SCOTTISH AMBULANCE SERVICE BOARD BEST VALUE IN THE SCOTTISH AMBULANCE SERVICE BY PAMELA McLAUCHLAN, DIRECTOR OF FINANCE AND LOGISTICS

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1 SCOTTISH AMBULANCE SERVICE BOARD BEST VALUE IN THE SCOTTISH AMBULANCE SERVICE BY PAMELA McLAUCHLAN, DIRECTOR OF FINANCE AND LOGISTICS INTRODUCTION The Scottish Ambulance Service embraces the characteristics of Best Value in all its activities and has reviewed its progress in 2010/11 in respect of the guidance issued by the Scottish Government in March 2011, namely Best Value in Public Services Guidance for Accountable Officers. This document builds on the previous Audit Scotland guidance in respect of the nine characteristics of Best Value and is also covered by the Scottish Public Finance Manual. The Guidance identifies five main themes with two cross cutting strands. These are: Vision and Leadership Effective Partnerships Governance and Accountability Use of Resources Performance Management The two cross cutting strands are: Sustainability and Equity. In all of this, public bodies are expected to demonstrate an ethos of continual improvement in performance and to strike a balance between quality and cost. Bodies should use benchmarking and outcome measures in order to assist them in measuring improvements made. SCOTTISH AMBULANCE SERVICE PROGRESS IN RESPECT OF BEST VALUE IN 2010/11 Vision and Leadership The Scottish Ambulance Service has its Strategic Framework Working Together for Better Patient Care in place. This is a five year strategy that provides the vision for the way in which the organisation will develop over this time period. The year 2010/11 has been the first year of implementation of this inspiring strategy and the organisation has been able to successfully deliver well over 80% of the intended objectives. The Service ensures that it communicates the successes and objectives of the strategy through a variety of media. This includes workshops with staff and key partners, our web site blogs by the Chief Executive, and Q&A sessions. An annual event was held in February 2011 with representation from staff throughout the

2 organisation and key partners. This event reflected on the successes during the previous 12 months and also worked through the key areas to be addressed in the forthcoming year which enabled the organisation to identify its key priorities for strategic development and implementation. The five areas examined were: Alcohol Mental Health Unscheduled care Profession to Professional lines Long term Conditions During the year we had a series of engagement events involving our staff and key stakeholders. This was intended to maintain progress and focus around Working Together for Better Patient Care. From these events, the key areas that the organisation intends to progress in the next 12 months are: Specialist retrieval supporting the design and development of a national retrieval service to improve efficiency; Scheduled Care improving the clinical focus of this service, managing demand, increasing productivity and efficiency within existing resources; Unscheduled Care streamlining developing alternatives to hospital admission and developing more standardised care pathways to support the management of patients within the pre-hospital environment; Major Incident Planning improving our capacity and capability to respond to major incidents. The Scottish Ambulance Service is aligned with government priorities and has ensured that it has linked the Quality Strategy with the Strategic Framework and used both of these documents to design the corporate plan. Around this, links to the Local Delivery plan and each Division and departmental plan flow from the corporate plan. Then, from the divisional plan, individual performance development plans will flow. Thus the organisation ensures that the linkages are in place, not only to ensure that strategy links to plans and to individual objectives, but that Best Value is imbedded in all of this process. At corporate level, performance is reported to the Board through the HEAT targets on a bi-monthly basis. From 2011/12, this will change to a balanced scorecard method of reporting performance. From this, it is possible to see the high level performance indicators and then delve under to see the detail that makes this level of performance up. The Board has in place codes of conduct for Board members and external scrutiny is provided through our External Auditors, currently Price Waterhousecoopers, and Audit Scotland also perform performance audits. In addition, we have benchmarked the organisation against other Ambulance Services to identify areas for improvement. 2

