SCOTTISH AMBULANCE SERVICE ANNUAL ACCOUNTS AND NOTES

Transcription

1 ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2012

2 Scottish Ambulance Service Board Annual Accounts CONTENTS Page Directors Report (including interests of Board members) 1 Operating and Financial Review 8 Remuneration Report 16 Statements of Responsibilities 20 Governance Statement 22 Independent Auditors Report 27 Direction by the Scottish Ministers 29 Principal Financial Statements 30 Notes to the Accounts Note 1 (Accounting Policies) 36 Note Scottish Financial Returns 100 Payment Policy 111 Resource and Cash Outturn 112 Sickness Absence 113

3 Scottish Ambulance Service Board Annual Accounts ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2012 DIRECTORS REPORT DIRECTORS REPORT 1. NAMING CONVENTION Scottish Ambulance Service is the common name for the Scottish Ambulance Service Board. 2. PRINCIPAL ACTIVITIES AND REVIEW OF THE BUSINESS AND FUTURE DEVELOPMENTS The information that fulfils the requirements of the business review, principal activities and future developments can be found in the Operating and Financial Review, which is incorporated in this report by reference. 3. DATE OF ISSUE Audited Financial Statements were approved and authorised for issue by the Board on 27 June ACCOUNTING CONVENTION The Annual Accounts and Notes have been prepared under the historical cost convention as modified to reflect changes in the value of fixed assets and in accordance with the Scottish Government Financial Reporting Manual (FREM). The Accounts have been prepared under a direction issued by Scottish Ministers, which is included at Page 29 of the accounts. The statement of the accounting policies, which are in line with the International Financial Reporting Standards (IFRS) and have been adopted, are shown at Note APPOINTMENT OF AUDITORS The Public Finance and Accountability (Scotland) Act 2000 places personal responsibility on the Auditor General for Scotland to decide who is to undertake the audit of each health body in Scotland. The Auditor General has appointed Deloitte LLP to undertake the audit of the Scottish Ambulance Service. The general duties of the auditors of health bodies, including their statutory duties, are set out in the Code of Audit Practice issued by Audit Scotland and approved by the Auditor General. 6. BOARD MEMBERSHIP Under the terms of the Scottish Health Plan, the Scottish Ambulance Service Board ( the Board ) is a Board of governance whose membership will be conditioned by the functions of the Board. Members of Health Boards are selected on the basis of their position or the particular expertise which enables them to contribute to the decision making process at a strategic level. The Board has collective responsibility for the performance of the Service as a whole, and reflects the partnership approach, which is essential to improving health and health care. The Scottish Ambulance Service Board comprised during 2011/12: David Garbutt Chairman Pauline Howie Chief Executive Councillor David Alexander Non-Executive Director Moi Ali Non-Executive Director Matt Bell Employee Director Dr George Crooks Medical Director (part time) Suzanne Dawson Non-Executive Director Theresa Houston Non-Executive Director Neelam Bakshi Non-Executive Director (from 1 July 2011) Edward Frizzell Non-Executive Director (from 1 July 2011) Douglas Marr Non-Executive Director (until 30 June 2011) Christine Humphries Non-Executive Director (until 30 June 2011) 1

4 Scottish Ambulance Service Board Annual Accounts Pamela Mclauchlan Director of Finance and Logistics Andrew Richmond Non-Executive Director Peter Ripley Director of Service Delivery (until 5 August 2011) Daren Mochrie Director of Service Delivery (from 8 August 2011) Shirley Rogers Director of Human Resources and Organisational Development New Appointments Neelam Bakshi and Edward Frizzell were appointed as non-executive directors with effect from 1 July Peter Ripley Director of Service Delivery resigned to take up a similar post with East Midlands Ambulance Service. Initially he was replaced with Daren Mochrie in an Acting Director position on 8 August 2011 and then as the permanent Director of Service Delivery as of 1 December The Board members responsibilities in relation to the accounts are set out in a statement following this report. 7. BOARD MEMBERS AND SENIOR MANAGERS INTERESTS The following interests have been declared by Board members and senior managers: Board Member Directorships Ownerships David Garbutt Chartered fellow of the Chartered Institute of Personnel and Development Fellow Scottish Police College Visiting Fellow Australian Institute of Police Management Self Employed Consultant Pauline Howie None None Councillor David Alexander Substitute Member Central Scotland Police Board Member and office bearer Scottish National Party Member CND Scotland Member Central Scotland Fire Board Elected Member Falkirk Council Moi Ali Fellow of the RSA Governor, Napier University Neelam Bakshi Judicial Complaints Reviewer Non-Executive Director NHS Education for Scotland Member Chartered Institute of Personnel & Development (Affiliate) Federation of Small Business Co Operative Society National Autistic Society Royal Horticultural Society Member BBC Audience Council Approved Training Institute American Board NLP NB Associates-owner; Scottish Government, Non-Executive Member; Lay Member Employment Tribunals Scotland, Reserve Forces Tribunal & Lay Race Equality Assessor to Judiciary Member Scotland Committee of Equality & Human Rights Commission 2 None Self Employed Consultant None Matt Bell None None Dr George Crooks Medical Director NHS24 None

5 Scottish Ambulance Service Board Annual Accounts Suzanne Dawson Lay member of Council of the Law Society of Scotland Edward Frizzell Theresa Houston Member of the Board of Newbattle Abbey College Fellow of Chartered Institute of Marketing Vice-Chair of Court of Abertay University, Dundee Visiting Professor, Queen Margaret University, Edinburgh Non-Executive Director NHS Education for Scotland Christine Humphries Vice Chair Scottish Borders Valuation Appeal Committee Member British Association of Social Workers Self-employed Marketing Consultant None None None Douglas Marr None None Daren Mochrie None None Pamela Mclauchlan Executive Member CIPFA in Scotland Non-Executive Audit Committee Member National Theatre for Scotland (from 1 January 2012) Andrew Richmond Non-Executive Member of NHS Tayside Chair of Angus CHP Non- Executive Director of Frontier IP Group PLC Trustee Tayside NHS Board Endowment Fund Associate of Society of Investment Professionals (ASIP) Member of Church of Scotland Lay Court member of the University of Dundee Trustee of the University of Dundee Superannuation and Life Assurance scheme None None Peter Ripley None None Shirley Rogers None None Senior Managers Directorships Ownerships Heather Kenney None None 7. PUBLIC SERVICES REFORM (SCOTLAND) ACT 2010 The Public Services Reform (Scotland) Act came into being in October In Sections 31 and 32 it placed a duty on all public bodies to publish information on expenditure and certain other matters as soon as is reasonably practicable after the end of each financial year. These items include: Overseas Travel; Public Relations ; Hospitality and Entertainment; and External Consultancy. In order to comply with this act, the Scottish Ambulance Service places on its external website the information relating to the expenditure incurred under these headings since 1 April In addition, public bodies are required to publish cash payments made to external parties that exceed 25,000 on a monthly basis, as soon as the monthly accounts are available. A list of these payments is also placed on our External Website. The following link will take readers to the relevant information: 3

