2014/15
quality review
quality account
Contents
An introduction to quality3
Part 1: A statement on quality from the Chief Executive
4
Part 2 - Priorities for improvement and statements of assurance from the Board of Directors
7
A review of quality improvement priorities made within the South Western Ambulance
Service NHS Foundation Trust in 2014/157
2014/15 Quality priorities
11
Quality priorities for improvement 2014/1519
Statements of assurance from the Board25
Key Performance indicators29
Part 3 : Quality overview 2014/1535
Assurance statements - verbatim52
Statement of Directors’ responsibilities in respect of the Quality Report
Glossary of terms and acronyms
2014/15
quality account
70
72
An introduction to quality
Quality Accounts now represent a critical
part of the overall quality improvement
infrastructure of the NHS. Their introduction
in 2010 marks an important step forward in
putting quality reporting on an equal footing
with financial reporting.
The Government’s White Paper, Equity and
evidence based quality improvement;
matter most to patients.
❚❚ set out to patients where improvements are
required;
❚❚ receive challenge and support from local
scrutineers;
❚❚ enable Trusts to be held to account by the
To improve accountability the Quality Account
must provide progress against previously
identified improvement priorities, or explain
why such priorities are no longer being
public and local stakeholders for delivering
pursued and demonstrate how the review
quality improvements.
of services and patient, public and, where
Excellence: Liberating the NHS, set out how
appropriate, governor engagement has led to
the improvement in quality and healthcare
This will realise the vision of an open and
outcomes would be established.
transparent NHS, enabling the success of the
these priorities being set.
NHS Foundation Trust governor model to
This joint statement to the NHS sets the
Quality Accounts demonstrate a relentless
become autonomous and locally accountable.
context nationally and underpins the South
focus on improving service quality. This
The published evidence shows that public
Western Ambulance Service NHS Foundation
compliments the duties set out in Monitor,
disclosure in itself does not generally
Trust’s approach to continuous quality
independent regulator of NHS Foundation
drive improvement, but rather it is the
improvement.
Trusts’, current quality governance guidance.
organisational response that Trusts put in place
to improve their record on quality that drives
Professor Sir Bruce Keogh
improvement.
NHS Medical Director Department of Health
must ensure that Quality Accounts:
Quality Accounts are beginning to demonstrate
Mr David Bennett
❚❚ demonstrate commitment to continuous,
quality improvements for the things that
Chief Executive of Monitor
Boards are ultimately responsible for quality of
care provided across all service lines and they
3
Part 1: A statement on quality
from the Chief Executive
As we enter a new financial year, I am pleased
patients. Developments this year have included
to have this opportunity to reflect on the quality
the phased introduction of the Electronic Patient
of care and services we have delivered and to
Clinical Record, which enables our clinicians to
look forward to the developments and initiatives
electronically capture and report quality patient
planned going forward.
information; whilst successful partnership
working has enabled us to operate a mobile
Last year was challenging for the NHS in
Alcohol Recovery Centre in Bristol, providing
general and the Trust specifically. Evolving
a place of safety where clinicians can assess
healthcare needs and higher expectations
and monitor these vulnerable patients without
have combined with increasing demand to
the need for a visit to the hospital emergency
test the NHS. A clear example of this was
department.
over the Christmas period where, in common
with the rest of the healthcare community,
The Trust’s Right Care2 initiative goes from
we saw an unprecedented demand on our
strength to strength with our clinicians working
services. I am proud to report that our staff
to ensure that patients receive the best possible
once again demonstrated their ability to rise
care, in the right place, at the right time. This
to any challenge and maintain the delivery
initiative has resulted in more patients in the
of high quality patient care in very difficult
South West receiving the appropriate treatment
circumstances.
without the need to be conveyed to an
emergency department than in any other area
2014/15
quality account
Despite the ever increasing daily demand on the
within England. This not only improves patient
Trust’s services we still maintain our drive for
experience, but has a positive impact on the
quality and innovation for the benefit of our
rest of the healthcare economy across the South
West. The success of Right Care2 is dependent
staff with us and that they feel comfortable
pilot, instead of allocating a resource to an
upon effective partnership working across the
and confident in the care we deliver. I am
incident as soon as the address of the incident
health and social care community and I would
assured of our success in this ambition by the
in question is available, we are able to fully
like to take this opportunity to thank our
results of the Care Quality Commission’s ‘Hear
triage the call to enable us to identify the most
partners for their support.
& Treat Survey’ in June 2014, which found
appropriate resource to deploy. Whilst the
that 90% of respondents who called our
outcome of the pilot is awaited, initial findings
Throughout the year the Trust continued to
999 service and didn’t receive an ambulance
are positive with us seeing an increased level
develop its delivery of urgent care services. In
response considered that they were listened
of ‘Hear and Treat’ cases and the number
July we took over the management of Tiverton
to and treated with dignity and respect by
of vehicles being unnecessarily dispatched
Urgent Care Centre which provides a seven
the first person they spoke to; whilst over
decreasing and so available for the ever
day a week GP and nursing service for Tiverton
90% understood the advice given to them at
increasing number of incidents we are required
and surrounding areas. Our provision of Out-
the end of the call and that this advice was
to attend.
of-Hours GP services during the year extended
possible to follow. This outcome is a credit to
across Dorset, Somerset and Gloucester whilst
our call handlers and clinicians and justifies
Throughout this busy year the Board of
our NHS 111 service continued across Devon,
our clinical hub in the North once again
Directors and I have made time to meet and
Dorset, Somerset and Cornwall. The next
maintaining its accreditation as a Centre of
speak with our dedicated staff across the Trust.
financial year will see us deliver a new Out-
Excellence.
As ever, when I meet with staff, I am impressed
of-Hours GP service across Gloucestershire,
by their attitude, commitment and sense of
which will not only provide visiting and hub-
In addition to its development of urgent care
pride in the quality of the care they provide
based triage doctors, but also visiting specialist
activities, the Trust maintains its national
to our service users. This willingness to go
paramedics and treatment centre based nurse
position as an innovator in the provision of
the extra mile is reflected in the messages of
practitioners.
emergency care. In February we commenced
thanks that we receive from patients and their
the national ‘Dispatch on Disposition’ pilot.
families. It is always gratifying to read these
Whilst we are keen to embrace development
This project has enabled us to amend our
plaudits and I congratulate and applaud the
opportunities, it is important, as our services
999 call handling procedure for the benefit of
Trust’s staff and volunteers for their collective
change and evolve, that we take patients and
patients who need our help. Throughout the
efforts and achievements over what has been
5
a challenging year. It is important to recognise
the pressure that our staff are under, given
the ever increasing demands placed on them;
therefore to have done so well achieving
many of the Ambulance Care Quality Indicator
standards for the year is testament once again
to their professionalism and commitment.
2015/16 will see us continuing to focus on
the integration of our emergency and urgent
care services for the benefit of patients and
the wider health community. I look forward to
reporting developments in this area to you in
future Quality Accounts.
I confirm that, to the best of my knowledge,
the information in this quality report is accurate
and reflects a balanced view of the Trust, its
achievements and future ambitions.
Ken Wenman
Chief Executive
2014/15
quality account
Part 2 - Priorities for improvement and statements of
assurance from the Board of Directors
A review of quality improvement
priorities made within the South
Western Ambulance Service NHS
Foundation Trust in 2014/15
From Prevention to Intervention:
1 Number, 1 Referral, 1 Outcome:
this phrase summarises the Trust’s ambition
captures the value added by the Trust as
to support a safer, more efficient and
a provider of NHS 111 services that are
sustainable urgent and emergency care
integrated with GP Out-of-Hours and 999
Providing quality services to its patients
system for the future. It recognises the
services.
remained the top priority for the Trust during
integral part ambulance services can play in
2014/15, with this priority being evidenced
working alongside health partners to prevent
Local Service, Regional Resilience:
through its vision, values and strategic goals.
disease and identify effective ways
recognises the dual role of the ambulance
of influencing people’s behaviours and
service in delivering a local service providing
The Trust’s vision statement is ‘To be an
lifestyles and in playing an increasingly
individual and personalised care to patients
organisation that is committed to delivering
significant role in urgent and emergency care
balanced with system wide coverage and
high quality services to patients and continues
provision.
capacity for resilience.
receive the right care, in the right place at
Right Care, Right Place, Right Time:
Values
the right time.’ This reflects the vision for
captures one of the Trust’s key initiatives that
The values agreed by the Board of Directors
emergency and urgent care set out by Sir
focuses on ensuring patients receive the best
demonstrate the emphasis that the Trust places
Bruce Keogh: “for those people with urgent
possible care, in the most appropriate place
on the individuality of patients and staff, and
but non-life threatening needs we (the NHS)
and at the right time. This is alongside a drive
the commitment the Trust has to delivering
must provide highly responsive, effective and
to safely reduce the number of inappropriate
high quality services.
personalised services outside of hospital.”
A&E attendances at acute hospitals and deliver
to develop ways of working to ensure patients
a wide range of developments to improve
Respect and dignity: We value each person
This vision is communicated and promoted
the appropriateness of the care delivered to
as an individual, respect their aspirations and
through the following:
patients.
commitments in life, and seek to understand
7
their priorities, needs, abilities and limits;
Commitment to quality of care: We earn the
Clinical Commissioning Groups (responsible
urgent care systems and providing high quality
for commissioning services) and our Council of
services 24 hours a day, seven days a week.
Governors.
trust placed in us by insisting on quality and
Creating Organisational Strength: Continuing
striving to get the basics of quality of care –
The corporate objectives are aligned to the
to ensure the Trust is sustainable, maintaining
safety, effectiveness and patient experience –
strategic goals set out below and show the
and enhancing financial stability. In this
right every time;
recurrence of quality throughout the strategic
way the Trust will be capable of continuous
approach.
development and transformational change
Compassion: We ensure that compassion is
by strengthening resilience, capacity and
central to the care we provide and we respond
Strategic Goals and Corporate Objectives
with humanity and kindness to each person’s
Safe, Clinically Appropriate Responses:
pain, distress, anxiety or need;
Delivering high quality and compassionate care
Performance and progress against these
to patients in the most clinically appropriate,
are all reported within the Trust’s Integrated
safe and effective way.
Corporate Performance Report, which is
Improving lives: We strive to improve health
and well-being and people’s experiences of the
NHS;
capability.
presented to the Board of Directors at each
Right People, Right Skills, Right Values:
publicly held meeting, and is available on our
Supporting and enabling greater local
website.
Working together for patients: We put patients
responsibility and accountability for decision
first in everything we do, by reaching out to
making; building a workforce of competent,
Quality Strategy
staff, patients, carers, families, communities,
capable staff who are flexible and responsive to
In September 2014, the Executive Medical
and professionals inside and outside the NHS.
change and innovation.
Director undertook a high level review of
the Trust’s Quality Strategy and its Clinical
The Trust’s long term strategic goals and
24/7 Emergency and Urgent Care: Influencing
Effectiveness Strategy to establish whether
corporate objectives reflect its quality priorities.
local health and social care systems in
the latter remained relevant. On review, it
These include national priorities for ambulance
managing demand pressures and developing
was found that the Quality Strategy fulfils
trusts and local commitments agreed with the
new care models, leading emergency and
the requirements of the Clinical Effectiveness
2014/15
quality account
Strategy and so it was recommended that
the latter was no longer required. The Quality
and Governance Committee approved this
❚❚ Ensure quality remains at the top of the
Trust’s agenda.
❚❚ Support staff to achieve the highest
decision. The Quality Strategy will be
standards of professional clinical practice
reviewed in full and updated in quarter two of
and effectiveness.
2015/16. This important document
❚❚ Promote the right behaviours and visible
ultimately aims to ensure delivery of high
leadership from all staff from board to
quality, cost effective emergency and urgent
frontline.
healthcare services to people in the Trust
area.
❚❚ Continuously improve the quality of patient
experience.
❚❚ Continuously improve the quality of staff
The strategy demonstrates that the Trust’s
approach to the delivery of high quality
care is patient centred and
partnership-based, whilst engaging staff. It
experience.
❚❚ Achieve the highest standards of quality
governance.
❚❚ Ensure early warning alerts are in place to
builds upon the already established integrated
inform the Board of any issues affecting
approach to service planning and delivery,
quality.
which will:
❚❚ Achieve the highest standards of patient
safety.
❚❚ Achieve the highest standards of staff
safety.
❚❚ Ensure clear accountability and responsibility
for quality.
❚❚ Foster a ‘quality culture’ encouraging staff
to speak out when quality could be further
improved.
9
2014/15
quality account
2014/15 Quality Priorities
In 2014 the Trust published a Quality Account
Although anybody can develop sepsis, some
which illustrated its continuous quality
people are more vulnerable, such as those
improvement journey and set out its priorities
at the extremes of life, the very old and the
Initiatives
for the year ahead. These priorities (listed
very young. As a result, children, particularly
❙❙
under the three categories of patient safety,
premature babies and infants, can be more
clinical effectiveness and patient experience)
susceptible to developing sepsis. The key
are restated below as they appeared at that
to saving lives lies in early recognition and
regarding the difference between fever
time, along with an overview of the Trust’s
immediate treatment.
and sepsis in children.
performance:
March 2015.
patients with fever and sepsis.
❙❙
❙❙
Aims
Patient Safety
❙❙
Audit the management of paediatric
Increase awareness amongst clinicians
Adopt a common paediatric recognition
tool within SWASFT for face to face use.
Increase the proportion of child
❙❙
Appoint paediatric sepsis champions in
Priority 1 – Sepsis - why a priority?
(paediatric) patients with sepsis who
each of the Trust operating areas to help
Sepsis is a life-threatening condition that
are rapidly identified and treated by
promote this key work stream.
is caused when the body over-reacts to an
ambulance clinicians.
infection; it results in the body injuring its own
❙❙
Embed current guidelines into practice,
Did we achieve this priority?
tissues and organs. There are 100,000 cases of
ensuring clinicians use common
We partially achieved this priority.
sepsis each year in the UK, with an estimated
terminology (NICE traffic light system)
37,000 deaths.
when communicating with other
The Trust increased clinical awareness;
health care professionals and when
developed guidance and a screening tool;
documenting their findings.
and appointed paediatric sepsis champions.
Reduce the number of adverse incidents
However, this raised awareness of sepsis in
and chest infections. Sepsis can lead to shock,
and serious incidents relating to the
children may have in turn led to increased
multiple organ failure and death especially if
treatment of children with fever/sepsis by
incident reporting with 10 adverse and serious
not recognised early and treated promptly.
50% from the 2013/14 baseline by 31
incidents being reported in 2014/15 compared
Sepsis can arise from infection in a huge variety
of sources, including minor cuts and bladder
❙❙
11
with 6 in the previous year, equating to an
number of reports by an increase of 10%.
increase of 67%.
patient information leaflets for parents
and carers. We worked with NHS England
During 2014/15 the Trust performed two
to develop the Sepsis Assessment and
It is important to note that despite an apparent
audits into the management of fever and
Management (SAM) leaflet, which aims to
increase in the number of reported incidents,
sepsis in paediatric patients. The purpose of
support parents when there are escalating
clinical care for patients with sepsis continues
the audits was to benchmark current
concerns or deterioration in their child’s
to improve. Mitigating circumstances may
practice, with the aim of improving the
condition. All vehicles within the Trust now
include the following:
recognition and management of fever and
carry the SAM leaflet, with clinicians mandated
❚❚ The Trust has completed a number of quality
sepsis and the communication between
to leave a copy with the patient and their
improvement initiatives aimed at educating
healthcare professionals when transferring
family when treating them at home or in the
clinicians in the awareness and recognition
clinical responsibility for the patient.
community.
increase in the reporting of adverse and
Following the initial audit, guidance was
In 2014/15 the Trust’s Sepsis Group went
serious incidents. This might be seen as
produced as well as a face-to-face screening
from strength to strength, with membership
a positive effect, as it is likely that the
tool for clinicians to use. The tool was largely
growing every month. The group reviewed all
incidents existed last year however went
based on the National Institute for Clinical
adverse and serious incidents relating to sepsis.
unreported.
Excellence (NICE) traffic light fever guidelines
The group’s perception is that due to
and was disseminated across the Trust.
an increase in awareness, reporting continues
providers of healthcare delivering quality
Anecdotal feedback so far has been positive,
to grow. However, this is not felt to be
improvement for this cohort of patients,
with clinicians finding the tool helpful not
reflective of an increase in incidents relating
which may have resulted in other HCPs
only for paediatric patients with a fever,
to sepsis, rather that they were not reported
identifying adverse and serious incidents
but also for those who appear generally
effectively when awareness was poor. The
and completing adverse or serious incident
unwell.
members of the Sepsis Group have become
of sepsis, which may have resulted in an
❚❚ Sepsis remains a national priority with all
reports.
❚❚ Demand on the Trust continues to increase
year on year, which has been mirrored in the
2014/15
quality account
paediatric sepsis champions for their respective
Alongside the sepsis guideline and screening
areas and continue to promote key work
tool, the Trust was also involved in developing
streams.
The Trust’s Clinical Development Manager
the urgent care agenda. The outcomes that
partnership with a leading supplier of mobile
(West) continues to lead this key work stream
will enable these benefits across the
solutions for modern emergency medical care
on a regional and national level, contributing
emergency care pathway cover include:
and developed by a dedicated Trust project
to the development of NICE and Joint Royal
team.
