SCOTTISH AMBULANCE SERVICE 2012-13 HEAT DELIVERY PLAN · This HEAT Delivery Plan sets out the...

SASLDP201213 (Final).docBoard Approved [March 2012] © Scottish Ambulance Service 2012

SCOTTISH AMBULANCE SERVICE 2012-13HEAT DELIVERY PLAN

Scottish Ambulance ServiceNational HeadquartersGyle Square1 South Gyle CrescentEdinburghEH12 9EB

16th March 2011

SASLDP201213 (Final).docBoard Approved [March 2012] © Scottish Ambulance Service 2012

List of Contents

Introduction Purpose of Plan Working Together for Better Patient Care – SAS Strategic Framework

2010-15 The HEAT Targets and Standards - Summary

Annex 1 -Supporting the quality ambitions and wider outcomes-based approach

Annex 2 - Risk Management Plans Delivery, workforce, finance, improvement and equalities related risks for

each target / standard, where appropriate Other Activity in Support of NHS Board HEAT targets Monitoring Progress

Core HEAT targets SAS Quality Scorecard

Annex 3 - SAS trajectories for NHSS HEAT targets NHSS E1 financial target

Annex 4 - Financial template

Annex 5 - Summary of Main Workforce Issues Facing Board

SASLDP201213 (Final).doc Introduction - Page 1Board Approved [March 2012] © Scottish Ambulance Service 2012

Introduction

Purpose of Plan

This HEAT Delivery Plan sets out the planned service delivery objectives andperformance for the Scottish Ambulance Service (SAS) in 2012/13, building onperformance achievements in 2011/12. It is designed to:

Set out the contribution that SAS will make to the Government’s NationalPerformance Framework outcomes

Enable the Board to fulfil its corporate governance role within NHS Scotland Allow the Board to be specific about its implementation and performance plans

for the forthcoming year Promote a robust planning process, including the involvement of stakeholders in

the development of the Plan Promote accountability by enabling progress against the Plan to be measured.

This document also meets our requirement, as for each NHS Board, to produce andpublish an annual Local (HEAT) Delivery Plan in agreement with the ScottishGovernment. This document will be incorporated into the SAS Corporate Plan for2012/13.

Working Together for Better Patient Care –SAS Strategic Framework 2010-15

This HEAT Delivery Plan is set firmly in the context of our wider Strategic Framework,“Working Together for Better Patient Care 2010-15”, published in 2010. 2012/13 will beyear 3 of our five year strategy and the Service has made significant progress indeveloping its scheduled and unscheduled care, strengthening community resilienceand in developing our organisation, staff and infrastructure over those first two years.

Our strategy sets out clearly our aims to be

Patient centred Clinically excellent Leading-edge

This year will see the completion of the development of our Single Clinical Triage Tool(SCTT) in partnership with NHS 24 and colleagues in A&E and Out of Hours. This toolwill ensure a more appropriate clinical assessment for patients and a consistent triageprocess whether they contact SAS or NHS 24. A key component of the development ofthe SCTT is clarity around care pathways and the Service will build on its success withfrail and elderly and fallers in 2011/12, continuing to develop pathways in respect ofalcohol and mental health, and explore the role of the Service in relation to dementiaand road traffic collisions. Further extension of the professional to professional linesacross NHS Boards, will offer additional decision support to crews and help reduceunnecessary attendances at A&E.

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We will also continue to improve our scheduled care service following detailed reviewand development of a business case and improvement plan in 2011/12. We willestablish three regional centres based in our EMDCs to offer increased direct patientaccess to booking and registration and, following completion of the roll out of mobiledata across our entire scheduled care fleet, increased efficiency and flexibility in thedeployment, planning and day control of our resources. We will also continue to workwith local and regional transport providers to ensure that those not requiring ambulancetransport are, nevertheless, routed easily to an alternative transport provider as part ofan integrated approach to meeting this challenge.

We have further strengthened our partnership working in the last year and will continueto build upon that as we deliver this year’s plans. We will work with our partners toincrease the number and awareness of public access defibrillators across Scotland andcontinue to grow the base of Community First Responder schemes strengtheningcommunity resilience. We will continue to work with communities and with NHS Boardsas we implement our Community Resilience Strategy published in 2011, developingappropriate integrated models of healthcare.

We will complete the procurement of the next generation of air ambulance andestablish a national specialist retrieval service for Scotland bringing together thevarious existing retrieval teams co-ordinated by SAS.

We will continue to make best use of the latest technology to support service delivery,linking in with the national tele-health agenda through the Scottish Centre forTelehealth and Scottish Government e-Health programmes. This will not only see theintroduction of mobile technology into the PTS fleet, but further integration with NHSsystems to transfer clinical information to hospitals on route, explore the potential to linkpatient booking systems for outpatient appointments, and investment in telephone andsystem technology as we take forward our EMDC quality improvement programme.

Underpinning our service delivery will be the continuation of our learning &development, organisational development and e-Health strategies. Following theestablishment of the new Scottish Ambulance Academy at Glasgow CaledoniaUniversity in 2011 and the introduction of our Careers Framework, we will look tofurther develop new roles such as critical care paramedics. And we will continue toimplement our organisational development and learning and development strategies,strengthening our leadership capability and embedding a culture of learning and qualityimprovement.

This Local HEAT Delivery Plan is set firmly in the context of “Working Together forBetter Patient Care” and the NHS Quality Healthcare Strategy and “2020 Vision” forScotland’s NHS and we will continue to build upon our success in delivering ourstrategy and contributing to that wider strategic direction of NHS Scotland in 2012/13.


The HEAT Targets and Standards

The delivery plan confirms what SAS is planning to deliver in terms of performance. Itcontains a manageable number of indicators, which are aligned to the three strategicgoals of the organisation. These indicators have been specifically chosen to provide abalanced summary of the organisations activities and performance. It is theseindicators that will be used to report performance externally.

The performance objectives of the HEAT Delivery Plan are not the only indicators ofperformance of the Service. Although core key performance objectives and indicatorshave been identified to represent a summary of the Service performance externally,there are other aspects of performance that will continue to be measured and managedinternally.

