Annual Report

& Accounts
2022/23
London Ambulance Service Annual Report 2022/23

Contents
 Chair and Chief Executive foreword 4

1. Performance report

 Performance overview 7
 About us: our vision, values and purpose 7
 The year in numbers 10
 The year in awards 12
 The year in pictures 18
 Our strategy 22
 Risks 27
 Performance analysis
 Performance 29
 Emergency preparedness resilience and response 38
 People 40
 Partners 49
 Anti-bribery and anti-slavery statement 51
 Public value 52
 London Ambulance Service charitable fund 56
 ‘Going Concern’ disclosure 57

2. Accountability Report

 Corporate Governance Report 59

– Director’s Report 59
– Statement of accounting officer’s responsibilities 61
– Governance Statement 64
 Remuneration and Staff Report 76

3. Annual Accounts

 Introduction to Annual Accounts 91

 Auditor’s report 96
 Annual Accounts 100
 Annual Report and Accounts compiling 104

London Ambulance Service NHS Trust 3

Chair and Chief Executive

Foreword
A message from our
Chief Executive Daniel Elkeles
and Chairman Andy Trotter

We are delighted to present this year’s Annual Report

– the official overview of how London Ambulance
Service performed during the financial year of 2022/23.
This overview includes a full rundown of the highlights
and challenges of our year, including how we
measured up against key standards of care for Chief Executive Daniel Elkeles Chairman Andy Trotter
ambulance services, how we performed against
financial targets, and the steps we have taken to And it wasn’t just our services that were busy – the NHS
further improve the care we provide to our patients as a whole experienced huge pressures and levels of
and the experience our staff and volunteers have while demand this year, which resulted in long waits to
working for us. handover patient care when our crews arrived at
hospital. In our most challenged months, November
It was another incredibly busy year, and our staff and December, 31,493 operational hours were lost as
worked around the clock to care for the people of we waited to handover patient care. This is the
London in their hour of need. equivalent to a loss of 2,624 ambulance shifts.
We answered more than four million calls (with We are very sorry to anyone who has waited for longer
2,080,022 calls into our 999 services and 2,192,104 calls than they should have for an ambulance response from
into our 111 services), provided care to 995,755 people us, and would like to assure our patients and members
face-to-face, at the scene, and treated more than of the public that we are doing all we can to reduce
175,000 people over the phone. delays and create innovative ways of working with our
health and social care partners to improve our ability to
Behind the scenes, a huge amount of work went into
provide the best possible care to each patient.
keeping our services running smoothly and sustainably
for the long-term future, from launching our most We are particularly proud about the launch of
ambitious recruitment campaign ever to opening a community joint response cars which we run in
brand new 999 call handling centre and education partnership with community providers across 11
centre. boroughs. In the first six months of running we cared
for over 2,500 frail elderly patients, offering a quicker
On top of the busy day job, there were some
and more tailored response than we have managed in
significant incidents that increased pressure on our
the past.
services, as well as large-scale events that brought
millions of additional people to the capital. This in turn Although there were challenges through the year,
meant that our services were much busier. In fact, there were moments of profound pride too. We were
every season of the year brought its own challenges, incredibly humbled to be able to support the
from the heatwave and wildfires during the summer, commemoration events following the sad death of our
to a difficult winter that included increased sickness in longest serving monarch HRH The Queen, and pleased
the community and periods of industrial action that that we could help the million additional visitors to the
affected us and the wider NHS. capital to stay safe while paying their respects.

4 London Ambulance Service NHS Trust

 Annual Report and Accounts 2022/23

We are also proud of the improvements we have been and 60

able to make to our estate, and throughout the year associate
we have invested £30.9 million in improving our ambulance
buildings and facilities and equipment, and secured practitioners
additional capital to fund new and more participating in our
environmentally-friendly cars and ambulances. programme to
progress towards
Our staff and volunteers remain our greatest asset,
becoming emergency
and we truly want London Ambulance Service to be an
medical technicians. In the
outstanding place to work for everyone. To help us
last year, we reached
achieve that, this year, we began a new programme of
a milestone of 1,000
work to transform our culture and improve the
apprenticeship starters since
working lives of our teams. Known as ‘Our LAS’, more
the introduction of the
than 2,000 members of staff and volunteers had their
Apprenticeship Levy in 2017.
say about what was good and bad about a working
day with us and what behaviours we should value and In partnership with the University
encourage. The result is a new set of values – designed of Cumbria, we were delighted to offer
by our staff and volunteers, which are now at the a range of apprenticeship opportunities
heart of all we do. Under the Our LAS programme, we to help individuals progress their careers.
took 650 of our line managers through a ‘leading with In fact, we were once again named the top
respect’ training programme and have improved the NHS employer for apprenticeships in the
way we interview and recruit staff and the method we country in the Department for Education’s Top
use for appraisals. 100 Apprenticeship Employers 2022. We were
also named Apprentice Employer of the Year at
Our LAS workshops also showed us that we needed to
The AAC Apprenticeship Awards and Apprenticeship
focus on teamwork and fostering those good
Employer of the Year at the Mayor of London Adult
relationships between colleagues, resulting in a new
Learning Awards. The Apprenticeship programmes
initiative called teams-based working, whereby
had their first ever full inspection from Ofsted and
colleagues choose the rota pattern they want,
received a successful outcome of ‘Good’ overall and in
managers and their teams work the same shifts
all graded areas.
together and we end the historic practice of relief
where new recruits can work anywhere rather than We also managed to provide care to our sickest
joining a fixed team. This transformation encourages patients during several periods of industrial
meaningful contact that will benefit staff, managers action. This required an extraordinary amount
and patients. The introduction of teams-based of planning and teamwork given the high
working to improve the working environment and number of staff who are union members at
culture for ambulance crews so there is more LAS. We very much hope that by the time
meaningful contact with managers, new rotas that this report is published the disputes
deliver a better work life balance and allocated time across the NHS will have been
for professional development. We plan to have this resolved.
approach rolled out across all our 999 ambulance
teams by autumn 2023. Providing emergency and urgent
care to the millions of people
This year also marked the time of LAS becoming an who live and work in London
accredited London Living Wage employer as we is an enormous task, but we
welcomed our cleaning and Make Ready teams to the are proud to do it. We
London Ambulance Service family. This was a proud hope you enjoy reading
moment for us, which truly reflected our new values this year’s Annual
of Caring, Respect and Teamwork. We also took the Report.
decision to bring our cleaning team in-house, which
came into effect on 1 April 2023.

We have had 215 new apprenticeship starters in the

last year. This includes 140 emergency medical
technicians taking part in the Paramedic Degree Level
6 programme to become a registered paramedic,
London Ambulance Service NHS Trust 5
 1. Performance report

1. Performance Report

Performance overview
This section provides an overview of who we are and what we do; a review of our achievements and
performance in 2022/23; and a summary of our objectives for the coming financial year.

About us
London Ambulance Service is the only London-wide appropriate care service to meet their needs through
acute healthcare provider, meaning we are one of the NHS 111 and the integrated clinical assessment service.
largest and busiest ambulance services in the world. We are now the lead provider of this service in three
We have around 10,000 people working and of the five care systems in London, with a key role to
volunteering with us, and we serve a growing and play in the remaining two. Thanks to our specialist,
ageing population of some nine million people. As the tailored approach to providing care, we now take
ambulance service for the capital, we are proud to fewer than half of our patients to hospital and work
support large-scale public events such as the with our health and care partners across London to
Platinum Jubilee, natural events (such as last develop effective care pathways to help make that
year’s heatwave and wildfires) and respond to a happen.
complex array of major incidents.
Our other work includes:
We respond to more 999 and 111 calls than
any other ambulance service in the  Planning for and responding to major and
country, and operate a number of significant incidents (with our partners)
specialist teams to provide tailored care to  Providing paramedics to work for London’s Air
people’s needs – this includes our mental Ambulance
health joint response cars (where a
 Educating the public in life-saving skills and use
paramedic is teamed with a mental health
of public access defibrillators
practitioner) and our joint community
response teams who care for frail older  Engaging with NHS partners, local authorities
people in their own homes. We attend more and the Mayor to encourage a healthier
than 2,700 patients presenting with emergencies population and a safer London
every day. Our staff, volunteers, patients and local  Coordinating Adult Critical Care Emergency
communities are at the heart of what we do, and Support Service (ACCESS), a pioneering specialist
we involve them in helping to shape our work and the ambulance service for transporting critically ill
care we provide. patients between hospitals that has been
adopted as the model for the whole of London
As a large NHS organisation service caring for the
whole of London, we are responsible for ensuring our  Finding hospital beds for seriously ill patients
services and employment practices are accessible and and ensuring their safe transfer to the best
inclusive for the diverse communities we serve and the place for care
people we employ or who volunteer with us. We
continue to improve the emergency and urgent care
we provide for our patients through 999 and 111, as
well as playing a vital role in supporting health and
wellbeing in London – this includes tackling health
inequalities, offering great jobs and career
opportunities, and delivering on our green agenda.

A growing part of our work is supporting patients

who need non-emergency care (also known as urgent
care) and ensuring patients access the most

London Ambulance Service NHS Trust 7

Our values
This year, we began a large programme of work to
transform our culture and improve the working lives
of our vital teams. Known as ‘Our LAS’, more than
2,000 members of staff and volunteers had their say
about what was good and bad about a working day
with us and what behaviours we should value and
encourage.

The result is a set of values and behaviours, designed

by our staff, which we put into practice every day.
Together, we put Caring, Respect and Teamwork at
the heart of everything we do for Londoners.
 The year in

numbers
2,080,022
175,070
Number
of patients
Number treated over
the phone
of 999 calls –
with 72,022 of
those related to
mental health
issues

£0.4m Raised
through
our charity

Number
of patients
seen – 52,037
995,766
related to
mental health
issues

10 London Ambulance Service NHS Trust

 1. Performance report

62,560,093
Our social
media posts
were seen

Number

1,313
of thank
you letters
received

32%
Recruits
from BME
background

2,192,104 Number
of 111
calls

1,600
Number
of people
recruited

London Ambulance Service NHS Trust 11

 The year in
awards &
achievements
This section includes a roundup of all the awards won
from April 2022 - March 2023.

 June 2022

QAM medal – Richard Webb-Stevens

London lifesaver awards
 April 2022

10 reconditioned ambulances
filled with medical supplies are
now in use on the streets of
Ukraine after LAS volunteers
delivered them to Ukraine.

 May 2022

The Prince’s Trust National

Marvel Rising Star Award-
Tania Makwana
Long service ceremony

12 London Ambulance Service NHS Trust

 1. Performance report

 July 2022

LAS Apprenticeship scheme – Top

100 Apprenticeship Employers

 Auguest 2022

Top NHS employers for

apprenticeships

 September 2022

Freedom of the City of London

award- Nigel Flanagan
Volunteers wining ALF Team of the
Year award.

 October 2022

Letter from the Mayor thanking

LAS for their work during period
of national mourning
Mayor of London Adult Learning
Awards

London Ambulance Service NHS Trust 13

Chief Executive's Award
1. Performance report

The year in
awards &
achievements
 November 2022

Cycle response team for Zero

Emissions Innovations, finalist at
HSJ awards

 January 2023

Letter of thanks from Prime Minister

Rishi Sunak commending colleagues
for attending to a patient at No.10
Downing Street. In his letter, Mr Sunak
noted the professionalism shown after
a member of their staff fell ill.

