Quality Account 2014-15 V1 .0 TOUR DE FRANCE 2014 2 CONTENTS PART 1 1. Statement on Quality from the Chief Executive 6 2. Statement of Accountability 7 PART 2 3. Priorities for Improvement 2014-15 9 4. Engaging with Staff, Patients and the Public about Quality 18 5. Statements from the Trust Board 19  Review of Services  Participation in Clinical Audit  Participation in Research  Goals Agreed with Commissioners  What Others Say About Us  Data Quality 6. Performance Against Mandatory Indicators 34 PART 3 7. Performance against Priorities for Improvement 2012-13 40 8. 2013-14 Review of Quality Performance 43 9. Statements from Local Healthwatch, Overview and Scrutiny Committees and Clinical Commissioning Groups (CCGs) 80 10. Statement of Directors’ responsibilities in respect of the Quality Report 101 11. Glossary of Terms 103 3 Our Mission Your Ambulance Service, Saving lives, Caring for you Our Vision Providing world-class care for the local communities we serve Our Aims Continually improving patient Setting high standards of Always learning Spending public money wisely care performance Strategic objectives 1 Improve clinical outcomes for key conditions 2 To deliver timely emergency and urgent care in the most appropriate setting 3 To provide clinically-effective services which exceed regulatory and legislative standards 4 To provide services which exceed patient and Commissioners’ expectations 5 To develop culture, systems and processes to support continuous improvement and innovation 6 To create, attract and retain an enhanced and skilled workforce to meet service needs now and in the future 7 To be at the forefront of healthcare resilience and public health improvement 8 To provide cost-effective services that contribute to the objectives of the wider health economy 4 I have worked for the Ambulance Service for 14 years and have been witness to many extraordinary events. I find it remarkable, and occasionally very daunting, how many patients and their relatives have absolute faith in your abilities and are prepared to put their trust in you. This job gives me the opportunity to truly make a difference to people's lives and that can be the best feeling in the world. Mark Ablett Paramedic 5 PART 1 Statement on Quality from the Chief Executive Welcome to our NHS Trust Quality Account 2014-15. Yorkshire Ambulance Service (YAS) has much to celebrate this year, including making significant improvements in the services we provide across the Yorkshire region. This has included working jointly with our partners across the region to develop and implement new and exciting ways of working to better the serve the people of Yorkshire and Humber. Like with many other NHS Trusts, YAS has faced significant challenges. Demand for our services has reached unprecedented levels this year, in some areas of the region. Like other healthcare providers, we have had to continually reassess and our resources and resilience both on the road within the Accident and Emergency (A&E) services and for our non-emergency Patient Transport Service (PTS). We will continue to strive to reach high standards of performance and deliver effective clinical outcomes, whilst spending public money wisely. The review of operational and supporting services continued into 2014/15. Programmes of work across a number of services have led to tangible results; including the continued improvement of clinical outcomes, especially for patients who experience a cardiac arrest. We have also further developed a culture of listening and learning across YAS. Collaborative working with commissioning groups and partner organisations has allowed YAS to consider new ways of working that deliver timely emergency and urgent care in the most appropriate setting. YAS remains at the forefront of healthcare resilience and public health improvement. Its ‘every contact counts’ programme has sign-posted members of the public to seek further help and support for their healthcare needs. YAS is dedicated to making a positive difference to the wider health economy and recognise that we have a unique role to play in the future provision of services, both across emergency and urgent care. 6 Statement of Accountability The Trust Board is accountable for quality. It oversees the development and delivery of the Trust’s strategy which puts quality of patient care at the heart of all the Trust’s activities. As Accountable Officer and Chief Executive of this Board I have responsibility for maintaining the standard of the Trust’s services and creating an environment of continuous improvement. This report is in the format required by the Health Act 2009, Quality Account Toolkit and Detailed requirements for quality reports 2014/15 (Monitor). It contains the sections mandated by the Act and also measures that are specific to Yorkshire Ambulance Service that demonstrate our work to provide high quality care for all. We have chosen these measures based on feedback from our patients, members of the public, Health Overview and Scrutiny Committees, staff and Commissioners. As Accountable Officer I confirm that, to the best of my knowledge, all the information in this Quality Account is accurate. I can provide this assurance based on our internal data quality systems and the opinion of our internal auditors. Rod Barnes Interim Chief Executive 7 An Introduction to Yorkshire Ambulance NHS Trust (YAS) YAS serves a population of more than 5 million people and covers 6,000 square miles of varied terrain from the isolated Yorkshire Dales and North York Moors to urban areas including Bradford, Hull, Leeds, Sheffield, Wakefield and York. We are commissioned by 23 clinical commissioning groups (CCGs) and, as the only regional healthcare provider, we are ideally placed to support joined-up care for patients and provide the gateway into urgent and emergency services. We employ over 4,500 staff and have over 1,000 volunteers and provide 24 hours emergency care to the region. For everyone working at YAS, providing high quality patient care is our number one priority. This applies to our ambulance clinicians responding to emergency calls, to our Patient Transport Service (PTS) crews taking patients to and from their planned hospital appointments, our call handlers handling 999 and 111 calls, to our managers developing new care pathways or ways of working, and to our Trust Board making decisions about the future of our Trust. 8 PART 2 Priorities for Improvement 2015-16 Our five year Integrated Business Plan (IBP) is reflective of the national agenda but importantly, identifies a number of priority areas for improvement locally. We always seek to test our ideas with stakeholders and this year has been no exception. External organisations including Healthwatch, the Health Overview and Scrutiny Committees and Commissioners have been consulted. We have worked to review these priorities with our Expert Patient and taken into account issues highlighted in feedback from patients and staff. Priorities for the coming year include improving the experience of patients by aiming to deliver care in the most appropriate setting, extensive review of our current estate and supporting functions via the Hub and Spoke Estate rationalisation programme and the on-going development of a sustainable workforce plan that delivers a skilled workforce to meet service needs now and in the future. The locally agreed commissioning priorities also include the Commissioning for Quality and Innovation (CQUIN) schemes for both A&E and PTS. Measuring, Monitoring and Reporting Quality is a central element of all Board meetings. The Integrated Performance Report focuses on key quality indicators, and this is supplemented by more detailed reports containing both qualitative and quantitative information on specific aspects of clinical quality. Reporting and monitoring frameworks have been developed for each of the priorities, through both the clinical and operational governance structures. In addition, communication and engagement work is planned to ensure that all our staff and external partners are kept informed and involved. 9 CLINICAL EFFECTIVENESS Priority 1 To assist paramedics to select the most appropriate treatment option for the patient. Rationale Supports the delivey of health and social care within settings outside the traditonal hospital by utilising alternative pathways. Aim To roll out the implementation of a decision making tool across the Trust both improving patient experience and reducing hospital admissions via emergency departments 10