Scottish Ambulance Service Annual Review 2010 - 11 Self

30 Pages·2011·0.28 MB·English

Scottish Ambulance Service
Annual Review 2010 - 11
Self- Assessment Documentation
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TABLE OF CONTENTS
Section 1 Introduction 3
Section 2 Overview 4
Actions from 2010 Annual Review
Overview of 2010/11
Section 3 Improving the Quality of Care and Treatment for Patients: 10
Unscheduled Care Service
 Clinical Strategy and Performance
 Access – Emergency and Unscheduled Care Service
 Air Ambulance Performance
Section 4 Improving the Quality of Care and Treatment for Patients: 18
Scheduled Care Service
 Performance and Access – Scheduled Care Service
Section 5 Improving Health and Reducing Inequalities 20
 Shifting the Balance of Care
 Supporting Remote and Rural Communities
Section 6 Finance and Efficiency 24
 Performance against Financial Targets
 Efficiency Targets
 Workforce
 Integration of Workforce and Financial Planning
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SECTION 1 - INTRODUCTION
The purpose of this Annual Review 2010/11 Self Assessment document is to
provide an overview of the performance of the Scottish Ambulance Service for
2010/11 and to outline the key issues and challenges going forward.
The Scottish Ambulance Service’s vision is to deliver the best patient care
whenever and wherever it is needed. In doing so, we aim to be patient-centred,
clinically excellent and a 24 hour, 7 day a week leading edge service.
Wehave three key goals:
 To improve patient access and referral to the most appropriate care
 To deliver the best service for patients
 To engage with all our partners and communities to deliver improved health
care.
This document reports against our targets for 2010/11 which directly contribute to
the Scottish Government’s national outcomes.
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SECTION 2 - OVERVIEW
Actions from 2010 Review
The Scottish Ambulance Service has progressed all the actions identified at its
Annual Review in September 2010
2010 Annual Review Action Update and Progress
1. The Scottish Ambulance Service Quality is a standing agenda item on
should prioritise Quality on Board the Service’s Board meeting agenda.
agendas, continue the process of staff The Service has put in place a wide-
engagement, identify and share ranging quality improvement
examples of good practice in quality programme which will deliver
improvement and work in partnership improvements to patient care while
with colleagues across the NHS, Public improving efficiency. Progress against
Sector and Third Sector to pursue three priority projects:
Quality Strategy ambitions.
 improving access to PTS
 workforce planning and working
practices
 administration support services
has been reported on at the Service’s
monthly Board meetings.
Staff engagement and empowerment
continues, and we have made
significant progress in implementing
our HR and OD strategy: “Doing the
Right Thing,” helping drive a culture of
continuous improvement in the quality
of patient care. Staff input in the three
improvement programmes above has
been instrumental in identifying
opportunities for service enhancement,
the sharing of good practice and
partnership working.
We are working together with NHS
Lanarkshire on a successful pilot of
improvements to PTS, with NHS 24 on
the development of a common triage
tool and with a range of NHS Boards
on a community paramedic model,
helping avoid unnecessary hospital
admissions, while ensuring patients are
appropriately referred in response to
their medical needs.
The Service is continuing to work
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closely with the British Heart
Foundation, British Red Cross and
other voluntary organisations, to further
build community resilience through
increasing the number of Community
First Responder schemes. We have
also worked with Chest Heart and
Stroke Scotland on awareness
campaigns. In February 2011 the
Service gained Investors in Volunteers
accreditation from Volunteer
Development Scotland.
2. The Scottish Ambulance Service Clinical governance is provided through
Board (and its Clinical Governance an organisation-wide structure
Committee) should continue to have reporting to the Clinical Governance
evidence available to it in order to Committee, a sub-committee of the
provide assurances with regard to the Scottish Ambulance Service Board.
robustness of clinical governance and
The Service now has the most
risk management arrangements
comprehensive pre-hospital data
system in the UK, and is continuing to
develop ways to evidence clinical
effectiveness. These include using
clinical information systems to support
clinical audit at local level, and
providing a framework for sharing
learning and continuous improvement,
for example through clinical case
studies and the review of incidents.
