Dorset Ambulance - Torbay and...2007/01/11 · While Dorset Ambulance can now justly pride itself...

Dorset AmbulanceNHS Trust

Audit committee

Celebrating a year of achievementsI am once again astounded at the progress that you (the staff) of Dorset Ambulance have made this past year by achieving further improvements in patient care and responding to more calls faster than ever before. Developing new services to meet the challenges facing tomorrow’s ambulance services has become a hallmark of the people who are the Dorset Ambulance NHS Trust.

Whilst the wider NHS in general often receive invalid criticism, the ambulance service here in Dorset has once again proved itself to be a dedicated, committed and hard working team of professionals and this is evidenced by the amount of appreciations we continue to receive.

Keeping the patient as the number one focus of our attention has seen improvements such as the FAST (face, arm and speech test) Stroke scheme, LUCAS cardiac device (see page 10 and 11), Continuous Positive Airway Pressure (CPAP) ventilation device for patients with chronic heart failure, more effective pain relief for children and greater awareness of ‘at risk children’ and ‘vulnerable adults’.

We are now an integral part of the NHS local health community, rather than being seen as a provider to it. Through the excellent work of our staff we have improved and further developed partnerships and relationships across Dorset and Somerset, all with the aim of improving the patient experience, as well as making life for our staff easier and more rewarding.

This can, and will, be further enhanced by the reconfiguration of ambulance services here in the South West. The emergence of a new Ambulance Trust from the two existing Dorset Ambulance Trust and Westcountry Ambulance Services, will provide further opportunities to improve patient care, reduce unnecessary overheads, generate greater economies of scale and take best practice from two excellent organisations to provide these benefits to more of our communities.

I am very proud of the achievements by the staff here in Dorset and I would like to use this opportunity to personally thank all of the staff that are part of this success. Well done on another very successful year.

Ken WenmanChief ExecutiveSouth Western Ambulance Service NHS Trust (1 July 2006)Above created from former Dorset Ambulance NHS Trust and Westcountry Ambulance Services NHS Trust

Contents

The Trust 2&3 ChiefExecutive 4&5 Chairman Human Resources 6&7 StaffEmployed Recruitment&Retention AgendaforChange&PerformanceManagement StaffInvolvement 8&9 Health&Welfare EqualOpportunities&Diversity/Equality Education,Training&Development CommercialTraining

Clinical Governance & Risk Annual Report 10&11 Chairman’sAnnualReview ClinicalGovernanceExplained ClinicalDevelopments&Effectiveness ClinicalAuditImprovements 12&13 GoldStandardPainRelief PublicHealth ImprovingPatientCare Patient&PublicInvolvement(PPI) 14&15 Appreciations Complaints PatientAdvice&LiaisonService(PALS) ClinicalGovernanceStarStatus TopMarksRiskManagement Nextsteps

Operations 16&17 Control&CommunicationsCentre Activity&Performance AchievementsSummary 18&19 PatientFocused PlannedPatientCare EmergencyPlanning AmbulanceCareAssistants(ACAs) RapidResponseVehicles 20&21 PatientTransportServices(PTS) Fleet&Equipment NewVehicles AirAmbulances EmergencyCarePractitioners(ECPs) 22&23 CommunityResponderSchemes PROMIS FallersHotline 24&25 InappropriateUseofAmbulanceSrevices UrgentCareServices(UCS)

Financial Summary 2005-06 26to32 Allrequiredfinancialinformation

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04 05 The 2005-06 Annual Report of the Dorset Ambulance NHS Trust

Mr T Jones OBE ChairmanSir B Kenny Non Executive DirectorMr T Ware Non Executive DirectorMrs P Rushton Non Executive DirectorMr J Knowles Non Executive Director (until 31/01/05)Mr K Wenman Chief ExecutiveMr R Ferre Deputy Chief ExecutiveMr C Launchbury Director of FinanceMr R Dunnill Medical DirectorMs J Liggett Associate Director of Corporate AffairsMr T James Associate Director of OperationsMrs N Lane Associate Director of Urgent Care Service Dorset & Somerset

Board members

Register of interestsMr T Jones Member of West Dorset District Council Member of Dorchester Town Council Vice Chairman Scrutiny Panel Local Government Association Member Local Government Pensions Committee Member Dorset Fire Authority Chairman Dorset County Council Audit and Scrutiny Committee Peer Member, Peer Clearing House Improvement and Development Agency Chairman Dorset Film Touring Ltd Trustee Dorchester Community Nursery SchoolSir B Kenny Governor Canford School Trustee – Dorset and Somerset Air Ambulance Charity King of Arms – Order of the BathMr T Ware Non Executive Director Southern Fruits Ltd Non Executive Director Baxters Food Group Director Auld Smokehouse Originals LtdMrs P Rushton East Dorset Magistrates Christchurch Borough Council Standards CommitteeMr K Wenman Board Director (unpaid) – Ambulance Service Association

Management appointmentsThe Executive Directors, comprised of the Chief Executive, Director of Finance, Deputy Chief Executive, all Associate Directors of Human Resources, Operations and Dorset Emergency Care Service {DECS}, were appointed following external advertisement and were not for set periods. Termination procedures are within individual contracts/staff policies/procedures. The Medical Director was employed on an open contract which may be terminated/renewed by the Board. The Chairman was re-appointed by the Secretary of State at the end of 2002 for four years. The other Non Executive Board members were appointed for four years by the NHS Appointments Commission on behalf of the Secretary of State for Health.

While Dorset Ambulance can now justly pride itself on running one of the best performing ambulance services in England, the Board were unanimous in agreeing that we would be even better placed as part of a new larger organisation and I wish everyone well for the future. My thanks go to all my colleagues on the Board who worked so well together to take the Trust forward and in particular to Ken Wenman, our Chief Executive from early 2002. It is the staff and their willingness to embrace new working practices, who have really made the difference. I am proud of my time as Chairman and hope I have left, as my legacy, a Trust eager to embrace change, while remaining at ease with itself.Trevor Jones (OBE) Chairman

Vital statisticsThe Trust covers an area of 1,020 square miles which serves 726,330 people. This figure almost doubles in the peak tourist season. The 2001 Census shows the county of Dorset to have under representation of 20 to 30 year olds, with over the UK average for the age group of 50 plus. Those from minority ethnic groups make up 3.79 per cent of the population.

Chairman

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Valuing staffHuman Resources Top quality services to patients on high calibre staff. Our workforce are, not only highly skilled and professional, but are totally committed to improving the patient experience and delivering optimum standards of care.