The Executive Directors and the Board have reviewed the risks raised in the plan, asoutlined in the risk narrative for each target (and where appropriate these will bemanaged through our standard risk management process).

Note The ‘SAS’ prefix below denotes a target specific to the Scottish AmbulanceService. The ‘NHSS’ prefix denotes a target for all NHS Boards

HEALTH

SAS H1: Between 12-20% of eligible cardiac arrest patients with Return ofSpontaneous Circulation (ROSC) on arrival at hospital.

SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland).

SAS H3: Reach 75% of Category A (life-threatening) emergency incidents within 8minutes (mainland)

SAS H4: Reach 95% of Category B (serious but not life-threatening) incidents within 19minutes (mainland)

SAS H5: Reach 56% of all emergency incidents within 8 minutes (Island NHS Boardareas)

EFFICIENCY

NHSS E1: NHS Boards to operate within their agreed revenue resource limit; operatewithin their capital resource limit; meet their cash requirement

SAS E2: Reduce energy consumption by 2.5% per annum

SAS E3: Achieve sickness absence rate of less than 5% for full year continuingdirection of progress towards the national HEAT Standard of 4%


ACCESS

SAS A1: Reach 91% of 1 hour GP urgent calls within time agreed

SAS A2: Ensure 72% of all PTS Patients arrive at hospital 30 minutes or less beforeappointment time

SAS A3: Ensure 90% of all PTS Patients are picked up within 30 minutes of agreedtime after appointment

SAS A4: Ensure that no more than 0.5% of booked PTS journeys are cancelled bySAS

SAS A5: Answer 90% of 999 telephone calls within 10 seconds

TREATMENT

SAS T1: Treat 15% of emergency incidents at scene.

SAS T2: Convey 80% of hyper acute stroke patients to hospital within 60 minutes ofreceipt of call at SAS

SAS QUALITY SCORECARD

In 2011/12, the SAS introduced a quality scorecard setting out a balanced suite ofperformance indicators and the Service will continue to use this tool in 2012/13 tomanage performance and delivery. The scorecard not only encompasses the targetsand measures set out in this HEAT Delivery Plan, but additionally includes a widerrange of KPIs under four headings:

Access and referral; Clinical excellence; Engaging with Partners; Organisational development.

In 2012/13, we propose to develop 2 new targets which reflect current service andclinical developments and will be monitored throughout the year as we implement thesedevelopments. These measures are;

DEV1: Average time spent on vehicle for scheduled care patients

This reflects the service improvements being implemented in 2012 to ourscheduled care service to be more demand responsive and our ability to monitorperformance through the introduction of mobile data across our PTS fleet. As weroll out mobile data we will begin to monitor performance; the current average isaround 90 minutes and the Service will determine an appropriate target duringthe year as we gather and analyse more available data.


DEV2: Answer 80% of scheduled care calls within 30 seconds

2012 will see the SAS establish 3 regional centres for scheduled care, a keydriver for which has been the intent to shift towards increased direct patientbooking. As with our A&E service, we will introduce a developmental target in2012/13 to monitor performance in respect of telephone answering as weestablish these three centres during the year.

.

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Annex 1 - Supporting the Quality Ambitions and wider outcomes-basedapproach

An outcomes-based approach encourages us all to focus on the difference that wemake to people using the service, their families, carers, staff and all who work withNHSScotland in delivering the vision of world-leading healthcare quality. It is aboutfar more than just the inputs or processes over which we have control. Success isabout impact and should be judged by tangible improvements in the things thatmatter to the people of Scotland. SAS has been working in partnership acrossNHSScotland, with Community Planning Partners and with the Scottish Governmentto embed an outcomes-based approach by identifying key priority areas. This hasenabled SAS to:

i. Align activity to explicitly contribute to the Government’s over-arching purposeof sustainable economic growth through the National Performance framework.

ii. Better integrate activities with local government, with other Public Bodies, andin partnership with the Third and private sectors to address the Government’sPurpose Targets and National Outcomes through Single OutcomeAgreements (SOAs).

iii. Focus activity and spend on achieving real and lasting benefits for people andas such minimise the time and expense on associated tasks which do notsupport the national outcomes and purpose.

iv. Create the conditions to release innovation and creativity in delivering betteroutcomes.

In 2010, the Healthcare Quality Strategy for NHSScotland set out the overarchingaim of achieving world-leading quality healthcare services across Scotland,underpinned by the 3 Healthcare Quality Ambitions;

Healthcare Quality Ambitions

Person-centred - Mutually beneficial partnerships between patients, their familiesand those delivering healthcare services which respect individual needs and valuesand which demonstrate compassion, continuity, clear communication and shareddecision-making.

Safe - There will be no avoidable injury or harm to people from healthcare theyreceive, and an appropriate, clean and safe environment will be provided for thedelivery of healthcare services at all times.

Clinically Effective - The most appropriate treatments, interventions, support andservices will be provided at the right time to everyone who will benefit, and wastefulor harmful variation will be eradicated.

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Over the last four years NHSScotland has developed its outcome approach.

National

National

CPPs

NHS/LAs/Vol

NHS

LAs

Other Other public service/Vol organisations objectives/targets

Local Authority / Health / System-wide Outcomes

Purpose (targets)

National Outcomes

HEAT/Support for Healthcare Quality Ambitions

Local objectives

Healthcare Quality Ambitions and Outcomes

Se

rvic

espe

cificactio

ns/o

utp

uts

Perfo

rman

ceM

ana

ge

men

t

Ou

tcom

es

Pu

blic

Rep

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The Quality Strategy sets out NHSScotland’s vision to be a world leader inhealthcare quality, described through 3 quality ambitions: effective, person centredand safe. These ambitions are articulated through the 6 Quality Outcomes thatNHSScotland is striving towards:

o Everyone gets the best start in life, and is able to live a longer, healthier life

o People are able to live at home or in the community

o Healthcare is safe for every person, every time

o Everyone has a positive experience of healthcare

o Staff feel supported and engaged

o The best use is made of available resources

Twelve ‘direction of travel’ Quality Indicators help demonstrate progress towardsthe six outcomes (these are not targets). Every year a small number of HEATtargets are agreed with NHSScotland and partners. These set out the acceleratedimprovements that will be delivered across Scotland in support of progress towardsthe Healthcare Quality Ambitions and Outcomes.