Colleges Ambulance Liaison Committee
Aim
(JRCALC) guidelines, and is also
❚❚ Deliver better clinical outcomes for patients,
Using a structured model of examination and
speaking at national conferences during
through better pathway management, data
assessment the software has been configured
2015.
sharing and informed decision making.
so as to take clinicians through a methodical
Clinical Effectiveness
Priority 2 – Electronic Care System (ECS) -
❚❚ Reduce the number of patients taken to
process of capturing clinical interventions and,
Emergency Departments unecessarily.
where possible and appropriate, incorporating
❚❚ Improve the communication of appropriate
validated assessment tools. This enhances the
Why a priority?
and essential patient information across the
clinical decision making process and supports
The implementation of the Electronic Care
healthcare community; including receiving
the clinician in making the most appropriate
System is an exciting innovation, which will
units, GPs and other parties involved with
decisions regarding a patient’s care needs.
be used in the pre-hospital arena to better
patient care.
manage patient care and which will also have
the technical ability to integrate with
❚❚ Deliver improved support for Trust staff
resulting in improved job satisfaction.
hospital and other wider health community
Although the initiative focussed on an
ambulance based solution, the ability for
it to be further integrated across the wider
systems.A fully managed service will be
Initiatives
healthcare community at a later stage has been
delivered, that allows the Trust to
Implementation of the Electronic Care System.
a consideration throughout. The high level of
electronically capture, exchange and report
clinical input to develop the system in a way
on better quality patient information. ECS
Did we achieve this priority?
that ensures that future, wider requirements
will support the Trust in delivering benefits
We partially achieved this priority.
are met has delayed its implementation.
throughout the wider health and social care
However, the ECS has been introduced across
community and assist the Trust to better meet
The ECS, incorporating the electronic Patient
West Somerset (incorporating Musgrove
the needs of patients and support
Clinical Record (ePCR), has been created in
Hospital, Taunton) and at Derriford
13
Ambulance Station which feeds into Derriford
of essential patient information with staff,
Hospital in Plymouth. Further implementation
for example, being able to make referrals
is scheduled across the Trust’s operating area
electronically through the system immediately
The time that it takes from the initial
during 2015 and early 2016.
rather than having to return to the ambulance
emergency call to the balloon being inflated
station to undertake this task. The hospitals
to relieve the clot during primary angioplasty is
It is too soon to provide definitive quantitative
currently using the system are also able to
known as the call-to-balloon (CTB) time.
data to demonstrate that the ePCR has
monitor the patient’s condition prior to their
The national target is to achieve a call-to-
reduced the number of patients being
arrival.
balloon time of under 150 minutes, which
taken to Emergency Departments (ED)
is likely to be.
is reflected in the ambulance clinical quality
unnecessarily or that the incorporation of
Priority 3 – Primary Angioplasty - Why a
indicator (ACQI) for patients who suffer
validated assessment tools within the system
priority?
from a heart attack. Local thresholds
has resulted in more appropriate clinical
When someone experiences a heart attack,
are set for the percentage of patients
outcomes for patients. However, initial data
the priority is to remove the blood clot
receiving such timely intervention.
and feedback indicates that these aims are
obscuring the blood vessel as soon as possible
achievable in the longer term.
to minimise the damage caused to the heart.
Aim
Primary Angioplasty is the definitive treatment
❙❙
Improve performance against the locally
Feedback received suggests that staff
for a heart attack, which involves hospital
set threshold of 84% for the number of
are more confident in making clinical
specialists inserting a small tube through a
patients achieving a call-to-balloon time
decisions as the system captures clinical data
vein, into the blocked blood vessel within the
of 150 minutes for primary angioplasty.
which supports the decisions that they are
heart. A tiny balloon at the tip of the tube
making. This is particularly important when
is then inflated to squash the blockage. A
Initiatives
they are with patients who they believe
stent (small piece of wire mesh) expands with
❙❙
can be treated outside of the ED setting,
the balloon, and remains in the blood vessel
as they are confident in selecting other
to ensure that it remains open. The sooner
more appropriate care pathways. The ECS
patients reach a hospital that can deliver this
to enable achievement of the local CTB
is already improving the communication
specialist procedure, the better their outcome
target of 84%.
2014/15
quality account
Complete a root cause analysis of CTB
breaches.
❙❙
Develop and implement an action plan
Did we achieve this priority?
in the proportion of patients who receive
question is aimed at giving hospitals a better
We partially met this priority.
primary angioplasty within 150 minutes of
understanding of the needs of their patients
their call. The CQUIN demonstrated that a
and enabling improvements.
As part of the Commissioning for Quality
disproportionate proportion of cases (75%)
and Innovation (CQUIN) programme with
missing the target, occurred during the
Implementation of this is a key part of NHS
the Clinical Commissioning Groups of Bath &
Out-of-Hours period. The presence of just
England’s current business plan. The Trust
North East Somerset, Bristol, Gloucestershire,
three facilities within the North Division
does not underestimate the significance of
North Somerset, South Gloucestershire,
providing 24/7 primary angioplasty limits the
the introduction of this indicator, and the
Swindon and Wiltshire the Trust focused on
ability of the Trust to exceed current 78%
local value of having a consistent indicator
improving the local CTB time.
performance.
about how patients ‘rate’ our services. Due
to its importance it has been included in the
The cases of 142 patients who received primary
Patient Experience
Percutaneous Coronary Intervention (pPCI)
Priority 4 – Friends and Family Test (FFT) -
during the period of 1 April 2014 - 30 June
why a priority?
Aim
2014 within the North Division were reviewed,
Quality Account guidance recommends that
The Trust has proactively encouraged feedback
establishing a baseline performance of 73%.
Trusts look at local and national indicators
from its patients both positive and negative.
as sources for proven indicators where they
We have worked on developing a range of
A root cause analysis of the breaches was
overlap with local priorities. As a result, this
feedback mechanisms to allow patients,
completed to identify the common themes,
year the Trust has included the Friends and
their carers and families to tell us about
which were addressed as part of an action
Family Test as a priority for 2014/15. This
their experiences. Patient feedback gives a
plan to increase performance. A re-audit
test was introduced in other parts of the
rich source of insight into the overall patient
was conducted during 1 October 2014 - 31
NHS in 2013, and asks patients whether
experience and is used to help inform the
December 2014 to review progress, and
they would recommend the hospital wards,
refinement and development of our future
reported performance of 78%. Despite
emergency departments and maternity services
services.
an increase in operational demand, the
to their friends and family if they need similar
Trust has made a significant improvement
care and treatment. Asking all patients this
priorities for 2014/15.
15
NHS England states that the FFT ‘aims to
Initiatives
In readiness for the implementation of
provide a simple headline metric which,
❚❚ Implement the patient Friends and Family
the patient FFT in October 2014, the Trust
when combined with follow-up questions,
Test according to the NHS England
undertook an analysis of its patient base and
is a tool to ensure transparency, celebrate
guidance.
a feasibility study of how the requirements of
success and galvanise improved patient
❚❚ Write to NHS England explaining our
the FFT could best be carried out. It was agreed
experience.’ SWASFT can use this measure,
experience to date of eliciting patient
that the test needed to be as convenient as
together with supporting questions to
feedback to help inform the detailed FFT
possible for patients and so they are offered
help understand the important elements that
guidance, so that it can account for the
three means of contact - text, telephone or an
drive patient satisfaction across its various
different approach that may be required for
on-line survey.
services.
ambulance trusts (expected towards the end
of June 2014).
Since April 2013, the FFT question has
❚❚ Carry out segmentation analysis of
The Trust devised a postcard which invites
patients to respond to the FFT and is handed to
been asked in all NHS in-patient and A&E
our patient base in preparation for full
999 patients who are not conveyed to hospital,
departments across England. From October
implementation of patient FFT.
as well as those patients who use the Patient
2013, all providers of NHS-funded maternity
services have also been asking women
the same question at different points
throughout their care. The implementation
❚❚ Undertake a feasibility study of how we
might conduct the patient FFT.
❚❚ Early implementation of FFT in one service
line by 1 October 2014.
of the FFT across all NHS services is an
❚❚ Full implementation of patient FFT.
integral part of NHS England’s business
❚❚ Internal promotion and reporting of FFT
plan for 2013/14 – 2015/16. As of 1 April
scores as they become available.
2014, all NHS trusts providing acute,
Transport Service. Patients who use the Trust’s
GP Out-of-Hours Service and the Tiverton
Urgent Care Centre (formally known as the
Minor Injuries Unit) are provided with the
postcard upon arrival.
The Trust staged a phased roll out of the
FFT across its operating area and across
community, ambulance and mental health
Did we achieve this priority?
the relevant service lines from 1 October
services in England were required to
Yes we did achieve this priority.
2014, with all areas and service lines having
implement the FFT for staff.
2014/15
quality account
implemented the FFT as of 1 April 2015.
Whilst the number of patients choosing to
take the opportunity to respond to the FFT
is still low, with only 195 responses being
received during 2014/15, the feedback that
has been received has been overwhelmingly
positive with 94% of those respondents
indicating that they would recommend the
service.
“My experience following an emergency
call out was excellent. The attending
paramedic was efficient, professional and
brilliant at explaining his actions whilst
offering just the right level reassurance to
put me at my ease. Thank you, I couldn’t
imagine how you could improve on the
way the service was conducted.”
of a 93 year old with severe breathing
difficulties was calm, knowledgeable and
cheerful - and spot on! He did thorough
checks on all areas and stayed to ensure
the patient was calm and able to breathe
without apparatus. I couldn’t have wished
for better assistance in the circumstances
and he saved a hospital bed for someone
else.”
The scoring for the FFT is collated on a
monthly basis and is reported to operational
managers for dissemination to all their staff.
The data is also provided to NHS England
which, in turn, makes it publicly available.
Looking forward to 2015/16 the Trust will
be making it easier for staff to hand patients
“111 call made at 9.00pm on Saturday
3 Jan, answered in less than 5 minutes.
Paramedic dispatched and arrived at
9.20pm. Wonderful response time.
Paramedic’s assessment and treatment
an invitation to answer the question by
including the details on patient safety leaflets
for those patients left at home. The Trust
will also be developing the way in which
it makes the FFT data accessible to the
public.
17
2014/15
quality account
Quality Priorities for Improvement 2014/15
The Trust is accountable to its patients and
ensure the health community supports the
for the agreed priorities were responsible
service users and the Quality Account provides
areas identified.
for monitoring progress at the appropriate
an ideal mechanism for addressing this. As
working groups, for example the Infection
a Foundation Trust, SWASFT has a Council
When setting the priorities for 2015/16
Prevention and Control Group. In addition,
of Governors (CoG) which is invaluable in
consideration has been given to Quality
the Trust’s Quality and Governance Committee
representing the views of Governors, the Trust
Account priorities from previous years,
monitored the Quality Account priorities
membership and the wider public, gained
the learning from these and the benefits
through exception reports at its bi-monthly
through engagement activities. The Trust
in focusing further on these areas. During
meetings. These governance arrangements will
liaised with its Council of Governors to obtain
2014/15 one quality priority related to sepsis
be continued during the forthcoming year.
their opinion and input on the suggested
in children. During 2015/16 the focus upon
priorities within this report and to encourage
patients under the age of 15 will continue
Patient Safety
them to think about how they can engage
with the clinical effectiveness priority being
Priority 1 – Sign Up to Safety
with the Trust Membership and the wider
in respect of the assessment and
Sign up to Safety is a national campaign,
public about these priorities.
management of the six most common
launched by NHS England, designed to
medical conditions which result in children
strengthen patient safety in the NHS and
In developing the priorities for the forthcoming
requiring emergency or urgent care
make it the ‘safest healthcare system in the
year, the Trust has taken into account
treatment. As these six conditions account
world’.1 By Signing up to Safety, we will align
feedback provided by stakeholders, including
for almost half of all emergency and
our patient safety improvement plans to the
commissioners, on the 2013/14 Quality
urgent care admissions, better management
NHS-wide purpose, thereby strengthening our
Account. This feedback has also informed the
will not only benefit children in the region
own activities. The campaign provides a robust
inclusion of information within the quality
but also the wider health community as
structure on which we can pin our safety
overview in Part 3 of this report. The Trust’s
unnecessary admissions are avoided.
improvements, and this should help to make
commissioners have also been consulted on
the priority areas proposed for 2015/16, to
1 www.england.nhs.uk/signuptosafety
them clearer and more accessible to our service
During 2014/15 the Implementation Leads
users.
19
Aims
4.Collaborate
Improvement (IHI) Accelerated Patient Safety
To develop and implement a clear and
Take a leading role in supporting local
Programme.
measurable programme of safety improvement
collaborative learning, so that improvements
across all of the Trust’s services (A&E, Out-
are made across all of the local services that
Board Sponsor:
of-Hours, NHS 111 and Patient Transport
patients use.
Jenny Winslade, Executive Director of Nursing
Services), which is underpinned by a published
and Governance
set of principles supporting the five Sign up to
5.Support
Implementation Lead:
Safety pledges, which are:
Help people understand why things go wrong
Vanessa Williams, Head of Patient Safety and
and how to put them right. Give staff the time
Risk
1.
Put Safety First
Commit to reducing avoidable harm in the NHS
and support to improve and celebrate the
progress.
by half and make public our goals and plans
developed locally.
priority?
Initiatives
❚❚ Develop a clear set of aims or principles to
2.
Continually Learn
Make our own organisation more resilient to
How will we know if we have achieved this
support the five Sign up to Safety pledges.
❚❚ Engage and consult with patients, staff,
❚❚ We will have a clear set of aims or principles
supporting the five Sign up to Safety
pledges signed off by our Chief Executive
Officer and published on the Trust website.
risks, by acting on the feedback from patients
governors, and other stakeholders, to seek
and by constantly measuring and monitoring
their feedback on what they see as priorities
governors, we will have received:
how safe our services are.
for patient safety.
▲▲Responses from a minimum 3% of
❚❚ Develop and implement a short/
❚❚ Through engagement with staff and
staff (n129/4285), and at least 50%
3.Honesty
medium/long term programme of safety
of governors (n13/26), to a new
Be transparent with people about our progress
improvement using the feedback provided.
engagement survey on safety, to be used
to tackle patient safety issues and support staff
❚❚ Support the work of the three Patient Safety
to be candid with patients and their families if
Collaboratives covering our operational
something goes wrong.
area, including encouraging managers
to undertake the Institute of Healthcare
2014/15
quality account
to develop the programme of safety
improvement.
❚❚ We will have a measurable short/
medium/long term programme of safety
improvement based around feedback
Committee, including a deep dive into the
people and their families, according with the
provided from stakeholders and signed
first year’s work at year end.
Trust’s Right Care2 initiative.
off by the Trust Quality and Governance
Clinical Effectiveness
Aims
Priority 2 – Paediatric Big Six
To promote the evidence-based assessment
actions (within agreed target deadlines)
A recent study reported an increase of 28%
and management of unwell children and
developed through learning from serious/
in the admission rate for children under 15
young people for the six most common
moderate harm incidents from the baseline
years of age between 1999 and 2010 in
conditions when accessing 999
(at April 2015) to 70%. This will be reported
England. In addition, a Kings Fund Review
ambulance services. The six conditions
to and monitored by the Directors’ Group.
of the South of England in 2012 reported a
are:
9% growth in general paediatric admissions
❚❚ Fever
involvement in the three Patient Safety
over the previous four years. National data
❚❚ Croup
Collaboratives covering our operational area,
shows that the “big six” conditions
❚❚ Abdominal pain
by ensuring a minimum of 3 Trust managers
accounted for 50% (2008/09) of all
❚❚ Diarrhoea (with or without vomiting)
attend the Patient Safety Collaborative
emergency and urgent care admissions.
❚❚ Asthma
Committee.
❚❚ We will have improved the completion of
❚❚ We will be able to demonstrate active
IHI training programme in 2015/16, and
❚❚ Head injury
that at least one representative attends
There is significant potential to better
each meeting of the three Patient Safety
manage these conditions if there is the right
Initiatives
Collaboratives.
distribution of services and a co-ordinated,
❚❚ Development of an overarching Trust
❚❚ Implementation of the new programme
systematic approach to the management,
document covering the Guideline for
will have commenced by quarter four of
monitoring and recording of a patient’s care,
Paediatric Big Six.
2015/16. This will include development of a
known as the care pathway. The South West
full plan for 2016/17.
Strategic Clinical Network has identified
❚❚ Progress towards the Sign up to Safety
scope to both reduce avoidable admissions
❚❚ Integration of the overarching document
into the Electronic Patient Clinical Record.
❚❚ Partnership working with Acute Trusts to
campaign during 2015/16 will be reported
and improve treatment and outcomes in the
identify ways in which direct admissions or
by exception to the Quality and Governance
South West in relation to children, young
advice can be achieved.
21
Board Sponsor:
Patient Experience
impact on the ability of the service to
Executive Medical Director
Priority 3 – Frequent Callers
meet the requirements of other users.
Implementation Lead:
Frequent callers are a small group of patients
Clinical Development Officer (East)
who access emergency healthcare on an
Aim
abnormally high number of occasions. These
To improve the management of Frequent
How will we know if we have achieved this
patients, who often have specific social or
Callers who present to the ambulance service
priority?
healthcare needs, also have a significant
and a range of health and social care providers.
❚❚ Trust clinicians will be supported by the
impact on the ability of the NHS and
latest evidenced best guidance with
emergency services to deliver a safe service
Initiatives
support from the region’s providers, to
to the wider community due to the level
❚❚ Establish links with Frequent Caller Leads
reduce variation in the assessment and
of resource required to deal with their
in external organisations including Acute
management of the six conditions and
requirements.
Trusts, Mental Health Trusts and NHS 111
ensure patients are safe and have access to
equitable care pathways.