6 Scottish Ambulance Service Board Annual Accounts Payments made to staff that exceed 100k per annum should also be disclosed. This information is contained in the Directors remuneration report. No other members of staff currently earn more than 100k per annum. 8. PENSION LIABILITIES The accounting policy note for pensions is provided in Note 1 and disclosure of the costs is shown within Note 24 and the remuneration report. 9. REMUNERATION FOR NON-AUDIT WORK Deloitte LLP, the Service s current External Auditors, have only undertaken audit related work during 2011/12 for the Scottish Ambulance Service Board. 10. RELATED PARTY TRANSACTIONS During the year, no Board member, key manager or other related parties have undertaken any material transactions with any body. 11. PAYMENT POLICY The Scottish Ambulance Service is committed to supporting the Scottish Government in helping businesses during the current economic situation by paying bills more quickly. The intention is to achieve payment of all undisputed invoices within 10 working days across all public bodies. The target has been communicated to all non-departmental public bodies, who are working towards the accelerated payment target of 10 working days. The Scottish Ambulance Service has endeavoured to work towards this target and does ensure that invoices received that have been correctly checked are processed within 7 working days of date of receipt. However those that require further investigation result in the following achievement of the target. In 2011/12 the Board paid 24% by value and 18% by volume within 10 days (2010/11 = 8% by value & 19% by volume - Restated) Prior to this, the Board did endeavour to comply with the principles of The Better Payment Practice Code ( by processing suppliers invoices for payment without unnecessary delay and by settling them in a timely manner. In 2011/12 average credit taken was 28 Days (2010/11 = 28 Days- Restated) In 2011/12 the Board paid 73% by value and 77% by volume within 30 days (2010/11 = 65% by value & 76% by volume - Restated) 12. CORPORATE GOVERNANCE The Board meets regularly during the year to progress the business of the Scottish Ambulance Service Board. This includes reviewing of performance against the key targets for the organisation. Considering the key strategies and policies the organisation wishes to develop. Seeking assurance that principal decisions are governed and implemented, as planned. In order to support the work of the Board and to provide a framework of assurance the following governance committees report to the Board: Clinical Governance; Audit; Staff Governance; and Remuneration. Clinical Governance Committee The Clinical Governance Committee of the Board has two key roles: 4

7 5 Scottish Ambulance Service Board Annual Accounts Systems assurance to ensure that clinical governance mechanisms are in place and effective throughout the Scottish Ambulance Service System; and - Public health governance to ensure that the principles and standards of clinical governance are applied to the health improvement activities of the NHS Board. The Clinical Governance Committee currently comprises four Non-Executive Directors: Ms Suzanne Dawson (Chair); Mr Andrew Richmond; Ms Neelam Bakshi; and Ms Theresa Houston. Mr David Nelson is the Public/Patient Representative. The Committee meets approximately four times per year to monitor standards of care and measure the effectiveness of pre-hospital treatment. Audit Committee The Audit Committee currently comprises four Non-Executive Directors: Mr Andrew Richmond (Chair); Ms Moi Ali; Mr Eddie Frizzell and Councillor David Alexander. Mr Frizzell took up his position at the start of July 2011, replacing Mr Doug Marr. Councillor Alexander replaced Ms Christine Humphries at the same time and Mr Richmond took up position of Chair of the committee. The Audit Committee meets four times per year to consider the various reports from both internal and external auditors to assess the risks that may arise in the Service. Staff Governance Committee The Staff Governance Committee comprises four Non-Executive Directors: Mr Matt Bell, Employee Director and Chair, Ms Moi Ali, Councillor David Alexander, Ms Neelam Bakshi and the Chairman, Mr David Garbutt. The Committee meets four times per year to ensure effective monitoring of staff governance within the organisation. Remuneration Committee The Remuneration Committee currently comprises the Chairman and three Non-Executive Directors: Mr Edward Frizzell; Ms Suzanne Dawson; and Councillor David Alexander. The Committee is chaired by the Chairman, Mr David Garbutt. It meets at least three times per year to consider the evaluation of performance and pay awards for Executive Directors. The committees have an important role in ensuring consistency of policy and equity of treatment of staff across the local NHS system, including remuneration issues, where they are not already covered by existing arrangements at national level. The Board Members responsibilities in respect of internal control are set out in a statement following this report. 13. DISCLOSURE OF INFORMATION TO AUDITORS The directors who held office at the date of approval of this directors report confirm that, so far as they are each aware, there is no relevant audit information of which the Board s auditors are unaware; and each director has taken all the steps that he/she ought reasonably to have taken as a director to make himself/herself aware of any relevant audit information and to establish that the Board s auditors are aware of that information. 14. HUMAN RESOURCES Throughout 2011/12, and in the face of difficult economic challenges, we have continued to live out the values and principles of partnership working, ensuring that effective staff governance exists across the Service. We are now almost half-way way through our 5 year HR strategy that was set out in Doing the Right thing covering the period 2010 to This is a strategy that continues to evolve as the expectations of the public increase and in light of continuing challenges over public sector funding. We are continuing to challenge ourselves to find innovative ways of developing the services we provide, focused solely on improving patient care. Effective and efficient communication is a key part of ensuring our staff are well informed. We have in place a communications strategy which aligns all the key pieces of strategy work, helping staff to see how the range of individual projects are coming together to deliver our strategy goals. We have seen significant improvement in the development of communications channels and re-launched our intranet and external website. The re-launched internal staff magazine: Response came third at the November 2011 Chartered Institute of Public Relations Awards in the Internal Newspaper or Magazine category. The recent introduction of Leadership Patient Safety Walk Rounds has provided an opportunity for senior staff and the Non-Executive members of the Service Board to meet frontline staff in every station to talk about how we can collectively improve patient safety. This has been a hugely successful listening exercise,