 December 2022  February 2023

Wellbeing team – Healthcare People Officially accredited Living Wage employer.
Management Association (HPMA) The accreditation by the Living Wage
Excellence in People Awards Campaign means every member of our staff –
Fleet Manager of the Year awards – including those in our control rooms and
Greenfleet awards those who prepare ambulances to go on the
road – now earns more than the
government’s minimum wage and receives an
hourly minimum rate of £11.95.

 March 2023

The AAC
Apprenticeship Awards

London Ambulance Service NHS Trust 17

 1. Performance report

This year in

pictures

March 2023

February 2023

January 2023

18 London Ambulance Service NHS Trust

 1. Performance report

December 2022

November 2022

October 2022

London Ambulance Service NHS Trust 19

 1. Performance report

This year in

pictures
July 2022

June 2022

April 2022

20 London Ambulance Service NHS Trust

 1. Performance report

May 2022

London Ambulance Service NHS Trust 21

 Our strategy
The Trust’s 2018-2023 strategy described how we
would move towards our vision to become a world-
class ambulance service at the heart of urgent and
emergency care provision in London. This detailed
plan, which was supported by a clinical strategy, set
out our aspiration of developing and embedding
urgent and emergency care pathways, delivering more
care on scene, and avoiding taking patients to hospital
when that was not the most appropriate place for the
patient to receive care.

Since 2018, we have transformed as an organisation

and the Trust is now faced with new challenges and
opportunities which have far-reaching implications for
the way we operate. These are:

 The long-term health, social and economic

impacts of the COVID-19 pandemic.
 Creating new ways of working and organisations to
collaborating with our NHS partners. help us conduct public engagement on
our behalf. In all, 26 Healthwatches took up this offer,
 The development of new models of delivering using their experience among local communities to
place-based care. involve over 2,100 people across London.
 Using our unique pan-London position to
contribute to improving the capital’s health and We also engaged with over 60 organisations across
tackling health inequalities. the five Integrated Care Systems (ICS) we work within,
meeting with over 300 health and care leaders to
 New targets to achieve carbon net-zero by 2040 gather their views. Alongside our external
(relating to the emissions that we directly engagement we ran a staff engagement programme,
control). conducting one-to-one interviews with over 500
To help us respond to these challenges, we began people in every part of our organisation, engaging
developing our new strategy to set a clear direction some 500 people through an online platform and
for the urgent and emergency care we provide, whilst involving some 360 people in leadership events.
laying out bold ambitions to develop the capital by A summary of the findings from our engagement
supporting the health of Londoners, offering great activities was published on our website, and we also
jobs and career opportunities for local people, looking encouraged local Healthwatches to share their
after and developing our current workforce, findings locally.
delivering on our green agenda and being an anchor
The new strategy will be launched in the new financial
institution.
year, with three mission statements underpinning our
strategic goals:
Developing our new strategy for 2023/2028
One of the core principles of developing our new  Delivering outstanding emergency and urgent
long-term strategy is co-development and co- care wherever and whenever needed.
production with staff, patients, health and social care  Becoming an increasingly inclusive, well-led and
partners, and the public. As a result, capturing the highly skilled organisation people are proud to
views and experiences of people formed an important work for.
piece of our work in 2022/23.
 Using our unique pan-London position to
In order to accurately reflect the patients’ view in this contribute to improving the health of the
vital work, we commissioned London’s 33 Healthwatch capital.

22 London Ambulance Service NHS Trust

 1. Performance report

Reflecting on the last year, and closing our  We aimed to work with London’s other public
2018-2023 strategy services to support improvements in patient
outcomes and experience while also improving
The vision set out in the Trust Strategy for 2018-2023 public value. We reaffirmed our commitment to
was to become a world-class ambulance service, and working ever closer alongside other emergency
we have made significant progress in a number of services and London’s wider stakeholder
strategic areas. Those strategic projects include: community during the five years of the Strategy.
Consequently, we saw the introduction of
 When the strategy was agreed in 2018, our
paramedics into Primary Care Networks (PCN),
ambition was to reduce conveyances to
Urgent community responses developed with
emergency departments by 10% from 63% to
ICSs, and collaborations in periods of high
just above 53%. This target was adjusted in
demand with our partners in the Metropolitan
2019 in response to the recommendations from
Police and London Fire Brigade.
the Carter Review. In spite of challenges from
the COVID-19 pandemic, we now convey less The last year was especially important for this,
than 50% of our patients to hospital, instead as we saw a further increase in partnership
treating them at the scene, referring them to working through periods of industrial action,
other health and social care providers, or major events such as the Queen’s funeral and
providing expert medical advice over the phone. engagement from 300 leaders across 60
organisations to co-develop the next trust
 In the last year we have maintained this low
strategy.
conveyance level, and worked towards safely
reducing it further by
working with healthcare
partners to develop
pathways for patients to
access urgent and
emergency care without
having to go to the
emergency department.
 Since November 2013 we
have provided a 111 service
(in South East London), and
expanded into North East
London (November 2018).
In the last five years, we
have been awarded full or
partial contracts in all
remaining areas of London,
most recently this year in
North Central, making us a
key player in the delivery
of urgent care across
London.
 We now have the same
number of contacts into
111 as we do 999, and are
working on integrating
them further, so that there
is a seamless transfer of
patients and their
information between the
two services.

London Ambulance Service NHS Trust 23

 Providing patients with the most appropriate
response tailored to their needs ensures
high-quality care and helps to reduce pressures
on emergency departments across London,
which in turn allows us to respond to emergency
calls more quickly. To meet this need, we have a
number of specialist teams operating across the
capital, including our mental health joint
response cars and our joint community response
cars. In addition we have continued to expand
our more highly skilled paramedics with an
increased number of advanced paramedics
(critical care and urgent
care) and first contact
paramedics. Providing
outstanding
patient
care

Mental
health joint
response
Our mental health eases pressure on
joint response cars hospitals and the wider cars
pair a mental health NHS, but importantly
professional with a helps patients experiencing a
paramedic to provide a mental health crisis to avoid busy emergency
specialist response to patients departments that may not be conducive to their
who are experiencing a mental health crisis. recovery, particularly in cases where the patient is
vulnerable. Since launching as a single car in south
By joining these clinicians, patients can receive both
east London in November 2018, the scheme has
a physical and mental health assessment from the
been expanded and has responded to and
team. This is particularly important given that nearly
supported more than 17,000 patients across London.
half of patients with a mental health condition also
have a long-term physical health condition. Ensuring equity of access to care is a key focus
within LAS, and thanks to the expertise of the LAS
When responding to a patient, the team’s
team members, the proportion of these often
paramedic is able to assess and manage their
complex patients who need to be taken to hospital
physical health needs. The mental health
emergency departments has been reduced. Just 16%
professional can assess the issues that are affecting
of patients experiencing a mental health crisis who
the patient’s mental health, delivering interventions
have been evaluated by the mental health joint
to support their needs and referring them to
response car team have needed to be taken to an
appropriate mental health services if required.
emergency department. In comparison, around 50%
Through this combined team, patients get the care of mental health patients who are assessed by
they need in their home and through local frontline ambulance crews are conveyed to an
community services, avoiding unnecessary visits to emergency department.
hospital emergency departments. This not only

24 London Ambulance Service NHS Trust

 1. Performance report

Community health joint response cars see an Advanced

experienced paramedic working with Paramedic
community nurses across London Our Advanced Practitioner Urgent
Paramedic Care (APP-UC)
responding to elderly and frail
patients. Uniting the skill sets of Community Practitioner Urgent
programme
these two professional clinical health joint Care (APP-UC)
groups delivers bespoke patient- response programme has been instrumental in
centred assessments, treatment and cars helping people avoid unnecessary
follow-up plans for patients in their hospital conveyances and receive the
own homes. support they need at home, with a
dedicated programme
The programme is delivering faster responses
for providing this care
to patients and reducing unnecessary
to older people. The
conveyances to emergency departments. Older
advanced clinical
and frail patients often benefit from a
skills of the APP-
specialist response because if they are
UC team allows
admitted to hospital they can experience a
them to treat
decline in their physical mobility and can be at
more patients
greater risk of deterioration. Through this
in their own
new model, the teams improve the patient
home, while
experience by helping people who want to be
their work
looked after at home and not be taken to a
monitoring 999
busy emergency department, which we know
calls coming into LAS
improves their overall outcomes and safety.
helps ensure that our
Working with community health providers, crews are being effectively deployed
LAS first launched the programme as a pilot of so patients are getting the right
three cars in south west London in October response for their needs.
2022. Following successful results and
improved services for patients, LAS expanded
the scheme to north east and north central
London. There are now eight community
response cars operating from 8am to 8pm in
these areas every day.
This year we were pleased to
Since launching as a pilot scheme, the First contact recruit additional First Contact
community response teams have responded to paramedics Paramedics, who work in
more than 1,400 older and frail patients in primary care alongside GPs and
south west London, around 350 patients in help manage routine or urgent
north central London and around 550 patients appointments, telephone triage
in north east London. (assessment of urgency of illness or injury) and home
The complex nature of older and frail patients visits. The first cohort of LAS staff have completed
mean that typically around 70% of these types their first contact development programme and
of patients would have been conveyed to qualification, and we have committed to expand
hospital if an ambulance attended. However, training posts in collaboration with GP practices.
the expertise in the
community health
joint response cars
means just 25% of
the patients the
teams attended
were taken to
hospital.

London Ambulance Service NHS Trust 25

 Recruiting
for the
To keep pace with the increasing
future
demand for our services, we launched our
most ambitious recruitment programme in
May 2022 and had recruited over 1,600 new
employees by the end of March 2023. We are delighted and proud
to have been able to recruit over 900 frontline ambulance staff and Our estates
almost 400 call handling staff across our 999 and 111 services vision
this year, as well as insourcing two key services, Make Ready – details how we are
the team of staff who work around the clock to re-stock, re-
fuel and deep clean ambulances at the end of a busy shift, Making the working to transform
our estate to better
and our Cleaning Services. most of our serve our patients
We have continued our focus on buildings and and to improve our
recruiting and training more clinicians, estates staff and volunteers’
call handlers and dispatch staff for our places of work.
emergency operations centres, ensuring The vision includes
patients waiting for an ambulance are kept proposals to refurbish existing
as safe as possible and our sickest patients stations and build new
are prioritised. Looking ahead, we are ambulance stations in the
planning to recruit over 1,400 frontline staff parts of London where our
as part of our 2023-24 recruitment programme estate is outdated and where
to meet levels of demand in London. sites need to be located to
help us deliver the best
response times for Londoners.
In 2022/23 we began rolling out new electric By being smarter with how
vehicles following the announcement of £16.6 we plan and run our estate,
million initial investment to purchase 225 new Making our we hope to use our space and
time more efficiently,
vehicles, including 40 new ambulances that are fleet greener
lighter and produce lower emissions than our whether this is where our
current vehicles, as well as 42 electric fast response ambulance crews start and
cars and three electric motorcycles. end their shifts or delivering
state of the art training.
The first of our 225 new greener vehicles are already in use, including
all-electric motorbikes and fast response cars and lighter emergency In 2022/2023 we began work
ambulances. The Trust is the first service to use electric motorbikes to to relocate our 111 call centre
respond to emergency calls. based in Croydon into a
modern facility in the town
Later this year we are expecting to take delivery of the first of four
centre which will have space
fully electric ambulances in the country, alongside additional electric
for a third education centre,
motorcycles. We now have enough greener ambulances and cars
enabling us to have a training
being manufactured for us that we will be fully compliant with ULEZ
facility in south London to
(Ultra Low Emission Zone) by the end of 2023. We will also be
complement our existing
investing in charging infrastructure across our sites and ambulance
centres in west London and
stations, as well as recruiting new mechanics and upskilling current
east London. We also began
mechanics to help maintain its growing modern fleet, bringing the
looking at plans to convert
total investment in this area to more than £30 million.
our former emergency
Having cleaner and greener vehicles is extremely important in operations centre in Bow into
improving air quality – not just for our people and our a new ambulance station for
patients – but also for the health of our communities across the Tower Hamlets area. In
London. Furthermore, these modern vehicles will also have addition, we opened a rebuilt
benefits for our crews and our patients, with features such ambulance station in Ponders
as a powered lift for stretchers, and new decorations inside End and further station
some of the ambulances to help soothe worried patients. refurbishments are planned
for later this year.
26 London Ambulance Service NHS Trust
 1. Performance report