❚❚ The Big 6 Guideline will be published and
providers.
Improved partnership working is required
❚❚ Review the top five Frequent Callers from
to ensure that frequent callers are treated
private addresses, aged 18 years and over,
uploaded to the intranet and electronic
in an equitable manner and that care plans
for each CCG area. Establish the percentage
patient record.
are developed and delivered, which meet
which already has an individual action plan
their individual needs in line with the Trust’s
in place.
❚❚ 75% of frontline clinicians (Specialist
Paramedics, Operational Officers and
Right Care initiative. This work will enable
Paramedics) will receive Big 6 training
the Trust to manage demand from this small
individual action plans for any patients
(excluding staff on secondment, maternity
group by ensuring that resources are not used
identified above where they are not already
and long term sick leave).
inappropriately and that their needs do not
in place.
2014/15
quality account
2
❚❚ Work with partner organisations to develop
Board Sponsor:
Director of Operations
Implementation Lead:
Frequent Caller Lead
How will we know if we have achieved this
priority?
❚❚ We will have produced a list of the
key contacts within relevant external
organisations.
❚❚ We will increase in the percentage of
frequent callers, identified during each
quarter, who have an action plan in place at
the end of the following quarter, compared
to the quarter in which they were identified.
A review of the progress against these priorities
will be included in next year’s Quality Report
and Account.
23
2014/15
quality account
Statements of Assurance from the Board
Statutory statement
95.79 per cent of the total income generated
❚❚ National Audit of Non-Conveyance.
This content is common to all healthcare
from the provision of relevant health services
❚❚ National Ambulance Clinical Quality
providers which make Quality Accounts
by the South Western Ambulance Service NHS
comparable between organisations and
Foundation Trust for 2014/15.
provides assurance that the Board has reviewed
Indicator Programme.
2.3 The national clinical audits and national
and engaged in cross-cutting initiatives which
2. During 2014/15, two national clinical
confidential enquiries that South Western
link strongly to quality improvement.
audits and zero national confidential enquiries
Ambulance Service NHS Foundation Trust
covered relevant health services that South
participated in during 2014/15 are as follows:
1. During 2014/15 the South Western
Western Ambulance Service NHS Foundation
❚❚ National Audit of Non-Conveyance.
Ambulance Service NHS Foundation Trust
Trust provides.
❚❚ National Ambulance Clinical Quality
provided and/or sub-contracted three relevant
Indicator Programme.
health services:
2.1 During 2014/15 South Western Ambulance
❚❚ Emergency (999) Ambulance Service;
Service NHS Foundation Trust participated
2.4 The national clinical audits and national
❚❚ Urgent Care Service (NHS 111; GP Out-of-
in 100 per cent national clinical audits and
confidential enquiries that South Western
Hours and Tiverton Urgent Care Centre);
100 per cent national confidential enquiries
Ambulance Service NHS Foundation Trust
of the national clinical audits and national
participated in, and for which data collection
confidential enquiries which it was eligible to
was completed during 2014/15, are listed
participate in.
below alongside the number of cases
❚❚ Non-Emergency Patient Transport Service.
1.1 The South Western Ambulance Service
NHS Foundation Trust has reviewed all the data
submitted to each audit or enquiry as a
available to them on the quality of care in three
2.2 The national clinical audits and national
percentage of the number of registered cases
of these relevant health services.
confidential enquiries that South Western
required by the terms of that audit or enquiry:
Ambulance Service NHS Foundation Trust was
❚❚ National Audit of Non-Conveyance (91.5%).
1.2 The income generated by the relevant
eligible to participate in during 2014/15 are as
❚❚ National Ambulance Clinical Quality
health services reviewed in 2014/15 represents
follows:
Indicator Programme (100%).
25
2.5 The reports of two national clinical audits
❚❚ Undertake Quality Improvement activity to
2014/15 was conditional on achieving quality
were reviewed by the provider in 2014/15
improve the assessment and management
improvement and innovation goals agreed
and South Western Ambulance Service NHS
of pain.
between South Western Ambulance Service
Foundation Trust intends to take the following
❚❚ Work with the Clinical Development team to
NHS Foundation Trust and any person or body
actions to improve the quality of healthcare
improve the use of the Major Trauma Triage
they entered into a contract, agreement or
provided:
Tool.
arrangement with for the provision of relevant
❚❚ Undertake a programme of Quality
❚❚ Work with the resuscitation clinical sub
health services, through the Commissioning
Improvement activity across the organisation
group to develop a programme of work to
for Quality and Innovation payment
to facilitate the delivery of high quality care.
improve the proportion of patients who are
framework. Further details of the agreed goals
resuscitated gaining a return of spontaneous
for 2014/15 and for the following 12 month
2.6 The reports of ten local clinical audits were
circulation on arrival at hospital.
period are available on request from www.
reviewed by the provider in 2014/15 and South
❚❚ Undertake a programme of re-audit
Western Ambulance Service NHS Foundation
swast.nhs.uk.
following quality improvement activity.
Trust intends to take the following actions to
4.1 The monetary total available for the
improve the quality of healthcare provided:
3. The number of patients receiving relevant
Commissioning for Quality and Innovation
❚❚ Continue to reinforce the importance
health services provided or sub-contracted
payments, for all service lines, for 2014/15
of good quality record keeping which
by South Western Ambulance Service NHS
was £2,927,940 and for 2013/14 was
underpins clinical quality reporting.
Foundation Trust in 2014/15 that were
£3,564,833.
❚❚ Work to ensure that all clinical audits cover
recruited during that period to participate
the whole Trust area to inform service
in research approved by a research ethics
5. South Western Ambulance Service NHS
delivery across the region.
committee was 68.
Foundation Trust is required to register with
❚❚ Ensure that the outputs of clinical audit
the Care Quality Commission and its current
are used to inform the work of the Quality
4. A proportion of South Western Ambulance
registration status is ‘registered without
Improvement Paramedics.
Service NHS Foundation Trust income in
compliance conditions’.
2014/15
quality account
5.1 South Western Ambulance Service NHS
8. South Western Ambulance Service
Foundation Trust has the following conditions
NHS Foundation Trust was not subject to
on registration:
the Payment by Results clinical coding audit
None.
during the reporting period by the Audit
Commission.
5.2 The Care Quality Commission has not
taken enforcement action against South
9. South Western Ambulance Service NHS
Western Ambulance Service NHS Foundation
Foundation Trust will be taking the following
Trust during 2014/15.
action to improve data quality:
❚❚ Continue to maintain and develop the
5.3 South Western Ambulance Service NHS
existing data quality processes embedded
Foundation Trust has not participated in any
within the Trust.
special reviews or investigations by the Care
❚❚ Hold regular meetings of the Information
Quality Commission during the reporting
Assurance Group to continue to provide a
period.
focus on this area.
❚❚ Ensure completion and return of the
6. South Western Ambulance Service NHS
monthly Data Quality Service Line Reports
Foundation Trust did not submit records
and in particular strengthen reporting by its
during 2014/15 to the Secondary Uses service
NHS 111 services.
for inclusion in the Hospital Episode Statistics
which are included in the latest published data.
❚❚ Continue to provide Data Quality Assurance
Reports to the Board of Directors.
❚❚ Where external assurance of data quality
7. South Western Ambulance Service NHS
is required, commission an independent
Foundation Trust Information Governance
review from Audit Southwest, the Trust’s
Assessment Report overall score for 2014/15
internal audit provider.
was 72% and green.
27
2014/15
quality account
Key Performance Indicators
This section includes the mandatory indicators, which the Trust is required to include in this report. Further performance information, including Category
A Performance by Clinical Commissioning Group, is shown in Part 3 of this report.
Category A Performance (Whole Trust)
Performance
Category A
Performance
A
Target
2014/15
National Average
2014/15*
2013/14
Highest Trust
2014/15*
Lowest Trust
2014/15*
Red 1
75%
75.24%
73.15%
74.7%
77.4%
67.6%
Red 2
75%
71.42%
77.23%
69.1%
74.3%
59.7%
Performance
Category A
Performance
19 Minute
A
Target
2014/15
95%
National Average
2014/15*
2013/14
93.62%
95.76%
Highest Trust
2014/15*
93.9%
Lowest Trust
2014/15*
96.8%
91.0%
* Highest/Lowest Trust reporting has been noted for each indicator independently, current information from YTD 2014/15 reported at the end of January 2015.
For clarification, Category A incidents are those
2 calls are those which are serious but less
Red 1, Red 2 and A19 performance targets
involving patients with a presenting condition
immediately time critical and cover conditions
quarterly by Monitor. The Trust met all three
which may be immediately life threatening and
such as stroke and fits. In addition, Category
targets for quarters one and two of 2014/15,
who should receive an emergency response
A patients should receive an ambulance
but breached all three in quarter three. In
within 8 minutes irrespective of location, in
response at the scene within 19 minutes in
quarter four the Red 1 target was achieved,
75% of cases. Red 1 calls are those requiring
95% of cases. A19 performance is based on
but the other two targets were breached.
the most time critical response and cover
the combination of both Red 1 and Red 2
Details of the breaches have been reported
cardiac arrest patients who are not breathing
categories of call.
within the Annual Governance Statement,
and do not have a pulse and other severe
conditions such as airway obstruction. Red
which forms part of the Annual Report and
The Trust is assessed against the delivery of the
includes assurance of the action taken to
29
improve the position. In accordance with the
conjunction with all directorates across
call handlers are able to better deploy resources
criteria contained in Monitor’s Risk Assessment
the Trust to identify where and how
where they are most needed. The additional
Framework, the Trust maintained its Green
improvements to performance can be
triage time also provides an opportunity to
Governance Rating throughout the year.
achieved.
identify the most clinically appropriate response
❚❚ The implementation of a trial of ‘dispatch
to meet the needs of the patient. In some
The South Western Ambulance Service NHS
on disposition’, approved by Professor Keith
cases this may not be an ambulance response,
Foundation Trust considers that this data is as
Willett, National Director for Acute Episodes
and patients may be better served by an
described for the following reasons:
of Care at NHS England.
immediate referral to another service (eg local
❚❚ The Trust has robust data quality processes
GP, pharmacy or a walk-in centre).
in place to ensure the reporting of
Dispatch on Disposition
performance information is both accurate
In February 2015 the Trust was delighted to
The Trust is working with NHS England, the
and timely.
have been chosen, in partnership with London
Association of Ambulance Chief Executives
❚❚ Information is collated in accordance with
Ambulance Service, to pilot a new way for
(AACE), the College of Paramedics and the
the guidance for the Ambulance Clinical
ambulance services to respond to 999 calls.
London Ambulance Service during the trial
Quality Indicators.
The trial allows call-handlers a small amount
period with strict oversight and monitoring
of extra time to triage the patient over the
of the results and impacts of these service
of Directors monthly in the Integrated
telephone before dispatching an ambulance
changes, including patient safety. The trial
Corporate Performance Report.
resource to respond.
is also subject to rigorous and independent
❚❚ This information is reported to the Board
external evaluation, the findings of which will
The South Western Ambulance Service NHS
This additional triage time does not apply
Foundation Trust is taking the following actions
to those incidents which are identified as
to improve these percentages, and so the
immediately life-threatening (i.e. Red 1
The trial commenced on 10 February 2015
quality of its services, by:
incidents) where an ambulance resource
and during the trial period (ie for the period
❚❚ The development and implementation
continues to be dispatched immediately.
10 February 2015 to 31 March 2015) the
of a red performance recovery plan. This
is a comprehensive plan developed in
2014/15
quality account
be published in due course.
Trust has been required to monitor against
The limited extra assessment time ensures that
two sets of metrics for Red 1, Red 2 and A19
thresholds have been agreed with the Trust’s
new calculation metrics for both Red 2 and
Ambulance Clinical Quality
Indicators (ACQIs)
A19 performance were introduced to take into
ACQIs are designed to reflect best practice in
32. In addition the data from the indicators is
account the additional telephone triage time
the delivery of care for specific conditions and
used to reduce any variation in performance
before an ambulance resource is dispatched.
to stimulate continuous improvement in care.
across Trusts (where clinically appropriate)
They were initially introduced in 2010/11, and
and drive continuous improvement in patient
The performance figures included within
since this time ambulance trusts have been
outcomes over time.
the Annual Report relate to the national
working nationally to agree and improve the
ambulance performance target metrics.
comparability of the datasets reported.
performance. In agreement with NHS England
However, had the Trust been using the
commissioners and these are shown on page
Further ACQI information is contained in Part
3 of this report and details of all ACQIs are
calculation metrics identified in the trial, this
In February 2015 a national benchmarking
contained in the Trust’s monthly Integrated
would have improved both Red 2 and A19
day was led by the Trust’s Research and
Corporate Performance Report presented to
performance figures for the year as set out in
Audit Manager. The day aimed to build
the Trust Board of Directors and available on
the table below
on the success of the 2013 workshop and
the Trust’s website.
improve comparative data quality through
understanding. The results of the work
Data for these indicators is not currently
will be shared with the National Ambulance
available for information after October
Clinical Quality Group and the National
2014. The longer timeframe for the
75.24%
Medical Directors Group during
production of this clinical data is due to the
75%
72.30%
2015/16.
manual nature of the collection process and
95%
93.78%
Key Performance Indicators
(Based on Trial Performance
Metrics) Category A
Performance
National
Target %
Red 1
75%
Red 2
Category A19
2
Actual
Performance
2014/15%
2 The A8 Red 1 performance figure is identical in both performance
tables because the way that life threatening emergency calls are
handled did not change during the trial.
the delays experienced in collecting
Whilst there are currently no national
some of the data from third party
performance targets for ACQIs, local
sources.
31
❚❚ Information is collated in accordance with
Foundation Trust considers that this data is as
the technical guidance for the Ambulance
described for the following reasons:
Clinical Quality Indicators.
quality of its services, by:
❚❚ Undertaking a programme of quality
improvement activity across all regions,
❚❚ The Trust has robust data quality processes
supported by Quality Improvement
to improve these percentages, and so the
Lowest
Trust Performance
(Apr to Nov 14)*
and timely.
Highest
Trust Performance
(Apr to Nov 14)*
Foundation Trust is taking the following actions
Indicator
Paramedics.
2013/14
performance information is both accurate
Year to date 2014/15
(Apr to Nov)
The South Western Ambulance Service NHS
Commissioner
Local Performance
Thresholds
in place to ensure the reporting of
National
Average
(Apr to Nov 14)
The South Western Ambulance Service NHS
Outcome from Acute ST Elevation Myocardial Infarction (STEMI) - % of patients
suffering a STEMI and who receive an appropriate care bundle.
85.0%
89.2%
89.6%
80.7%
89.5%
70.6%
Outcome from Stroke for Ambulance Patients - % of suspected stroke patients
(assessed face to face) who receive an appropriate care bundle
95.0%
97.4%
97.4%
97.1%
99.4%
93.5%
*Highest/Lowest Trust reporting has been noted for each indicator independently.
2014/15
quality account
Staff Survey
One of the key findings in the 2014 national staff survey relates to staff recommending the Trust as a place to work or receive treatment. Staff were
asked to rate their answer on a five point scale from “1” strongly disagree to “5” strongly agree. Staff responses were then converted into scores. The
table below shows the Trust’s performance compared to last year, together with the performance of other Ambulance Trusts.
Staff Survey Indicator
Staff recommendation of the trust as a
place to work or receive treatment
Performance
2014
National Ambulance
Average
Performance
2013
3.28
3.31
Highest Ambulance Trust
2014
3.17
Lowest Ambulance Trust
2014
3.37
2.60
South Western Ambulance Service NHS Foundation Trust is taking the following actions to improve staff engagement, and so the quality of its services,
by:
❚❚ Reviewing the results of the 2014 staff survey with each of the locality managers to develop suitable targeted action plans for their individual areas
aimed at improving response rates and performance across the Trust.
❚❚ Ensuring that staff have the opportunity to give feedback on this point through ongoing implementation of the Friends and Family Test for staff
throughout 2015/16.
33
National Reporting and Learning System
All Trusts are required to provide confidential
2014/15**
Indicator/Date
Learning System (NRLS). This information is
analysed to identify common risks to patients
and opportunities to improve patient safety.
These incidents are identified through the
1 Apr to 30
Sep
Lowest
Trust*
1 Apr to 30
Sep
1,252***
234***
699
730
434
843
196
Number of Incidents
Reported as Severe
Harm
27
5
2
21
9
29
0
Number of Incidents
Reported as Death
2
1
0
0
3
13
0
Total Incidents
Reported to NRLS
1 Oct to 31
Mar
Highest
Trust*
1 Oct to 31
Mar
and anonymised reports of patient safety
incidents to the National Reporting and
National
Average
2013/14
1 Apr to 30 Sep 2014
Trust’s incident reporting processes, and of the
*Highest/Lowest Trust reporting has been noted for each indicator independently.
10,544 incidents reported in 2014/15, 1,486³
**This information is sourced from the Trust’s incident reporting system based on the criteria used in NRLS reports. All other information in this table is
published by the NRLS based on the data they received and collated from the Trust during their reporting periods. Information is published in arrears,
and therefore the most recent information available from the NRLS relates to the period 1 April to 30 September 2014.
have been identified as relating to patient
safety.
*** The apparent variation in these figures from previous reporting periods is as a result of changes to the staff involved in uploading incidents to
NRLS rather than the actual number of incidents over the reporting period.
