Core standards assessment final declaration

Reference: CSA91982 Date: 02/05/2006

Trust self-declaration: Organisation Name Westcountry Ambulance Services NHS Trust Organisation Code: RJ9

Please supply the following information: General The Board of directors at Westcountry Ambulance Services NHS Trust statement of have confirmed a self assessment that the organisation complies with all compliance 7 domains within Standards for Better Health. In addition there were no significant lapses in meeting the Standards for Better Health core standards during the period 1 April 2005 - 31 March 2006. The Board has overseen the development of a compliance framework which mapped organisational performance against each of the 24 core standards within Standards for Better Health. The framework took into account other national priorities, the Healthcare Commission consultative document 'Assessment for Improvement: Understanding the Standards', the document 'Criteria for assessing core standards: Information for ambulance trusts' and the Healthcare Commission inspection guides. The Trust's compliance framework is used as a unifying governance tool to direct and control Trust functions to achieve organisational objectives safely and in order to provide quality services, in liaison with stakeholders and within the Government's objectives for the NHS. Executive directors are responsible for delivery of specific items within the compliance framework and Non Executive directors oversee delivery through established Board sub-committees. The directors of Westcountry Ambulance Service's decision on compliance is based on a review of evidence relating to the standards and assurances provided by the Board from organisations such as the Audit Commission, Internal Audit and the NHS Litigation Authority. Trust stakeholders are invited to provide feedback on the Trust's performance. Their comments are welcome and should be placed in the context of: - the Trust's robust arrangements such as those on infection control for which a separate annual report is produced. - Agenda for Change, the new NHS pay system and modernisation programme which necessitated the Trust to review operational service delivery across its area. Modernisation proposals were discussed widely and revised.

page 1 of 14 Core standards assessment final declaration

- a review of non urgent patient transport services being undertaken by one of the Trust's strategic health authority's on behalf of all trusts within the Peninsula in 2 of the 3 counties covered by the organisation. - The Board's responsibility to prioritise work to meet expectations within its financial envelope and taking into account its available resources. It is not always possible for the Trust to respond to every demand placed upon it by external stakeholders. For the future Westcountry Ambulance Servcies NHS Trust will continue to embed the Standards for Better Health core standards and increase its focus on meeting the requirements of the developmental standards.

Please indicate your trust's compliance with each of the following standards: C1a Healthcare organisations protect Compliant patients through systems that identify and learn from all patient safety incidents and other reportable incidents, and make improvements in practice based on local and national experience and information derived from the analysis of incidents. C1b Healthcare organisations protect Compliant patients through systems that ensure that patient safety notices, alerts and other communications concerning patient safety which require action are acted upon within required timescales. C2 Healthcare organisations protect Compliant children by following national child protection guidelines within their own activities and in their dealings with other organisations. C3 Healthcare organisations protect Compliant patients by following National Institute for Clinical Excellence (NICE) interventional procedures guidance. C4a Healthcare organisations keep patients, Compliant staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in Methicillin-Resistant Staphylococcus Aureus (MRSA). C4b Healthcare organisations keep patients, Compliant staff and visitors safe by having systems to ensure that all risks associated with the acquisition and use of medical devices are minimised. C4c Healthcare organisations keep patients, Compliant staff and visitors safe by having systems

page 2 of 14 Core standards assessment final declaration

to ensure that all reusable medical devices are properly decontaminated prior to use and that the risks associated with decontamination facilities and processes are well managed. C4d Healthcare organisations keep patients, Compliant staff and visitors safe by having systems to ensure that medicines are handled safely and securely. C4e Healthcare organisations keep patients, Compliant staff and visitors safe by having systems to ensure that the prevention, segregation, handling, transport and disposal of waste is properly managed so as to minimise the risks to the health and safety of staff, patients, the public and the safety of the environment.