Risks and challenges to the

service we provide
During 2022/23, we identified the following strategic we have maintained our infection control and
risks: prevention oversight to keep our patients and staff
Demand for services exceeding the available safe, the increase in wider infections was not
unexpected given the lack of exposure over the past
resources.
few years during lockdown and mandated mask
During the year we identified risks associated with wearing.
increased demand and long handover times which led
to delays in ambulances being dispatched, patients Continuing to deliver high-quality care to
waiting too long for assistance and performance patients during a period of disruption to
targets being missed. Throughout the financial year,
service due to industrial action as a result of
we put a number of measures in place to help
mitigate these risks, including working more closely
the pay dispute between the unions and the
with London hospitals to release our crews from government.
handover queues as quickly as possible, changing our Following the ballots for national industrial action, a
processes in order to reduce calls from Met police, and series of strikes took place leading to a reduction in
implementing alternative ways of assisting patients workforce availability to respond to calls, provide
with more bespoke offers. health advice, dispatch ambulances and crew
ambulances including specialist responders. We were
In the final quarter of this year (in the new calendar
supported by the wider NHS to ensure we could
year), we began to see the impact of our ambitious
maintain a safe service and worked closely with our
recruitment plan, and were able to put an additional
unions to agree a continuation of life and limb cover.
30-40 ambulances on the road every day (this equates
We hope the dispute will be resolved by the
to 1000 hours of ambulance crew time). This has
government pay offer.
resulted in an improvement to our Category 1 and 2
response times.
Challenge of recruiting and retaining a
Despite the improving picture, we continue to skilled workforce, maintaining the welfare
monitor and review any delays to patient care and of staff and promoting diversity.
patient handover at hospital. The Category 2
Despite our successes in recruiting a record number of
Performance Improvement Plan, which includes the
people, we have still carried vacancies throughout the
national Category 2 segmentation pilot, continues to
year despite an ambitious recruitment programme.
ensure patients are receiving the right care in the
The Trust is mitigating this risk through a UK graduate
right place and allows us to dispatch crews to our
recruitment programme, having an international
sickest and most seriously injured patients as quickly as
recruitment partner in place, establishing recruitment
possible.
and retention programmes and working with
providers to ensure that the ambulance service
Continuing to deliver high-quality care to
remains the employer of choice for paramedics. In
patients against the impact of COVID-19 addition, where alternative healthcare professionals
and other infections, whilst maintaining can undertake roles, we are welcoming colleagues
the safety of staff and the public. from other professions to broaden our skill base.

As a result of decreased infection rates and The Trust has developed a wellbeing strategy in line
vaccination roll-out, there has been a marked with current government recommendations and
reduction in demand as a result of COVID-19 during guidance, which includes projects and programmes
the course of this year. We have, however, seen which aim to raise the health and wellbeing of our
demand spikes associated with other infections such as staff and, as a result, our organisation and our
Streptococcus A, influenza and norovirus. Although
London Ambulance Service NHS Trust 27
 patients. Our award-winning LAS Wellbeing Hub has
also been set up to support staff (seven days a week)
with both physical and mental health support.

Because the diversity of our staffing profile is not

representative of London, our ability to deliver a more
inclusive service may be diminished. Recruitment
campaigns are not attracting diverse applicants in
sufficient numbers, mainly caused by the fact the
paramedic education courses and training (also known
as a pipeline) lacks diversity. The Board has agreed an
action plan and a committee charged with overseeing
its implementation has been set up.

The potential for failure in IT systems and

disruption through cyber-attacks.
Over the last three years the Trust has invested over
£17 million in technology, not just refreshing
hardware and software but also embarking on a
massive improvement programme that has seen nearly
all the Trust’s operational and corporate IT
infrastructure upgraded and moved to purpose-built
data centres, improving the resilience of the technical
infrastructure and establishing a technology
foundation from which LAS can develop future digital
products and services.

Cleric is now the Trust’s computer-aided dispatch

system, and with successful failover testing, we are
making preparations to replace legacy radio and
mobile data systems.

We have a programme to replace the existing Mobile

Data Terminals (MDTs) in trust emergency vehicles –
these data terminals communicate information
between the computer-aided dispatch system to our
ambulances. The national rollout of radio and mobile
data systems to all Trusts has been delayed, but the
Trust has a legacy system that is no longer available to
purchase, and devices are reaching the end of their
economic life. It is unlikely that the full national
system will be available in time for this situation not
to become a major issue for the Trust and therefore an
interim system to bridge the period is a necessity.

We continue to mitigate this threat through technical

solutions and utilising support from NHS England. The
Trust will continue to address the ongoing challenges
in mitigating these risks, for example, through the
replacement of our computer-aided dispatch system to
help mitigate cyber and resilience risk.

28 London Ambulance Service NHS Trust

 1. Performance report

Performance analysis
We are absolutely committed to providing our patients with great care in a timely way, and work to a number
of national standards in order to measure our performance.

Ambulance Response Programme

The Ambulance Response Programme sets the performance standards for all ambulance trusts in the UK, and
uses the following definitions:

Target average
Response
response time

An immediate response to a life-threatening condition, such as

Category 1 cardiac or respiratory arrest 7 minutes

A serious condition, such as stroke or chest pain, which may

Category 2 require rapid assessment and/or urgent transport 18 minutes

An urgent problem, such as an uncomplicated diabetic issue,

Category 3 which requires treatment and transport to an acute setting 2 hours

A non-urgent problem, such as stable clinical cases, which

Category 4 requires transportation to a hospital ward or clinic 3 hours

How we performed pandemic before moving into a busy summer of major

events, including millions of additional visitors to the
2022/23* capital for the Platinum Jubilee and, sadly, the death
of Her Majesty The Queen.
Response time Incidents (n) During the summer months, we also experienced
extreme weather, which had an impact on the health
Category 1 00:08:08 139,125 of the capital. As winter set in, like the majority of
NHS services, we were under increased sustained
pressure responding to the ongoing issue of COVID-19
Category 2 00:47:40 622,311 and a surge in flu cases as well as the usual seasonal
viral illnesses and an outbreak of Streptococcus A in
children. We also had to contend with and plan for
Category 3 01:41:03 181,276 national ambulance service industrial action,
experiencing four 12 hour periods of industrial action
with 90% of our ambulance staff going on strike.

Category 4 07:29:50 9,272 The implementation of Resource Escalation Action

Plan (REAP) Level 4 was triggered during periods of
sustained high demand. REAP 4 allows us to put
* 2022/23 Response Time Performance excludes Oct’22 and increased focus on responding to and caring for
Nov’22 data. Please see the Annual Governance Statement patients by mobilising additional resource and
for further explanation. working in different ways. Although it is only ever
meant to be a temporary way of managing demand,
Responding to patients
sustained pressure meant we found ourselves
The past year has been extremely challenging for our spending protracted periods of the year operating at
111 and 999 services. We started the year at the most this level.
severe level of pressure for ambulance services,
known as REAP (Resource Escalation Action Plan) level Demand increased further during two periods of
4, coping with the ongoing effects of the COVID-19 unusually hot weather – the most severe being in July
when we received 13,400 calls to 999 – this equates to

London Ambulance Service NHS Trust 29

 one call every 13 seconds. This busy period also saw above a mean of 90 minutes.
wildfires on 19 July and a number of high-profile
In early January 2023, NHS England asked London
events across the capital, all of which saw us closely
hospitals to support the timely handover of patient
collaborating with our emergency service and local
care and the release of our crews within a maximum
authority partners. Across the Platinum Jubilee
of 45 minutes when it was safe and appropriate to do
weekend and Pride in London parade in July, our
so. With support from the five Integrated Care
teams worked hard to ensure a smooth response to
Systems in the capital and all London hospital trusts,
these important events as hundreds of thousands of
we began to see a significant improvement in
visitors came to the capital.
handover delays and a reduction in the number of
times cohorting was required at some hospitals.
As the nation paid their respects to Her Majesty The
Queen, our staff and volunteers helped ensure Working in collaboration with our health and social
Londoners got the care they needed over this historic care partners across London, we continued to
occasion. With 250,000 people attending the Queen’s innovate to manage patient care and reduce handover
lying-in-state and an estimated one million arriving delays by setting up more alternative care pathways to
for the funeral, the capital was very busy. We put ensure every patient received the right care in the
plans in place to ensure we could provide the right place. Based on the successes of schemes such as
necessary care, including a daily surge of up to 300 our mental health response cars, we launched an
additional staff across our 999 control rooms and Urgent Community Response (UCR) car pilot in south
teams on foot in crowded areas to manage the west London with paramedics working with
increased demand. More than 1,000 staff overall were community nurses to care for elderly and frail patients
involved in our response and colleagues from in their homes rather than taking them to hospital in
neighbouring ambulance services including, South an ambulance.
Coast Ambulance Service were also involved in
Our teams and patients have also benefited from the
supporting the events and caring for the large crowds.
Service being an early adopter of NHS England’s
The Service worked with St John Ambulance, treating
Category 2 segmentation pilot, which sees our
more than 2,000 people who were in the city for the
clinicians assessing appropriate calls to check whether
lying-in-state and the funeral, and taking 240 of them
these patients need to be prioritised for an ambulance
to hospital. Our teams across the capital also remained
or whether they could be treated more quickly
very busy, with the service taking around 5,500 999
elsewhere. This ensures that those who are most in
calls each day.
need receive the fastest response. Out of the calls
receiving this assessment, 40% of patients have been
Over a difficult winter period, we implemented a
supported to access a more appropriate healthcare
number of initiatives to make sure we were getting to
pathway or received self-care advice from one of our
people who needed us as quickly as possible. This then
clinicians. The number of patients we can clinically
meant that we were able to maintain a good level of
assess will increase over time as we build up the team
patient care despite the challenges of meeting
of senior clinicians able to undertake this work. The
performance targets against national standards. The
success of this pilot meant the measure has now been
response was led by our Deputy Chief Executives’ team
introduced to ambulance services across the country.
which ensured there was strong clinical and
operational focus. During the four periods of industrial action that
directly involved our staff, the Service worked
Handover delays at hospitals remained a significant incredibly hard to provide a rapid response to patients
challenge throughout the year, with our crews facing in a life or limb threatening emergency. This was only
delays when handing over patient care to hospital possible due to the goodwill and help of senior
emergency departments. In response, we clinicians from elsewhere in the NHS, the support of
implemented ‘cohorting’ care, where selected crews the military, London Fire Brigade, and the
stay with a number of patients in emergency Metropolitan Police. We were also grateful for the
departments to free up colleagues to go back on the support of the public who continued to use the 999
road. This helped to improve our Category 2 response service wisely. Although we saw a reduction in
time, and we ended the year with an average demand on the first day of industrial action in
response time of 47 minutes (against the standard of December 2022, subsequent industrial action days saw
18 minutes). However, without cohorting in place, our an increase in numbers of calls and incidents on each
Category 2 response would have been consistently occasion.