The National Patient Safety Agency recognised
Reporting and Learning System (NRLS)
❚❚ Reviewing the mechanisms for learning
that organisations that report more incidents
electronically through the upload of data
from adverse incidents to ensure this is done
usually have a better and more effective safety
taken from the Trust’s adverse incident
quickly and effectively, and disseminated
culture, stating ‘you can’t learn if you don’t
reporting system.
to staff so they have confidence in the
know what the problems are’.
reporting system.
South Western Ambulance Service NHS
❚❚ Reviewing the mapping of coding of
South Western Ambulance Service NHS
Foundation Trust has taken the following
patient safety incidents with the NRLS to
Foundation Trust considers that this data is as
actions to improve the number of incidents
ensure reporting is consistent with national
described for the following reasons:
reported, and so the quality of its services, by:
requirements.
❚❚ The Trust has a good culture for reporting
❚❚ Continuing to encourage the reporting of
adverse incidents.
❚❚ Information is provided to the National
adverse incidents by all members of staff so
learning can occur at all levels of the Trust.
³ This figure only includes incidents that were reported on the Datix system 2014/15. The table above includes incidents that were exported to NRLS in 2014/15.
2014/15
quality account
Part 3 : Quality Overview 2014/15
Additional Quality Achievements
and Performance of the Trust
against selected metrics
call 999 can be managed safely and effectively
This successful initiative resulted in the
without the need for an emergency
proportion of 999 calls that were managed
ambulance to take them to an ED. An
without attending an ED increasing from
This section provides an overview of other
increasing proportion can be managed
50.84% in 2010/11 to 57.45% in
performance metrics for the Trust.
through telephone assessment, and
2013/14. In reality, this means that the Trust
sometimes referral to another service, such
annually conveyed 83,517 fewer patients
The indicators and information contained
as making their own way to a Minor Injuries
to EDs than the UK average for ambulance
within this section of the report have been
Unit. Over half of the Trust’s patients can be
services. Following the success of the
selected to describe the Trust’s continuous
managed by highly skilled ambulance
initiative, the Trust was commissioned in
quality improvement journey. They build on
clinicians in their own home, delivering care
2014/15 to deliver the Right Care2
the indicators reported in the previous Quality
that has historically only been delivered within
programme.
Reports and where possible historical and
a hospital, for example suturing (stitching) a
national benchmarked information has been
wound.
provided to help contextualise the Trust’s
performance.
The Right Care2 programme has built on
this initial success to ensure that even more
Delivering the right care for patients,
patients are able to be safely managed
outside of an ED wherever possible and at
within in the community. During 2014/15
Right Care
the time of the call has three significant
8,148 fewer patients were conveyed to
In 2010, the Trust developed the Right Care,
advantages. Patients receive care without
EDs than in the previous year, despite an
Right Place, Right Time initiative. This five-
having to leave their home, EDs have
8.9% increase in the number of emergency
year commissioner funded agreement that
greater capacity to deal with true
calls received. The Trust estimates that
committed the Trust to reducing unnecessary
emergencies and precious emergency
managing patients more effectively in the
admissions to Emergency Departments (EDs)
ambulances are better able to be utilised
community has led to savings of around
by 10%, through managing patients using
to attend patients who most need a rapid
£6,192,000 for the region’s health
alternative pathways. Many of the patients that
response.
economy.
35
This improvement has been achieved through
commissioners, hospital, community and
In addition, following positive feedback from
the introduction of a system to enable
ambulance clinicians together.
ambulance clinicians, the following seven
ambulance and ED clinicians to provide
feedback on issues which prevent the delivery
of the right care to a patient. Over 800
feedbacks were received during 2014/15,
❚❚ Utilising frontline Right Care station
2
champions to promote the programme.
❚❚ Better utilising social media to promote the
initiative.
with many then shared with local Clinical
additional guidelines were also published:
❚❚ Catheterisation
❚❚ Croup
❚❚ Headache
❚❚ Mental Health and Mental Capacity
Commissioning Groups (CCGs) to help
Clinical Guidelines
❚❚ Palliative Care
identify service improvements. A wide range
During 2012 the Trust introduced 24 new
❚❚ Pain Management
of projects have been completed to improve
local clinical guidelines, to provide additional
❚❚ Spinal Management.
access to alternative care pathways, which
support to ambulance clinicians managing
include:
the more complex of medical presentations
All Trust clinicians were issued with an
❚❚ Producing the first South West wide list of
thereby ensuring that all patients receive the
individual printed copy of the guidelines
same high standard of care. During 2013/14
during October 2014, with electronic
these guidelines resulted in the Trust winning
versions also being available on the internet,
a Shared Learning award from the National
intranet and electronic Patient Clinical Record.
the acceptance criteria for every MIU.
❚❚ Developing a wide range of alternative
hospital pathways.
❚❚ Better publicising local services.
Institute of Health and Clinical Excellence
❚❚ Auditing the management of healthcare
(NICE).
professional calls.
Care Quality Commission (CQC)
The Trust maintains its registration with the
❚❚ Launching the Right Care education award.
As part of the planned two year cycle, all
❚❚ Specialist Paramedic (ECP) Review to
24 of the guidelines were reviewed during
CQC with no conditions.
develop a strategy to better utilise our most
early 2014 to ensure that they continued
The Trust is proactive in ensuring compliance
clinically skilled staff.
to reflect the latest evidence base. Ten of
with CQC regulations through the
❚❚ Pilot to link with community pharmacies.
the existing 24 guidelines were revised to
maintenance of a centralised evidence
❚❚ Holding Right Care2 roadshows at every
incorporate further learning from internal
system; an annual review of processes;
incidents and the latest published evidence.
and an annual assessment of compliance
Acute Hospital across the South to bring
2014/15
quality account
across all service lines by way of an internal
Patient Safety
a centralised team monitoring the incoming
audit review. A “green” rated internal
Incident Reporting
incidents provides another mechanism to
audit outcome was achieved for 2014/15
As reported in Part 2 of this report, the Trust
support trend analysis.
with the Trust robustly evidencing
has a central reporting system for adverse
compliance against all three of the outcomes
incidents, including near misses, as well as
Working groups within the Trust receive reports
reviewed.
moderate and Serious Incidents (SIs).
on incidents relating to their remit. In addition
the Trust has an Experiential Learning Forum
No inspections were undertaken by the
All three core service lines for the Trust: A&E;
(ELF) whose specific duty is to undertake
CQC during 2014/15, with the last
Patient Transport Service (PTS) and Urgent
focused reviews of themes identified from
inspection being carried out in February
Care Service (UCS), are covered in the patient
trends identified, or concerns raised as a result
2014. That inspection, which was routine
safety measures reported within this section,
of feedback. The focused reviews that took
and not triggered as a response to any
including the table below which sets out the
place during 2014/15 included Mental Health
concern, resulted in a very positive outcome
categories and numbers of incidents managed
and Capacity, Health and Wellbeing, and the
with the Trust being judged as fully
by the Trust.
non-conveyance of patients.
compliant with the five outcomes assessed.
Other Patient Safety Measures
2014/15
2013/14
Recommendations resulting from incident
The CQC is changing the way in which
Adverse Incidents
it inspects health and social care
Moderate Harm Incidents
48
18
2014/15 include:
organisations and a new regime was
Serious Incidents
56
78
❚❚ Review and circulation of a new spinal care
1,450
1,270
4
investigations and the work of ELF during
2014/15. The Trust is not anticipating being
4 A figure of 6,787 was reported in the 2013/14 Quality Account and
Report. That figure, however, related to all adverse incidents reported
during 2013/14 rather than those which specifically related to patient
safety
inspected during the first half of
The Trust reports information relating to
course for new Operational Officers to
2015/16; however, it has commenced
adverse incidents, moderate harm incidents
improve the quality and standard of
its preparation to ensure it maintains its
and SIs to a variety of forums, in order for
investigations.
unconditional registration.
themes and trends to be identified. Having
implemented for ambulance trusts during
clinical guideline.
❚❚ Development of a two day investigation
❚❚ A review of guidelines in relation to the
37
assessment of paediatrics and adolescents
remains very low. In addition, the Trust has
Action Plan is maintained to monitor progress
presenting with the symptoms of meningitis.
seen a decrease in SIs in 2014/15. Analysis
against actions identified.
❚❚ Implementation of a process within the
of the 2014/15 SIs has identified that there
Clinical Hub to look at patterns of staff
is an equal split between those identified for
The Trust has contributed to the National
errors, identify issues and address them with
the North and East/West divisions for the A&E
Ambulance Service Risk and Safety Forum
additional support and training.
service line. In addition, the majority of SIs
(NASRAF) review of SIs reported by all
which related to the Trust’s A&E Clinical Hubs
Ambulance Trusts. This identified very similar
took place within the North Division, with
themes to those being seen at this Trust.
❚❚ A change to the order of the opening script
for third party callers contacting NHS 111.
❚❚ An additional focus on training within NHS
two of these incidents relating to cross border
111 on the management of emergency
arrangements. As a result of these incidents
Duty of Candour
calls.
work has taken place with neighbouring
On 1 April 2013, the contractual Duty of
ambulance services to address the lessons
Candour was introduced for all NHS Trusts to
learned.
report to patients or their next of kin where it
Serious Incidents
A fundamental part of the Trust’s risk
is identified that moderate or severe harm has
management system is appropriately managing
SI investigations are considered within Serious
resulted from care provided by the Trust
SIs to ensure lessons are learned. SIs are
Incident Review Meetings which are designed
(where this has not already been identified
identified through a systematic review of both
to identify organisational learning. These
as a SI). This duty became statute on 27
adverse incidents and patient feedback. All
meetings are chaired by a Clinical Director or
November 2014 and was included within the
incidents that are believed to potentially meet
Deputy Director with a clinical background.
Health and Social Care Act 2008 (Regulated
the nationally set criteria for a SI are passed to
All staff involved in the incident are invited to
Activities) as Regulation 20.
the clinically qualified Patient Safety Manager
attend as this provides the best opportunity
for preliminary review, before being circulated
for the Trust to identify learning. Learning
The Trust has developed a process for the
to the Director led decision making group.
can either be at a local, Trust wide or at times
management of these incidents which has
national level, for example referring learning
been agreed with our commissioners.
It is important to note that the proportion of
to NHS Pathways to help them improve the
The Trust supports an open culture and has
SIs as a percentage of patient contact activity
national Pathways system. A Serious Incident
introduced a ‘Proactive Apology Process’,
2014/15
quality account
which involves apologising to patients when
the level of service that has been provided
to them is below the standard that the Trust
would expect. This process, which applies to
incidents rated as being negligible or low,
complements the Trust’s approach to the Duty
of Candour.
Central Alert System
The Central Alert System (CAS) is an electronic
web-based system developed by the
Department of Health, the National Patient
Safety Agency (NPSA), NHS Estates and the
Medicines and Healthcare products Regulatory
Agency (MHRA). This aims to improve the
systems in NHS Trusts for assuring that safety
alerts have been received and implemented.
During 2014/15 the Trust acknowledged 100%
of CAS notifications within 48 hours, thereby
meeting the national requirement. The number
of notifications received is set out in the table
below.
Other Patient Safety Measures
Central Alert System (CAS)
Received
2014/15
2013/14
157
232
39
Clinical Effectiveness
The Trust is committed to maintaining excellent standards of clinical effectiveness, developing its existing practice and processes through the review of
learning, audit, guidance and best practice.
The table below shows the Trust’s Category A Performance by Clinical Commissioning Group.
Red 1 Performance
Clinical Commissioning
Group
No of
Incidents
2014/15
Red 2 Performance
2013/14
No of
Incidents
2014/15
A19 Performance
2013/14
No of
Incidents
2014/15
2013/14
1,601
74.83%
70.44%
33,435
69.20%
76.67%
34,826
90.74%
94.24%
966
83.23%
78.49%
18,656
75.99%
82.49%
19,617
96.21%
97.77%
NEW Devon
2,486
79.49%
78.88%
51,516
75.61%
81.98%
53,720
93.69%
95.91%
Somerset
1,399
72.98%
71.56%
28,531
70.92%
78.17%
29,886
92.82%
95.88%
Dorset
2,517
84.07%
83.63%
47,531
73.70%
81.78%
49,970
95.77%
97.86%
North Somerset
816
70.34%
63.36%
11,451
68.56%
67.70%
12,255
93.25%
93.15%
Bath & NE Somerset
594
74.75%
71.50%
8,409
72.22%
74.10%
9,001
93.73%
94.71%
2,045
76.63%
78.17%
27,922
74.29%
78.50%
29,931
97.11%
97.87%
808
65.35%
62.71%
12,235
63.64%
66.36%
13,037
94.58%
96.75%
Gloucestershire
2,223
67.07%
69.10%
30,573
66.44%
71.92%
32,790
91.53%
94.44%
Wiltshire
1,479
65.86%
58.73%
22,569
62.28%
64.38%
24,013
88.71%
90.72%
Swindon
839
81.88%
88.70%
11,705
79.03%
87.70%
12,545
96.99%
99.00%
17,806
75.24%
73.15%
305,072
71.42%
72.23%
322,159
93.62%
95.76%
Kernow
South Devon & Torbay
Bristol
South Gloucestershire
Trust
2014/15
quality account
Urgent Care Service
and Gloucester. The table below shows
from their own homes) to triage patients
The Urgent Care Services, both GP Out-of-
the achievement of the national quality
when they have spare capacity, thereby
Hours and NHS 111, are monitored through
requirements. These requirements are set by
enhancing and supporting the capacity
the assessment against national quality
the Department of Health and are
of our central triage team. Other actions
requirements. These quality requirements
applicable to every Out-of-Hours service in
have included revising the training plan for
cover a number of different areas (including
England.
supervisors and dispatchers to ensure a
the auditing of calls and patient experiences).
high level of focus on responding
This information is reported in the Integrated
Despite a challenging year, the
quickly to patients with urgent needs;
Corporate Performance Report, presented to
Out-of-Hours services performed well and
enhancing GP pay in both Dorset and
the Board of Directors at each meeting, and
improved on last year’s performance against
Somerset to encourage good levels of
available on the Trust’s website.
the quality requirements. In order to meet
shift coverage; reviewing shift patterns to
some of the challenges faced by the service,
make them more attractive for GPs; and
GP Out-of-Hours Service
we implemented a number of actions including
implementing direct booking into treatment
During 2014/15 the Trust delivered GP Out-
changes to the triage queue to enable GPs
centres by the NHS 111 services to free up GP
of-Hours Services across Dorset, Somerset
in local treatment centres (and in some cases
time.
Quality Requirement
Target
Dorset
Somerset
Gloucester
QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality
Requirements
Compliance
Compliant
Compliant
Compliant
QR2 - Percentage of Out-of-Hours consultation details sent to the practice where the patient is registered
by 08:00 the next working day
95.00%
99.51%
99.74%
Compliant
QR3 - Providers must have systems in place to support and encourage the regular exchange of information
between all those who may be providing care to patients with predefined needs
Compliance
Compliant
Compliant
Compliant
QR4 - Providers must regularly audit a random sample of patient contacts (audit should provide sufficient
data to review the clinical performance of each individual working within the service)
Compliance
Compliant
Compliant
Compliant
QR5 - Providers must regularly audit a random sample of patients’ experiences of the service
Compliance
Compliant
Compliant
Compliant
41
Quality Requirement
Target
Dorset
Somerset
Gloucester
QR6 - Providers must operate a complaints procedure that is consistent with the principles of the NHS
complaints procedure
Compliance
Compliant
Compliant
Compliant
QR7 - Providers must demonstrate their ability to match their capacity to meet predictable fluctuations in
demand for their contracted service
Compliance
Compliant
Compliant
Compliant
QR10a - All immediately life threatening conditions (walk in patients) to be passed to the ambulance
service within 3 minutes of face to face presentation
95.00%
n/a
n/a
n/a
QR10b - Definitive Clinical Assessment for Urgent cases presenting at treatment location to start within
20 minutes - not applicable to this service as a separate clinical assessment is not carried out between
presentation and clinical consultation at walk-in-centres
95.00%
n/a
n/a
n/a
QR10b - Definitive Clinical Assessment for Less Urgent cases presenting at treatment location to start
within 60 minutes - not applicable to this service as a separate clinical assessment is not carried out
between presentation and clinical consultation at walk-in-centres
95.00%
n/a
n/a
n/a
QR10d - At the end of an assessment, the patient must be clear of the outcome
Compliance
Compliant
Compliant
Compliant
QR11 - Providers must ensure that patients are treated by the clinician best equipped to meet their needs in
the most appropriate location
Compliance
Compliant
Compliant
Compliant
QR12 – Emergency Consultations (presenting at base) started within 1 hour
95.00%
50.00%
QR12 - Urgent Consultations (presenting at base) started within 2 hours
95.00%
92.27%
94.74%
95.68%
QR12 - Less Urgent Consultations (presenting at base) started within 6 hours
95.00%
96.73%
97.15%
95.76%
QR12 - Emergency Consultations (home visits) started within 1 hour
95.00%
75.00%
100.00%
100.00%
QR12 - Urgent Consultations (home visits) started within 2 hours
95.00%
91.76%
91.57%
94.03%
QR12 - Less Urgent Consultations (home visits) started within 6 hours
95.00%
95.45%
97.67%
97.19%
QR13 - Patients unable to communicate effectively in English will be provided with an interpretation
service within 15 minutes of initial contact. Providers must also make appropriate provision for patients
with impaired hearing or impaired sight
Compliance
Compliant
Compliant
Compliant
2014/15
quality account
n/a (no emergency
cases)
100.00%
NHS 111
exacting targets relating to the percentage
to retain due to local job market forces and
The Trust commenced delivery of the
of calls being answered within 60 seconds
the nature of the service which requires high
NHS 111 service across Devon, Dorset,
and the percentage of abandoned calls.
numbers of part time staff.
