31 March 2007

Rea

l inc

reas

e in

pen

sion

at

age

60 (b

ands

of £

2,50

0)

Rea

l inc

reas

e in

pen

sion

lu

mp

sum

at a

ge 6

0 (b

ands

of

£2,

500)

Tota

l acc

rued

pen

sion

at

age

60 a

t 30

June

-06

(ban

ds

of £

5,00

0)

Lum

p su

m a

t age

60

rela

ted

to a

ccru

ed p

ensi

on a

t 30

June

-06

(ban

ds o

f £5,

000)

Cas

h Eq

uiva

lent

Tra

nsfe

r Va

lue

at 3

0 Ju

ne-0

6

Cas

h Eq

uiva

lent

Tra

nsfe

r Va

lue

at 3

1 M

arch

06

Rea

l Inc

reas

e in

Cas

h Eq

uiva

lent

Tra

nsfe

r at 3

0 Ju

ne 0

6

£000 £000 £000 £000 £000 £000 £000 K Wenman (Chief Executive)

7.5-10 27.5-30 35-40 115-120 596 428 157

G Bryce (Medical Director)

2.5-5 7.5-10 30-35 90-95 435 375 51

S Davies (Director of Finance)

0-2.5 2.5-5 10-15 30-35 134 114 18

J Liggett (Director of Human Resources and Workforce Development)

0-2.5 2.5-5 0-5 10-15 46 28 17

S Pryor (Director of Operations)

0-2.5 0-2.5 30-35 95-100 473 438 25

N Lane (Clinical Director)

2.5-5 10-12.5 20-25 45-50 276 214 56

The trust’s treatment of pension liabilities may be found in the full set of Annual Accounts under note 1.10. As Non-Executive members do not receive pensionable remuneration, there will be no entries in respect of pensions for Non-Executive members. Cash Equivalent Transfer Values (CETV) A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time. The benefits valued are the member’s accrued benefits and any contingent spouse’s pension payable from the scheme. A CETV is a payment made by a pension scheme or arrangement to secure pension benefits in another pension scheme or arrangement when the member leaves a scheme and chooses to transfer the benefits accrued in their former scheme. The pension figures shown relate to the benefits that the individual has accrued as a consequence of their total membership of the pension scheme, not just their service in a senior capacity to which disclosure applies.

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The CETV figures and the other pension details include the value of any pension benefits in another scheme or arrangement which the individual has transferred to the NHS pension scheme. They also include any additional pension benefit accrued to the member as a result of their purchasing additional years of pension service in the scheme at their own cost. CETVs are calculated within the guidelines and framework prescribed by the Institute and Faculty of Actuaries. Real Increase in Cash Equivalent Transfer Values (CETV) This reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation, contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation factors for the start and end of the period. Auditors Remuneration Audit services for the trust were provided by the Audit Commission and Mazars LLP. The fee for provision of audit services for the 12 month period was:

• £188,000 for statutory audit services; • £110,000 for internal audit and local counter fraud services.

Post Balance Sheet Events Given the demise of Westcountry Ambulance Services NHS Trust and the Dorset Ambulance NHS Trust and the establishment of the new South Western Ambulance Service NHS Trust, the financial and legal responsibilities of both former trusts now sit with the new trust. These accounts, whilst taking into account the costs arising from merger, including redundancies, have not taken account of any employment disputes following redundancy. Recent action has highlighted the potential for a legal claim on former Westcountry Ambulance Service NHS Trust. Provision for this has now been made in the 12 months accounts for South Western Ambulance Service NHS Trust. Better Payment Practice Code Details of compliance with the better payment practice code are given in note 7.1 to the full set of Accounts.