This has been proven by the achievement of the NHS Improving Working Lives (IWL) Practice Plus award. The annual staff survey echoes this result by showing the highest return rate in the country, with quality of work life balance/job satisfaction rated in the top twenty per cent.

Staff EmployedAt 31 March 2006, the Trust employed 623 staff equating to a whole time equivalent of 594.

Accident/ Emergency 306

Patient Transport Service 86

Logistics 18

Control 41

Vehicle Maintenance 5

Domestic 8

Admin/ Support 50

Management 27

Urgent Care Service (OOHs Doctors) 82

TOTAL 623

Recruitment and RetentionForty seven staff left the Trust during the year, a turnover of 7.5 per cent. This was significantly down compared with the past two years. There were 122 new starters, to increase frontline staff to accommodate the reduction in the working week of three hours per week per person, under the new Agenda for Change Terms and Conditions. Development opportunities remained high with 69 staff being promoted and a further 34 successfully qualifying as Ambulance Technicians following their year of being student technician status.

Agenda for Change and Performance Management2005-06 continued to embed the NHS new pay and conditions initiative which brings about a fairer system of pay that supports modernised working practices. This is underpinned by an environment of partnership working with staff side representatives. The Trust has applied this principle to all aspects of organisational development.

The Knowledge and Skills Framework (KSF), that forms part of Agenda for Change to promote and enhance development opportunities within the Trust, continues to be rolled out, with individual personal development plans further helping employees and managers identify and meet training needs in order to assist with career progression.

Staff InvolvementStaff are actively encouraged to participate in decision making in a variety of ways. This includes involvement in working groups, an online voting system, team meetings and regular management visits to stations.

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Health and WelfareThe annual sickness rate was 5.93 percent at the year end, continuing the downward trend from past years. Support to staff, which has helped in this year on year reduction, includes reimbursement of chiropractor costs, welfare calls during periods of sickness, regular review where individuals have ongoing health problems, referral to Occupational Health and a 24/7 advice and counselling helpline. In total 15 staff used the helpline during 2005-06.

The high profile zero tolerance of violence towards staff policy continued. During 2005-06, a total of 50 staff experienced violent incidents from patients/public (thankfully none of these staff were seriously injured).

The Trust will continue to work with the Police to prosecute and take a consistent approach in reviewing all serious incidents with the provision of support and feedback to staff on the outcome of each reported incident.

For frontline and support staff involved in particularly difficult incidents the Trust has provided ‘hot’ and ‘cold’ debriefs which have been shown to help staff deal with their feelings afterwards and which also highlight lessons for the future aimed at improving patient care.

One hundred and six staff reported an accident at work and in-house training continues to equip staff with skills to minimise accidents at work.

Equal Opportunities and Diversity/EqualityThe Trust has a commitment to equal opportunities and diversity, supported by policies and procedures including an Equal Opportunities Policy and Race Equality Scheme. The Trust is committed to equality for patients and staff, regardless of race, age, sexual orientation, gender, religion or disability. Steps have been taken to ensure the workforce is representative of the local community and efforts continue to target prospective applicants from Dorset’s 3.79 per cent Black and Minority Ethnic (BME) population which is currently under-represented among staff. The proportion of BME staff employed is 1.75 per cent. The ratio of women employed compared with men is two to three and almost a third of staff are between the ages of forty and fifty.

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

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

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

Commercial TrainingThis training has continued to expand and now includes Police Medic and Resuscitation Council UK courses, as well as those accredited by the Health & Safety Executive. Work with Primary Care is gathering momentum and likewise is the successful First Aid at Work training.

Rolling out this work across the Trust’s new area in the future will be at the top of the agenda for the training team.

Men Women

Full-time 339 156

Part-time 45 83

Total 384 239

BME staff 7 3

Age

18 – 24 16 14

25 – 35 97 82

36 – 45 112 68

46 – 55 92 53

56 – 65 64 21

66+ 3 1

Total 384 239

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Clinical GovernanceChairman’s Annual ReviewClinical Governance has gone from strength to strength and is now fully integrated into all areas of the Trust.

Risk awareness and the management of risk is now well understood and departments currently have their own Risk Register which contributes to the Trust’s overall Risk Register. The number of reported incidents has increased considerably which has helped the audit procedure and enabled front-line crews to get a good feedback on their delivery of patient care. This high level of risk management within the Trust was confirmed when it achieved the top level in the National Risk Management Assessment. We are now only one of three ambulance trusts to achieve this level.

All front line Paramedics can now administer the clot busting drug needed for patients suffering a heart attack, without the need for confirmation from clinical staff at the hospital. This has been brought about by the identification of risks with process of transmitting data to the hospital. Clinical audit developments have included the introduction of oral morphine for pain relief, and trials have been successfully carried out on the LUCAS device (pictured opposite) which is currently being evaluated by the Trust.

This is the last Clinical Governance annual review to be produced under the Dorset Ambulance Trust. I have much enjoyed my role as Chairman of the committee, not only because the meetings embrace such a wide area of the work being done in the Trust, but it has also given me the opportunity to meet those who do the work at the ‘coal face’, and to appreciate how much they contribute to the Trust. It is invidious to pick out names but I must in particular thank Hazel McAtackney and her team for all that they have done to improve the standards of Clinical Governance within the Trust. Well done!

I have no doubt that the formation of the South Western Ambulance Service NHS Trust will reflect the very high standards achieved by Dorset Ambulance NHS Trust.Sir Brian KennyChairman of Clinical Governance committee

Clinical Governance ExplainedClinical Governance is a system through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish.

Implementing Clinical Governance is helping the transformation of culture, of ways of working and of attitudes and systems within the NHS. It is fast becoming a new way of working and a new way of thinking. Helping with this transformational change is the Trust’s growing work with patients and the public. The Trust’s Clinical Governance is changing the way people work, demonstrating that leadership, teamwork and communication is as important to high quality care, as risk management and clinical effectiveness.

All levels of staff have continued to embrace change as the Trust constantly strives to improve the services provided to the population of Dorset, not least the new Contract to provide Out of Hours Primary Care services to Dorset and Somerset. This new facet of patient care is embedding the improvement of patient experience into everyday practice regardless of the discipline in which staff work.