30 London Ambulance Service NHS Trust

 1. Performance report

In our Emergency Operational Centres (EOC) teams of Within the EOC a group of clinicians work to provide a
Emergency Call Handlers answer 999 calls and send telephone assessment of patients to determine
our vehicles out across London to treat patients. whether they require an emergency ambulance or can
Working in this environment is extremely demanding, be treated over the phone or referred to another
and our teams coped well throughout the year to provider. Every call resolved by the clinical hub is one
maintain patient and public confidence. less call where an ambulance attendance is required
which increases availability and therefore reduces
In June 2022 a purpose-built control room in Newham, delays to patients.
east London, opened following a £9.6 million
investment. The site handles half of the 999 calls that In the past year we continued recruiting additional
come into the Service from across the capital. The new clinicians, enabling us to respond to nearly 175,070
EOC was set up to handle the new computer-aided calls this way and treat our patients successfully and
dispatch system which we launched in September 2022 safely without the need to dispatch an ambulance.
to allow for faster dispatch of ambulances and better This was essential at times of extraordinary demand
integration with national systems and patient records, and equates to 15.0% of 999 calls. We have the
thereby ensuring an improved response for our highest ‘hear and treat’ rates among ambulance trusts
patients. The introduction of this new computer-aided in England and this is an area we will continue to
dispatch system allowed us to identify an issue with develop with other health care providers to ensure
our previous outdated reporting system, which we prompt and efficient health care.
worked hard to rectify quickly.

NHS 111

Measure National target 2020/21 2021/22 2022/23

Total number of calls - 1,639,087 2,224,565 2,192,104

Average calls per day - 5,909 6,095 6,006

Calls answered within 60 seconds 95% 87% 71.7% 48%

Calls abandoned after 30 seconds No more than 5% 2.7% 5.3% 16%

Calls referred to 999*** <10% 8.1% 7.6% 6.8%

London Ambulance Service is one of the largest 111 Fortunately, the extreme levels of demand COVID-19
providers in the country and is acknowledged as one put on our 111 services have eased and our total
of the best performing services for call answering, number of calls in 22-23 was lower than the previous
which allows patients to access urgent care advice. We year. A successful media, social media and stakeholder
now have coverage across London, which gives us the campaign to raise awareness of the NHS 111 online
ability to manage the 111 workload coming into 999 service during periods of industrial action, also led to
more effectively. We continue to build a Clinical fewer calls.
Assessment Service (CAS) with a large multi-
disciplinary clinical workforce to assess and treat However, the service continued to face many
patients calling 111 or 999 to improve care and avoid challenges which impacted our performance. In
sending an ambulance when appropriate. August, a month-long cyber attack resulted in a
national outage of the software system we use to
In 2022/23 we answered 2,192,104 calls to 111, and manage 111 calls. This meant clinical assessments,
our experts referred 6.8% of these calls to 999, well appointment bookings, emergency prescriptions and
below the national average of 11%. Around 9.2% of referrals had to be completed manually, adding
111 calls were referred to alternative care pathways. considerable time to our call handling times.

London Ambulance Service NHS Trust 31

 Call answering was also affected by industrial action Despite the pressures on the Service, we made
over the winter. Meanwhile an outbreak of significant progress in delivering the ambitions of our
Streptococcus A (strep A) over the same period led to Clinical Strategy (2016-2023) to ensure every patient
a significant increase in call volume, similar to the receives the right care in the right place. A key focus
sharp rise in demand we saw during the pandemic. To has been aimed at reducing the number of patients
help manage demand and redirect patients to the who are conveyed to the emergency department who
most appropriate place for help NHS England could have been cared for closer to home. This
activated a recorded message which contributed to an includes our work with Barts Health NHS Trust to
increase in our call abandonment rate. Unfortunately, provide access to remote telephone hub and ‘virtual
the Strep A outbreak also caused high levels of consulting rooms’ known as the Remote Emergency
sickness for our staff at this time which further Access Coordination Hub (REACH) which offers
challenged the service. alternative emergency care provision for patients that
have either been referred to attend the emergency
Patient care and quality department by the 111 Clinical Assessment Service or
where a London Ambulance Service paramedic crew is
Maintaining of safety for our patients and people
intending to convey the patient to the emergency
remains our top priority, and we continue to use well
department. The average number of calls to REACH is
governed processes, including the dynamic use of our
29 per day, with a conveyance rate of 21.7%.
clinical escalation plans, to ensure the best possible
outcome for all patients.
Linking in with NHS England's national approach to
reducing health inequalities, we have been working
We are aware that during periods of sustained
this year to better understand and identify the health
pressure that some of our patients waited for longer
and social inequalities that exist in London. We have
than the national standards for an ambulance,
been gathering data relating to gender, age and
particularly those patients with non-life threatening
ethnicity, broken down by borough, to improve the
conditions. We apologise to those people who waited
identification of unrecognised hypertension, as well as
longer than we would have wanted for an ambulance
continuing to improve the care we provide to our
response and would like to assure people that we
patients with sickle cell disease and identifying health
continued to take daily clinical safety reviews and
inequalities within pre-hospital maternity care to
ensure that there were clinicians working in our
improve clinical decision making and improve the
Emergency Operations Centres to increase clinical
patients’ experience. We are now currently reviewing
oversight. This meant that patients waiting for an
this data which will help to inform our new clinical
ambulance could be continually monitored, treated
strategy and a health inequalities action plan.
over the phone or managed closer to home with a
Alongside data collection, we have been holding
referral to appropriate community service. By
workshops and learning opportunities for staff to
providing high-quality clinical assessments for our
increase their awareness of how health inequalities
patients who will be better treated closer to home,
can affect access and experience of patient care. Our
we continued to protect our response capacity for
maternity team held several workshops throughout
patients whose care needs required a physical
the year so our frontline staff could learn more about
attendance.
the inequalities faced by black, Asian, deprived and
With multidisciplinary clinical assessment areas in both vulnerable women, and the ways the Trust can
our 999 and 111 teams, patients can be triaged quickly improve care and safety for women and their babies.
and accurately to determine whether they require an The conversations and learnings from these workshops
emergency ambulance or can be treated over the have been captured and will be used to influence our
phone or referred to another provider (such as a GP). maternity care in the future.
Access to patient records, care plans and video
Whilst industrial action undoubtedly had an impact on
consultation provides our clinicians with the
the care delivered to patients, our contingency plans,
information they need to support decision making in
such as the Clinical Safety Cell of senior clinicians (GPs,
order to achieve the best outcomes for patients. The
emergency department consultants and nurse
ability to e-prescribe and access to referrals and direct
specialists based in our call handling centres)
booking via the national directory of services enable
supporting clinical telephone assessments helping to
us to provide the most appropriate care based on
increase referrals to alternative care pathways, NHS
clinical need.
clinicians on ambulances and the enhanced level of

32 London Ambulance Service NHS Trust

senior clinical oversight in all
operational areas helped to keep
patients from harm in very
challenging circumstances. In total,
we were supported by up to 22
external clinicians in the Clinical
Safety Cell, 15 external clinicians on
ambulances and 65 military
personnel who were available for
the period of each strike.

During the period of industrial

action patients who required a face-
to-face response were clinically
assessed and assigned to an EMR 1
(meeting ‘life or limb’ derogation or
a call clinically reviewed as
immediately life-threatening,
requiring the nearest suitable
responding vehicle including a
striking crew providing life and limb
cover from a picket line) or EMR 2
(a call clinically reviewed as requiring
a face-to-face response outside of
derogations). Patients with
conditions that did not require
immediate attendance by an
ambulance were either referred to
alternative care pathways,
transported by alternative means or
given self-care advice.

The Clinical and Quality Directorates

continued to undertake a daily
review of the incidents reported to
ensure any of note were escalated
and there is early identification of
themes and learning.

In the past year, as a result of

sustained demand pressures, a
number of potential harm incidents
were reported by staff as a
consequence of delayed responses.
As an early adopter of the Patient
Safety Incident Response Framework,
the Trust was well placed to identify
themes and drive changes in practice
to prioritise patient safety.

Weekly meetings have also been

held to discuss potential incidents led
by the Chief Paramedic and Quality
Officer and Chief Medical Officer.
 Quality Account robust for the coming year. For the 2022/23 financial
year, we set three themed quality priorities with 12
supporting objectives and associated Key Performance
Every year, the Trust sets specific quality priorities Indicators (KPIs). We have made progress against all
which are reported in the annual Quality Account. priorities, completing six objectives in the year, with
These priorities are identified in consultation with further work continuing on the remaining objectives
both internal and external stakeholders, including our going into the next financial year. Our progress is
Public and Patients Council, as well as sources of outlined in detail in our 2022/23 Quality Account.
quality intelligence to ensure they are relevant and

34 London Ambulance Service NHS Trust

 1. Performance report

Patient Care – Overview Status

Improve care for patients presenting with out of hospital cardiac arrest
1 and / or ST-Elevation Myocardial Infarction

Improve the identification and referral of unrecognised hypertension

2 responding to the rise in incidents of cardiovascular disease and stroke and
linking with Core20PLUS5 - an approach to reducing healthcare inequalities.

3 Develop a Health Inequalities Action Plan

Improve our compliance with infection prevention and control

4 measures

Patient, Family & Carer – Overview Status

5 Deliver the Right Care, Right Now Programme

Improve how the Trust triangulates and shares learning from incidents,
6 complaints, claims and excellence

Improve against response and call answering/ call-back indicators,

7 reducing avoidable harm and poor experience due to delays

Staff Engagement and Support – Overview Status

Improve access to clinical supervision for all clinicians to improve access

8 to clinical development and progression

Improve access to specialist/ advanced practice opportunities and

9 rotational working

Improve the percentage of staff who feel able to make improvements

10 in their area of work

11 Quality Improvement projects responding to patient’s needs by sector

12 Back to basics: kit and equipment

For the new financial year, we have identified five 5. What matters to our staff, patients and the
quality priorities. In identifying these priorities, we communities we serve
have considered:
Our five priorities for 2023/24 are:
1. Our progress against the 2022/23 quality priorities
1. Cardiac arrest management
2. Triangulation of data sources
2. Care after a fall
3. The new Care Quality Commission (CQC) strategy
3. Hear and treat consultations
and framework
4. Reducing delays
4. Sources of quality intelligence and performance
metrics, business plans and our strategic intentions 5. Infection Prevention and Control

London Ambulance Service NHS Trust 35

 1. Performance report

Safeguarding understanding. A drive

to improve education
We have continued to maintain and improve our
and communications
support to children and those at risk of abuse and
on sexual safety
neglect during the year. In 2022/23 our staff have
amongst the Trust has
raised the following number of safeguarding referrals
been implemented
and care concerns:
along with updated
 Children 14,009 and strengthened
guidance relating to
 Adult safeguarding 8,577
professional
 Adult care concerns 10,416 standards.