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Statement of Internal Control (SIC) The Statement of Internal Control (SIC) for the period 01/07/2006 to 31/03/2007 can be found on pages XXXX of the full set of Annual Accounts. The SIC for the period 01/03/2006 to 30/06/2006 for the predecessor organisations can be found in the 3 month Annual Reports which are available on request from the Communication and Public Relations Department on 01392 261509. Former Westcountry Ambulance Services NHS Trust 1 April 2006 to 30 June 2006 Audit Committee The Committee comprised of Non Executive Directors Mr Barry Lewis, Mr Ken Burrows and Mrs Charlotte Russell. It monitored both internal/statutory audit plans, held meetings with the Director of Finance/audit representatives to scrutinise audit findings/recommendations and identified ‘Value for Money’ projects. Remuneration Committee The Committee comprised Mrs Heather Strawbridge (Chair) and Non Executive Directors, Mr Bryn Evans, Mr Barry Lewis, Mrs Jane Cowdery, Mrs Charlotte Russell and Mr Ken Burrows. It reviewed pay/conditions of service so they remained competitive and affordable, recommended pay and conditions for the Chief Executive and Executive Directors, having first considered proposals submitted by the Chief Executive. Clinical Governance Committee The Committee comprised Mr Ken Burrows (Chairman) and Non Executive Directors, Mrs Heather Strawbridge, Mrs Jane Cowdery, the Chief Executive, Director of Operations, Director of Finance, Medical Director, Director of Corporate Affairs and other senior managers of the trust. It was the Committee for Clinical Governance. Risk Management Committee The Committee comprised of Non Executive Directors Mrs Charlotte Russell (Chair) and Mr Bryn Evans, the Chief Executive, Director of Corporate Affairs, Director of Finance, Director of Operations and other senior managers of the trust. It was the trust’s overarching committee for risk management.

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Former Dorset Ambulance NHS Trust 1 April 2006 to 30 June 2006 Audit Committee The Committee comprised of Non Executive Directors Mr Trevor Ware, Mrs Patricia Rushton and Sir Brian Kenny. It monitored both internal/statutory audit plans, held meetings with the Director of Finance and audit representatives to scrutinise audit findings and recommendations and identified ‘Value for Money’ projects. Remuneration Committee The Committee comprised Mr Trevor Jones (Chair) and Non Executive Directors, Sir Brian Kenny, Mr Trevor Ware and Mrs Patricia Rushton. It reviewed pay and conditions of service so they remained competitive and affordable, recommended pay and conditions for the Chief Executive and Executive Directors, having first considered proposals submitted by the Chief Executive. Governance Committee The Committee comprised Sir Brian Kenny (Chairman) and Non Executive Directors Mr Trevor Ware and Mrs Patricia Rushton, the Chief Executive, Deputy Chief Executive and other senior managers of the trust. It was the overarching committee for risk management and clinical governance. South Western Ambulance Services NHS Trust 1 July 2006 to 31 March 2007 Remuneration Committee The Committee comprised Mrs Heather Strawbridge (Chairman) and any of the Non Executive Directors (mandatory for at least 2 to attend meetings). It reviewed pay and conditions of service so they remained competitive and affordable, recommended pay and conditions for the Chief Executive and Executive Directors, having first considered proposals submitted by the Chief Executive. Audit Committee The new Committee took responsibility for risk management within the trust. The Committee comprised of Non Executive Directors Mr Ray Lock (Chairman), Mr Trevor Ware, Professor Mrs Mary Watkins and Mrs Charlotte Russell. It monitored both internal and statutory audit and risk management plans, held meetings with the Director of Finance and audit representatives to

- 59 -

scrutinise audit findings and recommendations, identifying ‘Value for Money’ projects. Service Development Committee This time limited Committee was set up during the reconfiguration period and comprised of Non Executive Directors Mrs Heather Strawbridge (Chair), Mr Bjorn Howard and Mrs Charlotte Russell, alongside Executive Directors Ms Gillian Bryce, Ms Julie Liggett, Mr Ken Wenman, Mr Simon Davies, Mr Steve Pryor and Associate Director Mrs Norma Lane and Mr Ian Hopkins, Staff Side representative. Value for Money Committee This time limited Committee was set up during the reconfiguration period and comprised of Non Executive Directors Mrs Charlotte Russell (Chair),Mrs Heather Strawbridge, Mr Bjorn Howard alongside Executive Directors Mr Steve Pryor and Mr Simon Davies. Clinical Governance Committee The Committee comprised of Non Executive Directors Mr Trevor Ware (Chairman) and Mr Ray Lock, the Medical Director, the Clinical Director, the Director of Operations, the Chief Executive, the Director of Human Resource and Workforce Development and other senior managers of the trust. It was the Committee for Clinical Governance. Trust and Charitable Funds Committee The Committee comprised of Heather Strawbridge (Chairman), the Chief Executive and the Director of Finance. It was the committee that oversaw the application and management of the charitable trust funds. Director statements All the Directors state that, as far as they are aware, there is no relevant audit information of which the trust’s Auditors are unaware. Each Director has taken all the steps that he or she ought to have taken as a Director in order to make him or herself aware of any relevant audit information and to establish that the trust’s Auditors were aware of that information.