Somerset and Cornwall during 2013/14. The
These targets have not been achieved due
following table shows the activity levels for
primarily to high levels of call volumes at peak
Despite great efforts and additional
the four counties during their first full year of
periods. These demand patterns require very
significant investment, the Trust has
operation in 2014/15, and the performance
large numbers of NHS 111 call advisors to be
reached the decision that the current
against national quality requirements. As with
employed for peak times at weekends over
NHS 111 operating model is not sustainable
Out-of-Hours services, national quality targets
short shift durations; i.e. between 08:00
and so, with great regret, has exercised its
are set out by the Department of Health for
and 13:00 hours and between 16:00 and
right to serve notice on the NHS 111
NHS 111 services and are applicable to every
20:00 hours on Saturdays and Sundays.
contracts in Devon and Cornwall and will not
service in England.
deliver these after 31 March 2016. The Trust
Whilst the Trust has recruited and trained a
will be working closely with commissioners
Whilst the Trust has provided high quality
high number of call advisors for weekend
during the notice period to ensure a
clinical care when delivering the NHS 111
working and improved the recruitment and
smooth handover to the new service
service, it has not been able to achieve the
retention process, these staff can be difficult
provider.
Quality Requirement
Somerset
Cornwall
and IOS
Dorset
Devon
n/a
248,683
384,831
154,773
129,940
QR1 - Providers must report regularly to NHS Commissioners on their compliance with the Quality
Requirements
Compliance
Compliant
Compliant
Compliant
Compliant
QR2 - Providers must send details of all consultations (including appropriate clinical information) to the
practice where the patient is registered by 0800 the next working day.
95.00%
88.82%
97.76%
96.71%
96.46%
QR3 - Providers must have systems in place to support and encourage the regular exchange of
information between all those who may be providing care to patients with predefined needs
Compliance
Compliant
Compliant
Compliant
Compliant
Activity (Total calls answered)
Target
43
Quality Requirement
Target
Dorset
Devon
Somerset
Cornwall
and IOS
QR4 - Providers must regularly audit a random sample of patient contacts (audit should provide
sufficient data to review the clinical performance of each individual working within the service)
Compliance
Compliant
Compliant
Compliant
Compliant
QR5 - Providers must regularly audit a random sample of patients’ experiences of the service
1.00%
0.29%
0.38%
0.36%
0.33%
QR6 - Providers must operate a complaints procedure that is consistent with the principles of the NHS
complaints procedure
Compliance
Compliant
Compliant
Compliant
Compliant
QR7 - Providers must demonstrate their ability to match their capacity to meet predictable fluctuations
in demand for their contracted service
Compliance
NonCompliant
NonCompliant
NonCompliant
NonCompliant
QR8a - No more than 5% of calls abandoned before being answered
5.00%
4.10%
5.07%
5.33%
6.08%
QR8b - Calls to be answered within 60 seconds of the end of the introductory message
95.00%
83.68%
79.91%
80.65%
77.09%
QR9a - All immediately life threatening conditions to be passed to the ambulance service within 3
minutes
100.00%
94.15%
95.45%
91.38%
95.15%
QR9b - Patient callbacks must be achieved within 10 minutes
100.00%
24.63%
44.72%
24.56%
22.97%
QR13 - Patients unable to communicate effectively in English will be provided with an interpretation
service within 15 minutes of initial contact. Providers must also make appropriate provision for patients
with impaired hearing or impaired sight
100%
100%
100%
100%
100%
QR14 - Providers must demonstrate the online completion of the annual assessment of the Information
Governance Toolkit at level 2 or above and that this is audited on an annual basis by Internal Auditors
using the national framework
Compliance
Compliant
Compliant
Compliant
Compliant
QR15 - Providers must demonstrate that they are complying with the Department of Health Information
Governance SUI Guidance on reporting of Information Governance incidents appropriately.
Compliance
Compliant
Compliant
Compliant
Compliant
Tiverton Urgent Care Centre
The Trust took over the management of the Urgent Care Centre in Tiverton in July 2014. The primary measure within the operating contract is the 4 hour
waiting time standard, which is the same target for Acute Trust Emergency Departments.
Indicator
Target
8 July 2014 – 31 March 2015
Percentage of cases completed within 4 hours
95%
99.43%
2014/15
quality account
Ambulance Clinical Quality Indicators
The following tables show Trust performance for further ACQIs. As previously stated one of the Trust’s selected priorities for 2014/15 was the
development of a Post ROSC Care Bundle.
Lowest
Trust
Performance
(Apr to Nov-14)*
Highest
Trust
Performance
(Apr to Nov-14)*
National
Average
(Apr to Nov-14)
2013/14
Indicator
Year to date
2014/15
(Apr to Nov)
Ambulance Clinical Quality Indicators
Return of spontaneous circulation (ROSC) at time of arrival at hospital (Overall)
24.8%
24.8%
27.5%
41.4%
18.7%
Percentage of Face Arm Speech Test (FAST) positive stroke patients (assessed face to face)
potentially eligible for stroke thrombolysis, who arrive at a hyperacute stroke centre within
60 minutes of call
56.9%
55.6%
60.6%
71.6%
47.5%
*Highest/Lowest Trust reporting has been noted for each indicator independently.
Lowest
Trust Performance
(Apr-14 to Feb-15)*
Highest
Trust Performance
(Apr-14 to Feb-15)*
National
Average
(Apr-14 to Feb-15)
2013/14
Indicator
Year to date
2014/15
(Apr to Feb)
Ambulance Clinical Quality Indicators: Ambulance calls closed with telephone advice or managed without transport to A&E departments (where clinically appropriate)
Calls closed with telephone advice
8.3%
6.8%
8.0%
13.4%
3.4%
Incidents managed without the need for transport to A&E
52.3%
51.6%
37.1%
52.4%
27.3%
*Highest/Lowest Trust reporting has been noted for each indicator independently.
45
Last year’s Quality Account reported on the first
and the 999 EMS Research Forum. One of the
❚❚ Modelling the Increase in Ambulance
stage of Transforming Urgent and Emergency
team also won the prize for ‘Most innovative
Demand - The Peninsula Collaboration
Care, which identified that by supporting
use of routine data’ at the 999 EMS Research
for Leadership in Applied Health & Care
and developing paramedics and providing
Forum.
(PenCLAHRC) led on this operational
direct access to GPs and specialists, around
research, which used a system dynamics
half of all 999 calls requiring an ambulance
Research Showcase
model to examine factors relevant to the
could be managed at the scene without an
The Trust held its second annual Research
increase in demand for ambulance resources
unnecessary trip to hospital. The Trust has been
Showcase in Exeter during March 2015.
in the South West.
❚❚ The OAK Project - Funded by the National
working with commissioners and other partner
organisations throughout 2014/15 to deliver
The aim of the event, hosted by the Trust’s
Institute for Health Research from the
this priority element of the Right Care initiative.
Research and Audit Team, was to showcase
Research for Patient Benefit Programme
The outcome of this focus is evident in the
some of the research currently being
(NIHR RfPB), aimed to examine whether
improved performance of ‘Hear and Treat’ as
undertaken within the Trust and to promote
Ambulance Paramedics and Emergency
set out in the table on page 45, which shows
engagement with staff and students,
Care Practitioners can use FRAX® (the WHO
the percentage of calls closed with telephone
highlighting some of the ways in which they
Fracture Risk Assessment Tool) to assist
advice and those managed without taking the
can become involved in, and develop, a
GPs in improving the future fracture risk in
patient to an Emergency Department.
research career. The event brought together
patients that fall. The feasibility of using the
a multi-disciplinary group including a wide
tool and the challenges of patient follow up
Research Activity
range of staff grades, students from University
were discussed.
Poster Displays at External Conferences
partners, and representatives from the
During 2014/15 the Research and Audit team
research community and Higher Education
National Institute for Health Research
showcased their work to a national audience
Institutions (HEIs).
(NIHR) Programme Development Grant.
through attendance at several key conferences.
❚❚ The CAIRO Project is funded as a
One of the Trust’s Research Paramedics
Posters were displayed at the National Health
The speakers presented on a range of projects,
gave an overview of the different work
Service Research Network Conference, the
including both recently completed and ongoing
packages and how the feasibility of the
National College of Paramedics Conference
studies:
project will be evaluated ahead of a
2014/15
quality account
potential full grant application.
self-poisoning in a pre-hospital setting.
❚❚ Pre-Hospital Lactate – This small scale
The Research and Audit team are already
planning for the 2015/16 event.
service evaluation aimed to assess the
Representatives from one of the local
feasibility and use of pre-hospital point of
Medical Schools were available to enthuse
Patient Experience
care lactate monitors in a single trial area
and encourage delegates with their
Patient experience and patient engagement
attending one acute Trust.
opportunities for Masters level study. The
provides the best source of information to
event was also supported by representatives
understand whether the services delivered by
randomised feasibility work undertaken
from one of the Trust’s lead NHS health
the Trust meet the expectations of the patient,
in the Trust, the Airways 2 project is a
libraries. There was a display dedicated to
including assessing whether a quality service is
multi-centre cluster randomised controlled
the library services with copies of resources
provided.
trial funded by the NIHR. The study will
available for delegates.
❚❚ Airways 2 – Building on previous
aim to compare supraglottic airway devices
The table below shows some of the Trust’s
(devices which are introduced into the
A poster display included some of the ongoing
existing methods and quantitative information
pharynx, ensuring the upper respiratory
research and quality improvement projects
on service user experience.
tract remains open) with current practice
conducted by staff and some that involved
during pre-hospital cardiac arrest.
collaborations with HEIs and other Trusts.
Patient Experience Measures
2014/15
2013/14
There was also a dedicated display for
Complaints, Concerns and
Comments 4
1,268
1020
Patient, Advice and Liaison
Service (PALS) – Lost Property,
signposting to other services etc
857
711
Health Service Ombudsman
complaints upheld
2
1
Compliments
2,055
1454
❚❚ The Shiftwork Study - This qualitative
study, funded with a research grant from
student projects and two prizes were
the College of Paramedics, explored the
awarded for these prior to the day.
views of Paramedics on the impact of
working shifts.
❚❚ The Single Dose Activated Charcoal
The event was shared with a global
audience through social media. Over 300
Study (SDAC) – This local trial evaluated
‘tweets’ resulted in over 410,000 twitter
the feasibility of using SDAC as an
impressions.
When noting the number of comments, concerns and complaints
received it is important to consider that the Trust proactively invites
feedback from patients and their representatives.
4
acceptable and effective treatment for
47
Compliments
of the Board of Directors and of the Council
The Trust receives telephone calls, letters and
of Governors. These stories can be written
emails of thanks from many patients every
testimonies, which are read out by a member
week. Wherever possible this gratitude is
of the forum and more recently have involved
passed directly onto the members of staff who
audio and video patient interviews obtained by
attended the patient or service user.
the Patients Association as part of the Trust’s
membership of this organisation.
599 more compliments were received during
2014/15 than in the previous year, which
Patient Opinion
equates to a 41% increase. This, however,
Patients and their relatives and carers can post
may be due to the way in which the process
details of their experience on the “Patient
is now managed, with all data being collated
Opinion” website, with these posts being
centrally to enable more accurate
available to anybody visiting the site. The
reporting.
Trust responds to every comment about its
service. Where the feedback is negative or
The Trust continues to use ‘wordles’ – a visual
Patient Engagement
indicates service failure, the individual who
representation of the key words included in
During 2014/15 the Trust continued to
provided the comments is invited to contact
the compliments received. These are shared on
develop its patient engagement activities. This
the Trust directly with further details so that
the Trust’s intranet so that all staff can see the
engagement helps to ensure that the Trust’s
the concerns can be addressed by the Patient
type of positive feedback that the Trust receives
services are responsive to individual needs; are
Experience Team. Where the post is positive
about the work that they do.
focused on patients and the local community;
and the incident in question can be identified,
and support the Trust in improving the quality
the posting is passed directly to the member(s)
of care provided.
of staff involved. If there is insufficient detail
The following picture is a year-end summary
of the compliments received for 2014/15, the
the Patient Engagement Team will respond
larger the word/phrase the more frequently it
The Patient Engagement Team source patient
requesting additional information in order to
was used.
stories for use at the start of each meeting
be able to convey the positive feedback.
2014/15
quality account
During the year 271 stories relating to the Trust
contact for example a sensitive case that may
patient expectations, whilst the issue of
have been posted on Patient Opinion. As of
be related to a safeguarding concern.
clinician availability was also raised.
experience had been viewed more than 47,590
A paper questionnaire is sent out to
836 responses were received from GP Out-
times.
respondents, which also contains a link to the
of-Hours surveys during the year. Feedback
online survey. The survey includes a series of
suggests that patients who are satisfied with
The headlines of the top three stories, based
questions under the following headings:
the service received, are likely to recommend
on number of times they have been viewed,
❚❚ Friends and Family Test
the service and to use it again. The positive
are shown below.
❚❚ Getting through
comments made particular reference to
❚❚ After the call
the quality of the service being provided,
❚❚ Satisfaction
with patients describing the service as
❚❚ Use of 111/Out-of-Hours telephone service
comprehensive, professional, caring and
31 March 2015 these accounts of patients’
“Paramedic arrived like a knight in shining
armour.”
and satisfaction with the NHS
“Emergency air lifted after tractor
accident.”
“Impressed by kindness and teamwork.”
❚❚ Caller/patient information.
invaluable. Patients also highlighted the way
the delivery of care made them feel; reporting
feeling reassured and grateful to Trust staff
The Trust provides a monthly report to
who they described as friendly, sensitive and
commissioners on the number of calls taken;
understanding.
and the forms returned within that period. A
Patient Experience Surveys
full report is submitted to commissioners every
The negative comments are often very detailed
The Trust audits 1% of patient contacts
six months.
though are significantly less in number
every month for the NHS 111 contracts and
compared to positive comments. Patients
separately for the GP Out-of-Hours contracts
During the year 661 people responded
have highlighted a concern regarding a delay
from the responses received from a fortnightly
to the survey in respect of their NHS 111
in receiving a call back from Trust clinicians
survey. The survey sample is randomly selected
experience. These responses highlighted that
and feeling that diagnosis was rushed or
and then an audit is undertaken to remove any
further consideration needs to be given to
incomplete. Patients also highlighted that they
individuals who it would not be appropriate to
communication about the service to manage
felt there should be more home visits made to
49
assess and treat.
group are very well attended and members
NHS service they have received to friends and
have let the Trust know how much they
family who need similar treatment or care.
At the end of 2014/15, the Patient
value this engagement, as evidenced by the
Implementation of this survey was one of
Engagement Team has taken responsibility for
comments from group members below:
the key priorities in the Quality Account for
conducting these patient experience surveys.
The Team are using a revised version of the
survey that was devised and tested by the
Picker Institute at the Trust’s instruction. It is
hoped that the new surveys will improve the
2014/15 and a report on progress made is
‘People were scared of being in an
ambulance but not anymore. The
ambulance service are now more aware
of people with a learning disability.’
Trust’s response rate and increase engagement
from patients.
Learning Disability
presented at pages 15-17.
Public and Patient Involvement
During 2014/15 148 patient and public
involvement events were attended, staffed
‘It’s good to mix with different people.
I liked it when the ambulance students
came to visit us; that was good.’
predominantly by volunteers drawn from
‘The group now know more things. As we
know the uniform is green we won’t be
scared in an emergency as we know the
uniforms.’
Examples of the types of events include county
clinicians, managers, administrators, governors
and community first responders.
During 2014/15 the Patient Engagement Team
has been working closely with Plymouth People
First, a self-advocacy organisation for adults
with a learning disability. There has been a
focus on education about the Trust’s services
and the development of a patient reference
group.
shows, community fetes and fairs, school and
college visits and public health awareness days.
These events provide a fantastic opportunity
to engage with existing patients and potential
It is intended that learning from this initiative
service users, informing them about the
can be shared across the Trust where
services provided and obtaining their views on
appropriate.
them.
was established in September 2014, has a 12
Friends and Family Test
The events also provide an opportunity
month programme which has been agreed
The FFT is a single question survey which asks
to deliver proactive health checks, 1,262
with all the members. The meetings of the
patients whether they would recommend the
members of the public received a ‘know your
The patient reference group, called SWAG
(South Western Ambulance Group), which
2014/15
quality account
blood pressure’ check and 48 people within
the community received a free NHS Health
Check, covering blood pressure, body mass
index, blood glucose and cholesterol levels. The
results are provided immediately and where
necessary recommendations about further
medical care, such as attending their own GP,
were made.
A number of activities were also
undertaken in conjunction with our
partners and included involvement in Road
Safety Partnership events, taking part in the
festive ‘Drink Drive’ campaign and by
placing the Trust’s Mobile Treatment
Centre in town centres to enable on the
spot access to health care. All of these
activities resulted in positive engagement with
the community.
51
Assurance Statements - Verbatim
Clinical Commissioning Groups (CCG)
of SWASFT as a provider of 999 services.