SAS is committed to working with our NHS partners and the wider social caresystem and voluntary community to develop services and solutions which meet theneeds of Scotland and deliver clinical excellence in a modern, effective and efficienthealth service, which makes a genuine difference to the lives of people in Scotland.

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This HEAT Delivery Plan sets out how SAS will contribute towards those nationaloutcomes and indicators with a strategy, “Working Together for Better Patient Care”which is clearly aligned to both the NHS Quality Strategy and the recently published“2020 Vision” set out below:

Our ‘2020 Vision’

Our vision is that by 2020 everyone is able to live longerhealthier lives at home, or in a homely setting. We willhave a healthcare system where we have integratedhealth and social care, a focus on prevention,anticipation and supported self management. Whenhospital treatment is required, and cannot be providedin a community setting, day case treatment will be thenorm. Whatever the setting, care will be provided to thehighest standards of quality and safety, with the personat the centre of all decisions. There will be a focus onensuring that people get back into their home orcommunity environment as soon as appropriate, withminimal risk of re-admission.

We will continue to build on our success in treating more people at home and in thecommunity, working in partnership with the rest of the NHS, social care, voluntarysector and communities to develop more appropriate care pathways, strengthencommunity resilience and develop appropriate, integrated healthcare models. We willcontinue to invest in staff and technology to offer the highest levels of clinical careand greatest opportunities to share information to improve treatment and response.

Patient Focus Public Involvement

SAS has a PFPI Strategy in place to 2014 and a clear Implementation Plan. TheService was assessed positively against the participation standard in 2011 and thisprocess has helped to focus the PFPI Implementation Plan for 2012/13 aroundfurther strengthening the governance of the divisional Involving People Groups andcontinuing to create the capability and capacity across the Service to effectivelyengage and involve patients and public. SAS is also an early adopter of the PatientOpinion web-based system and will continue to develop more innovative means ofinvolving patients and public in service development and delivery.

SAS will continue to build on the strong involvement to date as we implement thedevelopments and improvements to our scheduled care service and the nextgeneration of the air ambulance service, as well as continuing to strengthenengagement at a local level, not least in remote and rural areas of Scotland as wework with partners and communities to develop resilience.


e-Health

SAS has developed its e-Health strategy in the context of our own strategy “WorkingTogether for Better Patient Care” and the National e-Health Strategy for Scotland.Technology is recognised as a key enabler in taking forward the SAS and is now awell-established strategic programme within the Service. Our approach to e-Healthaligns with the strategic aims of the National e-Health Strategy, to:

maximise efficient working practices, minimise wasteful variation, bring aboutsavings and value for money;

support people to communicate with NHSS, manage their own health andwellbeing, and to become more active participants in the care and servicesthey receive;

contribute to care integration and to support people with long termconditions;

improve the availability of appropriate clinical information for healthcareworkers and the tools to use and communicate that information effectively toimprove quality; and

improve the safety of people taking medicines and their effective use.

Our commitment to using technology more effectively to support and enable servicedelivery will be demonstrated through:

delivery of a mobile-health agenda which recognises the potential of a mobileambulance fleet in shifting the balance of care, taking care to the patient andmaximising the use of telemedicine;

continued sharing of data and linking of systems to transfer patientinformation between ambulance and hospital to improve pre-arrivalinformation for emergencies, treatment by crews at scene with access toECS, and booking of non-emergency appointments, for example;

partnership working with NHS24 and OOH providers to develop a singleclinical triage tool and improve triage and assessment of need and onwardreferral and ambulance dispatch;

more efficient use of SAS ICT systems to minimise duplication and waste andoffer improved flexibility for operational and back-office services;

continued development of our data warehouse and management informationsystems to offer evidenced based service development, improve patient careand support better understanding across the NHS in Scotland and with ourpartners of the challenges and potential opportunities in respect of thenational outcomes.


HEAT TARGETSCONTRIBUTING TOWARDSCOTTISH GOVERNMENT’SNATIONAL OUTCOMES

We have tackled

the significant

inequalities in

Scottish society

Our children have

the best start in

life and are ready

to succeed AND

We have improved

the life chances for

children, young

people and

families at risk

We live longer,

healthier lives

Our public

services are high

quality, continually

improving,

efficient and

responsive to local

people’s needs

We reduce the

local and global

environmental

impact of our

consumption and

production

We have strong,

resilient and

supportive

communities

where people take

responsibility for

their own actions

and how they

affect others.

SAS H1 Cardiac arrest ROSC rates

SAS H2 Cat A cardiac arrest patientsresponse times

SAS H3 Category A response times

SAS H4 Category B response times

SAS H5 Island Board emergency responsetimes

NHSS E1 Financial Balance

SAS E2 Carbon emissions and energyconsumption

SAS E3: Sickness Absence Rates

SAS A1 GP urgent calls responses

SAS A2 PTS punctuality for appointment

SAS A3 PTS punctuality for pick up

SAS A4 PTS journeys cancelled by SAS

SAS A5 999 telephone answering times

SAS T1 Reducing Hospital Admissions

SAS T2 Conveyance of hyper-acute strokepatients to hospital

clear line of sight in supporting short term

indirect or longer term contribution


Healthcare Quality Ambitions

Person-centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and valuesand which demonstrate compassion, continuity, clear communication and shared decision-making.

Safe - There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for thedelivery of healthcare services at all times.

Clinically Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wastefulor harmful variation will be eradicated.

HEAT TARGETS CONTRIBUTINGTOWARD SCOTTISHGOVERNMENT’S NHS QUALITYAMBITIONS

People livelonger

healthier lives

People supportedto live at home /community with

access totreatment

Healthcare issafe

People have apositive

experience ofhealthcare

Staff feelsupported and

engaged

There is noinappropriate

variation

SAS H1 Cardiac arrest ROSC rates

SAS H2 Cat A cardiac arrest patients response times

SAS H3 Category A response times

SAS H4 Category B response times

SAS H5 Island Board emergency response times

NHSS E1 Financial Balance

SAS E2 Carbon emissions and energy consumption

SAS E3: Sickness Absence Rates

SAS A1 GP urgent calls responses

SAS A2 PTS punctuality for appointment

SAS A3 PTS punctuality for pick up

SASA4 PTS journeys cancelled by SAS

SASA5 999 telephone answering times

SAS T1 Reducing Hospital Admissions

SAS T2 Conveyance of hyper-acute stroke patientsto hospital

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Annex 2: Risk Management Plans

SAS H1: Between 12-20% of eligible cardiac arrest patients with Return ofSpontaneous Circulation (ROSC) on arrival at hospital

NHS BOARD LEAD: Medical Director

DeliveryRisk Management of RiskThere is a risk that we fail to achieve 12-20% ROSC in eligible patients.