8 Scottish Ambulance Service Board Annual Accounts and regular updates in the Chief Executive s weekly bulletin have been keeping staff abreast of the changes made in response to staff feedback. In the summer of 2011 a new recognition and awards scheme was introduced. The award events highlight the excellent work done by our staff and by our volunteer partners. The events are supported with funding from the Benevolent Fund and through sponsorship from Scotmid. By recognising individual and team contributions to outstanding patient care we aim to inspire staff to replicate good practice. This has generated positive coverage in local and national media for staff across the Service. Because of the nature of our work, the clinical elements of staff training are highly regulated and provide assurance that both basic training and professional development activities are carried out to required standards. The new Ambulance Service Academy based within Glasgow Caledonian University is fast becoming an exemplar for the NHS and we continue to be the only UK ambulance service that is able to boast triple accreditation of our training. This accreditation comes from Glasgow Caledonian University, the Health Professions Council and the College of Paramedics. Supporting our efforts to ensure patient safety we have continued to roll out appropriate training and support to ensure appropriate Prevention and Control of Infection (PCOI) education programmes are in place. There are now some 429 Cleanliness Champions across the Service and work is underway to make sure that every team leader across the Service is also educated to Cleanliness Champion status. Our firm commitment to the principles of partnership continues with National Partnership and Divisional Partnerships continuing to operate with the full support of managers and staff. The strength of these relationships has been critical in us finding solutions to long term issues such as rest breaks. The solution to which is now being implemented in partnership and to helping us jointly plan for future challenges. While recognising that we have a strong partnership model, we have agreed to review the Partnership Forum terms of reference and reinforce the principles of partnership during 2012/13. The Scottish Ambulance Service is committed to the principles of Equality and Diversity, and this is demonstrated by means of the well established policies in this area. We have embraced the new responsibilities in respect of diversity and will be developing these further in 2012/13. Over the past year we have continued to review and improve our policies and mechanisms that support the health and safety of our people and the people we serve. We have appropriate risk assessments in place alongside a system for reporting defective equipment in order to ensure that we place Health and Safety measures at the forefront in staff s clinical practice. We provide staff with training and development and increasingly, we are linking this to continuous learning. Our aim is to create a culture of operating with a clear mindset of dynamic risk assessment when faced with circumstances that are by their nature, situational and create a learning environment. We have continued to promote pro-active management of sick absence with an aim of reducing to 5% across the service. This year sick absence has been 5.7%. This increase in absence rate is as a result of all types of sickness and from all areas of the organisation. We currently are conducting a comprehensive review of the causes of sickness absence and options for improvement will be taken to the Board in the Summer of We believe this is something that can be improved and it is important to remember that the UK Ambulance Service average is 6.3%. This recognises the particular pressures on emergency services staff because of their working environment. In January we reached agreement over the management of rest breaks. A high level action plan has been developed and the immediate focus is on implementing the new arrangements across the Service. This agreement, constructed in partnership, will provide a sustainable solution to the issue of rest breaks. It will address concerns over patient and staff safety and enhance resilience and ambulance service capability. This year we sought accreditation to the Healthy Working Lives award and our efforts have resulted in the Service being accredited at Bronze level. This standard provides an additional assurance that we have clear health and safety roles established for our staff and that we plan and record Health and Safety training activity. We must always remember that it is the efforts of our dedicated and professional staff that will ultimately deliver the service to the people of Scotland. Many have chosen to work for the service because of a desire to serve their fellow citizens. This is often in the face of danger and brings staff into contact with the whole 6

9 Scottish Ambulance Service Board Annual Accounts spectrum of people in our society. The principles of staff engagement and promoting diversity are the two areas that have the greatest potential to deliver improved and efficient patient care. 15. EVENTS AFTER THE END OF THE REPORTING PERIOD There have been no significant events after the end of the financial year that would materially impact on the information contained within the accounts. 16. FINANCIAL INSTRUMENTS Information in respect of the financial risk management objectives and policies of the Board and the exposure of the Scottish Ambulance Service to price risk, credit risk, liquidity risk and cash flow risk is disclosed in note 27. The Accounting Officer (Chief Executive) of the Scottish Ambulance Service has authorised these financial statements for issue on the 27 June Signed:... Date: 27 June 2012 Mrs Pauline Howie Chief Executive 7

10 Scottish Ambulance Service Board Annual Accounts OPERATING AND FINANCIAL REVIEW NHS Boards are required to prepare an Operating and Financial Review under section 7.2 of the FReM. This provides a narrative explanation of the main trends and factors underlying the development, performance and position of the Board during the financial year covered by the financial statements, and those which are likely to affect its future development, performance and position as defined in the Accounting Standards Board Reporting Statement objectives. The operating and financial review has been prepared in accordance with the FReM and complies with best practice. 1 Principal activities and review of the year The Scottish Ambulance Service was established in 1999 under The Scottish Ambulance Service Board Order 1999 which amended the National Health Service (Scotland) Act 1978 and is responsible for the provision of Accident & Emergency Response, Patient Transportation Service and Air Ambulance services for the residents of Scotland, including the islands communities. This covers a total population of over 5.2 million. The role of the Scottish Ambulance Service is to: provide accident and emergency, patient transport and air ambulance services to the people of Scotland; improve and protect the health of people; improve health services for local people; focus clearly on health outcomes and people s experience of their local NHS system; and promote integrated health and community planning by working closely with other local organisations. The functions of the Scottish Ambulance Service Board comprise: strategy development; implementation of strategic framework; resource allocations; implementation of its Delivery Plan; and performance management. During this year the Organisation has delivered the following: Progressed procurement in partnership with NHS24 of a Single Clinical Triage Tool (SCTT), which will mean that regardless of whichever route patients use to access emergency and urgent healthcare, there will be consistency in the assessment and triage of patients needs; Increased the number of clinical advisors in our Emergency Medical Dispatch Centres (EMDC) to provide improved clinical care and assessment and support the introduction of the SCTT; Lead the development, with the Long Term Conditions Task and Finish Group looking at falls and general frailty, of a protocol and screening tool to be used by Scottish Ambulance Service, Primary Care and Out of Hours clinicians to assess older people who have fallen; Progressed the development of care pathways in respect of diabetes, alcohol/drug abuse, Chronic obstructive pulmonary disease (COPD), breathlessness and mental health; Undertaken comprehensive review and stakeholder engagement to improve scheduled care services, which will result in establishment of 3 regional booking centers for Scotland to increase direct patient access, the roll out of mobile data across the Patient Transport Service fleet, and an improvement in the quality and efficiency of the scheduled care service; Completed four Learn and Improve reviews and developed improvement programmes to take forward findings; these were PTS, workforce planning, administrative services, and EMDC; Progressed implementation of our Community Resilience Strategy and strengthened our capacity to support community engagement and build resilience; Increased the number of Community First Responder schemes by around 8%, with over 1,000 volunteers across over 130 schemes; Increased numbers of public access defibrillators in partnership with British Heart Foundation and Scotmid amongst others and upgraded our C3 system to track the position of public access defibrillators so call takers are able to make callers aware; Continued to work with NHS Boards and communities to take forward appropriate integrated healthcare models in line with the Strategic Options Framework for remote and rural communities; 8

11 Scottish Ambulance Service Board Annual Accounts Opened the Scottish Ambulance Service Academy at Glasgow Caledonian University with the first students completing the new Foundation Paramedic Training Course; Launched our Careers Framework and introduced the role of Critical Care Paramedic to the Service; Entered into partnership with the Chartered Management Institute and are now offering two qualifications for frontline and middle managers. Over 450 leadership development courses have been undertaken by almost 300 managers across the Service; Rolled out new defibrillators across our A&E fleet with enhanced telehealth links to PCI centers across Scotland for the transmission of ECGs; Rolled out access to the Emergency Care Summary and Palliative Care Summary for crews through mobile data; Successfully piloted the transmission e-prf records in real time to two A&E facilities in Fife and Ayr where records of treatment and condition are received ahead of ambulance arrival; and Introduced smart phone technology for community first responders and ambulance officers offering increased information and data transfer. 2 Financial Performance and Position The Scottish Government Health Directorate (SGHD) sets three financial targets at NHS Board level on an annual basis. These limits are: revenue resource limit - a resource budget for ongoing operations; capital resource limit - a resource budget for new capital investment; and cash requirement - a financial requirement to fund the cash consequences of the ongoing operations and the new capital investment. NHS Boards are expected to contain their net expenditure within these limits, and to report on any variation from the limits set. The Scottish Ambulance Service achieved each of the targets set and the table below indicates the financial performance against each target. Revenue resource limit Core Revenue resource limit Non Core (1) Limit as set by SGHD 000 (2) Actual Outturn 000 (3) Variance (over)/under (1)-(2) , , ,500 12, Capital resource limit 13,881 13,873 8 Cash requirement 211, , / / (79) Brought forward (surplus) from previous financial year (46) (33) Savings/(excess) against in year revenue resource limit (5) 9