Clinical Developments and EffectivenessThe Trust has numerous ongoing clinical developments and reports on clinical effectiveness but space within the Year End Report does not permit reflection of all of these. More information is available at www.swast.nhs.uk. However, one example of a new initiative is a life saving device called LUCAS (pictured opposite). Staff continue to save lives on the front-line by using the new device. This has enabled ambulance crews to increase survival to hospital for cardiac arrest patients by over ten percent.

Work behind the scenes with the pioneering LUCAS device continues with the Education Team joining forces with Professor Douglas Chamberlain on a European pre-hospital study. Results will be published in the future on the outcome of the study.

Clinical Audit ImprovementsClinical audit is a quality improvement tool used to examine the care we deliver to patients. Closely examining how we treat patients ensures that areas where improvements can be made are identified and addressed.

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The most important contribution of the audit program has been the clinical changes it has to enhance patient care, such as:

Paramedics administering the most effective pain relieving drug availableHeart attack patients now receiving more life-saving thrombolysis than ever beforeClinical treatments being delivered more quicklyPain being treated more effectivelyEnabling the Trust to become the first ambulance service in the UK to allow experienced Ambulance Technicians to practice an extended range of skillsEmpowering staff to become more involved in the audit processEnabling staff to receive basic clinical audit training during the year

The past year has demonstrated that the Trust is a learning organisation committed to quality improvement and audit acting as a powerful catalyst for change to ensure that every patient receives the very best clinical care.

Gold Standard Pain ReliefFollowing the introduction of a more effective pain killer (analgesic) in 2004, many more patients are receiving what is recognised as the gold standard for pain relief. Double the number of patients received intravenous pain relief in 2005-06, a total of 1,582, than the previous twelve months. A potent oral analgesic has also been introduced to improve the management of children and adults experiencing pain.

Public HealthThe Trust Board agreed a Public Health Strategy in 2005 to take forward the Department of Health’s National Strategy ‘Choosing Health: Making Healthier Choices – November 2004’.

The Strategy will be led by the clinical directorate from 2006 onward. The aim of the Strategy is to establish a five year framework of actions to improve access and contribute to the reduction of health inequalities. The strategy identified four priorities for the future:

Tackle the social, economic and environmental determinants of healthSupport and promote healthy lifestylesProtect healthImprove provision of and access to local health and health related services

Improving Patient CareThe Education and Department of Professional Development has undergone its busiest year to date. Some of the notable achievements are reported upon here to celebrate the success of the highly experienced and dedicated team who are helping to improve patient care.

In excess of 50 student technicians in ambulance aid and advanced driving, were trained, which included a ‘blue light’ module. Twelve technicians attained paramedic status with numerous Emergency Care Practitioner (ECP) programmes delivered alongside colleagues at Bournemouth University. Development of non-clinical staff and Ambulance Care Assistants (ACAs) continues with ongoing National Vocational Qualifications (NVQs).

The re-certification training for all operational staff was undertaken at Bournemouth and Weymouth training schools, allowing staff to continue, develop and practice to the required standard with 95 per cent of all staff being successfully re-certified.

Patient and Public InvolvementThe Trust’s Patient and Public Involvement Strategy explicitly states our intention of enabling and empowering patients, members of the public and stakeholders to contribute to the development, organisation and evaluation of services.

An important aspect of patient and public involvement is feedback via appreciations, complaints and the Patient Advice and Liaison Service (PALS). The latter is a relatively new service that provides on the spot advice and help for those who do not wish to make a formal complaint but prefer to raise matters as a concern.

All of these services provide very important opportunities to learn from the experience of patients and all others, who come into contact with the ambulance service. It helps to inform service developments by the Trust responding to patient led suggestions.

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AppreciationsThe Trust was delighted to receive a total of 327 letters of appreciation, an increase of 61 from the previous year. Forty three letters of appreciation were received in February 2006 which was the highest number ever received in a month.

ComplaintsSometimes service users prefer to raise a formal complaint, and comparing these with 2004-05, overall complaints decreased by 16.9 percent. This was an incredible achievement when the service has expanded so much with the new Out of Hours service for Dorset and Somerset now led by the Trust. During 2005-06, the Trust dealt with 94 percent of all complaints within the target of 20 working days. Ninety four percent of all complaints were resolved locally to the satisfaction of the complainant.

Patient, Advice and Liaison Service (PALS) The PALS service received 406 enquiries this year compared to 189 the previous year. The increased use of the service is partly due to expansion of services with the Out of Hours function, but also due to increased and successful promotional activity designed to raise awareness on how to access the service. A total of 239 enquirers (59 percent) received a formal response within 10 working days of receipt of their enquiry, which is the Trust target. Those that were over 10 days were agreed with the enquirer.

Clinical Governance Star StatusThe past year has been a particularly challenging yet successful year in achieving three star status, compliance with the Healthcare Commission Standards for Better Health, Improving Working Lives Practice Plus and the responsibility for the out of hours Urgent Care Service (UCS) for Dorset and, more recently, Somerset. This has been a considerable undertaking and much credit must go to all those involved in setting it up. The out of hours GP service is now ranked as the model for other trusts.

Top Marks for Risk Management The NHS Risk Management Standard for the Provision of Pre Hospital Care in the ambulance service was introduced in 2004-05 and brings together organisational, clinical and non-clinical risks, including risks specific to those providing ambulance services. Examples of these requirements include the need for clear systems for managing ‘first responders’, clinical guidelines for pre-hospital care, and obstetric training which reflects national guidelines.

Dorset are proud to be one of only three ambulance services throughout the UK to achieve this top mark of level three. In January 2006 the Trust successfully underwent assessment at the top level of three for this national standard.

Next StepsThe Healthcare Commission have introduced a new system of performance monitoring called ‘Standards for Better Health’ which replaces the previous star rating systems for NHS Trusts. This is known as the ‘Annual Health Check’. The Trust welcomes this new and far reaching performance monitoring system that now enables ‘what matters most to patients’ to be measured and for Trusts to be rated upon that key aspiration of patients.

In addition, this new reporting enables key stakeholders to comment upon Trust performance. Local authority led Overview and Scrutiny committees (OSCs) and Patient and Public Involvement Forums (PPIF- soon to be known as Local Information Networks {LINks}) are able to provide annual commentary on NHS Trust performance and this feeds into the marking process.