Continue to work with NHS Boards andpartners to improve treatment of cardiacarrest patients.

Work to increase levels of first respondersand working in communities acrossScotland in line with our CommunityResilience Strategy.

Continue to work with our voluntary sectorpartners to increase level public accessdefibrillators, mapping of all cPADs throughour EMDCs, and raise public awareness.

Continued prioritisation of cardiac arrestpatients by EMDC to improve responsetimes.

WorkforceRisk Management of RiskThere is a risk that staff are not fullytrained and developed to provide theappropriate care for cardiac arrestpatients.

ALS training as part of all mandatorytraining.

Strengthen capacity of PTS staff as FPOSand availability of defibrillators in PTS fleet.

Increase number of Community FirstResponder schemes and associatedsupport from CRDOs.

FinanceRisk Management of RiskThere is a risk that funding for further jointworking and roll out of defibrillators incommunities is not available.

Explore funding opportunities for researchand improvement and opportunities withvoluntary organisations to support roll outof community public access defibrillators.

EqualitiesRisk Management of RiskThere is a risk that communities are notaware of the public access defibrillatorsand the role they can play.

Ongoing engagement with communities toraise awareness and supportestablishment of CFR schemes.


SAS H2: Reach 80% of cardiac arrest patients within 8 minutes (mainland)

BackgroundNHS BOARD LEAD: Medical Director

DeliveryRisk Management of Risk80% of cardiac arrest patients are notresponded to within 8 minutes

Clinical Decision Making processes identifyand give priority to patient in or at risk ofcardiac arrest and are well-embedded indevelopment of Single Clinical Triage Tool.

Work to increase levels of first respondersand public access defibrillators availableacross Scotland.

WorkforceRisk Management of RiskThere is a risk that we do not necessarilyhave first responder schemes in the rightplaces deemed appropriate to the SAS asopposed to areas communities want themto be set up

Implementation of plans developed inresponse to SOF targeting vulnerablecommunities

Targeted engagement with vulnerablecommunities through communications andengagement plans in place acrossDivisions

Implement Community Resilience Strategyand strengthen role of CRDOs to supportincreased levels of CFR schemes.

FinanceRisk Management of RiskAs per SAS H1 As per SAS H1

EqualitiesRisk Management of RiskThere is a risk that communication linkswith 999 are not accessible for allcommunities and this is not addressed asSAS/NHS24 develop new triage tool.

Communication support facilities areutilised where appropriate, e.g. SMSmessaging, Type Talk and Language LineService. Work with staff and communitiesto ensure we raise awareness regardingthese facilities and continue to monitortheir use in practice.


SAS H3: Reach 75% of Category A (life-threatening) emergency incidents within 8minutes (mainland)

NHS BOARD LEAD: Director of Service Delivery

DeliveryRisk Management of RiskThere is a risk that the single clinicaltriage tool will continue to be risk adversein assessing clinical need and,consequentially, finite A&E resources willbe dispatched inappropriately.

Ensure EMDC make full use of all availableresources to respond to demand, includingtactical deployment and furtherdevelopment of first responder schemes.

Continue progress in specification andprocurement of single common triage toolensuring Cat A incidents are quicklyidentified and resourced appropriately.

WorkforceRisk Management of RiskThere is a risk that all resources are notfully utilised and not adequately matchedto demand profile.

There is a risk that any changes to staffdeployment will take longer than requiredto deliver performance

Ensure that rosters match demand profileacross all divisions and that staff aredeployed appropriately geographically andto match demand.

Establish a short-life working group to fullyreview deployment and implement acrossthe Service involving partnership.

FinanceRisk Management of RiskThere is a risk that existing resources arenot sufficient to meet demand andadditional funding may be required.

Ensure effective deployment and utilisationof existing and new resources as part ofdeployment review across Service.

Tight management of overtime, non-productive hours and sickness absencerates. Opportunities through cash releasingefficiency savings to generate efficienciesfor A&E resources.

EqualitiesRisk Management of RiskEnsuring equity of access.

As per H2

Ensuring appropriate response to meetindividual patient needs.

Working with partners to exploreopportunities to develop more integratedhealthcare provision in line with SASCommunity Resilience Strategy.

As per H2.


SAS H4: Reach 95% of Category B (serious but not life-threatening) incidentswithin 19 (mainland)


BackgroundThe Scottish Ambulance Service previously reported performance against three timestandards for Category B calls dependent upon population density in a Health Boardarea, but this year has moved to a single 19 minute response target, ensuring everyarea of mainland Scotland receives the same standards of response and clinical care.

DeliveryRisk Management of RiskAs per SAS H3 As per SAS H3

WorkforceRisk Management of RiskAs per SAS H3 As per SAS H3

FinanceRisk Management of RiskAs per SAS H3 As per SAS H3

EqualitiesRisk Management of RiskAs per SAS H3 As per SAS H3


SAS H5: Reach 56% of all emergency incidents within 8 minutes (Island NHSBoard areas)


DeliveryRisk Management of RiskAs per SAS H3 applied to all emergencycalls

There are specific geographicalchallenges for the 3 Island Boards

As per SAS H3 applied to all emergencycalls

Work with NHS partners to exploreopportunities to maximise use of jointresources

Further development of SOF models ofservice for remote & rural communities

WorkforceRisk Management of RiskAs per SAS H3 AS per SAS H3

Further development of SOF models ofservice for remote & rural communities

FinanceRisk Management of Risk

As per SAS H3

There is a risk that NHS Boards will beunwilling or unable to share resources incurrent financial climate

As per SAS H3

Work with NHS partners to exploreopportunities to maximise use of jointresources

Further development of SOF models ofservice for remote & rural communities.

