board of directors meeting · 9/26/2012 · board of directors meeting – meeting held in public...

BOARD OF DIRECTORS MEETING MEETING HELD IN PUBLIC

DATE: Wednesday 26 September 2012

TIME: 10.00am - 12.30pm VENUE: Readbury Room

Holiday Inn – Reading West Padworth Lane, Bath Road, Reading, RG7 5HT

DISTRIBUTION CHAIR OF MEETING: Trevor Jones Chairman BOARD MEMBERS: Ilona Blue Non Executive Director

Claire Carless Non Executive Director Alastair Mitchell-Baker Non Executive Director Keith Nuttall Non Executive Director Eddie Weiss Non Executive Director Professor David Williams Non Executive Director

Will Hancock Chief Executive John Black Medical Director Duncan Burke Director of

Communications & Public Engagement

John Nichols Interim Chief Operating Officer

Charles Porter Director of Finance Fizz Thompson Director of Patient Care

IN ATTENDANCE: Steve Garside Company Secretary James Underhay Director of Strategy &

Business Development (Designate)

APOLOGIES: None

AGENDA

Board of Directors Meeting – Meeting Held in Public Date: Wednesday 26 September 2012 Time: 10.00am – 12.30pm Venue: Readbury Room, Holiday Inn – Reading West, Padworth Lane,

Bath Road, Reading, RG7 5HT ______________________________________________________________

No.

Agenda Items

1 Chairman’s Welcome and Apologies for Absence

Note Verbal

2 Declaration of Directors’ Interests Trevor Jones – Chairman

Note Verbal

3 Minutes from the 25 July Meeting Trevor Jones – Chairman

Approve

Paper

4 Matters arising from the 25 July Meeting Trevor Jones – Chairman

Note

Paper

5 Chairman’s Report Trevor Jones - Chairman

Note Verbal

6 Chief Executive’s Report Will Hancock - Chief Executive

Note Paper

OPERATIONAL PERFORMANCE

7 Operational Response Performance Report John Nichols – Interim Chief Operating Officer

Note Paper / presentation

QUALITY AND PATIENT SAFETY

8 Quality & Patient Safety Report Fizz Thompson - Director of Patient Care

Note Paper

FINANCIAL AND INTEGRATED SERVICE PERFORMANCE

9 Integrated Performance Report Charles Porter - Director of Finance

Note

Paper

10 Finance and Estates Report Charles Porter – Director of Finance

Note Paper

STRATEGY – no items for this meeting 11 NHS 111 Update

Fizz Thompson - Director of Patient Care

Note Paper

REGULATORY, COMPLIANCE & CORPORATE GOVERNANCE 12 Board Assurance Framework

Fizz Thompson - Director of Patient Care

Note Paper

13 Trust Constitution Steve Garside – Company Secretary

Approve Paper

BOARD SUB-COMMITTEE CHAIR REPORTS 14 Audit Committee Report

Eddie Weiss – Audit Committee Chair Note Paper

15 Quality and Safety Committee Report Keith Nuttall – Quality and Safety Committee Chair

Note Paper

16 Charitable Funds Committee Report Claire Carless – Charitable Funds Committee Chair

Note Paper

17 Remuneration Committee Report Alastair Mitchell-Baker, Deputy Chairman

Approve Paper

ANY OTHER BUSINESS (Should only normally include any matters previously notified to the Chairman at least 48 hours prior to the date of the meeting)

18 Date and Time of Next Meeting held in Public : Date: 28 November 2012 Time: 10.00am Venue: Shaw House, Newbury

Confirm

RESOLUTION TO EXCLUDE MEMBERS OF THE PUBLIC

19 To resolve that the representatives of the press and other members of the public be excluded from the remainder of

this meeting having regard to the confidential nature of the business to be transacted, publicity of which would be prejudicial to the public interest Section 1 (2) of the Public Bodies (Admissions to Meetings Act 1960) refers.

Close of public session of the meeting

Agenda Item: 3

PUBLIC BOARD PAPER 26 SEPTEMBER 2012

Details of the paper

Title Minutes from the 25 July 2012 Board Meeting in Public

Lead Director Trevor Jones, Chairman

Presenter(s) of the paper (if different to Lead Director) Trevor Jones, Chairman

Purpose of the paper To present to the Board the minutes of the previous Board meeting in public

Recommendation (eg. note, approve, endorse)

To seek approval of the minutes, as an accurate record of the 25 July 2012 Board meeting in public

Links to SCAS Business & Risks

Strategic theme to which the paper relates (please mark in bold)

To deliver clinical excellence by improving clinical outcomes

To achieve operational excellence

To deliver effective stakeholder relationships

To deliver sound governance, VFM & financial standing

To deliver leadership, staff engagement & a learning culture

To develop the portfolio of commercially viable non emergency commercial contracts

Please provide details of the risks associated with the subject of this paper

The minutes of the July 2012 Board meeting in public record discussion about the Trust’s main strategic risks (Board Assurance Framework – p11), a number of additional financial risks that have emerged (Finance and Estates Report – p8), and risks associated with operational performance (p4) and quality (p6).

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) N/A to this particular item.

Financial implications / impact (e.g. CIPs, FRR, year-end outturn)

The minutes record the discussion about the Trust’s financial position (p8) and the current Monitor financial risk rating (p10).

Council of Governor implications / impact (e.g. links to governors statutory role)

The minutes of the 25 July 2012 Board meeting in public were shared with the Trust’s governors on 8 August. Three governors were also present at this particular Board meeting.

Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The minutes record a range of discussions relating to patients (e.g. performance against national standards, clinical quality and patient safety, NHS 111 services). They also record the discussions relevant to staff (e.g. the closure and transfer of Wokingham Emergency Operations Centre, sickness absence and appraisal).

Other Supporting information, including background papers and previous considerations by the Board

The minutes were agreed with the Trust Chairman following the meeting and shared with Board members on 2 August.

Unconfirmed minutes of the public meeting of the South Central Ambulance Service NHS Foundation Trust Board of Directors held on 25 July 2012 at Shaw House, Newbury, Berkshire Present: Trevor Jones, Chairman

Alastair Mitchell-Baker, Deputy Chairman / Senior Independent Director

Ilona Blue, Non Executive Director Claire Carless, Non Executive Director Keith Nuttall, Non Executive Director Eddie Weiss, Non Executive Director Professor David Williams, Non Executive Director Will Hancock, Chief Executive

Fizz Thompson, Director of Patient Care / Deputy Chief Executive John Black, Medical Director Duncan Burke, Director of Communications and Public Engagement John Nichols, Interim Chief Operating Officer

Charles Porter, Director of Finance In attendance: Steve Garside, Company Secretary Apologies: None 12/191 Chairman’s Welcome and Apologies for Absence The Chairman welcomed all present to the meeting, including Mr Colin Hill, member of the public, and three of the Trust’s governors, Mr Bob Duggan, Mr Barry Lipscomb and Mr David Palmer. There were no apologies for this meeting. 12/192 Declaration of Directors’ Interests No new interests were declared. 12/193 Minutes of the Board meeting held in public on 30 May 2012 The Board approved the minutes without amendment. It was noted in respect of minute 12/187 that, subsequent to the May meeting, a Charitable Funds Committee had been arranged and took place on 19 July. 12/194 Matters arising from the Board meeting held in public on 30 May 2012 The Board noted the update on the matters arising from the previous Board meeting in public, and two particular actions were highlighted:

Unconfirmed minutes – 25 July 2012 Page 1 of 13 SCAS

Steve Garside and Duncan Burke would be considering arrangements for production of the 2012/13 Annual Report; this was likely to be undertaken in two


stages, firstly in terms of a review of the process for 2011/12, and then development of a plan for 2012/13 once the Monitor Annual Reporting Manual is released

the Chief Executive would address the matter arising relating to IM&T during his

Chief Executive’s Report 12/195 Chairman’s Report The Chairman highlighted a number of key points as part of his verbal report: this was the first meeting in public since the May meeting as part of the Trust

reverting to meeting in public on a bi-monthly basis. Both he and the Company Secretary had assured the governors that six public meetings a year would be sufficient for the Trust to deliver its business and that private meetings would not be used to deal with matters that should be discussed in public

linked to the above point, the Chair advised that at the June Board Development

meeting, the Board had received an update on the current position in relation to the new commissioning and public health landscapes, and also undertaken some work to develop the Trust’s stakeholder engagement strategy. Steve Garside had written to the Council of Governors to update them on this session and offered to share the presentations used on the day with them

the Council of Governors held its third formal meeting on 25 June at the

Hazardous Area Response Team (HART) facility in Eastleigh. The main topic had been a review of the Trust’s key quality and clinical performance indicators, with two of the Trust’s Non-Executive Directors explaining how they seek assurance that robust quality arrangements are in place. This session had been particularly well-received, and a similar session on finance would take place at the next meeting on 10 September

the first governor workshop was being arranged and Steve Garside advised that

this was likely to take place on 27 September and would consider the governor role and how the governors and Board of Directors can best work together

the Chairman had attended a recent NHS South Central event for Chairs and

Chief Executives, with the ongoing NHS reorganisations being a strong theme to the discussions

12/196 Chief Executive’s Report The Chief Executive explained that, in response to the Board’s comments about having more detail on performance in his report, John Nichols would be delivering a more detailed presentation on current performance. In terms of the key headlines, the Chief Executive advised that performance in May had not been particularly good, and although June represented a much better position, July was proving to be challenging. However, performance in terms of both finance and quality indicators was on track against the year-to-date targets. The Chief Executive provided an update on other key issues including the following:


the relocation of the Wokingham Emergency Operations Centre to Northern House, Bicester had been concluded successfully, including in respect of staffing and IT issues. The Wokingham HOSC were making two visits to Bicester as part of the process of seeking assurance that the relocation will not have a detrimental impact on the service provided in Berkshire

the NHS 111 pilot in Oxfordshire had gone live yesterday, with out of hours calls

being handled after 6.30pm. The service was expected to be formally launched next week, with the commissioner leading on delivery of the publicity campaign. The Department of Health had given the go-ahead following their assurance review, and the Board acknowledged the fantastic effort made by the team in getting to the current position

Ilona Blue asked whether the Trust were tracking the impact of NHS 111 on 999 emergency services. John Nichols responded that this started yesterday. Eddie Weiss asked how the Board would be kept up-to-date, and the Chief Executive explained that there would be a suite of metrics, most contractually required, reported in the Integrated Performance Report. The Chair asked the executive to consider the reporting arrangements in detail ahead of next meeting, noting the requirement for service level reporting and the in-depth monitoring of performance that the commissioners were likely to undertake John Black added that the challenge now would be to get the general public to use NHS 111 when appropriate, rather than presenting themselves at the local Emergency Department.

the ‘white noise’ telephony problems discussed at the last Board meeting in public have been successfully resolved, with the application of a software upgrade. In terms of overall IM&T strategy, the Chief Executive advised that an updated Trust strategy needed to be presented to the Board for approval, following completion of the actions arising from the recent review of resilience.

Action 12/196a The Chief Executive and Steve Garside to identify the most appropriate date for presenting the updated IM&T Strategy to the Board for approval.

detailed plans were in place for the 2012 Olympic Games, with the Trust having a

responsibility for the rowing events in Berkshire. The Board acknowledged the hard work of those involved in contributing to preparation of the Trust’s plans

Ahead of the presentation on performance, Keith Nuttall advised that he had attended the last day at Wokingham prior to the transfer of the EOC, and had been impressed with the positive attitude of the staff who, whilst naturally being sad about the end of an EOC at Wokingham, appreciated that the relocation was the right decision to make. He suggested that the Chief Executive should write to those affected by the EOC transfer thanking them for their co-operation and dedication. Action 12/196b The Chief Executive to write to staff affected by the Wokingham EOC thanking them for their co-operation and dedication.

*****


John Nichols gave a detailed presentation on current performance issues, covering activity and demand, performance, action plans and risks. The following key issues were identified: Demand there has been a significant increase in demand during quarter 1 (6% at overall

SCAS level compared with the corresponding quarter of 2011/12) and this has impacted on performance, particularly in terms of the red 8 target.

the SHA are intending to commission a piece of work aimed at identifying the

factors behind the increase in demand. Within SCAS, call volume trends are being studied to help shape future planning

the national REAP model provides some guidance, for planning purposes, in

working out the impact on performance of increases in demand at various levels Performance a number of other factors have had implications for the Trust’s performance,

including telephony, higher than expected sickness levels, and the immediate impact of the EOC relocation

the Board noted performance on a range of different targets, including at cluster

level, and against both the national targets and SCAS’ own trajectories. Weekly red 1 performance this year, against the 75% national target, has been challenging and highly variable, and that has been replicated in terms of red 8 although performance on this is holding well in July

the hospital element of handover delays has worsened by the equivalent of c500

lost hours per month when comparing quarter 1 of 2012/13 with the corresponding quarter of 2011/12

Operational improvement plan a detailed operational improvement plan is in place; this includes a number of

general aspects ranging from improved EOC performance management to improving the consistency, and increasing the effectiveness and efficiency of hours on the road; as well as specific measures to improve red 8 performance in Berkshire and red 19 performance in Hampshire.

Risks five key risks were noted: activity/demand, fleet, weather (adverse winter),

abstraction rates and hospital delays Conclusions the executive are confident that the quarterly national A8 and A19 targets will be

achieved


an EOC staffing action plan is in place, as well recovery plans for Berkshire red 8 performance and Hampshire red 19 performance, and mitigation plans to address additional increases in demand

an action plan is also in place to strengthen the fleet position. Alastair Mitchell-Baker stated that it appeared that, in terms of performance, the Trust were not particularly resilient, and that the impact of the Olympics could also be a major threat. John Nichols responded that it was consistency rather than resilience that was the main factor. In terms of the Olympics, an assumption had been made nationally that there will be no impact on demand, and London, for example, are essentially running two types of service: their core/standard service, and another service relating to the games. He added that the REAP process is effectively the Trust’s short-term response to any major and sudden increase in demand, and that all Trusts are working together and have contingency/mutual aid arrangements if required. Eddie Weiss commented that the Trust had very little alternative in the short term to either recruiting more staff or making greater use of private providers. John Nichols agreed that this was broadly correct although other measures were included in a priority list. He added that the priority of the Trust continued to be maintaining a safe service for patients. In response to a question from Keith Nuttall, John Nichols explained that having reviewed demand patterns over the last six years, it was quite clear that whilst demand has historically followed a predictable seasonal pattern, this had not been the case in 2012. Keith Nuttall asked about the impact of the new rota arrangements. John Nichols responded that these were in place in Hampshire and a review was required to determine their impact. Implementation in the North had been deliberately delayed, reflecting the fact that implementation over the summer could be difficult; January 2013 was now regarded as the most likely date for their introduction. The Chairman asked about the new area manager and team leader approach. John Nichols responded that a post-implementation review was now required to assess the extent to which the perceived benefits had been realised. It was agreed that this should be presented to the Board either in September or November. Action 12/196c The Chief Executive and John Nichols to present the post implementation review of area manager /team leader approach, and other aspects of the Operations reorganisation, at either the September or November 2012 Board meetings.

The Chairman stated that the operational improvement plan presented at today’s meeting needed a summary action plan and a range of metrics on which the Board could monitor implementation. He asked John Nichols to take this forward and a present a progress report at the next meeting. Action 12/196d John Nichols to present a scorecard at the next Board meeting showing details of progress against the actions identified in the Operational Improvement Plan.


In conclusion, the Chairman reminded the Board that all of the performance targets considered during the presentation were about patients, and the delivery of high quality, safe and responsive services. The Chief Executive took the opportunity to pay tribute to the Trust’s staff who were working incredibly hard to help the organisation deliver its aims. Finally, Eddie Weiss asked whether the recent serious incident requiring investigation (SIRI) relating to a delay in response and the death of a child was a reflection of some of the issues discussed. John Nichols stated that the increase in demand was certainly relevant, and Fizz Thompson agreed that once the SIRI investigation was concluded the outcomes would be brought back to the Board as a case study. Action 12/196e Fizz Thompson to present the outcomes of the SIRI review into the baby death in Wycombe at an appropriate future Board meeting.

QUALITY AND PATIENT SAFETY

12/197 Quality and Patient Safety Report Fizz Thompson presented the latest report, explaining that this now had a quarterly reporting focus and was shaped around the new outcomes framework. Key issues were highlighted as follows: there are two current main risks in respect of the quality agenda: the increased

numbers in terms of long delays, and the reduction in the number of vehicles cleaned due to the vehicles being off-road (however, where the vehicles are cleaned, leadership walks had confirmed that cleaning is to a satisfactory standard)

the Trust’s level of CQC compliance continues to improve consistently, with all

essential standards and outcomes currently being complied with the Trust continues to plan for the NHA Litigation Authority assessment taking

place on 18 and 19 October a security management plan is in place for 2012/13 and will be monitored by the

Quality and Safety Committee. Claire Carless asked for more information about the National Ambulance Clinical Performance Indicator cycle 8 report. John Black explained that this benchmarked all of the Ambulance Trusts on a range of clinical metrics every six months, and allowed SCAS to see where they were an outlier in performance terms (e.g. STEMI morphine administration). He added that the executive were currently drilling down into a number of indicators where SCAS appeared to be an adverse outlier. In response to a question from the Chief Executive, Fizz Thompson explained that the Trust has a Security and Risk Management Lead who leads on the operational delivery of the security management agenda, and that there are a range of hard and


soft measures that help determine the extent to which the arrangements in place are effective. Finally, Fizz Thompson provided more detail about the national dementia challenge, explaining that dementia was regarded by the government as a key priority this year. The Trust, in partnership with local PCTs, were planning to bid for some of the available funding.

FINANCIAL AND SERVICE PERFORMANCE 12/198 Integrated Performance Report (IPR) Charles Porter highlighted the overall scorecard for June 2012 performance, with operational performance and human resources being the elements rated as ‘red’. In contrast, commercial was now rated as ‘green’. The Chief Executive explained that he was seeking personal assurance that improved performance would be delivered against the HR and workforce metrics. He added that sickness absence was the main area of concern, and that this was being subject to robust performance management with him personally reviewing with the Area Managers on a fortnightly basis. The Chief Executive informed the Board that he had spoken with staff side about the current levels of sickness absence. They had reported that staff are generally under pressure for a variety of reasons but accepted that there are opportunities to improve. Staff side had also fed back that the medical bags used by certain groups of front-line staff were excessive in weight and, as a result, the Trust were currently redesigning the bags. Professor Williams asked how confident the executive were that HR/workforce metrics would be green at the year-end, as forecast in the IPR. Charles Porter responded that although the executive were confident with the actions in place, it was difficult to be fully confident about the outcomes due to factors outside of the Trust’s control (e.g. a flu epidemic). Ilona Blue asked how the short-term sickness absence position compared with that for long-term sickness. The Chief Executive responded that he was not clear, with it not necessarily being easy to separate the reporting of total sickness into the two categories. The Chairman stated that both Professor Williams and Ilona Blue had raised good questions and that the Board should revisit both issues at the next Board meeting as part of a detailed look at the HR/workforce metrics. Action 12/198a The Chief Executive to report back in detail at the next Board meeting on sickness absence rates, including an analysis of the factors behind the levels of sickness, and the actions being taken to address and improve performance (the executive to review the year-end risk rating).

Claire Carless stated that the issue with the weight of medical bags had been around for some time. Fizz Thompson responded that a task and finish group were just concluding their investigations into this.


In response to a question from the Chairman, Charles Porter confirmed that he remained confident that all cost improvement programmes for 2012/13 would be successfully delivered. The Chairman expressed his frustration with the substandard performance on appraisals, explaining that this was very much under the Trust’s control. He asked for the key messages to be reinforced across the organisation. Action 12/198b The Chief Executive to ensure that the importance of delivering staff performance appraisals to the required timescales is reinforced across the organisation.

12/199 Finance and Estates Report Charles Porter explained that, since the Board papers were distributed, the Trust had some additional financial risks that he would now cover by way of a presentation. He added that the key headlines at this stage were: the Trust’s year-to-date financial position was satisfactory and in line with plan the planned surplus for quarter 1 of 2012/13 had been delivered the cash position was ahead of that planned at this stage of the year the Monitor financial risk rating remained at 3, and would move to 4 during the

final quarter of the year (in line with plan) there were increased risks associated with the year-end forecast which would

now be discussed. Charles Porter explained that there were some additional financial risks, expected to be in the order of £1.2m, but with a potential worst-case scenario of £2.5m. A range of additional financial opportunities (including commercial) had been identified in mitigation, but again taking a worst-case view there could be a shortfall in cover of £1.4m. Charles Porter discussed some of the factors behind the additional risks, which included the increased levels of demand and therefore the Trust’s financial plans were now based on a 6% increase in demand for the rest of the year. It was noted that although the Trust would receive additional income for the extra activity, this would only be at a marginal rate. In conclusion, Charles Porter stated that the Trust needed to identify additional opportunities and, with this in mind, the Executive Team would be carrying out a detailed review on Tuesday of the current financial forecast and potential new opportunities. Alastair Mitchell-Baker enquired about the provision for redundancies. Charles Porter responded that the TUPE redundancy risks associated with NHS 111 were already included in the forecast. The Chairman stated that the level of risk to the forecast had increased significantly and the Trust needed to identify further contingencies. A revised mitigation plan should be presented at the next Board meeting.


Action 12/199a Charles Porter to present a detailed plan at the next Board meeting demonstrating how the Trust’s increased financial risks will be fully mitigated.

Charles Porter asked the Board to consider a minor change to the Treasury Policy (relating to Board approvals), in terms of extending the term period for investments from three months to 95 days, thus allowing SCAS to benefit from increased interest receivable income. The Board APPROVED the minor change to the Treasury Policy as described on page 7 of the Board paper. Finally, the Chairman asked whether the executive were satisfied that the Trust would receive the additional income in the PTS business from extra contractual requirement (ECR) journeys which would derive from the increased use of private providers. The Chief Executive agreed to investigate and confirm. Action 12/199b The Chief Executive to confirm that the Trust will receive the additional income from those ECR journeys where private providers are being used.

STRATEGY

12/200 NHS 111 Services The Chairman explained that the content of the report should be familiar to Board members as it reflected the strategy the Trust had been following in recent months in relation to NHS 111. He added, however, that this meeting was a timely point at which the Trust should articulate its current strategy and make an update in public of the non-commercially sensitive elements. The Chief Executive highlighted the national picture in relation to the NHS 111 contracts already awarded, noting that these were largely dominated either by regional ambulance services or Harmoni. He added that SCAS were fairly unique in their strategy to date as the Trust had chosen not to partner with other organisations. Eddie Weiss asked for more details about the involvement of local commissioners and clinicians and their ability to delay the roll-out of NHS 111. The Chairman explained that initially there was a national requirement that NHS 111 services be rolled-out by April 2013. However, there has been a suggestion of more flexibility recently with, in exceptional circumstances, the possibility of delaying roll-out locally by up to six months if the PCTs and Clinical Commissioning Groups are supportive of this. The Board noted the paper and reiterated its support for the direction of travel for SCAS as outlined in the paper. 12/201 Risk Management Strategy Fizz Thompson stated that she was seeking Board approval of the revised Risk Management Strategy, drawing attention to the review and amendment log on page 3, and highlighting that most changes were as a result of the Trust’s FT status.


Eddie Weiss advised that the Audit Committee had discussed the draft strategy at its recent meeting and were recommending that only the Board Assurance Framework should be presented to the Board, with the Audit Committee and Quality and Safety Committee carrying out the detailed review of the risk register. The Risk Register would be made available to Board members Alastair Mitchell-Baker advised that the Quality and Safety Committee had also discussed the draft strategy recently and felt that it represented a good step forward, particularly in terms of the revised risk scoring system and the ‘Board to Road/Floor Visibility’ process outline. Ilona Blue suggested that greater clarity could be given (p11/12) to the respective roles of the Audit and Quality and Safety Committees in terms of the review of the corporate risk register, as there was a danger of duplication. Eddie Weiss agreed that the respective roles could probably be explained better. He added that whilst the Quality and Safety Committee would use the risk register to carry out deep dive reviews, and seek assurance, over the Trust’s quality and clinical risks, the concern of the Audit Committee was more with the corporate and financial risks (e.g. non clinical) and the overall process for risk management. Keith Nuttall noted that section 6.0 was incorrect in implying that minutes of the Audit and Quality and Safety Committee meetings were presented to the Board, as the Board received summary reports instead (with the minutes available on request). The Board APPROVED the risk management strategy subject to two amendments relating to the roles of the Audit and Quality and Safety Committees, and the reporting of those committees to Board. Action 12/201 Fizz Thompson to finalise the Risk Management Strategy by clarifying the respective roles of the Audit and Quality and Safety Committees in relation to the review of the corporate risk register, and the reporting of these committees to the Board (i.e. summary reports rather than minutes are presented).

REGULATORY, COMPLIANCE AND CORPORATE GOVERNANCE

12/202 Monitor 2012/13 Quarter 1 Report Charles Porter advised that Monitor had issued a reminder to all Foundation Trusts that the Board must be absolutely clear and content with the declarations made in the quarterly returns. He highlighted the three declarations that underpinned the proposed quarter 1 return for 2012/13: 1. “the Trust will continue to maintain a financial risk rating of at least 3 over the next

twelve months” – Charles Porter advised that the Trust’s current position and forward plan supported this declaration being made

2. “the Board confirms that there are no matters arising in the quarter requiring an

exception report to Monitor which have not already been reported” – Charles Porter drew the Board’s attention to appendix 2 in the Board paper, and offered the view that the Board should support this declaration being made


3. “the Board is satisfied that plans are in place and sufficient to ensure ongoing

compliance with all existing targets (after the application of thresholds) and a commitment to comply with all known targets going forwards” – Charles Porter recommended that, in light of the perceived risks to achieving the new red 1 target on a quarterly basis (starting with quarter 2), the Board did not make this declaration and submitted an explanation of the Trust’s position.

In terms of the second declaration, the Chief Executive noted that the list of exceptions to be reported to Monitor included an “adverse report from internal audit”. Steve Garside responded that no adverse reports had been received and the most appropriate measure for this was probably the annual head of internal audit opinion which gave an overall conclusion on the robustness of the Trust’s internal control environment. In this respect, a positive report had been received during the course of Q1 in relation to the 2011/12 financial year. With reference to the form of wording proposed by Charles Porter for the third (and non-compliant) declaration, Board members expressed a range of concerns: the declaration needed to be clear that there was a risk of failing to achieve one

particular target and not all of them the action plan to improve red 1 performance needs to have been completed

before the Trust can use that form of wording the elements of the action plan need to be fully understandable and better

explained (and the Trust should ensure that the new relationship managers have an understanding of the problem and how SCAS are attempting to resolve it)

the wording should be clear about the areas where the Board does / does not

have full assurance at this stage The Chairman suggested that the Trust’s declaration should make reference to this being a new target with limited historical data and one which involved a relatively small volume of cases and was affected by a number of external factors. Alastair Mitchell-Baker stressed the importance of continuing to lobby and make the Trust’s concerns with the new target well known. In conclusion, the Board approved the proposed declarations for 1) and 2), and gave authority to the Chairman and Chief Executive to determine and submit an appropriate form of wording in respect of declaration 3. Action 12/202 The Chairman and Chief Executive to determine an appropriate form of wording for the declaration regarding compliance with targets in the Monitor 2012/13 quarter 1 return.

12/203 Board Assurance Framework Fizz Thompson presented the latest Board Assurance Framework (BAF) explaining the three main components:


the seven red risks which had been identified by the Executive Team the overall profile of the current biggest 16 risks (e.g. red/amber/green) and the

expected year-end position the detailed Board Assurance Framework information showing controls,

assurances, gaps and actions. The Chairman commented that, whilst he accepted the BAF should be the Board’s main tool for risk assurance, it would be concerning if some major risks were highlighted only in the risk register, and therefore not brought to the Board’s attention. The Chief Executive responded that, as far as he was concerned, all of the major current risks were encapsulated in the seven agreed by the Executive Team and highlighted in the summary paper. Alastair Mitchell-Baker, in noting that the risk relating to the achievement of new national operational performance standards was currently rated as ‘amber’, asked whether this should in fact be ‘red’ given the earlier discussions around the red 1 target. The Board agreed that red 1 was best shown separately as a risk, and should currently be rated as ‘red’. Action 12/203 Fizz Thompson to include red 1 as a separate risk in the BAF (in additional to the general risk around operational performance against new national standards), with this currently being rated as ‘red’.

Eddie Weiss highlighted that two risks had increased substantially in terms of their scoring: resources and staff sickness absence. He asked for it to be noted that the Board had discussed these two issues extensively during the discussions on performance. The Chairman asked when the risks relating to commercial performance would be downgraded to ‘green’. The Chief Executive replied that this was probably appropriate once a couple of specific contracts that had been agreed in principle were formally signed. BOARD SUB-COMMITTEE CHAIR REPORTS

12/204 Audit Committee Report Eddie Weiss explained that two key areas were the source of ongoing focus for the Audit Committee: IM&T (particularly resilience) and the external audit selection process. In terms of the latter, it was noted that three firms would be presenting their tenders to the evaluation panel as part of the next stage of the process. 12/205 Quality and Safety Committee Report David Williams had chaired the most recent meeting, and stated that the main outcome of the meeting had been the review of the current Board Assurance Framework, with the committee concluding that this represented a significant improvement.


12/206 Charitable Funds Committee Claire Carless updated the Board on the Charitable Funds Committee meeting that had taken place on 19 July, the key points being: the Finance Team had been asked to provide some additional clarity about the

structure of the charity, and particularly the element relating to “designated” funds (e.g. whether small ‘pots’ of designated funds could be merged together, or released into the general funds of the organisation)

the committee were still considering the arrangements for external audit of the

charitable funds, with a potential option being to use the successful provider of the current audit tender exercise being undertaken at Trust level

the committee had considered a range of requests for funding, with some

approved and some rejected. ANY OTHER BUSINESS

12/207 Any Other Business The Chairman closed the meeting by stating that he would welcome feedback on today’s meeting from the three governors in attendance. He asked Steve Garside to co-ordinate this and ask the governors if they would also be willing to feedback at the next Council of Governors meeting. Action 12/207 Steve Garside to ask the three governors present at the Board meeting for their feedback and arrange for them to provide an overview of this at the next Council of Governors meeting (in recognition that the governor role includes holding the Board of Directors to account for the performance of the Trust).

12/208 Date and time of next meeting The next public meeting of the South Central Ambulance Service NHS Foundation Trust Board of Directors will be held on Wednesday 26 September 2012 at a venue to be confirmed.

12/209 Resolution by the Chairman To resolve that the representatives of the press and other members of the public be excluded from the remainder of this meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest (Section 1 (2) of the Public Bodies (Admissions to Meetings) Act 1060 refers).

Agenda Item: 4



Title Matters Arising from the 25 July 2012 Board Meeting in Public


Presenter(s) of the paper (if different to Lead Director) Trevor Jones, Chairman

Purpose of the paper To present to the Board an update on progress against the action points raised at the previous Board meeting in public


To note that good progress has been made in addressing the thirteen action points from the previous meeting, and the four action points from the two prior meetings










The action points from Board meetings, in some cases, deal with a range of potential risks to the organisation and how these will be mitigated. In the case of the July meeting, two action points explicitly dealt with the Trust’s approach to managing risks: finalising the risk management strategy by clarifying the respective responsibilities of the Audit and

Quality and Safety Board sub-committees including the delivery of the new red 1 target as a standalone risk in the Board Assurance

Framework Both actions have been addressed.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) One of the action points from the previous meeting related to the Trust’s quarter 1 return to Monitor; this action was duly completed and Monitor have confirmed that as a result of this return SCAS has a financial risk rating of ‘3’ and a governance rating of ‘green’.


There were two actions explicitly relating to finance and both have been completed: a detailed plan will be presented at today’s meeting demonstrating how the Trust’s financial risks

will be mitigated the Chief Executive has confirmed that the Trust will receive the additional income from those ECR

journeys where private providers have been used


This paper has been shared with the governors as part of them receiving all Board meeting in public papers.


A number of actions from the previous meeting related to patients and staff and have been completed, including: the Chief Executive has expressed his thanks to the staff affected by the Wokingham EOC transfer

for their co-operation and dedication the Trust are conducting a SIRI review into the death of a baby in Wycombe the Integrated Performance Report includes more details about sickness absence rates


The minutes from the previous meeting – item 3 – provide more detail and context about the action points that were raised.

South Central Ambulance Service NHS Foundation Trust

Agenda Item 4 Trust Board Meeting 26th September 2012

MATTERS ARISING

Page 1 of 4

No. Minute

ref. Agenda Item Action Resp Target

Due Date Comments/Outcome

Actions arising from 25 April 2012

1. 12/165 Board sub-committee Chair reports

To consider the future arrangements, including timing, for reporting the work of the Quality and Safety Committee through to the Board.

KN, FT, SG

Sept Board

Action completed. Reporting will be as follows: 16 August Q&S to 26 September Board; 18 October Q&S to 28 November Board; 13 December Q&S to 30 January Board; 14 February Q&S to 27 March Board (to include ToR and effectiveness review, and forward programme for 2013/14).

Actions arising from 30 May 2012 2. 12/176 Quality & Patient

Safety Report Fizz Thompson to lead a discussion on locally determined “never events” at the future Board Seminar on risk.

FT Sept Board

Action completed. Risk will feature as a component of all future seminar and workshop discussions. However, it is expected that a seminar session devoted to risk (covering never events) will be held in early 2013/14.

3. 12/179a Integrated Performance Report

Review the performance management arrangements for the cleaning of vehicles, ensuring that there is clarity around the optimum frequency for cleaning vehicles, and that an appropriate evidence-based target is set.

Q&S Committee

Sept Board

Action completed. Please see item 8 (page 2) – the Quality and Patient Safety Report.

4. 12/183b Annual Report 2011/12

Duncan Burke and Steve Garside to review the process for the production of the Annual Report, ensuring improved arrangements for 2012/13

SG/DB

August 2012

Action in hand. A stronger process to be developed for 2012/13,



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No. Minute



with a project plan and governor involvement.

Actions arising from 25 July 2012 5. 12/196A Chief Executive’s

Report The Chief Executive and Steve Garside to identify the most appropriate date for presenting the updated IM&T Strategy to the board for approval.