The seven domains below will continue to form a strong patient led focus for the new Trust in 2006-07 and beyond:

SafetyClinical and cost effectivenessGovernancePatient focusAccessible and responsive careCare and environment amenitiesPublic health

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OperationsThe Operations Directorate is rightly proud of its continued commitment to patient care. The service delivered its aims to exceed patients’ expectations and to improve their treatment and recovery. Staff continue to spearhead new developments in the delivery of pre hospital care, combining the focus on handling a record amount of emergency calls in 2005-06, whilst continually striving to improve standards. The Operations component of the service comprises the A&E Service, the routine Non Emergency Patient Transport Service (PTS) incorporating the Voluntary Hospital Preparedness, and it is well supported by the Logistics and Medical Transport Unit.

Control and Communication CentreThe NHS Communications Centre at St. Leonards has become restricted for space over the last two years due to the rapid expansion of the Urgent Care Services in Dorset and Somerset, as well as the requirement to expand capacity for NHS Direct operations. A further need for expansion resulted from the announcement that the Department of Health is to fund the replacement of the existing ambulance radio systems with the digital Tetra communications system throughout England.

The Dorset and Somerset Strategic Health Authority made £1 million of capital available for the Trust to develop a new, larger Communications Centre in a redundant NHS Logistics building at St Leonards. Building commenced in the Spring of 2006. When completed in the Autumn, the new centre will provide an 87 seat communication facility with the infrastructure in place to expand to 130 seats in the future. All Ambulance and Urgent Care Services will share the new centre together with NHS Direct and rota planning services. The building also supports these functions with a training suite and Gold Command Centre for major Health incidents.

Activity and PerformanceDuring the last year we activated to 89,973 emergency/urgent calls – a rise of 5.64 percent on the previous year which saw the Trust manage the challenge of meeting response times against a backdrop of the highest volume of calls it had ever received. In line with Government prioritisation procedures, all calls are classified as either Category A (immediately life threatening), Category B (serious but not life threatening) or Category C (not urgent). Each call is responded to appropriately which may include a response by an ambulance, a rapid response vehicle or medical advice being given to the caller from a Paramedic based in the Control Centre. We also send the Dorset and Somerset Air Ambulance to the most serious or difficult to reach incidents.

Our key targets for the year, as set out by the Government, was to have reached 75 percent of category A calls within the target time of 8 minutes (480 seconds). For Category B/C calls to have reached 95 percent of incidents within 19 minutes. From October 2004, national standards for responses to Category C calls were withdrawn, and replaced with locally agreed standards.

Achievements SummaryStaff have during the year with significant improvements in responding to patients more quickly. Despite an increase in calls of over 8 percent in the past two years.

Activated to 89,700 emergency/urgent calls – a rise of 5.05 percent on the previous yearCategory ‘A’ calls - 77.95 percent were responded to within 8 minutesCategory ‘A’ calls – 98.26 percent were responded to within 19 minutesCategory ‘B’ calls – 95.43 percent were responded to within 19 minutes

Our new initiatives such as Emergency Care Practitioners (ECPs) and Paramedic Advisors have reduced the proportion of emergency patients who are taken to hospital

Improvements in Clinical Practice has continued to Progress Patient Care: THE FAST Track Stroke Scheme has won two prestigious awards from the Dorset and Somerset Strategic Health Authority. Dorset is now the only area in the UK with an organised county-wide system of acute stroke care

33 Paramedic staff have now gained additional skills to become Emergency Care Practitioners (ECP’s)Improved intravenous pain relief (during the latter half of 2005) 1,582 patients received intravenous pain relief, double the number during the same period in 2004Achievement of Clinical Negligence Scheme for Trusts (CNST) level 3 assessment (highest level)Introduction of pilot for the LUCAS cardiac device (see page 10)

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New Responsibilities in Patient Services has led to better Out of Hours careAwarded Service Level Agreement to provide Out of Hours Primary Care in Somerset as well as Dorset1 February 2006 Urgent Care Services (UCS) began providing full GP cover outside surgery hours for the whole of Dorset, Somerset and a small area of South Wiltshire (1,248,093 patients)

Committed to the Professionalism and Working Lives of StaffAchievement of the NHS’s Improving Working Lives (IWL) Practice Plus AwardThe annual sickness rate was 5.93 percent

Well Supported by Logistics, Medical Transport, Vehicle Maintenance and Fleet UnitsThe Dorset and Somerset Air Ambulance flown in excess of 730 missions (308 in Dorset) in the past yearThe Trust introduced four new A&E ambulance, four new Patient Transport Services (PTS) vehicles and four new Urgent Care Service (UCS) vehiclesSpecially adapted high dependency vehicle for regular ‘fallers’

Patient FocusedPatient, Advice and Liaison Services (PALS) enquiries received over the past two years have increased by 56 percent with further improvements recommendedPALS feedback has resulted in new patient focused training for front-line staff and improved public information on how to access servicesThe new initiative for patient property set up by PALS with Poole Hospital NHS Trust has been extended county-wide and has been short listed for a regional Award

Planned Patient CarePatient Transport Services (PTS) carried out 57,592 patient journeysHospital Car Service (HCS) undertook 120,248 patient journeys

Proud to Serve the CommunityAward of three stars (top rating for performance)

Emergency PlanningThe Trust continues to play a key role whilst partaking in inter-agency collaborations such as Local Resilience Forums, in emergency planning across the local, regional and national structures to protect the public. The subsequent Civil Contingencies Act (November 2005) placed a statutory duty on the Trust to liaise and exercise with other organisations and all activity throughout the year has been aimed at ensuring an appropriate response to any perceived challenges. The focus of work has centred around four key areas:

Emergency Planning Risk AssessmentBusiness Continuity Planning Warning and informingThe 2012 Games will see Dorset hosting the only major Olympic sporting events outside

of London. The Trust is pleased to be actively involved in the preparatory work and will take a lead role in providing an assessment of the required medical provision throughout the events.

Ambulance Care Assistants (ACA)The role of an ACA has changed greatly over the last 12 months. They now have more opportunities to learn extra skills. In line with the Bradley Report, these members of staff have been given extra skills to enable them to deal with a more dependant category of patient, promoting bringing health care to the community. These skills include; defibrillation, administering analgesic gases, pulse oximitary, blood pressure monitoring and care of fractures.

Rapid Response VehiclesAmbulance resources are deployed to an incident in most cases whilst the call is being taken. The severity of the call will reflect the type of vehicle sent to the scene. Category ‘A’ life-threatening calls may, in addition to an ambulance, receive a response from a Rapid Response Vehicle (RRV). These RRVs are staffed with one Paramedic and can be found in most areas of Dorset.