EqualitiesRisk Management of RiskAs per SAS H3 As per SAS H3


NHSS E1: NHS Boards to operate within their agreed revenue resource limit;operate within their capital resource limit; meet their cash requirement

NHS BOARD LEAD: Director of Finance and Logistics

BackgroundThe Service recognises that this year will be particularly challenging financially. Specificareas of concern are: the volatility of the economy in respect of fuel and related costs,this also impacts on the air ambulance service, where demand and contract pricing areadding to the cost pressure. In respect of other non – pay areas there are significantcost pressures from heat, light and power, supplies inflation and CNORIS contributionsincreases that are outwith the control of Ambulance Service. The service has in place achallenging CRES programme that will be required to enable financial balance to bemet, however some of the programmes are high risk and the full benefit may not beachieved in year.

The Service is acutely aware that redesign of services will require to be cost neutral asa minimum and wherever possible deliver cash efficiencies as part of the redesignprocess.

DeliveryRisk Management of RiskThere is a high risk that the increase infinancial allocation will be insufficient tomeet pay award for staff and non- payinflation increases.

There is a risk that the economic climateis producing volatility in fuel costs whichis creating cost pressures and makesfinancial planning challenging. There is arisk that the continued volatile nature offuel prices will increase pressure onrevenue spending.

There is risk that Service redesignprogrammes are not progressed aseffectively and timeously to achieve theefficiency required.

There is a risk that pay terms andconditions are not yet known withcertainty beyond 2012/13. Thereforefinancial planning for future years is morechallenging. There are still unresolvedterms and conditions issues in relation toon-call.

There is a risk that the CNORIScontributions which have alreadyexceeded budget figure will escalatebeyond the projections provided.

Robust Budget Setting, Achievement of theCRES programme that will be required toenable status quo.

Fuel and energy projections used in budgetsetting. Management of Energy usage.Additional new fuel-efficient vehicles will bepurchased to add to existing fuel-efficientfleet.

Robust and appropriately resourced projectmanagement which ensure delivery withinagreed timescales and generates plannedefficiencies.

Scenario planning relating to future payawards. Dialogue with national terms andConditions groups relating to unresolvedissues and impact on SAS.

Continued dialogue with centre remethodology for contributions and ways inwhich Scotland wide the risks can bereduced.


There is a risk that the air ambulancereprocurement produces a preferredoption that is unaffordable within currentSAS resources.

Debate with Health Boards re methodologyfor Risk Sharing in respect of AirAmbulance Services for additional activityand national agreement as to funding forenhanced specification aircraft.

WorkforceRisk Management of RiskThere is a risk that staff will notappreciate the impact of tighteningfinancial resources and change ineconomic environment

That the economic environment thatresults in tightening pay settlements andany impact on pensions will lead to IRissues that are not able to managedwithin the Service.

There is a risk that the proposed changesto NHS pensions have an adverse impacton both staff retention and potentialindustrial relations issues.

Training and awareness raising session tobe held at all levels throughout theorganisation

Open debate in partnership of the issuesboth locally and nationally to gain anunderstanding of staff expectations andintended actions.

FinanceRisk Management of RiskAs Above As Above

EqualitiesRisk Management of RiskInsufficient funds available to ensure weare able to sustain full SAS ambulancemodel in some communities.

Insufficient funds to support plannedengagement with communities acrossScotland.

Work with NHS Boards and withcommunities and voluntary sector toenhance community resilience and developappropriate integrated models.

Work with local partners to shareengagement opportunities.


SAS E2: Reduce energy consumption by 2.5 % per annum

NHS BOARD LEAD: Director of Finance and Logistics

BackgroundAlthough this is not a mandatory target for Special Boards during 2012/13 SAS iscommitted to contributing to the reduction in emissions. We will therefore aim tocontinue to put in place measures to reduce our dependence on fossil fuels and movetowards renewable energy sources. In addition we aim to reduce our overall energyconsumption by 2.5% year on year. We aim to ensure our fleet have as low as possibleC02 emissions. We are also actively engaged in exploring alternative fuel sources.

DeliveryRisk Management of RiskThere is a risk that reductions in energyconsumption may not be achieved due towinter.

There is a risk that initial funding may notbe available to change to renewableenergy sources

There is a risk that vehicle manufacturersmay not be able to combine SASspecifications and reductions in Co2emissions

Aim for higher reductions in the lighterconsumption months of the year

Business case to identify benefits ofrenewable energy sources

Partnership working with suppliers toidentify requirements

WorkforceRisk Management of RiskThere is a risk that staff awareness ofenergy reduction measures may not besufficient to achieve desired impact

Training Education and feedback onprogress

FinanceRisk Management of RiskThere is a risk that funding fordevelopment of renewable energysources is restricted or unavailable

Business case development as appropriate

EqualitiesRisk Management of RiskNone Known


SAS E3: Achieve sickness absence rate of less than 5% for full year continuingdirection of progress towards the national HEAT Standard of 4%

NHS BOARD LEAD: Director of Human Resources and OrganisationalDevelopment

DeliveryRisk Management of RiskThere is a risk that we fail to reducesickness absence below 5%.

Continued focused management ofsickness absence across all divisions anddepartments following revision ofattendance management policy.

Ensure continued use of employeecounselling, occupational health and fast-track physiotherapy services for staff.

Implementation of high impact changesidentified during Workforce Learn &Improve review.

Improve information available to managersto manage sickness absence in a moretimely manner.

WorkforceRisk Management of RiskThere is a risk that staff are not fullysupported to return to work as timeouslyas possible.

There is a risk that high absence levelshave an effect on the management ofrelief staff and/or overtime usage

As above

Implementation of high impact changesidentified during Workforce Learn &Improve review.

FinanceRisk Management of RiskThere is a risk that sickness absenceimpacts on overtime budgets andreduced benefits of efficiency savings.

As above.

EqualitiesRisk Management of RiskThere is a risk that reasonableadjustments are not made for individuals.

Ensure absence management toolkit isused and that needs are based onindividual requirements.