Safeguarding activity and compliance has continued The Trust has

to increase throughout the year with the addition of a undertaken
new safeguarding specialist for our Integrated Urgent considerable work
Care teams, ensuring all areas of the Trust have a and engagement
named local contact for safeguarding. with the learning disability and autistic
community, establishing a Learning Disability and
We have continued to train our staff in safeguarding,
Autistic Patient and Public group which sits as a
which has included using e-learning and virtual
sub-group of the LAS Patient and Public Council. The
training sessions delivered by our safeguarding
group has recently produced a number of accessible
specialist. We also provide bespoke Trust Board
and online digital resources for those with a learning
safeguarding training.
disability and autistic people to help them understand
what happens when they call an ambulance.
The Trust exceeded the 85% safeguarding training
compliance in all areas except Level 2- which covers
We submitted 73 reports to the Learning Disabilities
our call taking staff. A recovery plan was put in place
Mortality Review (LeDeR) and as a result of the actions
in December 2022 to further improve Level 2
have delivered bespoke education and training to a
compliance and we are making good progress to
range of staff groups.
achieve our 85% target.
The Trust undertakes Disclosure and Barring Checks on
Training Trust-wide figures eligible staff and the Trust is 99.9% compliant with
this. From 2023 the Trust is undertaking a full recheck
Safeguarding Level 1 92.08%
and requiring staff to sign up to the update service to
Safeguarding Level 2 71.45% improve internal recruitment and DBS checking.
Safeguarding Level 3 91.10%
The Trust raises safeguarding concerns with the local
Prevent level 1 91.70% authority for both children and adults at risk. In
Prevent Level 2 91.12% addition we also report fire safety concerns to the
London Fire Brigade, concerns about radicalisation or
Mental Capacity Act 89.84% extremism to the Metropolitan Police and concerns of
Trust board training 100% involvement with gangs to Redthread, a charity that
supports vulnerable young people in crisis and with
complex needs.
There have been 58 safeguarding issues raised for
staff allegations this financial year of which 41 were
We held our annual Safeguarding Conference in
related to sexual safety concerns and 30 of these were
November titled ‘Think Family’ focusing on topics
staff on staff related. Since the introduction of the
including domestic abuse, maternity safeguarding,
Trust’s Sexual Safety Charter in February 2022, there
online grooming and role of LeDeR reviews.
has been an increased awareness and subsequent
increase in reporting the number of sexual safety The safeguarding team have also met with Integrated
allegations. The Charter sets out our commitment to Care System (ICS) chief nurses, safeguarding & quality
make sure everyone behaves in a way that ensures colleagues to build productive relationships within the
sexual safety and shows our commitment to take any new safeguarding system.
concerns raised seriously with empathy and

London Ambulance Service NHS Trust 37

 Emergency preparedness
resilience and response
(EPRR)
The NHS needs to plan for, and respond to, a wide
range of incidents and emergencies that could affect
health or patient care. Under the Civil Contingencies
Act (2004), NHS organisations and providers of NHS
funded care must show that they can effectively
respond to emergencies and business continuity
incidents while maintaining services to patients.

The NHS England Core Standards for Emergency

Preparedness, Resilience and Response are the
minimum standards which NHS organisations and
providers of NHS funded care must meet. The
purpose of these standards are to:

 Enable health agencies across the country to

share a common approach to EPRR;
 Allow coordination of EPRR activities
according to the organisation’s size and scope;
 Provide a consistent and cohesive framework
for EPRR activities; and
 Inform the organisation’s annual EPRR work
programme.

The standards are reviewed and updated as lessons

are identified from testing, national legislation and
guidance changes and/or as part of the rolling NHS
England governance programme. As part of the
national EPRR assurance process we are required to
assess ourselves against these core standards.

We submitted our self-assessment and evidential

documents to NHS England in September 2022. The
NHS England EPRR team visited our Headquarters on
15th November 2022 to conduct the annual
assurance review, where they confirmed our
compliance ratings against the EPRR core standards
and the interoperable capabilities standards.
Additionally, the team reviewed the Trust against
the 2022 deep dive subject of Shelter and
Evacuation.

Of the 2022 EPPR core standards, we are rated as

fully compliant for all.

Of the 163 interoperable capabilities standards we

were rated as follows:

38 London Ambulance Service NHS Trust

 1. Performance report

We received a green rating for 157 standards and six

received an amber rating, which gave us an overall
rating of substantially complaint for the interoperable
capabilities standards. The six interoperable
capabilities standards amber ratings related to staffing
numbers, data capture surrounding the dispatch
timings of the Hazardous Area Response Team (HART)
and the estate specifications of the Trust’s specialist
capabilities. Our key priorities were identified as
carrying out further work in relation to these six
standards, maintaining 2023 our current level of
compliance and ensuring we update Trust
documentation in line with the development of the
ICSs. For the local evacuation and shelter
arrangements Deep Dive the Trust received a full
complaint rating.

The second Manchester Arena inquiry report was

released on Thursday 3rd November 2022, detailing
the findings and recommendations on the emergency
response to the attack on the 22nd May 2017. The
report detailed 149 recommendations in total, of
which the inquiry team has identified the priority
recommendations for monitoring. Whilst the Trust was
not directly identified within the report, a full review
was undertaken by the Trust to identify lessons,
learning, and relevant actions. We continue to work
with other blue light partners to address those
recommendations relevant to London.

London Ambulance Service NHS Trust 39

 People
London Ambulance Service is a growing team of work and rest in safe and comfortable environments.
multi-skilled people, in a variety of roles, focused on a
single, simple purpose: to save lives. We call ourselves It is essential people feel they can enjoy a meaningful
a family: the family in green. career within London Ambulance Service. We are
constantly looking at ways to attract, develop and
We have more people working for us than ever retain high quality people.
before. Our substantive employment headcount is
7,400 people. However, when you add our agency and We want to ensure we have a motivated workforce
bank staff, contractors, students and volunteers, we who are well-led and inspired by their line managers
have over 10,000 people caring for Londoners. to reach their potential.

On average, our staff stay working for us for eight Our highlights from the past year include:
years but more than a quarter of our team members –  We embedded a new set of values and
almost 2,000 members of staff – have worked for behaviours for our teams through the Our LAS
London Ambulance Service for more than 10 years. programme, as we focussed on making the
Service an exceptional place to work.
Most of our workforce has contact with patients,
including our ambulance crews and call handlers.  The introduction of teams-based working to
However, it takes a whole team working behind the improve the working environment and culture
scenes to ensure all our patients get the right help at for ambulance crews so there is more
the right time. meaningful contact with managers, new rotas
that deliver a better work life balance and
Developing and managing talent allocated time for professional development.

In support of the NHS People Plan and People Promise,  The Service became an accredited London Living
we are developing a more resilient, flexible and Wage employer as we welcomed our cleaning
sustainable service attracting people from diverse and Make Ready teams to the London
backgrounds to deliver our vision of being at the Ambulance Service family.
heart of urgent and emergency care in London,  We celebrated the achievements of our
contributing towards Londoners having healthier exceptional staff and volunteers at our VIP
outcomes. Awards in City Hall.

We have supported the insourcing of two key services  Our apprenticeship programme went from
– Make Ready and Cleaning Services – which both play strength to strength, receiving recognition at
an integral part in ensuring our frontline crews, in multiple national awards ceremonies.
particular, are ready for action and are enabled to  The launch of the Our LAS, Our Leaders
programme has seen more than
163 of our Band 6 and 7
members of staff beginning
further training to develop their
leadership skills.
 A new and simplified appraisal
process has been implemented
with associated training to
encourage regular and effective
conversations throughout the
year between line managers and
their team members.

40 London Ambulance Service NHS Trust

 1. Performance report

Recruitment the Service employs, almost 500 are from Australia

and New Zealand.
The recruitment team continues to work with
frontline and clinical education colleagues to deliver a Each year the service recruits around 500 paramedics,
strong pipeline of registered and non-registered staff half of whom are recruited through apprenticeships
and call handling colleagues. and paramedic science degrees in the UK and half
recruited internationally and from other NHS
Our biggest ever recruitment drive has seen us recruit
organisations.
1,600 new starters since 1 April 2022, including teams
we have bought in-house. This has meant we have Apprenticeships
been able to increase the number of ambulances on
the road by up to 20 to 30 every day. We have had 215 new apprenticeship starters in the
last year. This includes 140 emergency medical
We have continued our focus on recruiting and technicians taking part in the Paramedic Degree Level
training more clinicians, call handlers and dispatch 6 programme to become a registered paramedic, and
staff for our emergency operations centres, ensuring 60 associate ambulance practitioners participating in
patients waiting for an ambulance are kept as safe as our programme to progress towards becoming
possible and our sickest patients are prioritised. emergency medical technicians. In the last year, we
reached a milestone of 1,000 apprenticeship starters
We are proud to have been able to recruit over 750 since the introduction of the Apprenticeship Levy in
frontline ambulance staff and almost 400 call handling 2017.
staff across our 999 and 111 services this year. Looking
ahead, we are hoping to recruit
over 1,400 frontline staff as part
of our 2023-24 recruitment
programme to meet levels of
demand in London.

Our focus on recruiting the best

talent from around the world
continued in 2022/23, with our
recruitment teams leading
campaigns to attract Australian
and New Zealand paramedics to
work in the British capital. These
ambulance crews have similar
skills and level of training to
their counterparts in the UK, so
make ideal additions to the
Service. Of the 2,500 paramedics

London Ambulance Service NHS Trust 41

 In partnership with the University of Cumbria, we from across the organisation to work on the issues
continue to offer a range of apprenticeship which drive higher turnover of staff, including flexible
opportunities to help individuals progress their working and recognition and reward. However, we
careers. The Service has now finalised our frontline recognise further action is still needed and we are
ambulance apprenticeship career pathway, enabling focussing our efforts to ensure staff have access to a
trainees to join London Ambulance Service without package of support and incentives to help them
clinical experience or qualifications and progress via remain in the Service. In particular, we recognise and
an apprenticeship to being a registered paramedic in are working to address challenges around job
four years. satisfaction that were highlighted by teams during
recent periods of industrial action.
London Ambulance Service was again named the top
NHS employer for apprenticeships in the country in As part of our efforts to help our staff build the skills
the Department for Education’s Top 100 they need to progress in their careers, we launched
Apprenticeship Employers 2022. We were also named the Our LAS, Our Leaders programme, with 167
Apprentice Employer of the Year at The AAC people enrolled by the end of the year. This
Apprenticeship Awards and Apprenticeship Employer programme gives our band 6 and 7 line managers a
of the Year at the Mayor of London Adult Learning chance to develop their leadership skills through a
Awards. The Apprenticeship programmes had their NVQ level 6 course provided by Middlesex University,
first ever full inspection from Ofsted and received a working in partnership with our Organisational
successful outcome of ‘Good’ overall and in all graded Development and Talent team. Those taking part will
areas. complete eight modules covering topics including
managing staff, building high-performing teams and
overseeing budgets.

Additional education programmes we introduced

included a new training package in our fleet
workshops and fleet workforce in conjunction with
the Henry Ford Training Academy. This programme
means these team members receive the latest and
most up-to-date training on modern day vehicles. This
Our teams in people and culture also won the award extra level of training has also allowed the banding of
for Outstanding Initiative in Education or Employment roles in this team to be re-evaluated and raised. The
in the East London Community Heroes Awards and a Service also introduced an NHS Master Technician
Recruitment Excellence Award at the National position to make sure our technicians have an
Apprenticeship Awards. opportunity to develop their career with the Service.

This recognition is a credit to the work done across

our apprenticeship teams. We are very proud of our
schemes and of all the people who pass through it to
join our crews.