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Patient Transport Service (PTS)The Patient Transport Service (PTS) provides non-emergency transport to patients who need to access health services and are unable to use public transport. This includes transport to and from hospitals for appointments, day units and out of county treatment centres. The service is accessed and booked for patients by doctors and healthcare professionals. PTS is provided on a contractual basis in competition with other organisations from both the public and private sectors.

The Trust is working towards improving partnerships in line with ‘Driving Change’ an NHS Modernisation Agency initiative, aimed at building relationships with Social Services and local authorities.

During the year 57,592 patient journeys were carried out. The service continues to be supported by Voluntary Hospital Car drivers for those patients not requiring ambulance or medical transport. The drivers use their own vehicles to which the Trust contributes towards expenses. Fleet and Equipment38 Front-line A&E Ambulances (28 Operational and 10 Reserve)42 Patient Transport Ambulances (29 Operational, 4 Urgent Transfer Vehicles, and 9 Reserve)17 Paramedic Response Cars (15 Operational and 2 Reserve)2 Transport Services Minibuses16 Logistical Support Vehicles (14 Operational and 2 Reserve)45 Support Vehicles (including 22 Officers, 6 Training, 4 Major incident support and 13 Others)16 Dorset Emergency Care Service cars

New VehiclesThe Trust introduced four new A&E ambulances during 2005-06. The vehicles were based on a Mercedes Sprinter chassis with a previous conversion designed by Trust personnel retained onto a modular body with further improvements incorporated from staff suggestions. The design included the latest ideas to improve manual handling and reduce the risk of injury to staff.

Four new PTS vehicles were also introduced incorporating design suggestions from both staff and patients. The use of the latest specification diesel engines, use of specialist lighting and recyclable interior materials demonstrates the Trust’s ongoing commitment to its Green Transport Plan.

With the addition of Somerset doctors Out of Hours service being incorporated within the Trust, four new Renault Megane estate cars were added to the Urgent Care Service fleet. These were based on the existing multi-functional design to enable the vehicles to be used by Doctors, Emergency Care Practitioners and Paramedics.

Air AmbulanceThe Dorset and Somerset Air Ambulance continues to be a vital resource for the Trust in delivering a high quality service to patients. The aircraft regularly enables its crew to provide a rapid response to patients who suffer injury or illness. Such a resource is particularly necessary when a patient’s injuries or illness is life threatening or when an incident occurs in a location which would be difficult to access in a conventional ambulance.

Recently ‘Easy Task’ new reporting software has been provided in order that the Trust and the charity may accurately audit Air Ambulance Operations. This enables comprehensive reports to be published and is also a useful tool for Clinical Audit.

In excess of 730 missions have been flown within the past year. During this period 308 missions were Dorset ranging from serious road traffic collisions and life threatening illnesses to ankle injuries in remote locations and sporting accidents.

Principal funding of the aircraft is through the efforts of the local fundraisers of Dorset and Somerset Air Ambulance Charity, supported by the Strategic Health Authority funding of Paramedic staff. The Trust would like to thank all the Air Ambulance volunteers who work tirelessly to keep the service flying.

Emergency Care Practitioners (ECPs)Emergency Care Practitioners (ECPs) are paramedics with additional training in injury assessment, diagnostic skills and advanced wound care. They can treat minor injuries such as wounds, burns, musculoskeletal injuries and minor illnesses (falls, blackouts or blood loss). This new breed of healthcare professional is playing a pivotal role in the delivery of unscheduled care across the county. ECPs are based in the community and provide on the

Voluntary Hospital Car Service (HCS)The Hospital Car Service undertook 120,248 patient journeys throughout last year. The Trust Board recognises this huge contribution to make this provision of patient services possible and would like to extend sincere appreciation on behalf of the Trust and patients to the volunteers who make this service possible.

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spot and patient focused emergency treatment to patients. They are helping to relieve pressure on the emergency ambulance service and are dealing with patients more effectively in their own home without transporting them to already busy A&E departments.

There are now 33 skilled ECPs working from six sites in Dorset and they are all supported by two Clinical Support Officers (CSOs) which has enabled significant improvements, such as new collaborations with other health and social care organisations, logistics and the development of more appropriate patient focused care pathways.

ECPs are able to call upon other agencies, such as Social Services, Occupational Therapy, Physiotherapy or Mental Health organisations, to provide fast access to appropriate care for patients. They are able to refer patients to community hospitals for assessment and treatment or for rehabilitation, eg after a patient has had a fall in the home.

They are also working with other healthcare professionals such as General Practitioners (GPs), and Nurse Practitioners, as well as within Minor Injury Units (MIUs).

Community Responder SchemesSuccessful Community Responder Schemes have been successfully established across the county during the past few years. This work forms part of the British Heart Foundation (BHF) and Department of Health (DH) project which is led locally by Lead Manager, Robbie Milham. The scheme provided funding for three years from January 2005 with the much welcome addition of 90 defibrillators for use across Dorset.

This year a new Community Responder Scheme was implemented at Lulworth. Participants in these schemes are currently benefiting from a tailor made training package which was devised by the Lead Manager.

In addition to this, we have a Co-Responder Scheme at Lyme Regis in conjunction with Dorset Fire & Rescue Service. The Fire Service is currently training all of their Fire Fighters in order that a BHF defibrillator can be carried on fire appliances across Dorset.

Community Responder Schemes are also in place at Bournemouth Airport and Monkey World. More schemes are planned in collaboration with St John Ambulance in Shaftesbury and Portland. The Trust has also recently implemented Staff Responder Schemes in Verwood, Purbecks and Portland.

Collaboration with the National Defibrillator Programme continues which is providing a comprehensive network of lifesaving community defibrillators. Successes include placing a defibrillator within rural locations, every Police Traffic Unit, Police Custody Suites, Bournemouth, Weymouth and Dorchester football clubs, Brownsea Island and the residents of Burton Bradstock.

Thanks are given to organisations and individuals who have helped and supported the delivery of all recognised schemes.

PROMISPROMIS is a software rota system which has helped the Trust manage its complex shifts required for a 24/7 healthcare service. The system commenced in April 2005 with a phased implementation across the county of Dorset to embed the rota system, for both A&E and PTS personnel, into the Trust working procedures. In May all staff were able to access PROMIS from the web in their own homes if required.

Bill Lynch took corporate responsibility for the PROMIS department in November 2005 on his appointment as Group Station Officer (East). During this time, the department moved to improved premises and continued enhancements saw Emergency Care Practitioners added to the system.

