Welsh Ambulance Services NHS Trust

Annual Report 2007-08 VISION CONTENTS 2/3

We will improve the health of our patients Values Beliefs by working in partnership to deliver a range of effective and appropriate Cooperative Our beliefs underpin everything we do. We healthcare services. We work together in partnerships, believe that the following shape and guide 2 | VISION involving staff, patients, volunteers, the everything we seek to achieve: The Welsh Ambulance Services NHS Trust has NHS and other partners to design and 3 | CONTENTS a mandate to improve healthcare outside ●● Patients come first deliver our services 4 | FOREWORD hospital in the context of Welsh Assembly Accountable ●● Partnerships are critical Government strategies including, principally, We are accountable to our communities ● 5 | ABOUT US Designed for Life and Delivering Emergency Care ● People are valued and one another for the effective and 6 | Story of the year Services. efficient delivery of our services ●● Public accountability is essential Our vision recognises that we can only do so Responsive 8 | Time to Make a Difference successfully if we work in partnership with We are responsive in developing our 10 | Feedback services according to the needs of our other NHS organisations, local government 12 | Volunteer First Responders and other bodies, including the Wales Air communities and partners Ambulance Charitable Trust, community health Ethical 14 | Emergency Medical Services councils and citizens’ groups. We do the right things, behaving with dignity and respect and treating others as 16 | Patient Care Services Our vision also informs the priorities set we would wish to be treated ourselves 18 | NHS DIRECT WALES out in this plan, requiring us to deliver Supportive effective services (e.g., clinically effective We support one another, ensuring our 20 | TRANING AND DEVELOPMENT emergency care and reliable non emergency patients benefit from an effective and 22 | AIR AMBULANCE transportation) and to do so appropriately appropriate level of service (e.g., improving our 999 call categorisation and 23 | CONSULTATION NHS Direct Wales triage). 24 | FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2008 34 | The Board 2007-08 36 | Statement oN Internal Control 2007-08 42 | Salary and Pension entitlements of senior managers 44 | Making the Connections – RecurrING and NON-RECURRING Savings 4 6 | Directors’ Statement 47 | Equality and Diversity FOREWORD ABOUT US 4/5

This was the year when the Welsh Ambulance Service At the same time, we would be ready, willing and We have also had great success with pre-hospital The Trust During the year the Trust has continued to develop really did begin to Deliver the Difference to the able to respond to 999 calls in those rural areas when thrombolysis when cardiac patients are given a new initiatives to deal with the ever-increasing number The Welsh Ambulance Services NHS Trust, established people of Wales. necessary. clotbusting drug. Only a small number of patients of emergency calls, these include managing demand in unsung heroes in 1998, serves a population of 2.9 million, across receive thrombolysis but there is no doubt that it saves different ways by developing alternative care pathways As we anticipated there were many difficulties along Fundamentally, we are a health care service. Where 20,640 kilometres. From April 2007 NHS Direct Wales lives. to meet the needs of patients. A pensioner who ‘flat-lined’ five times has described the way and there are others we have yet to overcome. a patient needs emergency care, we have to deliver became an integral part of the Trust. the ambulance men who saved her life as “unsung clinically effective care and in all cases we have to One area where we have recognised that we still have NHS Direct Wales provides a 24-hour health advice But less than two years into our five-year The Trust: heroes”. deliver care that is appropriate to meet the needs a great deal of work to do is the way we communicate and information service to the people of Wales, and modernisation programme, Time to Make a Difference, of the individual patient whether that be a 999 with staff. ●● is managed by a Board of Executive and Non- in the last year dealt with over 685,000 contacts. This Now Doris Evans has sent a cheque for £250 we are broadly on track. We are getting there. ambulance or referral to another service or simply self Executive Directors that meets regularly at various includes 356,755 telephone calls and 328,332 web hits. towards the ambulance service in the Pembroke We have lessons to learn from the Trust’s staff survey We are achieving our performance targets in care advice. locations across Wales. The Service has contact centres across Wales in Bangor, area where she lives. and we can assure the people who work for the Welsh responding to life-threatening emergencies. As a Cwmbran and Swansea. One of the key developments of the year was the fact Ambulance Service that we will learn them. ●● employs 2,922 people – 67% are operational – Doris, 78, fell over while getting out of bed so result, we are reaching more patients more quickly. that NHS Direct Wales became a full and integrated 1,309 on emergency duties, 636 on non emergency husband Philip dialled 999 and within minutes As we look forward to next year, we are confident that Accountability What we need to do now is ensure that our part of the Welsh Ambulance Service NHS Trust. ambulance and health courier services, 430 paramedic Marcus Viggers and technician Andy the Welsh Ambulance Service will continue to improve Everything done by those who work in the Trust must performance is consistently good across Wales. management/administrative support, 547 Control Wilson were at the scene. Assimilating NHS Direct Wales into WAST makes a lot of and that implementing our five-year strategy will make be able to stand the test of Government scrutiny and NHS Direct Wales call handlers. During the year, we were complying with our target sense in relation to delivering emergency care services even more of a difference. and public judgements on propriety and satisfy the On no less than five occasions - three times while of reaching 60% of Category A patients within eight – creating a single point of access to healthcare so that ●● operates from 90 ambulance stations, seven requirements of professional codes of conduct. with the paramedics – Doris had experienced “flat- minutes in 15 of the 22 Local Health Board areas. We liners”, when her heart stopped beating, but each people can be treated closer to home or even in their control centres, three regional offices, five vehicle Probity are now determined to be compliant in all LHB areas. own homes when they do not need or want to go to workshops time they revived her. hospital. The Board, its managers and staff, are committed It is not possible to deliver a service in the same way ●● has a National Training College with regional “For that I will be eternally grateful, and no words to maintaining absolute standards of honesty and in a sparsely populated area with a widely distributed NHS Direct Wales has also made significant progress training centres of mine can fully describe my appreciation of their integrity. population and a poor road network. in increasing the number of callers who are given ‘self excellent work,” she said. In 2007-08 the service dealt with 302,664 emergency care’ advice. Openness So, we have to think differently about places like Powys incidents, 57,236 urgent journeys and transported Andy added: “It’s nice when a patient takes the and Ceredigion where we are working in partnership Fewer people who call NHS Direct Wales are 1,293,047 non-emergency patients to over 200 The Trust strives to demonstrate sufficient transparency trouble to Stuart Fletcher Alan Murray thank us for with Local Health Boards to develop new ways of being transferred to 999 and that’s all being done Chairman Chief Executive treatment centres throughout England and Wales. about its activities to promote confidence among the working. appropriately and safely. In turn, that enables Trust and its staff, patients and the public. the service, but it was We believe this should include putting ambulance emergency crews to concentrate on life-threatening emergencies. a real practitioners into rural areas so that we can provide a If you require this document in other languages, large print, surprise wider range of health care. Where appropriate, it would None of this would have been achieved without the or an audio format please ring 01745 532948. to learn be possible to keep people out of hospital by treating outstanding contribution of our staff and a whole host she had and supporting them in their own homes. of volunteers, including Community First Responders sent a and Ambulance Car drivers. cheque.” Story of the year 6/7

It was another year of immense change and That was far too high and above the national There was a perception that back up This had an impact on overall performance, Another positive development was the challenges for the Welsh Ambulance Services average but during the year that figure went ambulances were slow in reaching patients so much so that December was the only introduction of a dedicated high dependency NHS Trust. down to 40% - the aim now is to get it down to being attended to by a paramedic in an RRV. month where the Trust failed to achieve the team to improve the service given to 30%. 60% target of reaching patients suffering patients with urgent needs while at the same The five-year modernisation programme, Time However, the Wales Audit Office found that life-threatening emergencies within eight time relieving the burden on emergency to Make a Difference, is work in progress – but One of the most significant developments across Wales of the call-outs initially attended minutes. ambulances. it is starting to Deliver the Difference. of the year was the successful integration of by Rapid Response Vehicles (RRVs), nearly 96% NHS Direct Wales as a full part of the Welsh were followed up by an ambulance in under The Minister announced a comprehensive During the year, Operations Director Mike Amid the successes of 2007-08 there were also Ambulance Service. 30 minutes and only 0.8% in over 50 minutes. review of the progress being made by the Cassidy became Deputy Chief Executive while frustrations and problems to overcome. Trust in implementing the modernisation Grant Gordon was appointed as Regional Among other things, this enabled the Trust It is unacceptable for any patient to wait For the first time ever, all three regions programme. Director in the South East, taking up his post to put nurses into two of the control centres 50 minutes for an ambulance and the Trust achieved the target of responding to 60% of on 1 May 2008. at Mamhilad and Carmarthen. In future, it is continued to work hard to make sure it did not The review was to be led by Trust Chairman life-threatening emergencies within eight hoped to do this in every control room. happen. Stuart Fletcher, with independent assessments Once again the Trust was given magnificent minutes – in a year when the number of 999 and contributions from staff representative support by an army of volunteers, including calls were at an all-time high. The role of the nurses is to assess or triage One of the main reasons for the problem was Dave Galligan, of UNISON, academic adviser Community First Responders and the Category C calls that are neither life- the extended turnaround times at hospitals, The massive overhaul of the service included Professor Morton Warner, the Wales Audit Ambulance Car Service. threatening nor serious and some Category especially in South East Wales. 78 individual projects, each of which was a Office and Dr. Nick Looker, from the National B calls which are categorised as serious but In Central and West Wales, staff from the major piece of work in its own right. Health Minister Edwina Hart announced the Public Health Service. sometimes turn out not to be. Mid and West Wales Fire and Rescue Service introduction of a new 15-minute handover It was perhaps inevitable that such a massive The review was partly in response to concerns acted as co-responders and they also made a This helped ensure that patients who did not target for hospitals which was a positive improvement programme would put a strain about the service’s performance in rural areas. valuable contribution. need to go to hospital were receiving more development. on staff. appropriate care. While there had been an improvement, more Co-responders are members of the other In the meantime, the Trust continued to This was borne out by the results of a staff needed to be done. Compliance with the eight emergency services trained by the Trust in life- The number of patients being assessed as work with health trusts and other partners to survey which showed that the necessary scale minute target was achieved in 15 of the 22 saving techniques. needing home care went up from around 18% develop new ways of dealing with patients, to and speed of the changes had affected morale. Local Health Board areas across Wales. to 39%. relieve bottlenecks and find more appropriate While difficulties undoubtedly remain, this was A series of measures were introduced to ways of providing care. The shared aim was to reach the 60% standard the year when things started to change for the It meant that fewer people who called NHS develop managers and improve the way we for life-threatening emergencies in every one better, the year when we did start to deliver Direct Wales were being transferred to 999 and Nevertheless, in December the problem communicate with staff. of the LHB areas. the difference. this was done appropriately and safely. was particularly acute because of extended When the modernisation process started, we turnaround times in hospitals and an increase One of the success stories of the year was As a result, ambulances and Rapid Response were classifying 50% of our 999 calls as life- in the number of 999 calls. the increased use of the clot-busting drug, Vehicles were freed up to concentrate on threatening emergencies. tenekteplase, in the pre-hospital thrombolysis patients whose lives were at risk. As a consequence, 16% of available ambulance of cardiac patients. hours were lost because crews were tied up in queues outside hospitals. time to make a difference 8/9