South Central and West Commissioning
Account and can confirm that the information
presented appears to be accurate and
Support Unit
SWASFT makes an important contribution to
demonstrates a successful organisation and
South Central and West Commissioning
the health and wellbeing of the population
a high level of commitment to quality in the
Support Unit (SCWCSU), who manage the 999
within CCG localities through the services
broadest sense which is commended. The
contract on behalf of Clinical Commissioning
it provides and is committed to providing
information it contains accurately represents
Groups across the South West (referred to
safe, high quality, clinically effective care. The
SWASFT’s quality profile and contains
as commissioners) is pleased to provide a
achievements noted in the Quality Account for
appropriate statements of assurance from
combined commentary on the South Western
2014/15 demonstrate this.
the Board. It reflects the very good work
Ambulance Service NHS Foundation Trust
undertaken by the organisation and sets out
(SWASFT) Quality Account. SCWCSU have
Quality Accounts are intended to help the
clearly the quality ambitions, challenges and
put routine processes in place with SWASFT
general public understand how their local
achievements from 2014/15 and sets the
to agree, monitor and review the quality of
health services are performing and with that in
direction for 2015/16.
services throughout the year covering the key
mind they should be written in plain English.
quality domains of safety, effectiveness and
SWASFT has produced a comprehensive, well
Review of Quality Priorities for 2014/15
experience of care.
written Quality Account. It is easy to read
Commissioners have noted SWASFT’s
and clearly set out. The document outlines
performance against last year’s quality
SWASFT is a responsive, dynamic and
SWASFT’s approach to delivering quality
priorities. They are of the opinion that, in
innovative organisation, and has worked hard
care and quality improvement within its
addition to the information given, it would
to develop excellent working relationships
services, providing an open account of their
be good to see more outcome focused data
with commissioners. SWASFT has taken on
performance in terms of patient safety, patient
from these priorities as well as from other
board extra responsibilities over the past two
experience and clinical effectiveness.
patient safety initiatives during the year.
years including NHS 111 provision but this
commentary is primarily based on knowledge
2014/15
quality account
Commissioners would also like to have seen
Commissioners have reviewed the Quality
the plans on how SWASFT will improve
performance for 2015/16, where priorities
child death from sepsis. SWASFT have been a
the development of the Sepsis Assessment
were not fully achieved.
committed partner in the pilot work in Torbay
and Management (SAM) leaflet and a clear
and continues to be a key player in the on-
commitment to ensuring sepsis is quickly
going initiatives to combat sepsis for all ages.
identified and treated and harm. Following the
Patient Safety
Priority 1: Sepsis (partially achieved)
evaluation by parents and clinicians of the SAM
The Quality Account highlights the work
The multi-agency group on Paediatric Sepsis
leaflet, any necessary changes will be made
SWASFT has done to improve the early
(lead by NHS England DCIoS Area Team) was
and the SAM leaflet reissued.
identification of sepsis, which is a major
formed to find whole health system changes
cause of unexpected death in the UK. Given
that would reduce the risk of avoidable
Clinical Effectiveness
the continued and justified local, regional
child death from sepsis. The group included
Priority 2: Electronic Care System (ECS)
and national focus and commitment to the
primary and secondary care, Devon CCG,
(achievement to be confirmed)
management of this important clinical issue,
Devon Doctors and SWASFT and also invited
The Quality Account presents work undertaken
commissioners recognise the work undertaken
parents of one child who had died and were
to implement the Electronic Care System (ECS)
by SWASFT in support of this priority.
campaigning for improvements in the care
which will allow SWASFT to better manage
system. The product and effects of these
patient care and report on better quality
Commissioners are particularly keen to
changes are being tested in Torbay and is being
patient information, with the technical ability
ensure people with sepsis are identified and
evaluated by Plymouth University over the
to integrate with hospitals and the wider
treated within the ‘golden hour’ and the work
summer. The work of SWASFT in this Quality
health community system. Commissioners
SWASFT has done to date, especially in the
Account therefore needs to be viewed in this
commend such innovative work and will be
development of the Sepsis Assessment and
wider context, in supporting both the regional
interested to note the long term success of
Management (SAM) has been a major support
and national direction in travel in respect to
this project (with supporting data highlighting
to that initiative.
sepsis management is to be applauded.
improved client care).
Commissioners are very pleased to note the
Further to this, the most important element
Commissioners would encourage SWASFT to
full engagement of SWASFT in the local and
of this work has been in supporting parents
be bolder in the roll out of the ECS, to further
national work to reduce the risk of avoidable
and carers to make appropriate decisions with
support the single view of the patient, service
53
interoperability and increasing further clinical
employed in more traditional care settings
Up to Safety’ agenda, Paediatric Big 6 and
effectiveness through the potential better use
can be more difficult to deliver. SWASFT’s
Frequent Callers. All are appropriate areas to
of more appropriate care pathways.
approach in the implementation of the FFT
target for continued quality improvements and
can be applauded and whilst response levels
link with the clinical commissioning priorities.
Priority 3: Primary Angioplasty
have been low the feedback provided is noted
The priorities demonstrate recognition of the
(achievement to be confirmed)
to have been positive. SWASFT has also been
need to advance clinical effectiveness as well
Commissioners are looking forward to being
able to confirm a reduction in complaints
as improve services across the whole patient
advised of the outcome of this work which has
during 2014/15 and an increase in the number
pathway. Commissioners would support
been attached to a CQUIN scheme.
of compliments received. Commissioners
SWASFT in ensuring that this work is reflected
recognise that the initiatives detailed for
across all of the services provided by them
Patient Experience
2015/16 will generate an even greater
where relevant. They would like to see more
Priority 4: Friends and Family Test (FFT)
opportunity for more patients to provide
specific and measurable quality outcomes
(achieved)
feedback to SWASFT allowing even greater
set for these and have noted that it is quite
Commissioners are pleased to see that SWASFT
reflection and consideration of the patient
powerful to acknowledge where something
achieved against the Friends and Family Test
experience.
hasn’t gone as well as could be expected and
2014/15 priority.
what the lessons learned were in order for onEnsuring that FFT data will be accessible to the
going improvement.
Commissioners noted the positive responses to
public demonstrates a transparent and open
the FFT, however they would like to have seen
culture. The innovative decision to include FFT
Commissioners highlight that achievement of
more specific actions and outcomes in relation
questions on patient safety details will enhance
the Paediatric Big 6 priority will be through a
to how they are using patient feedback from
the response rate and should give a rich picture
Trust-wide CQUIN scheme. They are keen to
the FFT initiative.
of the service.
ensure that this scheme builds on work already
done and does not replicate it.
Commissioners appreciate that this is
Quality Improvement Priorities for 2015/16
not always an easy task for a provider of
Commissioners are pleased to see SWASFT’s
If the Paediatric Big 6 priority is achieved
emergency care, where measures more easily
priorities for 2015/16 focusing on the ‘Sign
SWASFT clinicians will be supported by the
2014/15
quality account
latest evidence/best guidance and patients
service even further with managers being
within target although the CCG acknowledges
will have access to equitable care pathways.
able to complete the Institute for Healthcare
an improvement on the previous year.
The rationale outlines that one of the reasons
Improvement (IHI) Accelerated Patient Safety
for this priority is that ‘national data shows
Programme and QI paramedics able to support
Performance against Red 1 and Red 2
that the “Big Six” accounted for 50% of
colleagues with QI projects and developments.
has also been disappointing within South
all emergency and urgent care admissions’
Gloucestershire. Commissioners acknowledge
(2008/2009) and that there is scope to reduce
Key Performance Indicators (KPIs)
this is alongside some challenging increases
this. Commissioners request that SWASFT
Whilst there was noted improvement in some
in ambulance activity locally in 2014/15. They
consider as a measurement of achievement, an
of the indicators, performance had reduced
hope work joint working in 2015/16 will
overall reduction in conveyances / admissions
from 2013/14. More detailed explanations
improve the performance of these.
of the ‘Big Six’ conditions.
on how SWASFT plans to improve on these
in 2015/16 would provide further assurance
Commissioners are supportive of the
The Frequent Callers priority will be through
to the public as well as commissioners and
encouraging early results from the Dispatch
a Trust-wide CQUIN scheme, supported by
give more value to the significant work that
On Disposition trial. The percentage of Hear
commissioners, to help manage demand and
SWASFT is doing. Commissioners acknowledge
and Treat non-conveyance has almost doubled
release capacity for SWASFT, although more
and commend the 8,148 fewer conveyances
indicating a better utilisation of vehicles and
consideration needs to be given to what
to ED despite an 8.9% increase in activity. It
crew-skills. This has clearly contributed to
success will look like for both the organisation
would be helpful to identify by commissioner
management of acute and urgent care services
and the high users of SWASFT services -
the variance in activity and conveyances
in 2014/15.
particularly care homes. They would like to see
from 2013/14 to 2014/15 as the effect varies
examples and evidence of how this has made
considerably across the commissioned service
In relation to Percutaneous Coronary
a positive impact on this group of clients and
areas.
Intervention (pPCI), SWASFT refer to North
how this has helped capacity in the service.
performance against Call to Balloon Time
Commissioners find it very disappointing that
targets as 85.2%. The Quality Account states
Commissioners are of the view work around
SWASFT’s performance against Red 1 and Red
the baseline, but does not confirm what
quality improvement (QI) will enhance the
2 within Wiltshire is one of the lowest and not
the outturn performance is following the
55
elements of the care bundle. An aide memoire
Right Care 2
has been attached (as part of a PDSA cycle)
Commissioners are supportive of the
Commissioners are disappointed to see that
to defibrillators within two divisional areas
Right Care 2 programme and in the
the Return of Spontaneous Circulation (ROSC)
to measure the impact on performance.
success SWASFT has demonstrated during
and Percentage of Face Arm Speech Test
SWASFT is actively engaged with a programme
2014/15 in safely managing patients in the
(FAST) KPIs were both below the national
of research activity around cardiac arrest
community rather than conveying them to an
average performance. SWASFT have advised
management, which may indirectly impact
Emergency Department (ED). Going forward,
they are aware that nationally there is
positively on this indictor. All Operational
commissioners would request that further
variation amongst how ambulance services are
Officers participated in discussions around the
information is presented in the 2015/16
reporting the ACQI data across all indicators.
ACQIs as part of the on-going engagement of
Quality Account in order to demonstrate
Steps are in place both nationally and locally
the Medical Directorate and the Delivery teams
to stakeholders the positive impact of the
to ensure that the inclusion criteria for this
with in the organisation.
programme, including number of patients
interventions taken to increase it.
indicator is more robustly applied in order
treated at the scene (including home) or
to facilitate meaningful comparisons, and
Commissioners wish to see the early
SWASFT is leading on this work. In order to
implementation of NHS Pathways within the
improve SWASFT’s performance, a post ROSC
North locality in 2015/16 and the resulting
SWASFT has worked hard to maintain its UK-
care bundle was introduced in 2012 and
improvement uplifts previous experienced
lead status for safe non-conveyance of 999
they are maintaining a focus of continuous
within the East and West areas uniformly
patients utilising two main streams of Hear and
quality monitoring which is reported to the
achieved across SWASFT.
Treat and See and Treat. Commissioners are
Resuscitation Clinical Sub Group. When
redirected to other services.
heartened by the robust approach undertaken
mapped as part of an SPC chart it is clear
Quality Overview 2014/15
by SWASFT in ensuring the safe delivery of
that SWASFT data is within the control limits.
Commissioners have highlighted that the there
Right Care 2. There is considerable sharing
SWASFT is actively engaged in improvement
is no mention of the locally agreed and funded
of issues between organisations and all
activity, and all clinical staff who attend a
Operational Resilience and Capacity Planning
primary care queries raised have been robustly
patient in whom ROSC is gained receive
(ORCP) schemes or the centrally funded
investigated and answered satisfactorily.
individual feedback reminding them of the
schemes, or their outcomes.
2014/15
quality account
Commissioners also recognise the excellent
national conferences and development when
at Tiverton. This work has been collaborative,
work that has taken place during the
it is available. Commissioners can further
transparent and based on improved patient
lifetime of the Right Care initiative to reduce
confirm that SWASFT engage fully with the
experience, with commentary invited
conveyances to ED. Having the highest non-
Directory of Services (DOS) team on a regular
from observers and participants as to the
conveyance rate in the South West has posed
basis to understand how pathways leads to
effectiveness of the trial.
a challenging starting point for Right Care 2
local services, most appropriate for the patient,
in terms of driving further improvement in
again support both provider and commissioner
Care Quality Commission
2014/15. Commissioners would like to see
in ensuring good use of local services close to
Commissioners have commented that even
fully developed local plans with clearly defined
people’s homes.
though the CQC inspection occurred during
deliverables for 2015/16.
2013/14 it is good to see that the inspection
Commissioners highlight that the account
did not trigger any concern and resulted in
NHS 111
notes that SWASFT commenced delivering
a positive outcome with SWASFT being fully
Commissioners have commented that the full
111 services in 2013/14 but does not make
compliant with all five outcomes assessed.
roll-out of 111 within the New Devon locality
mention of the fact that SWASFT has now
has been successfully delivered with robust
given notice on the contracts for Devon and
Patient Safety
monitoring and evaluation of performance.
Cornwall.
Commissioners fully support SWASFT’s
Quality monitoring of all issues raised has been
commitment to high quality, safe and effective
at the forefront of SWASFT’s delivery with
Tiverton Urgent Care Centre (UCC)
care that provides a positive experience for the
clinician to clinician contact where that has
Commissioners welcome the extensive input
patient.
been required. There have been some issues of
from SWASFT into innovation and development
KPI delivery at times of extreme demand in the
of services at Tiverton UCC. Not only has this
SWASFT fully support the National Patient
service but these have mirrored similar issues
provided a more robustly consistent service
Safety Agency expectation to report all patient
across the UK occurring with unprecedented
to the immediate surrounding area, but there
safety incidents that occur and are a high
peaks in telephone demand. SWASFT has been
has been a ‘can-do’ approach to testing
reporter of incidents. SWASFT continues to
actively engaged in both local and peninsula-
alternatives to acute ED attendances based
demonstrate that they have in place a culture
wide clinical effectiveness groups, attending
on improved multi-disciplinary team-worker
that supports open investigation, review and a
57
commitment to action and learning. This is
Clinical Effectiveness
Although some patient stories were included
an approach positively welcomed
SWASFT have shown good involvement
there could have been more examples given
by commissioners.
in both national and local audits however,
to demonstrate their high level of public and
commissioners feel it would be good to show
patient engagement and could have been an
The reporting of incidents to the NRLS shows
the learning gained from these and how this
opportunity to demonstrate this in more detail
a positive increase in the number, though
will be taken forward in 2015/16.
from the patient perspective.
highlighted themes or any learning derived
Patient Experience
Commissioners commend the introduction
from the increase in data. This would be
SWASFT has a number of systems in place
of a ‘Proactive Apology Process’ and would
helpful to demonstrate the importance
to support patient and public feedback,
appreciate an understanding of how this has
of incident reporting. Concern has been
engagement and involvement to ensure its
impacted on the experience of patients and
expressed regarding the rise in number of
services are responsive to individual needs.
carers in the incident / complaints process.
in the latter half of 2014/15 and as
The Quality Account outlines the compliments,
Commissioners recognise SWASFT’s work in
to whether SWASFT is confident that the
complaints and concerns SWASFT has received
supporting people with a Learning Disability.
causes are understood and being fully
including those on the Patient Opinion
The work of the South Western Ambulance
addressed in 2015/16.
website, and it is good to note the increase
Group (SWAG) has allowed both service users
in the number of compliments received by
and the service to learn more about each
The report explains a big variation in NRLS
SWASFT, whilst acknowledging that the new
other in a positive and reflective way, removing
data between periods as “changes to the
system allows for more accurate reporting of
a great deal of the anxiety and fear that an
staff involved in uploading incidents”
these.
ambulance journey may cause. Feedback
the Quality Account does not explain any
incidents reported as severe harm and deaths
– commissioners have requested the
from service users has been very positive and
provision of further explanation around this
The Quality Account was particularly strong in
the commissioners would welcome further
and assurance that the NRLS data is now
areas of patient and public involvement and
development of SWASFT’s Patient Engagement
being identified and uploaded
experience with good and clear explanation of
Team’s work with people with a Learning
appropriately.
both how this was achieved alongside the FFT.
Disability, their advocates and carers across the
2014/15
quality account
wider New Devon CCG footprint.
been particular areas of improvement in the
SWASFT over the coming 12 months to
identification and management of Venous
maintain and improve high quality healthcare
Overall Commissioners are happy to commend
Thromboembolism and in seeking patient
services for the population of Dorset.
this Quality Account and SWASFT for its
feedback.
Healthwatch
continuous focus on quality of care. They look
forward to continuing to work in partnership
The Trust have found sustaining performance
Healthwatch Dorset
with SWASFT during 2015/16 and developing
in the 111 service a challenge, but the Trust is
In the past year Healthwatch Dorset
further relationships to help deliver their
working closely with commissioners to improve
has received feedback about the Trust’s
vision of healthy people, living healthy lives, in
this.
services from patients, relatives and carers.
healthy communities.
Overwhelmingly, the feedback has been
In relation to the priorities identified for
positive, especially in relation to staff attitudes
NHS Dorset Clinical Commissioning Group
2015/16 there is an increased focus on
and the high quality of care and compassion
Over the past 12 months South Western
working on initiatives across all service lines
patients receive in emergency situations from
Ambulance Service NHS Foundation Trust
which NHS Dorset CCG welcomes. The CCG
first responders, paramedics and ambulance
(SWASFT) have continued to focus on
recognises and endorses the priorities for the
staff.
improving the clinical outcomes, safety and
999 element of the service which support
experience of patients within the Urgent Care
some of the priorities that the CCG will
However, we received some feedback that on
Service. The work that SWASFT has done
also focus on, particularly in relation to the
occasion, the telephone support via NHS 111
throughout the year on improving compliance
management of sepsis.
has not been as good as it should be, with
with the National Quality Requirements for
people telling us that they were told to “get a
the Out-of-hours Service has seen continued
The CCG would like to note that a CQUIN plan
taxi” or that the service was “too busy” and
improvement on last year’s performance with
is being developed for Urgent Care Services for
ambulances could not be dispatched or having
no areas of non-compliance at the year end.