12 Scottish Ambulance Service Board Annual Accounts In respect of financial position and performance: The Scottish Ambulance Service generated an overall surplus against Non-Core Revenue Resource Limit at the year end of 18k, and against Core Revenue Resource Limit at the year end of 23k, resulting in an overall saving of 41k; The Scottish Ambulance Service contained its costs within the revenue and capital resource limits; The closing bank balance as at 31 March 2012 was 60k; Provisions for bad and doubtful debts of 56k were made; Provision for legal obligations of 459k were made, of which 127k relates to medical and clinical claims, 307k relates to employers liability claims and 25k relates to third party claims; Land and buildings were fully revalued by the Valuation Office Agency at 31 March 2004 on the basis of fair value (market value or depreciated replacement cost where appropriate). Other Property Plant and Equipment were revalued on the basis of indices at 31 March 2012; o The net impact was an increase in value of 382k (2010/11: 1,389k reduction), of which 374k (2010/11: 21k) was credited to the revaluation reserve and 8k (2010/11: 1,410k) credited to the Statement of Comprehensive Net Expenditure. The net credit of 8k to the Statement of Comprehensive Net Expenditure was comprised of 512k (2010/11: 1,819k) impairment losses and 520k (2010/11: 409k) reversal of previous impairment losses; Total outstanding liabilities are m; All of the five operating divisions returned deficits against budget in the year. This was due to high utilisation of overtime due to an additional cost pressure from a late extra public holiday coupled with increased levels of sickness. Improvements in overtime utilisation have been made; however, further work is required in 2012/13; and In addition, fuel costs rose significantly during the year due to oil prices and taxation changes. Fuel costs therefore exceeded the available funding which also contributed to the overspend position in the divisions. There was one personal data incident during the year as a result of a theft of a mobile data terminal. The Service has an encryption policy and this therefore mitigated the risk around the loss of this personal data. 10

13 Scottish Ambulance Service Board Annual Accounts Key Performance Indicators (KPIs) Health Boards are required to report on their Key Performance Indicators, as agreed with the Scottish Government Health Directorate, shown below. Examples of KPIs include financial break-even targets, waiting times targets, delayed discharges, absences and suicide rates, which are all examples of the main NHS objectives. These objectives can be classified under four categories: Health Improvement for people in Scotland; Efficiency improvements; Access more quickly to service; and Treatment Appropriate for Patient (HEAT). NHS Scotland Objective 1: Health Improvement for the people of Scotland improving life expectancy and healthy life expectancy Target No. H1 H2 H3 H4 H5 Target Save more lives: Achieve a return of spontaneous circulation on arrival at hospital of 12% to 20% Actual 16.1% Cardiac Arrest Cardiac Arrest patients responded to in 8 minutes Target 80% Actual 78.3% % of Cat A incidents responded to within 8 minutes Target 75% Actual 73.0% % of Cat B incidents responded to within 14, 19, or 21 minutes Target 95% Actual 92.4% % emergency incidents responded to within 8 minutes in Island Boards Target 55% Actual 54.6% NHS Scotland Objective 2: Efficiency and Governance Improvements continually improve the efficiency and effectiveness of the NHS Target No. E1 E5 E6 Reduce Sickness absence to a target of 5% Actual 5.7% Target NHS Boards to operate within their Revenue Resource Limit and Capital Resource Limit; and to meet their cash requirement. Target achieved Deliver a 3% Cash Releasing Efficiency Saving per annum Actual 3.9% 11

14 Scottish Ambulance Service Board Annual Accounts NHS Scotland Objective 3: Access to Services recognising patients need for quicker and easier use of NHS services Target No. Target A1 A2 A3 A4 % of 1 hour urgent calls responded to within an hour Target 91% Actual = 86.3% Improve punctuality for appointment for Priority 1 PTS patients target 72% Actual = 70.7% Improve punctuality for pick up for Priority 1 PTS patients target = 90% Actual = 80.1% % of PTS journeys cancelled by SAS Target < 0.5% Actual = 0.6% NHS Scotland Objective 4: Treatment Appropriate to Individuals: ensure patients receive high quality services that meet their needs Target No. Target T3 T4 T5 Reduce Hospital admissions. Increase % of calls treated at scene target = 12% Actual = 12.2% % of patients with SEWS Score above 4 taken to hospital Target 95-98% Actual = 96.5% % of Hyper Acute Stroke patients taken to hospital in 55 minutes Target 80% Actual = 78.4% 12

15 4 Sustainability and Environmental Reporting Scottish Ambulance Service Board Annual Accounts Significant work has been ongoing during 2011/12 in relation to sustainability and environmental reporting. Our National Headquarters is continuing to lead the Service in waste management and energy conservation. The organisation achieved a 2.66% reduction in energy consumption 0.16% over and above the expected 2.5% savings. This equates to an efficiency saving of 31k. Fleet continues to follow its action plan to reduce carbon emissions by purchasing vehicles with reduced carbon emissions. Waste Minimisation and Recycling The Scottish Ambulance Service in December 2011 relocated its National Headquarter function to shared NHS premises within Edinburgh. A recycling area is set up within the new NHQ building which is proving to be extremely popular. Recycling will be monitored and measured and target figures will be set for 2013/14. Energy Efficiency As part of our property strategy, we are continuing to install energy saving devices in our upgrades/new builds; in particular, thermostatic valves to all radiators; time clocks to all heating systems; automatic devices for lighting and - within the actual build - energy saving insulation. Transport Vehicle Emissions The Scottish Ambulance Service has continued to monitor its CO 2 emissions on a monthly basis, with month to year trend analysis. The Scottish Ambulance Service is now showing an increase in its overall emissions footprint from its previous plateau on a rolling annual basis. However, the Service has now decided to purchase smaller more fuel-efficient Accident and Emergency vehicles, which should reduce the output of CO 2 emissions. 150 new vehicles were delivered in 2011/12. The leased vehicle essential-user car scheme has been reviewed with greater emphasis now put on fuel efficient, low carbon emission vehicles that will ease the current emissions profile. A limit of 140g has been imposed on all vehicle choices except for a small number of 4x4 vehicles, which are required for resilience purposes. Vehicle Selection New vehicle acquisition has to consider the Environmental Criteria of CO 2 reduction and increased miles per gallon (MPG). The latest A&E vehicle selection will reduce emissions and is expected to be the best in class of those vehicles deemed suitable for front line operations. An electric Patient Transport Ambulance has been ordered and its delivery is expected in June This vehicle will be monitored very closely and the usage of electricity will hopefully be linked to the CO2 emissions that were emitted to generate that electricity. Waste Management The workshop waste management process is now well established. Its aim of having a one-stop shop for all waste disposal from the Service s workshops has been achieved. This is currently still in place and links to the workshop waste disposal register, where we continue to keep waste disposal consignment certificates which are kept for audit purposes. 13