WH, SG

TBA Action in hand. A further Board discussion to be held but timing will be confirmed once the outcomes of the IT resilience work are known.

6. 12/196b Chief Executive’s Report

The Chief Executive to write to staff affected by the Wokingham EOC thanking them for their co-operation and dedication.

WH ASAP Action in hand. The Chief Executive to provide a verbal update.

7. 12/196c Chief Executive’s Report

The Chief Executive and John Nichols to present the post implementation review of area manager/team leader approach, and other aspects of the Operations reorganization, at either the September or November 2012 Board meetings.

WH, JN

Sept or Nov Board

Action in hand. This has been scheduled for the November 2012 meeting.

8. 12/196d Chief Executive’s Report

John Nichols to present a scorecard at the next Board meeting showing details of progress against the actions identified in the Operational Improvement Plane.

JN Sept Board

Action completed. This will be covered as part of the Interim Chief Operating Officer’s presentation on operational performance.

9. 12/196e Chief Executive’s Report

Fizz Thompson to present the outcomes of the SIRI review into the baby death in Wycombe at an appropriate future Board meeting.

FT Sept Board

Action completed. This is covered in today’s Quality and Patient Safety report.

10. 12/198a Integrated Performance Report

The Chief Executive to report back in detail at the next Board meeting on sickness absence rates, including an

WH Sept Board

Action completed. To be covered as part of



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analysis of the factors behind the levels of sickness and the actions being taken to address and improve performance (the executive to review the year-end risk rating)

Integrated Performance Report item.

11. 12/198b Integrated Performance Report

The Chief Executive to ensure that the importance of delivering staff performance appraisals to the required timescales is reinforced across the organisation.

WH ASAP Action in hand. The Chief Executive to provide a verbal update.

12. 12/199a Finance & Estates Report

Charles Porter to present a detailed plan at the next Board meeting demonstrating how the Trust’s increased financial risks will be fully mitigated.

CP Sept Board

Action completed. To be covered as part of the Finance and Estates Report item.

13. 12/199b Finance & Estates Report

The Chief Executive to confirm that the Trust will receive the additional income from those ECR journeys where private providers are being used.

WH Sept Board

Action completed. Confirmation received.

14. 12/201 Risk Management Strategy

Fizz Thompson to finalise the Risk Management Strategy by clarifying the respective roles of the Audit and Quality and Safety Committees in relation to the review of the corporate risk register, and the reporting of these committees to the Board (i.e. summary reports rather than minutes are presented).

FT ASAP Action completed. The Risk Management Strategy has been finalised.

15. 12/202 Monitor 2012/12 Quarter 1 report

The Chairman and Chief Executive to determine an appropriate form of wording for the declaration regarding compliance with targets in the Monitor 2012/13 quarter 1 return.

TJ, WH

ASAP Action completed. Wording shared with Board members on 2 August.

16. 12/203 Board Assurance Framework

Fizz Thompson to include red 1 as a separate risk in the BAF (in addition to the general risk around operational performance against new national standards), with this currently being rated as ‘red’.

FT Sept Board

Action completed. Red 1 is now shown as a separate risk in the Board Assurance Framework.

17. 12/207 Any other business Steve Garside to ask the three governors present at the Board meeting for their feedback and arrange for them to

SG August 2012

Action completed. Governors were asked



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provide an overview of this at the next Council of Governors meeting (in recognition that the governor role includes holding the Board of Directors to account for the performance of the Trust).

but this item needed to be deferred. To be rescheduled for January 2013.

Key:

AMB Alastair Mitchell-Baker

CC Claire Carless CP Charles Porter DB Duncan Burke EW Eddie Weiss FT Fizz Thompson KN Keith Nuttall SG Steve Garside WH Will Hancock TJ Trevor Jones IB Ilona Blue JN John Nichols DW David Williams JB John Black

Agenda Item: 6



Title Chief Executive’s Report

Lead Director Will Hancock, Chief Executive

Presenter(s) of the paper (if different to Lead Director)

As above

Purpose of the paper To present to the Board an update on key issues and developments affecting the Trust, and also to seek agreement of the terms of reference for the forthcoming post implementation benefits realisation review of the operational and clinical restructure.


To note the contents of the report, and approve the terms of reference at Appendix A.










The paper deals with a range of key potential risks currently faced by the Trust, including in relation to the impact on performance of hospital handover delays and winter and adverse weather pressures.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) The report notes the following: We continue to be fully compliant with the essential standards set by the Care Quality Commission Monitor are currently rating us as “green” for governance, and “3” for our financial risk rating, which

is fully in line with the plans we set at the start of the financial year


In addition to our positive current financial risk rating (FRR) of “3”, the report notes that this is a financially challenging time as we deal with factors such as high levels of activity and hospital handover delays in order to sustain our response times and ensure continuation of high standards of care to patients.


This report has been shared with the Council of Governors as part of the process of them receiving all papers for Board meetings in public. At the last meeting on 10 September 2012, I present a detailed Chief Executive’s Report containing many of the issues included in this report to the Board of Directors.


The sections in the report covering service performance, hospital handover delays, winter planning, and quality, particularly relate to the services we provide to patients. In turn, there are sections on Wokingham EOC, the operational and clinical structure review, the corporate services review, and the annual staff recognition awards that are particularly relevant to SCAS staff.


The Trust Board receives a Chief Executive’s Report as a standing agenda item.

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CHIEF EXECUTIVE’S REPORT

The purpose of my Chief Executive’s Report for September is to keep the Board abreast of key issues and developments affecting the Trust, shaped around the Trust’s six strategic themes. I am asking the Board to note the report, but also to agree the terms of reference for a post implementation benefits realisation review of the operational and clinical restructure (Appendix A). To achieve operational excellence by achieving response times, performance standards, resilience and efficiency

Service Performance Having achieved the plans we submitted to Monitor at the start of the year for quarter 1, and concluded that period with a financial risk rating of ‘3’ and a governance rating of ‘green;’ quarter 2 is proving to be particularly challenging. With continuing high levels of demand (6% higher year-to-date compared with the corresponding period in 2011/12), our current financial position is slightly behind budget as a result of the need to support our A&E operations and absorb start-up costs associated with our new NHS 111 service. The red 19 national target is the main challenge in terms of operational performance and a robust improvement plan is in place. Comprehensive performance data can be seen in the Integrated Performance Report and a thorough presentation will be given at the Board meeting by the Interim Chief Operating Officer. The latest financial position is reported in the Finance and Estates Report. Hospital handover delays Hospital handover delays remain an area of concern. In August we achieved 63% of handovers within the required fifteen minutes, against a target of 85%. The hospital element of handover delays worsened by the equivalent of c500 lost hours per month in quarter 1 of 2012/13 compared with the same quarter in 2011/12, and although there has been an improvement, the Trust are taking all possible actions to try and resolve. We will cover this in further detail during the operational performance item. Resources Escalation Action Plan (REAP) REAP is a national system, used to inform short-term capacity planning in response to the prevailing level of demand for services and other factors

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including: performance levels, demand, staff availability, control room issues, external influences, and NHS internal influences. Each level of escalation indicates the level of pressure that the Service is experiencing and includes a menu of options to implement to respond appropriately. SCAS is currently at REAP level 3 (out of 6). This is due to the higher than planned demand levels which are impacting on our Red performance. To mitigate the impact of the higher demand, the REAP actions provide additional operational hours through agreed processes such as managers responding as part of their daily duties and certain training courses being postponed. We review our REAP level every week and hope to lower this at the end of this quarter. To assist us with managing our current performance we have implemented a Silver Command cell in each Emergency Operation Centre (EOC) to manage any daily issues that arise and allow the EOC team to manage their responsibilities. We are also holding two daily conference calls chaired by a Gold Manager to implement the required actions and resolve any issues. Winter planning We have robust plans for delivering the service in adverse weather which are supported with our REAP and Escalation plans. We are also feeding into local winter plans which are agreed through the Strategic Health Authority. The local plans provide the Area Managers with more details around services that are available and what support is required in their local area and also provides SCAS the opportunity to share with key stakeholders our plans and how we will operate during adverse weather. Wokingham Emergency Operation Centre (EOC) The Wokingham EOC is now closed and following a period of consultation individual staff members have either been relocated to Bicester or Otterbourne EOCs, or redeployed into other roles within SCAS (e.g. Emergency Care Assistant roles). There have unfortunately been some redundancies where the roles being offered were not assessed as representing ‘suitable alternative employment’. The Bicester EOC is now dispatching all Berkshire resources and, where possible, we are utilising ex-Berkshire EOC staff to do this maintaining their local knowledge. We are also exposing all the Bicester EOC staff to the Berkshire area to build their knowledge and improve our resilience in dispatching in Berkshire. These moves are complex and challenging, and staff are working hard and doing their very best to make the new arrangements as effective as possible. Information Management and Technology (IM&T) and telephony Following the problems experienced with our telephony systems in May the Trust Board commissioned an independent review of proposals to improve resilience. This review supported the main recommendations which had been made by Vodafone and work is now ongoing to improve the service reliability and performance and enable us to operate more effectively from either Northern or Southern House on a virtual regional basis. To assist in delivering this improvement programme an Interim Head of ICT Resilience has been appointed on an initial four month contract to improve existing service standards, and plan for the introduction of the revised telephony and IT solutions.

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Over the past three months we have seen the introduction of the 111 Service in Oxfordshire. There have been some minor technical issues in respect of telephony services, most of which have been related to the external service provision outside of our control; those which related to our own systems have been largely related to set-up requirement changes introduced to improve patient service delivery. During August and September we have been implementing a number of system updates across the Trust Fleet on the Airwave and Terrafix equipment which will improve communication standards and enable better information sharing with the control room iCAD system. Review of Olympics The Trust had been planning and preparing for the Games with partner agencies since 2007 when London was chosen as the host city. London Ambulance Service (LAS) required mutual aid from around the country and SCAS provided a small contingent of staff who resided in London before and during the Olympics. Initial feedback has been that our staff were a credit to the organisation. The actual operational response began when the Torch Relay arrived in Milton Keynes on 9

July. As well as operational support to the Torch Relay itself,

managers were present at the various police and local authority control rooms as the Torch made its way through South Central and until it left Portsmouth for Brighton on 16 July. The Trust’s support of two motorcycles and Hazardous Area Response Team (HART) capability produced unexpected benefit to our patients. During the Thames Valley part of the relay the motorcycles responded to two red calls (unrelated to the relay) which may not have been reached within 8 minutes otherwise. SCAS provided on site medical cover at Eton Dorney for the Olympic rowing which was very successful and there were no adverse incidents reported. The release of SCAS staff to the Olympics was backfilled with Private Providers to cover any shortages and mitigate the impact of this release. I would like to pay tribute to Trust staff, whose enthusiasm, commitment and hard work ensured that we were ready for the start of the Games and delivered excellent support throughout. Operational and clinical structure review The Board will recall that, in early 2011, the Trust undertook a major review of its operational and clinical structure. There were four key drivers for this review: the need for strong front line clinical leadership to continue our focus on

clinical outcomes, patient experience and safety requirement for consistent management and leadership across SCAS

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scope to make savings and reduce operational costs in the existing NHS financial climate

rise to the new regulatory requirements of being a Foundation Trust A new structure for operational and clinical services was built, with some of the key features being an area management approach to operations, with Area Directors and Area Managers; establishment of an Investigation Unit to oversee processes for serious complaints, SUIs and investigations; an increased focus on teamworking; new arrangements for resilience and dealing with major incidents. The new structures were in place in October/November 2011, and a post implementation benefits realisation review is shortly due to commence, with a report being presented to the Board in November. The Board are asked to agree the terms of reference for the post implementation benefits realisation review and these are shown at Appendix A. Review of Community First Responders scheme Volunteers make an important and valued contribution to SCAS operations, and the Trust periodically carries out reviews of its volunteer functions to ensure that these are robust and being operated as effectively as possible.

A review of voluntary car driver arrangements has been undertaken, and we are now reviewing the arrangements for the operation of the SCAS Community First Responders (CFR) Scheme.

This is a high-level review into the general functioning of the CFR Scheme, making recommendations for improvement where appropriate. It will include an assessment of the arrangements for the effective deployment of CFRs, including ensuring that arrangements for allocating and dispatching CFRs to incidents are robust (e.g. timely, geographically sound, supportive of good patient safety) and that the appropriate use of CFRs is fully promoted across the organisation. The review, which we expect to be completed in October will also consider how CFRs are supported in the delivery of their duties, including ensuring that there is effective overall management support and communication, and appropriate training and development To deliver clinical excellence by improving clinical outcomes, ensuring patient safety and providing a positive patient experience

Quality There is a comprehensive quality and patient safety report on today’s agenda, but I would like to highlight that during this time of challenging operational pressures SCAS remains fully compliant with the CQC essential standards Cardiac arrest survival rates by ambulance There has been some recent media coverage regarding the Department of Health’s Ambulance Quality Indicators for cardiac arrest survival rates by ambulance service. This is the first time that such an indicator has been

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measured, and we were ranked as the lowest of ambulance trusts with a rate of 10.8% (compared with the highest of 31.7% in London). There are some issues associated with data collection and we are working closely with the various Acute Trusts to obtain more robust data (there were particular problems prior to April 2012 which meant that SCAS was under reporting its performance). The data set for cardiac arrest survival rates by ambulance is small and therefore month on month variations will occur. Equally, regional comparison is difficult for a variety of reasons including age of population and rurality. It is important to note that the Trust audits every cardiac arrest, all of our staff are trained to use the latest guidelines and best practice, and operate with high quality kit and equipment. We also operate an on-going widespread research trial to test the efficacy of the automatic chest compression device. We are, however, strongly focused on improvement and learning from best practice. John Black, the Trust’s Medical Director, leads nationally on behalf of all ambulance trust Medical Directors on cardiac care and we will carefully monitor our performance in this area. To deliver leadership, staff engagement and a learning culture by developing the workforce, motivating and enabling our people to deliver excellence

Appointment processes I am delighted to inform you that we have now successfully filled the key Board level role of Director of Strategy and Business Development, with the appointment of James Underhay. James will join the Trust on 8 October, and has held a number of senior operational and commercial roles in both the private and not-for-profit sectors, including with British Airways, KPMG and Turning Point. He will bring a strategic approach to business development and commercial opportunities, whilst managing our commercial business and providing leadership to the Commercial Management Team. I look forward to introducing James to the Board of Directors at this meeting. We have formally started the process to recruit substantively to the key position of Chief Operating Officer, with John Nichols continuing to fill this role on an interim basis. Corporate Services Review Update As a reminder, the Board accepted the recommendations from the Chief Executive at their meeting on 27 June to restructure the Corporate Service departments of Finance, including procurement, performance information, IM&T, and estates HR, including recruitment Education Communications Service development and operational planning

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Corporate services and Chief Executive’s Office Appointment procedures for all posts are now being undertaken, with most Directorates well through this process. For some staff this will mean relocating from Berkshire to either Northern or Southern House, as services are aligned to the Operational management structure. Relocation criteria are applied in line with Trust policies, to assess whether the job at the new location is suitable alternative employment. Once fully implemented, the Trust should benefit from a fit for purpose structure corporate roles which support delivery of the Trust’s business alignment of resources to direction of travel – internal and external structures which can support internal and external demands and relationships Annual Staff Recognition Awards 2012 (“Ambies”) Our annual Staff Recognition Awards ceremony will be taking place on the evening of the Board meeting (26 September). Following receipt of nominations, shortlisting has taken place across the various categories, which are: A&E person of the year Commercial Services person of the year Emergency Operations Centre person of the year Support person of the year Volunteer person of the year Team of the year Trainee of the year Educator of the year CEOs commendation for outstanding service to the Trust Chairman’s special award The various winners will be announced in due course. To develop further the portfolio of commercially viable and high quality non emergency commercial contracts

NHS111 An update on NHS111 is provided in a paper later in the agenda, but as a reminder we have been successful in terms of winning contracts / pilots in Hampshire, Oxfordshire and Berkshire. We were disappointed not to be shortlisted in the process to award a contract for Milton Keynes. Performance on the various NHS111 contracts will be reported through the Integrated Performance Report, starting this month with Oxfordshire.

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To deliver sound governance, value for money and a strong financial standing

Quarterly returns to Monitor As the Board will recall, we discussed and agreed the nature of our quarter 1 return to Monitor at the previous Board meeting, and this was subsequently submitted. Following review by Monitor, we have received notification from them that we currently have a financial risk rating of ‘3’, and a governance rating of ‘green’. This is in accordance with the plan we submitted to Monitor at the start of the year. Monitor are visiting the Trust on 1st October as part of a routine process to introduce their new relationship team, and discuss the Trust’s plans for the rest of 2012/13. To deliver effective stakeholder relationships

Media coverage Since the last Board meeting in public in July, there has been a range of national and local media coverage of the Trust, including in respect of:

our Energy Wise Campaign as a Finalist in the Health Service Journal’s Efficiency Awards 2012 (awards being presented in London 25 September);

our 999 Misuse Costs Lives campaign being shortlisted in two regions

(Wessex and Thames Valley) in the Chartered Institute of Public Relations Pride Awards 2012

SCAS supporting delivery of the Olympic Games in London and at Eton

Dorney, Berkshire.

following SCAS’ success in achieving two Institute of Practitioners in Advertising Awards for the 999 Misuse Costs Lives campaign, the Trust gave radio interviews to The Breeze (Newbury) and to Banbury Sound.

a further radio interview was recorded with Reading 107FM on alcohol

misuse following the publication of a study by North East Ambulance Service / Newcastle University.

front-line SCAS staff responding swiftly to support the home delivery of a

baby in Windsor with shoulder dystocia There has also been some media coverage of the recent development that a former employee of SCAS had failed to declare a criminal conviction on joining one of our predecessor organisations, Two Shires Ambulance Service. SCAS has a rigorous process in place for carrying out criminal record bureau (CRB) checks (which were not in existence at the time of the individual’s appointment to Two Shires in 1994) on anyone applying for positions that put them in contact with patients and their families, and we have also been retrospectively CRB

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checking any member of frontline staff that came from other organisations before SCAS was formed in 2006. As at 14 September, there had been 65,570 viewings of the “Misuse Costs Lives” viral video, and 903 people are now following SCAS through Twitter. Membership SCAS currently has 9,946 public members (as at 18 September). Consultations involving key stakeholders Monitor is running a consultation over their proposed new NHS provider licence. This licence will replace the terms of authorisation for a Foundation Trust, and will be the key way in which SCAS are regulated. The licence will cover seven sections setting out the conditions that providers must comply with:

general (e.g. the standard behaviours which Monitor will expect from all licencees, including fit and proper Directors and Governors)

pricing (e.g. compliance with the national tariff)

choice and competition (e.g. prevention of anti-competitive behaviour)

integrated care (e.g. working with commissioners to develop integrated

care)

continuity of service (e.g. ensuring services continue to operate where a provider becomes financially distressed or insolvent)

Foundation Trust governance (e.g. providing information relevant to

Monitor’s duty to maintain the register of Foundation Trusts)

definitions and notes SCAS will be submitting a response to the consultation ahead of the deadline of 23 October 2012, and it is expected that the new provider licence for Foundation Trusts will be introduced from April 2013. Further details will be provided at subsequent Board meetings. Stakeholder visits Members of the Wokingham HOSC visited our Northern EOC (call taking centre) in late July. The visitors were able to meet and talk to staff and listen in to emergency calls. They were able to see the dedicated ambulance despatch desks for all three counties covered by the centre: Berkshire, Buckinghamshire and Oxfordshire. We have received positive feedback from the visit, noting that they were impressed with what they saw and the staff they met. Following a similar visit from members of the Buckinghamshire HOSC we have arranged for a number of members to visit their local station and go out on an ambulance shift and observe. The first of these visits to High Wycombe Station has taken place and I am delighted to say that the Councillor was full of praise,

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talking about our crew she said 'Their care of the people we went to assist has left a lasting impression. It was absolutely wonderful to observe and thank you for the opportunity.' We have hosted our first FT trust members day at our Headquarters in Bicester. Our members had the opportunity to meet staff and governors, get health advice, blood pressure checks and see other demonstrations. Visitors enjoyed looking around an ambulance and commented that it really was a mobile health clinic. We were delighted to welcome members of all ages including one of our youngest, who is 14 and was full of ideas for further engagement, which we plan to progress. Launch of the SCAS Lesbian, Gay, Bisexual and Transgender (LGBT) Network On Saturday 8 September SCAS joined the circus themed parade from Reading Civic Centre to Kings Meadow Park. SCAS took a stand for diversity at Reading PRIDE for the fifth consecutive year to engage with the local community and to launch our Lesbian, Gay, Bisexual and Transgender (LGBT) Network. I joined staff from across the Trust, as well as Berkshire Public Governors Benita Playfoot and Gary Clark in celebrating the contributions SCAS’ LGBT staff make to the service and diversity within the local communities they care for. Appointments in the regional and local health economy There have been a number of recent key appointments in the local health economy, including:

Stephen Billingham has been appointed to the position of Chairman at Royal Berkshire NHS Foundation Trust

Karen Baker has been appointed as Interim Chief Executive at Isle of

Wight NHS Trust A number of Directors at NHS South of England have been successfully appointed to positions with the NHS Commissioning Board Authority:

Steve Fairman has been appointed national Director of Improvement, Development and QIPP

Dominic Hardy, Charlotte Moar, and Liz Redfern have been appointed as

Southern region Directors for Operations and Delivery, Finance, and Nursing respectively.

Peter Bradley has now left London Ambulance Service NHS Trust and Deputy Chief Executive, Martin Flaherty, is currently acting as Chief Executive. Will Hancock, Chief Executive Steve Garside, Company Secretary September 2012

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APPENDIX A

Operational and Clinical Restructure - Benefits Realisation Review

Terms of Reference

In July 2011 the Trust Board approved a restructure of the Operational and Clinical Directorates of the Trust. Following a period of implementation, the new structures became operational on 1 November 2011. A review of the restructure is now to be undertaken to assess the extent to which the restructure has achieved the original objectives and delivered the associated benefits. In particular the review will seek to evaluate the success of the operational and clinical directorate restructures in relation to

The operational effectiveness of the new structures and their ability to

deliver against the restructure objectives The capacity of front line managers to deliver the outcomes as defined

within the benefits realisation plan and associated CIPs The capability of front line managers to fulfil their roles, following the

development programme which has been put in place The capacity of the clinical directorate to support greater operational focus

in the areas of patient safety, clinical excellence and patient experience The capacity of the clinical directorate to provide required evidence for our

regulators Prior to Board approval of the restructure an independent assurance panel made a number of recommendations for implementation. The extent to which these recommendations have been addressed will also be considered by this review. The review will be undertaken by the Director of Human Resources and will seek opinion from a cross section of key staff and staff groups, including the following

Director of Patient Care Interim Chief Operating Officer Directors of Operations Area Managers Emergency Services Managers Team Leaders Clinical Mentors Clinical Directorate Managers Frontline A&E staff

The review will consider evidence in relation to the benefits realisation plan and assess the impact of the structure in delivering these. It will also include a review of the rota changes implemented to support teamworking. An initial report and supporting evidence will be provided for assurance before being taken to the board. It is recommended that the assurance be undertaken by the same team as provided independent assurance to the original review.

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Background The proposal for the Operational and Clinical restructure outlined a number of objectives to be achieved from the restructure. These were listed as follows

Support our continued desire to become increasingly patient focused and clinically led

Provide greater focus in the areas of patient safety, clinical excellence and patient experience

Support our front line staff who deliver patient care, in particular providing education, development and the tools to do the job

Protect the provision of front line hours delivering patient care Empower and de-layer Ensure clear lines of accountability Focus on external stakeholder relations Deliver value for money compared to best in class ambulance services,

recognising any legitimate differences Improve clinical leadership in the front line Promote integrated working across SCAS Increase our ability to provide evidence for our regulators

Prior to approving the restructure the Board asked for an independent assurance exercise to be undertaken to assess the risks within the structures. This exercise raised a number of concerns and highlighted areas of risk. It was generally understood that the financial context within which SCAS is operating, requires savings to be made and that inevitably there needs to be a balancing of savings with operational resilience. The assurance review recognised that the restructure had a number of significant risks over the implementation period and in the subsequent 18 to 24 months. The assurance review concluded that to be a success there were three significant shifts required:

a general increase in management and leadership capability at first and second line management level by team leaders and area managers and their assistants as a level of management is effectively being removed

a shift towards managing things right first time and avoiding subsequent time consuming management and support activities. This particularly covers people management and operational support areas.

A shift to the south of leaders as it is anticipated that after slotting in there will be excess team leaders in the north and vacancies in the south.

The assurance panel also made a number of recommendations, which were incorporated into the final document approved by the Board. The panel recommended that as part of the implementation plan a set of key performance indicators needed to be developed which would be carefully reviewed to ensure the overall organisation development and performance improvements were being achieved. They recommended that anticipated benefits of the changes be actively managed to ensure they were realised, suggesting that these might include measures such as actual use of time by team leaders - on the road/in the office/dealing with operational support/providing day-to-day operational/bronze management, sickness absence, disciplinary and grievance cases, clinical

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performance at team/area level, training and development delivery, staff survey feedback, and operational support performance (VOR, make ready, etc.). Following implementation, a benefits realisation paper was agreed by the Board in December 2011. This required Area Managers to put together plans to deliver the benefits from the review. These benefits were grouped under 5 headings, and were initially to be set at area level, with later cascade to team level as structures evolved (Annex A).

Quality Operational Performance Staff engagement Financial performance Leadership and culture

Key to successful benefits realisation would be the successful implementation of teams. This was defined as:

Team leaders in place Clinical mentor embedded in every team Every team member tagged to the team leader Performance and clinical competence measured by team Individual performance fed back to each team member Plans in place for team leader to work 2 shifts per year with each

individual Team regularly work together Quarterly team meetings planned

Area Managers would also be expected to engage effectively with a wide range of local stakeholders, within an overall SCAS framework to work with local partners to tailor services to local needs – eg developing local care pathways, reducing hospital turnaround etc. Progress against the area plans to deliver effective teams was to be tracked through performance review meetings and reported routinely to the Board.

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Annex A

Benefits Measurement

Area Team

Quality Clinical performance indicators including new care pathways (PCI, stroke and trauma)

Patient experience feedback See and treat % Improvement in the priority

areas of the quality accounts Improved management of risk

through incident reporting and feedback to staff

Increased safeguarding reporting

Clinical performance indicators

Patient experience feedback See and treat % Evidence of staff clinical

competence Improved management of risk

through incident reporting and feedback to staff

Increased safeguarding reporting

Operational performance

Hospital clear up times Mobilisation times

Hospital clear up times Mobilisation times

Staff engagement % appraisals completed % training completed Employee Opinion Survey

(EOS) - staff engaged

% appraisals completed % training completed

Financial performance

Sick absence Delivery of CIP’s Job cycle time

% return to work interviews carried out

Job cycle time

Leadership and culture

Reduction in staff grievances EOS – support from line

manager Positive feedback from

leadership walk rounds

External stakeholder engagement

Local CQUIN plans in place

Agenda Item: 7



Title Operational Response Performance Report

Lead Director John Nichols, Interim Chief Operating Officer

Presenter(s) of the paper (if different to Lead Director) As above

Purpose of the paper To update the Board on the Trust’s latest operational performance position


To note the current position of the Trust against the required performance targets and the actions being undertaken.










There is a risk to the achievement of Red 19 performance, both for Q2 (July, August and September) and full year (being 1st April 2012 to 31st March 2013). There is a risk to achievement of some elements of full year PCT cluster performance.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) Monitor – there is currently a risk to us achieving our red 19 performance target for Q2. The Q2 return will be made to Monitor at the end of October and any reported failures could potentially adversely impact on our Monitor ratings CQC – N/A


There are potential financial penalties should our full year PCT cluster performance (in line with the service level agreement with the lead commissioner) not be achieved.


The Council of Governors received an update on our current operational performance at the meeting on 10 September. Governors have received this paper, and the Integrated Performance Report, as part of them receiving all Board meeting in public papers, and to support their role in holding the Board of Directors to account. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

This paper deals with the operational performance of the Trust, and the national standards which reflect the services provided to patients. A number of elements of our action plan to improve performance impact on staff (e.g. those associated with resource allocation).


This paper is presented as part of the process of the Board undertaking a continuous review of the Trust’s operational performance position. Background reading can be found at: Monitor Compliance Framework 2012/13 http://www.monitor-nhsft.gov.uk/home/browse-category/guidance-foundation-trusts/mandatory-guidance/compliance-framework-2012/13

http://www.monitor-nhsft.gov.uk/home/browse-category/guidance-foundation-trusts/mandatory-guidance/compliance-framework-2012/13




OPERATIONAL RESPONSE PERFORMANCE REPORT

Response Standards

1 SCAS (Trust wide) performance An overview of the key response time measures is shown in table 1 below

SCAS YTD Q2 MTD

Red 8 75.57 75.54 76.79

Red 1 (8 minute) 75.25 77.34 84.04

Red 19 94.86 94.37 95.15 Table 1 Red 8 is above the required standards Red 1 is on track for an exit trajectory of 80% (in preparation for this indicator becoming a formal target from April 2013). Red 19 is currently below the required standard, both in terms of Q2 and full year. An improvement plan is in place (see below).

Page 1 of 6

2 PCT Cluster performance An overview of PCT Red 8 performance is shown below in table 2 and Red 19 performance in table 3.

Cluster YTD MTD

Berkshire 71.95 74.5

Hampshire 76.98 78.56

OxBucks/MK 79.95 77.38 Table 2 – red 8

Cluster YTD MTD

Berkshire 95.1 95.45

Hampshire 95.15 95.36

OxBucks/MK 95.29 95.28 Table 3 – red 19 It is important to note that Milton Keynes remains (for SLA reporting purposes) within the Oxfordshire and Buckinghamshire cluster. Red performance for the Berkshire cluster is below standard (see table 4 below for weekly performance information) with an action plan for improvement in place.

Page 2 of 6

Berks PCTs Weekly Red8

50

55

60

65

70

75

80

85

30/0

4/201

2

07/0

5/201

2

14/0

5/201

2

21/0

5/201

2

28/0

5/201

2

04/0

6/201

2

11/0

6/201

2

18/0

6/201

2

25/0

6/201

2

02/0

7/201

2

09/0

7/201

2

16/0

7/201

2

23/0

7/201

2

30/0

7/201

2

06/0

8/201

2

13/0

8/201

2

20/0

8/201

2

27/0

8/201

2

03/0

9/201

2

10/0

9/201

2

17/0

9/201

2

24/0

9/201

2

01/1

0/201

2

08/1

0/201

2

15/1

0/201

2

22/1

0/201

2

29/1

0/201

2

Previous Q2 target

Revised target

Actual

Table 4 –red performance in Berkshire Board members will note that whilst SCAS Red 19 performance is currently below the standard, all PCT cluster Red 19 performance, whilst tight, is above the required standards. The variation is as a result of “out of area” incidents being included within the SCAS (Trust wide) report. Out of Area incidents are those where we have received the call for an incident that is not in our operating area. The current National position is that the responsibility for reporting the performance of these calls lies with the Trust that received that call. Overview Members should not underestimate the challenge faced by SCAS to recover Red 19 and (for the Berkshire Cluster) Red 8 positions. Equally, whilst there is no “penalty” within our SLA with NHS commissioners against individual PCT performance, there is a clear expectation that SCAS should achieve for each individual PCT. Planning at the start of the year made allowances for performance during Quarter 3 (October, November and December) being challenged as a result of expected “Winter” pressures. These pressures typically include further increases in demand, difficult driving conditions and seasonal increases in sickness (both across the population and thus, of course, amongst our own staff and volunteers). High demand during the first period of this year (running at +6% against plan, with a monthly peak high during May of plus 8%) has, amongst other contribution factors, resulted in SCAS performing below its internally set monthly trajectories, which were designed to overachieve each month to provide a continuing level of assurance that both quarterly and full year targets could be met. Moving into Foundation Trust status also changed the way in which SCAS must operate, in that we have now moved away from being required to achieve standards only at the end (full year) position, to being required (by Monitor) to achieve standards for each individual quarter of the year. This year’s planning process has taken this change into account, but given a need to recover performance (as noted above) an overarching action plan is appropriate, not only to recover,

Page 3 of 6

but to seek to improve resilience across all targets and draw nearer to achieving performance at individual PCT level. Achievement of performance at PCT level fits well with our strategic themes of clinical and operational excellence. Action Plans Detailed action plans are in place, designed specifically to achieve: Quarterly performance at SCAS (Trust wide) level Full year performance at PCT cluster level

By default, delivery of these plans will bring performance up across individual PCTs, but within the specific plans are detailed actions to address Red 8 performance across Berkshire PCT Cluster and Buckinghamshire PCT. There is also a specific plan to improve our call answer performance (which in itself, if delivered, will directly improve operational response time performance). High level items for immediate action within the action plans include: Enhanced (twice daily) performance cell

i. Daily targets and KPIs Weekly (Chief Executive lead) Performance review process Targeted additional resource allocation Reworked deployment plan to enable best use of additional resources Revised internal escalation plan to fully account for Red 19 performance (was focused

on Red 8 performance only) Increase to EOC call taker numbers to account for demand increase Aggressive EOC call taker recruitment and training programme Re basing available resources and resource planning for Q3 and Q4 Finalising the formal “Winter Planning” process

In addition to this plan, work has commenced already in planning for next year, sustainably moving SCAS further forward to enable response times to be achieved (at worst) at every individual quarter, not just at SCAS (Trust wide) level, but at individual PCT level. This development focuses on moving forward from our current monthly planning assumptions to predicable daily planning process. Effectively this approach to planning, which considers daily demand variations, allows greater accuracy in delivering the right levels of resource. This ensures we neither over nor under resource on any given day through greater understanding of variations that can be masked by planning using monthly averages. This approach will benefit our patients and benefit our staff. We will be able to better plan and manage abstractions (such as training, staff development, appraisals and annual leave), allocation of staff working a “relief” shift, and forward plan more focused over time opportunities.