This year the future of the Welsh Ambulance Vantage Point House is an important part Service started to take shape at Vantage Point of our five-year modernisation plan, Time House, in Cwmbran. to Make a Difference, which is an evolving rapid response improvement programme. The new state-of-the-art control room serving When carpet-fitter David Hurley had a the South East Region will provide a template We are working hard to ensure that staff, trade heart attack at his home in Pentrebane, for the rest of Wales. unions and other NHS and local authority Cardiff, paramedic Robin Petterson was on partners are involved in the process. the scene in minutes in a Rapid Response Staff have been and continue to be heavily Vehicle to deliver a clot-busting injection. involved in bringing the scheme to fruition, It has been designed so that it dovetails with creating one of the biggest and most up to the Welsh Assembly Government’s vision for David’s wife, Gina, said: “Robin was fantastic. date control rooms in Europe. developing health care services in Wales. He was so cool and calm and he kept us all calm even though it was the first time he The advent of digital technology means there Among our priorities is to develop clinical had used this drug.” is no longer a technical requirement to have excellence within the Trust. We are establishing We are committed to developing a service that the two control rooms at Church Village and a paramedic development framework which is designed around the needs of the patient, Robin, who joined the ambulance service Mamhilad. will deliver improved assessment skills to all of giving them the most appropriate care at the as a cadet at 15, our paramedics. most appropriate time. admitted it had been As well as providing a new headquarters for a difficult situation: “I the South East Region, Vantage Point House In addition, we are creating a foundation Vantage Point House is the signpost for the had never given the will also be the new nerve centre for Patient Practitioner Programme and a Master of future. thrombolysing drug Care Services, NHS Direct Wales and Gwent Sciences for fully fledged practitioners. before and I was on Out of Hours. To achieve this the Trust appointed its first my own. Not everybody who rings 999 needs an Consultant Paramedic, Andrew Jenkins, “It was certainly emergency ambulance. At Vantage Point who will lead a team of senior clinicians touch and go. He House we will be able to assess or triage dealing with issues like the development was very poorly and Category C calls and some Category B calls so of paramedics, focusing research activities looked terrible but that patients receive the care that is right for on practice development, improving the it’s a brilliant result.” them. It will provide unscheduled care at its protection of children and vulnerable most modern and most effective. adults and improving our patient-public Robin said: “I really involvement. love being on the RRVs. It’s a new challenge and they allow us to target emergencies.” Feedback 10/11

The Trust welcomes complaints and compliments as an important indicator of the ●● Issues identified in the investigation of the same complaint also fed into the A breakdown of complaints by region and department is as follows: A breakdown of complaints is shown below: quality of service we are providing. The feedback from patients, their carers and family, planning stage of the project for the new planning and control system. It was (More than one category can be registered against each complaint) members of the public, advocates and elected representatives, allows the Trust to identified that a new category of mobility needed to added to the existing list of EMS 2007-08 2006-07 improve the quality of service it provides. requirements and that existing resources needed to be re-categorised, to identify C&W North SE Total Reason Total Control EMS NHSDW PCS Total EMS PCS vehicles that could meet this new mobility category. During the course of the year the Trust Board has approved a new complaints policy and 2006-07 62 29 92 183 Attitude 35 0 25 2 8 39 22 17 the individual Regions now have the day-to-day ownership of complaints. Complaints The above example had national implications. However the Trust is equally willing to 2007-08 32 27 66 125 Clinical care 25 1 23 1 0 27 27 0 are investigated by senior officers using a variety of techniques, such as face-to-face visits learn from community based issues. Variance -48% -7% -28% -32% Communication 24 2 9 3 10 34 21 13 to the complainants and interviews with staff and witnesses. The Chief Executive signs all ●● An example of this is when an ambulance responding to a 999 call was delayed General care 40 0 24 3 13 30 11 19 final letters in response to the complaint. PCS because the crew were following the satellite navigation route. The satellite C&W North SE Total Other 32 1 12 7 12 12 4 8 During 2007-08 a group was piloted in the North Region. This group ensures that any navigation system did not register that the postcode was split to either side of a Service Provision 17 0 3 6 8 0 0 0 commitment made to the complainant is fulfilled and that service delivery risks are dual carriageway. By working with local residents, the electronic system used for 2006-07 34 25 60 119 Standard of driving 12 0 9 0 3 2 0 2 identified and recorded. The group also monitors and discusses any lessons learned identifying the location of emergencies was adjusted and the Trust was able to 2007-08 49 49 48 146 from complaints and compliments, sharing these lessons, both within the region and, if reassure the community that there would be no further delays in responding to Time 195 11 72 2 110 193 92 101 Variance +44% +96% -23% +23% appropriate, nationally. Additionally the group considers any trends that are emerging. their calls. Vehicles 9 0 2 0 7 0 0 0 This group will be replicated in the South East and Central & West regions during the Control This is the first report that includes figures for complaints received by NHS Direct Wales. While 96% of all complaints were acknowledged within 2 working days, only 29% forthcoming year. The Trust received a total of 314 formal complaints during the year; this includes 29 C&W North SE Total were fully investigated and a full response provided within 20 working days. The As a result of complaints investigations various recommendations can be made. These complaints for NHS Direct Wales. In a like for like comparison this shows a 5.6% decrease 2006-07 0 0 0 0 principal reason for this was as a result of delays in investigations being completed result in a variety of actions taken by the Trust. This can include additional training in complaints received by the 3 ambulance regions. 2007-08 5 4 5 14 and heightened importance being placed on the response letter being sent to the for individual staff members or changes to national training programmes. Also an complainant, with more emphasis on lessons learned and improvements in service Although complaints about Control were received during 2006/07 they were not identified as a separate category and delivery. investigation may identify a need for closer working with other emergency services Year C&W North SE NHSDW Combined were included within the figures shown above for EMS and PCS. or NHS Trusts. Where appropriate, station bulletins and other communications are 2005-06 2006-07 2007-08 Total NHSDW published as a result of complaints investigations. 2004-05 83 47 145 - 275 Total Achievement against 20 day target 33% 44% 29% The lessons learned from a complaint can affect both current processes and procedures, 2005-06 99 62 162 - 323 2007-08 This is the first year that NHSDW complaints have been 29 During the year the Trust received three requests for independent reviews. This equates as well as feed into future actions and ongoing projects, two examples of lessons learned 2006-07 96 54 152 - 302* included within the Trust’s annual report. are given below:- to 0.95% of the total number of complaints received. Of these three requests, one has 2007-08 86 80 119 29 314 been returned for further local resolution and one has been refused with no further ●● Following the investigation into a complaint, staff received instruction on how to * During this year a data cleanse exercise took place that identified 3 duplicate complaints opened action to be taken. The last request is still ongoing and is awaiting a decision from the make better use of the existing electronic notepad, to ensure that the patient’s independent lay reviewer. No Ombudsman reviews were requested during the year. specific or special transport needs were correctly identified. This ensured that the during 2006-07 and additionally the data cleanse exercise also identified complaints incorrectly assigned patient did not have to repeat their individual requirements each time they needed to the different regions. This has resulted in a change to the figures previously reported. The figure of 420 compliments received for 2007/08 represents a significant increase transport and the correct type of transport was automatically identified for them. when compared with the 294 compliments received during the previous year. A computerised system will be used to record compliments from 2008/09, which will provide a greater degree of accuracy and which will produce information to identify trends and record improvements against projects that are ongoing within the Trust. VOLUNTEER FIRST RESPONDERS 12/13

Volunteer First Responders are playing a vital This year also saw the first ever group in the Seven Co-responder defibrillator sites have role in reacting to life-threatening incidents UK to be made up of medical students. Based been set up in police custody suites and these across Wales. in Cardiff they first saw action on the weekend are currently being reviewed. scary experience of a Wales rugby international against South And more and more of them are being There are eight Public Access Defibrillator sites A Flintshire woman who has suffered from diabetes for over 30 Africa. trained by dedicated Ambulance Service staff staffed by 65 St John’s Ambulance members. years can look to the future with more confidence thanks to the to provide that vital, life-saving treatment First Responders have also worked hard on expertise of a Mold-based ambulance crew. This illustrates the way the Trust works in which is crucial in the first few minutes of an fund-raising initiatives and recruitment drives partnership with organisations like the police, But it was a scary experience for Nesta Lucas and her husband emergency. to ensure that they are able to maintain and local councils, Arriva trains and even the chain Richard when he found her unconscious one morning and because expand the level of cover. In Wales, there are 184 teams of Community of Castle Bingo clubs in South and West Wales of her condition he could not get her to swallow. First Responders or Co-responders, all ready In South East Region there are now 66 to provide equipment and training. He dialled 999 and within a very short time paramedic Debbie to jump into action at a moment’s notice. They volunteer groups in operation, with over The sites such as the leisure centres, clubs Roberts, from Flint, and technician Ieuan Williams were at the are based in shopping and leisure centres and 600 volunteers. These include 38 teams of and railway stations have been equipped scene and, as Nesta had come railway stations as well as small towns and Community First Responders, 16 at Public with defibrillators and staff have been round and come downstairs, remote rural communities. Access Defibrillator (PAD) sites like universities, trained in their use and in administering they put a tiny amount of a leisure centres, factories, prisons and at Cardiff All team members are trained to use cardiopulmonary resuscitation. glucose jelly substance in her International Airport. There are also 12 police- defibrillators and oxygen equipment and to mouth which, when mixed based teams. Across Wales, school pupils, aged from administer cardiopulmonary resuscitation. with saliva, she was able to five upwards, are being taught life-saving They are ready, willing and able to fill the gap Central and West has 19 Community First swallow. techniques thanks to a joint initiative by the in time before the arrival of a Rapid Response Responder schemes and a further 450 in Co- Welsh Ambulance Service and the British Heart She recovered very quickly Vehicle or an emergency ambulance. Their role responder groups -12 in the Fire and Rescue Foundation. and didn’t need to be is to supplement emergency cover not replace Service and 19 in the Police. A further 16 are taken to hospital: “The it. based at PAD sites which also include prisons, The project is being funded by the BHF with ambulance crew were universities and even bingo halls. training provided in first aid and resuscitation Nineteen more teams are expected to be fantastic. They were so by the Ambulance Service. In two years more on board by August 2008. Community In North Wales the number of Community professional and helpful,” than 800 teachers from 249 schools have been First Responders have included such First Responder teams rose from 28 to 31 with she said. trained to pass on life-saving skills. diverse individuals as a Welsh Ladies darts membership still on the rise – the year ended “I had never heard of the international in Central and West Region, with 287 trained volunteers in the region. glycogel they gave me, a chapel minister in North Wales and a There is also plenty of interest around the but they told me I could gravedigger in South and East. region, both in setting up new schemes and in get it myself, which I individuals joining existing groups, including, have since done. In fact, in Bangor, another chapel minister – the Rev I learned a lot from Gerwyn Roberts is already a stalwart of the them that morning.” Conwy Valley group. emergency medical services 14/15

