Scottish Ambulance Service Annual Report and Accounts for year ended 31 March 2020 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2020 Contents 3 Chair and Chief Executive Statement Scottish 5 Performance Report Ambulance 5 Overview 16 Performance Analysis Service The Accountability Report Annual Report and Accounts 22 for year ended 31 March 2020 22 Corporate Governance Report 22 i) Directors’ Report 26 ii) Statement of the Chief Executive’s Responsibilities as the Accountable Officer of the Health Board 27 iii) Governance Statement 34 Remuneration Report and Staff Report 34 i) Remuneration Report 37 ii) Staff Report 40 Parliamentary Accountability Report 41 Independent Auditor’s Report 44 Financial Statements 44 Consolidated Statement of Comprehensive Net Expenditure and Summary of Resource Outturn 45 Consolidated Summary of Financial Position 46 Statement of Consolidated Cash Flow 47 Consolidated Statement of Changes in Taxpayers’ Equity 48 Notes to the Accounts 82 Direction by the Scottish Ministers 2 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2020 Chair and Chief Executive Statement As the new decade gathers pace, the Scottish on critically unwell 999 calls; meanwhile, Advanced Ambulance Service is faced with new challenges, Urgent Care Practitioners, are utilising the instant but also new opportunities. Our remit remains the video capabilities of the GOODSAM App to consult same – to save more lives and to give patients patients online, helping to guide clinical decision across Scotland the very best services – but we making about the most effective care with patients. need to be prepared for what we know is on the In addition, all our staff have found new ways of horizon; and for what we cannot predict. working which reduces their amount of physical We know, for example, that demand for services contact, by maximising the use of online software is only likely to increase. Scotland’s population such as Microsoft Teams and using remote telephone has grown by five per cent in the previous decade. meeting technology to conduct business meetings. There are now around 250,000 more people This really has been one of the most challenging living in Scotland than there were in 2010. We times for the Service. However, these new ways of also know that, as people live longer, we are working are helping us to find new ways of providing dealing with an increasingly older population. good patient care. Meanwhile, new resources are On the other hand, there are unpredicted events which being utilised out of necessity during the pandemic, we must try to anticipate by having in place, robust that could forever change the way we operate. escalation procedures and resilience plans; for example, As we move to the next stage of the pandemic, the bad weather from the beast from the east that hit we will continuously assess the worth of all the us in the early part of 2019 and, of course, the vastly changes implemented, building on our learning to bigger challenge of dealing with the Coronavirus and ensure we give patients the best care possible. our contribution to Scotland’s Recovery and Renewal. Prior to the pandemic we were in the advanced stages Our staff, volunteers and partners have responded of developing our forward strategy. These longer- fantastically to the Covid-19 pandemic, rapidly term plans - though now on temporary hold until the developing innovative solutions to ensure we can pandemic abates - are designed to help us plan for the effectively help patients and communities safely. future, so that we can meet both those changes we are pretty sure about and those we can only anticipate. Frontline staff have learned new skills in treating patients wearing protective PPE kit that was Our 2020 ‘Taking Care to the Patient’ strategy was previously not necessary; Critical Care Advanced developed in 2015 and enabled the Service to improve Practitioners are providing enhanced triage support survival rates, clinical safety and effectiveness and shift 3 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2020 the balance of care through a programme of clinical We have specialists too – our Special Operations service transformation, workforce development and Response Team is on hand to help patients in dangerous investment in new technology, equipment and vehicles. or potentially risky environments, while our SCOTSTAR We are very proud to report that we have largely teams have specialist skills in retrieving patients needing delivered that 2020 strategy. As per our plans and specialist care en-route to hospital, such as trauma ambitions, we are saving more lives and taking more patients, or premature babies. Our air ambulance planes care to patients through investment in our workforce, and helicopters are kept busy every day transporting equipment and technology. The biggest change we patients from some of Scotland’s most remote areas. introduced was our New Clinical Response Model. Approximately half of all the calls we receive Introduced in November 2016, this new triage model, each year come from patients who rely on our which prioritises our sickest patients, has contributed patient transport services. These patients are to improved patient survival rates; a trend we want too unwell to get safely, by other means, to and to ensure continues as the 2020s progress. from hospital appointments or inpatient stays. Our longer-term plans now are centred around our In addition, we have around 1,200 people working 2030 strategy. Our focus is to imagine what Scotland, selflessly across Scotland as volunteer Community and the world, could look like ten years from now and First Responders providing immediate assistance use that information to design and develop our services to people in need and supporting the ambulance whilst maintaining high quality, patient-focused care. response. We have also made much progress in Our prime focus will be aligning our work over the developing co-responder models with Police Scotland, next decade to deliver national outcomes as one of the Scottish Fire and Rescue Service, volunteer Scotland’s key national assets. Besides maintaining pre-hospital emergency clinicians (BASICS GPs and improving our services, we will be developing and Nurses), and the Sandpiper Trust is helping to closer collaborative working with other health and save more lives and improve patient outcomes. care partners, volunteers and voluntary groups, other statutory bodies and partners in innovation and research. Helping people with physical pain or ailments may be our primary focus, but we also recognise that good mental Our strategy is being co-designed with staff, our health is often just as important to overall wellbeing. key stakeholders and, most importantly, our patient That is why we have developed an increasing focus on users - essentially anyone and everyone who has mental health and wellbeing – both for patients and our the potential to be one of our patients. We want it staff. We are signed up to the Distress Brief Intervention to be based on the best evidence we can source programme and have links to Scotland’s mental health and driven by feedback from those sources so hubs to help patients who find themselves in difficulty. that we can drive change and improvement. Sometimes staff can also have mental health concerns, Though demographics, technology and innovation which is why we also have a number of initiatives may change over time, the general thrust of our and resources to help them – we are linked into the work remains unchanged. The first contact most patients have with us is via a 999 emergency Lifelines project, which provides support for front call. Everyone receives a telephone assessment line workers, whilst our TRiM initiative provides staff by one of our call handlers to establish the most with peer support to help them cope with a traumatic appropriate care pathway - with some of those event. Staff also have access to a range of valuable patients being referred to other, more appropriate resources internally to help them cope with stress services such as NHS24 or community services. and to encourage wellbeing and mindfulness. Anyone needing an ambulance response receives a The current COVID-19 pandemic brings with it face-to-face assessment at their location to establish much uncertainty, however we have a strong level the most appropriate care pathway, which, in over of preparedness and resilience in place. Overall, 20% of cases, results in treatment and referral rather we are looking towards the new decade with than being taken to hospital. These face-to-face confidence in our staff, the work we are doing, assessments we provide have also been extended the plans we are making and the leadership into local communities, with Advanced Practitioners development we are investing in; all of which will working as part of GP multi-disciplinary teams. ensure a successful coming year and decade. Tom Steele, Chair Pauline Howie OBE, Chief Executive 4 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2020 Performance Report 1. Overview 1.3 Our 2020 strategy: Taking Care to the Patient The purpose of the following overview is to provide a The Scottish Ambulance Service recognises that short summary providing sufficient information to gain it has a significant contribution to make to this an understanding of the Scottish Ambulance Service, strategy as a frontline service providing emergency, its purpose, the key risks to the achievement of its unscheduled and scheduled care 24/7. objectives, and how it has performed thought the year. In 2015/16, we launched our five year strategy Towards 2020: Taking Care to the Patient. This 2020 strategy is 1.1 Who we are based on the principle that care should be appropriate to need – and that where care is delivered should also The Scottish Ambulance Service was established be appropriate, which may not be in a hospital setting.