16 Scottish Ambulance Service Board Annual Accounts Water Efficiency The constant use of water at all of our sites for vehicle cleaning does mean that our water consumption is high. Unfortunately, unless we undertake the vehicle cleaning off site, there is very little latitude to reduce water consumption. However, 85% of our sites now have water meters. This does allow us to closely monitor the consumption and although we may not be able to reduce the consumption because of our vehicle cleaning, it will alert us quicker to any leaks or problems with the water supply. We continue to concentrate on installing water-saving devices such as touch-sensitive taps within certain areas of the station as part of our upgrades and new builds. A new initiative is being trialled at a new build Ambulance Station for the use of recycled water for vehicle washing. This will be monitored during 2012/13 and if successful will be incorporated into all upgrades and new builds. Green Purchasing The Service has in place an environmental procurement policy which supports the Service s environmental policy and the Scottish Executive s policy on Public Procurement and Sustainable Development. As a national public service, the Scottish Ambulance Service is committed to investing in Green Procurement practices and recycling initiatives that will have a positive impact on sustainability of the environment. 5 Equality and Diversity The Scottish Ambulance Service is committed to putting equality and diversity 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. Scotland is an increasingly diverse country. Whilst this provides great opportunities, it also presents significant challenges in ensuring that we, as both a service provider and employer, ensure that we do not consciously or unconsciously discriminate and instead provide equitable access to our services and fair employment practice in the workplace. 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 our partners and communities to deliver improved health care. This work is especially important in the service redesign process where engagement with our stakeholders, members of the public and community groups is key to ensuring patients needs are met. With the introduction of the Equality Act 2010 the Service ensures the work it does has due regard to eliminating discrimination, harassment and victimisation, advances equality of opportunity and fosters good relations. In keeping with the new Public Sector Duty, work is underway to develop and set equality outcomes for the Service, to continue to mainstream equality activity in all that we do and to review and revise our current procedure for the equality impact assessment of all our proposed policies and practices as well as the changes we make to our existing policies. We continue to monitor the Service Anti-Bullying and Harassment campaign, the aim of which is to raise awareness of unacceptable behaviour and encourage staff to raise any concerns/issues at the earliest opportunity in order to resolve problems as soon as possible. The Equality and Diversity Steering Group continues to meet bi-monthly to take some of the key areas of work forward. Membership includes representatives from across the divisions. 14

17 Scottish Ambulance Service Board Annual Accounts Equal Pay The Scottish Ambulance Service has received one claim under the Equal Pay Act 1970 from a woman seeking compensation for past inequalities with male colleagues, under their pay arrangements. The basis of claims is as follows: The claimant s job has been rated as being of equivalent to that of their comparator using a valid Job Evaluation Study, and/or is of equal value to that of their comparator; Their comparator is currently paid or has been paid more than them; and They claim equal pay, back pay and interest. (Back pay is claimed for the statutory maximum of five years). Claims still do not provide sufficient detail about the comparator jobs to allow an estimate to be made of the likelihood of the success of the claims or of any financial impact that they may have. The NHS Scotland Central Legal Office and Equal Pay Unit are continuing to monitor the progress of all equal pay claims in NHS Scotland as well as developments relating to NHS equal pay claims elsewhere that may further inform the position. They continue to advise that it is not possible to provide any financial quantification at this stage because of the lack of information available. On the basis of their view, the appropriate accounting treatment is to disclose the claims as a contingent liability that is not possible to quantify. Signed:... Date: 27 June 2012 Mrs Pauline Howie Chief Executive 15

18 Scottish Ambulance Service Board Annual Accounts ANNUAL ACCOUNTS AND NOTES FOR YEAR ENDED 31 MARCH 2012 ANNUAL REPORT REMUNERATION REPORT BOARD MEMBERS AND SENIOR MANAGERS REMUNERATION The remuneration of Board members and senior employees is determined in accordance with the NHS MEL(2000)25 Pay and Conditions of Service. This document sets out the pay arrangements for Board members and senior employees of NHS Boards. The arrangements referred to in this document are mandatory from 1 April Performance appraisal for Board members and senior employees is conducted in accordance with HDL(2002)64 Appraisal arrangements for staff on Executive pay ranges. As stated above, the Remuneration Committee meets at least three times per year to consider the evaluation of performance and pay awards for Executive Directors. This committee comprises the Chairman and three Non- Executive Directors: Mr Edward Frizzell, Ms Suzanne Dawson, and Councillor David Alexander. The Committee is chaired by the Chairman, Mr David Garbutt. 16

19 Scottish Ambulance Service Board Annual Accounts REMUNERATION REPORT FOR THE YEAR ENDED MARCH 2012 CURRENT YEAR 2011/12 Remunerati on (Bands of 5,000) Performance Related Bonus (Bands of 5,000) Real increase in pension at pensionable age (bands of 2,500) Total accrued pension at pensionable age at 31 March (bands of 5,000) Cash Equivalent Transfer Value (CETV) at 31 March 2011 Cash Equivalent Transfer Value (CETV) at 31 March 2012 Real increase in CETV in year Benefits in kind '000 '000 '000 '000 Remuneration of: Executive Members Chief Executive: Pauline Howie Director of Finance & Logistics: Pamela McLauchlan Director of HR and Organisational Development: Shirley Rogers Part Time Medical Director : George Crooks A A A A A A Director of Service Delivery: Peter Ripley (Left 05/08/11) B B B B B B Director of Service Delivery: Daren Mochrie (Started 08/08/11) Non Executive Members Chairman: David Garbutt Suzanne Dawson Andrew Richmond David Alexander Theressa Houston Moiram Ali Douglas Marr (Left 30/06/11) Christine Humphries (Left 30/06/11) Neelam Bakshi (Started 01/07/11) Eddie Frizzell (Started 01/07/11) Other Snr Employees Director of Strategic and Planning and Quality Improvement: Heather Kenney Total 1,816 2, Note A B George Crooks' Director's pension information is included within NHS24 information. Peter Ripley's Pension information is included within East Midlands Ambulance Service NHS Trust The salary costs stated above include Employers Contributions to National Insurance and NHS Pension Scheme plus On Call Allowances where applicable. 17