The Emergency Medical Services responded to Another notable success was the increased use There was only one month, December, where a record number of 999 calls during the year. of clot-busting drug, tenekteplase. the Trust did not attain the Welsh Assembly Government target of reaching 60% of personal thanks Even so, for the first time ever, the Welsh Pre-hospital thrombolysis has revolutionised Category A emergencies within eight minutes. Ambulance Service achieved its target of the treatment of cardiac patients by busting A Lampeter man has said a personal “thank reaching 60% of Category A life-threatening the clot which causes a heart attack. Over the year, the total number of 999 calls you” to the team who brought him back to calls within eight minutes. rose to 302,664 compared to 299,862 for the life with the revolutionary thrombolysing Paramedics administered the drug 205 previous year. drug that busts the blood clots that cause This was made possible by the skill and times within the target golden hour which is heart attacks. dedication of the staff who once again rose equivalent to a success rate of 90.2%. The number of calls in December peaked to the immense challenge of the five-year at 27,284. At the same time, there was an Building worker Terwyn Jenkins, 58, was at This is well above the Wales target of 70% and modernisation programme, Time to Make a unprecedented number of delays in turnround home when he began feeling unwell: “At makes the Welsh Ambulance Service one of Difference. times at hospitals. As a result, 16% of the first I thought I had indigestion, but then I the top performing ambulance trusts in the available ambulance hours were lost to had a terrible pain in my chest and down The Trust is the only one in the UK to attain UK. queuing outside hospitals. my arms,” he said. and surpass the goal of training 60% of The top performing area in Wales was the Emergency Medical Staff as paramedics. Once again, a number of individuals were His wife, Mandy, called an ambulance which South East region where paramedics gave 91 recognised during the year. Paramedic arrived within two minutes and ambulance The new fleet of emergency ambulances clot-busting injections within the golden hour, Christine James, of Blaina, had her actions in technician Chris Doughty and paramedic became a common sight across Wales and also 94.5% of all cases. saving three people from a burning house in Mark Boothby began treating Mr Jenkins had a starring role on television. In Central and West Wales, the figure was 63 Tredegar recognised by Tredegar Town Council who suffered cardiac arrest. The state-of-the-art vehicles were featured in or 88.9% of cases and in North Wales it was and by a local radio station. He was revived with CPR and Mark gave him a documentary programme on the Discovery administered 51 times, equivalent to 84.3% of The crew of Bernard Williams, from Tredegar, the clotbusting injection which took almost Channel in the UK, Europe and the USA at the the cases. and Julian Rudge, from Aberbug, were immediate effect and Mr Jenkins was taken beginning of 2008. New high dependency vehicles were commended by South Wales Police for to Glangwili Hospital in Carmarthen. The use of more Rapid Response Vehicles introduced to transport urgent patients, carrying a seriously injured man a mile across “I’m still a bit weak but otherwise I’m fine,” to target life-threatening Category A leaving emergency ambulances free to rough mountain terrain to their ambulance. he said: “I’m so lucky to be here, and it’s all emergencies was effective, helping concentrate on incidents where lives are at down to the paramedics to reach seriously ill or injured risk. ambulance patients more quickly. crew.” Significantly, there was also an improvement too in the speed with which follow-up ambulances arrived to provide transport for the patients. Patient Care Services 16/17

Patient Care Services provides 1.3 million When patients ring up, they are taken through During the year, the modernisation of Patient patient journeys every year – that’s equivalent the eligibility criteria to decide whether they Care Services included: to moving half the population of Wales. need ambulance transport. Those who need moving moment ●● Procurement and pending transport are taken safely to and from their That adds up to 5,000 people a day in almost implementation of a new computer appointments, either in a PCS vehicle or in a A meeting between a paramedic and a man 250 vehicles on non-emergency and pre- system car driven by a volunteer. whose life he saved had a special poignancy planned trips which must be co-ordinated ●● Strengthening the management structure as he had been led to believe that the man with hospitals and clinics the length and The volunteer Ambulance Car Service drivers had died. breadth of Wales. cover eight million miles annually and provide ●● Development of assured policies and transport for patients who have limited procedures “I am really chuffed that he is doing well. It’s It is a massive undertaking but one that is a mobility but are able to get in or out of a car. made my day,” said Stephen (Stef) Roberts vital part of the work done by the Trust every ●● Introduction of performance management Volunteer car drivers make a huge difference on meeting 64-year-old Albert Knight who day. to patients across Wales who rely on them for ●● Collaboration with voluntary and local has made a full recovery. PCS takes patients to and from more than 300 lifts to and from hospital appointments. government colleagues to share resources. Mr Knight, a former lorry driver, collapsed treatment centres in the UK for a variety of Car Service co-ordinators have also ●● Development of new training programmes in the early hours of the morning. His wife reasons, including out-patient appointments, been introduced to professionalise the and packages dialled 999 and within minutes paramedic critical treatment such as renal care and cancer management of the car service and a higher Stef was there and he correctly diagnosed treatment, taking people home after hospital ●● Establishing regular volunteering forums remuneration rate for car service drivers has that Mr Knight’s condition was due to a stays and supporting the Emergency Medical and working with volunteers to develop been introduced. cholesterol clot as opposed to the more Services at major incidents. and review existing working practices. common blood clot. The commitment to staff and volunteers The Trust’s fleet of Patient Care vehicles ●● The new computer system will improve has been enhanced with the development It was a first time for Stef to use the has been designed to meet the needs of a planning and scheduling of journeys, of a dedicated management structure. This revolutionary thrombolysing drug but it broad range of patients and the Trust has laying a foundation for an even better includes Regional PCS Heads of Service, took immediate effect although he later invested significantly in the replacement and service. Customer Service Managers and Customer heard that Mr Knight had died. modernisation of its PCS vehicles. Services Supervisors, PCS Control Managers ●● Meanwhile, Patient Care Services So he was delighted to find that he had, in The staff, who are supported by a dedicated and Ambulance Car Service Managers in each continues to work with a whole host of fact, recovered team of volunteers, are the Service’s most Region. partners and stakeholders to provide and he added: significant asset. the highest quality service for the “It was a real PCS has also been strengthened by the communities of Wales. Their skill and dedication ensure patients are appointment of a National Modernisation thrill to meet given the best possible service. This starts Manager and a Business Change Manager him and a with the booking arrangements in the new to help implement the comprehensive very moving patient non-emergency call centres. modernisation programme. experience to see him looking well.” NHS DIRECT WALES 18/19

NHS Direct Wales is playing a significant role NHS Direct Wales provides a call handling and The website provides detailed health NHS Direct Wales March March in implementing the Trust’s modernisation telephone triage service to three Local Health information, including a search facility for programme, Time To Make A Difference. Boards in Wales and 25% of patients accessing local services, and a bilingual A-Z health End Point Disposition 07 08 old pals act this service are being appropriately signposted encyclopaedia - the Welsh language version is 999 3.0% 2.5% Among the initiatives has been the introduction away from GP Out of Hours Services to non- the first of its kind – which provides information Paramedic Dylan Parry saved the life of a family friend after of Clinical Desk Pilots. urgent forms of care or being supported to care on over 650 health conditions and medical A&E 9.1% 8.0% responding to a 999 call to a road crash. They are Senior Nurse Advisors from NHS Direct for themselves at home. problems. GP Urgent 15.9% 9.9% Dylan discovered the casualty was old pal Stephen Morgan who had Wales who are working in the control centres We also provide a 24-hour dedicated dental Other new features on the site include an suffered a heart attack at the wheel. at Mamhilad and Carmarthen. Their role is to GP Same Day 18.2% 14.6% helpline to 13 LHBs , advising approximately online enquiry service enabling users to send Stephen’s wife, Jennifer, wrote to the Welsh Ambulance Service assess or triage the Category C calls that are 3,000 callers a month on how to manage and receive health information via a web-based GP Routine 18.5% 16.2% neither life-threatening nor serious and some praising their friend for saving her husband’s life: “There’s no doubt their symptoms at home or how to access e-mail service; an information prescription Pharmacist 2.4% 2.5% Category B calls where people are not suffering emergency or routine dental care. facility that provides tailor-made information in my mind that but for Dylan things would have been very different,” a life-threatening emergency. for people with long term conditions and Self Care 25.1% 38.9% she says. NHS Direct Wales is working closely with the an SMS text messaging service which allows As a result, callers are being safely directed Community Pharmacist in Wales. As part of Dentist 6.2% 5.8% Dylan, 45, a paramedic for 15 towards more appropriate care and 999 localised service information to be sent free of years, says: “I’d known Steve and the Continuous Professional Development charge to mobile phones. Other Professionals 1.6% 1.5% ambulances are being freed up to concentrate Programme staff are trained to use the on dealing with life-threatening emergencies. Jenny for years because my wife, appropriate pathway for callers requiring Content for the website is driven by public need Number of Calls to NHSDW 11797 11691 Sue, and Jenny used to work Before NHS Direct Wales joined the Ambulance pharmacy advice. and ongoing developments to the site are part together. Service on 1 April 2007, only 25% of patients of the larger strategic developments within GP out of hours calls March March NHS Direct Wales also provides a 24-hour health the service to provide multi-channel access “We got Steve hooked up to were triaged as needing home care. Now, home advice and information service to the people End Point Disposition 07 08 care is assessed to be appropriate in 39% of and to direct users to the appropriate health the defibrillator and shocked of Wales, and in the last 12 months the service information. 999 5.5% 4.7% him and that got his heart cases. has dealt with over 685,000 contacts either NHS Direct Wales offers a telephone triage by phone (356,755 calls) or on their website A&E 5.6% 4.9% going and I got a line into him service to six major A and E Departments and www.nhsdirect.wales.nhs.uk and gave him two shots of in 2007-08 they answered 2,557 calls. Of those, GP Urgent 31.7% 20.7% adrenaline and when we got Across Wales NHS Direct Wales has just in excess him into the ambulance he 58% were signposted away from A and E to of 219 full time staff. These include 125 Nurse GP Same Day 32.7% 32.4% non-urgent forms of care, including self care was breathing on his own Advisers, 10 Dental Nurse Advisers, 52 Call GP Routine 9.1% 8.6% and community pharmacists. Handlers and 32 Health Information Advisers. and his pulse had returned.” Pharmacist 1.1% 1.8% Dylan adds: “I think Steve Self Care 12.9% 24.9% was lucky, lucky that there Dentist 0.9% 1.3% were two police officers there immediately to give Table shows the number of calls recieved by the Other Professionals 0.5% 0.7% him CPR and that I was team and the % of callers that were sent to the Number of GPOOH Calls 3762 4783 there within a couple of end point dispositions outlined. minutes.” TRAINING AND DEVELOPMENT 20/21