SAS A1: Reach 91% of 1 hour GP urgent calls within time agreed


BackgroundThe Scottish Ambulance Service categorises incidents which require the skills of ourA&E staff but not an emergency response under blue lights as an urgent call. Thesecalls are primarily received from GPs, hospitals and other health care professionals andaround 30% of all these calls are a request to transfer patients from one hospitallocation to another. At the time of the call, SAS agrees a time to arrive at the patientbased on acuity of the patient’s condition, which can be 1, 2 or 4 hours or longer ifagreed with the requesting clinician.

Previously SAS has reported against those urgent calls with a 1 hour responseregardless of which clinician the request came from. Whilst we will continue to internallymonitor our response against each of the time standards requested and each of thegroups requesting transfer, this year we will report specifically on those requests fromGPs within 1 hour, which result in an admission to hospital and our performance inmeeting their expectations within time agreed.

DeliveryRisk Management of RiskThere is a risk that there are insufficientresources to meet all the demandsplaced upon the A&E fleet.

There is a risk that where resources arediverted from urgent requests, calls willincreasingly be upgraded to emergenciesfurther impacting the problem, or targetwill not be met.

There is a risk that the time expectationsfor urgent calls are not appropriatelyassessed by clinicians and agreed whenthe request is made based on clinicalneed of patients

Ensure maximum availability and utilisationof dedicated mid-tier vehicles for urgenttransfers and calls as part of plannedreview of deployment.

Work with GPs to agree and monitorclinically appropriate response times forurgent requests.

Ensure EMDCs liaise closely with cliniciansrequesting transfer to review timescalesappropriately for clinical need and avoidunnecessary upgrading of calls toemergencies or unnecessary one hoururgent calls where a longer time periodwould be appropriate. Ensure DivisionalManagement Teams are liaising with NHSBoards around consistent appropriateurgent requests.

WorkforceRisk Management of RiskThere is a risk that dedicated urgentresources are not fully utilised puttingadditional pressure on emergency A&Eresources.

Ensure maximum availability and utilisationof dedicated mid-tier vehicles for urgenttransfers and calls as part of plannedreview of deployment.


Where appropriate, make use of scheduledcare service ensuring robust clinicalgovernance is in place.

FinanceRisk Management of RiskThere is a risk that existing resources arenot sufficient to meet demand andadditional funding may be required.

Ensure effective deployment and utilisationof existing resources. Tight management ofovertime, non-productive hours andsickness absence rates.

Opportunities through cash releasingefficiency savings to generate efficienciesfor urgent resources.



SAS A2: Ensure 72 % of all PTS patients arrive at hospital 30 minutes or lessbefore appointment time


BackgroundIn 2011, the SAS Board approved the Scheduled Care business case and serviceimprovement plan. 2012 will see the implementation of that improvement plan, not leastwith the establishment of 3 regional centres for all booking, registration, day control andplanning. Coupled with the roll out of mobile data across the scheduled care fleet, theservice will be better placed than ever to manage and monitor performance and servicedelivery.

DeliveryRisk Management of RiskThere is a risk that developments flowingfrom the Service’s Scheduled CareProgramme do not deliver the serviceimprovement identified.

There is a risk that the projections ofreduced demand do not materialise andthe Service is unable to generate thepredicted efficiency savings to reinvest inthe service improvements identified.

There is a risk that public and patientperceptions of the scheduled care serviceis negatively affected by perceivedchanges to service delivery resulting fromconsistent application of patient needsassessment.

There is a risk that NHS Boards andtransport partners do not engage fullywith the planned improvements and thereis no perceptible change in practice foraccessing scheduled care as a result.

Implementation across all NHS Boardareas of agreed patient needs assessmentfor ambulance transport.

Relocation of Area Service Office functionsto 3 regional centres increasing directpatient access, more robust managementof clinical need and standardisation ofpractice.

Roll out of mobile data solution to PTS fleetto allow for real time management anddeployment of resources and maximiseefficiency.

Working with NHS and other transportpartners to develop integrated transport tohealthcare models.

Patient, partner and staff engagementmechanisms and approaches establishedduring the review period and developmentof improvement plans will be maintainedduring implementation. A comprehensiveprogramme of awareness raising andcommunication will be critical to successand has been factored into all plans.

WorkforceRisk Management of RiskThere is a risk that changes to the servicedelivery model will impact on staff rolesand responsibilities and managementstructures.

Fully engage with partnership nationallyand locally and adhere to servicemanagement of change policies andprocedures.

Ensure staff continue to be involved at


each stage in the design and developmentof the scheduled care service.

FinanceRisk Management of RiskThere is a risk that efficiencies identifieddo not generate sufficient resources toreinvest in service improvements

Raise awareness and robustly manage thepatient needs assessment process andincrease level of direct patient booking willdeliver a reduction in demand which in turnwill generate efficiencies.

Consistent communication will be key tosuccess as will standardisation of approachwhich will be better managed through 3regional centres.

Effective management and monitoring ofimplementation across Service throughanalysis of data generated through mobiledata solution, local delivery plans andprogramme board.

EqualitiesRisk Management of RiskThere is a risk that rigid application ofpatient needs assessment could leavepatients with social need for transportunable to attend for appointments forfinancial reasons.

There is a risk that transport needs arenot met in respect of need for advocacyor carers or, for example, wheelchairusers.

There is a risk that ineffectivecommunication with patients results inconfusion at the time of booking and/orcollection for appointment.

Work with local NHS Board Transport Co-ordinators, Regional TransportPartnerships and other transport providersto implement patient needs assessmentand develop protocols for referral of non-medical needs patients as appropriate inline with SAS strategy and NHS ScotlandHealthcare Transport Framework.

Explore ICT system links between SAS andtransport information service providers.

Ensure patient needs assessment is fullyembedded and staff are all fully trained toensure patients’ needs are established andmet through regional booking centres.

Ensure communication with patients isclear and unambiguous and wherematerials are provided they are in plainEnglish.


SAS A3: Ensure 90 % of all PTS patients are picked up within 30 minutes ofagreed time after appointment


DeliveryRisk Management of RiskAs per SAS A2 As per SAS A2

WorkforceRisk Management of RiskAs per SAS A2 As per A2.