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Risks There are a number of risks associated with achieving operational performance on top of risks associated with failing to deliver against specific actions/tasks contained within the action plan. Demand

Demand is at +6% against (SLA) plan.(see table 5 below). There is a risk that demand grows at a greater rate over the coming winter period, either generally across the period, or spikes over a shorter defined period (as a result, for example, of a short severe weather snap, or an outbreak of flu)

Overall Emergency demand

32000

33000

34000

35000

36000

37000

38000

39000

40000

April May June July August

Overall EmergencyDemand 2011/12

Overall EmergencyDemand 2012/13

Table 5 Hospital Handover Delays.

Handover at hospital remains a significant risk. Delays remain higher than last year (see table 6)

Hospital Handover Delays (Hours)

0

200

400

600

800

1000

1200

1400

April May June July August

Excess Handover Hours 2011/12

Excess Handover Hours 2012/13

Working with the Acute trusts to enable them to accept our patients without delay is receiving a great deal of attention, involving high level intervention.

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It is, however, necessary to plan on hand over delays occurring. Options are being drawn up that could be implemented to effect rapid release of ambulances and staff from queues at hospitals that do not increase further the clinical risks to those patients “in the queue”. Winter

As well as winter influenced high demand, poor/severe weather may impact upon:

o SCAS workforce sickness rates o Vehicle availability (increased break down rates) o Speed of response

These risks are recognised and actions to mitigate are being put in place, described in detail within our “winter planning” arrangements. Revised Performance Trajectories Based upon the action plan, and drawn up in conjunction with finance colleagues, draft revised trajectories covering Q3 and Q4 (October through to March 2013) are now being tested for achievability with operational and Emergency Control room managers. These revised trajectories will be shared with Board members once completed and agreed by the Executive team. John Nichols Interim Chief Operating Officer 13 September 2012

Agenda Item: 8



Title Quality and Patient Safety Report (including review of progress against Quality Accounts and SIRI group summary report)

Lead Director Fizz Thompson, Director of Patient Care/Deputy Chief Executive

Presenter(s) of the paper (if different to the Lead Director)

As above

Purpose of the paper To update and assure the Trust Board on the quality and patient safety work stream areas.


The Trust Board is asked to receive and note the report.










All clinical risks are detailed in the Trust’s risk register and integrated performance report that link to the quality workstreams.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards)

All quality related workstreams aid and enhance compliance with the CQC essential standards. Information provided in this paper provides evidence of compliance.


No implications directly; however, this report should be considered in conjunction with the Integrated Performance Report and Finance Report as the Trust must ensure that it delivers its key performance requirements and provides high standards of quality and patient care within the available financial resources.


Quality and Patient Safety work streams are shared with commissioners and stakeholders through regular updates and meetings and performance shared through the Integrated Performance Report. The Council of Governors receive all Board meeting papers in public, and an update on quality at each Council of Governors meeting. At the last meeting on 10 September there were particular discussions over cardiac arrest survival rates and hospital handover delays. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

Links to all elements of NHS constitution.

Other Background papers / supporting information

Quality and safety report is presented at every Board meeting, and quality accounts were presented to the Council of Governors in April 2012. Care Quality Commission Guidance about compliance: Essential Standards of Quality & Safety Care Quality Commission (2012) Guidance about compliance: Judgement framework Department of Health (2012/13) The NHS Outcomes Framework Monitor (2012) Quality Governance Framework Monitor (2012) The NHS Foundation Trust Annual Reporting Manual 2011/12 National Quality Board (NQB) (2012) Quality in the new health System


QUALITY AND PATIENT SAFETY REPORT

Overview and executive summary This report provides information on progress and the work to maintain clinical excellence and high standards of care to the public we serve. This report also provides an update on progress against the Quality Accounts published in June 2012. Details and information on the delivery of performance can be found in the Integrated Performance Report. The report follows the key domains of the Department of Health, NHS Outcomes Framework (2012-13). The framework reflects the principles set out in the white paper Equity and Excellence: Liberating the NHS and acts as a catalyst to drive quality improvements and outcome measurements. It is structured around five domains: Preventing people from dying prematurely, Enhancing quality of life for people with long term conditions, Helping people to recover from episodes of ill health or following injury, ensuring that people have a positive experience of care and treating and caring for people in a safe environment and protecting them from harm. Risks identified. Risks to quality have been identified within the IPR. These are:

Operational delivery of service with risks to performance standards Performance under target on leaving the scene within 39 minutes of patients with a

positive FAST test Increased percentage of patients re-contacting the service following a hear and treat

contact Increase in numbers over the target of administration errors with medicines

Recovery plans are in place and these are monitored through the Executive team and Quality and Safety Committee. Highlights Complaints have reduced during August and teams are answering complaints in a more timely manner. The quality Risk Profile remains consistent with all areas having a risk rating indicating compliance risk is low. Good areas of progress are being made against the Quality Accounts priorities as highlighted below.

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Quality Accounts – review of progress against the priorities SCAS published its 2012/13 quality accounts at the end of June 2012. As a Foundation Trust, external audit by the Audit Commission was required prior to publication and submission to Monitor and the Department of Health (DH). SCAS remains compliant with all CQC essential standards and leadership walkarounds aid the monitoring of the quality accounts priorities. DH core indicators were included in this years accounts; these were to meet Red 1 call targets and to report on the percentage of patients receiving appropriate care bundles for STEMI and stroke and to benchmark the above with the national average. Priority 1 (Patient Safety) Continue to decrease the numbers of patients experiencing a delay in response (new core indicators on response times for Red calls). Refer to IPR Maintain and improve the monitoring of cleanliness of all vehicles to provide assurance A programme of cleaning by make ready is in place and a plan of ATP (adenosine triphosphate) is in progress. This measures (after deep cleaning) the effectiveness of the cleaning of the vehicle. The evidence to date shows that an 8 week deep cleaning schedule could be achieved and provide a greater availability of vehicles for crews. Areas for improvement in terms of cleaning are the cab areas (steering wheels/gear sticks) to prevent staff cross infection and patient stretchers. Actions continue with further testing and staff refresher training. Reduce delays in handing over our patients to acute hospitals. This is a key priority to ensure that we can respond in a timely way to those patients who have unassessed needs in the community. Delays due to queuing in Emergency Department is closely monitored through the daily performance escalation framework and through the IPR. Priority 2 (Clinical Effectiveness) Ensure patients who have a heart attack or stroke receive an appropriate care bundle (new DH core indicators) The Audit commission conducted an audit of the Stroke NCPI and gave two minor recommendations one of which has been completed. The data for the forensic in depth analysis of stroke patients has been received and an in depth audit is to be conducted shortly. Team leaders have been targeting the stroke care bundle to date with their staff

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Ensure the data we report on Return of Spontaneous Circulation (ROSC) is reliable, accurate and complete.

A forensic review of the data has been undertaken and issues identified in the collection and analysis of the data. The quality of the data has been improved to ensure a robust reporting framework and all elements are due to be completed by October 2012. Significant improvements have been made but need to be embedded to reduce the resources required to maintain the accuracy.

Monitor the effectiveness of the trauma pathway and bypass decisions. In April 2012 the way patients with major trauma were treated changed. Instead of trauma patients being taken to the nearest emergency department, patients with major trauma are now taken directly to Major Trauma Centres. To help crews decide whether a patient has “major” trauma a triage tool, the Trauma Unit Bypass Tool, was developed by SCAS and the Wessex Trauma Network, along with other neighbouring ambulance services. There have been concerns that the Trauma Unit Bypass Tool may over-triage patients, inundating the major trauma centres with trauma patients. However, a 4 month review of the Trauma Unit Bypass Tool in SCAS has shown that 68% of patients that “trigger” the triage tool have “major trauma”, and the remaining patients have injuries serious enough to be managed in a Major Trauma Centre. This is almost a third of the over-triage rate found in some other areas of the country. The new trauma care pathway often involves our crews travelling long distances across the Trust with critically unwell patients. For this reason an education programme was implemented that ran from October 2011 to April 2012. To date over 95% of our frontline staff have been trained in:

Recognition of Major Trauma Use of the Wessex Trauma Unit Bypass triage tool Advanced trauma techniques Use of new medicines, such as Tranexamic acid (used to reduce bleeding),

Ondansetron (used to prevent sickness) and intravenous Paracetamol (an excellent pain reliever as effective as Morphine)

A standardized handover for trauma patients at receiving hospitals, across the whole Trust.

To provide assurance of competence in trauma care, all frontline qualified staff had to successfully complete a formal assessment. All Major Trauma cases are being reviewed by the Consultant Pre-Hospital Practitioner on an individual basis, and bi-monthly Morbidity and Mortality reviews are planned where appropriateness of trauma bypass will be formally reviewed. The Trust pharmacy advisor is performing regular audits of the medicines used in trauma to assess compliance and use.

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Priority 3 (Patient Experience) Ensure we answer all concerns as quickly as possible AND reduce the number of complaints about the attitude of our staff.

Regular meetings of the Patient Experience Review Group – ensuring learning outcomes robustly implemented.

Improved reporting to the PERG concentrating on complaints/concerns which the Trust can learn from.

Strengthening of the Patient Experience Team to ensure more efficient management of patients concerns.

Reviewing procedures for the management of patient experience issues. Plan of service user and patient experience contacts surveys for the next year. Positive results from ECP survey – ongoing. Positive outcome from survey of patients over 65 years using CSD. Providing case histories to the Trust Board for discussion and learning. Attitude related complaints analysis being conducted.

Improve care for patients with dementia and learning disabilities. Clinical Fellowship on dementia care awarded. As part of the Dementia Clinical Fellowship (CF) a small survey of staff was completed - on their experience of using the SCIE on-line learning resources (on Dementia). The Kirkpatrick Model of Evaluation was used and this process is being evaluated as part of the CF project. The final report (to be presented to the SHA) is due at the end of September. Results will inform internal education programmes and may have national implications. Partnership work with local statutory service providers. Partnerships with the Older People’s Mental Health service in Southern health have been strengthened, and work is progressing to develop a DVD learning resource (on Dementia) specifically for the ambulance service. No such resource currently exists so this is an important piece of work. The final content will include lived experience of people who have dementia (and their carers) and their encounters with front line ambulance services. Key areas to be included – explanation of what dementia is, communication, understanding and managing challenging behaviour. Focus Group – Dementia. A small focus group has been established in Oxfordshire (in conjunction with the local Alzheimer’s Society). This provides an opportunity for people who have dementia to contribute to developments within the ambulance service. Patient Satisfaction Survey A patient satisfaction survey of calls to CSD regarding people over the age of 65 was completed in May. The survey focussed on qualitative aspects of the whole experience of using SCAS (from the call taker right through to end outcome). The response was positive and 80% rated the patient experience as ‘excellent’.

4

LD Champions. In March the DVD ‘First impressions’ was finished. This was designed to inform front line staff about key issues to consider when they are called to a person who has a learning disability. The script was produced using the lived experience of some people from Oxfordshire and Buckinghamshire LD services (statutory and voluntary) and they were also involved in the filming. The DVD was launched at the Patient Safety Federation conference and our first LD ‘Champion’ (a gentleman who has Asperger’s syndrome) spoke very movingly about his own experience and his enthusiasm for becoming the first SCAS LD Champion (an LD Champion is someone who has a LD and who is willing to work with SCAS on future developments; LD Champions will be included at every step in new developments and also the on-going monitoring and review of existing services). Other work the LD Champions have been involved in include the production of ‘vehicle communication sheets’ – pictorial guides to assist with communication when verbal skills are reduced – and review of new Patient Information Leaflets in an accessible format. Production of information in an accessible format. SCAS has supported a Paramedic to complete a one day course on accessible communication. The course was run by Inspired Service Publishing, which was delivered including people who had a learning disability. SCAS now has access to the Valuing People ClipArt Collection and can produce Easy Read documents in-house using the ClipArt. Guidance notes on how to produce information in an Easy Read format will be made available in due course. SCAS is currently working on production of the Patient Information Leaflets in an accessible format and other documents to be made available via the web site (including EDS info). LD ‘Open days’. In June SCAS ran two ‘open days’ in conjunction with LD service providers in Hants and Bucks. Service users were able to explore an ambulance and speak to a paramedic. This type of event is extremely important in raising awareness and allaying fears. Awareness of Autism Alert Cards, Vehicle Communication Sheets and Health Passports were also included. SHA LD Self Assessment Framework. Of the four standards applicable to ambulance service providers, SCAS scored 2 greens and 2 ambers in the RAG rating. Deficits (i.e. Making the EDS available in accessible format and disaggregating LD complaints from all complaints) will be reviewed. DOMAIN 1 (Preventing people from dying prematurely) 1.0 Quality Performance All safety, experience and effectiveness measures and metrics (including the Clinical Quality Performance Indicators) and new clinical outcome measures are reported through the Integrated Performance Report. Red rated exceptions and risks have been highlighted above. 1.1 DH Never Events The DH has updated the Never Events list for 2012/13 and includes the amendments below. SCAS has not reported any never events in quarter 2 (to date) 2012/13.

5

Locally Specified ‘Never

Events’ Threshold

Method of Measurement

Consequence per breach

1. Patient falling or jumping from Moving Vehicle

>0

Review of National Patient Safety Agency (“NPSA”) / SUI reports and Monthly Service Quality Performance Report

Recovery of the cost of the subsequent treatment of the individual (all costs)

2. No patient should fall from an ambulance trolley

>0



3.

No ambulance should be involved in a blameworthy fatal collision (either pedestrian or other vehicle occupant)

>0



1.2 Safeguarding SCAS continues to see an increase in Safeguarding Vulnerable adults and child protection referrals. In July and August 2012 SCAS reported the following concerns: Adult Children July 140 37

August 175 39 The Oxford 111 pilot has referred 7 patients via the Safeguarding alert system since go live. 5 were vulnerable adults and 2 involved concerns for children. An analysis of social services dispositions and safeguarding referrals for 111 contacts has commenced to ensure appropriate referral, ongoing care and follow up.

6

DOMAIN 2 (Enhancing quality of life for people with long term conditions) and DOMAIN 3 (Helping people to recover from episodes of ill health or following injury) (combined 2.0 National Quality Board update. The new National Quality Board was established as one of the key developments associated with the national changes to the healthcare system which have now been enshrined in the Health and Social Care Act 2012.

The National Quality Board brings together leaders from across the health system alongside lay and patient representatives, with a remit to champion quality and ensure alignment for improving quality throughout the health service. In August 2012, the National Quality Board updated its Maintaining and improving quality during the transition: safety, effectiveness, experience, with a new draft document entitled: Quality in the new health system – maintaining and improving quality from April 2013. This document re-affirms the primary importance of quality in the health system. It provides an updated view of the roles and responsibilities of individual members of staff, organisations providing care, commissioners and regulatory bodies in ensuring the maintenance and continuous improvement of quality, and in detecting and responding effectively to lapses in quality of care. This document is for consultation until 30th September 2012. The NQB await the publication of the Mid Staffordshire NHS Foundation Trust inquiry before completing. .2.1 Quality in the new health system – maintaining and improving quality from April 2013. The consultation document provides an updated view of the roles and responsibilities of individual members of staff, organisations providing care, commissioners and regulatory bodies in the new health system, in ensuring the maintenance and continuous improvement of quality, and in detecting and responding effectively to gaps in quality of care. The document re-affirms the single NHS definition of quality: care that is effective, safe and provides as positive an experience as possible. It also outlines three key areas of responsibility for quality:

Frontline professionals – clinical and managerial Boards and senior leaders of healthcare providers The external structure and systems for assuring the public about quality of

care.

The document will be further discussed to ensure that the board has clarity as to where the responsibilities for quality lie with the new health system.

2.2 MINAP The South Central Cardiovascular Network congratulated SCAS in July 2012 for reducing the percentage of indirect transfers for primary PCI from 17% in 2010/11 to 10% in 2011/12.

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SCAS have analysed the data in this area and of the 21 patients making up the 10% possible only 5 patients were inappropriately conveyed to a district general hospital rather than a pPCI centre which actually equates to 2%. Quarter 1 performance from the MINAP Ambulance Outcome Database; Call to Door (CTD) <=80 Minutes 86% Call to Balloon (CTB) <= 150 Minutes 93% Call to Balloon (CTB) <=120 Minutes 72% 2.2 National Ambulance Benchmarking comparisons and patient safety data The national ambulance service group, QGARD (Quality and Risk Directors) collects and benchmarks patient safety data from ambulance trusts. This has been published for 2011/12. 2.2.1 Patient Safety incidents SCAS reported 498 incidents with no patient harm or a near miss. The range across 11 trusts was 43 - 3273. SCAS reported 111 incidents with some level of harm. The range for all trusts was 34 -721. SCAS was 7th overall in both. 2.2.2 RIDDOR incidents SCAS reported 129 RIDDOR reportable incidents in 2011/12. The range across the trusts was 49 -178. SCAS was 4th highest reporter. SCAS was one of only two trusts who reported all RIDDOR incidents to the HSE on time. 2.2.3 Serious Incidents Requiring Investigation. SCAS reported 18 SIRI’s in 2011/12. The range was 1 - 48. Many trusts reported around 20-30 serious incidents. 2.3 Dementia challenge NHS South of England have responded to the Prime Ministers challenge to improve care for people with dementia by releasing a development fund of £10m for communities and health partners to bid for. SCAS have joined in partnership with NHS Oxfordshire and NHS Berkshire in separate bids for monies for training and resources. The process for applications is not yet complete but planning has commenced. DOMAIN 4 (Ensuring that people have a positive experience of care) 3.0 Complaints and compliments 3.1 Complaints Ratios of complaints to patient contact in SCAS remains very low. National benchmarking is underway but anecdotally SCAS has a low number of complaints. The number of complaints has fallen since the last board report and compliments improved.

8

There have been no complaints upheld by the Parliamentary and Health Service Ombudsman to date this year. There has been one complaint re-referred to the Ombudsman in August 2012 for review. The Ombudsman has not yet decided whether to investigate further. A&E EOC

/CSD

Number of events

% per 1000

July 6 7 38725 0.04 August 1 1 Not

available

Total 7 8 Numbers of complaints for the Patient Transport Service (PTS) are provided below: PTS Number of

events % per 1000

July 2 40597 0.003 August 2 41380 0.004 Total 4 3.2 Compliments Compliments Received Northern Cluster Southern Cluster Trust Total July 26 33 59 August 21 41 62 3.3 Friends and family test – survey of patient satisfaction. In May 2012 the Prime Minister announced that a friends and family test would be used across all NHS providers. This is a national survey methodology of asking 100% of users if they would recommend the service to friends and family. This test will apply to all acute wards and A&E departments from April 2013. There is currently no date for ambulance services and SCAS will be working with NHS South to ensure a “fit for purpose” survey.

DOMAIN 5 (Treating and caring for people in a safe environment; and protecting them from avoidable harm) 4.0 Serious Incidents Requiring Investigation (SIRI) During quarter 2 (to date) 2012/13, SCAS reported 1 serious incident to the lead commissioner, CQC and Monitor. However in August Oxfordshire PCT declared a Serious Incident regarding 111 activity and performance over the weekend of 18th and 19th August

9

2012. SCAS will work in partnership with the CCG and PCT to investigate, report and action any learning from this. July 2012 1 SIRI reported August 2012 0 August 2012 1 (Oxford 111) Incident date

Nature of incident

Location Status Actions/update

2012/17913 20th July 2012

Delay in answering red call to a newborn.

Northern Cluster

Reported on STEIS. Investigation open and ongoing. Family in contact with patient experience team.

As this is a public board paper details are not included here but an in-depth investigation has commenced focusing on:

Call answering processes Dispatch of vehicles Use of resources Attempts to contact the

family Resourcing of the EOC

18th/19th August 2012

Performance of 111 service.

Oxford 111 OPEN on STEIS with Oxfordshire PCT

Investigation Manager appointed and working in partnership with Oxfordshire PCT.

The table provides summary information on incidents which remain open and under investigation or where actions are still being implemented.

Incident Date and Reference Number

Nature of Incident

Location

Status

Actions to complete

2012/10904

30th April

2012

Delay getting Amb to RRV – Patient Cardiac arrest in house while waiting (H/Wycombe)

High Wycombe

OPEN – investigation manager appointed.

Investigation to ascertain any whole organisation learning re: deployment of resources/delays /categories

2012/12044 8th May 2012

EOC communications failure

Bicester HQ

Closed on STEIS at August SIRI review meeting.

Actions to be managed through Audit Committee.

2012/4967 23/02/12

Vehicle breakdown on M40 (Bucks)

Trust wide Investigation ongoing - OPEN

Immediate action taken to ensure patient transferred and vehicle repaired. Maintenance history of vehicle scrutinised. Remedial actions re:

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updating IVECO software and vehicle checks to mitigate further break downs. Review of fleet maintenance actions ongoing – which is why this case remains open.

2012/8594 Feb 2012

Delay in attending female patient

Oxford Investigation ongoing - OPEN

Investigation looking at outcome for the patient and reason for delay. Awaiting Coroners report.

2012/15640 29th June 2012

Tail lift failure while attending a cardiac arrest

Amersham OPEN Investigation commissioned. Fleet division working on reporting to Executive Committee actions re: similar vehicles

SCAS are working in partnership with other health agencies to investigate their serious incidents where an ambulance was involved or required. There are currently 4 ongoing cases which highlight a significant improvement in inter health partner working. Each SIRI has been declared by the other organisation and SCAS has and continues to work proactively and in partnership with the other Trusts ensuring that the principles of “Being Open” are followed with the end goal of learning being established. This in turn will reduce the likelihood of a similar occurrence in the future. To date there are no serious concerns for SCAS in any of the reviews. The first SIRI relates to an incident in January where a patient fell at a walk in centre in Hampshire. An ambulance attended and the patient was transferred to University Hospital Southampton. Information in relation to the SCAS response has been shared with the lead investigator from Solent NHS Trust. The second SIRI relates to a baby who was born and was in difficulty at a midwife run community birthing centre. There was a delay in the staff at the birthing centre being able to make contact with EOC, however the responding ambulance arrived within the government standards for this type of call. The SCAS Investigations Unit Manager has had a number of conversations with the lead Trust, Portsmouth hospitals and is currently waiting for a date for a meeting to be convened in Portsmouth where the SCAS findings will be put to the SIRI panel. The third SIRI relates to a patient who died in the care of a hospital which specialises in mental health. The SCAS Investigations Unit Manager has met with the lead investigator from Solent NHS Trust and shared information in relation to the SCAS response. There is also a Death in Custody review by Oxfordshire PCT where an ambulance attended. There is a new Ombudsman requirement for prisons to report death in custody as a SIRI.

11

4.1 Care Quality Commission (CQC) 4.1.2 Essential standards compliance. The trust remains compliant with all essential standards and outcomes. The Quality and Safety committee continue to monitor the provider compliance assessments for each outcome and the Governors will be seeking assurance on the self assessed compliance evidence in October 2012. Annual inspections will continue with unannounced visits taking place if a concern is highlighted. Unannounced inspections can occur at any time. 4.1.3 Quality Risk Profile (QRP). The latest QRP available from the CQC is dated 31st July 2012. The risk profile has remained unchanged since June 2012.

Jan-12 Feb-12 Mar-12 May-12 Jun-12 Jul-12 High Red 1 0 0 0 0 0 Low Red 0 0 0 0 0 0 High Amber 0 1 0 0 0 0 Low Amber 0 0 0 0 0 0 High Neutral 1 1 2 1 1 1 Low Neutral 6 7 6 6 6 6 High Green 1 1 1 0 0 0 Low Green 2 1 1 3 3 3 Insufficient Data 3 3 4 4 4 4 No Data 2 2 2 2 2 2

All SCAS’s risk estimates are either green or neutral indicating a decreasing risk of non compliance. The outcome with the highest risk of non compliance (at present) is outcome 8 – Infection Control and Cleanliness. The information source is uptake of flu vaccination and availability of hand washing materials. Both of these areas have plans and actions against them. 4.1.4 Risk estimates over time by section The Care Quality Commission's quality and risk profiles (QRPs) bring together information about a care provider and provide an estimate of risk of non compliance against each of the 16 essential standards of quality and safety. They are primarily intended as a tool to support the day to day work of CQC's inspectors. The graphs and tables below present the risk estimates by section from the six most recent QRP refreshes.

12

Section 1 – Involvement and information

Dial Key

High Red

Low Red

High Amber

Low Amber

High Neutral

Low Neutral

High Green

Low Green

Insufficient Data

No Data

Outcome Jan-12 Feb-12 Mar-12 May-12 Jun-12 Jul-12

Outcome 1 Low Neutral Low Neutral Low Neutral Low Green Low Green Low Green

Outcome 2 No Data No Data No Data No Data No Data No Data

Section 2 – Personalised care

Dial Key

High Red

Low Red

High Amber

Low Amber

High Neutral

Low Neutral

High Green

Low Green

Insufficient Data

No Data


Outcome 4 Low Green Low Neutral High Green Low Neutral Low Neutral Low Neutral

13

Outcome 5 No Data No Data No Data No Data No Data No Data

Outcome 6 Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data

Section 3 - Safeguarding and safety

Dial Key

High Red

Low Red

High Amber

Low Amber

High Neutral

Low Neutral

High Green

Low Green

Insufficient Data

No Data


Outcome 7 Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data Insufficient Data

Outcome 8 High Neutral High Neutral High Neutral High Neutral High Neutral High Neutral

Outcome 9 Low Neutral Low Neutral Insufficient Data Insufficient Data Insufficient Data Insufficient Data

Outcome 10 Low Neutral Low Neutral Low Neutral Low Neutral Low Neutral Low Neutral


Section 4 - Suitability of staffing

4 - Suitability of staffing Dial Key High Red

Low Red

High Amber

Low Amber

High Neutral

Low Neutral

High Green

Low Green

Insufficient Data

No Data

14


Outcome 12 High Green High Green Low Neutral Low Neutral Low Neutral Low Neutral

Outcome 13 High Red High Amber Insufficient Data Insufficient Data Insufficient Data Insufficient Data


Section 5 - Quality and management

High Red

Low Red

High Amber

Low Amber

High Neutral

Low Neutral

High Green

Low Green

Insufficient Data

No Data


Outcome 16 Low Green Low Green Low Green Low Green Low Green Low Green


Outcome 21 Insufficient Data Insufficient Data High Neutral Low Green Low Green Low Green

4.2 NHSLA planning (NHS Litigation Authority) The NHS LA assessment will take place on the 18th and 19th October 2012. Work continues to rigorously review all policies and procedures under the new Ambulance Standards for 2012/13 of which there are 50. SCAS will be assessed under level 1 of the scheme again this year. Policies required will be approved through the committee meeting cycle in the organisation. The NHSLA has announced a review of assessments, beginning a survey and consultation process in August 2012. This will not affect SCAS’s assessment this year. Debbie Marrs /Fizz Thompson 11th Sept 2012

15

Summary Upward Report Upward reporting from the SIRI review Group to the Quality and Safety Committee (16th Aug 2012) Issues identified by the SIRI review group held on 1st August 2012 Topic Issue Action Taken

Items with issues not achieved/ compliant

1 Lessons learned from serious incidents not consistently embedded in the organisation.

Whole system learning and feedback not embedded in SCAS – patchy in terms of whole organisation learning. Need to strengthen.

Thematic analysis commenced to extract learning. SIRI meeting identifying learning in a systematic way. Lessons learnt template to be completed by investigators. Emerging themes to be discussed at each SIRI review group.

2. Fleet resilience A number of SIRI’s have an element of fleet resilience as a root cause. The group are not assured on actions taken.

Executive and NED review of actions by Operation Support Director. 6 vehicles being specifically looked at in terms of tail lift replacement or removal from the flee..

3. EOC call handler staffing plan. A number of SIRI’s have arisen from time taken to answer calls, staffing resilience at handover periods and numbers of call handlers on duty. The group are not assured regarding staffing plan and escalation procedures.

EOC managers to provide written assurance for SIRI group on staffing numbers and ability to handle calls in a timely way.

Areas of Concern/ Risk

16

17

4. Accumulative effect of themes identified which can affect operational performance escalated quickly to the board and actions developed.

A number of themes identified as a result of SIRI investigations may contribute to poor operational performance. These are escalated via this group to Q&S committee and through the corporate risk register. Concerns were raised about the effect a combination of issues can have on performance such as:

time taken to answer calls, patient delays, availability of vehicles, re-routing and stand-downs, communications from road staff to EOC.

Themes to be escalated in real time by investigations managers and AD Quality and onto risk register in order for board to challenge demand assumptions with commissioners.

5. Time taken to resolve issues or carry out recommendations/actions from SIRI’s.

Assurance is required that recommendations are acted upon and expedited quickly to resolve issues arising from SIRI’s.

Investigation managers to follow up recommendations from reports asking for updates.

Items for awareness / assurance

6. IT and telephony resilience SIRI re: white noise, Vodafone Closed on STEIS after report from Associate Director of IT. External scrutiny and audit been extensively applied and will now be monitored through a Programme Board (IT) and the Audit Committee.

7. Terms of reference for the SIRI group.

Reviewed at June 2012 meeting. Quality and Safety committee asked to endorse these ToR.

8. Joint SIRI with Oxford Health resulted in multiagency working recommendations.

Asked National Ambulance Directors meetings to note, share and adopt the learning. This has fallen off their agenda.

Action will be taken (by Patient Experience Manager) to inform the national meeting chairs of the actions and learning from this case again for their review, in particular in relation to managing emergency calls across more than one county boundary.

Best Practice / excellence

9. Community first responders handbook

In response to incident learning SCAS has developed a comprehensive handbook for volunteer staff (in line with NHS LA standards)

This booklet will be rolled out across the South from 13th August 2012 to tie in with new training programme. Copyright will also be sought.

Agenda Item: 9



Title Integrated Performance Report

Lead Director Charles Porter, Director of Finance


As above

Purpose of the paper To present to the Board an update on performance against key national and local targets


To note the contents of the report










Risks associated with the delivery of performance standards are shown in the Board Assurance Framework.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) The report includes performance against a number of standards which are monitored by Monitor and the Care Quality Commission.


N/A – see the Finance and Estates Report.


The Integrated Performance Report is shared with the governors.


The report covers our performance on a range of indicators that relate to patients and staff.


The Trust Board receives an Integrated Performance Report as a standing agenda item.

Intergrated Performance Report

Overall Scorecard Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

RAGVs. last month

R A GLead Director Assessment

of Risk

Clinical Performance A 18% 14% 68% A

National Standards A 0% 100% 0% John Nicholls A

Operational performance R 43% 35% 23% John Nicholls R

Safety and risk management A 29% 0% 71% Fizz Thompson R

Patient Experience G 0% 6% 94% Fizz Thompson A

Finance A 29% 0% 71% Charles Porter A

QIPP's (cost improvements) A 12% 12% 77% Charles Porter A

QIPP's (quality impact) A Fizz Thompson A

Commercial Division A 29% 0% 71% Will Hancock G

Human Resources R 56% 17% 28% Will Hancock A

FT Membership & Governors A 8% 27% 65% Duncan Burke A

Report on Exceptions (Red)

Operational R

Action planPage

5

Human Resources R

Action planPage

18

Integrated Performance ReportReport Period: August 2012

John Black

Achievement of Red 8 performance for the Berkshire PCT cluster and also for Buckinghamshire and North Hampshire PCT areas is below target. Red 19 performance remains very tight, with the Hampshire cluster below the current full year requirement. Robust action plans are in place, which are already demonstrating recovery. However, risks remain associated with "Winter", including further increases in demand and any further deteriorating in hospital handover delays. A further risk, associated with the impending changes within the Buckinghamshire economy (Better health care in Bucks) may impact on Buckinghamshire Red 8 and Red 19 performance.

Absence rates remain high although trend in Commercial Directorate is downwards. Absence management processes in place in Operations and Commercial Directorates. Managers trained and supported to manage both long term and short term sickness. Sickness absence managed through performance review. Absence in corporate areas remains low. Reported Appraisals below target in all areas. Operational REAP position impacting on appraisals as focus remains on performance. Similarly training has been suspended while focus remains on operational performance. Operational and Commercial areas have plans to complete appraisals by end January 2013 to avoid winter pressures.

1

Integrated Performance Report

Clinical performance Overall rating A Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Clinical Treatment

Actual Plan RAG Actual Plan RAG Forecast Plan RAG

STEMI care bundle 90.5% 90.0% G 91.9% 90.0% G 90.0% 90.0% G No Comment Required

Stroke care bundle 100.0% 98.0% G 99.3% 98.0% G 98.0% 98.0% G No Comment Required

Hypoglycaemia care bundle 99.3% 98.0% G 99.6% 98.0% G 98.0% 98.0% G No Comment Required

Asthma care bundle 96.0% 95.0% G 95.1% 95.0% G 95.0% 95.0% G No Comment Required

% STEMI with PPCI to centre in 80 min 87.5% 75.0% G 83.0% 75.0% G 83.0% 75.0% G No Comment Required

% STEMI with PPCI to treatment in 150 min 94.0% 85.0% G 93.0% 85.0% G 93.0% 85.0% G No Comment

% FAST patients call to leave scene 39 min 50.9% 56.5% R 53.0% 56.5% A 53.0% 56.5% A

Enhanced clinical advice has been provided to assist rapid extraction to hospital from

scene.