The Trust has an established Education and ●● Call handling Curriculum As well as the work to manage the Development department. This department The design of this curriculum has seen transition into higher education the design has sites in all three of the Trust’s Regions NHSD and Swansea University working of a meaningful Continuing Professional praise for responder with the National Training College located in in collaboration to develop an accredited Development programme has taken place The mother of a young asthma sufferer praised a volunteer lifesaver Swansea. This Education and Development programme that is fit for purpose. that ensures other strategic objectives are who rushed to her daughter’s aid when she had an attack in the department primarily focuses on clinical/ delivered. These are primarily to support Both programmes have therefore been middle of the night. professional education for Patient Care the Trust’s clinical governance framework designed in partnership with Swansea Services, Emergency Medical Services, NHS and plans to integrate with unscheduled And it wasn’t until the following day that Lynda Brown learned that University and are required to be quality Direct Wales and control staff. care services. The result of all this work will the woman who had done such a wonderful job for her daughter assured and approved through robust be that during 2008-09, Paramedics will Georgia, 8, was not a professional. The year 2007–08 has seen the Education academic processes. These would include a receive updates (via a 2 day programme) on and Development department put plans in School of Health Science Curriculum Approvals Now Lynda, from Tywyn, is keen for the public to know what a refusal of treatment and transport, mental place to change education provision. This Board and the Swansea University Faculty valuable role First Responder groups are fulfilling. capacity, protection of vulnerable adults, was not only to meet the requirements of Approvals Board. scope of practice and medical history taking And after tracking down Good Samaritan Jackie Patterson, Lynda our modernisation plan, ‘Time To Make A All WAST Regional Practitioner Educators (to allow them to better manage resolved has presented her with a bouquet as a thank you. Difference’, but also to start the transition have achieved Honorary Lecturer status with hypoglycaemia and resolved convulsions as from vocational training programmes to an “Jackie did a fantastic job, but I didn’t realise that First Responders Swansea University following an induction per their clinical guidelines). accredited higher education curriculum. were volunteers until I read an article about them the following day,” programme. This will enable Trust tutors to To ensure that WAST is able to sustain said Lynda: “It’s really comforting to know they are in the area.” The process of designing the following become fully integrated within the academic the evolution of pre-hospital practice, a curricula has been completed: educational processes that the University has Jackie, 46, said: “I just threw on my clothes and got there as quickly development framework has been designed to offer. as possible. I ●● Paramedic Science Curriculum that provides three levels that culminate at the really enjoy The design of this curriculum has seen level of Paramedic practitioner. The framework being a First WAST and Swansea University working is in keeping with regulatory requirements Responder in collaboration to ensure that both of the profession. It will allow paramedics and it’s very the academic and professional content and other allied health professionals, such as satisfying was appropriate. The curriculum design Nurses, (through an accredited prior learning to know we has had to meet specific regulatory process) to develop their skills to care for are helping requirements set by the Health Professions patients with a wider range of unscheduled local people, Council. care needs. This framework is being shared but I didn’t with other health providers as part of the expect Trust’s plans to integrate into the whole health flowers.” system in NHS Wales. Air Ambulance CONSULTATION 22/23

Wales Air Ambulance, a charity, is one of Wales Air Ambulance are committed to Our Patient and Public Involvement Strategy To promote World Heart Day in June 2007 the the fastest-growing and busiest in the UK, upgrading their current helicopters to a sets out a commitment to ensure that patients Trust liaised with the swimming co coordinator answering almost 1,800 life-threatening calls New Generation aircraft by the end of 2009, and the public are central to the Trust’s for the City and County of Swansea to work fundraising in the past year as stipulated by Civil Aviation Authority development and modernisation. in partnership in supporting a swimming Last year, Helen and Gary Davies were legislation. competition for local schoolchildren aged facing every parent’s nightmare - that their It operates three helicopters, based in During the year a number of projects were from seven to 11. The winners were awarded son Iestyn would die following an horrific Swansea, Welshpool and Caernarfon, and The Bolkow 105’s currently in use have seen carried out to raise awareness of the Trust’s Trust ‘goody bags’ with health information bike accident that smashed his skull and provides cover across the whole of the country great service but the new technology now work and to improve its interaction with the messages and keeping fit and active. damaged his brain. every day of the year and the two paramedic available on the New Generation aircraft will public. crews can be anywhere in Wales in less than increase benefits to both crew and patients. The Trust’s strategy for PPI is the responsibility But now not only is Iestyn walking and These included developing a series of 15 minutes. of everyone within the organisation in talking, he is back at school in Talgarreg Having to upgrade to the New Generation ‘directions’ leaflets from Withybush Hospital ensuring that the services and care provided and has presented £26,000 to the South Since 2001, Wales Air Ambulance crews have aircraft will impact significantly on the funds to the four major hospitals at Morriston and are outcome driven and patient centred. Wales Air Ambulance crew that saved his flown more than 8,650 missions throughout of the Charity, as they will now need to raise Singleton in Swansea, Glangwili, Carmarthen, life. Wales, saving countless lives in the process. £4 million a year from public donations, and University Hospital, Cardiff. It sets out a commitment to ensure that an in-house lottery and 10 shops. There is patients and the public are central to the “Without the air ambulance, who got him Last year the Swansea-based South Wales This followed patient feedback from the no financial support available from Central Trust’s development and modernisation. to Morriston Hospital so quickly, I’m sure aircraft responded to over 800 calls during Pembrokeshire and Derwen NHS Trust Government or the National Lottery. Iestyn wouldn’t be alive today,” says his the year, Welshpool’s Mid Wales helicopter and allows ambulance crews to hand over A Partners in Health Network has been formed mum, Helen. covered 385 and North Wales crews from In order to raise awareness of the necessity to leaflets to relatives and friends if a patient is with representatives from local community Caernarfon a further 600 giving a combined upgrade the helicopters, the Charity embarked transferred. groups, members of the public, patients Iestyn’s family and friends have held a Body total of 1,785 life-threatening traumas – on a Pound Appeal Launch combined with a and the Trust that will enable improved Shop party and a barn dance and Iestyn’s Plans have also been put in place to relaunch almost 400 fewer than the previous year. ‘Round the Principality Tour’ in March which involvement and engagement in Trust classmates did a sponsored walk while a website aimed at children and young proved to be a great success. activities. at Christmas relatives stripped off for a The service has also taken on two new people and answering their questions about saucy calendar, pushing the total raised to patrons, BBC newsreader and Breakfast The Welsh Ambulance Services NHS Trust healthcare. This follows a detailed consultation £26,000. presenter Sian Williams and Swansea singer is committed to ensuring that people are with schools and youth groups. Bonnie Tyler to join operatic great Bryn Terfel actively involved in decisions about their care, We have also carried out a series of Health and rising rugby star James Hook. that they are engaged with across Wales and Promotion and Education Events promoting that their involvement sits at the heart of The rapid development of the service is down the Welsh Ambulance Services and NHS Direct service planning and delivery. to the staff and volunteers of the charity and, Wales. of course, the people of Wales who have From May to June 2007 a number of donated the funds required to sustain and promotional events were held in local schools, expand the organisation. meeting young carers and discussing access to health information and services available to them. FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2008 24/25

Report of the Director of Finance, T Woodhead. 2. Prior to 1 April 2006, Ambulance leasing At the end of this period the Trust will have REVIEW OF THE 2007-08 YEAR This is an increase of £19 million from 2006- costs had been funded by a transfer of recovered previous deficits in full. 07 as this year’s income includes £11 million FINANCIAL PERFORMANCE AGAINST The Finance Report once again highlights resources from the Trust’s discretionary capital in respect of NHS Direct Wales, a service that he’ll never forget STATUTORY FINANCIAL DUTIES FOR THE In addition the Trust’s Modernisation achievement of challenging financial targets allocation to revenue. However, as a result transferred into this Trust on 1 April 2007. In YEAR ENDED 31 MARCH 2008 Plan - Time to Make a Difference - is and management of resources through a Paul Walsh doesn’t remember very much about his heart attack of HM Treasury restrictions limiting capital/ addition the Trust received £8 million relating intended to contribute significantly to particularly demanding year for our services. - but he will never forget the paramedic whose decision to As part of its Service Change and Efficiency revenue transfers across the public sector, such to inflation and pay award funding (£3.1m) improved operational performance and the administer the clotbusting thrombolysing drug saved his life. Plan (SCEP) the Trust agreed a target deficit a transfer was not permissible for 2006-07 or The 2007-08 Financial Year saw the Trust and support for Capital Charge costs on Fleet development and modernisation of services. for 2007-08 of £2.311million. The out-turn 2007-08. A business case has been approved continue to progress implementation of and Estate Modernisation (£4.4m). Paul, 51, from Llangefni, was at work when the attack happened. The Trust’s philosophy in developing and position of £1.738million deficit represents a by WAG for additional capital and associated Agenda for Change pay and conditions for Colleagues called the ambulance and paramedic Dylan Thomas progressing the SCEP will be that wherever Other Operating Income favourable variance of £573k on the agreed capital charges funding to move to a policy of staff, with some 99% assimilation being Jones was quickly there and decided to give Paul the thrombolyser: possible the level of efficiencies planned SCEP target. This means that the Trust has vehicle purchase rather than lease and steps to achieved by the year end. The Trust received £16,437,000 of Other ”I told him to fire away and should not only be met, but exceeded in therefore met Part Two but has not met Part resolve this issue have been taken. Operating Income. This is an increase of £6 then I just remember going order to release resources to develop and The Trust also continued to review staff One of the statutory break even duty. million from 2006-07. to sleep. It was a nice feeling The key cost pressures listed and others such modernise services and create “head room” for rostering and deployment arrangements to of falling gently,” Paul says. There are 2 main contributory factors to the as inflationary pressures have been partially development. improve effectiveness, achieving increased The increase mainly relates to additional net deficit reported: offset by stringent management action in year efficiency and significantly improved response funding of £6 million in respect of the Dylan adds: “I was working The Trust achieved the External Financing resulting in the reduced net variance reported times as reported elsewhere in this report. Ambulance Radio Replacement Programme on my own in the rapid 1. With effect from October 2004 the Trust has Limit (EFL) of £18.233 million set by the Welsh above. (total in year funding for this amounted to response vehicle and had been required to implement new Pay Terms Assembly Government 2007-08 saw significantly increased levels of £7,506,000). to make the decision to and Conditions for staff under the UK wide The Trust’s SCEP was accepted by WAG WAG Capital investment in the Trust, totalling The Trust achieved a Public Sector Payments administer the drug, rather Agenda for Change (AFC) initiative. Regional Office and main commissioner Health some £18.3 million. Operating Expenses Policy (PSPP) of 92.6% within 30 days, against than being able to talk it Commission Wales and accepted by the Chief As a result of the unsocial hours worked by the target 95%, despite disruption early in Administrative functions, including Operating expenses during 2007-08 totalled over with a colleague. Executive of NHS Wales in February 2007. This Ambulance Staff, the implementation of AFC the Financial Year following the transfer of Procurement, Creditor Payments and Accounts £136,521,000. This is an increase of £19 projects financial performance for financial “The result was good, we pay arrangements has particularly severe services to the North Wales Business Support Receivable moved to the North Wales Business million from 2006-07. resuscitated him and he financial implications which are generic to years as follows:- Support Partnership in May/June 2007, they Partnership (BSP) Staff costs increased by £8.7 million compared recovered quite quickly.” Ambulance Service Trusts resulting in an 2006-07 Planned deficit £6.4 million (actual have since provided a shared service for these ●● From May 2007 the creditor payment to the previous year’s reported expenditure. increase of up to 30% in the total pay bill. £6.3 million) functions within NHS North Wales. Paul is making a good service transferred to The North Wales The increase is mainly attributable to NHS 2007-08 Planned deficit £2.3 million (actual recovery and says: Significant additional funding to offset BSP. Following this transfer a decline in Pay awards for Very Senior Managers have not Direct Wales staff who joined the Trust on 1 £1.8 million) “I’ve talked to several AFC has been made available by the Welsh performance was experienced. A similar exceeded the 1.3% WAG guideline. April 2007, together with a reduction in staff 2008-09 Breakeven doctors who have told Assembly Government (WAG) to the NHS but decline in performance was experienced costs of some £0.5 million relating to the 2009-10 Surplus £2.9 million INCOME AND EXPENDITURE FOR THE YEAR me I’ve been very Trust projections indicate a recurrent shortfall by all of the other North Wales Trusts who transfer of services to the North Wales Business 2010-11 Surplus £2.9 million ENDED 31ST MARCH 2008 lucky and that the in funding of £5.2 million, which was further transferred their services. For the last 2 Support Partnership. 2011-12 Surplus £2.9 million paramedic saved my partly offset in 2007-08 by an additional non quarters of 2007-08 PSPP performance Income from Activities life,” he says. recurrent allocation of £1.029m. averaged 96.87% The Trust received £119,528,000 Income from Healthcare activities. FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2008 26/27