Our Clinical Strategy was developed
during the year, with a particular focus
on Patient Safety, Clinical Leadership
and evidence-based practice.
3. The Scottish Ambulance Service The Service has significantly reduced
should ensure momentum and the number of cancellations of PTS
progress on improving the journeys, achieving less than 1%
management and performance of the during the year to March 2011.
Scheduled Care Service (PTS),
The Improving Access to PTS
alongside continuing to work with
programme has consulted extensively
partners to support those patients who
with staff, patients and carers to
do not have a medical need for
identify areas for improvement, which
transport.
will streamline systems and process to
improve patient access to PTS, and
focusing resources on the patients who
need the service. In line with the Audit
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Scotland report: “Transport for health
and social care” the Service is working
closely with NHS Board and volunteer
partners to signpost alternative
transport options to patients who do not
have a medical need.
4. The Scottish Ambulance Service Patient safety is at the forefront of the
should continue active participation in Service’s clinical strategy. The Service
the Scottish Patient Safety Programme. works to national best practice
guidelines from the Scottish Patient
Safety Programme, as well as the
Manchester Patient Safety Framework
- Ambulance and the National Patient
Safety Agency. For example the
Service has adopted the model for
improvement (Plan, Do Study, Act)
recommended by the Scottish Patient
Safety Programme and has a specific
Patient Safety action plan within our
Clinical Strategy.
Working in partnership with Nursing
Midwifery and Allied Health
Professions Research Unit
(NMAHPRU) at the University of
Stirling, the Service carried out a
national study to develop a prioritised
vehicle equipment check-sheet (VECS)
for use by paramedics in practice. The
prioritised nature of the VECS ensures
that the most important items are
checked first, so that ambulance
clinicians can be confident that life-
saving equipment is present and
functioning, even if they are called to
an emergency before a complete check
can be carried out. The VECS study
won a national research prize in
February 2011.
5. The Scottish Ambulance Service Working closely with NHS Boards, the
should ensure that there is a robust Service has developed a new approach
strategy for managing demand on the to triaging and tasking in relation to Air
Air Ambulance Service, working closely Ambulance resource. Year on year,
with NHS Boards to ensure the best this has reduced the number of
use of available resources to meet missions by approximately 14.3%,
clinical need. again, focusing resource on those
patients who need it. The Service has
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also supported the roll out of the
Emergency Medical Retrieval Service
to all of Scotland, and is a key partner
in the review of Specialist Retrieval
Services.
6. The Scottish Ambulance Service The Single Common Triage Tool
must continue to work with NHS 24 and programme has been established and
other partners in developing a common requirements gathered, with the
integrated triage system and clinical programme linking closely with the
pathways that support continuous NHS 24 SFLA programme. Both the
improvement to the patient experience Scottish Ambulance Service and NHS
of contacting unscheduled care 24 have approved the formation of a
services. joint programme governance structure.
Membership of the working groups of
the Single Common Triage Tool
Programme includes
National Representatives from A&E,
GPs and Out of Hours Services ( from
NHS Partner Boards) The Programme
has also been presented to wider
clinical and patient groups at various
Unscheduled Service meetings
A joint communications strategy has
been developed and presented to
the PPF groups of both organisations.
7. The Scottish Ambulance Service The Service recognises that success of
should ensure that staff, and their our wide ranging programmes driving
representatives, are fully engaged in improvements to patient care is
the development and operation of the dependent on high levels of
organisation. engagement with staff.
The Service has developed several key
strategies: our Human Resources and
Organisational Strategy, our Clinical
Strategy, our Community Resilience
Strategy – all with input from staff and
staff-side. In addition, staff and staff-
side have also been engaged in three
improvement programmes:
 improving access to PTS
 workforce planning and working
practices
 administration support services.