FinanceRisk Management of RiskAs per SAS A2 As per SAS A2

EqualitiesRisk Management of RiskAs per SAS A2 As per SAS A2


SAS A4: Ensure that no more than 0.5% of booked PTS journeys are cancelled bySAS


DeliveryRisk Management of RiskAs per SAS A2 As per SAS A2

WorkforceRisk Management of RiskAs per SAS A2 As per SAS A2

FinanceRisk Management of RiskAs per SAS A2 As per SAS A2

EqualitiesRisk Management of RiskAs per SAS A2 As per SAS A2


SAS A5: Answer 90% of 999 calls within 10 seconds


BackgroundIn 2011, following a Learn and Improve review, the SAS established an EMDC QualityImprovement Project Board and identified a number of service improvements to betaken forward, including ensuring the highest levels of telephone answering service forpatients and the public. Additionally, the Service has reviewed the suite of indicatorsnow used in other UK ambulance services and as such, has introduced this measurefor 2012/13 as part of its HEAT indicators, which has been internally monitored for anumber of years.

DeliveryRisk Management of RiskThere is a risk that the Service fails toanswer 90% of 999 calls within 10seconds.

Ensure staffing profile in EMDCs matchesdemand patterns, including the impact ofGP urgent activity.

Progress to call virtualisation across the 3EMDCs to minimise delays in respondingdue to high levels of demand at any time.

Implement EMDC quality improvementprogramme developing staff, systems andprocesses reducing variation in practiceand improving service delivery.

Upgrade existing telephone systemincluding additional reporting capabilities toprovide better analysis of call handlingfunction.

WorkforceRisk Management of RiskThere is a risk that staff are not aware ofthe importance of achieving this measureand its contribution to patient safety.

Staff fully engaged in the EMDC qualityimprovement programme whichencompasses organisational developmentand coaching to support a performancemanagement culture.

FinanceRisk Management of RiskThere is a risk that the finance is notavailable to take forward improvementidentified in EMDC programme.

Expectation that EMDC improvementprogramme will deliver efficiencies.Business case developed as appropriate.

EqualitiesRisk Management of RiskThere is a risk that training / developmentwill not be available to all staff.

Clear staff development workstream inEMDC development programme.


SAS T1: Treat 15% of emergency incidents at scene


DeliveryRisk Management of RiskThere is a risk that we are unable toaccess or develop joint pathways toreduce hospital admissions andattendances.

There is a risk that partners are not fullyengaged in supporting a reduction inattendances and admissions.

There is a risk that the existing scope ofconditions where see and treat protocolsapply will be insufficient to generatequantifiable performance gain.

Working with partners to develop jointpathways to reduce hospital admissions

Explore opportunities for appropriatedevelopment of clinical pathways toincrease levels of see and treat.

Development of single-common triage toolin partnership with NHS 24, A&E andOOHs services which delivers improvedtriage and clinical assessment, deploymentof appropriately skilled resource to attendand referral to appropriate care.

Continued roll out of professional toprofessional lines across NHS Boards toprovide decision support to crews.

Progress m-health strategy to strengthenuse of telemedicine to support to supportnear patient testing and assessment ofpatients in the community.

WorkforceRisk Management of RiskThere is a risk that staff awareness andconfidence is not sufficient to increaselevels of see and treat.

There is a risk that staff do not make fulluse of ECS/KIS systems and professionalto professional advice to support delivery.

Update training to commence as newguidelines are published and competenciesidentified.

Continue to roll out professional toprofessional support for crews.

Continue to monitor the use of ECS andprof to prof support and demonstrate itseffectiveness to staff.

FinanceRisk Management of RiskThere is a risk that the efficiency gains forthe NHS through reduced attendance atA&E are not fully realised.

Work with NHS Boards and partners toensure appropriate referral pathways areavailable and appropriately applied.

EqualitiesRisk Management of RiskThere is a risk that patients will not beeffectively communicated with.

Ensure supportive material is clear andappropriate to leave with patients.


SAS T2: Convey 80% of hyper acute stroke patients to hospital within 60 minutesof receipt of call by SAS


DeliveryRisk Management of RiskThere is a risk that we fail to convey 80%of hyper acute stroke patients to hospitalwithin 60 minutes of symptom onset

Development and liaison with ManagedClinical Networks to ensure access to stokeservices.

Introduction and monitoring of ‘no standdown’ procedure for hyper-acute stroke toensure fast response and dispatch ofambulance to convey to hospital.

Engage effectively with the development oftele-health decision support for effectivemanagement of hyper-acute strokepatients.

Clinical decision-making to quickly assesspatients and minimise delays inconveyance to hospital through dispatch ofappropriate ambulance resource.

Introduction of an additional measurearound response times for hyper-acutestroke patients will minimise delays inresponding and impact on overall pathway.

WorkforceRisk Management of RiskThere is a risk that staff awareness ofstroke protocols is not sufficient.

All staff trained in FAST assessment,including EMDC call taking and dispatchstaff.

Awareness for staff of local and regionalstroke services and agreed pathways.

FinanceRisk Management of RiskNone Known



Other Activity in Support of NHS Board HEAT targets

In addition, in order to support territorial boards meet their LDP targets, SAS willcontinue to support boards where appropriate. Examples of this activity include, but arenot restricted to, the following:

2012/13 HEAT Target Reference CommentReduce suicide rate between 2002 and2013 by 20%.

SAS will continue to promote suicideawareness and mental health first aidtraining amongst front line crews.

Deliver 18 week referral to treatmentfrom 31 December 2011

SAS will work with NHS Boards toimplement improvements to scheduledcare service to reduce the number ofaborted and cancelled journeys whichimpact on levels of ‘did not attend’. SASachieved fewer than 1% cancellations in2010/11 and aims to further reduce thisbelow 0.5% in 2011/12.

To improve stroke care, 90% of allpatients admitted with diagnosis ofstroke will be admitted to a stroke uniton the day of admission, or the dayfollowing presentation by March 2013.

SAS will continue to monitor itsperformance in respect of initial responseand subsequent routing of hyper-acutestroke patients directly to hospital with CTscanner in line with the agreed pathwaysto support delivery of this target andimprove are for stroke patients.