% FAST patients to centre in 60 min 47.3% 51.7% A 51.2% 51.7% A 51.7% 51.7% G As above

Lead Director: John Black

Treatment Measure Aug‐12 Year to date Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to

reduce risk, Green ‐ nil)

Full year

2


Clinical Outcome


% patients with return of spont's circul'n by hospital arrive (ROSC)

33.33% 19.5% G 30.48% 19.5% G 19.5% 19.5% G No Comment Required

% patients with return of spont's circul'n by hospital arrive (ROSC) ‐ witnessed cardiac arrest

60.0% 40.7% G 54.72% 40.7% G 50.0% 35.0% G No Comment Required

Cardiac Arrest: % discharged alive following ambulance resus'n (nationally submitted data for period May 2012)

15.0% 6% G 14.0% 6% G 10% 6% G No Comment Required

Cardiac Arrest: % discharged alive following ambulance resus'n - witnessed cardiac arrest (nationally submitted data for period May 2012)

7.7% 10% G 13.6% 10% G 12% 10% G No Comment Required

Safeguarding


Statutory & Mandatory 85.0% 95.0% R 85.0% 95.0% R 95.0% 95.0% GNo change from last month ‐ Under review by the new Education Team

Number of adult referrals ‐ this relates to vulnerable adults who may be at risk from abuse or neglect

175 130 A 796 650 G 1,560 1,560 G No comment required

Number of child referrals ‐ this relates to children who may be at risk of abuse or neglect

49 30 G 184 150 G 360 360 G No comment required

Year to dateAug‐12

Aug‐12 Year to dateOutcome Measure

Measure Full year

Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to


Full year



3


Hygiene & infection prevention & control


Number of vehicle deep cleans 312 270 G 1,253 1,350 A 3,240 3,240 G

Number of vehicle routine cleans* 5,143 7,737 R 25,467 38,185 R 84,107 84,107 G

Number of cleanliness compliance audits* 68 54 G 298 270 G 648 648 G No Comment Required

Medicines management


Number of adverse events due to administration errors* 2 1 R 6 5 R 12 12 GIV adrenaline instead of IM. Oral morphine dose incorrect

Number of controlled drug incidents* 0 3 G 15 15 G 36 36 G No Comment Required

Measure Aug‐12 Full year

* These items are also reported in the quality accounts



These measures are nationally reported CQI's ‐ see glossary for definition and explanation

Year to dateAug‐12Measure

Year to date

Make Ready teams managing the deep clean schedules with support from OSD. With the removal of PTS daily cleans, the Make Ready teams will have more resources to address the backlog of overdue cleans. Hot‐swapping of vehicles is preventing Make Ready getting access to vehicles to do deep cleans. To address issue of new rotas in Hants ‐ Make Ready are changing shifts to achieve more deep cleans at night

Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to


4


Operational performanceR

Overall rating (other)R

Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Performance Pressures


Incidents 5.6% 3.0% R 6.0% 3.0% R 6.0% 3.0% RNational trend. Being raised with commissioners. Consider altered approach to public messaging

Hospital delays

‐ Handover % in 15 minutes 62.9% 85.0% R 60.8% 85.0% R 60.8% 85.0% R High level actions continue to attempt to reach agreement with individual hospitals.

‐ Clear‐up % in 15 minutes 80.2% 85.0% A 80.6% 85.0% A 80.6% 85.0% A Continued focus at team Leader level and at Area Manager level, through scorecard performance management process.


Red 1 A8: % on scene within 8 minutes (standard = 75%, plan = SCAS trajectory)

78.8% 75.0% G 74.5% 75.0% G 75.8% 75.8% G No commentary required

Red 2 A8: % on scene within 8 minutes (standard = 75%, plan = SCAS trajectory)

76.6% 76.7% A 75.6% 76.7% A 76.2% 76.2% G Whilst slightly below internal trajectory, remains above National standard at SCAS level.

Red A8: % on scene within 8 minutes (standard = 75%, plan = SCAS trajectory)

76.8% 76.7% G 75.5% 76.7% A 76.2% 76.2% G Whilst slightly below internal trajectory, remains above National standard at SCAS level.

Red A19: % conveying response within 19 minutes (standard = 95%, plan = SCAS trajectory)

94.8% 95.8% R 94.8% 95.8% R 95.5% 95.5% GFormal action plan in place to recover Red 19 position. Daily monitoring with weekly formal reviews

Amber 20: % response within 20 minutes 87.15% 90.0% A 87.9% 90.0% A 90.0% 90.0% G Focus on increasing utilisation of DECA crews to "free up" DCU availability.

Green 60: response within 60 minutes n/a n/a n/a n/a n/a n/a n/a n/a n/a No commentary required

Overall rating (national - Red8 & Red19)

Aug‐12 Full year

Time to Respond ‐ front‐linePerformance Measure

Lead Director: John Nicholls

Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)


Full yearYear to date

Demand Measure

Aug‐12

Year to date

5

Integrated Performance ReportTime to Treat

Time to Treat ‐ 99th percentile (hr:min:sec) 00:34:29 00:29:00 R 00:32:50 00:29:00 R 00:29:00 00:29:00 G

Time to Treat ‐ 95th percentile (hr:min:sec) 00:19:14 00:19:00 A 00:18:56 00:19:00 G 00:19:00 00:19:00 G

Time to Treat ‐ 50th percentile (hr:min:sec) 00:06:10 00:06:00 A 00:06:08 00:06:00 A 00:06:00 00:06:00 G

Time to Respond ‐ EOC


Call connect to call answer in 5 sec (95%) 71.4% 92.0% R 77.8% 92.0% R 84.0% 92.7% G

Call connect to call answer (hr:min:sec) ‐ 99th percentile

00:02:34 00:01:40 R 00:02:41 00:01:40 R 00:01:52 00:01:29 R


00:01:23 00:00:11 R 00:01:26 00:00:11 R 00:00:57 00:00:10 G


00:00:03 00:00:03 G 00:00:03 00:00:03 G 00:00:03 00:00:03 G

% calls abandoned 3.3% 1.0% R 4.2% 1.0% R 2.8% 1.0% AAs above and including additional project work stream to review "live" call centre management information needs of EOC management (Senior call takers) to better enable call centre performance management.

Aug‐12 Year to date

New approach to focus to long waits (and thus time to treatment) being introduced which will be integrated into area performance reviews.


Full yearPerformance Measure

Recruitment and training action plan in place to achieve (increased by 12 WTE) call taker WTEs by November 2012. Additional ICT actions in place to review and

reduce in built system delays between call presentation to switch and presentation to call taker (both in local EOC and then to full ‐ virtual ‐ call taker

skill set).

6

Integrated Performance ReportQuality Control Measures


% calls with telephone advice only (Hear & Treat)

5.0% 6.1% R 5.0% 6.1% R 6.4% 6.4% GOn going CSD recruitment. Agreed CSD activity focus (Green vs. vulnerable Red) in place.

% resolved without convey to Type 1/2 A&E (See & Treat)

38.8% 40.4% R 38.4% 40.4% R 40.5% 40.5% G

Relaunched GP triage process.MDT upgrade (completed in South) enables better, more accurate data capture, both to record GP Triage attempts and delineate transports to an Acute site between A&E department and other departments/facilities within the site.

% conveyed to Type 1/2 A&E 55.9% 56.9% G 56.0% 56.9% G 53.0% 53.0% G

Relaunched GP triage process.MDT upgrade (completed in South) enables better, more accurate data capture, both to record GP Triage attempts and delineate transports to an Acute site between A&E department and other departments/facilities within the site.

% Hear & Treat re‐contacts in 24 hours 18.8% n/a n/a 19.0% n/a n/a n/a n/a n/aReview of recontacts to be undertaken to see if trends exist. This will allow decisions on any necessary remedial action.

% See & Treat re‐contacts in 24 hours 6.9% 5.9% A 7.2% 5.9% A 5.90% 5.9% G No Comment Required

% calls from patients at risk 1.36% n/a n/a 1.36% n/a n/a 1.36% n/a n/a No Comment Required

Performance Measure Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)


7

Integrated Performance ReportA&E Performance by PCT and PCT Cluster

Perf (%) Perf (%) RAG Actual Plan RAG Forecast Plan RAG

Actual Plan

Red A8

Berkshire Cluster 76.8% 75.5% G 71.9% 75.5% R 75.1% 75.1% G

Berkshire East PCT 76.7% 75.7% G 71.7% 75.7% R 75.3% 75.3% G

Berkshire West PCT 76.8% 75.3% G 72.1% 75.3% R 75.0% 75.0% G

Hampshire Cluster 77.7% 77.3% G 76.1% 77.3% A 76.6% 76.6% G

Hants PCT 73.4% 75.5% R 72.9% 75.5% R 75.1% 75.1% G

Southampton City PCT 82.7% 80.2% G 76.6% 80.2% A 78.0% 78.0% G

Portsmouth City PCT 86.3% 80.9% G 84.5% 80.9% G 80.7% 80.7% G

Ox Bucks Cluster 77.8% 76.9% G 78.9% 76.9% G 76.5% 76.5% G No Comment Required

Bucks PCT 70.0% 71.5% R 70.7% 71.5% A 71.6% 71.6% G

Bucks Red 8 improvement has slowed. Link with EOC relocation (South Bucks Area) which is now embedded. Expected Red 8 improvement as a result, but further analysis and focus on both additional CFR schemes and increased efficiency from Ambulance resource.

Milton Keynes PCT 89.0% 85.1% G 88.4% 85.1% G 85.0% 85.0% GNo Comment Required

Oxfordshire PCT 77.5% 77.1% G 79.9% 77.1% G 76.2% 76.2% GNo Comment Required

Red A19

Berkshire Cluster 94.8% 95.5% R 95.2% 95.5% A 95.4% 95.4% G No Comment Required

Berkshire East PCT 95.1% 96.3% A 95.3% 96.3% A 95.9% 95.9% G No Comment Required

Berkshire West PCT 94.5% 96.1% R 95.0% 96.1% A 95.5% 95.5% G No Comment Required

Hampshire Cluster 95.2% 96.1% A 94.9% 96.1% R 95.5% 95.5% GAdditional Red 19 targeted resources placed into Hants Cluster. Specific Red 19 improvement plan in place.

Hants PCT 93.7% 95.9% R 93.1% 95.9% R 95.0% 95.5% A

Additional Red 19 targeted resources placed into Hants Cluster. Specific Red 19 improvement plan in place.

Southampton City PCT 97.3% 98.0% A 97.6% 98.0% A 97.5% 97.5% GAdditional Red 19 targeted resources placed into Hants Cluster. Specific Red 19 improvement plan in place.

Portsmouth City PCT 98.4% 98.5% A 98.7% 98.5% G 98..3% 98.3% GAdditional Red 19 targeted resources placed into Hants Cluster. Specific Red 19 improvement plan in place.

Ox Bucks Cluster 95.3% 95.8% A 95.3% 95.8% A 95.7% 95.7% GNo Comment Required

Bucks PCT 95.0% 95.3% A 93.6% 95.3% R 95.0% 95.0% GRed 19 improvement plan in place ‐ Reviewed deployment plan introducing additional key Red 19 standby points.

Milton Keynes PCT 98.5% 99.3% A 98.9% 99.3% A 99.1% 99.1% GPerformance remains well above the required standard, but has shown some deterioration. This is associated with increases in Hospital Handover delays at Milton Keynes FT.

Oxfordshire PCT 93.9% 95.3% R 94.7% 95.3% R 95.1% 95.1% GNo Comment Required

Performance Measure Aug‐12

These measures are nationally reported CQI's ‐ see glossary for definition and explanation

Recovery on track following (in particular) July dip that coincided with EOC relocation. Full year achievement will be challenging.

Additional focus on CRF and Co responder activity in N Hants PCT, along with revised resource plan to protect SCAS resources in N Hants area.

Year to date Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)

8


Safety and Risk Management Overall rating A Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Patient Safety


Number of IR1s (this is the internal form to report incidents in SCAS ‐ this covers all types of incident ‐ accidents, injuries, missing equipment etc)

208 232 G 1063 1160 G 2784 2784 G No Comment Required

Number of incidents reported to the NPSA (CQC/NPSA reportable)

19 20 G 99 100 G 240 240 GForecast has been increased due to improved reporting by the Trust.

Number of incidents reported to the NPSA within 30 days (CQC/NPSA reportable)

100% 100% G 100% 100% G 100% 100% G No Comment Required

Number of Serious Untoward Incidents (SUI) reported (CQC/NPSA/SHA reportable)


Number of SUI investigations outstanding after 60 days 1 10% G 1 10% G 1 10% G No Comment Required

Number of Never Events (CQC/NPSA/SHA reportable)


Clinical negligent claims (CNST) 2 1 R 4 3 R 0 6 GTwo claims received this month relating to different types of clinical management issues.

Public liability claims 0 1 G 2 5 G 8 12 G No Comment Required

Long waits (Red 8)* ‐ over 30 minutes 64 27 R 224 135 R 324 324 G

Long waits (Red 19)* ‐ over 30 minutes 128 79 R 387 396 G 950 950 G

Long waits (Amber)* ‐ over one hours 143 37 R 298 186 R 358 446 G

Staff Safety


Number of RIDDOR reports (HSE reportable)

0 5 G 17 25 G 60 60 GThere were zero RIDDOR reportable incidents this month. This can be viewed as a positive step.

Number of Physical Assaults (NHS Protect reportable)

4 6 G 35 30 R 72 72 G

Although the YTD actual figure is above the plan the majority of assaults are graded as minor/moderate in terms of severity.

Number of Non‐Physical Assaults (NHS Protect reportable)


Number of Security Incidents (NHS Protect reportable)


* These items are reported in the quality accounts as well

Staff Safety Measure Aug‐12 Year to date Full year

Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk,

Green ‐ nil)

Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk,

Green ‐ nil)

Increased focus required within EOC. Action plan in place that requires duty EOC shift officer/manager to focus on these vulnerable patients and report exception

reasons.

Lead Director: Fizz Thompson

Patient Safety Measure Aug‐12 Full yearYear to date

9


Patient Experience Overall rating G Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Complaints


Complaints received

‐ A&E frontline 1 8 G 27 32 G 96 96 G No Comment Required

‐ A&E EOC and CSD 1 4 G 9 16 G 48 48 G No Comment Required

‐ PTS 2 4 G 7 16 G 48 48 G No Comment Required

‐ Other 0 1 G 1 4 G 12 12 G No Comment Required

Total 4 17 G 44 68 G 204 204 G No Comment Required

Complaints responded to within 25 days target

(Data relates to July 12)

87% 95% A 95% 95% G 95% 95% G

Delay in investigations being returned to PET team in light of increased numbers being received for EOCs; some delays in receipt of PTS complaints for northern cluster, but improving picture on last month

Compliments


Compliments No. No. No. No. No. No.



g

Full year

Measure Aug‐12 Year to date

Measure Aug‐12 Year to date Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐

nil)

Full year

10


Surveys


Surveys completed No. No. No.

‐ A&E frontline 1 1 G 1 1 G 2 2 G No Comment Required

‐ A&E EOC 0 0 G 1 1 G 1 1 G No Comment Required

‐ PTS 0 0 G 1 1 G 1 1 G No Comment Required

‐ Other 1 1 G 1 1 G 1 1 G No Comment Required


Actual Plan RAG Actual Plan RAG Actual Plan RAG

FOI (Freedom of Information Act) 82% 100% R 96% 100% A 98% 100% ANot able to meet all deadlines over August due to annual leave.

Data protection Act (DPA) ‐ police 100% 100% G 100% 100% G 100% 100% G No Comment Required

DPA ‐ solicitor/medical 100% 100% G 100% 100% G 100% 100% G No Comment Required

DPA ‐ subject access request 100% 100% G 100% 100% G 99% 100% A No Comment Required

Requests responses within timescales

Requests for Information

Measure Aug‐12

Measure Aug‐12

Year to date Full Year

Year to date Forecast

11

111 111 rating A


111 Measures


Oxford contract:

Calls (no.) 10,901 11,667 A 13,589 14,583 A 94,492 105,000 A Volume reflects delay of full launch of service

999 referrals (%) 4.8% 10% G 4.1% 10% G 6.0% 10% G No Comment Required

Calls Abandoned (target <5%) 3.0% 5% G 3.6% 5% G 3.6% 5% G No Comment Required

Warm transfers (clinician %) 36.6% 20% R 33.1% 20% R 20.0% 20% R Higher % during start up, being managed to reduce %.

Time taken for call back (% < 10 mins ‐ target 95%)

97.9% 95% G tba 95% n/a tba 95% n/a Forecast to be set once more data available from service roll‐out


Measure Aug‐12 Year to date Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)

12


Finance Finance rating A QIPP rating A


Financial Measures


Surplus (£k) 6 97 R 367 418 R 1,556 1,556 G

Lower surplus year to date to reflect additional resources invested to deliver operational performance against a background of higher than budgeted volumes and hospital delays.

Financial Risk Rating n/a n/a n/a 3 3 G 4 4 G No commentary required

Liquidity ratio 4 4 G 4 4 G 4 4 G No commentary required

Return on Assets (ROA) n/a n/a n/a 1.3% 1.3% G 2.4% 2.4% G No commentary required


Unplanned EBITDA variance for 2 Q's Yes No R yes No R No No G As a result of Q4 shortfall

FRR forecast variance < 3 No No G No No G No No G No comment required

FRR 2 in any quarter No No G No No G No No G No comment required

Overdraft used last quarter No No G No No G No No G No comment required

Debtors > 90 days> 5% total balance Yes No R Yes No R No No GSmall reduction compared to last month ‐ total of £76k overall

Creditors > 90 days> 5% total balance No No G No No G No No G No comment required

2 or more change FD in last 12m No No G No No G No No G No comment required

Interim FD > one quarter No No G No No G No No G No comment required

Q end cash<10 days of op expenses or <£4m

No No G No No G No No G No comment required

Capex<75% of ytd plan Yes No R Yes No R No No GExpected to catch up by end of Q2 in line with quarterly reporting


Full yearMeasure

Year to date Full yearMeasure Aug‐12

Lead Director: Charles Porter

Monitor Forward Financial Risk Ratings



13



£k £k £k £k £k £k

Total CIP's G G 6,245 6,516 A

Commercial Division 65 57 G 252 203 G 707 737 AOverall commercial performance expected to be better than budget although some of their CIP's have slipped

CSD 0 15 R 0 30 R 191 277 RCSD recruitment continues to be an issue which has adversely affected our resources and expected improvement

Dual ECA Crews 103 62 G 377 331 G 816 771 G No commentary required

Sickness 0 33 R 0 65 R 308 369 ANo improvement to date but underlying actions continue to tackle this issue.

Kronos Savings 8 8 G 42 42 G 100 100 G No commentary required

Operational Restructure 47 47 G 237 237 G 345 369 A Interim ESMs extended period.

EOC Restructure 41 41 G 213 213 G 254 254 G No commentary required

Hospital Delays ‐8 6 R ‐7 12 R 51 71 RProportion of hospital delays due to clear‐up has gone up from

20% August 2011 to 22% in August 2012 although year to date the same

Private Provider Replacement 28 28 G 138 138 G 331 331 G No commentary required

Resource Utilisation 40 63 R 199 244 A 405 405 GOptima improvement running behind plan

Non Conveyance Improvement 18 18 G 86 91 A 219 219 G Slightly behind plan but expected to catch up

Overhead Squeeze 0 0 G 0 0 G 0 0 G No commentary required

Overtime 0 0 G 0 0 G 0 0 G No commentary required

Max Shift Cover 0 0 G 0 0 G 200 400 R Planned paper to Execs to consider revised benefits

Overhead Cost Savings 25 20 G 149 86 G 498 383 G No commentary required

Procurement 25 24 G 127 122 G 418 418 G No commentary required

Project Management Reduction 9 9 G 36 45 A 98 107 ASaving not achieved in April 2012 but now on track although April deficit will not be recovered

Telephony 19 17 G 101 95 G 185 152 G No commentary required

Fleet Savings 10 10 G 48 48 G 95 95 G No commentary required

Project Cost Reduction 45 45 G 216 216 G 288 288 G No commentary required

Corporate Savings 26 26 G 125 125 G 360 414 ASome reduction in Corporate Review savings following consultation and appeals

Property Savings 4 4 G 22 22 G 44 44 G No commentary required

111 0 0 G 0 0 G 0 0 G No commentary required

Non Recurring 68 39 G 202 133 G 421 404 G No commentary required

Contingency G G ‐89 ‐90 G No commentary required

Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)

Cost Improvement Plans (QIPP's)Measure Aug‐12 Year to date

14

Quality and Delivery Risk Assessment of the Cost Improvement Programmes 2012‐13

Risk Mitigated risk

Key Average A

1 to 3 - Low risk 8 64 to 6 - moderate risk7 to 12 - significant risk13-15 - high risk

Q 9 6

D 6 6

Q 15 12

D 15 12

Q 9 6

D 9 6

Q 12 9

D 9 6

Q 12 9

D 16 16

Q 15 12

D 16 12

Q 16 12

D 20 20

Q 12 9

D 16 12

Q 9 6

D 0 0

Q 12 8

D 12 9

Q 6 4

D 9 4

Q 15 12

D 12 9

Q 9 4

D 0 0

Q 12 9

D 16 12

Q 9 6

D 12 8

Q 2 2

D 2 2

Q 6 4

D 4 4

Q 4 3

D 9 6

Q 6 4

Operational / clinical restructuring

369 Savings as per approved structure from 1 Nov 2011

Quality/Deliver

Sickness reduction 369 Focus on reducing A&E sickness using Kronos absence module

Action to Mitigate Downside Scenario

£000’s Mitigated Risk Level

Time and Recording / Rostering Project

100 Better control of payroll, via more information and improved controls / unsocial hours payments

Source of Saving Risk Rating

Hospital delays 51 Continuation of delays project, getting to 85% within 15 minutes, focusing on clear up time

Clinical Support Desk 148 Increase hours saved per month

Operational efficiency – marginal resources

405 Reducing those resources which are most expensive per incident through the use of Optima Predict Software

Maximising shift cover 400 Roster reviews to improve use of skill mix and resource numbers

Non conveyance 219 Increased / Improved non conveyance

Overhead squeeze 0 Review of corporate functions

EOC restructure 254 Virtual EOC savings from reduced use of Wokingham

Project cost reduction 318 Reduction in project management through use of integrated approach across directorates

Dual ECA crews 778 Dual ECA crews on the road where safe to use, as opposed to an ECA/Paramedic crew, which is more expensive thereby reducing resourcing costs

Overtime rate changes 0 Change rates of pay and terms of conditions for over time

Corporate overhead review 571 Planned changes from corporate savings

Private Provider replacement 331 The cost differential of using our own staff and reducing Privates

Property savings 44 I&E savings linked to disposal programme

Telephony 152 Flow through of 2011/12 Telephony & IT savings

Overhead cost savings 408 Continuation of projects to reduce overhead costs

Fleet savings 95 Change to depreciate DCUs over 10 years following mid term refurb.

15

D 0 0

Q 6 4

D 6 4

Q 6 4

D 12 6

Q 4 2

D 6 2

Q 6 4

D 12 6

QDQ 4 2

D 4 2

Q 2 2

D 6 2

Q 2 2

D 2 2

Q 2 2

D 2 2

Q 4 2

D 4 2SUBTOTAL: 6,477

Commercial Training 51 Reduction in Management and Staffing costs

Non pay 282 Non pay savings focusing on procurement

PTS North 307 • Autoplan ‐ fuel & planner saving• Replacement of London Ambulance with station at Chalfont

128 • Autoplan ‐ reduction in one dispatcher from 1 July• Online Booking ‐ reduction in 3 call takers from 1 July• Meal breaks• Staff not being replaced

Staff Cost Savings/Restructures

PTS Berks 174 • Lower overtime• Lower use of privates• Not replacing staff

PTS South

Service developments 0 Development of improvements to delivery of care

Logistic Services 33

Non recurring 375

107

Non recurring

Other Commercial 9 Agency staff savings/reduction in overtime

Project Management Reduction

FT Project Management Cost Saving

16


Commercial Division Overall rating A Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Savings vs Prior Year


£k £k £k £k £k £k

Total Commercial Division 65 57 G 252 203 G 707 737 AOverall commercial performance expected to be better than budget although some of their CIP's have slipped

PTS Hampshire 13 13 G 28 39 R 145 128 G Forecast better overall but phasing YTD

PTS Berkshire 17 17 G 87 87 G 209 209 G No Comment Required

PTS Ox & Bucks 19 19 G 88 38 G 231 307 A Resource cost higher due to vacancies

Commercial Training 5 4 G 24 21 G 35 51 R Tough market conditions

Logistic Services 10 3 G 21 14 G 79 33 G No Comment Required

Other Commercial 1 1 G 3 3 G 9 9 G No Comment Required

Savings ‐ milestones


£k £k £k £k £k £kTotal Commercial Division

PTS Hants ‐ mealbreakNot

RealisedNot Due G

Not Realised

Not Due G Yes Yes G No Comment Required

PTS Hants ‐ Margin Improvement Realised Due GNot

RealisedDue G Yes Yes G No Comment Required

PTS Hants ‐ OnlineNot

RealisedDue R

Not Realised

Due R No Yes ROverall PTS Hants savings to be achieved via improved income

PTS Ox/Bucks ‐ RecruitmentNot

RealisedDue R

Not Realised

Due R No Yes GOverall PTS Ox/Bucks savings to be achieved via improved income

PTS Ox/Bucks ‐ AutoplanNot

RealisedDue R

Not Realised

Due R Yes Yes GOverall PTS Ox/Bucks savings to be achieved via improved income

PTS Ox/Bucks ‐ Review of contracts Realised Not Due G Realised Not Due G Yes Yes G No Comment Required

PTS Ox/Bucks ‐ BHT Contract negotiation

Not Realised

Not Due GNot

RealisedNot Due G Yes Yes G No Comment Required

Year to date Full year

Lead Director: Paul Clarke


Measure Aug‐12 Year to date Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)

Measure Aug‐12

17


Human Resources Overall rating R Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Sickness absence


% % % % %

Trust 5.3% 5.3% G 5.2% 5.3% G 5.3% 5.7% G On‐track to hit 5%

‐ A&E Operations 5.8% 5.2% R 5.6% 5.2% A 6.0% 6.0% GOn‐track, but requires focussed effort in several hot‐spots in order to achieve sub 5%

‐ A&E EOC 5.3% 7.0% G 7.1% 7.0% A 8.0% 8.3% G EOC still running high, but overall result falling.

‐ PTS 5.7% 5.0% R 5.7% 5.0% R 5.7% 5.7% G

‐ Other Commercial Division 5.0% 5.0% G 6.6% 5.0% R 3.5% 5.0% G

‐ Other 3.0% 3.0% G 3.8% 3.0% R 3.8% 4.0% G


% % % % %

Trust 85.0% 95.0% R 85.0% 95.0% R 95.0% 95.0% G

‐ A&E Operations 86.0% 95.0% A 86.0% 95.0% A 95.0% 95.0% G

‐ A&E EOC 79.0% 95.0% R 79.0% 95.0% R 95.0% 95.0% G

‐ PTS 78.0% 95.0% R 78.0% 95.0% R 95.0% 95.0% G

‐ Other Commercial Division 77.0% 95.0% R 77.0% 95.0% R 95.0% 95.0% G

‐ Other 84.0% 95.0% R 73.0% 95.0% R 95.0% 95.0% G

Lead Director: Will Hancock

Measure Aug‐12

Measure‐ Data refers to previous month (July 2012)

Aug‐12

Appraisals (% completed of those due)


Year to date

Slight Increase in July 2012. However, Trend for Commercial over 12 months in heading in the right direction, falling from 8% to 5.7%

Full year Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)

Year to date

Full year

Improved response in July/Aug, but still off‐target. Urgent actions are needed to redress overdue appraisals and bring forward some Feb‐Mar

appraisals to spread the workload evenly across the year.

Management aware and appraisals booked in. Expecting improved results in September.Appears lower since the Division's plan is differently phased to spread the appraisals more evenly. The division is around 10% behind it own phased plan and this is forecast to be caught up by the end of Q3.Appraisals delayed by corporate review ‐ this will catch up in Q3

18


Recruitment


Front‐line recruitment 0 0 G 40 40 G 108 108 G No Comment Required

CSD recruitment 8 8 G 12 12 G 20 20 G No Comment Required

PTS recruitment 0 0 G 16 16 G 30 30 G No Comment Required

Training


Statutory & Mandatory 85.0% 95.0% R 85.0% 95.0% R 95.0% 95.0% GNo change from last month ‐ Under review by the new Education Team

Clinical Development 3 0.0% TBA n/a 0.0% TBA n/a 0.0% TBA n/a No change from last month ‐ Not yet started

Conflict Resolution 85.0% 90.0% A 85.0% 85.0% G 90.0% 95.0% A No change from last month.

Measure Aug‐12 Full year

Full year

Year to date

Measure (% completed of staff requiring the training)

Aug‐12 Year to date Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐ nil)


19


FT Membership Overall rating A Red > 30% Red scores, Green > 70% Green and no Reds, Amber - rest

Public membership


No. No. No. No. No. No.

Public 321 300 G 9,743 9,650 G 12,000 12,000 G No comment required

Representation

‐ Age (no. of people in under‐represented categories) 5 5 G 594 640 A 923 923 GCurrently working with specific organisations to meet targets

‐ Gender (no. of people in under‐represented categories) 105 100 G 4,038 4,115 A 5,934 5,934 G Particular focus to correct this

‐ Ethnicity (no. under presented categories) Ethnicity

White ‐ Irish 1 1 G 103 91 G 126 126 G No comment required

White ‐ Any other White background 6 5 G 261 281 A 340 340 GCurrently working with specific organisations to meet targets

Mixed ‐ White and Black Caribbean 0 5 R 43 58 R 72 72 GCurrently working with specific organisations to meet targets

Mixed ‐ White and Black African 1 0 G 20 13 G 13 13 G No comment required (achieved yearly target)

Mixed ‐ White and Asian 3 1 G 50 43 G 43 43 G No comment required (achieved yearly target)

Mixed ‐ Any other mixed background 2 0 G 38 34 G 34 34 G No comment required (achieved yearly target)

Asian or Asian British ‐ Indian 33 25 G 161 150 G 162 162 G No comment required

Asian or Asian British ‐ Pakistani 8 16 R 86 110 R 150 150 GCurrently working with specific organisations to meet targets.

Asian or Asian British ‐ Bangladeshi 0 0 G 23 22 G 25 25 G Only need 2 more members

Asian or Asian British ‐ Any other Asian background 4 0 G 73 61 G 35 35 G No comment required (achieved yearly target)

Black or Black British ‐ Caribbean 2 2 G 51 50 G 64 64 G No comment required

Black or Black British ‐ African 3 0 G 128 114 G 42 42 G No comment required (achieved yearly target)

Black or Black British ‐ Any other Black background 0 0 G 21 20 G 9 9 G No comment required (achieved yearly target)

Other Ethnic Groups ‐ Chinese 0 0 G 34 36 A 55 55 GCurrently working with specific organisations to meet targets

Other Ethnic Groups ‐ Any other ethnic group 2 2 G 33 34 A 44 44 GCurrently working with specific organisations to meet targets

‐ Socio‐economic (no. under presented categories)

Urban Prosperity [2] 30 33 A 878 905 A 1,195 1,195 G No comment requiredModerate Means [4] 33 33 G 1,109 1080 G 1,420 1,420 G No comment required

‐ Geography

Hampshire 7 0 G 2,728 2,891 A 4,800 4,800 GFocus will be mainly on Hants from Sep onwards. Events planned for Sep‐Nov period

Oxfordshire 141 140 G 2,438 2,266 G 2,400 2,400 G No comment required (achieved yearly target)

Buckinghamshire 110 120 A 2,222 2,147 G 2,400 2,400 G No comment required Berkshire 46 40 G 2,315 2,261 G 2,400 2,400 G No comment required

Staff membership


No. No. No. No. No. No.

Staff membership n/a n/a n/a 2,431 2,431 G 2,431 2,403 G No Comment RequiredStaff opt‐outs n/a n/a n/a 19 19 G 19 19 G No Comment Required

Measure Aug‐12 Year to date Full year

Measure

Lead Director: Duncan Burke

Aug‐12 Year to date Full year

Please note: 90.3% of the population within SCAS area is White British

Commentary on exceptions (Red ‐ action to correct, Amber ‐ action to reduce risk, Green ‐

nil)

20

Cat Red 8

Cat Red 19

Cat Red 1

Cat Red 2

Abandoned calls

Recontact 24hrs Telephone

Recontact 24hrs On Scene

Frequent caller

Resolved by telephone

Non A&E

ROSC

ROSC - Utstein

STEMI - 60

STEMI - 150

STEMI - Care

Stroke - 60

National Ambulance Clinical Quality Indicators (CQI's)

The number of patients who have been cared for and treated at the scene of the 999 call or taken to somewhere other than an A&E department for treatment (for example, an NHS Walk-in Centre).

The percentage of Category Red (immediately life-threatening) calls reached within 8 minutes – the target is 75%.

The percentage of Category Red (immediately life-threatening) calls where a vehicle able to transport the patient has arrived within 19 minutes – the target is 95%.

The percentage of 999 callers who have hung up before their call was answered in an emergency control room.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and been offered clinical advice over the phone.

The proportion of 999 calls that have been resolved by providing telephone advice and no ambulance response.

Red 1 call are the most time critial of Red call and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe conditions such as airways obstruction.

Red 2 calls are serious but less immediately time critical and cover conditiona such as stroke and fits.

The total number of patients who having had suffered a cardiac arrest and stopped breathing have then been recorded as having had a return of spontaneous circulation (a pulse/heartbeat) at the time of their arrival at hospital.

The number of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which allowed it to be shocked with a defibrillator and have then been recorded as having had a return of spontaneous circulation (ROSC) at the time of their arrival at hospital.

The number of patients who have re-contacted the ambulance trust within 24 hours of them having called 999 and then were discharged on scene following face to face ambulance assessment.

The number of patients who have re-contacted the ambulance trust within 24 hours for whom a locally agreed frequent caller procedure is in place. These patients are referred to as "patients at risk" in SCAS.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) – a type of heart attack – and who have received thrombolysis (treatment with a clot-busting drug) within 60 minutes of the original 999 call to attend them.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who then been directly transferred to a centre capable of delivering primary percutaneous coronary intervention (PPCI) and received angioplasty treatment within 150 minutes of the original 999 call to attend them.

The percentage of patients who have suffered an ST-elevation myocardial infarction (STEMI) - a type of heart attack - and who have received the correct treatment (appropriate care bundle) in line with ambulance guidelines.

The percentage of patients who have suffered a stroke, as confirmed by the face to face carrying out of a Face Arm Speech Test (FAST) and who were potentially eligible for stroke thrombolysis (treatment with a clot-busting drug) and who arrived at a hyperacute stroke centre within 60 minutes of the original 999 call to treat them.

21

Stroke - Care

Cardiac - STD

Cardiac - STD Utstein

Time to Answer - 50%



Time to Treat - 50%

Time to Treat - 95%

Time to Treat - 99%

Handover improvement

Clear-up improvement

Turnaround improvement

CQC

NPSA

SHA

RIDDOR

HSE

NHS Protect

The percentage of patients who have been witnessed suffering a cardiac arrest and stopped breathing, whose heart was then in a rhythm which allowed it to be shocked with a defibrillator and were successfully resuscitated and survived to be discharged from hospital.