Future expansion plans for PROMIS include opportunities for all staff to attend training on the successful system, adding Urgent Care Systems (UCS) to the system and moving to the new control suite being built at St Leonards.

Fallers HotlineThe Trust is pleased to be part of a pilot scheme involving Social Services and a rapid response team. Ambulance staff now alert Social Services to patients in need of individual support which is helping patients receive faster and more appropriate support. This proactive approach enables patients to remain independent and in their own home.

A direct telephone line to enable front-line staff to contact and log a person at risk from falling in their home has also been installed. The line is automated making it easier to log the calls and the relevant falls team co-ordinator arranges a risk assessment to take place to prevent further falls and the potential risk of injury.

To complement this service a new project has just been launched that consists of a higher dependency vehicle designed to meet the individual needs of regular ‘fallers’. The new vehicle will be based at Bournemouth Ambulance Station and crewed by Ambulance Care Assistants that will have extra clinical skills.

Cycle Response UnitThe incredibly successful launch of a cycle response scheme back in 2003-04 in Bournemouth and Weymouth has meant that other areas are now benefiting form this innovative new way to reach incidents more quickly. Congested roads and over populated streets make cycles ideal as a mode of emergency help for patients. Fitted with blue lights and sirens, and carrying a defibrillator and other life saving equipment, the bikes enable Paramedics to deliver medical treatment before an ambulance arrives and, if not required, it is cancelled and is immediately available to respond to another 999 call. Special thanks to the Rotary Club in Weymouth who have once again offered their financial support for the forthcoming year.

Audit committee


Inappropriate use of Ambulance ServicesThe Department of Health confirmed that, despite increasing investment in ambulance services in the UK and implementation of new ways of working, keeping up with increasing demand was a real challenge. The clock times for calculation of calls will change in 2007 and this will bring additional pressures. Whilst patients and the public have a right to expect an appropriate and effective emergency response, they equally have a duty to use the service responsibly.

The Trust is ahead of many others with early implementation in 2004 of a decision support software called Advanced Medical Priority Dispatch System (AMPDS). This is complemented with fully trained paramedics in the Control Centre to enable clinically safer decisions when grading 999 emergency calls to allow the most appropriate resource to be assigned to each incident. This is helping to reduce some of the burden of inappropriate calls for ambulances from non life threatening injuries.

Urgent Care Service (UCS)The Out of Hours services for Dorset and Somerset resulted in the two services merging into a single service provided by Dorset Ambulance NHS Trust on 1 February 2006. Call handling and administration were centralised into the single communications Hub at St Leonard’s. The integration coincided with winter pressure peaks which saw a twenty percent increase in normal call levels for both counties. Despite the phenomenal demand, satisfactory performance was maintained. The integration included taking on dispatch and lone working communication processes for Somerset District Nurses, as well as providing a central point of contact and communications for Somerset on call Primary Care Trusts manager rota.

Congratulations to all the communication Hub staff, both operational and administrative, Doctors, Emergency Care Practitioners, drivers and remote treatment centre Nurse Practitioners for the continued high level of commitment to the service.

Nurse TriageFurther to the existing Swanage Nurse Triage, which provides dedicated Triage for all Out of Hours, we now have a small bank of Hub Triage Nurses providing Triage at peak times Joining Forces The Trust was commissioned to provide Out of Hours care for all the Army bases in Dorset, as well as Navy bases in Somerset. Activity levels are low and the majority of military personnel attend treatment centres. Workforce DevelopmentThe multi-disciplinary workforce operate as a team with the GPs dealing with ninety percent of patient calls. However, we are increasing the number of Emergency Care Practitioners and Triage Nurses so less reliance on Doctors is planned for the future whilst maintaining patient services with a greater professional skill mix.

NHS Dental Services ChangesChanges to Dental services in 2005 saw the Trust take over the call handling and overnight Triage for the Out of Hours Dorset Urgent Dental service. This has led to up to 100 dental calls on a peak day with over 1,100 received in April 2006.

Future DevelopmentsThe ‘Operations’ section on page 16 of this report provides information on the future of the Communications and Control Centre. Improvements to Triage capacity and effectiveness will continue with developments planned for a call streaming processes and further expansion of the Nurse Triage roles. Medicines management for Somerset will be improved whilst ensuring timely access to controlled drugs for palliative care patients. Emergency Care Practitioners (ECPs) continue to be integrated into the service to improve responsiveness. Discussions continue with the Prison service to consider providing Out of Hours Medical Care services in Dorset prisons. Adastra software improvements continue to be exploited to assist efficient call handling.

Finally, the consolidation of operations, systems and processes, after such a rapid period of significant growth, is helping modernise the service, with competency based frameworks for Hub staff training and development are also planned. Further recruitment of Hub staff will ensure adequate capacity to meet increased 2006 Christmas and Winter demand.

Intermediate Care LinksIntermediate ‘fallers schemes’ continue to be proving a success and were introduced following recognition that a significant number of patients were taken to hospital unnecessarily when it was clear that they could remain safely at home with rapid health or social care support. 20 percent of our 999 calls are as a result of a fall.

Audit committee


Balancing the booksIncome and ExpenditureI am pleased to report that the Trust achieved all its Financial duties in 2005-06.

In spite of experiencing an increase in activity, and ongoing cost pressures, the Trust achieved a surplus of £250k during the financial year, which generated a positive accumulated reserve position for the first time in its history.

During the year Dorset Ambulance extended its provision of the GP out of hours service in Dorset, when it was appointed by the Primary Care Trusts to provide a similar service in Somerset.

As always, achieving financial balance was a challenge and I would like to convey my thanks to managers /budget holders in the stringent control of their budgets which made this possible.

Looking forward, the Trust has agreed its Local Delivery Plan for 2006-07 and after three months activity in the new financial year has maintained financial balance.

External Financing Limit (EFL)The Trust is required to remain within the target set by the Department of Health. During 2005-06 the Trust undershot its target by £4,000

Capital Resource Limit (CRL)During 2005-06 the following expenditure was incurred

This significant capital expenditure was made possible by the support of the Strategic Health Authority who granted additional discretionary capital to reprovide the Command and Control Centre.

Further investment will be made in this significant project in 2006-07, completion is planned in early Spring 2007.

The Trust operated within its Capital Resource Limit during the year.

Capital Cost Absorption RateThe Trust is required to absorb the cost of capital at a rate of 3.5% of average relevant net assets.

The Trust achieved a 2.6% return during the year due to the significant additional capital expenditure referred to as above.