20 Scottish Ambulance Service Board Annual Accounts Remuneration of: Remuneration (Bands of 5,000) REMUNERATION REPORT FOR THE YEAR ENDED MARCH 2012 PRIOR YEAR 2010/11 Performance Related Bonus (Bands of 5,000) Real increase in pension at pensionable age (Bands of 2,500) Total accrued pension at pensionable age at 31 March (bands of 5,000) Cash Equivalent Transfer Value (CETV) at 31 March 2010 Cash Equivale nt Transfer Value (CETV) at 31 March 2011 Real increase in CETV in year Benefits in kind '000 '000 '000 '000 Executive Members Chief Executive: Pauline Howie (14) 3.7 Director of Finance & Logistics: Pamela McLauchlan Director of HR and Organisational Development: Shirley Rogers (45) 5.7 Part Time Medical Director : George Crooks A A A A A A Director of Service Delivery: Peter Ripley (12) 4.0 Non Executive Members Chairman: David Garbutt Douglas Marr Christine Humphries Suzanne Dawson Andrew Richmond David Alexander Theressa Houston Moiram Ali Other Snr Employees Director of Strategic and Planning and Quality Improvement: Heather Kenney (11) 2.5 Total 2,224 2,155 (69) 19.4 Note A George Crooks' Director's pension information is included within NHS24 information. The salary costs stated above include Employers Contributions to National Insurance and NHS Pension Scheme plus On Call Allowances where applicable. CETV opening balances in 2010/11 were different from the closing balances in 2009/10. This is due to a change in pension factors supplied by the Government Actuary's Department. 18

21 Scottish Ambulance Service Board Annual Accounts REMUNERATION REPORT - ADDITIONAL DISCLOSURE FOR THE YEAR ENDED MARCH 2012 CURRENT YEAR 2011/ Highest Earning Director's Total Remuneration ( 000s) Highest Earning Director's Total Remuneration ( 000s) Median total Remuneration 30,591 Median total Remuneration 29,411 Commentary Ratio 4.66 Ratio 4.85 As there was no pay award in 2011/12 except for staff earning less than 21k, there has been very little movement in the median total remuneration. Signed:... Date: 27 June 2012 Mrs Pauline Howie Chief Executive 19

22 Scottish Ambulance Service Board Annual Accounts STATEMENT OF THE CHIEF EXECUTIVE S RESPONSIBILITIES AS THE ACCOUNTABLE OFFICER OF THE HEALTH BOARD Under Section 15 of the Public Finance and Accountability (Scotland) Act, 2000, The Principal Accountable Officer (PAO) of the Scottish Executive has appointed me as Accountable Officer of NHS Scottish Ambulance Service. This designation carries with it responsibility for: the propriety and regularity of financial transactions under my control; the economical, efficient and effective use of resources placed at the Board s disposal; and safeguarding the assets of the Board. In preparing the accounts, I am required to comply with the requirements of the Government s Financial Reporting Manual and in particular to: observe the accounts direction issued by Scottish Ministers including the relevant accounting disclosure requirements and apply suitable accounting policies on a consistent basis; make judgements and estimates on a reasonable basis; state whether applicable accounting standards as set out in the Government s Financial Reporting Manual have been followed and disclose and explain any material departures; and prepare the accounts on a going concern basis. I am responsible for ensuring proper records are maintained and that the Accounts are prepared under the principles and in the format directed by Scottish Ministers. To the best of my knowledge and belief, I have properly discharged my responsibilities as Accountable Officer as intimated in the Departmental Accountable Officers letters to me of 24 June 2008 and 5 November Signed:... Date: 27 June 2012 Mrs Pauline Howie Chief Executive 20

23 Scottish Ambulance Service Board Annual Accounts STATEMENT OF HEALTH BOARD MEMBERS RESPONSIBILITIES IN RESPECT OF THE ACCOUNTS Under the National Health Service (Scotland) Act 1978, the Health Board is required to prepare accounts in accordance with the directions of Scottish Ministers which require that those accounts give a true and fair view of the state of affairs of the Health Board as at 31 March 2012 and of its operating costs for the year then ended. In preparing these accounts the Directors are required to: apply on a consistent basis the accounting policies and standards approved for NHSScotland by Scottish Ministers; make judgements and estimates that are reasonable and prudent; state where applicable accounting standards as set out in the Financial Reporting Manual, have not been followed where the effect of the departure is material; and prepare the accounts on the going concern basis unless it is inappropriate to presume that the Board will continue to operate. The Health Board members are responsible for ensuring that proper accounting records are maintained which disclose with reasonable accuracy at any time the financial position of the Board and enable them to ensure that the accounts comply with the National Health Service (Scotland) Act 1978 and the requirements of the Scottish Ministers. They are also responsible for safeguarding the assets of the Board and hence taking reasonable steps for the prevention of fraud and other irregularities. The NHS Board members confirm they have discharged the above responsibilities during the financial year and in preparing the accounts. Director of Finance and Logistics. Date: 27 June 2012 Mrs Pamela McLauchlan Chairman..... Date: 27 June 2012 Mr David Garbutt 21

24 Scottish Ambulance Service Board Annual Accounts ANNUAL ACCOUNTS 2011/12 GOVERNANCE STATEMENT Scope of Responsibility As Accountable Officer, I am responsible for maintaining an adequate and effective system of internal control that supports compliance with the organisation s policies and promotes achievement of the organisation s aims and objectives, including those set by Scottish Ministers. Also, I am responsible for safeguarding the public funds and assets assigned to the organisation. Purpose of Internal Control The system of internal control is based on an ongoing process designed to identify, prioritise and manage the principal risks facing the organisation. The system aims to evaluate the nature and extent of risks, and manage risks efficiently, effectively and economically. The system of internal control is designed to manage rather than eliminate the risk of failure to achieve the organisation s aims and objectives. As such, it can only provide reasonable and not absolute assurance. The process within the organisation accords with guidance from Scottish Ministers in the Scottish Public Finance Manual (SPFM) and supplementary NHS guidance, and has been in place for the year up to the date of approval of the annual report and accounts. The SPFM is issued by Scottish Ministers to provide guidance to the Scottish Government and other relevant bodies on the proper handling and reporting of public funds. The SPFM sets out the relevant statutory, parliamentary and administrative requirements, emphasises the need for efficiency, effectiveness and economy, and promotes good practice and high standards of propriety Governance Framework The Scottish Ambulance Service has set out its vision and how the Service will be delivered in the future through its Strategy Working Together for Better Patient Care and has consulted widely with stakeholders including the public, other Health Boards and the Scottish Government both in the preparation of this document and also in the progress made with the strategy. The strategy has 5 key Programme Boards set up in partnership, that report to the Scottish Ambulance Service Executive Team and the Scottish Ambulance Service Board and this is the mechanism to ensure appropriate governance and performance management of the workstreams are carried out. The Scottish Ambulance Board is supported in its governance responsibilities by the following committees: Staff Governance Is conducted in Partnership with Joint Chairs. Audit Committee Looks after the review of Standing Financial Instructions, Procurement, Fraud and Risk matters as well as the Scheme of Internal Controls operating within the organisation. Clinical Governance Looks after the clinical controls that are required to be in place, as well as assessment of new clinical practices and clinical development of staff. Remuneration Committee Examines the pay and benefits of senior staff within the organisation. The Board also examines its own effectiveness in line with current best practice, approves the scheme of delegation and ensures compliance with current legislation. The Board has endeavoured to ensure compliance with the UK Corporate Governance Code and is assured that it is in compliance with all relevant areas that impact on public bodies. 22