Retention
Our overall vacancy rate on 31 March 2023 was 5.6%
and we have seen a fall in our turnover rate on the
previous year. This positive progress follows a package
of initiatives in recent years to improve our record on
retention, which included providing extended periods
of leave and travel loans for staff to visit families
overseas following the COVID-19 pandemic, funding
indefinite leave to remain and supporting staff to
utilise the Government’s automatic one-year visa
extension. We have also launched our Workforce
Retention Group which brings together colleagues

42 London Ambulance Service NHS Trust

 1. Performance report

Paying the Living Wage The Wellbeing Hub also offers temporary employment
opportunities for colleagues from other departments
who are on restricted duties through injury or illness.
These team members are trained to work in our Hub
answering queries via phone or email, or on tea trucks
or wellbeing cafes. More than 50 of these colleagues
on restricted duties worked in the Hub in 2022/23.
“I am delighted that the
London Ambulance In recognition of their outstanding work on our
Service NHS Trust has Wellbeing Hub, this year our Wellbeing team won the
become a London Living NHS Employers Award for Wellbeing at the Healthcare
Wage Employer. LAS staff People Management Association Excellence in People
work tirelessly to keep us Awards.
all safe and it is only right
To further support the wellbeing of our teams, the
that they are paid fair
Service’s five wellbeing support vehicles – or ‘tea
wage for their efforts.”
trucks’ - are continuing to visit hospital emergency
departments around London to provide colleagues
In February 2023, London Ambulance Service became with peer support, a hot drink and a chance to talk
an accredited Living Wage employer meaning every through challenging issues. Staff at all of our contact
member of our staff earns more than the centres are also continuing to benefit from Wellbeing
Government’s recommended minimum wage and will Cafes, which allow team members to receive support
receive a minimum hourly rate of £11.95. Our staff are while picking up a drink or snack.
our biggest asset, so it is only right that we pay
everyone the Living Wage.

We are now one of almost 11,000 organisations to

have voluntarily raised salaries as part of this scheme
and among only a few NHS Trusts in London who have
achieved this accreditation.

The Service was able to achieve this after we bought

in-house our 400 Make Ready staff – who work to re-
stock and re-fuel ambulances before a shift – in April
2022 and the 90 members of our cleaning staff – who
work in our headquarters, ambulance stations and
other buildings - in February 2023. All of us at the
Service were pleased to welcome these newest
members of our green family.

Wellbeing
Over the past year our
Wellbeing team has
grown to 12 colleagues
who oversee support
services including the operation of our seven-day-
a-week Wellbeing Hub, the management of our
external occupational health contracts and our
seasonal flu programme. Our Wellbeing Hub
alone dealt with around 3,500 calls and 7,000
emails from colleagues in 2022/23, with
wellbeing team members signposting colleagues
to support in areas such as mental health,
maternity services and financial advice.
 Our
To ensure wellbeing support runs throughout the Values &
Service, our Wellbeing Team delivers a range of Behaviours
training for managers across the Trust, meet staff at
inductions, run support groups on menopause and
for new international paramedics and work with
local management teams on improving sickness and
Caring able
ing, approach
retention. lite, welcom
an d co m passionate, po oa ctive
be caring stic and optim
istic, pr
Kindness be enthusia tives
em br ace change, nsider other perspec
Positive s, co
In the past year we have increased our mental health f in ot her people’s shoe ace to speak
put mysel le, give othe
rs sp
Empathetic , approachab
support offering, including the recruitment of a hear othe rs, be op en
Listening
further 50 peer support workers who receive expert
training from the LAS psychotherapist. We have also
established a buddy scheme for our new Respect
are
international paramedics, introduced menopause for who they
cept others
ir, em br ac e diversity, ac te rn ative views
be fa t al
training, improved our wellbeing rooms across the Equity rs, ask for input, seek ou
advocate fo
r othe grounds
ries and back
Trust, run workshops on nutrition and implemented Inclusive feelings, sto
in te reste d in others’ , va lue others
ing be out feedback
Understand e praise, seek
regular visits from therapy dogs. offe r de sc rip tiv
Appreciative

Teamwork
In recognition of the challenges many of us are
facing around the cost of living, the London &
Ambulance Charity committed £25,000 to a hardship gularly
it, check in re
yo u no tic e others need
offer help w
he n clarify
fund to provide grants for staff and volunteers who mmunicate,
Supportive or k together, co
rtunitie s to w d reassuring
find themselves in financial difficulties. These grants e seek oppo ude, calm an
Collaborativ on sib le for my attit
table, re sp best interests
l be accoun rs’ and LAS’
are being administered by the UNISON welfare Professiona e le arni ng s, act in othe
ar
be honest, sh
charity ‘There for You’. Integrity

In March 2023, LAS launched teams-based working –

Agreeing our values and set of behaviours
a collaborative response to the desire of our staff and
volunteers to improve their working life and the As part of our continued focus on making the Service
culture at the Service. The approach supports an exceptional place to work, we collaborated with
colleagues to improve their working environment our staff and volunteers to deliver the Our LAS
through locally agreed plans that see teams and programme to create a culture at London Ambulance
managers work the same shift patterns to ensure Service that works for everyone.
more meaningful contact, new rotas that deliver a
better work life balance and allocated non- Created with the contributions of almost 2,000 team
operational time to develop and grow as a team, as members, the programme includes a new set of values
well as an end to the relief system. Our Oval Group and behaviours for the organisation alongside
was the first team to go live with the approach, with commitments to sexual safety, reducing violence and
99% of these staff pleased with the change. After the aggression and promoting equality, diversity and
first two months, these members of staff at the Oval inclusion.
Group said they felt part of a team, morale had
Through the programme, London Ambulance Service
increased and access to their line manager was much
teams agreed on three new values that should run
easier, and staff sickness fell significantly.
through the heart of what we do: Caring, Respect and
To further support a positive working environment, Teamwork.
members of the London Ambulance Service executive
These values are supported by a new set of behaviours
board have taken part in ongoing staff Sounding
to outline the standards we can expect from our
Board meetings which provide an opportunity for
colleagues, remind people of the types of behaviours
operational managers from across the capital to have
we will not tolerate at work and provide guidance on
an open conversation about what is working well,
how to challenge poor behaviour in a constructive
what hasn’t been successful and their ideas for
way. These values are a representation of how teams
improvement.
in the Service want to work: together, putting Caring,
Respect and Teamwork at the heart of all that we do
for Londoners.
44 London Ambulance Service NHS Trust
 1. Performance report

We are putting these values and behaviours into Our dedicated Violence Reduction Officers support
action at every opportunity, launching values-led our staff and volunteers such as Charlotte who report
recruitment, appraisal and talent development incidents of abuse and guide them through the court
processes so that we can demonstrate our values, process.
behaviours and expectations at every stage of people’s
careers. Together with our teams, we will make the We continue to work with the other Ambulance
Service somewhere where all of our staff and Trusts, through Association of Ambulance Chief
volunteers are able to be their very best, fulfil their Executive’s national campaign #WorkWithoutFear,
potential and feel safe and supported. which seeks to cut the number of verbal and physical
attacks on ambulance staff.
Protecting our teams
Staff networks
Keeping our people
safe will always be a
priority for London
Ambulance Service.
Our members of staff
and volunteers
should never have to
experience violence
or aggression, but To support and champion equality, diversity and
sadly – due to the behaviours of a small minority of inclusion across our Service we have five staff
patients and members of the public – these incidents networks – LGBT, B-ME, Christian Ambulance
remain unacceptably high. Association, EnAbled and the Women’s Network. The
In September 2022, we invested more than £3 million networks support our staff and volunteers, while
to fit 510 of our ambulances and 55 of our fast challenging us as an organisation to create a more
response cars with upgraded and comprehensive crew inclusive place to work.
safety systems to deter violence and aggression
against team and help secure a conviction in court Freedom To Speak Up
should an assault occur. These measures are further Our Freedom to Speak Up
supported by our continuing work to roll out body (FTSU) Guardian and
work cameras for our teams. The Service is continuing ambassadors continue to
to work with the police to increase convictions for support our colleagues to
hate crimes, which include people using racist or feel safe to speak up
homophobic language when speaking to our call should they have a concern.
handlers. The following objectives
have been put together to ensure this happens:
We have recruited a dedicated Violence Reduction
Manager, who is working closely with the police to  Ensure there are fair and inclusive processes in
ensure staff and volunteers get help and support and place
information when cases go to court.
 Listen to diverse groups across the Trust, as well
as our staff networks
London Ambulance Service is working hard to address
violence and aggression experienced by staff while  Embed FTSU in everyday practice and promote a
trying to do their jobs and to bring down the number “speak up” culture
of incidents and secure the toughest possible
 Respond to and influence the changing
convictions for those who commit them.
landscape of the Trust’s culture

This year, one of our paramedics Charlotte bravely  Use data and intelligence to inform our
spoke out about her experience of being sexually decisions
assaulted by a patient in the hope it would encourage
 Regularly seek feedback and learn from it
others to seek justice. The Mayor of London Sadiq
Khan wrote to Charlotte in February to thank her for
her courage in sharing her story.

London Ambulance Service NHS Trust 45

 Recognition
It is important that we recognise the incredible
work done by our staff and volunteers, so we
were very pleased to be able to take time to
celebrate our teams at our VIP Awards 2022 at
City Hall in October. We are very proud of all the
individuals who won an award, as well as those
who were highly commended. The Mayor of
London Sadiq Khan and our sponsor Assembly
Member Caroline Pidgeon MBE were both able
to join us on the night to join the celebrations.
You will have seen pictures from key award and
recognition ceremonies throughout the year at
the start of this annual report.

46 London Ambulance Service NHS Trust

 1. Performance report

Equality, diversity and inclusion Our 2022 Workforce Disability Equality Standard
(WDES) shows improvements in terms of bullying,
We understand that actively promoting equality and
harassment and abuse from patients, managers and
inclusivity among our organisation is an important
colleagues, and experience of feeling pressure from a
part of making the Trust a great place to work. We
manager to come to work when not feeling well
strive to ensure equal and fair access to our services
enough. We need to address issues with how
for all our patients and their families. We recognise
colleagues with a disability feel less engaged and less
our responsibility to eliminate discrimination and
valued by the organisation.
harassment while supporting and empowering all our
people. The report also shows we have more to do to respond
to requests for reasonable adjustments. In order to
We are working towards
address this, we have worked with our partners at the
ensuring our workforce
Business Disability Forum to host
better reflects the diversity
Disability Confidence workshops,
of the population it serves
with some aimed at People and
in London. We end 2022/23
Culture colleagues, and some for
having recruited more than
a more general audience. These
400 black, minority ethnic
engaging sessions increase
(BME) staff, representing
awareness of the issues facing
over 32% of all our new
colleagues with a disability and
starters. We now have more
highlight the responsibilities
than 1,580 BME staff which
employers have when requests
is 21% of our total
for adjustments are made.
workforce. There is still
more to do to increase these numbers and we will In December 2022, our B-ME staff network met NHS
continue to put time effort and attention into this England’s Chair Richard Meddings and Chief Strategy
work. Officer Chris Hopson to share their lived experiences
of the workplace. With the guidance of our staff, we
Our 2022 Workforce Race Equality Standard (WRES)
will continue to listen, learn and improve the plans we
report shows that we have made progress in metrics
already have in place for taking meaningful steps
looking at experiences of bullying, harassment and
towards becoming a truly anti-racist, equal and
abuse from patients, managers and colleagues and for
inclusive organisation.
belief that the Service provides equal opportunities
for career progression and promotion. However, we To make sure we are treating people equitably, and
have more to do to improve the experiences of providing the same opportunities across our diverse
colleagues from Black, Asian and Minority Ethnic teams, our People and Culture Team has reviewed and
backgrounds, especially around recruitment and updated our recruitment and development processes.
disciplinaries. As a result, in the last 18 months, we have seen more
people from diverse backgrounds in visible clinical
We launched our See ME First campaign in October
roles.
2022, giving our staff and volunteers the opportunity
to pledge to visibly show a commitment to race equity We have also worked hard to increase gender
and speak up if they see or diversity, with 50% of our
experience discrimination workforce and 40% of our
of any kind. This senior leadership team being
commitment makes clear female. Following a targeted
we are an open, non- recruitment drive in our
judgemental NHS Hazardous Area Response
organisation that treats all Team, in the last year we
black, Asian doubled the number of
and minority women working in the team
ethnic staff to 22 out of 98 members of
with dignity staff.
and respect.