Expenditure on the Ambulance Radio During the year, additions of £21.6 million The Trust’s capital structure is funded from Post Balance Sheet Events an annual update of the scheme liabilities Replacement Programme increased by were made to vehicles and equipment. Public Dividend Capital (PDC) issued by the for FRS 17 purposes. The latest assessment of The Trust had no post balance sheet events £6 million compared to the previous year. Additions of £1.1 million to buildings included Welsh Assembly Government, revaluation the liabilities of the Scheme is contained in having a material effect on the accounts. trainee medics new role Higher utility prices and increased buildings £450k re NHS Direct Wales’ Bangor offices and reserve and cumulative Income and the Scheme Actuary report, which forms part It was a busy weekend for a team of trainee medics in a ground- maintenance costs resulted in costs for the £656k in respect of a review of the value of Expenditure Reserve. The Trust’s Treasury Pension costs of the NHS Pension Scheme (England and breaking new role - answering emergency call-outs. year of £11 million an increase of £3.8 million properties held under finance leases. policies are to draw down PDC funding as Past and present employees are covered by Wales) Resource Account, published annually. on last year. The addition of NHS Direct Wales agreed with WAG as and when required to These accounts can be viewed on the Business The UK’s first First Responder group to be formed exclusively from A revaluation of all of the Trust’s land and the provisions of the NHS Pensions Scheme. contributed to an increase in computer fund capital expenditure. Short term cash Service Authority - Pensions Division website medical students had their baptism of fire on the weekend of the buildings was undertaken as at 1 April 2007. The Scheme is an unfunded, defined benefit hardware and maintenance costs of £1 million. surpluses are held in interest bearing public at www.nhspa.gov.uk. Copies can also be Wales v South Africa rugby international in November. This resulted in an overall increase in property scheme that covers NHS employers, General The move from leased ambulances to owned sector investments with the Paymaster obtained from The Stationery Office. book values of £5 million. Practices and other bodies, allowed under the They responded to a total of 11 ‘999’ emergencies and Welsh ambulance vehicles has contributed to a General and HM Treasury Deposits. direction of the Secretary of State, in England The conclusion of the 2004 investigation was Ambulance Service First Responder Officer for South East Wales Tony reduction in costs of £2.9 million. Fleet fuel During the year, the Trust disposed of surplus The Trust maintained positive cash balances and Wales. The scheme is not designed to be that the scheme had accumulated a notional Rossetti said: “It was a busy spell for them and they coped superbly. equipment with a Net Book Value of £40k. costs have however risen by £455k due to run in a way that would enable NHS bodies throughout 2007-08. As part of the Trust’s deficit of £3.3 billion against notional assets “They have been excellent to train and to work with and we hope price increases (13%). Current Assets and Liabilities to identify their share of the underlying SCEP plans cashflow for 2008-09 will continue as at 31 March 2004. This is after making some that they get something out of the experience to stand them in scheme assets and liabilities. Therefore The net cost of fixed asset impairments NHS Debtors have increased by £1.5m, this to be carefully monitored, repayments of allowance for the one-off effective of pay good stead for their future careers as well as the service they are the scheme is accounted for as a defined totalled £683k offset by additional WAG increase relates to non recurrent Agenda for capital to WAG will occur during the year to modernisation, but before taking into account providing for the community.” contribution scheme: the cost to the NHS body funding. Change funding, Capital Charge funding and ensure the Trust maintains appropriate levels any of the scheme changes which come into of liquidity. participating in the scheme is equal to the effect on 1 April 2008. Taking into account First Responders are trained by the Ambulance Service and come Overall Trust management costs increased by funding in respect of the cost of technical contributions payable to the scheme for the the changes in the benefit and contribution from all walks of life and include a gravedigger from Llantwit Major, 0.2% to 4.8% from 2006/07 to 2007/08. This is adjustments to the NHS Permanent Injury Contingent Liabilities accounting period. structure effective from 1 April 2008, employer a Welsh Ladies darts international from Cwmllynfell and a minister mainly due to the addition of NHS Direct Wales Benefit Scheme. The Trust has received a number of formal contributions could continue at the existing from Llanrwst. from 1 April 2007. The Scheme is subject to a full actuarial At year end the Trust held £2.15m invested claims under equal pay legislation, following investigation every four years. The main rate of 14% of pensionable pay. On advice An incredible 300 medical Excluding NHS Direct Wales, Trust with HM Treasury National Loans Fund. Agenda for Change assimilation. There is purpose of which is to assess the level of from the actuary, scheme contributions may students showed an interest management costs on a like-for-like basis were significant uncertainty regarding both the Non NHS Capital creditors increased from liability in respect of the benefits due under be varied from time to time to reflect changes in joining and there are plans 4.5%. likelihood of success of any claims and the £3.5 million to £5.1 million as a result of the the scheme (taking into account its recent in the scheme’s liabilities. Up to 31 March 2008 for a rolling programme liability of the Trust if any claims were to be Fixed Assets substantial capital investment programme demographic experience), and to recommend employees paid contributions of 6% (manual of training to ensure two successful. 97 cases have been referred to during the year. the contribution rates to be paid by employers staff 5%) of their pensionable pay. From 1 teams are topped up as The net value of the Trust’s Fixed Assets employment tribunal. It is unlikely that any of and scheme members. The last such April 2008, employees will pay contributions students qualify and move increased by £20.6 million from 2006-07 to Balance Sheet provisions decreased by £6.5 these cases will be settled within the next two investigation, on the conclusions of which according to a tiered scale from 5% up to 8.5% on. 2007-08. million on the previous year due in the main years. of their pensionable pay. to the reduction in the provision for Agenda scheme contribution rates are currently based, They will cover the Heath, for Change costs as assimilation of staff has had an effective date of valuation of 31 March Gabalfa and Cathays areas progressed. 2004 and covered the period from 1 April of Cardiff where they live 1999 to that date. Between the full actuarial and work. valuations, the Government Actuary provides FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2008 28/29

CAPITAL EXPENDITURE 2007-08 ACCOUNTS The Director of Finance Report of the Auditor General for Wales Opinion Welsh Ambulance Services NHS Trust to the National Assembly for Wales on the During the year a total of £22.8 million was These summary financial statements for the In my opinion the summary financial HM Stanley Hospital Summary Financial Statements clean your hands invested in new and replacement assets. year ended 31 March 2008 are a summary statements are consistent with the statutory St Asaph The Welsh Ambulance Services Trust has been chosen as a pioneer This was financed from the Trust’s annual of the financial information contained in I have examined the summary financial financial statements of Welsh Ambulance Denbighshire in the National Patient Safety Agency‘s extension of its award- discretionary capital allocation and an the Trust’s annual accounts. They have been statements of Welsh Ambulance Services NHS Services NHS Trust for the year ended 31 LL17 0RS winning cleanyourhands campaign to care settings outside additional £13.3million from the Welsh prepared by the Welsh Ambulance Services Trust statutory financial statements set out on March 2008 on which I have issued an hospitals. Assembly Government All-Wales Capital NHS Trust under Section 98(2) of the National Tel: 01745 532938 pages 30 to 33. unqualified opinion. Health Service Act 1977 in the form which the The Trust celebrated its selection by hosting an event at the Programme. A further £4.3m was financed Certificates of Chairman, Chief Executive Respective responsibilities of the Directors Secretary of State has, with the approval of the Millennium Stadium, Cardiff, and in the spirit of the Rugby World through Finance Lease commitments. and Director of Finance and auditor Treasury, directed, as amended by the National Cup, Cardiff paramedic Sarah Vivian was on hand to ‘kick bugs into The major elements of the capital programme Health Service and Community Care Act 1990. We certify, that the summary of the annual The Directors are responsible for preparing touch’. were vehicles/fleet £9.2 million, medical accounts set out on pages 30 to 33 are the Annual Report. My responsibility is to equipment £2.4 million, Information, Statement on Internal Control 2007-08 Sarah, from Llanelli, is also a member of the Welsh women’s touch consistent with the Trust’s full statements for report my opinion on the consistency of rugby squad, and scored a try against England in the Touch Rugby Communication, Technology £4.2 million, Jeremy Coleman In accordance with Welsh Assembly the year ended 31 March 2008. the summary financial statements with the World Cup in South Africa. estates £1.2 million, purchase of NHS Direct Government requirements the Trust’s full Signed on behalf of the Board statutory financial statements. I also read the Auditor General for Wales Wales assets £0.5 million and capitalisation of accounts for the financial year include a other information contained in the Annual Wales Audit Office Scrum half Sarah said: “In the Ambulance Service, we treat people Vantage Point House lease £3.4million. Statement on Internal Control which sets out Report and consider the implications for my 24 Cathedral Road in all sorts of different locations. We need to ensure that we don’t 2008-09 and beyond responsibilities and mechanisms within the report if I become aware of any misstatements Cardiff pass germs from one patient to the next – cleaning our hands can Trust for the management of risk. This includes S Fletcher or material inconsistencies with the summary CF11 9LJ prevent this. The Trust faces another very challenging year a review of effectiveness and any significant Chairman financial statements. ahead in which modernisation of services “We all have a internal control issues arising during the year. will need to continue, whilst at the same time Basis of opinion responsibility to The Trust’s external auditor is the Auditor ourselves as well as the Trust is required to return a balanced I conducted my work in accordance with budget. Further service change and efficiency General for Wales and included in “operating to our patients and A Murray Bulletin 1999/6 ‘The auditor’s statement on the improvements will be taking place in order to expenses”, on page 30 of this document is the colleagues to stop the Chief Executive summary financial statements’ issued by the achieve this. cost of £137,000 for the external audit fee. spread of infections Auditing Practices Board for use in the United through good hand The Trust’s recent track record gives The financial information contained within Kingdom. hygiene – playing as confidence that the challenges will continue to this financial review is a summary of that a team and working be addressed with vigour and determination contained within the final accounts and T Woodhead together is as and that the on-going dedication and might not contain sufficient information for Director of Finance important in patient determination of its staff will build on the a full understanding of the Trust’s financial safety as it is on the achievements made over the past two years to position and performance. If you would like a rugby pitch.” take the Trust forward. complete copy of the Trust’s full accounts, they are available on request from the following address:- FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2008 30/31