The percentage of suspected stroke patients who were assessed face to face and who received the correct treatment (appropriate care bundle) in line with ambulance guidelines.

The overall percentage of patients who having suffered a cardiac arrest and stopped breathing were successfully resuscitated and survived to be discharged from hospital.

The time taken for a health professional working for the ambulance trust to arrive at the scene of a Category A (immediately life-threatening) call, measured by the time below which 50% of patients were reached.



The time taken to answer 999 calls in an emergency control room measured by the time below which 50% of calls were answered.



Other terms and abbreviations

NHS Protect leads on work to identify and tackle crime across the health service.

National Patient Safety Agency

Strategic Health Authority

Reporting of Injuries, Diseases and Dangerous Occurrences Regulations

The Health and Safety Executive

Care Quality Commission

Clear-up time is the time from clinical handover above to the time that the ambulance vehicle departs hospital. This had a target of 15 minutes. Clear-up improvement is where the total clear-up time for all hospital visits has improved compared to the same period last year.

Turnaround time is the total of handover and clear-up time. This had a target of 30 minutes. Turnaround improvement is where the total turnaround time for all hospital visits has improved compared to the same period last year.

Hospital handover time is the time from hospital arrival by ambulance personnel to clinical handover to hospital clinical staff. This had a target of 15 minutes. Handover improvement is where the total handover time for all hospital arrivals has improved compared to the same period last year.

22

Agenda Item: 10



Title Finance and Estates Report

Lead Director Charles Porter, Director of Finance


Purpose of the paper To update the Board on the Trust’s latest financial position


To note the current financial position of the Trust, including the risks and sensitivities to the forecast.










See risks and opportunities analysis

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) Monitor – our current financial risk rating remains at 3, which is in line with the plans we submitted to Monitor. CQC – N/A


As noted in the paper, we are currently ahead of our year-to-date trajectory for cost improvement programmes. There are growing risks to the £1.5m surplus, which may result in a risk rating of 3 at the year end rather than 4 as planned. A 3 is defined as “regulatory concerns in one or more components. significant breach unlikely”.


This paper has been shared with the Council of Governors – as part of them receiving all public Board papers - so that they are clear about the Trust’s current financial position. As part of their holding to account role, we provided an update on financial performance at the Council of Governors meeting on 10th September 2012. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The paper should be read in conjunction with the Quality and Patient Safety Report, recognising that the Trust’s objective is to ensure clinical quality whilst maintaining a sound financial position.


This paper is presented as part of the process of the Board undertaking a continuous review of the Trust’s financial position. Background reading can be found at: Monitor Compliance Framework 2012/13 http://www.monitor-nhsft.gov.uk/home/browse-category/guidance-foundation-trusts/mandatory-guidance/compliance-framework-2012/13

A. Executive Summary

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to

budget

Variance to Prior

Year

Profitability

SCAS Income £k 11,525 11,286 239 57,271 56,503 768 139,602 137,717 138,616 1,884 985

SCAS Contribution £k 2,574 2,646 (72) 13,885 13,663 221 32,876 33,161 33,956 (284) (1,080)

% Contribution % 22% 23% -1% 24% 24% 0% 24% 24% 24% -1% 0%

Corporate overheads £k 2,568 2,549 (19) 13,518 13,246 (273) 31,321 31,605 31,900 284 489

EBITDA £k 735 847 (112) 4,070 4,166 (97) 10,309 10,579 9,534 (270) 775EBITDA % % 6% 8% 7% 7% 7% 8% 7%

Overall Surplus/(Deficit £k 6 97 (91) 367 418 (51) 1,556 1,556 2,056 (0) (501)

% Surplus/(Deficit) % 0.0% 0.9% (0.8%) 0.6% 0.7% (0.1%) 1.1% 1.1% 1.5% (0.0%) (0.4%)

Memo: tech'l acc'ting surplus (£k) 6 97 (91) 367 418 (51) 1,556 1,556 912 (0) 644

Month Year to date Full Year

The results for the month to 31 August 2012 are below the budget level due to the cost pressures to support our A&E operations at a time of high demand as well as start-up costs associated with our new 111 service. The Commercial Division has continued to contribute positively and was 20% ahead of its budgeted contribution. Year to date operational contribution remains ahead of budget although this is expected to be behind budget on a full year basis – costs will remain high to support the expected continuation of high levels of demand. Central costs were close to budget in the month (less than 1% adverse) with year to date central costs higher due to the additional redundancy provision taken in May, relating to the SHIP 111 contract. Central costs for the full year are expected to be lower than budget with the favourable items relating mainly to funding costs and depreciation. This positive effect offset the operational contribution negative variance to bring our forecast surplus to the budgeted level. There are increasing risks to delivering the forecast. Different scenarios are shown in the Risks & Sensitivities section of the Detailed Review below.

Actual Budget Variance Actual Budget Variance Forecast Budget Prior Year Variance to budget

Variance to Prior

Year

Cash and capital position

EBITDA £k 735 847 (112) 4,070 4,166 (97) 10,309 10,579 10,741 (270) (432)Working capital mov't £k (1,358) (504) (854) (398) (235) (163) (809) (920) (611) 111 (198)Capital Expenditure £k (301) (816) 515 (2,258) (3,459) 1,201 (8,712) (8,712) (3,513) 0 (5,199)Disposals £k 0 0 0 11 0 11 3,696 3,696 1,483 0 2,213PDC paid £k 0 0 0 0 0 0 (1,800) (1,855) (1,900) 55 100Interest £k (1) 1 (2) 4 5 (1) (46) (150) (181) 104 135Repayments of loans £k (9) 0 (9) (45) 1 (46) (1,406) (1,406) (1,434) 0 28Other £k 0 0 0 4 4 0 0 0 11 0 (11)PDC & DOH Loans £k 0 0 0 0 0 0 0 0 0 0 0Cashflow £k (934) (472) (462) 1,388 482 905 1,232 1,232 4,596 0 (3,364)

Cash balance £k 10,961 10,055 906 10,961 10,055 906 10,805 10,805 9,573 0 1,232

Liquidity ratio 4.0 4.0

Full YearMonth Year to date

The Trust’s cash balance at the end of August was £10.9m, which was lower than the level at the end of July (£11.9m). Cash at the end of August remains above the plan of £10.0m and the forecast year end position of £10.8m remains unaltered from the previous month. There are increasing risks to the year -end cash position relating to delivery of disposals (£3.7m) and risks to the surplus. The capital programme is being reviewed to partly mitigate the effect of these risks.


Variance to Prior

Year

Financial Risk Rating

Overall Score n/a n/a n/a 3.15 3.0 0.2 3.55 3.6 2.9 0.0 0.7


This is ahead of budget year to date and in line with expectations for the full year. Due to the risks outlined later in the paper there is a risk that the year end rating will be 3 rather than 4. A 3 is defined as “regulatory concerns in one or more components. Significant breach unlikely”.

B. Supporting Information FINANCIAL REPORT – DETAILED REVIEW Income The variances to budget can be analysed in further detail as follows:

Month Year to date Comments£k £k

Fav/ (adv) Fav/ (adv)

Budget income 11,286 56,503A&E activity increase 187 628

A&E delays (6) 67

CQUINN - conveyance reduction to Type 1 & 2

12 85

CQUINN - GP Triage, trauma network & ACP system support,

(43) (108)

A&E other 1 54

Commercial division 102 451

Training monies from NESC (15) (26)

Miscellaneous 1 (384)

Actual income 11,525 57,271

Variance relates mainly to delayed insurance refunds.

Timing difference expected to reverse

Volumes up 7.4% in August compared to our budget of 3%.

Close the budget in the month but higher year to date due to high handover delays

Main items are higher ECR's in PTS and higher OOH income in Oxford due to delay in 111 go-live

Year to date variance relates to PY movement

No NHS numbers income accrued in Quarter 2 as this is measured at the end of the quarter.

Higher in month than budget as this was prudently budgeted

Income is ahead of budget due to higher activity levels which is expected to flow through to the year end. Expenditure The principal expenditure variances can be analysed as follows:

Month Year to date Comments£k £k

Fav/ (adv) Fav/ (adv)Budget 11,189 56,085Pay - A&E 87 806 Mainly due to lower pay costs in 111 service as well as

vacancies in A&E offset by higher overtimePay - Commerical Services 2 85 VacanciesPay - other cost centres (4) 119 VacanciesPrivate providers - A&E (455) (823) Higher in month to cover SCAS staff on Olympics duties

as well as to support operational performancePrivate providers - PTS (125) (429) Offset by higher ECR incomeFuel 2 (89) Year to date mainly in A&E - relates to higher activityOne-offs 0 (274) Year to date includes provision of £200k not in budgetOps Support Desk (40) (133) Additional agency and other costs to support performanceWinter provision 121 104 Release of provision made last monthIT telephone costs (10) (81) One-offs in the month

Other 94 (104) Small value offsetting variancesActual 11,519 56,904

Total expenditure is higher than budget by £0.3m in the month and £0.8m year to date. The majority of this expenditure is offset by additional income which offsets the adverse effect on the budgeted surplus.

Cash and Capital Expenditure Report Receipts in August at £10.7m were down on plan (£11.4m) due to early receipt of income attributable to August received in July. In month payments were slightly lower than plan with pay expenditure lower by £400k and capital payments £500k lower than plan. However payments on non-pay expenditure were higher than plan in August (£600k) due to a prepayment of lease (£275k) and general increases in private provider expenditure. 90 day debtors reduced by £8k over the previous month and now stand at £77k. The biggest issues are ongoing PTS ECR issues with several PCTs. The breakdown of the £77k balance comprises £14k PTS shortfalls, £37k PTS extra contractual activity, and £26k miscellaneous items mainly fleet and TVEA. The amount of 60 day debt is higher at £73k with a risk of up to £50k falling within the 90 day debt in September so efforts will be made to minimise this risk. Sales ledger debt stands at £0.67m, which is low level, therefore the 90 day debt, although low, represents an increasing percentage of the total debt (up to 11.5% from 8.8% in July). Total capital payments in August (£301k) were lower than plan (£816k). This is due principally to lower payments on the capital scheme relating to SHIP 111 with in-month payments of £76k as against a plan of £571k. However outstanding orders for SHIP stands at £511k, which indicates that this is a timing difference. The principal risks in the cash forecast relate to the timing of the £3m Battle disposal in March 2013) and the risk around delivering the forecast surplus. Cost Savings Plans Progress against the plan can be summarised as follows:

Actual Budget Var Actual Budget Var Forecast Budget Var

13 13 -0 28 39 -12 145 128 1717 17 0 87 87 0 209 209 019 19 0 88 38 50 231 307 -76 5 4 1 24 21 3 35 51 -16 10 3 8 21 14 8 79 33 461 1 0 3 3 0 9 9 00 15 -15 0 30 -30 191 277 -86

103 62 40 377 331 46 816 771 46

0 33 -33 0 65 -65 308 369 -61 8 8 0 42 42 0 100 100 047 47 0 237 237 0 345 369 -24 41 41 0 213 213 0 254 254 0-8 6 -14 -7 12 -20 51 71 -20 28 28 0 138 138 0 331 331 040 63 -23 199 244 -46 405 405 018 18 0 86 91 -6 219 219 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 200 400 -200 25 20 5 149 86 63 498 383 11525 24 1 127 122 5 418 418 -0 9 9 0 36 45 -9 98 107 -9 19 17 2 101 95 6 185 152 3410 10 0 48 48 0 95 95 045 45 0 216 216 0 288 288 026 26 0 125 125 0 360 414 -54 4 4 0 22 22 0 44 44 00 0 0 0 0 0 0 0 0

Non Recurring 68 39 30 202 133 69 691 404 2870 0 -89 -90 1

Total 574 573 1 2,560 2,498 62 6,516 6,516 08.8% 8.8% 39.3% 38.3%

A &

E

Kronos Savings

Co

mm

erci

al

Div

isio

n

Other Commercial

PTS BerkshirePTS Ox & BucksCommercial TrainingLogistic Services

PTS Hampshire

Max Shift Cover

Dual ECA Crews

Sickness

OvertimeOverhead Squeeze

Contingency

Project Cost ReductionCorporate SavingsProperty Savings

Procurement

111

TelephonyFleet Savings

Project Management Reduction

Co

rpo

rate

Month YTD Full YearProject

CSD

Private Provider Replacement

Overhead Cost Savings

Resource UtilisationNon Conveyance Improvement

Operational RestructureEOC RestructureHospital Delays

CIP’s are on target cumulatively with the negative effect of the A&E operational CIP’s being behind target mitigated by higher overheads savings and better commercial division performance. The CSD cip is behind target due to the difficulties recruiting nurses. As explained in the IPR the actions taken on sickness have yet to flow through to a reduction in the sickness %. The Optima modeling is behind trajectory so the resource utilization CIP is behind plan. It is expected that this will be recovered by the year end. Risks and Sensitivities There follows a summary of the current risks to the forecast position. Whilst the forecast is on track to deliver the budget surplus in the possible and downside case there are significant risks as shown below.

Risks Potential WeightingCurrent forecast

Weighting Possible Weighting Downside

£k % % %Growth - net cost up to income cap up to 4.5% 225 100% 225 100% 225 100% 225Growth - cost beyond income cap. Potential at 8% 2,100 0% 0 33% 900 67% 1,200Growth - forecast resource reduction -439 100% -439 0% 0 0% 0CQUINN/non conveyance not earned 670 45% 300 60% 400 100% 670OSD / Fleet 417 65% 269 82% 344 100% 417Penalty risk - Berkshire Red 8 431 0% 0 50% 216 50% 216Penalty risk - Hants Red 19 1,000 0% 0 0% 0 25% 250Sub total 999 3,404 10% 355 61% 2,085 87% 2,978

CIPS under-delivery non ops (Potential 20% ) 443 0% 0 25% 111 50% 222NESC funding risk re new bids 320 0% 0 100% 320 100% 320NESC funding (net) 250 0% 0 100% 250 100% 250Property revaluation 2,000 0% 0 0% 0 25% 500Sub total Other 3,013 0% 0 23% 681 43% 1,292

Total risks 6,417 6% 355 43% 2,765 67% 4,269

Opportunities Potential WeightingCurrent forecast

Weighting Possible Weighting Downside

Additional CQUINN 450 0% 0 50% 225 25% 113CSD spend lower than forecast 380 0% 0 75% 285 60% 228Sub total 999 830 0% 0 61% 510 41% 341

Commercial improvement 400 46% 184 59% 234 46% 184

Sub total Commercial 400 46% 184 59% 234 46% 184

Austerity measures / control totals 600 0% 0 100% 600 100% 600Balance sheet /insurance refunds 300 63% 190 80% 240 67% 200Lower net overheads (Depeciation/PDC) 334 85% 284 100% 334 100% 334Other 1,234 38% 474 95% 1,174 92% 1,134

Sub total Opportunities 2,464 658 1,918 1,659

Total Net opportunities/(risks) pre 111 (3,953) 303 (847) (2,611)

111 Net Opportunities / (risks) (648) (303) (504) (776)

Total Net opportunities/(risks) (4,601) 0 (1,352) (3,387)

Current forecast 1,556 1,556 1,556 Resulting surplus / (deficit) 1,556 204 (1,831)

Risks & Opportunities (compared to budget)South Central Ambulance Service NHS Foundation Trust

ESTATES REPORT Projects ASAP’s Planning underway for four new ASAP’s in the

Milton Keynes area at Burners Lane, Linford Wood, Woolstone and Howe Park.

Northern Area

S.E. Hants. Resource Centre

Planning permission received 16th September, no onerous conditions, contract with landlord to activate lease now commenced.

Approved by March Trust Board

Battle Fleet, PTS & Logistics facilities.

Currently Fleet are looking at clarifying short listed options. Preferred option will dictate Estates solution.

Awaiting outcome of Fleet review.

111 Service

Planning workshops completed, options for new layout for NH and SH being developed, discussions will take place with user group leads and recommendations will be made to Executive Team.

Project extended to incorporate corporate review and Wokingham relocation.

Energy Efficient Lighting

A scheme is under way to install energy efficient lighting systems in our properties. Project due for completion in early October.

90% completed

High Wycombe AS

Scheme to create new Make Ready facility and appropriate drainage facilities underway.

Acquisitions / Disposals Site Comment Book

Value Est. Gross disposal value

Estimated Disposal Date

Battle Hospital

Wates (2nd bidder) survey completed, meeting scheduled with Wates and RBH in September to discuss results and BAFO.

£3.2M £3.8M, net value will reduce this to accommodate remediation works.

Wates ground survey underway. RBH wish to retain part of the site for decontamination facility, longer than proposed sale date

Deanshanger Re-market summer 2012. Still functionally required for communications network

£665K £0.7M Retained costs £60Kpa Summer 2014

Totton AS PCT Renal service have submitted BC for purchase of site. Chasing outcome.

£250K £250K Retained costs £11.5K pa. Mar 2013. awaiting outcome of their business case.

Banbury AS Property on market, bid discussions underway.

£181K £350K Retained costs £6k pa. Mar 2013

Appendix A1


Variance to Prior

Year

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME 11,525 11,286 239 57,271 56,503 768 139,602 137,717 138,616 1,884 985

Emergency ServicesIncome 9,861 9,725 136 48,917 48,600 317 119,873 119,617 115,279 256 4,594

Direct costs 7,485 7,242 (243) 35,922 35,627 (295) 89,052 88,329 83,809 (724) (5,243)

Gross contribution 2,376 2,483 (107) 12,995 12,974 22 30,821 31,288 31,470 (468) (649)24% 26% -1% 27% 27% 0% 26% 26% 27%

Non-Emergency ServicesIncome 1,664 1,562 102 8,354 7,903 451 19,729 18,100 23,338 1,629 (3,609)

Direct costs 1,466 1,398 (68) 7,465 7,213 (251) 17,673 16,228 20,852 (1,445) 3,178

Gross contribution 198 163 34 890 690 200 2,056 1,872 2,486 184 (430)12% 10% 1% 11% 9% 2% 10% 10% 11%

Contribution Operational Activities 2,574 2,646 (72) 13,885 13,663 221 32,876 33,161 33,956 (284) (1,080)

Central Costs (inc op overheads)Fleet 326 303 (23) 1,555 1,516 (39) 3,745 3,638 3,762 (107) 17Clinical Services 172 165 (6) 824 825 1 1,956 1,981 1,864 25 (92)Finance 246 219 (27) 1,132 1,088 (44) 2,704 2,636 3,317 (68) 613Estates 344 323 (21) 1,706 1,633 (72) 3,947 3,947 4,288 0 341IM&T 359 353 (5) 1,756 1,766 9 4,095 4,339 4,051 245 (44)Transformation & OD 350 386 36 1,808 1,911 103 4,661 4,691 4,794 30 133Communications & Public Engag't 50 51 2 235 257 22 588 582 729 (5) 141Corporate 51 43 (7) 247 224 (23) 612 528 495 (84) (117)Other (57) (44) 13 553 279 (274) 275 254 0 (21) (254)Loss/(Profit) on disposal 0 0 0 (11) 0 11 (12) 0 (329) 12 (329)Depreciation 573 583 10 2,907 2,917 10 6,919 7,019 6,866 100 (153)Financing Costs 155 166 11 804 828 24 1,830 1,988 2,063 158 233

Total overhead costs 2,568 2,549 (19) 13,518 13,246 (273) 31,321 31,605 31,900 284 489

Net surplus/(deficit) 6 97 (91) 367 418 (51) 1,556 1,556 2,056 (0) (501)

Memo: technical accounting surplus (£k) 6 97 (91) 367 418 (51) 1,556 1,556 912 (0) 644

Memo:Depreciation 573 583 10 2,907 2,917 10 6,919 7,019 6,866 100 (53)

Public divident capital 155 155 0 773 773 0 1,800 1,855 1,900 55 100

Net interest payable 2 12 11 34 58 24 46 149 186 103 140

Profit on disposal 0 0 0 11 0 (11) 12 0 329 (12) (317)

EBITDA 735 847 (112) 4,070 4,166 (97) 10,309 10,579 9,534 (270) 775

% 6.4% 7.5% 7.1% 7.4% 7.4% 7.7% 6.9%

South Central Ambulance Service NHS Foundation TrustFinancial results for Month 5 ended 31 August 2012


Actual Budget Variance Actual/ forecast

Budget Variance Forecast Budget Variance Forecast Budget Variance Forecast Budget Variance

£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

TOTAL SCAS INCOME 34,183 34,006 177 34,816 33,833 983 35,210 34,685 525 35,392 35,193 199 139,602 137,717 1,884

Emergency ServicesIncome 29,153 29,226 (73) 29,763 29,149 614 30,388 30,367 20 30,569 30,875 (305) 119,873 119,617 256

Direct costs 21,101 21,254 154 22,500 21,719 (781) 22,731 22,491 (240) 22,721 23,065 344 89,052 88,529 (523)

Gross contribution 8,052 7,972 80 7,263 7,429 (167) 7,657 7,877 (220) 7,849 7,810 39 30,821 31,088 (267)27.6% 27.3% 24.4% 25.5% 25.2% 25.9% 25.7% 25.3% 25.7% 26.0%

Non-Emergency ServicesIncome 5,030 4,780 250 5,053 4,685 369 4,822 4,318 505 4,822 4,318 505 19,729 18,100 1,629

Direct costs 4,566 4,418 (148) 4,428 4,179 (250) 4,372 3,817 (554) 4,299 3,814 (485) 17,665 16,228 (1,437)

Gross contribution 464 361 102 625 506 119 451 500 (50) 524 504 19 2,064 1,872 1929.2% 7.6% 12.4% 10.8% 9.4% 11.6% 10.9% 11.7% 10.5% 10.3%

Contribution Operational Activities 8,516 8,334 183 7,888 7,935 (47) 8,108 8,377 (269) 8,372 8,314 58 32,884 32,960 (76)

Central Costs (inc op overheads)0

Fleet 864 910 45 1,000 910 (90) 934 910 (24) 947 910 (38) 3,745 3,638 (107)Clinical Services 492 495 3 496 495 (1) 484 495 11 484 495 11 1,956 1,981 25Finance 638 601 (37) 633 606 (27) 633 606 (27) 602 606 4 2,505 2,419 (86)Estates 1,003 988 (16) 1,015 969 (46) 942 974 32 986 1,017 31 3,946 3,947 1IM&T 999 1,059 60 1,108 1,059 (49) 1,018 1,059 42 971 1,059 89 4,095 4,238 142Transformation & OD 1,042 1,136 94 1,160 1,138 (22) 1,232 1,168 (64) 1,230 1,168 (62) 4,664 4,610 (54)Communications & Public Engag't 147 154 7 140 149 9 150 140 (11) 149 140 (10) 587 582 (5)Corporate 144 137 (6) 158 130 (28) 157 130 (27) 154 130 (23) 612 528 (84)Contingency 707 394 (313) (242) (68) 174 16 75 59 (206) (147) 59 275 254 (21)Loss/(Profit) on disposal (12) (6) 6 0 0 0 0 0 0 0 0 0 (12) (6) 6Depreciation 1,750 1,750 0 1,727 1,750 23 1,712 1,750 38 1,729 1,767 38 6,919 7,019 99PDC 464 464 0 456 464 8 440 464 24 440 464 24 1,800 1,855 55Interest 29 33 4 2 33 31 (1) 33 34 (1) 33 34 30 133 103Injury benefit 50 50 0 50 50 0 50 50 0 50 50 0 200 200 0

Total overhead costs 8,317 8,165 (152) 7,703 7,686 (17) 7,768 7,854 86 7,535 7,692 157 31,324 31,398 74

Net surplus 198 169 29 184 247 (63) 339 521 (182) 835 620 216 1,556 1,556 (0)

South Central Ambulance Service NHS Foundation Trust (Appendix A2)

Q1 Q2 Q3 Q4 Full Year

Financial results for Month 5 ended 31 August 2012

Appendix B

Income analysis


Variance to Prior

Year£000's £000's £000's £000's £000's £000's £000's £000's £000's £000's £000's

Emergency ServicesE&U Contract 2012/2013 9,177 9,026 151 45,858 45,132 726 108,788 108,316 108,703 472 85HART income 257 257 (0) 1,287 1,287 (0) 3,089 3,089 3,142 (0) (53)111 Service 87 151 (64) 422 685 (263) 4,320 4,640 0 (320) 4,320Public Events 22 18 4 89 92 (3) 221 221 233 0 (12)CBRN/Flu funding 219 49 171 567 243 324 747 582 682 165 65RTA Recoveries 8 50 (42) 208 250 (42) 500 600 523 (100) (23)Training Monies from NESC 71 86 (15) 406 432 (26) 1,037 1,037 1,577 0 (540)Workshop Income 8 5 4 27 23 4 65 56 82 9 (18)TVEA 17 17 0 86 86 (0) 207 207 338 (0) (131)Other Income 22 94 (72) 117 522 (404) 1,262 1,232 619 30 643AfC Transfer (30) (30) 0 (151) (151) 0 (363) (363) (363) 0 0Total Emergency Services 9,861 9,725 136 48,917 48,600 317 119,873 119,617 115,536 256 4,337

Non-Emergency ServicesPTS Hampshire 286 266 21 1,513 1,328 186 3,616 3,187 3,438 429 178PTS Berkshire 359 305 54 1,529 1,526 3 3,774 3,661 3,633 113 141PTS Ox & Bucks 670 658 13 3,384 3,289 95 8,304 7,893 7,583 411 721Out of Hours - Berkshire 61 60 0 311 302 9 521 362 888 159 (366)Out of Hours - Ox & Bucks 0 0 0 254 95 159 254 95 751 159 (497)Logistic Services - Berkshire 118 117 1 588 585 3 1,412 1,032 1,323 380 89Logistic Services - Ox & Bucks 90 93 (2) 473 463 11 1,113 1,110 976 2 137Community Equipment Provision 26 0 26 0 0 0 0 0 2,881 0 (2,881)Commercial Training 23 33 (10) 151 165 (14) 372 396 569 (24) (197)Events Management 0 0 0 0 0 0 0 0 1 0 (1)AfC Transfer 30 30 0 151 151 0 363 363 363 0 0Total Non-Emergency Services 1,664 1,562 102 8,354 7,903 451 19,729 18,100 22,405 1,629 (2,676)

Total income 11,525 11,286 239 57,271 56,503 768 139,602 137,717 137,941 1,884 1,660

South Central Ambulance Service NHS Foundation Trust (Appendix B)

Financial results for Month 5 ended 31 August 2012


South Central Ambulance Service NHS Foundation Trust Appendix C

Actual Budget Variance Actual Budget Variance Forecast Budget Prior year

Key Operational Ratios Aug-12 Aug-12 Aug-12 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Activity - % year on year 7.4% 3.0% n/a 5.7% 3.0% 2.7% 4.5% 3.0% 3.5% - income from growth (£k) 300 113 187 1,191 563 628 2,000 1,351 1,444Delays at hospitals - income from delays (£k) 102 108 (6) 609 542 67 1,300 1,300 700CQUINN (Clincal Quality Incentive) - Trauma network support 43 43 0 215 215 0 516 516 n/a

- Anticipatory Care Plan System support 0 17 (17) 49 86 (37) 155 206 n/a- NHS numbers/GP reporting 0 26 (26) 58 129 (71) 155 310 n/a- GP Triage 43 43 0 215 215 0 516 516 n/a- Reduction in conveyance to Type 1&2 A&E 55 86 (31) 300 430 (130) 1,032 1,032 363- Contingency/Other 0 -43 43 0 -215 215 -615 -516 1,181Subtotal CQUINN 141 172 (31) 837 860 (23) 1,759 2,064 1,544

Performance penalty 0 0 0 0 0 0 0 0 0

Total income from activity related measures 543 393 150 2,637 1,965 672 5,059 4,715 3,688

Actual Budget Variance Actual Budget Variance Forecast Budget Prior year

Key Operational Spend (£k) Aug-12 Aug-12 Aug-12 YTD YTD YTD Full Yr Full Yr Full Yr

+/(-) +/(-)

Overtime

- A&E - North 195 132 (64) 870 659 (211) 1,789 1,582 2,394 - A&E - South 130 83 (46) 672 480 (192) 1,389 914 1,642 - A&E - Control 60 12 (48) 196 68 (128) 493 150 291 - A&E - Comm Resp/Emer Plan/Fleet 45 23 (22) 167 116 (52) 332 278 255 - Commercial Division - PTS 44 29 (15) 210 155 (55) 415 358 489 - Commercial Division - non-PTS 4 7 4 36 41 5 76 70 133 - Other 38 15 (2) 170 75 (95) 2,043 179 90Total Overtime 515 301 (194) 2,321 1,594 (727) 6,537 3,531 5,294

Private Providers - A&E - North 440 131 (309) 1,552 887 (665) 2,746 1,693 3,876 - A&E - South 248 102 (146) 805 646 (159) 1,152 1,152 3,373 - PTS 260 135 (125) 1,132 702 (429) 2,432 1,649 3,429Total private providers 949 368 (580) 3,489 2,236 (1,253) 6,330 4,495 10,678

Fuel- A&E 166 179 13 929 876 (54) 2,185 2,131 3,428- Commercial Services 96 90 (6) 451 452 1 1,087 1,042 1,132- Fleet central 6 5 (1) 21 24 4 52 58 63- Other 138 134 (4) 694 655 (40) 1,667 1,594 247Total fuel 407 409 2 2,095 2,007 (89) 4,990 4,825 4,870


YTD YTD Variance Full year Full year Prior year Comments Rating Weighted Rating Weighted

Key Financial Ratios Actual Budget Forecast Budget YTD Rating Forecast Rating

I&E Surplus (k) 367 418 (51) 1,556 1,556 726

I&E Surplus Margin 0.6% 0.7% -0.1% 1.1% 1.1% 0.5% Tracking slightly ahead of plan 2 0.4 3 0.6

Return after financing 1.3% 0.8% 0.6% 2.4% 2.4% 2.6% One would expect this mesasure to be relatively low in a not for profit organisation.

3 0.6 4 0.8

EBITDA margin 7% 7% 0% 7% 8% 6% This measures the Trust's fundamental earning power and is in line with budget.

3 0.75 3 0.75

EBITDA % achieved 98% 100% -2% 97% 100% 99% This measures the performance of EBITDA to budget and this is moving in line with profitability.

4 0.4 4 0.4

Liquidity Ratio (days) 33.5 33.0 0 33.5 33.5 0.1 This measures the ability of the Trust to pay its costs based on its net current assets.

4 1 4 1

Total out of maximum score of 5 3.15 3.55

Target 3 3.55

Aug-12 Jul-12 Jun-12 Last Year

YTD YTD YTD Full year

Better payment practice target

- Non-NHS by number 88% 88% 87% 89%

- Non-NHS by £ value 93% 93% 94% 94%

- NHS by number 91% 92% 93% 96%

- NHS by £ value 93% 94% 92% 98%

Debtors > 90 days (£k) 76 85 84 128

As % of total debts 11.3% 8.8% 20.1% 13.6%

% cost improvements secured (actual) 39.3% 30.4% 21% 100%

% cost improvements secured (plan) 38.3% 29.5% 20% 100%

For information only:Ratings applied to financial ratings

Metric Weight 5 4 3 2 1EBITDA margin 25% 11% 9% 5% 1% <1%EBITDA, % achieved 10% 100% 85% 70% 50% <50%Return after financing 20.0% 3% 2% -0.5% -5% < 5%I&E surplus margin 20.0% 3% 2% 1% -2% < -2%Liquid ratio 25.0% 60 25 15 10 <10

100%

Appendix D

Comments

Current Risk Ratings:

Monthly not required

Monthly not required

Nil of note

Nil of note - % of total is higher since debtors relatively low.