Please indicate your trust's compliance with each of the following standards: C5a Healthcare organisations ensure that Compliant they conform to National Institute for Clinical Excellence (NICE) technology appraisals and, where it is available, take into account nationally agreed guidance when planning and delivering treatment and care. C5b Healthcare organisations ensure that Compliant clinical care and treatment are carried out under supervision and leadership. C5c Healthcare organisations ensure that Compliant clinicians continuously update skills and techniques relevant to their clinical work. C5d Healthcare organisations ensure that Compliant clinicians participate in regular clinical audit and reviews of clinical services. C6 Healthcare organisations cooperate with Compliant each other and social care organisations to ensure that patients’ individual needs are properly managed and met.

Please indicate your trust's compliance with each of the following standards: C7a Healthcare organisations apply the Compliant and principles of sound clinical and C7c corporate governance and Healthcare organisations undertake systematic risk assessment and risk management. C7b Healthcare organisations actively Compliant support all employees to promote openness, honesty, probity,

page 3 of 14 Core standards assessment final declaration

accountability, and the economic, efficient and effective use of resources. C7e Healthcare organisations challenge Compliant discrimination, promote equality and respect human rights. C8a Healthcare organisations support their Compliant staff through having access to processes which permit them to raise, in confidence and without prejudicing their position, concerns over any aspect of service delivery, treatment or management that they consider to have a detrimental effect on patient care or on the delivery of services. C8b Healthcare organisations support their Compliant staff through organisational and personal development programmes which recognise the contribution and value of staff, and address, where appropriate, under-representation of minority groups. C9 Healthcare organisations have a Compliant systematic and planned approach to the management of records to ensure that, from the moment a record is created until its ultimate disposal, the organisation maintains information so that it serves the purpose it was collected for and disposes of the information appropriately when no longer required. C10a Healthcare organisations undertake all Compliant appropriate employment checks and ensure that all employed or contracted professionally qualified staff are registered with the appropriate bodies. C10b Healthcare organisations require that all Compliant employed professionals abide by relevant published codes of professional practice. C11a Healthcare organisations ensure that Compliant staff concerned with all aspects of the provision of healthcare are appropriately recruited, trained and qualified for the work they undertake. C11b Healthcare organisations ensure that Compliant staff concerned with all aspects of the provision of healthcare participate in mandatory training programmes. C11c Healthcare organisations ensure that Compliant staff concerned with all aspects of the provision of healthcare participate in further professional and occupational development commensurate with their work throughout their working lives.

page 4 of 14 Core standards assessment final declaration

C12 Healthcare organisations which either Compliant lead or participate in research have systems in place to ensure that the principles and requirements of the research governance framework are consistently applied.

Some core standards do not appear on the declaration form as they are assessed through other components of the annual health check. Standards C7f and C19 are picked up through our assessment of existing targets. Standard C7d is assessed through our use of resources component which uses information from assessments undertaken by the Audit Commission and Monitor.

Please indicate your trust's compliance with each of the following standards: C13a Healthcare organisations have systems Compliant in place to ensure that staff treat patients, their relatives and carers with dignity and respect. C13b Healthcare organisations have systems Compliant in place to ensure that appropriate consent is obtained when required, for all contacts with patients and for the use of any confidential patient information. C13c Healthcare organisations have systems Compliant in place to ensure that staff treat patient information confidentially, except where authorised by legislation to the contrary. C14a Healthcare organisations have systems Compliant in place to ensure that patients, their relatives and carers have suitable and accessible information about, and clear access to, procedures to register formal complaints and feedback on the quality of services. C14b Healthcare organisations have systems Compliant in place to ensure that patients, their relatives and carers are not discriminated against when complaints are made. C14c Healthcare organisations have systems Compliant in place to ensure that patients, their relatives and carers are assured that organisations act appropriately on any concerns and, where appropriate, make changes to ensure improvements in service delivery. C15a Where food is provided, healthcare Non applicable - ambulance trusts only organisations have systems in place to ensure that patients are provided with a choice and that it is prepared safely and provides a balanced diet.

page 5 of 14 Core standards assessment final declaration

C15b Where food is provided, healthcare Non applicable - ambulance trusts only organisations have systems in place to ensure that patients’ individual nutritional, personal and clinical dietary requirements are met, including any necessary help with feeding and access to food 24 hours a day. C16 Healthcare organisations make Compliant information available to patients and the public on their services, provide patients with suitable and accessible information on the care and treatment they receive and, where appropriate, inform patients on what to expect during treatment, care and after care.