Income and Expenditure Account for the year Statement of Total Recognised Gains and Losses Current Assets Cash Flow Statement for the year ended ended 31 March 2008 for the year ended 31 March 2008 2007-08 2006-07 31 March 2008 perfect outcome 2007-08 2006-07 2007-08 2006-07 £000 £000 2007-08 2006-07 £000 £000 A cool, calm and collected ambulance £000 £000 Stocks and work-in-progress 242 197 £0 £0 controller has been praised for talking a dad Deficit for the financial year (334) (5,547) Debtors 13,030 11,900 Operating activities through delivering his baby daughter on Income from activities 119,528 100,833 the phone. before dividend payments Investments 2,150 5,000 Net cash inflow from 1,203 (7,387) Other operating income 16,437 10,671 Fixed asset impairment 0 (1,124) operating activities In fact, David Twigdon Williams, from Cash at bank and in hand 326 326 Prestatyn, did such a good job that a Total Income 135,965 111,504 losses Returns on investments Total Current Assets 15,748 17,423 recording of the call has been made for Unrealised surplus on 5,006 2,196 and servicing of finance the Welsh Ambulance Service to use for Operating expenses (136,521) (117,574) fixed assets revaluations / Creditors: (14,604) (11,330) Interest received 440 840 training purposes. Operating surplus/ (deficit) (556) (6,070) indexation amounts falling due within one year Interest element of finance (118) (212) Company director Roy Barlow was talked Reduction in the donated (7) (7) leases Profit /(loss) on disposal of (14) (18) asset reserve due to the Net Current Assets 1,144 6,093 through the delivery of little Millie Megan at his home at Halton, near Chirk, after fixed assets depreciation /disposal of Total Assets less current 72,225 56,553 Net cash inflow/(outflow) 322 628 from returns on investments dashing home from work to take his wife, Surplus /(deficit) before (570) (6,088) donated assets liabilities and servicing of finance Alison, to hospital. interest Total gains/(losses) 4,665 (4,482) Creditors: (7,827) (758) Roy added: “David was brilliant and very recognised in the financial amounts falling due after Capital expenditure Interest receivable 440 840 year more than one year calm. Alison and little Millie are fine so it Payments to acquire tangible (17,637) (14,658) was just a perfect outcome.” Interest payable (118) (212) Provisions for liabilities and (13,115) (19,615) fixed assets Other finance costs (86) (87) Balance Sheet as at 31 March 2008 charges 2007-08 2006-07 Receipts from sale of tangible 26 16 Surplus /(deficit) for the (334) (5,547) Total assets employed 51,283 36,180 £000 £000 fixed assets financial year Financed by: Payments to acquire/receipts (145) (82) Fixed Assets from sale of intangible assets Public Dividend Capital (1,404) (794) Taxpayers’ equity: dividends payable Tangible assets 70,870 50,378 Public dividend capital 44,221 32,379 Net cash inflow/(outflow) (17,756) (14,724) from capital expenditure Retained surplus /(deficit) (1,738) (6,341) Intangible assets 211 82 Revaluation reserve 16,819 11,488 for the year Total Fixed Assets 71,081 50,460 Donated asset reserve - 7 Income and expenditure (9,757) (7,694) reserve Total taxpayers’ equity 51,283 36,180 FINANCIAL PERFORMANCE FOR THE YEAR ENDED 31 MARCH 2008 32/33

Cash Flow Statement 2007-08 2006-07 Management costs Related Party Disclosures (continued) £000 £000 The Trust has calculated its management costs using the definitions During the year none of the board members a mum’s tribute obtained within WHC (2000) 113. or members of the key management staff or A mum has paid a heartfelt tribute to off-duty paramedic Julie Public dividend capital dividends (1,408) (441) Overall, management costs totalled £6,503,000, which represents 4.8% parties related to them has undertaken any Jenkins who saved her son Jason’s life. paid of total income received by the Trust. material transactions with the Trust. Purchase of current asset (2,150) (5,000) The Welsh Assembly Government is regarded Mrs Rita Phillips said: “Julie saved my son’s life, there’s no two ways about that. He wouldn’t be alive today but for her.” investments 2007-2008 2006-2007 as a related party. During the year the Trust Sale of investments 5,000 15,000 had a number of material transactions with Amazingly when Julie came upon the scene of the horrific car crash £000 % of £000 % of Net cash inflow/(outflow) (14,789) (11,924) the Assembly and with other entities for which on Farm Road, Aberamman, near Aberdare, she had a shock – all four Total Total the Assembly is responsible, namely: young men in one car were friends of her daughter. before financing Income Income ●● Health Commission Wales; Julie began treating the casualties who included her daughter’s Trust 6,503 4.8% 5,128 4.6% Financing boyfriend, John Phillips, and gave the kiss of life to his brother, Jason, Management ●● All Welsh NHS Trusts; and Public dividend capital received 11,842 13,954 who wasn’t breathing. Costs ●● The All-Wales Risk Pool. Public dividend capital repaid - (1,902) He had suffered serious head injuries, including a bleed to the brain, (not previously accrued) Income 135,965 111,504 The Trust has also received revenue and capital as well as a broken pelvis, broken ribs and bleeding into the lungs Public dividend capital repaid (989) - which were also punctured. He still remembers nothing about the (accrued in previous period) payments from a number of charitable funds, Public Sector Payment Policy - Measure of Compliance certain of the Trustees for which are also crash. Loan advances/brokerage received 3,500 - members of the Trust Board. Julie said it was down The Assembly requires that Trusts pay all their trade creditors in to the speed of the accordance with the CBI prompt payment code and Government In July 2000 a charity appeal and trading Capital element of finance leases 436 (128) care: “Luckily I was Accounting rules. The target is to pay all trade creditors within 30 days company were set up with the aim of raising money to fund the operation of the Wales on the scene straight Net cash inflow / (outflow) 14,789 11,924 of receipt of goods or a valid invoice (whichever is the later) unless Air Ambulance Service. This charity has been away and paramedic from financing other payment terms have been agreed with the supplier. registered with the Charity Commission Trina Boyle was there Increase in cash - - 2007-2008 2006-2007 separately from the Trust’s NHS charitable within four minutes of the 999 call. Number £000 Number £000 funds. “After that we Total have to thank the Total bills paid 34,930 52,690 33,497 38,631 Service training Total bills paid within 32,217 49,207 32,065 37,235 department for target giving us the skills to do what we Percentage of bills 92.2% 93.4% 95.7% 96.4% did.” paid within target The board 2007-08 34/35

The Trust is managed by a Board of Executive Executive Directors (alphabetical) Board Committees In addition to the formal membership of Executive Directors are rewarded for their and Non-Executive Directors which meets the committees as outlined above, the individual contribution to the organisation, Mike Cassidy – Deputy Chief Executive During the year the Board reviewed its regularly at various locations across Wales. The Chief Executive, Executive Directors and whilst having proper regard to the moving in bardic circles committee/governance arrangements. The Board meets on a bi-monthly basis. Meetings Dr Mick Colquhoun - Medical Director 2006-7 other officers of the Trust attend committee organisation’s circumstances and performance Board is now supported in its work by five An ambulance man has spoken of his pride at being inducted into are open to the public and are advertised (Retired from position December 31, 2007) meetings as appropriate. and to the provisions of any national committees as follows: the Gorsedd of Bards - and of the special task he has been entrusted accordingly. agreements for such staff where appropriate. Lyn Meadows – Director of Personnel and Board members declare any interests relevant with by the Archdruid himself. Audit (mandatory); Brian Meredith (chair until Development (left Trust on 25 March 2008) and material to their role as Directors of the The Trust does not operate a performance 31 March 2008); Felicity Williams (chair from 1 Ambulance technician Trevor Lloyd Hughes, from Holyhead, was Trust. A register of interests is kept at Trust related pay scheme. Board members Tim Woodhead – Director Finance April 2008); Dilwyn Evans. made a member of the Gorsedd at the Eisteddfod at Mold for his Headquarters and is available for inspection at The Chief Executive and Executive Directors work with the Welsh Ambulance Service, his local community in Chairman – Stuart Fletcher Sara Jones - Director of Unscheduled Care/ Risk Management and Modernisation: Dilwyn any time. are employed on permanent contract, which Anglesey and the game of football in Wales, particularly for his Clinical Director Evans (chair); Clare Cookson; Peter Price; Chief Executive – Alan Murray Remuneration Report can be terminated by giving due notice (six promotion of the Welsh language within the game. Felicity Williams; Deputy Chief Executive; David Jackland - Director of ICT months) unless for reasons of misconduct. Director of Finance; Director of ICT; Director of The Remuneration and Conditions of Service Trevor, known as Trefor o’r Ynys in bardic circles, said: “When I went up Archdruid Selwyn Iolen shook hands with me but then he held Non Executive Directors (appointed by Julie Rowles - Interim Director of Personnel Unscheduled Care/Clinical Director. Committee reviews the pay and benefits of Full details of senior managers’ remuneration and Development from February 11, 2008 the Chief Executive, executive directors and are given on pages 42 and 43 while details of on to my hand and said ’I’ve known this man for many, many years the Welsh Assembly Government) Human Resources: Felicity Williams (chair); senior managers and recommends the level of management costs are given on page 32. and his dedication is well worth the honour. But I have one message Three staff representatives, appointed by Clare Cookson; Peter Price; Deputy Chief Clare Cookson any increase to the Board. The Chief Executive for him and that is that he teaches the Welsh football team the the GMB, TGWU and UNISON, attend Board Executive; Director of Finance; Director of The Trust complied with Welsh Assembly and Director of Personnel and Development National Anthem.’ Dilwyn Evans meetings and are able to contribute to Unscheduled Care/Clinical Director. guidance during the year and pay awards for attend the meetings, except for any review “I have taken up the challenge and will be speaking to John Brian Meredith discussions. The Board of Community Health very senior managers have not exceeded 1.3%. Councils in Wales is also represented. Clincal Governance: Clare Cookson (chair); of their performance, remuneration or terms Toshack about it.” Peter Price Dilwyn Evans; Brian Meredith; Deputy of service. The Committee’s constitution and Chief Executive; Director of ICT; Director of terms of reference are available from the Felicity Williams Unscheduled Care/Clinical Director. Corporate Secretary at Trust Headquarters. Remuneration & Conditions of Service (mandatory): Stuart Fletcher (Chair); Peter Price; Felicity Williams. Statement oN Internal Control 2007-2008 36/37

