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Annual Health Check - Ambulance Service Ratings

17 October 2007

17 October 2007

The Healthcare Commission has today (18 October) published the performance ratings for all NHS organisations in England. Two main areas are evaluated - how effectively an organisation uses its resources and the quality of its services.

In the ratings, the Yorkshire Ambulance Service (YAS) received an overall assessment of 'weak' for 'Use of Resources' and 'weak' for 'Quality of Services' for the period of April 2006 - March 2007. 

Commenting on the 2007-07 Annual Health Check, Ian Walton, Acting Chief Executive of YAS said: "We fully anticipated this result. When YAS was established from the former TENYAS, SYAS and WYMAS Trusts in July 2006, it inherited a deficit. Furthermore 66% Category 'A' performance in the WYMAS Trust pre-merger was well below the national target of 75%.

"We knew that resolving these problems was going to be a marathon not a sprint - and developed plans which would take many months of hard work to return the Trust to financial balance and improve Category A performance to 75%."

Although not formally acknowledged by the ratings, a great deal of progress has been made and a huge amount of work undertaken to address the weaknesses identified. For example the score of weak for 'Use of Resources' reflects that YAS ended the 2006-07 financial year with a ?4.5 million deficit and does not take into account that it has an agreed recovery plan in place and is making good progress towards ending 2007-08 in surplus. 

In addition YAS has made substantial improvement in its activation and response times, achieving a year-to-date figure in September of 75% response in eight minutes for Category A life-threatening calls (meeting the 75% national target for ambulance trusts). The weak score in the annual health check reflects that YAS did not achieve the national target of 75% for the whole of 2006-07.

YAS is compliant with 26 of the 44 Standards for Better Health (59%) spanning across all seven domains (although there are two standards that ambulance trusts do not get assessed against). 

Of the 18 standards with which YAS was not compliant in 2006-07, the Healthcare Commission has since acknowledged that it is making significant progress towards achieving a further 12. This leaves four standards towards which the Trust must demonstrate progress by the time of its next assessment. 

Acting Chief Executive of Yorkshire Ambulance Service (YAS) - Ian Walton added: "Despite the annual health check score of weak for both key criteria, YAS staff have shown unstinting dedication, professionalism and commitment to delivering a first class clinically focused service to the patients and public of Yorkshire during 2007-07.

"We welcome the findings of the annual health check and are absolutely committed to improving in the areas where we are weak and developing further the areas in which we have shown good practice to be in place."

Of the ambulance services across England, for 'Use of Resources', 41.6%
were rated as 'good', 41.7% as 'fair' and 16.7% as 'weak' - no ambulance service was given an 'excellent' rating. For 'Quality of Services', 8.3% were rated as 'good', 66.7% as 'fair' and 25% as 'weak'. No service was given an 'excellent' rating.


1. The Yorkshire Ambulance Service (YAS) is now in its second year of operation. It was formed on 1 July 2006 when the three Yorkshire-based services merged. It operates 60 ambulance stations throughout the county, with the main headquarters in Wakefield. YAS serves a population of over 5 million people and covers varying terrain from coastal areas, large urban areas and inner cities to dales and rural expanses covering an area of 6,000 square miles.

2. YAS was formed on 1 July 2006 through the merger of Tees, East and North Yorkshire, West Yorkshire Metropolitan and South Yorkshire Ambulance Services.

3. The Healthcare Commission's annual health check is made up of two parts - 'Use of Resources' and 'Quality of Services'.  Ratings are 'excellent', 'good', 'fair' or 'weak'.
a. 'Use of Resources' is based on how well an NHS organisation manages its finances. This includes how it plans and reports on its financial performance, how it monitors the money it spends and how it makes sure the services it offers to patients represent good value-for-money.
b. 'Quality of Services' covers a range of areas within a healthcare organisation which can affect the care and treatment a patient receives. This includes access to services, safety, and the way an organisation is run. In particular, it reflects on whether an organisation provides the basic standards of care required by the Government and whether it strives to improve the care and treatment it provides for patients.
c. A trust will be marked as weak in 'Use of Resources' if it has ended the financial year in deficit. Furthermore it will be marked as weak in 'Quality of Services' if it has not met nationally set performance targets.

4. Since April 2007 we have made the following significant improvements which will be a considerable step towards improving its annual health check for 2007-08:
a. YAS has made good progress in infection control using several initiatives including the formation of an Infection Prevention and Control Committee, access to a Communicable Disease Control Consultant, the publication of a booklet about Infection Prevention and Control for all front-line staff and a successful bid for £200,000 from the SHA to use for reducing the risks of Healthcare Associated Infections.
b. YAS has now appointed a Local Security Management Specialist to ensure our staff work and our patients are treated in an environment that is safe and secure.
c. YAS has also now appointed a named professional for safeguarding children.
d. It has developed guidance on data protection, data quality and IT security and a new mandatory e-learning module is to be rolled out to all staff to help raise awareness about the importance of good information governance.

5. What is the annual health check?
In 2005 the Department of Health published "Standards for Better Health". It describes 24 essential or 'core' standards that all healthcare organisations in England that treat NHS patients should be achieving, and 13 developmental standards that they should be working towards achieving in the future.
By assessing compliance against these core standards as part of the annual health check each year, we get an overview of how well each organisation is achieving the general standards of care that the Department of Health requires.
The core standards cover seven areas of activity:

  • safety
  • care environment and amenities
  • clinical and cost effectiveness
  • patient focus
  • accessible and responsive care
  • public health

The annual health check also assesses the services that healthcare organisations provide, paying particular attention to the experiences of children, older people, people with long-term conditions, and people with mental health problems.

The Healthcare Commission was set up as an independent body responsible for reviewing the quality of healthcare and public health in England and Wales. Its role is to:

  • inspect the quality and value for money of healthcare and public health services
  • keep patients informed with clear and relevant information about the provision of healthcare
  • promote improvements in healthcare and public health.

When assessing an organisation's compliance with core standards, the emphasis of meeting these is not an end in itself. The purpose of the standards is to ensure that healthcare organisations provide the best possible service to patients and the public.

Boards of NHS trusts are responsible for making a self-assessment and public declaration on the extent to which their organisation has met the core standards. These declarations are supplemented with comments from representatives of patients and other partners in the community - such as patient and public involvement forums, local authorities' overview and scrutiny committees, foundation trusts' boards of governors and strategic health authorities.

Checks of these self-declarations are made by the Healthcare Commission against a wide range of surveillance information and are followed up where concerns are identified. Trust boards must satisfy themselves that they are meeting core standards. If they are not, they must take appropriate action.

Produced By: Corporate Communications Department