Please indicate your trust's compliance with each of the following standards: C17 The views of patients, their carers and Compliant others are sought and taken into account in designing, planning, delivering and improving healthcare services. C18 Healthcare organisations enable all Compliant members of the population to access services equally and offer choice in access to services and treatment equitably.

Some core standards do not appear on the declaration form as they are assessed through other components of the annual health check. Standards C7f and C19 are picked up through our assessment of existing targets Standard C7d is assessed through our use of resources component which uses information from assessments undertaken by the Audit Commission and Monitor.

Please indicate your trust's compliance with each of the following standards: C20a Healthcare services are provided in Compliant environments which promote effective care and optimise health outcomes by being a safe and secure environment which protects patients, staff, visitors and their property, and the physical assets of the organisation C20b Healthcare services are provided in Compliant environments which promote effective care and optimise health outcomes by being supportive of patient privacy and confidentiality. C21 Healthcare services are provided in Compliant environments which promote effective care and optimise health outcomes by being well designed and well maintained

page 6 of 14 Core standards assessment final declaration

with cleanliness levels in clinical and non-clinical areas that meet the national specification for clean NHS premises.

Please indicate your trust's compliance with each of the following standards: C22a Healthcare organisations promote, Compliant and protect and demonstrably improve the C22c health of the community served, and narrow health inequalities by cooperating with each other and with local authorities and other organisations and C22c Healthcare organisations promote, protect and demonstrably improve the health of the community served, and narrow health inequalities by making an appropriate and effective contribution to local partnership arrangements including local strategic partnerships and crime and disorder reduction partnerships. C22b Healthcare organisations promote, Compliant protect and demonstrably improve the health of the community served, and narrow health inequalities by ensuring that the local Director of Public Health’s annual report informs their policies and practices. C23 Healthcare organisations have Compliant systematic and managed disease prevention and health promotion programmes which meet the requirements of the national service frameworks (NSFs) and national plans with particular regard to reducing obesity through action on nutrition and exercise, smoking, substance misuse and sexually transmitted infections. C24 Healthcare organisations protect the Compliant public by having a planned, prepared and, where possible, practised response to incidents and emergency situations, which could affect the provision of normal services.

The Healthcare Commission recommends that all members of the trust board, including the non-executive directors (for foundation trusts this should be the board of directors) should sign off the declaration in the space provided below. Here, sign off is achieved by recording the name(s) and position(s) of the individual(s) concerned. We do not require scanned signatures.

As a minimum, we require the declaration to be signed off by an appropriate officer(s) with delegated authority. There is no requirement for a paper copy of the final

page 7 of 14 Core standards assessment final declaration

declaration to be signed and returned to the Healthcare Commission. The completion of the sign off page will be taken as verification that the individual(s) who are recorded as signing off the declaration have reviewed the contents of the declaration form and are certifying that: the general statement of compliance, and information provided for each standard, are a true representation of the trust’s compliance any commentaries provided by specified third parties have been reproduced verbatim. Specific third parties are: strategic health authority, and foundation trust board of governors, where relevant, and patient and public involvement forums and overview and scrutiny committees they are signing off the declaration form on their behalf and with delegated authority on behalf of all members of the trust board as referred to above

Please state how many individual(s) will be signing off the declaration (maximum of 30): Number of 11 signatories