Negative effect of the A&E operational CIP’s being behind target mitigated by higher overheads savings and better commercial division performance

South Central Ambulance Service NHS Foundation Trust Appendix E

CASHFLOW Apr-12 May-12 Jun-12 Q1 Q1 Q1 Jul-12 Aug-12 Sep-12 Q2 Q2 Q2 Oct-12 Nov-12 Dec-12 Q3 Q3 Q3 Jan-13 Feb-13 Mar-13 Q4 Q4 Q4

Aug-12 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Actl Actl Actl Fcst Budget Variance Actl Actl Fcst Fcst Budget Variance Fcst Fcst Fcst Fcst Budget Variance Fcst Fcst Fcst Fcst Budget VarianceIncomeSL Receipts 10,512 10,989 11,265 32,766 32,983 (217) 13,349 10,451 10,704 67,270 66,791 479 11,522 11,581 12,037 102,410 101,215 1,195 11,601 12,049 12,026 138,086 136,691 1,395Fixed Asset Receipts 0 0 0 0 0 0 3,696 3,696 3,696 0Interest 3 2 3 8 3 5 2 3 3 16 6 10 3 3 3 25 9 16 3 3 97 128 12 116Capital Loan From HA 0 0 0 0 0 0 0 0 0 0Other Income/PDC/VAT/RTA 272 215 328 815 772 43 323 258 250 1,646 1,432 214 260 260 266 2,432 2,218 214 222 222 198 3,074 2,824 250Advance of SLA/brokerage

Total Cash In 10,787 11,206 11,596 33,589 33,758 (169) 13,674 10,712 10,957 68,932 68,229 703 11,785 11,844 12,306 104,867 103,442 1,425 11,826 12,274 16,017 144,984 143,223 1,761

ExpenditurePay expenditure 7,149 7,153 7,091 21,393 21,584 191 7,631 7,348 7,325 43,697 44,519 822 7,351 7,350 7,354 65,752 68,079 2,327 7,689 7,654 8,248 89,343 92,635 3,292Non Pay expenditure 3,028 3,717 3,383 10,128 9,250 (878) 3,733 3,996 3,638 21,495 18,964 (2,531) 3,496 3,402 3,362 31,755 28,270 (3,485) 3,459 3,479 3,614 42,307 37,222 (5,085)Capital expenditure 299 300 24 623 2,286 1,663 1,334 301 1,023 3,281 4,623 1,342 1,266 1,403 883 6,833 6,956 123 506 656 717 8,712 8,712 0Dividends on PDC 0 888 888 928 40 888 928 40 872 1,760 1,854 94PDC/Loan Repayment 0 664 664 664 0 664 664 0 664 1,328 1,328 0Working Capital Loan 0 0 0 0 0 0 0 0 0 0Interest on DH Loans 0 75 75 81 6 75 81 6 81 156 162 6Other expenditure 6 51 6 63 20 (43) 35 1 7 106 39 (67) 6 6 7 125 58 (67) 6 7 7 145 78 (67)Total Cash Out 10,482 11,222 10,504 32,208 33,140 932 12,733 11,646 13,620 70,207 69,818 (389) 12,119 12,161 11,606 106,093 105,036 (1,057) 11,660 11,796 14,203 143,752 141,991 (1,761)

Net Cash In/(Out) 305 (16) 1,092 1,381 618 763 941 (934) (2,663) (1,275) (1,589) 314 (334) (317) 700 (1,226) (1,594) 368 166 478 1,814 1,232 1,232 0

Balance B/fwd 9,573 9,878 9,862 9,573 9,573 0 10,954 11,895 10,961 9,573 9,573 0 8,298 7,964 7,647 9,573 9,573 0 8,347 8,513 8,991 9,573 9,573 0

Balance C/fwd 9,878 9,862 10,954 10,954 10,191 763 11,895 10,961 8,298 8,298 7,984 314 7,964 7,647 8,347 8,347 7,979 368 8,513 8,991 10,805 10,805 10,805 0

CASHFLOW Apr-12 May-12 Jun-12 Q1 Q1 Q1 Jul-12 Aug-12 Sep-12 Q2 Q2 Q2 Oct-12 Nov-12 Dec-12 Q3 Q3 Q3 Jan-13 Feb-13 Mar-13 Q4 Q4 Q4

RECONCILIATION £000 £000 £000 Fcst Budget Variance £000 £000 £000 Fcst Budget Variance £000 £000 £000 Fcst Budget Variance £000 £000 £000 Fcst Budget VarianceEBIT 303 222 687 687 663 24 1,005 1,167 1,311 1,311 1,414 (103) 1,609 1,932 2,099 2,099 2,437 (338) 2,169 2,776 3,390 3,390 3,560 (170)Depreciation & Amortisation 584 1,167 1,751 1,751 1,752 (1) 2,334 2,907 3,480 3,480 3,503 (23) 4,064 4,648 5,183 5,183 5,206 (23) 5,766 6,358 6,919 6,919 7,019 (100)EBITDA 887 1,389 2,438 2,438 2,415 23 3,339 4,074 4,791 4,791 4,917 (126) 5,673 6,580 7,282 7,282 7,643 (361) 7,935 9,134 10,309 10,309 10,579 (270)Impair/Other Non Cash 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Stock (Inc)/dec (56) (56) (46) (46) 0 (46) (58) (44) (45) (45) (45) (45) (45) (45) (45) (45) (45) (45) (45) (45) 0 (45)Debtors (Inc)/dec (1,951) (2,435) (3,100) (3,100) 133 (3,233) (1,774) (2,568) (2,000) (2,000) 225 (2,225) (1,142) (976) (432) (432) 235 (667) (183) 103 (636) (636) 105 (741)Creditors Inc/(dec) 1,721 1,271 2,114 2,114 353 1,761 2,779 2,251 1,317 1,317 0 1,317 734 945 1,284 1,284 (1) 1,285 1,051 697 472 472 (425) 897Provisions Inc/(dec) 730 610 610 0 610 13 (37) (400) (400) (400) 0 (600) (800) (800) (800) (800) 0 (800) (800) (600) (600) (600) 0Capital expenditure (299) (599) (623) (623) (2,286) 1,663 (1,957) (2,258) (3,281) (3,281) (4,623) 1,342 (4,547) (5,950) (6,833) (6,833) (6,956) 123 (7,339) (7,995) (8,712) (8,712) (8,712) 0Capital disposals 5 11 11 11 11 11 11 11 11 11 11 11 11 11 11 11 3,696 3,696 3,696 0Free Cashflow pre finance 302 305 1,404 1,404 615 789 2,353 1,429 393 393 119 274 84 (235) 467 467 121 346 630 1,105 4,484 4,484 4,643 (159)

Interest 3 2 4 4 3 1 5 4 (75) (75) (75) 0 (73) (71) (69) (69) (77) 8 (66) (63) (46) (46) (149) 103Dividends on PDC 0 0 0 0 0 0 0 0 (888) (888) (928) 40 (914) (914) (914) (914) (928) 14 (914) (914) (1,800) (1,800) (1,856) 56Free Cashflow 305 307 1,408 1,408 618 790 2,358 1,433 (570) (570) (884) 314 (903) (1,220) (516) (516) (884) 368 (350) 128 2,638 2,638 2,638 0PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0Loan repayments 0 0 0 0 0 0 0 0 (664) (664) (664) 0 (664) (664) (664) (664) (664) 0 (664) (664) (1,328) (1,328) (1,328) 0Lease Borrowings 0 (18) (27) (27) 0 (27) (36) (45) (41) (41) (41) 0 (42) (42) (46) (46) (46) 0 (46) (46) (78) (78) (78) 0Capital Loan from DH 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Net Cash In/(Out) 305 289 1,381 1,381 618 763 2,322 1,388 (1,275) (1,275) (1,589) 314 (1,609) (1,926) (1,226) (1,226) (1,594) 368 (1,060) (582) 1,232 1,232 1,232 0

South Central Ambulance Service NHS Foundation Trust Appendix E

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

Apr-13 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Fcst Fcst Fcst Fcst Fcst Fcst Fcst Fcst Fcst Fcst Fcst Fcst Fcst BudgetIncomeSL Receipts 11,310 11,313 11,294 11,208 10,158 12,375 11,318 10,550 11,458 11,451 10,763 11,286 134,484 134,484Fixed Asset Receipts 893 893 893Interest 3 3 3 3 3 3 3 3 3 3 3 3 36 36Capital Loan From HA 0 0Other Income/PDC/VAT/RTA 161 161 161 161 161 161 161 161 161 161 161 161 1,932 1,932Advance of SLA/brokerage 0 0 0Total Cash In 11,474 11,477 11,458 11,372 10,322 13,432 11,482 10,714 11,622 11,615 10,927 11,450 137,345 137,345

ExpenditurePay expenditure 7,622 7,610 7,582 7,586 7,684 7,773 7,746 7,753 7,733 7,732 7,746 7,764 92,331 92,331Non Pay expenditure 2,756 2,757 2,757 2,757 2,757 2,757 2,757 2,757 2,757 2,757 2,757 2,757 33,083 33,083Capital expenditure 415 500 579 439 318 426 271 444 820 532 537 488 5,769 5,769Dividends on PDC 930 930 1,860 1,860PDC/Loan Repayment 688 319 1,007 1,007Working Capital Loan 0Interest on DH Loans 55 41 96 96Other expenditure 0Total Cash Out 10,793 10,867 10,918 10,782 10,759 12,629 10,774 10,954 11,310 11,021 11,040 12,299 134,146 134,146

Net Cash In/(Out) 681 610 540 590 (437) 803 708 (240) 312 594 (113) (849) 3,199 3,199

Balance B/fwd 10,805 11,486 12,096 12,636 13,226 12,789 13,592 14,300 14,060 14,372 14,966 14,853 10,805 10,805

Balance C/fwd 11,486 12,096 12,636 13,226 12,789 13,592 14,300 14,060 14,372 14,966 14,853 14,004 14,004 14,004

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

RECONCILIATION £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000 £000Operating Surplus 415 844 1,582 2,030 2,430 2,758 3,056 3,280 3,532 3,778 4,222 4,344 4,344 4,344Depreciation & Amortisation 600 1,200 1,800 2,400 3,000 3,600 4,200 4,800 5,400 6,000 6,600 7,200 7,200 7,200

1,015 2,044 3,382 4,430 5,430 6,358 7,256 8,080 8,932 9,778 10,822 11,544 11,544 11,544Impair/Other Non Cash

Stock (Inc)/dec 0 0Debtors (Inc)/dec 100 200 (1,100) 0 100 (500) (200) 100 (500) (273) (273) (273)Creditors Inc/(dec) (22) (44) (66) (88) (110) (132) (154) (177) (200) (223) (246) (269) (269) (269)Provisions Inc/(dec) 0Capital expenditure (415) (915) (1,494) (1,933) (2,251) (2,677) (2,948) (3,392) (4,212) (4,744) (5,281) (5,769) (5,769) (5,769)Capital disposals 0 893 893 893 893 893 893 893 893 893Free Cashflow pre finance 678 1,285 1,822 2,409 1,969 4,442 5,147 4,904 5,213 5,804 5,688 6,126 6,126 6,126

Interest 3 6 9 12 15 (37) (34) (31) (28) (25) (22) (60) (60) (60)Dividends on PDC 0 0 0 0 0 (930) (930) (930) (930) (930) (930) (1,860) (1,860) (1,860)Free Cashflow 681 1,291 1,831 2,421 1,984 3,475 4,183 3,943 4,255 4,849 4,736 4,206 4,206 4,206PDC Payment/(Repayment) 0 0 0 0 0 0 0 0 0 0 0 0 0 0Loan repayments 0 0 0 0 0 (688) (688) (688) (688) (688) (688) (1,007) (1,007) (1,007)Lease Borrowings 0 0 0 0 0 0 0 0 0 0 0 0 0 0Capital Loan from DH 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Net Cash In/(Out) 681 1,291 1,831 2,421 1,984 2,787 3,495 3,255 3,567 4,161 4,048 3,199 3,199 3,199

Capital resources available F1 Budget Exp summary F1 Budget

Core Depreciation 7,155 7,155 Clinical 0

Estates 1,623 1,622

Available Surplus 1,557 1,557 Operations 487 418

Fleet 4,248 4,186Total capital resources available 8,712 8,712 IT 2,055 1,981

Contingency 299 505Shortfall to be financed 0 0 Total 8,712 8,712

Actual/Forecast Spend ProfileScheme Description Budget April May June July August September October November December January February March Total

Actual Actual Actual Actual Actual F/cast F/cast F/cast F/cast F/cast F/cast F/cast F/cast£000

ESTATESEstates Database 20 20 20Refurb Stoke Mandeville 45 21 15 13 5 54Refurb High Wycombe 45 1 22 5 5 5 5 5 45Oxford City Generator 25 30 30High Wycombe - Make ready 70 3 13 19 19 7 7 7 7 82Oxford o2 store 15 7 2 1 1 1 1 1 1 15Oxford w'shop & make ready 20 8 2 2 2 2 2 2 20NH BMS & A/C control improvements 10 2 1 1 1 5 10NH Fire Protection works 23 23Bletchley 40 8 8 8 4 4 4 4 40Various ASAPS Incl MK 24 5 5 0 4 6 4 5 29PortsmouthNew 20 2 8 2 2 2 2 2 20Andover Refurb 36 4 14 4 4 4 4 4 36Basingstoke Refurb 64 6 25 12 6 6 6 7 70Alton Shutter 8 4 1 1 1 1 1 8Nursling Refurb 11 1 5 1 1 1 1 11Newbury Garage Extension 92 9 36 10 9 9 9 9 92Driver Training Centre 25 10 3 3 3 3 3 3 25Battle PTS Transcare 200 50 50 100 200SE Hants Resource Centre 511 511 511Lighting Systems 70 37 33 70Basingstoke Make Ready Heating 40 4 16 4 4 4 4 4 40Air Conditioning (Server Room) 100 4 36 10 10 10 10 10 10 100Salto Locks 50 1 7 5 12 5 5 5 5 5 50Haslemere ASAP to be confirmed 38 38 5 43Thame ASAP to be confirmed 29 10 19 2 1 32Hart 0 0FLEET6 Ambulances C/forward from last year 724 530 18 98 64620 X Front Line Ambulances 2,692 15 275 296 1,533 222 51 523 2,915Berkshire Workshop Vans 29 49 49Modernisation of Ambulances 109 39 17 11 7 7 7 7 7 7 109Equipment FOR 6 dcu 152 59 93 152Fleet Management System 21 4 10 7 21Equipment on Vehicles (RRVs) 137 137 1376 x Converted Discoveries 289 3 194 92 2891 x Non Converted Discovery 33 32 1 33Tail lifts for 7 Ambulances 42 42Purchase of Volvo VX70 42 42 42OPERATIONSClincial Equipment General 100 25 25 25 25 100Intra Ossieus Devices 130 170 170Aeds 188 186 2 188LP12 Helicopter system 18 19 19Lucas 2 Chest Compression system 8 10 10ITBicester EOC/111 Config 124 110 14 124Microsoft Licences 62 62Final CAD Implementation 5 5 5CAD Developments 40 25 15 40Emergency CAD/111 Servers 85 85 85CAD Software Upgrade 20 13 2 15111 Interfaces /R1 & R2 80 40 40 80Operational Forecasting System 110 3 48 30 29 110Terrafix radio Installations 50 50 50PTS On Line Booking System 10 10 10PTS CAD 80 26 27 27 80SHIP 111 952 75 163 76 284 199 129 26 952Talari Fail 60 60 60TARP 23 5 18 23NHS Pathways/CAD Software 188 88 100 188Qlickview 54 53 37 30 120Terrafix Upgrade 31 18 21 39Thame Radio Facility 55 55 55Finance - Disaster Recovery 17 17 17Contingency 448 1 1TOTAL PROGRAMME 8,712 299 219 1,245 234 235 1,289 1,300 1,903 383 206 656 743 8,712

Movement in Capital Cr (Increase)/Reduce 0 0 -1141 1100 66 0 0 0 0 0 0 0 25

Total Capital Cash Expended 299 219 104 1,334 301 1,289 1,300 1,903 383 206 656 743 8,737

Forecast Quarter Spend 1,762 1,758 3,586 1,605 8,712

Budget (Monitor) 2,286 2,337 2,334 1,755 8,712

Variance -524 -578 1,253 -150 077.09% 75.25% 153.68% 91.46% 100.01%

New Build New Build 43 20 19 6 7 16 16 5 5 55 55 616 860Maintenance Maintenance 7 0 3 11 40 130 224 86 81 74 72 69 795IT IT 151 195 160 163 108 625 339 241 44 20 0 26 2,073Other Other 98 4 1,063 54 18 518 679 1,572 254 58 530 33 4,880

Total 299 219 1,245 234 173 1,289 1,258 1,903 383 206 656 743 8,608

Appendix F

For the period to 31/08/2012

SOUTH CENTRAL AMBULANCE NHS FOUNDATION TRUST

CAPITAL EXPENDITURE 2012/2013

Appendix G

BALANCE SHEET Actual Actual ForecastAs at Aug 12 As at Aug 12 As at 31 Mch 12 As at 31 Mch 13

(£k) (£k) (£k)

FIXED ASSETS

Property, Plan & Equipment 58,795 59,251 60,955Intangible assets 1,388 1,604 1,388

60,183 60,855 62,343

CURRENT ASSETS

Stocks & Work In Progress 977 933 933

Assets held for resale 3,865 3,864 169

Sales Ledger Debtors 183 765 874Prepayments & Accrued Income 8,339 5,304 5,300Other Debtors 571 437 438Trade & Other Receivables 9,093 6,506 6,612Cash and cash equivalents 10,961 9,573 10,805

TOTAL CURRENT ASSETS 24,896 20,876 18,519

CREDITORSPurchase Ledger Creditors (1,064) (569) (580)Accruals & deferred income (8,443) (6,723) (6,281)Other Creditors Incl Pensions, PAYE & NI (3,859) (2,988) (3,000)Capital Accruals (153) (178) (178)Borrowings < 1 year (1,380) (1,406) (1,007)Provisions < 1 year (2,979) (3,015) (2,416)CURRENT LIABILITIES (17,878) (14,879) (13,462)

NET CURRENT ASSETS/(LIABILITIES) 7,018 5,997 5,057

TOTAL ASSETS LESS CURRENT LIABILITIES 67,201 66,852 67,400

Borrowings (2,831) (2,849) (1,842)Provisions (2,267) (2,267) (2,267)Other Financial Liabilities (26) (26) (26)Non-Current Liabilities (5,124) (5,142) (4,135)

TOTAL ASSETS EMPLOYED 62,077 61,710 63,265

FINANCED BY:TAXPAYER'S EQUITYPublic Dividend Capital (57,874) (57,874) (57,874)Revaluation Reserve (6,440) (6,440) (6,440)Donation ReserveOther Reserve 350 350 350Govt Grant Reserve- bfwdRetained Earnings 2,254 2,262 2,254I & E YTD (367) 0 (1,555)

TOTAL TAXPAYERS EQUITY (62,077) (61,702) (63,265)


Agenda Item: 11



Title NHS 111 Update

Lead Director Fizz Thompson – Director of Patient Care/Deputy Chief Executive


As above

Purpose of the paper To update the Board on the local and national picture of NHS 111 services


The Trust Board is asked to note the report










The Board Assurance Framework on today’s agenda includes two potential risks associated with NHS111: the risk that poor performance against NHS111 contracts leads to loss of reputation and other

potential contracts, as well as financial loss SCAS fails to achieve market growth in new NHS111 business areas. Specific project risks are detailed in the Trust risk register and individual project plans, and performance information is contained within the Trust Integrated Performance Report.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) NHS111 is subject to the same quality regime as the 999 emergency service. As such: we are reviewing our arrangements to ensure that we maintain the essential CQC standards during

the implementation and delivery of the NHS111 services we provide we are applying the provider compliance assessment regime to NHS111 we are ensuing that all staff recruited to support delivery of NHS111 are subject to the required

CRB checks where relevant


All income and expenditure (including the implementation costs associated with the go-live of the Oxfordshire and Hampshire contracts) relating to NHS111 delivery are accounted for in the Trust’s financial projections.


The Council of Governors are kept up-to-date in terms of ongoing developments with NHS111; for example, most recently at the meeting on 10 September. The public governors will, for example, have an interest in the effectiveness of the delivery of NHS111 in their areas (where SCAS are successful in being the providers) and will be able to monitor performance on NHS111 through the dashboard in the Integrated Performance Report. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

The NHS111 services enable better access to health services and the most appropriate outcome for patients. For SCAS staff, it provides an opportunity for staff moving across to work on NHS111 to develop their portfolio of skills and experience.

Other

Supporting information, including background papers and previous considerations by the Board

Board paper of July 2012 Department of Health minimum data set Department of Health NHS 111 National specification


NHS 111 UPDATE

1.0 Background and the National Strategic Context The first of the NHS 111 pilots was launched on 23rd August 2010, in County Durham and Darlington. The roll-out of the NHS 111 service nationally is set to be by April 2013. This new service does not replace the emergency 999 number – it will replace the multiple urgent care contacts such as the Doctors out of Hours service number and also the NHSD number.

2.0 What is NHS 111 designed to do? A team of fully trained call advisers, supported by nurses, will assess patients’ symptoms and put them directly in touch with the people who can help; for example, an out of hours doctor, a district nurse or an emergency dentist — or it may be something as simple as a 24 hour chemist. NHS 111 can also send an ambulance, without delay, if required. The call advisors and clinicians use a Clinical Decision Support System (CDSS) to assist in their assessment of the callers needs. We have chosen to use the NHS Pathways system as our CDSS. This is a well proven system, developed by clinicians in the UK, which will give a safe, effective and trusted outcome from the discussion with the patient. Calls are free from landlines and mobile phones and the service is available 24 hours a day, 365 days a year. 3.0 Benefits for patients and the wider NHS The benefits for patients and the wider NHS include: Improve the public’s access to urgent healthcare Help people use the right service first time including self care Provide commissioners with management information regarding the usage of services

4.0 The benefits for SCAS There are a number of benefits for SCAS in being the provider of NHS 111 services: NHS 111 services led by SCAS will help the organisation to diminish the level of

inappropriate callers to the 999 system. SCAS leading the provision of the NHS 111 service will support the organisation to

transform into a truly mobile healthcare provider There may be future economies of scale in the utilisation of the NHS Pathways CDSS as a

clinical triage tool for both 999 and 111 In the current financial climate all health and social care services are working hard to

maximise constrained capacity and ensure demand is closely matched to supply (and therefore reduce costs).

Page 1 of 5

We can capitalise in existing Clinical Support Desk and existing Emergency Operations Control Room clinical infrastructure.

5.0 What are the prerequisites for the service?

Completion of a clinical assessment on the first call without the need for a call back. Ability to refer callers to other providers without the caller being re-triaged. Ability to transfer clinical assessment data to other providers and book appointments

where appropriate. Ability to dispatch an ambulance without delay. 6.0 Early learning from pilots The main findings are:

Activity has steadily increased across all sites There is a difference between providers in transfer rate (the proportion of answered calls

that go through to a clinician). All sites have similar referral rates to primary care based services of between 45% and

55% are directed to Urgent Care Centres. Refer to ambulance rates vary from 8% to 15%. All sites have met the National Quality Requirements since launch 7.0 Current Status

The DH set out the minimum requirements for the delivery of the services in the invitation

for expressions of interest. The first of these requirements was ‘The ability to dispatch an ambulance without delay’. This pre-requisite means that all regional ambulance services must be involved in the

delivery of NHS 111 services. A number of other providers will be able to deliver the other minimum requirements but the

extent to which they have unrestricted access to ambulance dispatch systems must be carefully considered.

An approved Clinical Decision Support System (CDSS) such as “NHS Pathways” must be in place to provide the triage, pathway of care and directory of services behind the 111 call number.

8.0 SCAS involvement in South Central Working in partnership with Oxford Health NHS Foundation Trust (OHFT) we have been selected to provide a two year pilot for Oxfordshire which went live on 24th July 2012. We expect to take some 170,000 calls when the service is fully established – mainly at our existing facility at Bicester. When the Oxfordshire NHS 111 pilot went live on 24th July it was not possible to put in place a full NHS 111 service 7 days per week, therefore a hybrid system to cover Out of Hours calls is in place over weekends to ensure the clinical safety of callers/patients. This has been necessitated by the need to review the demand profile and realign staff rosters to match unforeseen variances to the original workforce plan due to delays with TUPE transfer and recruitment. Call lengths have also been longer then planned due to IT interoperability issues which are being resolved.

Page 2 of 5

There has been a successful recruitment campaign and we are on track to have full capacity to deliver a full NHS 111 service. Call length is now declining with additional new staff passing through NHS Pathways training and we have a supportive coaching regime using a best practice operating model. We are monitoring performance daily to ensure calls are answered within 60 seconds and to ensure delivery of the service as per the national NHS 111 specification. From 24th July until 30th August we took 6466 weekday calls (full NHS 111) and 8302 weekend calls (hybrid) – a total of 14768 calls. Peak volume in one fifteen minute period was 51 calls and demand has been very variable, exceeding the capacity plan which has just been reviewed. Transfers to 999 are now 7-8% on average, which is lower than most other NHS 111 pilots (9-15%) - however we are not yet fully operational. Due to initial teething problems with the new service and the very high call volume on 19th August and a long call answering time, a performance notice was received from OHFT, therefore a remedial action plan was put in place by SCAS. As a result a Serious Incident was raised by the PCT. A full investigation is under way and learning will be incorporated into the service. Performance is monitored daily and is steadily improving. We are working to extend the 7 day NHS 111 service during September/October subject to testing and DH approval. In Hampshire we have won, against very strong competition, the five year contract to provide the NHS 111 service across the county of Hampshire commencing in October 2012. We expect to take in the region of 600,000 calls a year, with the main call centre being based at our existing site in Otterbourne near Winchester. We have been selected to provide a two year pilot for Berkshire commencing in February 2013; we expect to be taking in the region of 262,500 calls a year. We have recently submitted a bid to provide the NHS 111 services in Buckinghamshire (130,000 calls). We have also submitted a bid to provide the service in Milton Keynes (85,000 calls), however we have not been successful in that bid (we do not have any further information at this stage). 9.0 The impact on SCAS – if we are the provider or if others provide the service in our area There are a number of risks associated with a supplier other than ambulance services leading the operation of a NHS 111 service. Allowing a third party to have unrestricted access to the dispatch system of ambulance services may result in the following performance and patient outcome risks: More ‘slack’ being built into the system to accommodate the requirements of a supplier

who would not have the sophistication in mapping demand that ambulance services have developed.

The risk of there being no emergency ambulance available if the 111 supplier (in a particular area) accessed a high level of resource without having predicted this and communicated it to the ambulance service.

Page 3 of 5

Risk to patient outcomes if no ambulance resources are available to reach the patient on time – although this could occur if SCAS run the service

A third party will not be incentivised to control demand or provide a “hear and treat” or “see and treat” response – commissioner efficiency plans should address this risk, but it will be difficult to control.

10.0 The current national picture The service may be provided by any willing qualified provider who can gain approval for the service offering from the commissioners and the Department Of Health. The competition for the service provision has been intense, with NHS organisations and the private sector bidding for the business. We do not have a complete picture of providers as yet as the procurement process is ongoing; however our current understanding is: Contracts

Southampton, Hampshire & Portsmouth SCAS

North East England North East Ambulance and Northern Doctors

Suffolk, Harmoni

Hillingdon, Wandsworth, Croydon Harmoni

Bath, NE Somerset, Wiltshire Harmon

Richmond & Kingston Harmoni

NW London Harmoni

N Central London London C & W Urgent Care

Great Yarmouth and Waveney South East Health

Bournemouth, Poole and Dorset South West Ambulance

South East England South East Coast Ambulance and Harmoni

Cumbria Fylde Coast Medical, NW Ambulance and NHSD

Inner NW London London Central and West Collaborative

Outer NE London Partnership East London Co ops

Norfolk East of England Ambulance

Yorkshire and Humberside Yorkshire Ambulance Service North West England NHS Direct Sutton & Merton NHS Direct Cornwall and Isles of Scilly NHS Direct

West Midlands NHS Direct SE London NHS Direct

Page 4 of 5

of 5

Pilots

Oxfordshire SCAS and Oxford Health

Berkshire SCAS

Nottingham, Lincolnshire, Luton NHS Direct

Derbyshire Derbyshire Health United

East and North Herts Herts Urgent Care

West Herts Herts Urgent Care

Isle of Wight IoW Trust

Paul Clarke

Business Development Director

13 September 2012

Agenda Item: 12a



Title Board Assurance Framework (BAF)

Lead Director Fizz Thompson, Director of Patient Care/Deputy Chief Executive

Presenter(s) of the paper (if different to the Lead Director)

As above

Purpose of the paper To highlight risks to the Board in delivering our strategic objectives, and to provide assurance over mitigating actions.


To note the risk scores and actions.










The BAF includes risks to the Trust delivering its key corporate objectives and strategic aims. There are 11 red rated risks in the current BAF.


Risks associated with response times or delays to patients can impact on compliance with CQC outcomes 1 and 4 (Dignity, respect and welfare of patients). Financial risks may affect compliance with the Monitor Framework 2012/13.


Risks associated with objective 6 (Commercial Viability) may have implications for the Monitor Compliance Framework.


This paper has been shared with the Council of Governors – as part of them receiving all public Board papers - so that they are clear about the Trust’s position in delivering the strategic objectives. As part of their holding to account role, we will be providing an update on the Board Assurance Framework at a future Council of Governors meeting. Patient / staff implications (e.g. linked to NHS Constitution, equality and diversity)

Links to the NHS Constitution – principle 7 – NHS is accountable to the public and should therefore transparently take responsibilities for services. The NHS also commits to ensure continuous improvement of services.


BAF presented to the Board at every public meeting Corporate risks evaluated in the risk register by Executive Committee on 28th August 2012 Audit Committee review on 3rd September 2012 Quality and Safety Committee review on 16th August 2012 SCAS NHS FT Corporate Risk Register Department of Health (2003) gate ref:1054 Building the assurance framework. A practical guide for NHS Boards. Good Governance Institute (2009) version 2.1 Board Assurance Frameworks: a simple rules guide for the NHS.


BOARD ASSURANCE FRAMEWORK

Purpose of the paper Executive Summary

The Board Assurance Framework (BAF) forms an essential part of the Trust’s system of internal control, identifying the principal risks to the successful delivery of the Trust’s strategic objectives, and the controls and assurances in place to mitigate these. This report sets out to the Board, an updated BAF for August/September 2012 and a risk profile which gives an “at a glance” view of the mitigated scores of identified risks on a bi-monthly basis.

Red Risks.

There are eleven red rated risks on the BAF (in June/July there were seven red rated risks) as reviewed by the Executive Directors on a monthly basis. They are:

Failure to meet response times resulting in poor patient experience in terms of quality of their care.

Risk to patient safety and performance while relocating EOC.

Inadequate resources to meet unexpected demand.

Failure to deliver hospital turnarounds resulting in delays.

Fleet availability including turnaround and servicing. (new)

Failure to meet Red performance targets. (new)

Poor performance against 111 contract. (new)

Failure to achieve financial targets and CIP’s

IT and telephony resilience.

Inability to reduce sickness absence.

Failure to deliver end of year financial targets. (new)

Review of the Board Assurance Framework

Risks on the BAF have been reviewed in full to ensure that appropriate controls and assurances have been identified, and that any action plans have agreed timescales allocated and that the necessary updates are provided. They have also been reviewed in terms of their alignment with the Trust’s Corporate Risk Register. The BAF is a key mechanism used to reinforce strategic focus and improved management of risk.

Debbie Marrs, Assistant Director of Quality, 9th Sept 2012

RAG

Strategic Objective Risk Reg Ref

Principal Risks Date Identified

Cons Likely Total Current Control Measures Gaps in Controls Current Assurance Gaps in Assurance Action to be taken Respons. Person Timing / review date

Cons Likely Total

1, 3, 6, 7 1.1 Inconsistency in providing clinically excellent, evidence based and safe patient care as outlined in national quality measures / indicators

May‐12 4 3 12 • DH quality indicators and measures• JRCALC guidelines• Trust Board and Quality and Safety Committee assures clinical and quality governance processes• Audit committee reviews and cross references quality domain • Executive Team monitors all quality and clinical processes and policies and performance • Performance, complaints and incidents reviewed by the PERG and Quality and Safety Committee • Clinical Review Group reviews • Processes and education for all staff to raise awareness• Monitoring of clinical work streams through Business Programme Board • Quality and clinical metrics embedded in Integrated Performance Report • CQC Quality Risk Profiles• New evidence supporting new care pathways (STEMI, stroke and trauma)

• Action plan in place for STEMI and stroke (in IPR) rate SCAS performance mid table • New trauma network implemented fully in Southern region – North not yet fully implementedInsufficient clinical outcome data ‐ now addressed for cardiac arrest survival to discharge

• All front line staff have JRCALC manuals and pocket books • PCI indicators benchmarked nationally • Individual scorecard for staff through the CARS system• Quality Account• Audit Commission assessment of quality account• SCAS clinical strategy• CQC compliance with Essential Standards • Cycle 7/8 CPI • Research and development strategy in place with research resource developing • Clinical Audit plan in place May 2012• Internal audit provided substantial assurance against CQC standards• New pathways of care in place for PCI. And Stroke with demonstrated outcome benefits• CSD and ECP patient survey data • Internal audit of medicines management – substantive assurance of safety of medicines storage and administration processes

•Safety Peer reviews•Consistent data quality•Organisational learning from

incidents, complaints and SIRI’s and patient experience data

Data quality reviews in place. Bypass decision audit to commence.

•Fizz Thompson, Director of Patient Care •John Black, Medical Director

Review Sept 2012

4 2 8

5 (cross reference with no 9 Hospital delays and no 8 AQI's on corporate risk register)

1.2 Failure to meet response targets resulting in patients in the care of SCAS not reporting a positive experience of their care and experiencing delays in care and treatment

May‐12 5 5 25 • DH quality indicators and measures• Patient Experience Group scrutinising data and developing actions• Executive Team monitors all quality and clinical processes and policies and performance • Complaints, concerns, comments and compliments monitored through the PERG

•Negative media stories•Increase in complaints and incidents in 2012‐ drill down to reasons – staff attitude, delay and not sending an ambulance remain the main reasons•Risk identified with non conveyance current theme for experience ‐ learning identified with CSD surveys•Good satisfaction results from CSD and ECP surveys Numbers of incidents reported as a delay

• Improved CQC QRP• Patient satisfaction surveys• Staff satisfaction surveys• increase in reported compliments • CQC compliance with Outcomes 1,4 and 7• Quality Accounts and national ambulance benchmarking• Audits of patient care records and delays to care• Information on complaints and incidents shared with staff • Production of ‘you said we did ‘ news letters • Trust lead human factors work stream across south central –conference March 2012 with LD Patient Champion• New Appraisal system implemented• Random reviews of delays provided assurance of quality of care, but also identified learning or improvement areas – (key priorities for quality accounts)• Incidents reported increased demonstrating more open and learning culture March 2012

•Patient outcomes and experience due to delays through whole organisational learning from SIRI’s and complaints.•Action required to address complaints pertaining to attitude of staff. Analysis of National Ambulance benchmarks (Sept 2012)•Staff training requires an element of customer services as a thread running through all programmes of education. Provider Compliance Assessment for CQC outcome 4 (Welfare of Patients)

Team structure in place. 25day reports sent weekly. Q&S committee review of PCA's for CQC outcomes. Quarterly review of progress against Quality Accounts. Analyse national benchmarking data.

Fizz Thompson, Director of Patient Care

Monthly review

5 4 20

13 new 1.3 Risk to patient safety and performance while relocating EOC Berks to HQ

Jun‐12 5 4 20 Escalation plan in place to relocate before planned date if staffing levels reduce to adversely affect patient safety and outcomes. Face to face staff communications daily to monitor situation.

Communications with staff. Absence monitoring. Incident reports analysis. Delays and performance monitored daily.

Patient experience data. Complaints.Target responses.