2015/16 that seeks to improve quality, safety
to call back repeatedly to find out whether an
and experience of service users and supports
ambulance was on its way. There were a few
The Trust have fully delivered by the CQUIN
some of the priorities set out by the Trust.
incidents where patients told us they had to
schemes set by NHS Dorset and there have
The CCG looks forward to working with
wait between 2 and 4 hours for an ambulance/
59
paramedic.
Healthwatch Tobay
to learning and its partnership with other
Healthwatch Torbay’s role, in this instance,
organisations. The realism associated with
We welcome the fact that the Trust “Patient
is to give an independent overview of the
the concept of financial viability is honest
Experience Priority 3 – Frequent Callers”
public experience of emergency and urgent
but challenging. System redesign to increase
will be looking at how to manage this group
care, as provided by South West Ambulance
the delivery of urgent care at the point of
of patients better. We have received
Foundation Trust. Our various ways of
need should be welcomed by the public
comments about patients being asked to sign
encouraging the public to provide feedback
and Healthwatch Torbay will be in a position
“service contracts” and being confused and
provides the body of knowledge which is the
to monitor their reaction. Although not
upset about what this means. We hope that
basis of our comment.
specifically mentioned but relevant, we are
this Priority will help to support this
vulnerable group moving forward.
concerned about the potential for disruption
We are very pleased to make the first comment
by future decisions about changes to the
a compliment. The Account is presented
delivery of NHS 111 and the associated GP
Healthwatch Dorset acknowledges that the
in a clear and readable manor, one which
Out-of-hours services.
Friends and Family Test is relatively new
the public will be able to understand and
to the Trust and all its service areas. We
appreciate. The glossary of terms is especially
Healthwatch Torbay was not directly consulted
look forward to seeing more results next
welcome as is the systematic presentation of
as stakeholders in the choice of quality
year. We commend the various methods
factual information. We are hopeful that the
priorities for 2015/16 but we consider the
being used to engage with service users and
final format will not be text alone as 43% of
decisions to be appropriate. The Paediatric
would appreciate further information, when
English adult working-age population cannot
Big Six is especially welcomed. It is a timely
available, about the results of the Patient
fully understand and use health information
contribution to national and local imperatives:
Experience Surveys. It would also be useful
using only text (Royal College of General
to see more information about the terms of
Practitioners. Health literacy, 2014).
reference, objectives and ultimately
the findings and actions arising from those
In overview the Account describes the Trust’s
findings, of the Patient Reference
drive for continuous practice improvement
Groups.
using evidence, the commitment of employees
2014/15
quality account
“The vast majority of children’s illnesses
are minor, requiring little or no medical
intervention and a significant number
of these attendances (emergency
department) can be deemed unnecessary
or inappropriate. However, each one of
these attendances tells us that a parent
was worried, and either unable or unsure
how to access a more appropriate
service.”
as the implementation of the Electronic
hospitals.
Patient Clinical Record (EPCR) system and
the continued implementation of the ‘The
HC is glad to see that SWASFT are continuing
Right Care’ programme, which has saved the
to build on the priorities of 2014-15 with the
South West health and social care system
new priorities that have been set, specifically
(Royal College of Paediatrics and Child Health.
millions of pounds. Alongside those successes,
in relation to the work done around SEPSIS
Facing the future together for child health.
Healthwatch Cornwall is disappointed that the
and EPCR. HC is pleased to see that SWASFT is
2015)
trust has not built on the improving picture of
trying to improve its current service by putting
the previous year and has missed a number of
in place a system that will be able to manage
The update report on 2014/15 priorities gives
targets in relation to ambulance response times
frequent callers in a more constructive way
evidence that quality improvement is building
to Red 2 calls and category A 19 minute waits.
and therefore use important resources more
on a sound foundation. We would like to
HC was expecting to see more detail in the
effectively.
see the Trust as Highest in all categories,
quality account regarding 111 performance as
but maybe as your report suggests, the
we are aware of missed targets in this service
The feedback received about the ambulance
middle position suggests honest reporting.
also.
service has always been very positive and
Healthwatch Torbay looks forward to being
shows that people in Cornwall value highly the
kept informed of progress and will play its part
During the year 2014-15 HC worked closely
service they receive and regard it as efficient,
in keeping the public informed.
with NHS Kernow as part of the multi-agency
professional, respectful and one in which
Urgent Care Partnership Board. SWASFT also
they have confidence. Individual staff is often
Healthwatch Cornwall
attended these meeting and HC was impressed
praised for the care and consideration shown
Healthwatch Cornwall (HC) is fully aware
with the level of information, commitment
to patients.
of the stresses on the current providers of
and willingness to change the current system
urgent care in Cornwall. From reading South
to alleviate the high current demand on the
In contrast the feedback that has been received
Western Ambulance Service NHS Foundation
emergency department. It was evident that the
in regards to the 111 service that SWASFT
Trust’s (SWASFT) quality accounts it is clear
changes that SWASFT were introducing were
runs is a mixture of positive and negative
that there have been many successes such
assisting with the reducing of admissions in to
comments, with them generally being more
61
negative. The feedback refers to the triage
The Statement on Quality from the Chief
up to Safety; Clinical Effectiveness – Paediatric
system and the length of time it takes; the
Executive provides a good overview and an
Big Six and Patient Experience – Frequent
types of questions asked, which are perceived
insight to initiatives undertaken during the
Callers as relevant priorities for 2015/16. These
to be irrelevant; and a predictable outcome
year.
are appropriate areas to target for continued
being stated as “attend your nearest A&E
improvement and demonstrate recognition of
department”. For these reasons some patients
The Quality Account helpfully identifies the
the need to ensure improvement to services
have stated that they wouldn’t use the 111
three domains of quality together with the
across the patient pathway.
number in the future but would automatically
priorities set under these headings. Progress
refer to the 999 number or attend the
has clearly been made although without
Healthwatch North Somerset notes that
emergency department, and they may need
corresponding data, we are unable to satisfy
there has been an increase in the number
challenging.
ourselves on the levels of achievement.
of Incidents Reported, Adverse Incidents
We note the improvements made last year
and Moderate Harm Incidents although it
Healthwatch Plymouth
particularly in the Friends and Family Test but
recognises the decrease in Serious Incidents
Healthwatch Plymouth report mostly positive
that the Patient Safety (Sepsis) priority was
compared to the previous year.
comments received on SWASFT services
partially achieved and that achievement of
but state that they would welcome an
the Electronic Care System and the Primary
Page 24 shows a surprisingly high incidence
opportunity to work more closely with the local
Angioplasty has not been confirmed.
of severe harm but figures do not correspond
management of SWAST covering the Plymouth
with those given for such incidents on page 27
area. This would enable service development to
Given the high profile media attention to
which are even higher. These issues may relate
include the patient experience.
waiting times and the impact for ambulance
to 111 and it would be useful to know how
service and A & E departments we would
appropriate 111 dispatches are.
Healthwatch North Somerset
have expected comment on this in the Quality
Healthwatch North Somerset is pleased to have
Account as this surely must have had a major
We welcome the actions that the Trust is
the opportunity to comment on the South
impact on provision.
undertaking to ensure that patient safety is
Western Ambulance Service NHS Foundation
Trust Quality Account.
2014/15
quality account
at the forefront of service provision and is
The Trust has identified Patient Safety – Sign
enhanced.
The substantial decrease in conveyance
and Family test and we would like the Trust
Somerset. Healthwatch North Somerset is an
of patients and subsequent cost savings
to consider the use of independent data
organisation set up by The Health and Social
through the Right Care programme is to be
gathering on its services which should give
Care Act 2012 to engage with the public in
commended.
unbiased and honest feedback, which we
North Somerset and to feedback issues to
would be happy to support them with.
commissioners and service providers, as well as
Key Performance Indicators
a role in formulating views of the standard of
Healthwatch North Somerset commends
Patient experience survey provide a good
services and how they can be improved.
the increase in target objectives achieved for
overview of those patients who responded
Red 1 but notes that Red 2 and 19 minute
to the survey and can provide valuable
We welcome more specific information and
Performance target objectives have decreased
information about the strengths and
data on the service provided in North Somerset
compared to the previous year – but further
weaknesses of an organisation, as well as
to better assess how the service is meeting the
note that all targets are commensurate with
providing pointers about which issues are of
needs of the North Somerset population and
National Averages. Breach of response times
importance to patients. It is disappointing
comparisons with service provided across the
in the last two quarters is a cause for concern.
to see reference to the Patient Experience
commissioned area. There is some concern
The report quotes ‘assurance of action ‘but
Surveys in the draft QR but no details about
(page 29) about poor performance in North
omits to detail how improvement is to be
the number received during the year or of the
Somerset compared to other areas served by
achieved.
contents.
the Trust.
There is commendable performance for
Patient Engagement
An ‘easy read’ version of the Quality Account
achievement against target for the clinical
The level of compliments received is very
would ensure greater accessibility for the
quality indicators.
positive and outweighs the complaints,
general public.
concerns and Comments received.
Patient Experience Surveys
Healthwatch Devon
We are pleased that the Trust takes clear and
Healthwatch North Somerset is disappointed
Healthwatch Devon welcomes the opportunity
robust account of issues raised by its service
that South West Ambulance Service has not
to provide a statement in response to the
users through the strengthening of the Friends
actively engaged with Healthwatch North
Quality Account produced by SWASFT this year.
63
Our response is based on the feedback we
have received from people who have called
and improving the management of ‘frequent
receive about the quality of the services that
111 is mixed. Some report that they have no
callers’ to the service. These are all topics that
the Trust provides in Devon.
confidence in the service and that they would
we hear about that can present difficulties for
not use it again, others found it valuable
patients and carers in Devon and which can cut
Firstly, in respect of the Trust’s vision and
in providing them with the right route for
across a number of services, therefore a multi
values that are outlined in this account,
treatment quickly. We note however from
agency approach and partnership working is
we are pleased to report that the feedback
the Trust’s account that data is not available
key to achieving better outcomes for patients.
that we have received during the last two
to indicate whether the Trust is compliant
We will be mindful of these priority areas
years, although only a small amount, clearly
in respect of auditing patient experiences of
during the coming year and will share any
demonstrates that staff are fully committed
the service and we would be keen to engage
feedback that we receive that may help to
to providing a quality service to patients.
with the Trust as to whether their findings are
inform this work, with the SWASFT Patient
Many people who share their experiences
comparative to ours.
Engagement Team.
of care that they provided to them, for their
In respect of progress, we commend
With regard to patient experience feedback,
compassion and for their professionalism. Any
that SWASFT is looking to increase the
the amount we receive that relates to services
negative feedback that we have received is
opportunities for people to complete the
provided by SWASFT is on the increase. With
mainly focussed on the 111 system, or delays
‘Family and Friends’ test, by making it easier
the imminent launch of our own online
in ambulance arrivals.
for staff to hand patient’s invitations to answer
patient feedback centre - which neighbouring
the questions, for those who remain at home.
Healthwatch organisations in Torbay, Plymouth
with us praise ambulance staff for the quality
Healthwatch Devon recently reported its
and Cornwall have already successfully
findings in relation to where people go if they
Looking forward, Healthwatch Devon is
implemented on their own websites – any
are seeking non-urgent medical treatment
encouraged by The Trust’s set of priorities for
experiences shared will be visible for the public,
and our report revealed that some people do
improvement which encompass: improving
NHS Providers and Commissioners to see.
not know about the 111 service and of those
patient safety; aiming to reduce avoidable
We hope that this will provide SWASFT with
that do, only a small number of respondents
admissions and improving treatment and
another rich source of experience data from
had ever used the service. Feedback that we
outcomes for children and young people;
which to further understand how their services
2014/15
quality account
meets the needs to those who come into
following key areas: patient safety, demand
of the Electronic Patient Clinical Record (We
contact with them.
management, hospital turnarounds and
would like to see this introduced into Wiltshire
improved partnership working.
as soon as practical) to the Right Care initiative
Local Health Overview and
Scrutiny Committees
It is noteworthy that whilst there has been a
without the need to be seen at an Emergency
Response to the SWASFT Quality Account on
significant improvement in the Red 1
Department. Although not highlighted it is
behalf of the SWASFT (Northern Area) Joint
performance data for the year from 58.73%
understood that substantial progress has been
Health Overview and Scrutiny Committee
to 65.86%, this was certainly overshadowed
made in South Wiltshire in setting up a 24
Thanks should be expressed to SWASFT
by a worsening situation in Red 2 performance
hour Community First Responder scheme,
for engaging with members and attending
resulting in the lowest A19 performance
this is most welcome and is indicative of the
individual HOSCs. In particular, Gloucestershire
data for Wiltshire and the Trust overall with
importance placed by the Trust in setting new
committee members would like to thank the
a decline in the previous year’s figures from
ambitious targets and priorities.
service for arranging the visits to the Acuma
90.72% to 88.71%. It is understood that
House Clinical Hub, and the ambulance ride-
the last reporting year has been particularly
Finally, commendation should be given to
a-longs. Elected members found these visits
challenging for SWAST, given the surge in
the South Western Ambulance Services NHS
to be invaluable and have seen firsthand
999 calls over the winter period and a large
Foundation Trust for its own engagement and
the compassion in care approach and
increase in the length of handover delays
openness and transparency of its operations
professionalism of SWAST staff members.
especially for those rural areas of Wiltshire
with this Council in these challenging times.
resulting in more patients receiving care
where response times have also been
It is believed that the Quality Account is an
challenging. Nevertheless, despite this and the
accurate reflection of its performance and that
increasing demand on the service year on year,
Below are additional comments
specific to HOSC areas:
the priorities set out should be supported.
we would hope to see improvements in the
Gloucestershire
data provided over the next reporting period.
Gloucestershire is a very rural county and
It is recognised that, despite the considerable
therefore a significant concern for members
challenges facing the Trust, significant
It is noted that the range of Trust
of the committee remains the poor response
improvements have been found in the
developments, ranging from the introduction
times in the rural areas. The committee has
65
regularly raised these concerns with the Trust
between performance in North Somerset and
by the Trust in implementing its 2014/15
and is aware of the work that the Trust is doing
elsewhere in the Trust’s locus of operation,
priority of improving the identification and
to try and address this matter. In this regard
Members are encouraged by initiatives
management of paediatric sepsis together
members are particularly interested to see the
to address these challenges including a
with its “sign up to safety” priority for
outcomes of the ‘Dispatch on Disposition’ pilot
dedicated North Somerset dispatch area
2015/16 - developing and implementing a
launched by the Department of Health; and
and management team; the “Right Care”
clear and measurable programme of safety
the initiative currently being trialled in Wiltshire
initiative and the Dispatch and Disposition
improvement.
to base paramedic cars at GP surgeries in order
Trial. The Panel recognises the considerable
to increase the number of emergency vehicles
potential of these initiatives for delivering
Clinical effectiveness – The Panel recognises
present in rural areas to combat them being
sustainable improvements to service efficiency/
the significant challenges faced by Trust (and
pulled into urban areas to the detriment of
performance and patient care in North
by the Healthcare Sector as a whole) around
rural residents.
Somerset.
the recruitment of clinical staff. They are
encouraged however by the Trusts initiatives
SWAST has just taken over the contract for the
Performance and priorities
to improve and better prioritise the allocation
Out-of-hours Service in Gloucestershire and the
Patient safety – Members recognise the
of clinical resources. Members were impressed,
committee will be monitoring this closely.
Trust’s achievement in meeting the Red 1
for instance, with the “Dispatch and
(Category A) performance target for 2014/15,
Disposition” trial and the Panel support the full
The committee would also encourage
particularly given the unpreceded year on
implementation of this scheme going forward.