1 Scope of responsibility 2 The purpose of the system of internal 3 Capacity to handle risk Day to day specialist advice on the ●● A Policy Statement setting out the control management of risk at national and Trust’s commitment and approach to risk The Board is accountable for internal control. The Trust’s Risk Management Policy and regional levels is provided through the Risk management and confirming that risk hitting the heights As Accountable Officer and Chief Executive The system of internal control is designed Strategy as endorsed by the Board sets out Management Department. management is everyone’s responsibility for this Board, I have the responsibility for to manage risk to a reasonable level rather the role and responsibilities of the Chief SIX volunteer lifesavers are preparing to hit the heights to raise within the Trust maintaining a sound system of internal than to eliminate all risk of failure to achieve Executive in relation to risk management. The Trust has also established a programme funds for their organisation. control that supports achievement of the policies, aims and objectives; it can therefore The Chief Executive has overall responsibility management department (PMD) to support ●● A general overview that describes the way In February, 2009, the members of Rhondda Cynon Taf First organisation’s policies, aims and objectives, only provide reasonable and not absolute for risk management and the Deputy Chief the development of projects under its in which the Risk Management Strategy is Responders Group aim to hike up Kilimanjaro in Tanzania to help whilst safeguarding the public funds and assurance of effectiveness. The system of Executive has been designated the Executive Modernisation Strategy “Time to Make a fully consistent with the strategies, aims publicise the work of their group and raise money. this organisation’s assets for which I am internal control is based on an ongoing Director with delegated responsibility for risk Difference” (TTMD) which facilitates the and objectives of the Trust and confirms personally responsible, in accordance with the process designed to identify and prioritise management and health and safety. identification and management of project risk. that a co-ordinated and holistic attitude It will be a step up for the team, which has twice completed the responsibilities assigned by the Accounting the risks to the achievement of organisational and approach towards Risk Management Three Peaks Challenge, taking in the summits of Ben Nevis, Scafell During 2007-08 oversight of risk management Risk Management, Health and Safety and Officer of NHS Wales. policies, aims and objectives, to evaluate the is integral to Management of the Trust and Snowdon in a weekend. and related health and safety processes Adverse Incident Reporting are included likelihood of those risks being realised and the The Trust’s system of internal control is based transferred from the Governance Committee in Corporate Induction and Departmental ●● Designated responsibilities of Committees The group was formed about two years ago and is believed to be impact should they be realised, and to manage on a continuous risk management process to the Risk Management and Modernisation Induction Programmes for staff. and individuals one of the busiest in Wales, having recently attended its 500th them efficiently, effectively and economically. designed to identify the principal risks to Committee, which will continue to liaise incident. The system of internal control has been in The Trust is an active part of networks with ●● Risk Management processes that include the organisation’s achieving its objectives, to closely with the Board’s Clinical Governance place in the organisation for the year ended 31 other ambulance services in England and arrangements for risk identification, Team co-ordinator Mark Howells, manager of Tonyrefail Leisure assess the nature of those risks and to manage Committee to ensure a comprehensive March 2008 and up to the date of approval of Scotland, as well as all-Wales networking classification, risk profiling and the Risk Centre, says: “I just love every minute of it, and you really do feel it’s them effectively, efficiently and economically. integrated approach is maintained to all the annual report and accounts, and accords of Risk Managers and Health and Safety Register, risk control and monitoring a worthwhile aspects of risk management. The organisation’s responsibilities for internal Managers, in order to “benchmark” and service.” with Welsh Assembly Government guidance. ●● Communications and dissemination to key control are also considered in the quarterly Both the Risk Management and Modernisation thereby maintain awareness of, and benefit stakeholders The group accountability reviews held with the Welsh Committee, and the Clinical Governance from, information about best practice. has six Assembly Government. Committee are chaired by non executive ●● Disaster recovery and contingency 4 The risk and control framework defibrillators Directors with membership comprising planning and has The Risk Management framework is set out Executive Directors and other relevant senior ●● Training arrangements recently managers and clinicians. in the Risk Management Policy and Strategy taken approved by the Board. The key elements of ●● Principal Committees for managing risks, delivery the Strategy include: including terms of reference of a 4 x 4 ●● Clinical Governance Framework vehicle which ●● An internal audit function with specialist cost audit management support from the £4,000. Mersey Internal Audit Agency (MIAA) Statement oN Internal Control 2007-2008 38/39

Risk assessment processes are included within 2007-08 performance against the Overall performance compared to the A healthcare standards improvement plan 5 Review of effectiveness the following policies: Healthcare Standards for Wales. previous years assessment was as follows for the year will be agreed by the Board prior As Accountable Officer, I have responsibility to submission to WAG Regional Office on paragliding accident ●● Adverse Incident and Hazard Reporting The Trust completed a self-assessment of The Trust assessed performance to have for reviewing the effectiveness of the 31st July. The Board is assured of progress Policy 2007-08 performance against the Healthcare improved on 9 standards system of internal control. My review of against it through the receipt of progress and An ex-paratrooper made it home for Christmas thanks to the skills of Standards for Wales. the effectiveness of the system of internal ●● Health and Safety Policy The Trust assessed performance to have been exception reports to the Clinical Governance Welsh Ambulance Service paramedic Simon Morgan who saved his control is informed by the work of the internal The process for undertaking the self maintained on 17 standards Committee. life after an horrific paragliding accident. ●● Moving and Handling Policy auditors and the executive officers within the assessment was achieved by identifying The Trust assessed performance to have Healthcare standards are embedded in the organisation who have responsibility for the Adrian Key crashed into a mountainside near Merthyr in July, losing ●● Violence and Aggression Policy Executive leads for each of the Healthcare deteriorated on 4 standards activity of the organisation in the following development and maintenance of the internal the sight in his left eye and suffering a bleed to the brain and Standards who verified the self assessment ●● Control of Infection Policy key ways – each of the Improvement actions control framework, and comments made by multiple broken bones and dislocations. submission for their lead areas. Assessed performance against the standards ●● Lone Working Policy that underpin the management of risk across contained within the Healthcare Standards the external auditors in their management If it hadn’t been for Simon the six foot two ex-para knows he The Self assessment covered all standards all Standards was as follows: Improvement Plan are cross referenced to letter and other reports. I have been advised wouldn’t have been home to spend Christmas with wife Jane and The Assurance Framework agreed by the other than the following, which were agreed the Modernisation Programme to ensure on the implications of the result of my review ten-year-old son Lloyd. Board covers the following: with HIW as not being relevant to Ambulance ●● Healthcare standard 14 – level 3, alignment of organisational activity. An of the effectiveness of the system of internal “He quite simply saved my life,” says Adrian, 35, of Little Mill, near ●● Main activities of the Trust Services: Developing Executive lead has been identified for each of control by the Board and the Audit Committee ●● Healthcare standard 16 – level 3, Pontypool,: “It’s down to him and what he did on that mountainside Standard 9 Food and Nutrition the Healthcare Standards and is responsible and a plan to address weaknesses and ensure ●● Objectives and targets which the Trust is Developing for driving the improvement actions. continuous improvement of the system is in that I’m back home.” striving to achieve or meet Standard 31 Disease Outbreaks ●● Healthcare standard 27 – level 3, place. Paramedic Simon, 40, was in a Rapid Response Vehicle and he Developing ●● Identification of the risks to the The Self assessment was also shared with radioed for the Sea King Helicopter before scrambling up the ●● Healthcare standard 28 – level 3, The Head of Internal Audit’s opinion for the achievement of objectives and achieving non executive directors prior to submission mountainside with his Developing year reports Significant Assurance both in targets and formal sign off at Executive Management respect of the Healthcare Standards in Wales, equipment where he carried out life-saving ●● Identification and examination of the Group. Self-assessment will be validated by HIW and overall on the range of individual opinions by 30th July in accordance with the agreed treatment and made the system of internal control in place to The self assessment is to be submitted to arising from risk-based audit assignments, assessment timetable. vital decision not to move manage the risks HIW on 9th May, and subject to formal Board contained within risk based plans that have been reported throughout the year to date. Adrian until the helicopter approval on 22nd May. arrived. He said: “I think he would have died before we could have got him to hospital if we’d tried to carry him to the ambulance. It’s a miracle he’s pulled through.” Statement oN Internal Control 2007-2008 40/41

During the year, the Trust’s governance ●● The Internal Audit Department provides ●● The Trust also has procedures in place for arrangements were also subject to quarterly reports to the Audit Committee the management of Health and Safety independent review as part of WAG’s and full reports to the Director of Finance Executive Improvement Notices. These a stroll through the mountains Governance in Health Project, which advised and Line Management. The Audit are regularly reviewed to ensure that the A Sunday afternoon walk in the mountains may be some people’s idea of fun but it proved a real test of skill and the Board that the procedures in place were Committee also receives details of actions Trust complies with the requirements endurance for two colleagues in the Welsh Ambulance Service. generally robust and fit for purpose, and in line that remain outstanding following any of Improvement Notices as soon as with current best practice. follow-up of previous audit work. The practicably possible and that the Trust is For, with help from four police officers, Bernard Williams and Julian Rudge had to carry a seriously injured man about a Director of Finance also meets with the not placed in breach of Health and Safety mile through rough, boggy terrain. ●● The Board’s role is to provide active Audit Manager on a regular basis to for lengthy periods of time. Now the extraordinary effort put in by them has earned them a commendation from the Chief Constable of South leadership of the Trust within a framework discuss issues arising. Wales. of prudent and effective controls that ●● As an employer with staff entitled to enable risk to be assessed and managed. ●● The Trust’s Executive and senior membership of the NHS Pension Scheme The drama began on a Sunday in June when Bernard and Julian were leaving Neville Hall Hospital, Abergavenny, and management team implement risk control measures are in place to ensure all received a call to an incident on the mountainside between Pontypool and Llanhilleth. ●● The Audit Committee, as part of an management policy as approved by the employer obligations contained within the They were told that a trials motorcyclist had fallen down a ravine while riding across the moorland and though he was integrated committee structure, is pivotal Board. Scheme regulations are complied with. badly injured he had managed to call the police on his in advising the Board on the effectiveness mobile phone. of the system of internal control. “He didn’t know exactly where he was but said he ●● The Clinical Governance Committee and could see a radio mast,” said Bernard, a supervisor the Risk Management and Modernisation who is stationed in Tredegar. Committees are key components by which The crew of the South Wales Police helicopter I am able to assess the effectiveness and Signed: Chief Executive Date:17 June 2008 eventually spotted the man, who was in his 40s and assure the Board of risk management (On behalf of the Board) from Newport, but the ambulance was directed to generally and clinical risk. the wrong side of the mountain. Bernard and Julian, who is based at Aberbug, took their vehicle as far as possible along the narrow lanes and tracks and were then airlifted to the spot, where they found the man suffering from a broken leg and complaining of back pains. The location was about two miles from the ambulance but the air ambulance was attending another incident, so Bernard, Julian and the police officers carried the rider on a stretcher about a mile over the mountain to a police Land Rover, in which he was then taken to the ambulance. Salary AND PENSION entitlements of senior managers 42/43