25 Scottish Ambulance Service Board Annual Accounts Purpose of the System of Internal Control The system of internal control is designed to manage rather than eliminate the risk of failure to achieve the organisation s aims and objectives; it can therefore only provide reasonable and not absolute assurance of effectiveness. The system of internal control is based on an ongoing process designed to identify and prioritise the principal risks to the achievement of the organisation s aims and objectives, to evaluate the nature and extent of those risks and to manage them efficiently, effectively and economically. The process within the organisation accords with guidance from the Scottish Ministers in the SPFM and supplementary NHS guidance and has been in place for the year up to the date of approval of the annual report and accounts. Risk and Control Framework All NHS Scotland bodies are subject to the requirements of the Scottish Public Finance Manual (SPFM) and must operate a risk management strategy in accordance with relevant guidance issued by Scottish Ministers. The general principles for a successful risk management strategy are set out in the SPFM. The Board meets annually to review and add to the corporate (high level) risk register. The key risks identified are prioritised through a risk matrix scoring methodology that examines likelihood and impact. Thereafter, the key risks have controls or mitigating actions developed which allow the organisation to manage these risks. Each quarter the Risk Management Steering Group meets to review these key risks and monitor action taken/to be taken. This group also ensures that organisational risks that require escalation can be fed into the Corporate Risk register. The Audit Committee receives updates on how these risks are managed to assure the Board that management is taking effective action. Internal Audit utilise the high level register and the findings from the annual risk workshop to develop their work plan for the forthcoming year. This process ensures that Internal Audit is focused on areas of greatest risk to the organisation. The Board s Risk Management Strategy for was launched in March 2008 and updated by the Board in Work is ongoing to achieve the goals set out in this document. The Scottish Ambulance Service aims to control, eliminate or reduce significant risk to an acceptable level by creating a culture founded upon assessment and prevention rather than reaction and remedy. The management of risk objectives are to: minimise risks to the quality and delivery of emergency and patient care transport services; protect the services, reputation and finances of the Service; optimise the resources available for patient care by managing risk, thus reducing the financial implications associated with adverse incidents; develop a partnership culture that secures the participation of all staff in risk assessment and incident reporting; integrate our risk management arrangements with our partners, where appropriate; ensure that routine and systematic identification, assessment and control of significant risk is an integral part of all work activities; ensure that an effective reporting process is in place to facilitate the systematic identification of adverse events and near misses; secure commitment of management to promote risk management and provide the necessary leadership and direction; adopt agreed standards of risk management throughout the organisation, monitor compliance and ensure that corrective action is taken where necessary; and have in place effective systems of communication to ensure that everyone in the organisation is appropriately informed about risk management. Review of Adequacy and Effectiveness As Accountable Officer, I am responsible for reviewing the adequacy and effectiveness of the system of internal control. My review is informed by: the executive and senior managers who are responsible for developing implementing and maintaining internal controls across their areas; 23

26 Scottish Ambulance Service Board Annual Accounts the work of the internal auditors, who submit to the organisation's Audit Committee regular reports which include their independent and objective opinion on the effectiveness of risk management, control and governance processes, together with the recommendations for improvement; comments made by the external auditors in their management letters and other reports; establishment of key performance and risk indicators, including the requirement for all projects to be managed according to PRINCEII project management methodology; maintenance of an organisation-wide risk register formally reviewed by the Board annually and the risk management steering group quarterly; a performance appraisal system is in place for staff with personal objectives and development plans designed to support the Board in the attainment of the corporate objectives set out in the Health Plan and Delivery Plan. In addition, personal development plans for all staff are being developed in line with the KSF framework; an efficient government programme which aims to achieve cash releasing savings and productivity improvements (e.g. overtime management); and implementation of a continuous improvement strategy. I have been advised on the implications of the result of my review of the effectiveness of the system of internal control by the Board, the Audit Committee, Clinical Governance Committee and Staff Governance Committee. Appropriate action is in place to address weaknesses identified and to ensure the continuous improvement of the system. Best Value In accordance with the principals of Best Value, the board aims to foster a culture of continuous improvement. As part of this, directors and managers are encouraged to review, identify and improve the efficient and effective use of resources. I can confirm that arrangements have been made to secure Best Value as set out in the Scottish Public Finance Manual. Risk Management NHS Scotland bodies are subject to the requirements of the Scottish Public Finance Manual (SPFM) and must operate a risk management strategy in accordance with relevant guidance issued by Scottish Ministers. The general principles for a successful risk management strategy are set out in the SPFM. The principles of the management of risk strategy are as follows: The Service will positively support all staff to take personal responsibility for their own learning; The Service will create an environment which encourages and supports staff to report adverse events, including their own human errors, so that learning and improvement can take place; The Service will not blame staff for their errors, providing that they are not wilful, criminal or the result of negligence; The Service will make non-threatening arrangements for the open discussion of incidents with the sole purpose of identifying what can be done to prevent it happening again; The Service will make suitable and inclusive arrangements to ensure that our learning is used to improve procedures and processes and share the lessons learned; All staff have a personal responsibility to perform their duties properly and in accordance with any procedures, rules or instructions provided; Consideration of risk should not inhibit innovation; and The Service will endeavour to understand the risks faced and be aware of the cost of risk to the organisation. The Patient Safety Group meets quarterly to review patient safety arrangements. The risk manager is responsible for co-ordinating risk management activity across the organisation. Each division has an identified risk champion who liaises with the risk manager. Awareness-raising activities are regularly undertaken, together with more formal training and education to ensure that there is an adequate understanding by staff on the steps that they should be taking to assess and manage risks. Systems for reporting adverse events and near misses have been updated and routine root cause analysis of incidents introduced. Subsequent findings/recommendations from such analysis then inform the sharing of best practice and lessons learnt. 24