Reducing the need for emergencyhospital care, NHS Boards will achieveagreed reductions in emergencyinpatient bed day rates for people aged75 and over by at least 12% between2009/10 and 2014/15.

Following development of a national carepathway for frail and elderly fallers, SASwill work with NHS Boards to embedthese locally and explore further pathwaydevelopment opportunities for this patientgroup in partnership.

To support shifting the balance of care,NHS Boards will achieve agreedreductions in the rates of attendance atA&E.

SAS will continue to work towardsincreased treatment of patients at homethrough development of better triage andassessment, further roll out of theprofessional to professional lines,continuing to grow community paramediccapability, embracing the tele-healthagenda and developing alternative carepathways in line with our strategicframework.

In line with our Strategy, “Working Together for Better Patient Care”, the ScottishAmbulance Service is also committed to working with NHS Boards and other partnersto develop joint action plans and more integrated healthcare provision. These include:


Developing appropriate models of healthcare for remote and rural communitiesin response to the Remote & Rural Implementation Group’s Framework

Developing integrated transport to healthcare solutions

Implementation of a common triage tool with NHS 24 and other out of hoursproviders to ensure an appropriate and consistent response and referral

As we take forward our strategy we will work with the wider NHS to identify furtheropportunities to support NHS Boards to meet their HEAT targets and evidence thepositive impact that SAS can have to that.


Monitoring ProgressThe table below sets out the core LDP targets for the Scottish Ambulance Service. These will be submitted monthly to the ExecutiveTeam, SAS Board and SGHD.Progress against Local Delivery Plan – LDP Targets


SAS QUALITY SCORECARDIn addition, SAS will continue to use its quality scorecard which will encompass the core LDPtargets together with other indicators that will be used to monitor performance and provide abalanced scorecard approach to performance management in line with the expectations set outin the Quality Measurement Framework. The list below will be monitored by the SAS Executiveand management.

Access & Referral Engaging With Partners

Unscheduled Category C calls transferred to NHS 24

Response to Cat A Incidents within 8 Minutes NHS 24 referrals with CHI recorded

Response to Cat A Cardiac Arrest Incidents within 8 Minutes PTS journeys with CHI recorded

Response to Cat B Incidents within 19 Minutes % emergency incidents treated at scene

Response to Emergencies on Island Boards PTS aborts and cancellations

Response to GP Urgent Incidents within time agreed

999 call pick up within 10 seconds Clinical Excellence

Patient experience ROSC

Scheduled Hyper Acute Stroke to Hospital in 60 mins

PTS Punctuality for Appointment % SEWS Score > 4 Taken to Hospital

PTS Punctuality for Pickup After Appointment

PTS Journeys Cancelled by SAS Organisational Development

Patient experience Sickness Absence

Air Ambulance Meet Financial Targets

Time from take off to landing within 60 minutes Meet Cash Efficiency Targets

Non-emergency Transfers within Agreed Timescales Energy consumption

SASLDP201213 (Final).doc Annex 5 Page 1Board Approved [March 2012] © Scottish Ambulance Service 2012

Annex 5 - Summary of Main Workforce Issues Facing Boards

In 2010/11, the Scottish Ambulance Service launched its Learning and DevelopmentStrategy “Realising our Potential” and its Organisational Development Strategy“Doing the Right Thing”. These are key enablers to the delivery of “Working Togetherfor Better Patient Care” and lay the foundations for the Service into the future. Theyare underpinned by a firm commitment to the values of SAS, not least puttingpatients at the heart of everything we do, and as such, closely align and support thewider NHS Quality Ambitions.

The Service recognises that 2012/13 will be a challenging year for staff as we takeforward our strategy and the development of emergency, unscheduled andscheduled care services. As our strategy moves forward, we will see thedevelopment of new roles and models of service and recognise the opportunities andchallenges this presents for staff. Partnership and staff across the Service have andwill continue to be involved at all stages in the development and implementation ofplans and we will develop our engagement and communication with staff throughvisible leadership, using innovative mechanisms for communication and introducing ateam briefing system to improve face to face communication.. We will also continueto involve staff in improving the efficiency and effectiveness of our Service andembed the improvements identified in our 2011/12 Learn and Improve programmearound workforce, scheduled care, EMDC and administration services.

WORKSTREAM AIMS/OBJECTIVES OF WORKSTREAMProgress scheduledcare improvement planand modernisescheduled careworkforce

Establishment of 3 regional centres for all booking,registration, planning and day control and introduction ofscheduled care co-ordinator and Health Board liaisonroles. Roll out of mobile data and implementation ofplanned service improvements; this will impact on workingpractices for crews and help to manage and reduceinappropriate demand for scheduled care services. PTSstaff will also work alongside EMDC and A&E colleaguesembedding the principle of one ambulance service andoffering greater resilience in both areas.

Additional investmentin A&E staff anddevelopment of newroles to supportmodernisation ofunscheduled care

We will carry out a deployment review to ensure alignmentof resources to demand and clinical need and increaseoverall numbers of A&E staff in 2012. We will enhance ourcommunity paramedic and critical care paramedic rolesand explore with our NHS partners opportunities for newmodels of joint working.

Development of SingleClinical Triage Toolwith NHS 24 andinvestment in EMDCquality improvementprogramme

We will invest in additional clinical advisors across our 3EMDC sites to enhance decision support, introduce newsystems and technology to improve dispatch and callhandling across and between sites and to support day today management of resources to improve performance.We will also ensure a comprehensive training programmefor staff as part of the implementation of the new SCTT.

SASLDP201213 (Final).doc Annex 5 Page 2Board Approved [March 2012] © Scottish Ambulance Service 2012

Strengthen ourleadership capabilityand complete review ofmanagement roles.

We will complete our review of team leader and areaservice manager roles to shift their focus towards clinicalleadership and ensure they are supported to meet thechallenges of that role through our leadership developmentprogramme.

Address the challengesof succession planningand talent developmentfor the Service.

Key to our success will be to ensure we approach bothsuccession planning and the development of futureleaders at a strategic level. The Service has made someprogress following the launch of ‘Doing the Right Thing’and we will continue to build on this to ensure we have aworkforce and management fit for future servicedevelopment and delivery.

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