Electronic sign off – details of individual(s) Title Full name Job title Mrs Heather Strawbridge Chair Mr Bryn Evans Vice Chair Mr Michael Willis Chief Executive Mr Barry Lewis Non Executive Director Mrs Charlotte Russell Non Executive Director Mrs Jane Cowdery Non Executive Director Mr Ken Burrows Non Executive Director Miss Karen Nethercott Director of Corporate Affairs Mr Simon Davies Director of Finance Dr Gillian Bryce Medical Director Mr Steve Pryor Director of Operations

Please enter the commentaries below. If copying and pasting, it is advisable to copy the text and paste unformatted into a new document. Then copy and paste the unformatted text into the web form. Strategic health Westcountry Ambulance Service covers the largest geographical area of authority any single Ambulance Service in England, extending over fifteen commentary thousand square kilometres. Covering , and , it provides one of the most challenging environments in which to provide an Ambulance Service. The static population over the fifteen thousand

page 8 of 14 Core standards assessment final declaration

square miles is roughly 2.2 million. The Trust achieved a 2 star rating for 04/05, this was unchanged from 03/04, however in 02/03 the Trust achieved a 3 star rating. The successes of the Trust for 05/06 include: - Delivery of the CAT A 75% target - Performance on responding to Category C calls has been consistently above target throughout the year. - The Trust is planning to deliver financial balance at the year-end. For the 2005/06 Standards For Better Health declaration, the Trust will be declaring full compliance across all the standards. Following a review with the Trust on the 30th March of their Standards for Better Health process, and through regular meetings between the trust and the SHA, the SHA has not identified any significant areas of concern and believes that a robust process for assessment has been implemented throughout the Trust. We were particularly pleased that the following were in place within the Trust: - There are clear lines of accountability - There are robust Board reporting mechanisms in place The SHA would wish to suggest to the Trust that further developments in working with Independent Contractors would further strengthen the work already undertaken by the Trust and would provide further assurance. We know that the Trust will continue to further strengthen their assurances in all areas. I am therefore writing to confirm our general support for Westcountry Ambulance NHS Trust’s final declaration and would welcome inclusion of this letter as part of the submission to the Healthcare Commission for the beginning of May. Best wishes Yours sincerely

Thelma Holland Chief Executive

Patient and The Forum commentary is as follows: public involvement WAST has demonstrated that Health & Safety is an important issue and forum is a subject in their weekly newsletter to staff (C1). WAST have commentary demonstrated that not only do they have a system in place to help patients, carers and family, but for staff as well (C14). WAST engages very well with the PPIF and public (C17). Formal and informal meetings are held regularly. Information is received in an open and timely manner when requested and members are invited to attend events as appropriate. WAST has made particular efforts to help Forum members to understand different aspects of the service, which has been very valuable. For example, members have been given tours of the control room and the Devon Air Ambulance. A rideout on a RRV is also

page 9 of 14 Core standards assessment final declaration

arranged for every member that joins the Forum. WAST involved the PPIF at an early stage of discussion about the modernisation of the service and used the PPIF as a sounding board. The Trust held several public consultation exercises to gain feedback from the public and explain the modernisation programme. The Trust also engaged with the OSCs and several Parish, District and County Councils. WAST demonstrated that they were listening to feedback from the public and stakeholders at these various consultations and changes to the programme were implemented (C17, C18). WAST have clearly demonstrated that they engage innovatively with members of the public (C16, C17). For example, attendance of County Shows, teaching members of the public basic life support techniques and going into schools to talk to children and encouraging them to write poems about an ambulance. Feedback leaflets are available to patients in vehicles. While patient care must remain a priority (attending to the patient rather than asking them to fill in a leaflet), the PPIF would like to see other ways of encouraging more patients to complete the Have Your Say leaflets. The PPIF is currently looking into cleanliness and transfer of infection (C21). In particular, the PPIF are gathering information on the transfer of blankets when patients are taken to hospital and how the interiors of all patient-carrying road vehicles are cleaned. The PPIF would like to see a programme of deep cleaning implemented across the Trust. WAST works with several partnerships (C22) and the ECPs also offer health care advice to patients. The Trust has a proven ability to emergencies and major incidents (C24), demonstrated by events such as in Boscastle in August 2004.