London Ambulance Service 47

 Volunteers
Our volunteers continue to play a vital
role at LAS. We have always hugely
valued their commitment to
supporting our services and time they
dedicate to helping the public. In the
last year, they gifted a remarkable
30,000 hours of their time to assist
the Service.

Our emergency responders and

community first responders have
continued to provide outstanding Our flagship internal
support to LAS teams across London, communication tool remains
responding to 999 calls alongside LAS Live: a weekly question
paramedics on ambulances, aiding in our and answer session with our
response to members of the public who Chief Executive and other
have had a fall, and providing invaluable senior executives. It is
assistance at events and training exercises. broadcast live and recordings are made available for
staff and volunteers to watch later on demand, this
Proving the importance of the role our volunteers platform enabled us to keep everyone up to date with
play, our emergency responders and community first the latest information while being able to address any
responders were first on the scene at almost 6,000 questions or concerns with transparency and
incidents across London in the last 12 months. openness.

More than 200 of our volunteers who The national NHS Staff Survey results allowed us to
work alongside paramedics and other look at what we do well compared to other NHS
staff were presented with the Team of workplaces and where we need to improve. We had
the Year award by the Association of 63% of our staff complete the survey, the highest
Ambulance Chief Executives at the return rate of any ambulance service and the highest
Ambulance Leadership Forum in 2022. ever number of responses for the Service. In
At the same ceremony, our emergency comparison to our results last year against the seven
responders were presented with the NHS People Promise topics and the themes of
Outstanding Service Award in recognition of all the engagement and morale, we significantly improved in
work they undertook during the COVID-19 pandemic. three areas – being a learning organisation, health
and wellbeing and morale - and only deteriorated in
We continue to expand our roster of volunteers, with
the question relating to pay and rewards. The results
successful recruitment campaigns over 2022/23 that
and responses have been analysed to ensure staff
will continue to benefit the Service for years to come.
experience drives the improvements we are making at
We have recruited 36 emergency responders in the
London Ambulance Service.
last year, while filling training courses to deliver an
additional 60 responders in the future.

Staff and volunteer engagement

and communication
Our Communications Team use a number
of channels to share important
information with our staff and volunteers
quickly and effectively. This year they have
launched a new version of our intranet
‘The Pulse’, which has supported our teams
to access information and share updates
more easily.

48 London Ambulance Service NHS Trust

 1. Performance report

Partners
By working together with our partners across health many different areas and backgrounds. The LAS Public
and social care, we can provide our patients with the and Patients Council (LASPPC) brings together a wide
best possible care. range of patients and public representatives across
London.
We will continue to engage with patient groups,
stakeholders, wider system partners and emergency The council, which is co-chaired by Dame Christine
service colleagues to build on our successes and ensure Beasley and Michael Bryan, meets at regular intervals
our communities are empowered to help shape the to give feedback on the care we provide and to help
future of their health services. shape the way care is delivered. Members provide a
voice for patients, the public and carers in the design,
Working with development and delivery of Trust’s service.
communities
Our Trust Board meetings are held in public and
The people who we regularly hear a patient story, usually told directly by
care for – and their the patient involved. This helps to ensure patients feel
families – are at the heard by the organisation and provides an
heart of everything opportunity for Board members to hear about
we do. By listening patients’ experiences first-hand and for these
to patients and the experiences to provide learning for colleagues across
public we can the Service.
improve patient
safety, patient experience and health outcomes. Working with our NHS partners
A key focus of patient and public engagement this As an integral part of the NHS in London, a key part of
year focused on ensuring that patients and the public our work focuses on how we bring different parts of
were involved in the development of our new Trust the health and care system together to keep as many
strategy, which will describe the organisation’s vision people as possible at home safely and well cared for
and goals for the next five years. We worked closely rather than taking them to hospital. Therefore, we
with 26 Healthwatches who used their experience and work closely with our NHS partners in NHS England,
knowledge amongst local communities to engage on Integrated Care Systems (ICSs), hospital and specialist
our behalf so we were able to hear from a number of trusts to develop and make more use of appropriate
diverse communities and engaged voices that may not care pathways that often offer our patients better,
have otherwise been heard. quicker, and more appropriate care.

Our Public Education Team attended 519 events in Collaboration with our NHS partners has been enabled
2022/23. The team visits hundreds of schools, by the expansion of specialist skills of our paramedics
community groups and organisations every year and and clinical teams, helping us to bring about
talk to thousands of people about what happens improvements for our patients. For example, working
when you dial 999 and what to do in a medical with five urgent community response providers in
emergency. The team focus mostly on activities south west London to pilot community response cars.
involving children and young people, such as
We are grateful to North West London Integrated
awareness sessions on the dangers of using alcohol
Care System (ICS) for their continued support as our
and other legal highs, the grim reality of carrying
lead ICS, recognising the particular challenges we face
knives and careers in London Ambulance Service.
as the only NHS trust to cover the whole of London.
Many of these are carried out with partner
organisations. We also use these opportunities to
Our strong relationships with all five ICSs have helped
teach CPR and other life-saving skills.
us to manage sustained surges in demand for our
services and enabled us to redirect urgent and
As a pan-London service we are in a unique position
emergency care activity across the capital. Working in
to work with patients and members of the public from
partnership across the capital has helped to reduce the

London Ambulance Service NHS Trust 49

 risk of parts of the London health and care system With the continued roll out of body worn cameras and
being overwhelmed. We also worked closely with our commitment to cutting the number of assaults on
Integrated Care Boards (ICBs) on seeking their views our staff and volunteers, we have also been working
and using their local system expertise to help shape with the police to develop our violence reduction
and develop our new trust strategy 2023-2028. processes. We are sharing learning and best practice
to ensure our people get the justice and support they
As part of our winter planning, we worked with the need.
ICSs and NHS hospitals across the capital to reduce the
waiting times for our ambulance crews and our During periods of industrial action, the Trust received
patients. support from the military, who volunteered to drive
ambulances alongside our LAS and expert clinicians
During the industrial action we worked with our who provided care to patients. These were operated
partners in NHS trusts to ensure patient handover from Wellington Barracks and provided around an
delays at emergency departments were kept to a additional 35 ambulances each strike day.
minimum and received help from all ICSs in London to
provide clinical expertise which proved to be vital in Working with Mayor of London and Greater
maintaining our services. London Authority (GLA)
Working with emergency services colleagues We have a close working relationship with the Mayor’s
Office and the Greater London Authority. We continue
Collaboration with our emergency service colleagues
to work with the London Situational Awareness Team,
in the Metropolitan Police and London Fire Brigade
which provides the Mayor’s Office and London
allows us to provide the best possible care for the
Assembly Members with accurate and timely
people who need us.
information on our performance.

We also regularly engage with the Mayor on many

topics including the actions we are taking to improve
our environmental impact, with our work to become
the NHS Trust with the most electric and low-emission
vehicles receiving significant support from the Mayor.
Recently the Mayor has supported our London
Lifesavers campaign to train 100,000 Londoners to
learn CPR and defibrillation skills.

In 2022/23, we worked closely with the London

Assembly Health Committee on developing our new
Our control rooms have long-established links with trust strategy. They supported our programme of
those of the Metropolitan Police, through which we public and patient engagement by issuing a ‘call for
share around 800 messages a day to ensure we are evidence’ asking Londoners for their views on the
together providing the best care for people in Service and paid visit to our emergency operations
London. This relationship has required significant centre in Newham and Dockside Education Centre so
collaboration and trust between all partners involved. they could learn more about our work and the
approaches we are taking to meet demand. Following
We are currently developing our new estates strategy
the visit and the findings from the call for evidence,
and anticipate that we will hold discussions with the
the Committee wrote to the LAS with six
London Fire Brigade on the potential for cohabiting
recommendations which asked for targets and
our ambulance stations with their sites.
commitments around public awareness and education
activities, improving the diversity of our workforce,
Our Tactical Response Unit has an ongoing
working with the wider public health system to
collaborative role with the Metropolitan Police,
improve the health of Londoners and working with
working with officers to provide medical care to
the Mayor on greening the LAS estate. We have
individuals involved in police operations, providing
agreed to keep the Committee updated on our actions
support on complex pre-planned police responses and
in response to the recommendations and our progress
working as part of responses to situations such as
in implementing the new strategy.
terrorist attacks.

50 London Ambulance Service NHS Trust

 1. Performance report

Our charity and control room deciding which calls might need this
charitable partners advanced trauma team.

This year, we continued to Additionally, we support the charity by providing

establish and build the our clinicians to work alongside an emergency
profile of our very own charity – medicine doctor on the Physician
the London Ambulance Charity. Response Unit. The team carries advanced
medication, equipment and treatments
The Charity has a cash balance of £1.1 usually only found in hospitals, which
million as of 31 March 2023, £0.6 means patients can be treated in their
million of which can be attributed to homes rather than being taken to an
the unspent element of the NHS Charities Together emergency department.
grant. Spend for the year
totals £0.1 million and income We also work closely with St John Ambulance, often
£0.4 million (leaving a net to plan and prepare for large public events, with our
asset increase of £0.3 million). partnership strengthening during the pandemic.

Looking outside of our own charity scope, we value We are extremely grateful to NHS Charities Together
our partnership with London’s Air Ambulance Charity for the support they have given us, including funding
(LAAC). We provide paramedics to respond to life-or- to increase the number of Emergency Responder
death emergencies by helicopter and by car. Every day volunteers that support the frontline.
one of our paramedics works alongside a doctor as
part of the London’s Air Ambulance service to treat As well as our long-established relationships with
patients, while a second paramedic is in our 999 charities, we are developing new ones to share best
practice as we aim to boost our own charity and
volunteering programme.

Anti-bribery and anti-slavery statement

The Trust does not tolerate any form of fraud, bribery The Modern Slavery Act 2015 introduced changes in
or corruption by its employees, partners or third UK law focused on increasing transparency in supply
parties acting on its behalf. We investigate allegations chains, to ensure they are free from modern slavery
fully and apply sanctions to those found to have (that is, slavery, servitude, forced and compulsory
committed a fraud, bribery or corruption offence. labour and human trafficking).

The Trust contracted its internal audit provider to The Trust fully supports the government’s objectives
provide its local counter-fraud specialist (LCFS) services to eradicate modern slavery and human trafficking
in accordance with Secretary of State Directions. The and encourages its staff to pursue training, such as
Board’s Audit and Risk Committee formally approves the one developed by Health Education England to
the counter-fraud annual work plan and progress train NHS staff, and direct its staff to further
reports are provided to the committee at each of its resources available.
meetings.
London Ambulance Service NHS Trust 51
 Public Value
The Trust delivered a year-end surplus of £0.1 million The Trust also invested £40.7 million in maintaining
after adjustments for impairments, donations and and updating the Trust’s capital and leased assets (£7.0
centrally allocated stock. The Trust’s total income was million of leased capital costs are included following
£646.2 million, which was an increase of £43.1 million introduction of new accounting standard on 1 April
(7.1%) on the prior year, as shown in the table below. 2022 - IFRS 16).

Finances 2022/23 2021/22 2020/21

Total Income (million) £646.2 £603.1 £570.3
Year end surplus (million) £0.1 £0.7 £2.6

Investment 2022/23 2021/22 2020/21

Capital expenditure and leases (million) £40.7 £44.9 £40.0

Throughout the year we have continued to focus on performance regime allows for a number of
maximising available resources to provide the best adjustments to be made so that financial performance
possible value for the public, who ultimately fund during the year can be assessed more accurately. The
London Ambulance Service. The Trust delivered a small Trust’s financial performance is therefore measured
surplus (£0.1 million) and achieved the control total following these adjustments- the Trust delivered a
agreed with North West London Integrated Care £0.1 million surplus, as measured against the NHS
System. performance targets.