A) Remuneration B) Pension Benefits 2007-08 2006-07 Real Real increase Total Lump sum at Cash Cash Real Employers Salary Other Benefits in Salary Other Benefits in Kind increase in Lump sum accrued age 60 related Equivalent Equivalent Increase Contribution Remuneration Kind Remuneration in pension at aged 60 pension at to accrued Transfer Transfer in Cash to Name and Title at age 60 related to real age 60 at pension at 31 Value at Value at Equivalent Stakeholder (bands of (bands of Rounded to (bands of (bands of Rounded to the Name and title (bands of increase in 31 March March 2008 31 March 31 March Transfer Pension £5000) £5000) the nearest £5000) £5000) nearest £100 £2,500) pension (bands 2008(bands (bands of 2007 2008 Value £100 of £2,500) of £5,000) £5,000) Stuart Fletcher - Chairman 35-40 35-40 £’000 £’000 £’000 £’000 £’000 £’000 £’000 £’000 Dilwyn Evans - Non Executive Director 5-10 5-10 Alan Murray - Chief Executive 0 0 30-35 95-100 530 554 11 16 Clare Cookson- Non Executive Director 5-10 5-10 Albert Don Page - Chief Executive (retired 30.09.06) N/A N/A N/A N/A N/A N/A N/A 0 Brian Meredith- Non Executive Director 5-10 5-10 Roger Thayne - Interim Chief Executive (left Trust N/A N/A N/A N/A N/A N/A N/A 0 Peter Price- Non Executive Director 5-10 5-10 31.05.06) Felicity Williams- Non Executive Director 5-10 5-10 Anton Van Dellen - Interim Chief Executive (left N/A N/A N/A N/A N/A N/A N/A 0 Alan Murray - Chief Executive 115-120 70-75 Trust 07.08.06) Albert Don Page - Chief Executive (retired 30.09.06) N/A 60-65 Mik Webb - Director of Finance (retired 17.12.07) 0-2.5 0-2.5 40-45 110-115 668 0 -488 8 Roger Thayne - Interim Chief Executive (left Trust 31.05.06) N/A 15-20 Tim Woodhead - Director of Finance 0-2.5 5.0-7.5 5-10 25-30 80 103 21 12 Anton Van Dellen - Interim Chief Executive (left Trust 07.08.06) N/A 15-20 Lyn Meadows - Director of Personnel and 0 0 15-20 50-55 270 284 6 10 Mik Webb - Director of Finance (retired 17.12.07) 55-60 80-85 Development (left Trust 25.03.08) Tim Woodhead - Director of Finance 80-85 30-35 Mike Cassidy - Deputy Chief Executive 5.0-7.5 17.5-20 30-35 90-95 353 473 112 12 Lyn Meadows - Director of Personnel and Development (left Trust 25.03.08) 65-70 5,500 65-70 4,500 Mike Collins - Temporary Director of Operations N/A N/A N/A N/A N/A N/A N/A N/A Mike Cassidy - Deputy Chief Executive 85-90 2,400 30-35 100 (secondment ended 31.03.07) Mike Collins - Temporary Director of Operations (secondment ended 31.03.07) N/A 45-50 3,800 David Lyden - Temporary Director of Operations N/A N/A N/A N/A N/A N/A N/A N/A (left Trust 31.03.07) David Lyden - Temporary Director of Operations (left Trust 31.03.07) N/A 45-50 2,700 David Jackland - Director of IT 80-85 900 35-40 David Jackland - Director of IT (wef 25.09.07) 0-2.5 5.0-7.5 15-20 55-60 229 269 35 11 Sara Jones - Director of Unscheduled Care/Clinical Director (wef 1.4.07) 75-80 3,400 N/A Sara Jones - Director of Uncheduled Care/Clinical 2.5-5.0 12.5-15.0 20-25 65-70 239 319 74 11 Director (wef 1.4.07) Julie Rowles - Interim Director of HR & Development (wef 19.2.08) 5-10 N/A Julie Rowles is employed by Gwent NHS Trust Mick Colquhoun - Medical Director (retired 31.12.07) 30-35 40-45 Dr M Colquhoun is employed by Cardiff University wef = with effect from MAKING THE CONNECTIONS-RECURRING AND NON -RECURRING SAVINGS 44/45

2007/08 Themes Smarter Procurement Streamlining Support Functions Shaping Public Making Better Use of Staff Totals Investment patchy bear replaced Services Time, Skills and Expertise Costs The Welsh Ambulance Service spread a little festive cheer by giving Cash Releasing Non-Cash Releasing Cash Releasing Non-Cash Releasing Cash Non-Cash Cash Non-Cash a little boy who lost his favourite companion an early Christmas Releasing Releasing Releasing Releasing present. £000s £000s £000s £000s £000s £000s £000s £000s £000s £000s Five-year-old Bradley Ashton, from Old Colwyn, lost his Patchy Bear, Recurring Efficiency Gains given to him by an ambulance crew when he was taken to hospital with breathing difficulties over two years earlier. List of main projects Scheme reference Lease Vehicle Savings Phase 1 37 0 0 0 0 1,837 0 0 0 1,837 He was upset when he lost it on a trip to Llandudno but Conwy and Denbighshire Locality Officer Jason Williams brought a smile back to Non Backfill of AFC lost hours 2 & 2A 0 0 0 0 0 0 1,314 0 1,314 his face when he presented him with a cuddly replacement. Reduction in Pay Expenditure N1 0 0 0 0 0 0 1,211 0 1,211 His mum Linda contacted the Welsh Ambulance Service and Jason Rota Changes 39a 0 0 0 0 0 0 1,082 0 1,082 said: “When we heard about Bradley’s loss, we wanted to help out as Overtime Reductions 23 0 0 0 0 0 0 903 0 903 his bear had helped him get through his Non Cover of AFC Holiday hours lost 25 0 0 0 0 0 0 636 0 636 difficulties when Overtime Reductions 1 & 1A 0 0 0 0 0 0 614 0 614 we took him into Other non operational savings 35 0 0 500 0 0 0 0 0 500 hospital.” Non operational Recruitment 34 0 0 474 0 0 0 0 0 474 Bradley was introduced to his Other non pay savings 29 0 0 0 0 228 0 0 0 228 new friend during Others - Total value of all other projects not included above: 24 0 299 0 1,083 0 318 0 1,724 a visit to Colwyn Bay Ambulance Recurring efficiency gains for 2007/08 (To be c/fwd to 2008/09) 24 0 1,273 0 3,148 0 6,078 0 10,523 0 Station for a personal Non- Recurring Efficiency Gains tour around Forecast total value of all non-recurring efficiency gains 6 1,903 313 217 2,439 the Welsh Ambulance TOTAL FOR 2007/08 30 0 3,176 0 3,461 0 6,295 0 12,962 0 Service’s new Please Note: The Welsh Ambulance Services NHS Trust 2006/7 return identified only those projects falling within a strict interpretation of the relevant guidance emergency The above data includes all current SCEP programmes following a review of the guidance and the advice of the auditors vehicle. DIRECTORS’ STATEMENT Equality and Diversity 46/47

As far as I am aware, there is no relevant audit information of which the Welsh Ambulance The Trust actively continues to ensure The Trust has been fortunate to serve as a host Services NHS Trust’s auditors are unaware. I have taken all the steps that I ought to have taken that patients and staff are treated fairly in organisation to two British Sign Language as a director in order to make myself aware of any relevant audit information and to establish accordance with their needs within the apprentice interpreters as part of the BSL textbook stuff that the Trust’s auditors are aware of that information. equality and human rights framework. This Futures project. This has resulted in raising Six years ago fitness fanatic Carl Feiven’s life was saved by a Welsh area of work is developed and promoted awareness throughout the Trust and has Ambulance Service paramedic – now he’s a trained lifesaver himself. Signed: by the work of the Equality and Diversity provided the Trust with the opportunity to Group, comprising of management and staff establish effective working links with the deaf And the man who saved Carl’s life, Tony Rossetti, is training more representatives who have met on a regular community this includes reviewing how the volunteer lifesavers like Carl. basis throughout the year. A number of deaf community can contact the Ambulance The two hadn’t met until Carl enrolled on a First Responder course policies have been reviewed by the group Service in an emergency. at the Bridgend Designer outlet – formerly McArthur Glen – last to support the Trust’s commitment on work- year. life balance issues. The Trust has also been Alan Murray Sara Jones successful in retaining Disability Two Ticks In 2001 Carl, 32, assistant manager of the Nike store at the Bridgend Chief Executive Director of Unscheduled Care/Clinical Director Symbol which supports the recruitments and centre, was in training for the London Marathon when he collapsed retention of people with disabilities. at home. The Trust has participated widely in public His wife, Claire, a nurse, treated him involvement and consultation events. These and dialled 999 and paramedic events have been extremely successful due Tony Rossetti was there within Tim Woodhead David Jackland minutes and shocked him twice Director of ICT to the partnership working that has taken Director of Finance place between the hospital Trusts in Wales, with the defibrillator before taking Local Health Boards and the Ambulance him to hospital. Service. As a consequence of the involvement Tony, now the First Responder events order a meaningful Gender equality Officer for South East Wales, Scheme and Action Plan has been produced. said: “Claire was only a student Mike Cassidy Additionally, a revised Race Equality Scheme nurse then but she started Deputy Chief Executive and Action Plan have been produced that resuscitation and then we reflects the comments received from the were there quickly with the involvement event. Annual reports for Race defibrillator and advanced and Disability have been produced and are treatment. available upon request. “It was textbook stuff and it meant a young man was able to carry on his life and the two were able to get married.”