3 Effective Partnerships The Scottish Ambulance Service has an ethos of working collaboratively across the public sector, most notably in the sharing of expertise, staff and premises with other NHS Bodies, such as the sharing with NHS24 of our Medical Director and Emergency Medical Dispatch centres. We completed the last of the three colocations of Control Centres during 2010/11. We also work effectively with Police and Fire services, most notably in Major Incident planning exercises and live situations. However, we also have various examples of the sharing of premises and fleet departments and this year saw the first full year of a shared initiative in Fife with Fife Constabulary for our vehicle maintenance. These partnerships will be further developed during 2011/12. During 2010/11, as a response to the requirement to deliver more challenging efficiency programmes, the Scottish Ambulance Service has been involved in working jointly with the seven other Special Health Boards in identifying areas where expertise and premises can be shared. We have examined the sharing of Health and Safety advice, ICT support, meeting and video-conference venues and estate. Also we have worked with the West of Scotland Territorial Boards to examine efficiency in terms of Procurement, Payroll and Internal Audit Services. In order to further develop our contribution to the wider NHS in terms of Clinical Service delivery, we held a one-day workshop involving our key stakeholders to examine the priorities for the Scottish Ambulance Service in the forthcoming year. We also reflected on our key successes over the previous 12 months. We are working effectively with NHS24 through the development of a Common Triage tool and are putting in place joint Governance arrangements for the procurement of this tool and its deployment across both services. We have also been involved with NHS Clinical colleagues and the Scottish Government in respect of two work streams relating to Air Ambulance: the Air Ambulance Re-procurement project and the consideration of the shape of service provision for Specialist Retrievals across Scotland. Governance and Accountability The Scottish Ambulance Service embarked on three ambitious projects during 2010/11 that were aimed at developing the skills and abilities internally to take forward programmes of work specifically targeted at developing a continuous Quality Improvement knowledge base. There were three demonstrator projects selected for our Learn and Improve teams. 3

4 These were: The Patient Transport Service Workforce scheduling Administration process. These programmes have developed quick wins and action plans to take forward the findings of the assessment of these work areas during 2011/12. The Organisation has further developed its Corporate Plan during 2010/11 and conducted an evaluation of progress in this way it is measuring the improvement of performance across the organisation year on year. The Corporate plan is also the starting point to cascade and hold to account the organisation for the delivery of key objectives. This then cascades to Divisional/ Departmental Plans and ultimately individual objectives. The Organisation takes decisions on significant investments and changes in policy on the evidence available. The Scottish Ambulance Service has enhanced its clinical governance reporting arrangements through the medical directorate and the clinical leads embedded in each division. The new Executive team that has been in post for over 12 months now has clear lines of accountability in place and this then cascades to the Senior Management team to take forward the implementation on decisions made at executive level. Use of Resources The organisation employs Best Value principles in terms of the management of its resources: Human, ICT, Estate and Financial. During 2010/11 the organisation has developed three work streams that employ LEAN methodology to examine three areas of the service, namely: Scheduled Care services; Workforce deployment; and Administration processes. Each of these has examined the employment of resources - predominantly Human, ICT and Financial - to identify where there is inefficiency in systems and to examine how processes can be redesigned to make more efficient use of the available resources. The Organisation, to support its Human resources successfully, has implemented the performance development process of the Knowledge and Skills Framework of the Agenda for Change system. This has ensured that staff have clearly defined objectives for them to achieve during the year that will develop them as individuals and also fit with the wider objectives of the organisation. The Learning and development strategy was launched in 2009/10 and during this year the focus has been on setting up a New Scottish Ambulance Academy within the grounds of Glasgow Caledonian University which has allowed us to foster close working partnerships with the University. Also one of our key Strategy 4

5 Implementation Boards Doing the Right Thing has focused on the diagnostics of the cultural change that exists in the organisation and has commenced on this journey taking staff at all levels through this process. The Service has also ensured that staff are fully involved in the implementation of the strategic framework through inclusion on programme work streams and involvement in workshops, four of which were held during 2010/11: Unscheduled Care Scheduled Care (2) Building Community Resilience Also, the Chief Executive and other Directors ran a series of question times through website to allow staff to feel involved and to suggest ideas that the service may wish to include in the various work streams of the strategy. During 2010/11 the Scottish Ambulance Service has produced an all-encompassing property and asset management strategy that has pulled together the preceding separate strategies for the management of Property, ICT and Fleet (including medical equipment). This will allow the organisation to develop each of these resources in a unified way and ensure that appropriate electronic systems are in place to track these assets. The organisation has in place appropriate systems of financial management and the control environment in which this operates has been further enhanced during the year with a risk based internal audit function that has made recommendations to strengthen this environment. These recommendations have then been put in place by management as the year has progressed. The procurement function of the organisation has ensured Best Value principles have been followed in all contracts awarded during the year and has been able to demonstrate 2.9million of efficiency during the year. Within the Estates function, four projects were completed in year. All of these were on time, some even ahead of schedule, and all within budget. The organisation has a history of accurate prediction of the likely cost of capital investment projects and the procurement process allows Best Value to be demonstrated in the award of contracts. Information governance has been progressed during the year with: The establishment of an Information Governance Committee, with a direct link to the Scottish Ambulance Service Board, and chaired by an Executive Director, who is also the Senior Information Risk Owner (SIRO) for the Service; A much greater staff awareness and understanding of their responsibilities with regard to Information Management and Security; Steady improvement in the attainment levels achieved by the Service within the Information Governance Standards; 5