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Statement of the Chief Executive’s responsibilities as the Accountable Officer of the trust The Secretary of State has directed that the Chief Executive should be the Accountable Officer to the trust. The relevant responsibilities of the Accountable Officers, including their responsibility for the propriety and regularity of the public finances for which they are answerable, and for the keeping of proper records, are set out in the Accountable Officers’ Memorandum issued by the Department of Health. To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an accountable officer. Date 21 June 2007 Chief Executive Statement of the Directors’ responsibilities in respect of the accounts The directors are required under the National Health Services Act 1977 to prepare accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these accounts give a true and fair view of the state of affairs of the trust and of the income and expenditure of the trust for that period. In preparing those accounts, the directors are required to: • apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the Treasury • make judgments and estimates which are reasonable and prudent • state whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the accounts. • The directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the trust and to enable them to ensure that the accounts comply with requirement outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities. The directors confirm to the best of their knowledge and belief they have compiled with the above requirements in preparing the accounts. By order of the Board: Date 21 June 2007 Chief Executive Date 21 June 2007 Finance Director

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THIS PAGE TO BE UPDATED ONCE AUDITORS HAVE SIGNED OFF THE REPORT ON MONDAY 18 JUNE OR TUESDAY 19 JUNE 2007

Independent Auditors’ Report to the Directors of the Board of South Western Ambulance Service NHS Trust I have examined the summary financial statements set out on pages 24 to 29. This report is made solely to the Board of South Western Ambulance Service NHS trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies, prepared by the Audit Commission. Respective responsibilities of Directors and Auditors The Directors are responsible for preparing the Annual Report. My responsibility is to report to you my opinion on the consistency of the Summary Financial Statements with the Statutory Financial Statements. I also read the other information contained in the Annual Report and consider the implications for my report if we become aware of any mis-statements or material inconsistencies with the Summary Financial Statements. Basis of opinion I conducted my work in accordance with Bulletin 1999/6 ‘The Auditor’s statement on the Summary Financial Statements’ issued by the Auditing Practices Board. Opinion In my opinion the Summary Financial Statements are consistent with the Statutory Financial Statements of the trust for the three month period 1 April 2006 to 31 March 2007. Date……………………….Signature…………………………..………..Name Lee Budge Address: The Audit Commission

5 – 6 Blenheim Court Matford Business Park Lustleigh Close Exeter Devon EX2 8PW

Feedback We welcome your views on this report and would appreciate any comments. The trust values the feedback of patients and the public on all its public documents and has designed this report around the views already received at a major consultation event in 2006. If you feel that there are other comments which would make any future production of reports more user friendly, please do take the time to note your thoughts down here. Thank you.

Please use either of these methods.

• Email: publicrelations@swast.nhs.uk • Fax: 01392 261560 • Tel: 01392 261500 • Post: Lynne Paramor

PR and Communications Manager South Western Ambulance Service NHS Trust Abbey Court Eagle Way Sowton Industrial Estate Exeter Devon EX27HY

If you would like a copy of this report in another format, please contact • Email: publicrelations@swast.nhs.uk • Fax: 01392 261560 • Tel: 01392 261500 • Post: Lynne Paramor

PR and Communications Manager South Western Ambulance Service NHS Trust Abbey Court Eagle Way Sowton Industrial Estate Exeter Devon EX2 7HY

Although this may take a little while to prepare, the trust is committed to ensuring they meet the needs of everyone and so will endeavour to accommodate any requests; as far as practicable.