Five Year Summary of Results

£000

Buildings – HQ/Commands & Control 315

A&E Vehicles 633

PTS Vehicles 182

IT/Communications 223

Stab Vests 95

Equipment 76

TotalExpenditure 1,524

2001-2002£000

2002-2003£000

2003-2004£000

2004-2005£000

2005-2006£000

Turnover 14 949 15 612 16 920 22 485 27 764

Retained (deficit)/surplus for the year 1 1 0 0 250

Prior year adjustment (10) 0 0 0 0

Break-even in year position (9) 1 0 0 250

Break-even cumulative position (78) (77) (77) (77) 173

Materiality test:

Break-even in-year position 0.06% 0.01% 0.00% 0.00% 0.90%

Break-even cumulative position 0.52% 0.49% 0.46% 0.34% 0.62%

The Trust has a cumulative surplus and has met its break-even duty.

Salary and Pension Entitlements of Senior Managers

2005-06 2004-05

NameandTitle Sala

ry(b

ands

of £

5000

)

Oth

er R

emun

erat

ion

(ban

ds o

f £50

00)

Bene

fits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

Sala

ry(b

ands

of £

5000

)

Oth

er R

emun

erat

ion

(ban

ds o

f £50

00)

Bene

fits

in k

ind

(rou

nded

to th

e ne

ares

t £10

0)

£000 £000 £000 £000 £000 £000

K Wenman (Chief Executive) 80 - 85 2,900 75 - 80 4,800

R Ferre (Deputy Chief Executive) 50 – 55 2,700 50 - 55 2,700

C Launchbury (Director of Finance) 55 – 60 3,700 55 - 60 3,500

J Liggett (Associate Director of Corporate Affairs) 50 - 55 2,500

Dr R Dunnill (Medical Director) 40 - 45 0

T Jones OBE (Chairman) 15 – 20 400 15 - 20 300

Sir B Kenny (Non Executive Director) 5 – 10 200 5 - 10 200

T Ware (Non Executive Director) 5 – 10 200 5 - 10 100

J Stanford (Non Executive Director) 0 - 5 100

P Rushton (Non Executive Director) 5 – 10 100 5 - 10 100

J Knowles (Non Executive Director) 0 - 5 0

Benefits in kind relate to Leased cars in the case of Executive Directors and mileage claims in the case of Non Executive Directors

2005-06£000

2004-05£000

Total Trust Income 27,861 22,485

Management and administrative costs 1,988 1,449

% of income 7.1 6.4

Auditors RemunerationThe fee for provision of audit services in 2005-06 was £54,212.

The information within this section provides a summary of the more detailed information contained in the Trust’s audited Annual Accounts which also include the Statement on Internal Control. A full copy may be obtained, free of charge, by telephoning 01202 851646 or e-mail [email protected] or visit www.swast.nhs.uk.

Rea

l inc

reas

e in

pen

sion

at

age

60 (b

ands

of £

2,50

0)

Real

incr

ease

in lu

mp

sum

at

age

60

(ban

ds o

f £2,

500)

Tota

l acc

rued

pen

sion

at

age

60 a

t 31

Mar

ch 2

006

(ban

ds £

5,00

0)

Lum

p su

m a

t age

60

rela

ted

to a

ccru

ed p

ensi

on a

t 31

Mar

ch 2

006

(ban

ds o

f £5

,000

)

Cash

Equ

ival

ent T

rans

fer

Valu

e at

31

Mar

ch 2

006

Cash

Equ

ival

ent T

rans

fer

Valu

e at

31

Mar

ch 2

006

Real

incr

ease

in C

ash

Equi

vale

nt T

rans

fer V

alue

NameandTitle

£000 £000 £000 £000 £000 £000 £000

K Wenman (Chief Executive) 0 - 2.5 2.5 - 5 25 - 30 85 - 90 429 393 36

R Ferre (Deputy Chief Executive) 0 - 2.5 0 - 2.5 20 - 25 65 - 70 393 373 20

C Launchbury (Director of Finance) 0 - 2.5 0 - 2.5 5 - 10 15 - 20 102 89 13

J Liggett (Associate Director of Corporate Affairs)

0 - 2.5 2.5 - 5 0 - 5 5 - 10 28 15 12

Audit committee


Post Balance Sheet EventsAs part of the reconfiguration of all English Ambulance Trusts, following public consultation, Dorset Ambulance NHS Trust will merge with Westcountry Ambulance Services NHS Trust on 1 July 2006.

Summary Financial StatementsA summary of the Annual Accounts for 2005-06 follows. These have been prepared under section 98 (2) of the National Health Service Act 1977 (as amended by section 24 (2), schedule 2 of the National Health Service and Community Care Act 1990) in the form which the Secretary of State has, with the approval of the Treasury, directed.

Income and Expenditure Account for the Year Ended 31 March 2005

2005-2006£000

2004-2005£000

Income from activities:Continuing operations 26,347 20,052

Other operating income 1,417 2,433

Operating expenses: Continuing operation (27,128) (22,263)

Operating Surplus (Deficit): Continuing operation 636 222

Profit (loss) on disposal of fixes assets 12 3

Surplus (Deficit) Before Interest 648 225

Interest receivable 49 44

Interest payable (66) (63)

Other finance costs – unwinding of discount (12) (16)

Other finance costs – change in discount rate on provisions (85) 0

Surplus (Deficit) for the Financial Year 534 190

Public Dividend Capital dividends payable (284) (190)

Retained Surplus (Deficit) for the Year 250 0

Balance Sheet as at 31 March 2006

31-03-06£000

31-03-05£000

Fixed Assets

Intangible assets 319 351

Tangible assets 10,629 9,950

10,948 10,301

Current Assets

Stocks and work in progress 252 243

Debtors 2,174 1,759

Cash at bank and in hand 598 465

3,024 2,467

Creditors: Amounts falling due within one year (2,455) (2,377)

Net Current Assets (Liabilities) 569 90

Total Assets Less Current Liabilities 11,517 10,391

Creditors: Amounts falling due after more than one year (437) (455)

Provision for Liabilities and Charges (604) (521)

Total Assets Employed 10,476 9,415

Financed by: Capital and Reserves

Public dividend capital 6,656 6,048

Revaluation reserve 3,453 3,289

Donated Asset reserve 275 272

Income and expenditure reserve 92 (194

Total Capital and Reserves 10,476 9,415

Cash Flow Statement for the Year Ended 31 March 2006

31-03-06 31-03-05

£000 £000 £000 £000

Opening Activities

Net cash inflow from operating activities 1,039 1,497

Returns on Investments and Servicing of Finance

Interest received 49 44

Interest paid 0 0

Interest element of finance leases (66) (63)