How many 6 overview and scrutiny committees will be commentating on your trust?

Please enter the commentaries below. If copying and pasting, it is advisable to copy the text and paste unformatted into a new document. Then copy and paste the unformatted text into the web form.

Overview and scrutiny committee 1 - commentary Overview and Torbay Council's Response to the Annual Health Check (February 2006) scrutiny Westcountry Ambulance Services NHS Trust committee commentary Torbay Council's Health Scrutiny Board has begun to work closely with Westcountry Ambulance Services Trust during the year on a number of national and local issues. The Board is content with the co-operation it has received in relation to the Joint Review the Board carried out in conjunction with Plymouth City Council and Somerset County Council on changes to the way the ambulance service would be delivered in the South West Peninsula.

page 10 of 14 Core standards assessment final declaration

The Board was also pleased that the Trust had consulted them over the new configuration of NHS Ambulance Trusts in England at the meeting of the Board held in January 2006 (Core Standard C22). Health Scrutiny Board February 2006

Overview and scrutiny committee 2 - commentary Overview and Westcountry Ambulance Services Trust scrutiny committee C6 commentary The Trust actively engages with Cornwall County Council's Health and Adult Social Care Overview and Scrutiny Committee. The Trust is regularly represented at OSC meetings, and through these meetings engages proactively with County and District Councillors, other Trusts and the Department of Adult Social Care. The Trust's Patient and Public Involvement lead officer serves as a regular point of liaison between the Trust and the OSC. This enables regular dialogue and coordination of activity. The Trust's senior managers and non executive board members meet regularly with the Council's senior managers and members to consider cross cutting issues. The Trust has demonstrated through its work with Central Cornwall PCT's Minor Injuries Unit, an ability and a willingness to work with other NHS organisations to provide services in response to the local population's needs. The OSC is working with the Trust's PALS service and Patient and Public Involvement lead officers, and those of other Trusts in Cornwall, to establish a coordinated approach to patient and public involvement in the County. C17 The Trust works formally and informally to engage the committee in plans for service developments.

Examples of the Trust's engagement with the OSC include: · Regular presentations to the OSC on current issues facing the Trust · Discussions concerning reform and modernisation plans · Progress reports showing the impact of modernisation arrangements in Cornwall

C22 The Trust has been actively involved in the OSC's work on specific

page 11 of 14 Core standards assessment final declaration

public health issues including the impact of tourism on healthcare in Cornwall. The Trust has been very responsive to work undertaken by the OSC in relation to public health issues - for example reacting positively to recommendations about ways in which healthy lifestyles could be promoted and cases of Type 2 Diabetes reduced. ------Philippa Dowling Senior Policy Officer Cornwall County Council County Hall, Treyew Road, Truro, Cornwall TR1 3AY

Overview and scrutiny committee 3 - commentary Overview and Devon County Council Health Overview/Scrutiny Committee scrutiny committee 1.0 INTRODUCTION commentary 1.1 The Devon County Council Health Overview/Scrutiny Committee (DCC OSC) has determined that the commentary provided in relation to the Westcountry Ambulance Services NHS Trust (WAST) will be restricted to the Healthcare Commission's Standard C17. 1.2 In formulating this statement, the views of the relevant district OSCs have been sought and taken into account. 1.3 All references relate to the reporting period 1st April 2005 to the date of this statement (22. March 2006). 1.4 Standard C17 refers to the involvement of patients and public in designing, planning, delivering and improving services. 2.0 WESTCOUNTRY AMBULANCE SERVICES NHS TRUST 2.1 WAST has sought to engage with the Devon County Council OSC during the relevant reporting period in relation to its Modernisation Proposals. 2.2 The matter was brought to the attention of the Devon County Council OSC on 30th June 2005 (and previously on the 31st January 2005). It was generally felt by the OSC Members that WAST should have made earlier representation to the Committee on this matter. That is, prior to the formulation of the proposals. However, lessons were learned from this scrutiny exercise and a solid relationship has now been established between the OSC and WAST. 2.3 Commissioning a Patient-led NHS - throughout the consultation period on the proposals relating to this initative, WAST has engaged effectively with the OSC, providing guidance and information when requested.

