Scottish Ambulance Service Annual Report and Accounts for year ended 31 March 2018 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2018 Contents 3 Chair and Chief Executive Statement Scottish 5 Performance Report Ambulance 5 Overview 13 Performance Analysis Service 18 SCOTSTAR Annual Report and Accounts for year ended 31 March 2018 19 The Accountability Report 19 Corporate Governance Report 19 i) Directors’ Report 23 ii) Statement of The Chief Executive’s Responsibilities as the Accountable Officer of the Health Board 23 iii) Statement of Board Members’ Responsibilities 24 iv) Governance Statement 29 Remuneration Report and Staff Report 29 i) Remuneration Report 32 ii) Staff Report 35 Parliamentary Accountability Report 36 Independent Auditor’s Report 38 Financial Statements 38 Consolidated Statement of Comprehensive Net Expenditure and Summary of Resource Outturn 40 Consolidated Summary of Financial Position 41 Statement of Consolidated Cash Flow 42 Consolidated Statement of Changes in Taxpayers’ Equity 43 Notes to the Accounts 77 Direction by the Scottish Ministers 2 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2018 Chair and Chief Executive Statement Each day around four thousand people call race to the front line and provide appropriate care the Scottish Ambulance Service for help. for patients. Our SORT teams undergo constant training throughout the year to ensure they are at Fortunately only a small proportion of the one and a peak performance and can respond and adapt to half million calls we receive annually concern patients new and emerging threats, such as terrorism. with a condition which is immediately life-threatening. The vast majority passed through to one of our three The role of the Scottish Ambulance Service does Ambulance Control Centres in the North, East, and not end there – we employ over 4,700 staff directly West of Scotland are for patients needing unscheduled, and we are delighted to have over 1,500 Community non life-threatening care. One hour we might tend First Responder volunteers working closely with us to a cyclist with broken bones sustained during an to provide prompt, early life-saving help to patients, accident; on another we might be called on to help whilst the ambulance is on its way. Our work in someone who has fallen and needs a face-to-face further exploring co-responder models with Police assessment to establish the most appropriate care Scotland, the Scottish Fire and Rescue Service, pathway; which might not result in a hospital admission. and BASICS GPs and Nurses is helping to save We might also be called on to help acutely ill patients, more lives and improve patient outcomes. or premature babies, who need the assistance of Whilst attending to patients across a wide spectrum our specialist SCOTSTAR team. Given that we of contexts has kept us busy throughout the provide care in some of northern Europe’s remotest year, our teams deserve extra special praise areas, patients in many areas of Scotland also rely this year for coping admirably with the additional on the swift response of our Air Ambulance crews. strains on our services during this year’s harsh Around half of the calls we receive are from winter, starting at the end of November and patients too sick to travel to and from their which lasted well into early Spring, characterised hospital appointments on their own and who appropriately as the ‘Beast from the East’. need help from our patient transport service. We are extremely proud of the fact that, even Meanwhile, whenever there is a major incident or in the face of incredible winter pressures and a major risk to life somewhere across the country, record levels of demand, our teams have our Special Operations Response Teams will saved more lives than ever before. 3 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2018 In common with all Scottish boards – and trusts have re-banded paramedics and technicians and we across the wider UK – we increasingly find ourselves are developing advanced practice roles within local operating within the framework of increased demands communities. This burgeoning pilot scheme has seen for unscheduled care services combined with pressures advanced practice paramedics working alongside on budgets and calls for public service reform. To multidisciplinary teams, including GP practices, in navigate through this, and continue to give our patients community settings across Scotland. Working with the highest quality care, we are in the process of other NHS Boards, Integrated Joint Boards and third implementing our strategy: “Towards 2020; Taking sector health and social care organisations, we are Care to the Patient”. Developed in partnership with ensuring patients are getting the right treatment by staff and the people using our services, the strategy better identifying their particular needs. This means has enabled us to focus on three key areas: that falls patients and those with mental health needs, for example, get the right care, rather than simply • Ensuring our response is more clinically being whisked off to the nearest A&E department; this focused, basing assessment on robust shifts the balance of care and ensures those patients clinical evidence and patient experience. can access the help they need within their local communities. Meanwhile, we have established a 24/7 • Giving staff the right tools to do their jobs well by specialist services desk and a major trauma triage tool enhancing technology, equipment and processes. which is having a positive impact in helping trauma • Widening the skills and capacity of our workforce patients who need highly specialised treatments. by providing education, training and development Our staff do a tremendous job – often in challenging for existing staff. To that end we are introducing circumstances – and we would like to acknowledge the new specialist and clinical roles and have fantastic contribution they have made over the past recruited record numbers of new staff towards year towards the continuous improvement of the care our goal of 1,000 additional paramedics. we provide for patients. Alongside providing excellent patient care and working as part of a whole system of In November 2016, we started to pilot a new response care in Scotland, we are committed to investing in our system so that patients with immediately life- staff. Indeed, they will remain one of our key priorities threatening conditions, such as cardiac arrest, or who over the coming years as we continue to implement have been involved in serious road traffic incidents, our 2020 strategy in line with our intent to provide are prioritised and receive the fastest response. In the best possible care to the people of Scotland. less urgent cases, call handlers may spend more time with patients (or their representatives) to better Finally, this foreword would be incomplete without understand their health needs and ensure we send acknowledging our gratitude for the tremendous the most appropriate resource for their condition. To contribution of our outgoing Chair David Garbutt, boost this element of our work, we are enhancing our QPM. David, whose new role is Chair of NHS Ambulance Control Centres and working collaboratively National Education Scotland, has been in post since with flow and discharge centres. Recognising the 2009 and deserves heartfelt thanks for the hard multi-disciplinary roles of those on the frontline, we work, support and direction he has provided. Tom Steele, Chair Pauline Howie OBE, Chief Executive 4 Scottish Ambulance Service - Annual Report and Accounts for year ended 31 March 2018 Performance Report 1. Overview In 2015/16, we launched our five year strategy Towards 2020: Taking Care to the Patient. This 2020 strategy is based on the principle that care should be appropriate to need – and that where care is delivered should also 1.1 Who we are be appropriate, which may not be in a hospital setting. The Scottish Ambulance Service was established Our 2020 goals are to: in 1999 under The Scottish Ambulance Service Board Order 1999, which amended the National 1. Ensure our patients, staff and the people Health Service (Scotland) Act 1978. who use our services have a voice and can contribute to future service design, with As a frontline service of the NHS in Scotland and with people at the heart of everything we do over 4700 members of staff, we provide an emergency ambulance service to a population of over 5 million 2. Expand our diagnostic capability and the people serving all of the nation’s mainland and use of technology to enhance local decision island communities. Our Patient Transport Service making to enable more care to be delivered also undertakes over 1.1 million journeys every at home in a safe and effective manner year and provides care for patients who need 3. Continue to develop a workforce with the support to reach their healthcare appointments necessary enhanced and extended skills due to their medical and mobility needs. by 2020 to deliver the highest level of We are therefore responsible for a range of services for quality and improve patient outcomes the people of Scotland, from accident and emergency 4. Evidence a shift in the balance of care through response, to delivering primary care, providing access to alternative care pathways that patient transport, dispatching rapid air ambulance are integrated with communities and with and SCOTSTAR support for critical patients, to being the wider health and social care service a Category 1 responder for national emergencies. 5. To reduce unnecessary variation in service and tackle inequalities delivering some services ‘Once for Scotland’ where appropriate 1.2 The Scottish Government vision 6. Develop a model that is financially “By 2020, everyone is able to live longer, healthier sustainable and fit for purpose in 2020 lives at home or in a homely setting.