Net cash inflow (outflow) from returns on investments and servicing of finance (17) (19)

Capital Expenditure

Payments to acquire tangible fixed assets (1,330) (2,205)

Receipts from sale of tangible fixes assets 17 3

(Payments to acquire)/receipts from sale of intangible assets (29) (192)

Net cash inflow (outflow) from capital expenditure (1,342) (2,394)

Dividends paid (284) (190)

Net cash inflow (outflow) before management of liquid resources and financing (604) (1,106)

Management of Liquid Resources

Purchase of investments 0 0 0

Sale of investments 0 0 0

Net cash inflow (outflow) from management of liquid resources 0

Net cash inflow (outflow) before financing (604) (1,106)

Financing

Public dividend capital received 608 1,142

Public dividend capital repaid 0 0

Other capital receipts 0 0

Capital element of finance lease rental payments (15) (17)

Net cash flow (outflow) from financing 593 (1,106)

Increase (decrease) in cash (11) 19

2005-06£000

Commercial Training 171

Medical message handling service 35

Other (mainly attendance at sporting/public events) 25

231

Better payment practice code

2005-06£000

2004-05£000

Total bills paid in the year 7,029 6,449

Total bills paid within target 6,532 6,247

Percentage of bills paid within target 93% 97%

The NHS Executive requires NHS Trusts to pay their non-NHS trade creditors in accordance with the CBI Prompt Payment Code and Government Accounting Rules. Non-NHS trade creditors must be paid within 30 days of receipt of goods or a valid invoice (whichever is the later) unless alternative payment terms have been agreed with the supplier.

Income GenerationDuring the year the Trust undertook the following income generation activities

Audit committee


Statement of Total Recognised Gains and Losses for the Year End 31 March 2006

2005-06£000

2004-05£000

Surplus (deficit) for the financial year before dividend payments 534 190

Unrealised surplus (deficit) on fixed asset revaluations/indexation 206 1,224

Increases in new donated assets 47 0

Depreciation on donated assets

Total recognised gains and losses for the financial year 787 1,414

Prior period adjustment 0 0

Total gains and losses recognised in the financial year 787 1,414

Statement of the Chief Executive’s Responsibilites as the Accountable Officer of the Trust

The Secretary of State has directed that the Chief Executive should be the Accountable Officer to the Trust. The relevant responsibilities of the Accountable Officers, including their responsibility for the propriety and regularity of the public finances for which they are answerable, and for the keeping of proper records, are set out in the Accountable Officers’ Memorandum issued by the Department of Health.

To the best of my knowledge and belief, I have properly discharged the responsibilities set out in my letter of appointment as an accountable officer.

Date: 28 June 2006 ......................................................................... Chief Executive

Statement of Directors’ Responsibilities in Respect of the Accounts

The Directors are required under the National Health Services Act 1977 to prepare Accounts for each financial year. The Secretary of State, with the approval of the Treasury, directs that these Accounts give a true and fair view of the state of affairs of the Trust and of the income and expenditure of the Trust for that period. In preparing those Accounts, the Directors are required to:

Apply on a consistent basis accounting policies laid down by the Secretary of State with the approval of the TreasuryMake judgments and estimates which are reasonable and prudentState whether applicable accounting standards have been followed, subject to any material departures disclosed and explained in the Accounts.

The Directors are responsible for keeping proper accounting records which disclose with reasonable accuracy at any time the financial position of the Trust and to enable them to ensure that the accounts comply with requirement outlined in the above mentioned direction of the Secretary of State. They are also responsible for safeguarding the assets of the Trust and hence for taking reasonable steps for the prevention and detection of fraud and other irregularities.

The Directors confirm to the best of their knowledge and belief they have compiled with the above requirements in preparing the accounts.

By order of the Board:

Date: 28 June 2006 ......................................................................... Chief Executive

Date: 28 June 2006 ......................................................................... Finance Director

■

■

■

Governance committeeThe committee comprised Sir Brian Kenny (Chairman) and Non Executive Directors Mr Trevor Ware, Mrs Patricia Rushton, the Chief Executive, Deputy Chief Executive and other senior managers of the Trust. It was the overarching committee for risk management and clinical governance.

Audit committeeThe committee comprised of Non Executive Directors Mr Trevor Ware, Mr John Knowles (until 31-01-06), Mrs Patricia Rushton and Sir Brian Kenny. It monitored both internal/statutory audit plans, held meetings with the Director of Finance/audit representatives to scrutinise audit findings/recommendations and identified ‘Value for Money’ projects.

Remuneration committeeThe committee comprised Mr Trevor Jones (Chair) and Non Executive Directors, Sir Brian Kenny, Mr John Knowles (until 31-01-06), Mr Trevor Ware and Mrs Patricia Rushton. It reviewed pay/conditions of service so they remained competitive/affordable and recommends pay/conditions for the Chief Executive and Executive Directors, having first considered proposals submitted by the Chief Executive.

Audit committee

Independent Auditor’s Report to the Directors of the Board of Dorset Ambulance NHS Trust

We have examined the summary financial statements set out on pages 28 to 33.

This report is made solely to the Board of Dorset Ambulance NHS Trust in accordance with Part II of the Audit Commission Act 1998 and for no other purpose, as set out in paragraph 36 of the Statement of Responsibilities of Auditors and of Audited Bodies prepared by the Audit Commission.

Respective responsibilities of directors and auditorsThe Directors are responsible for preparing the Annual Report. Our responsibility is to report to you our opinion on the consistency of the summary financial statements within the Annual Report with the statutory financial statements. We also read the other information contained in the Annual Report and consider the implications for our report if we become aware of any misstatements or material inconsistencies with the summary financial statements.

Basis of opinionWe conducted our work in accordance with Bulletin 1999/6 ‘The Auditors’ statement on the summary financial statement’ issued by the Auditing Practices Board.

OpinionIn our opinion the summary financial statements are consistent with the statutory financial statements of the Trust for the year ended 31 March 2006.

Signature: .............................................................................

Date: 6 September 2006

Name: Mazars LLP, Chartered Accountants & Registered Auditors

Address: Regency House Grosvenor Square Southampton Hampshire SO15 2BE

32 The 2005-06 Annual Report of the Dorset Ambulance NHS Trust

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