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2.2 Overview of 2010-11
In the course of 2010/11 the Service has continuously strived to fulfil the
ambitions of the Quality Healthcare Strategy, delivering person-centred, safe and
effective care to patients.
Working with patients, carers, the public, NHS Boards and third sector and
voluntary groups, and with staff, the Service put in place a range of action plans
to deliver the aims of the five year strategic framework: “Working Together for
Better Patient Care: ”to be patient centred, clinically excellent and leading edge.
Our focus during 2010/11 has been working towards the three goals of our
strategic framework:
 to improve patient access and referral to the most appropriate care;
 to deliver the best service for patients;
 to engage with our partners and communities to deliver improved
healthcare.
Our progress towards these goals has contributed to the achievement of the six
Quality Outcomes.
The following summary outlines the key achievements in delivery and
performance:
 Maintained an average response time to Category A calls at 6.9 minutes
across Scotland
 Category A performance maintained at 72% over the year 2010/11 despite
the severe weather conditions in December 2010.
 Improved response performance in Island Boards, reaching 54% of all
emergencies within 8 minutes
 Exceeded target (90%) for response to urgent incidents with an agreed
one hour response time
 Conducted a review of access to the Patient Transport Service (PTS) in
order to deliver an improvement programme
 Significantly reduced SAS cancellations for PTS, achieving less than 1%
in March 2011
 Improved triaging and tasking of Air Ambulance Resource, reducing
demand by 14.3%, focusing the service on the people who need it
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 Successfully rolled out the Emergency Retrieval Service across Scotland
 Met or exceeded all three financial targets, further reducing our energy
consumption, operating within revenue and capital limits, meeting the cash
requirement and achieving cash releasing savings
 86% of AfC staff had an Agenda for Change (AfC) Knowledge Skills
Framework (KSF) review by March 2011, against a target of 80%.
 Significant investment in Leadership and Management Development, with
Service managers taking up 358 places on leadership and management
development programmes during this financial year
 Built capability and capacity for Patient Focus Public Involvement, and
undertook an extensive engagement exercise to inform the specification
for the next generation of air ambulances in Scotland
 Achieved Investors in Volunteers Status, with over 1,000 volunteers
working with the Service to support their communities through Community
First Responder schemes.
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Section 3
Improving the Quality of Care and Treatment for Patients:
Unscheduled Care Service
The Service established five strategic programme boards to oversee the delivery
of our strategic framework: “Working Together for Better Patient Care 2010-
2015.” The Emergency and Unscheduled Care Board has focused on a number
of priority deliverables, including the development of a single clinical triage tool
with NHS 24, the development of care pathways and developing shared access
to electronic records.
3.1 Clinical Strategy and Performance
Key Achievements - Performance
 Category A Cardiac Arrest Patients - Throughout the year 2010/11 the
Service responded to 77.4% of cardiac arrest patients within 8 minutes
against the target of 80%. By March 2011 this had improved to 80.1%.
 Return of Spontaneous Circulation - Throughout the year the Service
achieved a rate of survival for cardiac patients at the point of arrival at
hospital of 14.5% against the Service’s target range of 12-20%. By March
2011 this had improved to 19.2%.
 Scottish Early Warning System (SEWS) informed clinical decisions –
The system is a clinical tool which supports the clinical decisions of
paramedics about taking patients to hospital. The Service monitors the
conveyance of patients with the highest SEWS scores, indicating those
who may be seriously unwell and in 96% of cases, these patients were
taken to hospital for further treatment, above the target of 95%.
 Hyper Acute Stroke Patients – The Service maintained a high level of
performance in supporting urgent access to a CT scanner at hospital for
patients suffering hyper acute stroke. 75.5% of such patients were in
hospital within 60 minutes against a target of 80%. Further improvements
will be made as stroke services develop.
Supporting Developments
In 2010/11, the Service developed its Clinical Strategy, approved by the
SAS Board in May 2011 and began to take forward a number of key
initiatives and developments in line with this strategy.
The Service has continued to improve the quality of care provided to
cardiac and stroke patients. Following the successful roll out of our new
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