Daily monitoring. Move almost complete (Aug 2012)

John Nichols Chief Operating Officer

Daily reviews

5 3 15

8 2.1 Failure to achieve operational performance against new national clinical indicators and measures

May‐12 4 4 16 • Regular monitoring through Executive Team and Business Programme Board. Reporting and measuring of new national standards and clinical measures• Performance management framework with operational teams • Metrics monitored through Integrated Performance Report• National performance report available on SCAS website• Qlikview enables performance to be tracked and managed at all levels in SCAS, down to individuals• REAP levels

•Some areas still reliant on manual data validation or collection•Some reporting functionality on Qlikview still to be developed

• Maintenance of current performance in Red 8 and 19 against national standards for SCAS and by PCT cluster • In top 3 performing Trusts for A8, telephone resolution and frequent user indicators.• Regular benchmarking of performance against other trusts reported to Board• Performance delivery plans based on area and locality• Trajectories developed for delivery of performance aligned to PCT commissioning clusters• Dry run of new DH indicators for performance in this years Quality Account

Monitored daily and through IPR John Nichols Chief Operating Officer

Weekly review

4 3 12

12 2.2 Inadequate resources and resilience to meet unscheduled and unexpected demand

May‐12 4 5 20 • Clear resourcing plan matched to demand Rota hours sustained when compared to last year, despite significant reduction in private provider hours• Integrated workforce plan linked to budget • REAP plans • Modelling tool to improve resourcing planning • Introduction of Time Attendance Recording Process (TARP) with focus on Sickness Management• Service development plans to manage demand (care plans frequent callers GP triage)• Cost improvement plans for dual ECA;s and sickness. absence

•Demand continues to increase•Contract need to increase use of alternative pathways CIP slippage identified

• Integrated workforce plan monitored through workforce board and executive team• Maintenance of national standards • Clear escalation processes through bronze, silver and gold command structures• Increase in GP triage use• Availability of private providers for short term use

•KRONOS not yet fully implemented in terms of new rotas for teams to ensure demand is met more effectively and patient safety is not compromised.•Increased focus of the CSD on hear and treat


Review August 2012

4 4 16

9 2.3 Failure to deliver adequate hospital turnaround times resulting in delays.

Apr‐12 5 4 20 • REAP plans and escalation procedure in place• Integrated Performance Report• Qlikview data on delay to individual level

•Project for A&E Turnaround not delivering any real improvement in hospital handovers•Demand continues to increase

• A&E turnaround project delivering reduction in ambulance clear up delays in hospital.• Monitoring lost hours in delays at hospitals• Joint working with hospital Directors.

Delays still reported through IR1 process and SIRI's

CEO level joint working to reduce turnaround.


Review Sept 2012

4 4 16

15 2.4 Fleet availability low in some areas, VOR and servicing schedules not compliant.

Aug‐12 5 4 20 Operations Directors and shift managers locating vehicles each day. Quality andSafety Committee reviewing cleaning schedules and VOR data to ensure maximum availability of vehicles. Hot news alerts.

Fleet review not completed in terms of planning servicing/VOR. SCAS staff not always sure where all vehicles are.

Plan in progress to increase garage staff hours. Cleaning schedule pilot in place. Staff still reporting lack of vehicles. New rotas for shift times not analysed sufficiently to assure whether vehicle availability to crews has improved.

Ops Director to assure Q&S committee (working with NED) on vehicle compliance with schedules and available resource. Replacement programme in development


Review Sept 12

4 4 16

16 2.5 Failure to meet Red call performance targets

Aug‐12 5 4 20 REAP escalation plans and implementation. Silver cell set up for each shift. Overtime scheme developed.

% performace still not improving due to demand.

Daily monitoring at Executive level. Numbers for Hear and Treat (CSD) reducing. Vehicle availibility not predictable. Delays at acute trusts not resolving.

Resources v demand to be considered. Continued partnership working with acute partners and GP's.


Daily review

4 4 16

17 2.6 Poor performance in time taken to answer calls

Aug‐12 5 4 20 Training plan for staff in progress. Recruitment plan to recruit call handlers. Functionality performance review of telephony to complete.

Monitoring and reporting daily on time taken to answer calls Number of complaints and incidents relate to time taken to answer calls.

Recruit new staff. John Nichols Chief Operating Officer

Daily review

4 3 12

18, 19 3.1 Failure to engage fully with stakeholders and commissioners, to build effective external relationships and enhance organisational reputation.

Dec‐11 4 3 12 • Targeted organisational visits• Partnership projects to reduce demand/costs• Stakeholder management strategy • Performance packs to PCT clusters ‐ development of Integrated Performance Report • Commissioner external review meetings with commissioners• Joint and local HOSCs communication and meetings

•Continuing uncertainty of commissioning of our service with changes to PCT’s and SHA disbanding•New clusters developing ‐ SHIP, OBB and Potential uncertainty of Milton Keynes

• Communications strategy in place • Quarterly stakeholder newsletter• Strengthened commissioner relationships from successful PCT visits – • CQC compliance • CQC QRP• Engagement throughout Quality Account development• Positive response from stakeholders including HOSCs• Stakeholder events• Council of Governors in place

•Membership increase still ongoing Membership still being targetted. Duncan Burke Review following COG in Sept 2012

3 2 6

2. Emergency Performance

3. Stakeholder Perceptions and Trust Reputation

Board Assurance Framework

Raw Risk RatingMitigated Risk

Rating

1. Clinical Excellence: Quality of care, patient safety and experience

RAG

Strategic Objective Risk Reg Ref

Principal Risks Date Identified

Cons Likely Total Current Control Measures Gaps in Controls Current Assurance Gaps in Assurance Action to be taken Respons. Person Timing / review date

Cons Likely Total

Board Assurance Framework

Raw Risk RatingMitigated Risk

Rating

20 3.2 Poor performance against 111 contract consequences maybe loss of repuation and other contracts and financial loss

Aug‐12 5 4 20 Daily sitrep meetings. Daily incident meetings. Operational and project board meetings.Comms plan, IBP, Clinical Strategy, robust mobilisation plans. Clinical Assurance Group.

Assurance required on IT workarounds relating to themes from

incidents.Marketing of new business, demand of new service.

CAG group fortnightly monitoring all data and governance issues. Audit schedule for call audit set up. Feedback to staff ‐ plan in place and feedback commenced. Head of 111 (North) appointed.Robust implementation plans, monthly update reports, new reporting structures in place, management team

in place, review of strategic communications plan.

Qlikview to export data required on DX codes in order to asssure partners.Recruitment plan to deliver increased staff numbers/resource. Dedicated AD 111 not yet in post. Service yet to go live in Hampshire. Public Launch in Oxs end Sept 12. Unknown service demand

Advertise to recruit staff. Publisher element of Qlikview to be obtained. Lessons learned and actions from incidents to be clear and apparent.Review of delivery post go live. Monitoring of KPI's. Review of feedback.

Charles Porter and Fizz Thompson

Daily review

5 3 15

21 4.1 Failure to achieve financial targets and realise CIP’s.

Dec‐11 4 5 20 • Cost improvement plans agreed and monitored• Board approved budget & performance management of budget• LTFM aligned to Monitor framework• Monthly financial monitoring by Board and Executive Team• Challenge by Audit committee• Internal Audit reviews or accounts• Local Counter Fraud work• External Audit & SIC . Cashflow reporting and analysis. Performance management of CIP's

None identified • History of good financial management• Board approved budget on 25th March 2012 • CIP meetings• Internal and external audits inc. year end audit reports• Minutes of Board, audit committee and executive committee• 6 monthly budget reviews • External Review Boards each month with commissioners • Benchmarking against peers• Improved SLR• Performance management of CIP’s through business programme board and executive team

• Clean audit report and value for money conclusion

•None identified CIP monthly meetings. Charles Porter, Director of Finance

Review June 2012

5 3 15

14 4.3 Poor IT/telephony resilience ‐ potential of critical system downtime.

May‐12 5 4 20 Virtual telephony in place at EOC level. IM&T strategy. Back up procedures in place. New IT postholder (interim head of IT resillience)appointed to action audit recommendations

Assurance on back up procedures. Over reliance on contractors. Disaster recovery testing.

IM&T strategy. Virtual EOC. ANS telephony audit and platform review. Infrastructure programme review.

All sites not on same operating procedure. Lack of documented disaster recovery plan.

Peer review of resilience systems. Develop IT metrics. Develop consistent maintenance schedule. Review IT roles and resources. Align report recommendations to 111 Hants.

Charles Porter, Director of Finance Thompson,

Review by ED's fortnightly

4 4 16

25 5.1 Failure to provide and deliver effective leadership through the corporate restructure

May‐12 3 4 12 • Corporate review monitored through Executive Director Committee • IBP outlines vision and strategy for future leadershipBoard seminar sessions

•Restructures not yet fully implemented – uncertainty for some levels within corporate teams

• Restructure consultation ends 8th June 2012• Board sign off July 2012• Programme of leadership development and networking days • Sickness absence monitoringS ff i d b i fi

•Evaluation of new structures and leadership to be determined for assurance of leadership and resilience

Staff meetings. Monitoring absence. July 2012 implementation phase commenced

Will Hancock, CEO. Sharon Walters Director of HR

Sep‐12 3 3 9

23 5.2 Failure to support staff and provide access to education and training to meet mandatory, clinical and organisational requirements

Dec‐11 4 4 16 • Education training programme• Statutory and mandatory training • Training needs analysis• Integrated workforce plan• Appraisals and training monitored through scorecard by Exec Committee and Board

•Operational pressures undermines ability to deliver against the trajectory•Sustainability of provision of training•CQC outcome 14 compliant but requires an outcome lead.

• Training remains on trajectory adhering to programme• Staff feel valued and have received training applicable to role – as reviewed by SHA and CQC visit • Recruitment plan trajectory aligned to integrated workforce plan. Training needs analysis and review of needs for commercial sector. • Staff survey results. Elearning programme to be introduced making learning more accessible.

•Loss of hours due to recovery action plans•Plans in place to deliver statutory and mandatory training•Rostering system will ensure correct availability of staff (June 2012)•Potential breach of H&S legislation not actioned in a timely manner. Review of reasons for absence with personal accident data. New education staff structure in place end Aug 12

Elearning being introduced 2012/13. TNA for commercial sector.


Oct‐12 3 4 12

24 5.3 Failure to effectively manage sickness absence.

Apr‐12 4 4 16 Area Managers action plans to reduce sickness absence. Monitoring at Workforce Board.

All ops managers to be trained to use Kronos absence module.

Team leaders trainined in absence management and use of policy. Joint working with Occupational Health to rehabilitate staff back to work.

Figures not showing month on month reduction.

Action plans to manage sickness in place


Ongoing 4 4 16

New Risk Area 25 (cross reference 18 CIP's)

6.1 Failure to improve current financial margins and quality of care in the commercial arm

May‐12 4 4 16 • Monthly finance reports detailing margin and other performance information as part of the reporting system• New detailed reporting system introduced June 2011External consultancy providing expert guidance to management team

• Time lag in activity versus reporting due to provision of external invoicing•Review all non guaranteed ‐income ‐secured 50% of total

• Development of a marketing strategy•Fortnightly business reviews with each head of department• Appointment of a business development director

CIP meetings Charles Porter, Director of Finance

Monthly review

4 3 12

24 6.2 Failure to achieve market growth in new business areas such as 111

Apr‐12 4 3 12 • Creation of a pipe line of opportunities monitored through the Trust Board• IBP outlining vision • Clinical strategy alignment with commercial growth• IPR

• Scope further possibilities and further development of pipeline opportunities• Marketing activities around potential 111 business

•Monthly RAG rated reporting to executive and Trust board •Oxford 111 pilot to go live June 2012•New post advertised for AD 111•New business achieved •Berkshire 111 project started in conjunction with PCT

• Improvement plan in place to improve business competency of exiting. DH testing for OH

Bids in place. Go live in Oxfordshire July 2012. Berkshire meetings commenced. AD 111 post appointed to

Charles Porter,Director of Finance

Monthly review

4 2 8

New Risk Area

6.3 Failure to meet financial targets at year end due to overspend on meeting performance targets.

Sep‐12 5 4 20

Monthly finance reports.

Use of private providers. Sickness absence still needs to reduce. Rotas still need to be introduced.

Financial constigency and action plan in place. Recruitment plan in place

Performance remains challenging. Resource demand high.

Close monitoring of performance and spend. Recruit correct staff in place at right time.

Charles Porter, Director of Finance

Fortnightly review by execs

4 4 16

RAG Key:Green ‐ Risk is low and or is being adequately mitigated (<15)Amber ‐ Risk is high and is being adequately mitigated (More than 15 but less than 20)Red ‐ Risk remains extremely high (More than 20)

5. Leadership & Culture

6. Commercial Viability

4. Sound Governance

Agenda Item: 13



Title Trust Constitution



Steve Garside, Company Secretary

Purpose of the paper To present to the Board a number of revisions to the Trust Constitution, which: emanate from implementation of the first phase of the new

Health and Social Care Act 2012 are in line with model wording provided by Monitor have the support of the Council of Governors following Board of Directors approval, will subsequently be

presented to Monitor for their own approval.


To seek approval of the revisions to the Trust’s Constitution










There is a risk that, if the required revisions are not made and approved, the Trust’s Constitution will not reflect the new Health and Social Care Act 2012 (see legal implications below).

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) The legislation provides that Monitor may grant authorisation as a Foundation Trust only if they are satisfied that certain criteria are met (this includes having a constitution that is in accordance with relevant legislation).


The proposed changes to the Trust’s Constitution include two with financial implications: the Trust will not be fulfilling its ‘principal purpose’ unless its total annual income from the provision

of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes

the Trust may only implement a proposal to increase by 5% or more the proportion of its total income in any financial year attributable to activities other than the provision of goods and services for the purposes of health service in England if more than half the members of the Council of Governors vote in its favour


Under the Trust’s Constitution (s40.2), the Trust is required to consult first with the Council of Governors, prior to approval by the Board of Directors, over any proposed amendments to the Constitution. This was done at the Council of Governors meeting on 10 September.


By the time the Health and Social Care Act 2012 is implemented in full, Monitor’s new role – which is geared around driving benefits for patients (e.g. safeguarding patient choice) – will be reflected in the Constitution of NHS Foundation Trusts.


The proposed changes to the Trust’s Constitution were considered, and supported, by the Council of Governors at its meeting on 10 September. Background reading: The Trust’s full constitution: http://www.southcentralambulance.nhs.uk/_assets/documents/policies/finance/constitution.pdf Monitor FT Bulletin, August 2012 (announcing required changes to FT Constitutions): http://www.monitor-nhsft.gov.uk/home/browse-category/guidance-foundation-trusts/monthly-nhs-foundation-trust-bulletin/ft-bulletin-au

http://www.southcentralambulance.nhs.uk/_assets/documents/policies/finance/constitution.pdf


http://www.monitor-nhsft.gov.uk/home/browse-category/guidance-foundation-trusts/monthly-nhs-foundation-trust-bulletin/ft-bulletin-au

http://www.monitor-nhsft.gov.uk/home/browse-category/guidance-foundation-trusts/monthly-nhs-foundation-trust-bulletin/ft-bulletin-au

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TRUST CONSTITUTION

Background 1. The Trust’s Constitution is a key governance document, setting out arrangements

for the functioning of the Council of Governors and the Board of Directors. It was developed and approved as part of the process of SCAS achieving Foundation Trust status.

2. The current requirements for amending the Constitution are set out in section 40 of the document; namely that any changes must be approved by Monitor, following approval by the Board of Directors (who must consult first with the Council of Governors).

3. The new Health and Social Care Act 2012 gives additional responsibilities and

powers to Foundation Trust governors, as well as introducing a range of new measures that Foundation Trusts must take into account in the delivery of their business.

4. The legislation is being introduced in a number of phases, through statutory

instruments known as commencement orders. The changes brought about by implementation of the legislation will require all Foundation Trusts to refine their constitutions.

5. The first phase reflects amendments which will come into force on or before 1

October 2012 as a result of the first two commencement orders – Statutory Instrument 2012/1319 and Statutory Instrument 2012/1831.

6. Further commencement orders will be issued to deal with implementation of the

other legislative changes, and it is understood that all elements of the new Act will come into force by April 2013.

7. This paper deals with implementation of the first phase. Constitutional changes as a result of the Health and Social Care Act 2012 8. Monitor have asked all Foundation Trusts to make the constitutional changes

required by implementation of the first two commencement orders as soon as possible. They have also requested that:

changes are made using the Monitor Model Core Constitution wording or

alternative wording which is compliant with the legislation (SCAS have opted for the former option)

the internal approvals required for Constitution changes (e.g. Board of Director

approval, following consultation with the Council of Governors) are secured

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the amended constitution is submitted to Monitor for approval (ideally by the end

of September 2012) no other constitutional changes are made at this stage, beyond those required

as a result of implementation of the first two amendment orders. 9. The amended SCAS Constitution following these changes is shown at Appendix A,

using tracked changes for audit trail purposes. It should be noted that the changes only affect the main body of the Constitution and therefore annexes 1 through to 8 remain unchanged (and are therefore not included in Appendix A). A full copy of the constitution (including the annexes) can be accessed through the following link:


10. The amendments to the Constitution as part of this phase, together with cross

reference to the relevant sections of the SCAS constitution, are as follows:

Change required by new Act

Comment SCAS Constitution (x-ref)

The continuation of the body corporate known as Monitor

Change made Page 5

Change from the ‘Board of Governors’ to the ‘Council of Governors’

Changes not required as SCAS already uses the term ‘Council of Governors’

Throughout

Requirement for the principal purpose (i.e. provision of goods and services for the health service in England) to be stated in the constitution

Changes made Sections 3.1, 3.3 and 3.4 added (page 6)

Introduction of the new legal duty to ensure that income from NHS funded goods and services is greater than income from other sources

Changes made Section 3.2 added (page 6)

Introduction of additional oversight and scrutiny by the Council of Governors over activities generating non-NHS income

Changes made Sections 37.5, 37.6 and 37.7 added (page 17)

Replacement of HM Treasury with Secretary of State as regards giving guidance over FT accounts

Changes made Section 36.4 added (page 16)



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Consultation with the Council of Governors 11. In accordance with section 40 of the Trust’s Constitution, the Council of Governors

were consulted over the proposed changes to the Constitution at its meeting on 10 September 2012. The changes were supported.

12. It should be noted that in time, as part of implementation of further aspects of the

new legislation, amendments to the Trust’s Constitution must be approved by the Council of Governors. Amendments will no longer need to be submitted to Monitor for approval.

Recommendation 13. The Board of Directors are asked to approve the changes made to the Trust’s

Constitution, in line with implementation of the first two amendment orders of the Health and Social Care Act 2012, and the standard wording provided by Monitor.

14. Subsequent to this approval, the Trust’s revised Constitution will be submitted to

Monitor for their own approval process.

Steve Garside Company Secretary 11 September 2012

(Appendix A)


Constitution

August 2012 (amended for SI 2012/1319 and 2012/1831

Deleted: Final

1

South Central Ambulance Service NHS Foundation Trust Constitution

-------------------------------- TABLE OF CONTENTS --------------------------------

Paragraph Page 1. Interpretation and Definitions…………………………………………………...3 2. Name..........................................................................................................6 3. Principal purpose........................................................................................6 4. Powers........................................................................................................6 5. Membership and constituencies .................................................................6 6. Application for membership ........................................................................6 7. Public constituency.....................................................................................7 8. Staff constituency .......................................................................................7 9. Restriction on membership .........................................................................8 10. Council of Governors – composition...........................................................8 11. Council of Governors – election of governors.............................................8 12. Council of Governors – tenure....................................................................9 13. Council of Governors – disqualification and removal ..................................9 14. Council of Governors – meeting of governors ............................................10 15. Council of Governors – standing orders .....................................................10 16. Council of Governors – conflicts of interest of governors ...........................10 17. Council of Governors – travel expenses.....................................................10 18 Council of Governors – further provisions...................................................10 19. Board of Directors – composition................................................................11 20. Board of Directors – qualification for appointment as non-executive ..........11 21. Board of Directors – appointment and removal ..........................................11 22. Board of Directors – appointment of initial chairman etc ............................12 23. Board of Directors – appointment of deputy chairman................................12 24. Board of Directors – appointment and removal ..........................................12 25. Board of Directors – appointment and removal of initial Chief Executive ...13 26. Board of Directors – disqualification ...........................................................13 27. Board of Directors – standing orders ..........................................................13 28. Board of Directors – conflicts of interest of directors ..................................13 29. Board of Directors – remuneration and terms of office ...............................14 30. Registers ....................................................................................................14 31. Admission to and removal from the registers..............................................14 32. Registers – inspection and copies ..............................................................14 33. Documents available for public inspection..................................................15 34. Auditor ........................................................................................................15 35. Audit committee..........................................................................................16 36. Annual accounts .........................................................................................16 37. Annual report and forward plans.................................................................16 38. Meeting of Council of Governors to consider annual accounts and reports16 39. Instruments.................................................................................................16 40. Amendment of the constitution ...................................................................17

2

Paragraph Page Annex 1 – The Public Constituency ....................................................................18 Annex 2 – The Staff Constituency.......................................................................19 Annex 3 – Composition Of Council Of Governors...............................................20 Annex 4 – Conduct Of Elections -The Model Election Rules ..............................22 Annex 5 – Additional Provisions – Council Of Governors ...................................51 Annex 6 – Standing Orders – Council Of Governors ..........................................59 Annex 7 – Standing Orders – Board Of Directors ...............................................72 Annex 8 – Further Provisions..............................................................................95

3

1. Interpretation and definitions Unless otherwise stated, words or expressions contained in this constitution shall bear the same meaning as in the National Health Service Act 2006.

Words importing the masculine gender only shall include the feminine gender; words importing the singular shall import the plural and vice-versa.

the 2006 Act is the National Health Service Act 2006. the 2012 Act is the Health and Social Care Act 2012

Accounting Officer is the person who from time to time discharges the functions specified in paragraph 25(5) of Schedule 7 to the 2006 Act.

Applicant NHS Trust means the South Central Ambulance Service

NHS Trust

Area of the Trust means the area, specified in Annex 1 of this Constitution.

Audit Committee means a committee of Non-Executive Directors appointed in accordance with paragraph 35 of this Constitution

Board of Directors means the Board of Directors as constituted in accordance with this Constitution

Chairman means the chairman of the Trust appointed in accordance with the Constitution. The expression “the Chairman” shall be deemed to include the Deputy Chairman if the Chairman is absent from the meeting or is otherwise unavailable.

Charitable Funds means a fund which has been set up and which

operates on a non-profit basis.

Chief Executive means the chief executive officer of the Trust

“Clear days” means complete days not including the day the period begins or day of the event

Committee means a committee or sub-committee created and appointed by the Trust.

4

Committee Members means persons formally appointed by the Board of Directors as members of specific Committees.

Constitution means this constitution and all annexes to it.

Council of Governors means the Council of Governors of the Trust as constituted in accordance with this Constitution and which shall have the same meaning as the Board of Governors in the 2006 Act.

Deputy Chairman means a Non-Executive Director who is appointed to perform the duties of the Chairman in any circumstances when the Chairman is unable to perform those duties.

Director means an Executive Director or a Non-Executive Director on the Board of Directors

Director of Finance the finance director to the Trust

Executive Director means an employee of the Trust holding executive office on the Board of Directors

Financial Year means- (a) the period beginning with the date

on which the Trust is authorised and ending with the next 31 March; and (b) each successive period of twelve months beginning with 1 April.

Funds Held on Trust means those funds which the Trust holds on the

date of authorisation as an NHS Foundation Trust, whether received on distribution by statutory instrument, or accepted under powers derived under paragraph 14(2)(c) of Part 2, Schedule 4 of the 2006 Act and those accepted whilst an NHS Trust under section 47(2) of the 2006 Act. Such funds may or may not be charitable.

Governor means a member of the Council of Governors

elected or appointed in accordance with this Constitution.

Lead Governor means the Governor nominated as the lead

governor by the Council of Governors in accordance with Annex 5, paragraph A5 6.12.

5

Local Authority Governor means a member of the Council of Governors appointed in accordance with this Constitution by a local authority specified in Annex 3 whose area includes the whole or part of the Area of the Trust.

Member means an individual who is eligible to join and

has joined the Public Constituency or the Staff Constituency in accordance with this Constitution.

Model Rules for Elections shall have the meaning given to them in paragraph

11.2 of this Constitution. Monitor is the body corporate known as Monitor, as

provided by Section 61 of the 2012 Act. Nominated Officer means an Officer charged with the responsibility for

discharging specific tasks within the standing orders. Non-Executive Director means a Non-Executive Director on the Board of

Directors including the Chairman Officer means an employee of the Trust or any other person

holding a paid appointment or office with the Trust. Partnership Governor means a member of the Council of Governors

appointed by the Partnership Organisation. Partnership Organisation means the organisation designated as a partnership

organisation for the purposes of this Constitution as specified in Annex 3.

PCT Governor means a Member of the Council of Governors

appointed in accordance with the provisions of this Constitution by a Primary Care Trust specified in Annex 3.

Public Constituency means (collectively) the parts of the Trust’s

membership consisting of those members living in an area specified in Annex 1 as an area for a Public Constituency

Public Governor means a member of the Council of Governors

elected by the members living in an area specified in Annex 1 as an area for a public constituency

Secretary means a person appointed to act independently of

the Board of Directors to perform the role as more particularly described in Annex 8, Paragraph A8 4.1.

Deleted: Independent Regulator of NHS Foundation Trusts

Deleted: 31

Deleted: 2006

6

Senior Independent Director means a Non-Executive Director nominated to the role of Senior Independent Director in accordance with the provisions of this Constitution.

Staff Class means a class of the Staff Constituency as specified

in Annex 2. Staff Constituency means that part of the Trust’s membership

consisting of the staff of the Trust and which is divided into the classes as provided by this Constitution as referred to in Annex 2.

Staff Governor means a member of the Council of Governors

elected by the members of a Staff Class. Terms of Authorisation are the terms of authorisation issued by Monitor

under Section 35 of the 2006 Act. the Trust means the South Central Ambulance Service NHS

Foundation Trust.

2. Name

The name of the foundation Trust is South Central Ambulance Service NHS Foundation Trust (the Trust).

3. Principal purpose

3.1 The principal purpose of the Trust is the provision of goods and services for the purposes of the health service in England.

3.2 The Trust does not fulfil its principal purpose unless, in each

financial year, its total income from the provision of goods and services for the purposes of the health service in England is greater than its total income from the provision of goods and services for any other purposes.

3.3 The Trust may provide goods and services for any purposes

related to: The provision of services provided to individuals for or

in connection with the prevention, diagnosis or treatment of illness, and

The promotion and protection of public health.

3.4 The Trust may also carry on activities other than those mentioned in the above paragraph for the purpose of making additional income available in order better to carry on its principal purpose.

4. Powers

4.1 The powers of the Trust are set out in the 2006 Act, subject to any restrictions in the Terms of Authorisation.

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4.2 The powers of the Trust shall be exercised by the Board of Directors on behalf of the Trust.

4.3 Any of these powers may be delegated to a committee of Directors or to an Executive Director.

5. Membership and constituencies

The Trust shall have Members, each of whom shall be a Member of one of the following constituencies:

5.1 a Public constituency; and

5.2 a Staff constituency

6. Application for membership An individual who is eligible to become a Member of the Trust may do so on application to the Trust.

7. Public Constituency

7.1 An individual who lives in an area specified in Annex 1 as an area for a public constituency may become or continue as a Member of the Trust.

7.2 Those individuals who live in an area specified as an area for any public constituency are referred to collectively as the Public

Constituency.

7.3 The minimum number of members in each area of the Public Constituency is specified in Annex 1.

8. Staff Constituency 8.1 An individual who is employed by the Trust under a contract of

employment with the Trust may become or continue as a Member of the Trust provided he is employed by the Trust under a contract of employment which has no fixed term or has a fixed term of at least 12 months; or he has been continuously employed by the Trust under a contract of employment for at least 12 months.

8.2 Those individuals who are eligible for membership of the Trust by

reason of the previous provisions are referred to collectively as the Staff Constituency.

8.3 The Staff Constituency shall be divided into three descriptions of

individuals who are eligible for membership of the Staff Constituency, each description of individuals being specified within Annex 2 and being referred to as a class within the Staff Constituency.

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8.4 The minimum number of members in each class of the Staff Constituency is specified in Annex 2.

8.5 An individual who is:

8.5.1 eligible to become a member of the Staff Constituency, and 8.5.2 invited by the Trust to become a member of the Staff Constituency and a member of the appropriate class within the Staff Constituency,

shall become a member of the Trust as a member of the Staff Constituency and appropriate class within the Staff Constituency without an application being made, unless he informs the Trust that he does not wish to do so.

9. Restriction on membership

9.1 An individual who is a member of a constituency or of a class within a constituency, may not while membership of that constituency or class continues, be a member of any other constituency or class.

9.2 An individual who satisfies the criteria for membership of the Staff

Constituency may not become or continue as a member of any constituency other than the Staff Constituency.

9.3 An individual must be at least 14 years old to become a Member of

the Trust. 9.4 Further provisions as to the circumstances in which an individual may not become or continue as a member of the Trust are set out in Annex 8 – Further Provisions.

10. Council of Governors – composition

10.1 The Trust is to have a Council of Governors, which shall comprise both elected and appointed Governors.

10.2 The composition of the Council of Governors is specified in Annex 3. 10.3 The members of the Council of Governors, other than the appointed

members, shall be chosen by election by their constituency or, where there are classes within a constituency, by their class within that constituency. The number of Governors to be elected by each constituency, or, where appropriate, by each class of each constituency, is specified in Annex 3.

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11. Council of Governors – election of Governors

11.1 Elections for elected members of the Council of Governors shall be

conducted in accordance with the Model Election Rules. 11.2 The Model Election Rules as published from time to time by the

Department of Health form part of this Constitution. The Model Election Rules current at the date of the Trust’s authorisation as an NHS foundation trust are attached at Annex 4

11.3 A subsequent variation of the Model Election Rules by the

Department of Health shall not constitute a variation of the terms of this Constitution for the purposes of paragraph 40 of the Constitution (amendment of the Constitution).

11.4 An election, if contested, shall be by secret ballot.

12. Council of Governors - tenure

12.1 Subject to the provisions contained in Annex 5 paragraph A5.3 (Initial tenure of office for the Council of Governors) an elected Governor may hold office for a period of up to 3 years.

12.2 An elected Governor shall cease to hold office if he ceases to be a

member of the constituency or class by which he was elected. 12.3 An elected Governor shall be eligible for re-election at the end of his

term but may not serve more than three consecutive terms or 9 years whichever is the lesser.

12.4 An appointed Governor may hold office for a period of up to 3 years. 12.5 An appointed Governor shall cease to hold office if the appointing

organisation withdraws its sponsorship of him or, he ceases to be employed by the appointing organisation.

12.6 An appointed Governor shall be eligible for re-appointment at the

end of his term but may not serve more than three consecutive terms or 9 years whichever is the lesser.

13. Council of Governors – disqualification and removal

13.1 The following may not become or continue as a member of the Council of Governors:

13.1.1 a person who has been adjudged bankrupt or whose estate has been sequestrated and (in either case) has not been discharged;

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13.1.2 a person who has made a composition or arrangement with, or granted a trust deed for, his creditors and has not been discharged in respect of it;

13.1.3 a person who within the preceding five years has been convicted in the British Islands of any offence if a sentence of imprisonment (whether suspended or not) for a period of not less than three months (without the option of a fine) was imposed on him.

13.2 Governors must be at least 16 years of age at the date they are

nominated for election or appointment. 13.3 Further provisions as to the circumstances in which an individual may not become or continue as a member of the Council of Governors are set out in Annex 5.

14 Council of Governors – meetings of governors

14.1 The Chairman of the Trust (i.e. the Chairman of the Board of Directors, appointed in accordance with the provisions of paragraph 22.1) or, in his absence the Deputy Chairman (appointed in accordance with the provisions of paragraph 23 below), shall preside at meetings of the Council of Governors.

14.2 Meetings of the Council of Governors shall be open to members of

the public. Members of the public may be excluded from a meeting on the grounds more particularly provided for in Annex 6, paragraph 4.1.2

15. Council of Governors – standing orders The standing orders for the practice and procedure of the Council of Governors are attached at Annex 6. 16. Council of Governors - conflicts of interest of Governors If a Governor has a pecuniary, personal or family interest, whether that interest is actual or potential and whether that interest is direct or indirect, in any proposed contract or other matter which is under consideration or is to be considered by the Council of Governors, the Governor shall disclose that interest to the members of the Council of Governors as soon as he becomes aware of it. The Standing Orders for the Council of Governors shall make provision for the disclosure of interests and arrangements for the exclusion of a Governor declaring any interest from any discussion or consideration of the matter in respect of which an interest has been disclosed.

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17. Council of Governors – travel expenses

The Trust may pay travelling and other expenses to members of the Council of Governors at rates determined by the Trust.

18. Council of Governors – further provisions Further provisions with respect to the Council of Governors are set out in Annex 5. 19. Board of Directors – composition

19.1 The Trust is to have a Board of Directors, which shall comprise both Executive and Non-Executive Directors.

19.2 The Board of Directors is to comprise:

19.2.1 a non-executive Chairman; 19.2.1 not more than 7 other Non-Executive Directors; and 19.2.3 not more than 7 Executive Directors.

19.3 One of the Executive Directors shall be the Chief Executive. 19.4 The Chief Executive shall be the Accounting Officer.

19.5 One of the Executive Directors shall be the Director of Finance. 19.6 One of the Executive Directors is to be a registered medical

practitioner or a registered dentist (within the meaning of the Dentists Act 1984).

19.7 One of the Executive Directors is to be a registered nurse or a

registered midwife. 19.8 Save where more than one person is appointed jointly to a post of

Executive Director and shares a vote in accordance with paragraph 2.6 of Annex 7, the Directors shall at all times have one vote each save that where the number of votes for and against a motion is equal, the Chairman shall be entitled to exercise a second and casting vote.

20. Board of Directors – qualification for appointment as a Non-Executive Director

A person may be appointed as a Non-Executive Director only if – 20.1 he is a member of the Public Constituency, and

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20.2 he is not disqualified by virtue of paragraph 26 below.

21. Board of Directors – appointment and removal of Chairman and other Non-Executive Directors

21.1 The Council of Governors at a general meeting of the Council of Governors shall appoint or remove the Chairman of the Trust and the other Non-Executive Directors.

21.2 Removal of the Chairman or another Non-Executive Director shall

require the approval of three-quarters of the members of the Council of Governors.

21.3 The initial Chairman and the initial Non-Executive Directors are to be

appointed in accordance with paragraph 22 below. 22. Board of Directors – appointment of initial Chairman and initial other

Non-Executive Directors

22.1 The Council of Governors shall appoint the chairman of the Applicant NHS Trust as the initial Chairman of the Trust, if he wishes to be appointed.