6 The development of closer working relationships between Information Governance and ehealth ICT, Operational and Clinical Teams, providing mutual support for a common aim; Increased awareness at all levels of Information Governance issues particularly those related to Information Sharing and Information Security; Much improved processing of Freedom of Information requests and response times; The regular publishing of an Information Governance newsletter Safe Assets ; The development and on-going maintenance of an Information Governance portal on the Service Intranet The establishment of a process, through the Information Governance Committee, for the approval of policies at Board level to support all aspects of Information Governance. Performance Management At Corporate level, the organisation has in place the tools to measure corporate performance in line with Scottish Government HEAT targets and at each public Board meeting a high level measurement of the out turn against each target is provided for assurance and discussion. Work has been ongoing during the year to further develop this and a balanced score card will be implemented in 2011/12 to identify the key areas of performance for the organisation. The organisation also has in place a corporate plan and this has been further developed in 2010/11. This then links to Divisional and Departmental Plans which allows the cascade of objectives and the measurement of performance against these objectives to be driven through the organisation. In each Division/Department, managers take their personal objectives from the Plan and this then feeds to individual staff PDPs. Monitoring reports will be presented to the Scottish Ambulance Service Board on a bi-monthly basis. The reports will outline progress against HEAT Targets and the key milestones identified in the corporate plan. In addition, performance against a range of additional quality improvement indicators will be reported through the balanced scorecard to demonstrate ongoing alignment and delivery with the ambitions set out in the national Quality Strategy. Good practice will be shared and cascade through various channels: Strategy Programme Boards Senior Management Team Development sessions Regular Divisional development sessions with front line staff Response Magazine 6

7 Sustainability and Equality In order to fully embrace Best Value, then the cross cutting themes of Sustainability and Equality require to be taken forward. The service has moved the sustainability agenda forward through examination of how it can reduce emissions and has performed well in terms of a 2.89% in year reduction in energy. Also the fleet are as green as they have ever been and the service has introduced a cap on lease cars (with the exception of 4x4s) of 140g/km. The new vehicles currently in production also have lower CO 2 emissions and will be more fuel efficient. This will help to lower the organisation's overall carbon footprint. Through procurement, the organisation attempts to support smaller and medium sized local business where possible and has examined supported business; however, so far the product/service range does not fit with SAS requirements. In terms of Equality, the organisation has a process in place to examine policy and business cases to ensure that equality and diversity requirements are being met and that decisions are not taken that may disadvantage elements of society. The new Equalities legislation that came into effect from October 2010 is still being worked through. However, the organisation has a clear action plan to ensure compliance with the legislation as promptly as possible. The Scottish Ambulance Service is committed to putting equality at the centre of all that it does and to continue to make progress in this area to ensure equality is firmly embedded across the organisation. Our strategic framework Working together for better patient care outlines the main goals to achieving our vision and direction and these include improving access and referral for patients and to engage with all out partners and communities to deliver improved health care. Activity in this area closely links with legislative requirements and in particular the Equality Act 2010 and the general duty to eliminate discrimination, promote equality of opportunity and foster good relations. Equality Impact Assessments are conducted for priority policies and work continues to ensure this process effectively informs decision making. Equality outcomes are and will continue to be developed further to meet the needs of the communities we serve and our staff. In doing so we will work with patients, staff and partners to gain a better understanding of equality needs in relation to the service and employment we provide. Conclusion The Scottish Ambulance Service has many of the building blocks in place to ensure that Best Value is embedded within the organisation and has been able to demonstrate continuous improvements against the key themes during the year. 7