SWAST to continue to work closely with the
year increases in demand for the service, and
Gloucestershire Fire and Rescue Service for the
note that necessary additional focus on the
The Panel notes that the 2014/15 clinical
benefit of the people of Gloucestershire.
most critical cases especially during the winter
effectiveness priority - the implementation
peak period contributed to the Trust’s weaker
of the Electronic Care System - is still work-
North Somerset
performance against the Red 2 and A19
in-progress but is encouraged that the early
Whilst the Panel remains concerned by the
targets.
indications are that its aims of delivering
Trust’s performance against some of the
key indicators and by the apparent disparity
2014/15
quality account
better clinical outcomes, reducing unnecessary
Members also welcome the work undertaken
transfers to emergency departments and
improving communication of patient
Borough of Poole Health and Social Care
assuring and the patient had understood the
information across the healthcare community
Overview and Scrutiny Committee
advice given. Members are also delighted to
will be deliverable by 2015/16. The Panel is
Members of Borough of Poole’s Health and
hear that the “Dispatch and Disposition” pilot
also encouraged by the greater focus in the
Social Care Overview and Scrutiny Committee
has led the Trust to amend 999 call handling
document generally on improved partnership
would like to thank South Western Ambulance
procedures to enable the Trust to fully triage
working, both in respect of priority setting
Service NHS Foundation Trust for the chance
the call rather than allocating a resource to
and delivering a more efficient and responsive
to comment on their account of activities
every incident when an address is available.
service “in the right place at the right time”.
undertaken to improve services over the
It will be interesting to understand further
2014/15 financial year.
if this has had a positive impact in reducing
Members welcome in particular the Trust’s
the numbers of ambulances deployed when
2015/16 priority of promoting the assessment
The HSCOSC are heartened to note the Trust’s
and management of unwell Children and
drive for maintaining quality and innovation.
young people for the six most common
We have noted your successful partnership
Members note that the four priority areas for
conditions when accessing 999 ambulance
working around mobile alcohol recovery
14/15 have made progress. This has meant
services.
services; that the Trust’s Right Care initiative is
greater identification of Sepsis at an early
leading the way in enabling patients to receive
stage; better pathway management and
Patient experience – The Panel note the
the right care without being conveyed to an
information sharing which has led to better
Trust’s achievement of its 2014/15 priority
emergency department and that you have
clinical outcomes for patients through the use
of implementing the Friends and Family Test
recognised crucial partners have been involved
of the Electronic Care System; an improvement
(FFT) and is encouraged by the positive patient
in achieving this.
in achieving the target time for those treated
feedback since its implementation.
unnecessary.
for primary angioplasty and implementing
It is also encouraging to read that the results
the Friends and Family Test using a number of
Members also welcome the Trust’s
of the Care Quality Commission’s “Hear and
different accessible methods to do this.
investment in vehicles, noting that to fleet is
Treat” which found that 90% of callers who
now the newest and most reliable to
did not receive an ambulance response felt the
Moving into 15/16 we will be interested to
date.
first person that they had spoken to was re-
understand what it achieved in the below
67
priority areas:
look forward to reading the published version
Gabrielle Longdin will let you know the name
a) aligning patient safety improvement plans
but please take this letter as Borough of Poole’s
of the ‘new’ chairman of Poole HASCOSC.
to the National Sign Up to Safety Campaign
response to that document based on the draft
which will strengthen current approaches by
version sent to the Council 13th April 2015.
adopting an NHS wide purpose
With warmest good wishes
Yours sincerely,
b) developing an overarching Trust document
May I add a personal thank you for the superb
Councillor the Revd Charles Meachin
covering the Guideline for Paediatric big six to
service you give to our residents. In January,
Chairman of Borough of Poole
address the growing hospital admission rates
in need of medical help, I phoned the 111
Health and a Social Care Overview and
for children under 15 suffering the six month
Service, received an immediate response; the
Scrutiny Committee
common conditions leading to 999 calls and
call handler, reassuringly dealt with my call
subsequent admission.
asked relevant questions and passed me to an
Bristol People Scrutiny Commission
c) improving the management of frequent
‘assessor’ who again asked relevant
At its meeting of 13th April 2015 the
callers who present to the ambulance
questions, quickly decided (all carried out in a
Commission received a presentation via a
service and cut across multiple patient facing
kindly reassuring, quiet and confident manner)
DVD setting out the progress against its
organisations
that I needed help and told me paramedics
2014/15 priorities, and its proposed priorities
would be with me soon. Within about 5
for 2015/16. There was general consensus
Members are particularly interested in gaining
minutes a knock on the door revealed two
amongst members that the priorities chosen
a better understanding of priority area c) in
paramedics, who again with reassurance and a
were appropriate.
regards to the review of the top 50 Frequent
kindly ‘bedside manner’ decided to speed me
Callers in relation to Poole residents. This may
to Poole Hospital A&E department. Thankfully I
Members recognised that 111 services in
be an area where the HSOSC could influence
am making a good recovery from a
Bristol were not provided by SWAST but
how local services work together in an efficient
‘stroke’.
by an alternative provider. Members were
way to deliver services to Frequent Callers.
pleased to receive information on the school
We look forward to continue building good
education programme which would
Thank you for the opportunity to comment on
working relationships with SWAS. I will be
provide information to schools on 111 and 999
an interesting Quality Review and Account we
retiring on May 7th. I am sure that
services.
2014/15
quality account
Cornwall Health and Social Care Scrutiny
break down at geographic level.
Committee
The Isles of Scilly Health Overview and
Scrutiny Committee
Cornwall Council’s Health and Social Care
Quality requirements appear to be being
The Isles of Scilly Health Overview and
Scrutiny Committee agreed to comment on
met however there are concerns about the
Scrutiny Committee welcomes the
the Quality Account 2014 -2015 of South
performance variation across the region,
opportunity to contribute to these Quality
Western Ambulance Service NHS Foundation
specifically regarding Red 2 and A19.
Accounts.
Trust. All references in this commentary relate
Performance in Cornwall appears to be lower
to the period 1 April 2014 to the date of this
than last year. The Committee is pleased
We would like to note the continued
statement.
that there has been an improvement in the
dedication and hard work of the staff
performance of Red 1.
who provide urgent and non emergency
South Western Ambulance Service NHS
The performance of NHS 111 is due to be
ambulance services across the five islands.
Foundation Trust have engaged when the
scrutinised in 2015 and the Committee will
committee and attended meetings when items
watch with interest this area.
relating to them have been placed on the
agenda.
The committee would welcome more specific
work done on the cost of providing urgent
The Committee welcome the commitment
and non emergency services to the islands.
to increasing patient feedback via the Friends
We feel that this would make the trust
Committee Members felt that the Quality
and Family Test and development of improved
better placed to provide seamless and
Account provided a good reflection of the
publically accessible data.
integrated service provision.
services provided by the Trust, and provided
a comprehensive coverage of the provider’s
The Committee supports the Trust’s Quality
services. The Committee were pleased to see
Priorities for Improvement and looks forward
that in some presentation of data there was a
to working in partnership in 2015-16.
69
Statement of Directors’ Responsibilities in respect of the
Quality Report
The Directors are required under the Health Act 2009 and the National Health Service (Quality Accounts) Regulations to prepare Quality Accounts for
each financial year.
Monitor has issued guidance to NHS foundation trust boards on the form and content of annual quality reports (which incorporate the above legal
requirements) and on the arrangements that NHS foundation trust boards should put in place to support the data quality for the preparation of the
quality report.
In preparing the Quality Report, directors are required to take steps to satisfy themselves that:
❚❚ the content of the Quality Report meets the requirements set out in the NHS Foundation Trust Annual Reporting Manual 2014/15 and supporting
guidance;
❚❚ the content of the Quality Report is not inconsistent with internal and external sources of information including:
▲▲ board minutes and papers for the period April 2014 to 28 May 2015
▲▲ papers relating to Quality reported to the Board over the period April 2014 to 28 May 2015
▲▲ feedback from the commissioners dated 1 May and 19 May 2015
▲▲ feedback from governors dated 19 February and 14 April 2015
▲▲ feedback from Local Healthwatch organisations dated 11 May, 12, 14 and 20 May 2015
▲▲ feedback from Overview and Scrutiny Committees dated 23 April, 6 May, 11 May and 12 May 2015
▲▲ the Trust’s complaints report published under regulation 18 of the Local Authority Social Services and NHS Complaints Regulations 2009, dated
16 April 2015
▲▲ the latest national patient survey dated 8 July 2014
▲▲ the latest national staff survey dated 24 February 2015
▲▲ the Head of Internal Audit’s annual opinion over the trust’s control environment dated 20 May 2015
2014/15
quality account
▲▲ CQC quality and risk profile dated 31 March 2014
❙❙
the Quality Report presents a balanced picture of the NHS Foundation Trust’s performance over the period covered;
❙❙
the performance information reported in the Quality Report is reliable and accurate;
❙❙
there are proper internal controls over the collection and reporting of the measures of performance included in the Quality Report, and these
controls are subject to review to confirm that they are working effectively in practice;
❙❙
the data underpinning the measures of performance reported in the Quality Report is robust and reliable, conforms to specified data quality
standards and prescribed definitions, is subject to appropriate scrutiny and review; and
❙❙
the Quality Report has been prepared in accordance with Monitor’s annual reporting guidance (which incorporates the Quality Accounts
regulations) (published at www.monitor.gov.uk/ annualreportingmanual) as well as the standards to support data quality for the preparation of the
Quality Report (available at www.monitor.gov.uk/annualreportingmanual).
The directors confirm to the best of their knowledge and belief they have complied with the above requirements in preparing the Quality Report.
By order of the board
20 May 2015 Heather Strawbridge, Chairman
20 May 2015 Ken Wenman, Chief Executive
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Glossary of Terms and Acronyms
Term
Description
111
National phone number for people to access non-emergency healthcare and advice
A19 Performance
A19 performance is based on the combination of both Red 1 and Red 2 categories of call. (Please see definitions of Red 1 and Red 2 below.)
A&E
Accident and Emergency
ACQIs
Ambulance Clinical Quality Indicators – a set of nationally agreed measures for ambulance trusts which reflect best practice and stimulate continuous quality
improvement.
AI - Adverse Incident
Any event or circumstance that could have or did lead to unintended or unexpected harm, loss or damage to any individual or the Trust.
Adverse incidents may or may not be clinical and may involve actual or potential injury, mis-diagnosis or treatment, equipment failure, damage, loss, fire, theft,
violence, abuse, accidents, ill health, near misses and hazards
ATP Testing
Adenosine triphosphate testing – process whereby a swab is used to pick up contamination on a surface which can then be measured to assess its cleanliness.
Audit Commission
The Audit Commission has the role of protecting the public purse which it does by auditing a range of public bodies in England. Information gleaned from audits are
used to provide evidence based analysis to help services learn from one another. The Audit Commission closed on 31 March 2015
Board of Directors
Executive body responsible for the operational management and conduct of the organisation
Category A Incidents
Incidents with patients with a presenting condition which may be immediately life threatening and who should receive an emergency response within 8 minutes
irrespective of location, in 75% of cases.
Clinical Audit
A quality improvement process that seeks to improve patient care and outcomes by measuring the quality of care and services against agreed standards and making
improvements where necessary.
CCGs
Clinical commissioning groups – GP-led commissioners of local healthcare services
Clinical Guidelines
Trust documents which introduce guidance which is either not considered within the scope of the JRCALC guidelines, or where further clarification is required.
Clinical Hub
SWASFT term for control room where phone calls to the Trust are handled.
CoG
Council of Governors – elected body that acts as guardians of NHS Foundation Trust, holding the board of directors to account and representing views of staff, public
and other stakeholders
CQC
Care Quality Commission - the independent regulator of health and adult social care.
CQUIN
Commissioning for Quality and Innovation payment framework enables commissioners to reward excellence, by linking a proportion of healthcare providers’ income
to the achievement of local quality improvement goals.
CTB
Call to balloon – when a heart attack is suffered, the time taken from the initial emergency call to the balloon being inflated during primary angioplasty (see below.)
Definitive Clinical
Assessment
An assessment carried out by an appropriately trained and experienced clinician on the telephone or face-to-face. It is the assessment which will result either in
reassurance and advice, or in a face-to-face consultation (either in a centre or in the patient’s own home).
DH
Department of Health – the government department that provides strategic leadership to the NHS and social care organisations in the UK
2014/15
quality account
Term
Description
ECG
Electrocardiogram - a diagnostic tool that is routinely used to assess the electrical and muscular functions of the heart.
ECS
Electronic Care System – allows the Trust to electronically capture, exchange and report on patient information.
Executive Directors
Senior members of staff – including the Chief Executive and Finance Director – who sit on the Board of directors, have decision-making powers and a defined set of
responsibilities.
FAQ
Frequently asked questions
FAST test
Face, Arm, Speech, Time – brief but effective test to determine whether or not someone has suffered a stroke.
FFT
Friends and Family Test – NHS single question survey which asks patients whether they would recommend the service received to their friends and family.
NHS FT
National Health Service Foundation Trust – A not-for-profit, public benefit corporation which is part of the NHS and created to devolve decision-making from central
government to local organisations and communities.
Governance
‘Rules’ that govern the internal conduct of an organisation by defining the roles and responsibilities of key offices/groups and the relationships between them, as well
as the process for due decision making and the internal accountability arrangements
GP
General Practitioner
Health Service
Ombudsman
Full title is the Parliamentary and Health Service Ombudsman established by Parliament to investigate complaints that individuals have been treated unfairly or have
received poor service from government departments, the NHS and other public organisations in England.
Healthwatch
Organisations comprised of individuals and community groups working together to improve health and social care services. They represent the views of the public,
people who use service and carers on the Health and Wellbeing boards set up by local authorities.
HOSCs
Health Overview and Scrutiny Committees – local authority committees with powers to scrutinise local health services to ensure improvements are made and
inequalities reduced.
Hospital Episode Statistics
A data warehouse containing details of all admissions, outpatient appointments and A&E attendances at NHS hospitals in England.
ICPR
Integrated Corporate Performance Report – a document which reports the Trust’s progress against its business plans; highlights where performance targets have not
been met; describes the corrective action and timescales to address any performance issues.
IG
Information Governance is a framework which brings together all the legal rules, guidance and best practice that apply to the handling of information. It
demonstrates that an organisation can be trusted to maintain the confidentiality and security of personal information and is consistent in the way in which it handles
personal and corporate information.
IV
Intravenous - substance administered to the body via a vein.
JRCALC Guidelines
National clinical practice guidelines for NHS paramedics developed by the Joint Royal Colleges Ambulance Liaison Committee.
KPIs
Key performance indicators – a set of quantifiable measures used to demonstrate or compare performance in terms of meeting strategic and operational objectives.
Local Clinical Audit
A quality improvement project involving healthcare professionals evaluating aspects of care they have selected as being important to the organisation and service
users.
MI
Myocardial infarction – heart attack
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Term
Description
MINAP
Myocardial Infarction National Audit Project – established in 1999 to examine the quality of heart attacks pre-hospital and in hospitals in England and Wales. As part
of this, ambulance services report regularly on the number of MI patients they have attended, the treatment provided (thrombolysis and/or PPCI) and the time it took
for patients to receive the treatment.
Moderate Harm Incident
A patient safety incident that resulted in a moderate increase in treatment and that caused moderate, but not permanent, harm to one or more patients. A moderate
increase in treatment is defined as a return to surgery, an unplanned readmission, a prolonged episode of care, extra time in hospital or as an outpatient, cancellation
of treatment, or transfer to another area such as intensive care as a result of the incident.
Monitor
Independent regulator of NHS Foundation Trusts.
National Clinical Audit
A clinical audit involving healthcare professionals across England and Wales in the systematic evaluation of their clinical practice against standards and to support and
encourage improvement and deliver better outcomes in the quality of treatment and care.
The priorities for national clinical audits are set centrally by the Department of Health and all NHS Trusts are expected to participate in the national audit programme.
NEDs
Non-Executive Directors – members of the Board of Directors, but not part of the executive management team
NICE
National Institute for Health and Clinical Excellence – independent organisation responsible for providing national guidance on promoting good health and preventing
and treating ill health.
NPSA
National Patient Safety Agency – An arm’s length body of the Department of Health that leads and contributes to improved, safe patient care by informing,
supporting and influencing organisations and people working in the health sector.
NRLS
National patient safety incident database.
OoH
Out-of-Hours – a service which enables patients to access a GP out of normal practice hours.
PALS
Patient Advice and Liaison Service – a confidential advice, support and information service in respect of health related matters.
Patient Opinion
An independent website where people can post their experiences of using a health care service.
Payment by Results
The payment system in England under which Commissioners pay healthcare providers for each patient seen or treated, taking into account the complexity of the
patient’s healthcare needs.
PPI
Patient and Public Involvement – the process of engaging with the needs and expectations of patients and the wider public in order to inform service development
and delivery.
Primary Angioplasty
Definitive treatment for a heart attack which involves the insertion of a small tube through a vein into the blocked blood vessel in the heart where a balloon at the tip
of the tube is inflated to open the blood vessel.
Priorities for Improvement
There is a national requirement for NHS Trusts to select three to five priorities for quality improvement each year. These priorities must reflect the three key areas of
patient safety, patient experience and patient outcomes.
PTS
Patient Transport Service – the non-emergency conveyance of patients to and from healthcare provision.
Quality Strategy
Trust document sets out how the Trust will deliver high quality, cost effective effective emergency and urgent health care services to people in the South West.
Red 1 and Red 2 Calls
Those calls requiring the most time critical response and cover cardiac arrest patients who are not breathing and do not have a pulse and other severe conditions such
as airway obstruction. Red 2 calls are those serious but less immediately time critical and cover conditions such as stroke and fits.
2014/15
quality account
Term
Description
Right Care
Trust initiative to work with local health communities to ensure that patients receive the right care, in the right place at the right time, resulting in patients being
treated without the need to attend an Emergency Department.
RoSC
Return of spontaneous circulation – desirable clinical outcome of a patient in cardiac arrest
Secondary Uses Service
A national NHS database of activity in Trusts, used for performance monitoring, reconciliation and payments.
Sepsis
A life threatening condition that arises when the body’s response to an infection injures its own tissues and organs.
SI – Serious Incident
An incident requiring investigation that has resulted in one or more of the following:
•
Unexpected or avoidable death;
•
Serious harm;
•
Prevents an organisation’s ability to continue to deliver health care services;
•
Allegations of abuse;
•
Adverse media coverage or public concern;
•
Never events (serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.)
SPoA
Single point of access – a contact point which health and social care professionals can use to arrange the right care for urgent and non-urgent patient needs
STEMI
ST elevation myocardial infarction – particular type of heart attack determined by an electrocardiogram (ECG) test
SWASFT
South Western Ambulance Service NHS Foundation Trust
Thrombolysis
Drug that can dissolve blood clots, used for patients who have suffered a heart attack or stroke
Triage
Process for assessing and sorting patients based on their need for or likely benefit from immediate medical treatment to ensure a fair, appropriate allocation of
resources
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responsive
committed
effective
© South Western Ambulance Service NHS Foundation Trust 2015
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2014/15
quality account