22.2 The power of the Council of Governors to appoint the other Non-

Executive Directors of the Trust is to be exercised, so far as possible, by appointing as the initial Non-Executive Directors of the Trust any of the non-executive directors of the Applicant NHS Trust (other than the Chairman) who wish to be appointed.

22.3 The criteria for qualification for appointment as a Non-Executive

Director set out in paragraph 20 above (other than disqualification by virtue of paragraph 26 below) do not apply to the appointment of the initial Chairman and the initial other Non-Executive Directors in accordance with the procedures set out in this paragraph.

22.4 An individual appointed as the initial Chairman or as an initial Non-

Executive Director in accordance with the provisions of this paragraph shall be appointed for the unexpired period of his term of office as Chairman or (as the case may be) Non-Executive Director of the Applicant NHS Trust; but if, on appointment, that period is less than 12 months, he shall be appointed for 12 months.

23. Board of Directors – appointment of Deputy Chairman The Council of Governors at a general meeting of the Board of Governors shall appoint one of the non-executive directors as a deputy chairman.

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24. Board of Directors - appointment and removal of the Chief Executive and other Executive Directors

24.1 The Non-Executive Directors shall appoint or remove the Chief Executive.

24.2 The appointment of the Chief Executive shall require the approval of

the Council of Governors. 24.3 The initial Chief Executive is to be appointed in accordance with

paragraph 25 below. 24.4 A committee consisting of the Chairman, the Chief Executive and the

other Non-Executive Directors shall appoint or remove the other Executive Directors.

25. Board of Directors – appointment and removal of initial Chief Executive

25.1 The Non-Executive Directors shall appoint the chief officer of the Applicant NHS Trust as the initial Chief Executive of the Trust, if he wishes to be appointed.

25.2 The appointment of the chief officer of the Applicant NHS Trust as

the initial Chief Executive of the Trust shall not require the approval of the Council of Governors.

26. Board of Directors – disqualification The following may not become or continue as a member of the Board of Directors:

26.1 a person who has been adjudged bankrupt or whose estate has been sequestrated and (in either case) has not been discharged. 26.2 a person who has made a composition or arrangement with, or granted a trust deed for, his creditors and has not been discharged in respect of it. 26.3 a person who within the preceding five years has been convicted in

the British Islands of any offence if a sentence of imprisonment (whether suspended or not) for a period of not less than three months (without the option of a fine) was imposed on him.

27. Board of Directors – standing orders The standing orders for the practice and procedure of the Board of Directors are attached at Annex 7.

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28. Board of Directors - conflicts of interest of Directors

If a Director has a pecuniary, personal or family interest, whether that interest is actual or potential and whether that interest is direct or indirect, in any proposed contract or other matter which is under consideration or is to be considered by the Board of Directors, the Director shall disclose that interest to the members of the Board of Directors as soon as he becomes aware of it. The Standing Orders for the Board of Directors (Annex 7) shall make provision for the disclosure of interests and arrangements for the exclusion of a director declaring any interest from any discussion or consideration of the matter in respect of which an interest has been disclosed.

29. Board of Directors – remuneration and terms of office

29.1 The Council of Governors at a general meeting of the Council of Governors shall decide the remuneration and allowances, and the other terms and conditions of office, of the Chairman and the other Non-Executive Directors.

29.2 The Trust shall establish a committee of Non-Executive Directors to

decide the remuneration and allowances, and the other terms and conditions of office, of the Chief Executive and other Executive Directors.

30. Registers The Trust shall have:

30.1 a register of Members showing, in respect of each Member, the constituency to which the Member belongs and, where there are classes within it, the class to which the Member belongs;

30.2 a register of members of the Council of Governors; 30.3 a register of interests of Governors; 30.4 a register of Directors; and 30.5 a register of interests of the Directors.

31. Admission to and removal from the registers

31.1 The Secretary shall ensure the removal from the register of members of the name of any Member who ceases to be entitled to be a Member under the provisions of this Constitution as soon as he is notified or becomes aware of any change.

31.2 The Secretary shall ensure that all registers are maintained and

updated.

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32. Registers – inspection and copies

32.1 The Trust shall make the registers specified in paragraph 30 above available for inspection by members of the public, except in the circumstances set out below or as otherwise prescribed by regulations.

32.2 The Trust shall not make any part of its registers available for

inspection by members of the public which shows details of any Member of the Trust, if the Member so requests.

32.3 So far as the registers are required to be made available:

32.3.1 they are to be available for inspection free of charge at all reasonable times; and 32.3.2 a person who requests a copy of or extract from the registers is to be provided with a copy or extract.

32.4 If the person requesting a copy or extract is not a Member of the

Trust, the Trust may impose a reasonable charge for doing so. 33. Documents available for public inspection

33.1 The Trust shall make the following documents available for inspection by members of the public free of charge at all reasonable times:

33.1.1 a copy of the current constitution; 33.1.2 a copy of the current Terms of Authorisation; 33.1.3 a copy of the latest annual accounts and of any report of the auditor on them; 33.1.4 a copy of the latest annual report; 33.1.5 a copy of the latest information as to its forward planning; and 33.1.6 a copy of any notice given under section 52 of the 2006 Act.

33.2 Any person who requests a copy of or extract from any of the above

documents is to be provided with a copy. 33.3 If the person requesting a copy or extract is not a Member of the

Trust, the Trust may impose a reasonable charge for doing so.

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34. Auditor

34.1 The Trust shall have an auditor. 34.2 The Council of Governors shall, taking into account the

recommendations of the Audit Committee, appoint or remove and agree the remuneration of, the auditor at a general meeting of the Council of Governors.

35. Audit committee

The Trust shall establish a committee of Non-Executive Directors as an Audit Committee to perform such monitoring, reviewing and other functions as are appropriate.

36. Accounts

36.1 The Trust must keep proper accounts and proper records in relation to the accounts.

36.2 Monitor may with the approval of the Secretary of State give

directions to the Trust as to the content and form of its accounts.

36.3 The accounts are to be audited by the Trust’s auditor.

36.4 The Trust shall prepare in respect of each Financial Year annual accounts in such form as Monitor may with the approval of the Secretary of State direct.

36.5 The functions of the Trust with respect to the preparation of the

annual accounts shall be delegated to the Accounting Officer. 37. Annual report, forward plans and non-NHS work

37.1 The Trust shall prepare an Annual Report and send it to Monitor. 37.2 The Trust shall give information as to its forward planning in respect

of each Financial Year to Monitor. 37.3 The document containing the information with respect to forward

planning (referred to above) shall be prepared by the Directors. 37.4 In preparing the document, the Directors shall have regard to the

views of the Council of Governors. 37.5 Each forward plan must include information about:

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The activities other than the provision of goods and services for the purposes of the health service in England that the Trust proposes to carry on, and

The income it expects to receive from doing so

37.6 Where a forward plan contains a proposal that the Trust carry on an activity of a kind mentioned in sub-paragraph 37.5, the Council of Governors must:

Determine whether it is satisfied that the carrying on of the

activity will not to any significant extent interfere with the fulfilment by the Trust of its principal purpose or the performance of its other functions, and

Notify the Directors of the Trust and its determination 37.7 A Trust which proposes to increase by 5% or more the proportion of

its total income in any financial year attributable to activities other than the provision of goods and services for the purposes of health service in England may implement the proposal only if more than half the members of the Council of Governors of the Trust voting approve its implementation.

38. Meeting of Council of Governors to consider annual accounts and reports

The following documents are to be presented to the Council of Governors at a general meeting of the Council of Governors:

38.1 the annual accounts 38.2 any report of the auditor on them

38.3 the annual report.

39. Instruments

39.1 The Trust shall have a seal. 39.2 The seal shall not be affixed except under the authority of the Board

of Directors. 40 Amendment of the Constitution

40.1 Amendments by the Trust of its Constitution are to be made with the approval of Monitor. For the avoidance of doubt, any amendments to the annexes attached to this Constitution must also be approved by Monitor.

40.2 No proposal for amendment of this Constitution shall be put to

Monitor unless it has been approved by the Board of Directors,




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which shall first have consulted the Council of Governors on each such proposal.

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LIST OF ANNEXES (NOT INCLUDED) ANNEX 1 – THE PUBLIC CONSTITUENCY ANNEX 2 – THE STAFF CONSTITUENCY ANNEX 3 – COMPOSITION OF COUNCIL OF GOVERNORS ANNEX 4 –THE MODEL ELECTION RULES

ANNEX 5 – ADDITIONAL PROVISIONS – COUNCIL OF GOVERNORS ANNEX 6 – STANDING ORDERS FOR THE PRACTICE AND PROCEDURE OF

THE COUNCIL OF GOVERNORS ANNEX 7 - STANDING ORDERS FOR THE PRACTICE AND PROCEDURE OF THE BOARD OF DIRECTORS

ANNEX 8 – FURTHER PROVISIONS

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Agenda Item: 14



Title Audit Committee Report

Lead Director Eddie Weiss, Non Executive Director / Chair of Committee


Purpose of the paper

To bring to the attention of the Trust Board: the report from the Audit Committee meeting held on 3

September 2012 the Audit Committee annual report for the 2011/12 financial

year


The Board is requested to NOTE the report.










the Audit Committee reviewed the Board Assurance Framework and risk register at its meeting on 3 September (page 1)

the Audit Committee’s remit includes oversight of risk management (page 5)

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) The Trust have a responsibility, both to Monitor and CQC, for having robust governance arrangements in place. The remit of the Audit Committee includes seeking assurance that good governance is in place.


As highlighted on page 6, the Audit Committee were informed by the Audit Commission that unqualified (positive) audit opinions had been issued both in terms of the annual accounts and the Trust’s value for money arrangements.


The Council of Governors (CoG) have received this paper as part of the process of them receiving all Board meeting in public papers. The CoG have also recently appointed new external auditors for the Trust, and these auditors will report on the outcomes of their work to the Audit Committee.


No direct implications.


Previous reports from the Audit Committee to the Trust Board.


REPORT OF THE AUDIT COMMITTEE FOLLOWING ITS MEETING OF 3RD

SEPTEMBER 2012

Key areas of discussion and decision included the following: Agenda item/title

Background information

Action

Internal Audit Report

The Committee received and discussed the progress report September 2012. The report commented on several routine matters but nothing of significance needs to be bought to the Board’s attention.

The Board to

NOTE.

External Audit Report

Progress Report It was noted that the Audit Commission had provided the Committee with their final report on progress in 2012/13 as SCAS’s external auditors. Annual Audit Letter The annual audit letter outlined all the work that the Audit Commission had completed as auditors for 2011/12. It was noted that the Audit Commission would resign on 9 September 2012, just before new auditors were appointed. The meeting recorded its appreciation for the work of the Audit Commission over the years they had been SCAS External Auditors and particularly thanked MG and CR for their help and wished them luck for the future.

The Board to

NOTE.

Review of BAF and Risk Register

The Committee received the BAF and Risk Register and noted the red risks. The meeting felt that more emphasis needed to be given to the potential prejudicial effect of the demand for private providers and the related expense on the achievement of the year’s budget. This would be added to the Risk Register and BAF and EW would notify the Board.

The Board to

NOTE.

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Policies

The Director of Finance gave a verbal update on SCAS policies; he noted the continuation of the Finance policies update and commented that satisfactory progress was being made overall.

The Board to

NOTE.

Counter Fraud

The Committee received and discussed the progress report August 2012. Nothing of major significance arose.

The Board to

NOTE.

IM&T

The Committee received and discussed the IT resilience report. It was noted that the report had already been submitted to the Board and initial investigations had been carried out. ANS had undertaken a review of the network infrastructure and server configuration/capacity planning and Vodafone had reviewed telephony Further work had been carried out to enhance the Trust’s resilience; Talari boxes had been installed in Bicester and Wokingham and all but one of the main network links had been moved from Virgin Media to the Global Crossing Infrastructure. It was also noted that Neil Knappett had joined SCAS as the Interim Head of IT Resilience to provide additional support.

The Board to

NOTE.

Other reports

No additional reports were submitted to the Committee.

The Board to

NOTE.

Page 2 of 8

Audit Committee Annual Report 2011/2012

1. Purpose of the Report

The Audit Committee has prepared this annual report for the 2011/2012 financial year for the attention of the Board. It sets out how the Audit Committee has satisfied its terms of reference during the year and provides the Board with information relating to its responsibilities.

Production of an Audit Committee Annual Report represents good governance practice and ensures compliance with the Department of Health’s Audit Committee Handbook.

2. Overview

An independent Audit Committee is crucial to the Board’s objective of ensuring that robust and effective internal control arrangements are in place. In addition, an Audit Committee can provide independent scrutiny of the executive arm of the Board, particularly in respect of process and on matters concerned with internal control and governance.

An Audit Committee independently reviews, monitors and reports to the Board on matters associated with the attainment of effective internal control and financial reporting systems. In particular, the Audit Committee focuses on risk, internal control and related assurances that underpin the delivery of the organisation’s objectives.

3. Membership

Audit Committee membership in respect of the 2011/2012 financial year has been:

Mr Edward Weiss, Non-Executive Director and Chair of the Audit Committee

Mr Keith Nuttall, Non-Executive Director and Chair of the Quality and Safety Committee.

Dr Ilona Blue, Non- Executive Director. In addition Mr Colin Hazell was an Audit Committee Member until 31August 2011.

4. Compliance with Terms of Reference

During 2011/2012 the Audit Committee has operated in a manner compliant with its terms of reference. In particular:

the Committee has met seven times during the year. all meetings have been quorate (at least 2 members). the Committee has fully exercised its full range of

responsibilities. summaries of Committee meetings have been

circulated to the Board.

Page 3 of 8

at Board meetings the Audit Chair has brought key issues/concerns to the attention of the Board.

the Committee has reviewed and evaluated its own effectiveness using the Department of Health’s “Audit Committee self-assessment Checklist”, which can be seen at Appendix A

5. Meetings

During the 2011/12 financial year Audit Committee met seven times:

E. Weiss C. Hazell*

K.Nuttall I.Blue**

3rd May 2011 6th June 2011

4th July 2011 5th September 14th November 9th January 2012 6th March 2012

*Resigned – 31 August 2011 ** Appointed – 01 November 2011

6. Audit Provision At the inaugural meeting of the Trust in 2006, the Audit Commission were confirmed as the Trust’s external auditors. From the 1st April 2007, and following a comprehensive tender evaluation exercise (which involved the then Chair of the Audit Committee), Parkhill Audit Agency were appointed as the Trust’s internal auditors. Both internal and external auditors have attended all relevant meetings held during 2011/12.

7. Duties and Findings The Audit Committee terms of reference comprises the following main areas of responsibility:

Governance, risk management and internal control

Internal Audit

External Audit

Counter Fraud

Other assurance functions

Management

Financial Reporting

Reporting

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Governance, risk management and internal control The Audit Committee has received regular reports on the governance, risk management and internal control processes throughout the period. It has also made extensive use of the Trust’s Board Assurance framework and Risk Register.

There is cross-membership between the Audit Committee and the Quality and Safety Committee whose Chair is a member of the Audit Committee. Minutes of the Quality and Safety Committee are submitted to the Audit Committee and this Committee also produces an annual report on its activities for the Board.

The Board and the Audit Committee regularly review the effectiveness of the Trust’s overall governance arrangements and the Chairs work closely together to ensure an effective programme of work across the year.

No significant control issues were identified for inclusion in the Statement of Internal Control. However the following matters should be mentioned:

Education & Training – The planned annual programme was not fully completed due to operational pressures which restricted staff being released from duty.

Workforce – Recruitment of trained clinical staff has been a challenge due to a national shortage of paramedics following the transfer of Paramedic education to a degree based qualification.

Certain matters require more attention, including the payroll exception reports and the need to ensure that there is similarity of payroll reporting across all Divisions of the Trust.

Counter Fraud In the previous year the Committee appointed CEAC as their Counter fraud specialist for the Trust. During 2011/12 the Audit Committee has been kept updated with progress against the Counter fraud plan at every meeting, with the LCFS attending alternate meetings. In it’s Qualitative Assessment of Counter Fraud activity at the Trust, NHS Protect again assessed the Trust as being a level 3 organisation (organisation performing well) and stated in it’s summary that ‘The organisation has provided evidence of considerable achievements across the full range of counter fraud actions during the year, corresponding to the investment and commitment made to counter fraud work within the organisation. The following results have been achieved at SCAS during 2011/12:

30 awareness ‘events’ (induction, presentations, training sessions, Fraud Awareness Month, HQ visits covering 405 inductees and 20 operational staff;

Awareness/Training session to Executive Team and Trust Board regarding Bribery Act 2010

Awareness/deterrence articles covering - Counter Fraud – local and national update NHS Protect, Mobile phone usage, GP Fit note issues, Local and National case studies and Survey feedback

19 new referrals/queries have been received;

Page 5 of 8

2 transferred into proactive reviews 11 proceeded to a formal investigation ( in accordance with PACE legislation); 6 were resolved without the need for a formal investigation; 16 cases were closed during 2011/12; 4 interviews under caution took place; 1 arrest took place; 1 case received a criminal sanction (guilty verdict and custodial sentence); 4 cases have been referred for internal sanction/disciplinary (2 dismissal, 1 first

written warning, 1 ongoing); 1 case received a caution against their registration at a professional

disciplinary hearing and 1 case is awaiting professional disciplinary hearing; 1 case was subject to recovery of £1988.09 1 case has ongoing recovery in relation to pension contributions (amount not

quantified yet) Ongoing average cost savings to be monitored and reported to audit

committee in respect of proactive work Local Proactive Exercise 10 and Local Proactive Exercise 11.

External Audit The Audit Commission have continued as external auditors for the Trust. The external audit covers 2 key areas in the year-

The audit of the Trust’s accounts for the 2010/11 The review of value for money.

The Trust has received an unqualified audit report and a positive value for money report. Internal Audit The 2011-12 Internal Audit plan was approved at the May 2011 Audit Committee meeting and the members have been kept informed of the progress against the agreed plan at each subsequent meeting. Regular progress meetings have been held with senior management in the Finance department to highlight areas of concern, monitor progress on the plan and re-direct audit resources as applicable. Parkhill attended all Audit Committee meetings in the year and all private sessions with Committee members. Internal Audit have liaised with external audit to co-ordinate work programmes, in order to prevent duplication of effort, where practicable. As in previous years, external audit has been able to rely on the work of Internal Audit for their opinions on the Trust’s final accounts. During 2011/12 we carried out 19 reviews which included three carried forward from 2010/11. In addition Internal Audit routinely followed up on agreed recommendations and the status was reported at each meeting. A the time of reporting, two IT reviews were yet to be finalised (Infrastructure Security – draft issued, were awaiting management responses, Information Governance Toolkit v9 was at review stage).

Page 6 of 8

Of 17 completed internal audit reviews Substantial or Adequate Assurance was provided for all areas except for the following four:-

Payroll Feeder Systems Sickness Management Procurement and Payroll input review.

Suitable recommendations have been made and accepted by Trust management to improve control environment. In total, internal audit work resulted in 79 recommendations, 18 of which were high priority. Based upon and limited to work carried out at the Trust, the Overall Head of Internal Audit Opinion for 2011-12 was that of Significant Assurance. (Significant assurance can be given that there is a generally sound system of internal control, designed to meet the organisation’s objectives, and that controls are generally being applied consistently. However, some weakness in the design and/or inconsistent application of controls put the achievement of particular objectives at risk) For more details, please refer to the 2011-12 Internal Audit Annual Report, presented at the May 2012 Audit Committee. Other Assurance Functions The Committee has a role in considering all assurance matters and reviewing the findings of the other significant functions. The Audit Committee has no matters which it needs to bring to the attention of the Board. Management and Reporting

The terms of reference for the Audit Committee state that the committee shall request and review reports and positive assurances from Directors and Managers as appropriate.

The Audit Committee has again been proactive in this respect and in particular during 2011/12 has requested a range of supplementary reports on matters relating to IT and to the control of non-contractual PTS trips.

During the year, the Chief Executive, the Chief Operating officer and the HR Director have all attended Audit Committee meetings to consider relevant issues.

8. Conclusions and further challenges The Audit Committee has met its terms of reference for 2011/12. The key area for 2012/13 is for the Committee to ensure that the present high standards of internal control and governance are maintained particularly as the Trust

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is now a Foundation Trust and at a time when the present financial environment is increasingly challenging. Edward Weiss, Audit Committee Chairman Date: Monday 3rd September 2012

Agenda Item: 15



Title Quality and Safety Committee Report

Lead Director Keith Nuttall, Non Executive Director / Chair of Committee


Keith Nuttall, Non Executive Director

Purpose of the paper To update and assure the Trust Board on the quality and patient safety work stream areas.


The Trust Board is asked to receive and note the summary report










All clinical risks are detailed in the trust risk register and integrated performance report that link to the quality work streams.


All quality related workstreams aid and enhance compliance with the CQC essential standards. Information provided in this paper provides evidence of compliance.


The Quality Impact assessment are risk assessed for the impact on Quality


Quality and Patient Safety work streams are shared with commissioners and stakeholders through regular updates and meetings and performance shared through the Integrated Performance Report


Links to all elements of NHS constitution.

Other

Supporting information, including background papers and previous considerations by the Board

Quality and safety report is presented at every Board meeting and quality accounts were presented to the Council of Governors.

Summary Upward Report Upward reporting from the Quality & Safety Committee to the Trust Board (26 September 2012) Issues identified by the Quality & Safety Committee on 16 August 2012 Topic Issue Action Taken

Items with issues not achieved/ compliant

1 Progress with Response Bag project

Project not yet completed following Task and Finish Group – now outstanding.

Report, recommendation and actions to be concluded by September Trust Board meeting.

2. Focus on highlighting and identifying metrics, understanding the actions and follow through with time lines and conclusion

Lack of assurance that actions are managed and monitored with timescales and conclusions

FT to look at the option of the Committee receiving an upward report from the Executive Team.

Areas of Concern/ Risk

3. Red rated risks in corporate risk register reviewed specifically:

Delays in delivery of care due to poor performance resulting in poor patient experience.

Monitoring daily and weekly by Executive and Operations team through IPR. Highlight report to be provided at next Q&S Committee meeting outlining recovery and improvement plans.

4.

Continued delays at ED departments resulting in risks to responding to patients.

Continued focus on escalation and joint working on handover plans. NEDs and Medical Director plan to meet acute trust CEO/Medical Director of key trusts.

1

2

5. Inadequate resourcing and resilience to meet demand.

Workforce plan to be on next agenda and to have a detailed report. The Trust Board to note how time consuming this area is and the amount of the effort being placed on recruitment.

6. Effectively manage sickness and absence. Monitoring of actions. Continued performance management of sickness – review at Trust Board meeting. The Trust Board to note the NEDs’ extreme concern.

Items for awareness / assurance

7. Leadership Walkrounds

Visits continue with NED’s and Executive Directors. Actions reported to Operations teams for resolution. Revisit to Fareham to check progress

8. Enhanced medical care proposal

Bid developed by University Hospitals Southampton (UHS) to provide enhanced medical care in Southampton area on Friday and Saturday nights to improve outcomes for critically ill patients.

Operational and governance team to work with UHS to review arrangements and proposal.

9. Policy Review: Safeguarding Infection Prevention Control

& Decontamination Claims Management

Policies approved following review. Board to note.

Best Practice / excellence

10. Team Leader role and front line clinical leadership

Presentation by Team Leader from SE Hampshire on role and areas of improvement.

Board to note best practice and sharing across Trust of benefits of Team Leader role.

FT/Q&S upward report ‐ Aug 2012

Agenda Item: 16



Title Charitable Funds Committee Report

Lead Director Claire Carless, Non Executive Director / Chair of Committee


Purpose of the paper To bring to the attention of the Trust Board, the report from the Charitable Funds Committee meeting held on 19 July 2012.


The Board is requested to NOTE the report.










No direct implications, although the work of the Charitable Funds Committee includes seeking assurance that appropriate controls in place over the management of the Trust’s charitable funds, and that any potential risks are mitigated.

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) No direct implications, although the Trust’s governance rating with Monitor (currently ‘green’) could be affected if there were governance issues around the management of the Trust’s charitable funds.


The Committee discussed, at its meeting on 19 July, the arrangements for the audit and approval of the 2011/12 charity accounts.


There is no formal role for the governors in terms of the Trust’s charitable funds and the associated charity accounts (as opposed to the main Trust accounts).


Charitable funds are applied for purposes that should benefit the provision of healthcare to patients.


Previous reports from the Charitable Funds Committee to the Trust Board.


REPORT OF THE CHARITABLE FUNDS COMMITTEE FOLLOWING ITS MEETING

OF 19 JULY 2012

Key areas of discussion and decision included the following: Agenda item/title

Background information

Action

Review of draft charity accounts 2011/12

The committee reviewed the draft charity accounts and noted no items of concern, ahead of the audit process.

The Board to

NOTE.

Audit of draft charity accounts 2011/12

The committee discussed the arrangements for the audit of the draft charity accounts and agreed that a competitive process was needed to appoint an auditor.

The Board to

NOTE.

Business cases The committee considered three business cases relating to the use of funds at ambulance stations, approving one and asking for further information on two.

The Board to

NOTE.

Page 1 of 1

Agenda Item: 17



Title Remuneration Committee Report

Lead Director Alastair Mitchell-Baker, Vice-Chairman


As above

Purpose of the paper To present to the Board: updated Remuneration Committee Terms of Reference

for Board approval (Appendix A) a review of Remuneration Committee effectiveness for

Board consideration (Appendix B)


To seek approval of the updated Terms of Reference, and for the review of effectiveness to be considered/noted










The work of the Remuneration Committee includes to ensure that there is good governance in place for the areas covered by its terms of reference. The Committee, for example, helps to ensure that key decisions associated with the employment/remuneration of staff are made in accordance with the relevant legislation (thus mitigating the potential risk of non-compliance).

Implications Regulatory and legal implications / impact (e.g. Monitor terms of authorisation and risk ratings, CQC essential standards) The Committee has a role to ensure that the Trust complies with relevant legislation.


N/A to this particular paper.


N/A to this particular paper (the remit of the Council of Governors, in terms of remuneration issues, covers the Chair and Non-Executive Directors, whilst the Remuneration Committee deals with the executives of the Trust).


The Committee is responsible for ensuring that a policy and process for remuneration and terms of service, and performance review and appraisal, of the Chief Executive, Executive Directors and senior managers are in place and that they are agreed by the Trust Board


N/A

APPENDIX A

SOUTH CENTRAL AMBULANCE SERVICE NHS FOUNDATION TRUST

REMUNERATION, NOMINATION AND TERMS OF SERVICE COMMITTEE

Terms of Reference Constitution The Board hereby resolves to establish a Committee of the Board to be known as the Remuneration, Nominations and Terms of Service Committee (The Committee). The Committee is a non-executive committee of the Board and has no executive powers, other than those specifically delegated in these Terms of Reference. Membership The Committee shall be appointed by the Board from amongst the Non-Executive directors of the Trust and shall consist of not less than three members. A quorum shall be two members. One of the members will be appointed Chair of the Committee by the Board. Attendance The Director of Human Resources and/or appropriate Human Resources Advisers shall normally attend meetings to provide professional support. On occasion, the Chief Executive and other executive directors may be invited to attend, but must withdraw when the Committee is discussing their particular remuneration packages. The Director of Human Resources shall be Secretary to the Committee and shall attend to take minutes of the meeting and provide appropriate support to the Chairman and Committee members. Frequency Meetings shall be held not less than two times a year. The Director of Human Resources may request a meeting if they consider that one is necessary. Authority The Committee is authorised by the Board to investigate any activity within its terms of reference. It is authorised to seek any information it requires from any employee and all employees are directed to co-operate with any request made by the Committee. The Committee is authorised by the Board to obtain outside legal or other independent professional advice and to secure the attendance of outsiders with relevant experience and expertise if it considers this necessary. The Committee is authorised by the Board to make decisions in respect of remuneration and terms of service of the Chief Executive and Executive Directors in line with current DH guidance and Monitor processes, taking due consideration of market factors in setting remuneration levels for new and existing Directors, and of

Reviewed - June 2012 Page 1 of 3 Appendix A For Board approval - Sept 2012

appraisal and performance review when considering annual uplifts and performance related bonuses. The Committee is authorised by the Board to make decisions in respect of termination of the Chief Executive, Executive Directors and other staff, following best practice guidance as currently laid down by NHS Employers and Monitor process. Duties The duties of the Committee can be categorised as follows: Salaries (including performance-related elements/bonuses), provisions for other benefits (including pensions and cars), and arrangements for termination of employment and other contractual terms. The Committee is responsible for ensuring that a policy and process for remuneration and terms of service, and performance review and appraisal, of the Chief Executive, Executive Directors and senior managers are in place and that they are agreed by the Trust Board. The implementation of the policy and processes is the responsibility of the Chairman of the Trust in respect of the Chief Executive, and the Chief Executive in respect of other Executive Directors and senior managers. In particular, the Committee will: Consider and agree the remuneration and terms of service of the Chief

Executive and Executive Directors to ensure that they are fairly rewarded for their individual contributions to the performance of the Trust, having proper regard for the organisational circumstances, and national and local planning and priorities. Where it is deemed necessary, final decisions will not be taken regarding remuneration, terms of service or termination until the Chair of the Committee has consulted all Non Executive Directors who are not members of the Committee.

Agree a Remuneration Policy for senior managers and oversee its application.

Monitor and evaluate the performance of the Chief Executive and Executive Directors, in which they will be advised, as appropriate, by either the Chairman of the Trust or the Chief Executive.

Oversee the development and performance management of senior management. Normally this will apply to managers reporting directly to Executive Directors.

Agree and oversee appropriate contractual and terms of service arrangements for the Chief Executive and Executive Directors, including the proper calculation and scrutiny of termination payments, taking account of national and other guidance.

Consider internal and external guidance in carrying out its duties, including compliance with the Trust’s Standing Orders and Standing financial Instructions; the NHS Codes of Openness, Conduct & Accountability, and Corporate Governance; relevant pay and contractual arrangements for Trust Executive staff; legal compliance, accepted best practice and high standards of probity.

Provide the Board with formal reports as required relating to remuneration, terms of service and termination relating to the Chief Executive and Executive Directors



In line with best practice and as recommended by NHS Employers guidance, the committee will follow the same process of scrutiny of termination payments to all Trust employees. Appointments The Committee is responsible for ensuring that a policy and process for the appointment of the Chief Executive and Executive Directors is in place, and that they are agreed by the Trust Board. The implementation of the policy is the responsibility of the Chairman of the Trust for the Chief Executive and the Chief Executive in respect of other Executive Directors. In particular the Committee will: Ensure an appropriate process is in place for the selection and recruitment of

the Chief Executive and Executive Directors, and recommend to the Board the appointment of the Chief Executive and Executive Directors.

Ensure a succession plan is in place for Executive Directors and senior Trust staff, taking account of the challenges and opportunities facing the Trust and therefore the skills and expertise needed for the future.

When considering new appointments, take account of the required structure,

size and composition of the Board, including skills, knowledge and experience.

Reporting Reports from each Committee meeting will be presented to the Trust Board for consideration at its next meeting. The Trust Board will note the key issues and decisions therein. Any decisions made by the Committee should be clearly stated with the Trust Board minutes. On occasions the Committee may take the view that the matter on which it is reporting to the Trust Board should not be openly reported (eg the Committee may wish to report on a matter that it considers commercial in confidence, or present information that is person identifiable). In such circumstances the Committee should seek advice as to whether an exemption may be applied from the Freedom of Information Act. If so, the Committee should report to the next Trust Board meeting in closed, confidential session, under an exemption that should be clearly spelt out in its report. Other Matters The Committee shall be supported administratively by the Director of Human Resources and duties in this respect will include: Agreement of agenda with Chairman and attendees and collation of papers. Taking the minutes and keeping a record of matters arising and issues to be

carried forward. Advising the Committee on pertinent areas.

of 2 Appendix B For Board noting - Sept 2012

APPENDIX B

REVIEW OF REMUNERATION AND NOMINATION COMMITTEE EFFECTIVENESS. July 2012

1. This short review is based on discussions at the Remuneration, Nomination and

Terms of Service Committee between three current members; Trevor Jones, Trust Chair, Claire Carless and Alastair Mitchell-Baker.

2. Composition, Attendance, Establishment and Duties

a. The committee’s self-assessment is that it is performing competently across the range of its duties.

b. The committee’s TOR were revised in February 2010 in line with central guidance and in preparation for FT status, and subsequently approved by the Board. They have been reviewed again by the Committee in June 2011.

c. From April 2011 – March 2012, we held 9 meetings (including virtual), with full attendance of members of the committee, although one meeting was informal and no minutes were taken.

d. The committee chair throughout the year has been Alastair Mitchell-Baker. 3. Governance Issues

a. The committee’s self-assessment is that it is generally performing competently across these areas.

b. During the year the Committee has spent considerable time reviewing and agreeing the Trust’s position with respect to redundancy business cases, individual Employment Tribunal and legal claims.

c. Recently the Committee has developed a Remuneration Policy for the FT, which has been approved by the Trust Board and revised the contract of employment for Executive Directors.

4. Setting Performance Objectives

a. This is an area where improvement continues to be needed although the Committee’s processes for working with the Chair and Chief Executive to ensure appropriate oversight, approval and review of the annual performance objectives of the Chief Executive and Executive Directors have improved.

b. The Committee will continue to press for further tightening in 2012/13 with more timely and comprehensive reporting.

c. The Committee will be extending it’s oversight of annual performance objectives and review to the next level of Trust senior management following FT authorisation.

5. Appointments

a. The committee appropriately oversees Chief Executive and Executive Director appointments.

b. There are two appointment processes currently underway: for the Director of Strategy and Business Development and Chief Operating Officer.

of 2 Appendix B For Board noting - Sept 2012

c. The Committee has continued to have oversight of succession planning for senior Trust staff.

6. Administration

a. The committee’s self-assessment is that it is performing competently across these areas.

b. It is well supported and advised by the Director of Human Resources. 7. Summary of key development issues

a. The key development area for the Committee will be improving oversight and clarity around Chief Executive, Executive Director and senior management objective setting and review processes.

Alastair Mitchell-Baker Chair, Remuneration and Nominations Committee 16th July 2012