27 Scottish Ambulance Service Board Annual Accounts More generally, the organisation is committed to continuous development and improvement: developing systems in response to any relevant reviews and developments in best practice. In particular, during the year to 31 March and up to the signing of the accounts, the organisation has put in place the following: The Risk Manager has contributed to the review of the standards for clinical governance and risk management in Healthcare Improvement Scotland; Quarterly Clinical Governance Risk Management and Patient Safety reports have been presented to the Clinical Governance Committee and Audit Committee; A Board risk workshop, facilitated by Scott & Moncrieff, reviewed the corporate risk register, identified new risks for the Service for the coming year and discussed the Organisation s Risk Appetite; The Risk Management steering group remained an integral part of the Senior Management Team; The Patient Safety Learn and Improve Group has been established to ensure lessons learned from incidents, claims, complaints continue to be shared internally and with external stakeholders in a consistent and open manner; A review of the risk register format was undertaken to include current and forecast risk levels; The Management of risk strategy and policy will be updated to reflect the above changes; Building on National Clinical Governance and Clinical Advisory Group and embedding them into the corporate and clinical governance structures; Development of the Clinical Governance and Quality Managers across the Service and ensuring clinical governance and patient safety are fully embedded and integrated into the day to day activity of the Service; A regular programme of facilitated workshops to identify and keep up to date the record of risks facing the organisation; Managers and staff have been trained to use the Service s incident reporting system; Management of risk training courses for managers and staff; There is an ongoing review of the Incident Reporting System which is web-based across the organisation; Maintenance of a corporate risk register; All risks recorded in the organisational risk register are tracked to ensure they are appropriately managed; Continued monitoring of our clinical performance reporting capabilities through the cab based terminals on which electronic patient reports are prepared; Established governance arrangements for Clinical Advisors within the EMDC; Regular reports from the Chair of the organisation s Audit Committee to the Board, concerning the issues of internal control considered by the Audit Committee; Regular reports by internal audit, which include their independent opinion on the adequacy and effectiveness of the system of internal control together with recommendations for improvement; Further development of Scottish Patient Safety Programme work streams: Leadership; Percutaneous Venous Cannulation (PVC) Bundle; Trigger Tools; Scottish Early Warning System (SEWS) Situation Background Assessment Recommendations or Requirements (SBAR); Continued facilitation of the ongoing delivery of the Service s infection control programme and plan; Implementation of new Medicines Management Policy to include controlled medicines and ensure the safe storage, transport and appropriate recording and auditing of these medicines; Ensure robust Corporate and Clinical Governance is in place for the development of scheduled and unscheduled care services, including specific workstreams such as Single Clinical Triage Tool; Ensure funding streams are available to ensure core clinical services are fit for purpose and evidence based, for example issue of the new Joint Royal Colleges Ambulance Liaison Committee guidelines; and Business Case was submitted to Scottish Government to enhance the Services capability to meet identified threats of the 2 Model Response sites in Scotland in line with the development of Hazardous Access response Team (HART) in England. Proportionate funding was provided to incorporate the HART concept within existing Special Operations Response (SOR) Teams at Newbridge and Johnstone. 25

28 Scottish Ambulance Service Board Annual Accounts Disclosures During the previous financial year, no significant control weaknesses or issues have arisen and no significant failures have arisen in the expected standards for good governance, risk management and control. Signed.. Date: 27 June 2012 Mrs Pauline Howie Chief Executive 26

29 Scottish Ambulance Service Board Annual Accounts Independent auditor s report to the members of the Scottish Ambulance Service, the Auditor General for Scotland and the Scottish Parliament We have audited the financial statements of the Scottish Ambulance Service for the year ended 31 March 2012 under the National Health Service (Scotland) Act The financial statements comprise the Statement of Comprehensive Net Expenditure and Summary of Resource Outturn, the Balance Sheet, the Statement of Cash Flows, the Statement of Changes in Taxpayers Equity and the related notes. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the 2011/12 Government Financial Reporting Manual (the 2011/12 FReM). This report is made solely to the members of the Scottish Ambulance Service as a body, the Auditor General for Scotland and the Scottish Parliament, in accordance with Public Finance and Accountability (Scotland) Act Our audit work has been undertaken so that we might state to the members of the Scottish Ambulance Service as a body, the Auditor General for Scotland and the Scottish Parliament those matters we are required to state to them in an auditor s report and for no other purpose. To the fullest extent permitted by law, we do not accept or assume responsibility to anyone other than to the members of the Scottish Ambulance Service as a body, the Auditor General for Scotland and the Scottish Parliament, for our audit work, for this report, or for the opinions we have formed. Respective responsibilities of Accountable Officer and Auditor As explained more fully in the Statement of the Chief Executive s Responsibilities as the Accountable Officer of the Health Board set out on page 22, the Accountable Officer is responsible for the preparation of the financial statements and for being satisfied that they give a true and fair view, and is also responsible for ensuring the regularity of expenditure and income. Our responsibility is to audit and express an opinion on the financial statements in accordance with applicable law and International Standards on Auditing (UK and Ireland) as required by the Code of Audit Practice approved by the Auditor General for Scotland. Those standards require us to comply with the Auditing Practices Board s Ethical Standards for Auditors. We are also responsible for giving an opinion on the regularity of expenditure and income. Scope of the audit of the financial statements An audit involves obtaining evidence about the amounts, disclosures, and regularity of expenditure and income in the financial statements sufficient to give reasonable assurance that the financial statements are free from material misstatement, whether caused by fraud or error. This includes an assessment of: whether the accounting policies are appropriate to the board s circumstances and have been consistently applied and adequately disclosed; the reasonableness of significant accounting estimates made by the Accountable Officer; and the overall presentation of the financial statements. In addition, we read all the financial and non-financial information in the directors' report and accounts to identify material inconsistencies with the audited financial statements. If we become aware of any apparent material misstatements or inconsistencies we consider the implications for our report. Opinion on financial statements In our opinion the financial statements: give a true and fair view in accordance with the National Health Service (Scotland) Act 1978 and directions made thereunder by the Scottish Ministers of the state of the board s affairs as at 31 March 2012 and of its net operating cost for the year then ended; have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2011/12 FReM; and have been prepared in accordance with the requirements of the National Health Service (Scotland) Act 1978 and directions made thereunder by the Scottish Ministers. Opinion on regularity In our opinion in all material respects the expenditure and income in the financial statements were incurred or applied in accordance with any applicable enactments and guidance issued by the Scottish Ministers. 27

30 Opinion on other prescribed matters Scottish Ambulance Service Board Annual Accounts In our opinion: the part of the Remuneration Report to be audited has been properly prepared in accordance with the National Health Service (Scotland) Act 1978 and directions made thereunder by the Scottish Ministers; and the information given in the Operating and Financial Review and Directors Report for the financial year for which the financial statements are prepared is consistent with the financial statements. Matters on which we are required to report by exception We are required to report to you if, in our opinion: adequate accounting records have not been kept; or the financial statements and the part of the Remuneration Report to be audited are not in agreement with the accounting records; or we have not received all the information and explanations we require for our audit; or the Governance Statement does not comply with Scottish Government guidance; or there has been a failure to achieve a prescribed financial objective. We have nothing to report in respect of these matters. Deloitte LLP Appointed Auditors Glasgow 27 June

31 Scottish Ambulance Service Board Annual Accounts BOARD DIRECTION BY THE SCOTTISH MINISTERS 1. The Scottish Ministers, in exercise of the powers conferred by sections 86(1), (1B) and (3) of the National Health Service (Scotland) Act 1978, as read with article 5(1) of and the Schedule to the Health Education Board for Scotland Order 1990, (S.I. 1990/2639), and all powers enabling them in that behalf, hereby give the following direction. 2. The statement of accounts for the financial year ended 31 March 2007, and subsequent years, shall comply with the accounting principles and disclosure requirements of the edition of the Government Financial Reporting Manual (FReM) which is in force for the year for which the statement of accounts are prepared. 3. Subject to the foregoing requirements, the accounts shall also comply with any accounts format, disclosure and accounting requirements issued by the Scottish Ministers from time to time. 4. The accounts shall be prepared so as to give a true and fair view of the income and expenditure and cash flows for the financial year, and of the state of affairs as at the end of the financial year. 5. This direction shall be reproduced as an appendix to the statement of accounts. The direction given on 30 December 2002 is hereby revoked. Signed by the authority of the Scottish Ministers 29