page 12 of 14 Core standards assessment final declaration

3.0 ADDITIONAL COMMENTS 3.1 In addition to the matters presented to the OSC, WAST has consistently provided Trust meeting notes and agendas to the OSC Chairman and Health Scrutiny Officer. Carolyn Y May LLB (Hons) MA Scrutiny Officer

Overview and scrutiny committee 4 - commentary Overview and COUNCIL OF THE ISLES OF SCILLY scrutiny committee Response of the Health Overview and Scrutiny Committee to the commentary Healthcare Commission Annual Health Check West Country Ambulance Service : March 2006 The Committee acknowledges the considerable commitment made to the Isles of Scilly by the West Country Ambulance Service in improving response times and providing resources. This has resulted in a level of service that Members believe merits considerable praise. C17 The Committee feels that WAS have now engaged the Council in the design, planning, delivery and improvement of services. Officers have attended Committee meetings to discuss pertinent issues when requested for which Members are grateful. The offer to attend future meetings is acknowledged and should satisfy the requirements of this standard for the Council. C22 Supporting evidence for involvement with the Cornwall and Isles of Scilly Community Safety Partnership has yet to be demonstrated to the Committee but contact information has been exchanged and it is hoped that this will be rectified in the near future. C24 The commitment of WAS to the Local Resilience Forum is recognised and involvement at a local level with other Category 1 Responders has been appreciated. The Committee expresses its concern at the decision by WAS not to participate in a ‘live’ exercise on St Mary’s that sought to validate multi-agency emergency planning arrangements for response to an air crash on St Mary’s. The committee recognises that WAST has a wide area responsibility and have acknowledged that the standards will not always be achieved on the Isles of Scilly for all criteria. Cllr Mrs A I Oyler Chairman of Health Overview & Scrutiny Committee

Overview and scrutiny committee 5 - commentary Overview and Following its meeting on 20th March 2006 the Health Scrutiny scrutiny Sub-Committee wishes its contribution to your declaration to be as committee follows: commentary

page 13 of 14 Core standards assessment final declaration

"Somerset County Council’s Health Scrutiny Sub-Committee is pleased to note the good co-operation of the trust in attending our meetings and in the provision of information to members. We are pleased with the progress made with your modernisation arrangements and infection control, both topics discussed at our meetings. We do not intend to comment on each element of the trust’s compliance statement this year, but will make a more detailed response on each of our investigations at the next annual health check." I look forward to your continued co-operation as the year progresses and through the changes in configuration of Somerset trusts. Stephen Martin-Scott Chairman Health Scrutiny Sub-Committee

Please enter the commentaries below. If copying and pasting, it is advisable to copy the text and paste unformatted into a new document. Then copy and paste the unformatted text into the web form.

Overview and scrutiny committee 6 - commentary Overview and PLYMOUTH CITY COUNCIL’S HEALTH AND WELLBEING OVERVIEW scrutiny AND SCRUTINY PANEL’S RESPONSE TO THE ANNUAL HEALTH committee CHECK (MARCH 2006) - WESTCOUNTY AMBULANCE SERVICES commentary TRUST Core Standard C2 The Panel is pleased to note that work has been done to ensure compliance on child protection issues and that the formation of the Safeguarding Children Board in Plymouth will be instrumental in further developing multi-agency working. Core Standard C6 The Panel is pleased with the open dialogue established with WAST following creation of the Public Involvement and Relations Manager which has helped develop a good all-round working relationship. The inclusion of a regular scrutiny feature within WAST’s 24-7 Newsletter helps to raise the profile of this joint working.

page 14 of 14