The Statement of Comprehensive Income (SOCI) in the The table below shows the movements from a deficit
financial statements showed that the Trust reported a of £6.7 million to a surplus of £0.1 million.
deficit of £6.7 million. However, the NHS financial

2022/23 £’m
Account in deficit for 2022/23 (6.7)
Add back AME impairments charched to expenditure 6.4
Remove capital donations (0.1)
Remove net impact of DHSC centrally procured inventories 0.5
Year end surplus 0.1

52 London Ambulance Service NHS Trust

 1. Performance report

Where our money comes from contracts with Primary Care Networks for provision
of paramedic services.
Following the suspension of normal contracting rules
during the COVID-19 pandemic, in 2022/23 the Trust The total income received by the Trust during 22/23
was operating under a post-Covid financial regime was £646.2 million of which £631.8 million was for
that required contracts to be agreed between provision of patient care and £14.4 million for non-
providers and commissioners. The Trust agreed patient care, majority of which is made up of training
contracts with all of our commissioners, covering and education and facilities income.
patient care, education and non-NHS commercial
income. The Trust’s largest contract, covering 81% of Patient Care Income from Clinical Commissioning
the total income was a block contract with the five Groups/Integrated Care Boards was £585.1 million and
London Integrated Care Systems for the provision of from NHS England was £39.8 million. A further £1.8
999 patient care services. The Trust’s remaining million patient care income was received from other
contracts were a variable income contracts NHS trusts and £5.1 million was received from other
including provision of 111 services, education, non NHS sources.

1% 90%
2%
1%
Clinical Commissioning Groups/
6% Integrated Care Boards
NHS England
Where our money Other NHS trusts
comes from Education & Training
Other income

What we spend our money on

1% 2% 70%
1% 1% Staff and executive directors
1% Supplies and service – clinical
4% Supplied and services – general
Establishment
Premises
4%
Transport
What we spend
Depreciation & amortisation
3% our money on Net impairments
2% Clinical negligence
Education and trainiing – non-staff
Research & development and education & training
6% Other spend

6%

The highest proportion of the Trust expenditure (71%) deploy services and provide the highest quality of
is spent on staff costs in order to enable the Trust to patient care.

London Ambulance Service NHS Trust 53

 Supplies for clinical and general services account for a Improving value for money
further 12% of the total expenditure, reflecting the
During 2022/23 the Trust continued to focus on
Trust’s focus on delivering patient care.
improving value for money to the public and saved
Capital expenditure £24.8 million through a number of schemes including
improving our productivity through decrease of
During 2022/23 London Ambulance Service spent sickness levels, improved supply chain management
£40.7 million on capital expenditure in the following and reducing overhead costs.
areas:
External Auditors
 £19.2 million on increasing and modernising
its fleet to replace ageing vehicle, and meet The Trust’s external auditor is KPMG for 2022/23. The
low-emission targets and improving crew cost of the auditor’s statutory work for 2022/23 was
safety systems. £97k (£97k in 2021/22 for Ernst & Young) which
included the auditing of the annual accounts and this
 £10.0m on estates modernisation including
annual report.
consolidating its training estate, improving its
logistics support capability, improving medicines
management.
 £4.5 million on digital programmes including
implementing a new Computer-Aided Dispatch
system.
 £7.0 million on capital value of leases, in line
with new reporting guidelines which came into
effect for 2022/23.

54 London Ambulance Service NHS Trust

 1. Performance report

Key financial targets for 2022/23

Target 2022/23 Performance Target met 2021/22 Performance Target met

Achieve the Financial The Trust reported a Yes The Trust reported a Yes
Performance total set by NHS surplus of £0.1 million surplus of £0.7 million
England
Do not overshoot the External The Trust stayed within Yes The Trust stayed within Yes
Finance Limit (EFL) its EFL Limit its EFL Limit
Do not overshoot the Capital The Trust stayed within Yes The Trust stayed within Yes
Resource Limit (CRL) its CRL limit its CRL limit
Meet the capital cost The Trust kept within Yes The Trust kept within Yes
absorption rate (CCAR) of 3.5% the 3.5% CCAR , the 3.5% CCAR
of net assets resulting in dividends resulting in dividends of
of £4.4 million £4.9 million
Meet the requirement of the The Trust scored very No The Trust scored very No
Public Sector Payment Policy to close to the 95% Target close to the 95% Target
settle creditors within 30 days
93.59% on value and 95.5% on value and
90.31% on volume
92.67% on volume

Looking forward to 2023/24

A capital plan of £27.6 million has been finalised for
next year. A high proportion of this programme is
committed to updating the Trust’s ambulance fleet
with a planned investment of £15 million during next
financial year.

The Trust has agreed a balanced income and

expenditure plan with North West London Integrated
Care System for 2023/24. As part of this, the Trust has
planned for a revenue savings programme of £25.0
million for 2023/24 to ensure we continue to deliver
value and provide the maximum level of patient care
for the resources we receive.

In order to ensure the maintenance of an appropriate

control environment, the Trust’s Standing Financial
Instructions and Scheme of Delegation remained in
place throughout 2022/23 to ensure that appropriate
oversight and assurance was maintained, whilst
recognising the significant operational pressures
facing the Trust. These were updated to reflect the
changes in senior structure. The revisions were
approved by the Audit Committee on behalf of the
Board in February 2023.

London Ambulance Service NHS Trust 55

 London Ambulance Service Charitable fund
The LAS Charitable as well as increase the number of Emergency
Fund continues to Responder volunteers that support the frontline.
develop and grow,
with an income of The charity raised a further £0.3 million through
£0.4 million. donations and legacies, including gifts from corporate
partnerships with London Market Forums and
Following increased Halfords. Additionally, funds were raised
engagement, we have through sponsorships of individuals running
expanded our fundraising the 2022 London Marathon and taking on the
activities to include events and Outrun An Ambulance Challenge for the
special campaigns. Diversifying Charity.
our fundraised income streams
will help to build capacity, support our frontline 26 grants were approved totaling more than
workforce with wellbeing initiatives, and promote £15,000 for projects specifically requested by staff to
innovation, transformation and efficient new ways of improve their working environments. A further
working. £84,000 was spent on large-scale projects that benefit
the welfare and wellbeing of our staff and volunteers.

We continue to deliver the objectives of the charity’s

five-year strategy supporting the wider Trust
objectives and to drive the charity to reach its full
potential. Year one of the strategy included creating a
working infrastructure, brand and working title. The
completion of these activities have placed the Charity
We are extremely grateful to NHS Charities Together in a strong position to promote and spread awareness
for their continued support. We have received a of charity activities, as well as document and track
further £0.1 million to develop the charity’s resource communications with supporters.

The charity looks to embark

on 2023/2024 with the
launch of its own website,
expansion of the charity
team and diversifying
income streams through
focused fundraising activity,
including the hosting of its
first ever Charity Event.

Income levels will continue

to surpass those of pre-
pandemic levels and focus
on unrestricted income
streams which deliver most
flexibility to the charity and
its beneficiaries

56 London Ambulance Service NHS Trust

 1. Performance report

‘Going Concern Disclosure’

Our full accounts, presented at the end of this report,
have been prepared in accordance with the directions
made under the National Health Service Act 2006 and
NHS England, the Independent Regulator of NHS
Trusts. The Chief Financial Officer is responsible for the
preparation of the financial statements and for being
satisfied that they give a true and fair view in
accordance with the Department of Health Group
Accounting Manual 2022/23. After making enquires,
the Chief Financial Officer has a reasonable
expectation that the Trust has adequate resources to
continue in operational existence for the foreseeable
future and this has been tested using unmitigated and
mitigated downside scenarios. For this reason the
Trust continues to adopt the ‘Going Concern’ principle
in preparing the annual accounts and annual report.
The CFO considers the annual report and accounts,
taken as a whole, are fair, balanced and
understandable and provide the information
necessary for patients, regulators and other
stakeholders to assess the Trust’s performance and
strategy.

Accountable Officer:

Daniel Elkeles, Chief Executive

Organisation: London Ambulance Service NHS Trust

London Ambulance Service NHS Trust 57

58 London Ambulance Service NHS Trust
 2. Accountability Report

2. Accountability Report
Corporate Governance Report
1. Directors’ Report
Name From Until
(Board members) Non-Executive Directors
Chair Heather Lawrence 01/04/2016 30/06/2022
Chair Andy Trotter 01/07/2022 30/06/2026
Non-Executive Director Karim Brohi 01/03/2019 28/02/2025
Non-Executive Director Sheila Doyle 06/02/2017 05/02/2025
Non-Executive Director Amit Khutti 01/01/2018 29/02/2024
Non-Executive Director Rommel Pereira 01/02/2020 31/01/2024
Non-Executive Director Mark Spencer 01/03/2019 28/02/2025
Non-Executive Director Anne Rainsberry 01/05/2021 30/04/2025
Non-Executive Director Robert Alexander 01/09/2021 31/08/2023
(Board members) Executive Directors
Chief Executive Daniel Elkeles 16/08/2021 Present
Deputy Chief Executive and Chief Paramedic and
Dr John Martin 01/03/2021 Present
Quality Officer

Deputy Chief Executive and Chief Medical Officer Dr Fenella Wrigley 01/03/2016 Present
Chief Finance Officer Rakesh Patel 01/12/2021 Present
Director of People and Culture Damian McGuinness 14/06/2021 Present
Directors
Director of Communications and Engagement Antony Tiernan 20/08/2019 Present
Director of Corporate Affairs Mark Easton 04/01/2022 Present
Director of Strategy and Transformation Roger Davidson 31/01/2022 Present

London Ambulance Service NHS Trust 59

 1.2 Composition of the Board of Directors appointed through a process of open advertising and
formal selection interview. Non-executive directors are
Our Trust Board is made up of 13 members — our
appointed by the same method but through NHS
Chair, seven non-executive directors and five executive
England. All executive appointments are permanent
directors (including our Chief Executive).
and subject to normal terms and conditions of
employment.
The Chief Executive and other executive directors are

60 London Ambulance Service NHS Trust

 2. Accountability Report

Relevant Relevant
Name Role Description of Interest Comments
Date - From Date - To
Andrew Trotter Chair Chair, Oxleas NHS Foundation 01/09/15 Present
Trust
Member of the Home office 01/01/18 Present
Independent Advisory Group
on Emergency Services
communication network,
Home Office, HM
Government. January 2018,
ongoing
Heather Lawrence Chair Non-Executive Director, Jul-16 Present
Royal Marsden Trust Board
Trustee, British Renal Society May-11 Present
now UKKA
Chair, NRC Medical Experts April-21 Present
Robert Alexander Non-Executive Trustee of Charity, Demelza Present
Director Childrens Hospice
Non-Executive Director and Various Present
Advisory Roles, Imperial
College Healthcare NHS Trust,
CHP Ltd, CIPFA, CHKS Ltd
Non-Executive Director, Present
London North West University
Healthcare NHS Trust
Rommel Pereira Non-Executive Non-Executive Board Member 01/05/2021 30/04/2024
Director and Chair, Audit & Risk
Committee, The National
Archives
Non-Executive Director and 01/06/2019 31/05/2023
Chair, Audit and Risk
Committee and Deputy Chair,
Homerton Healthcare NHS
Foundation Trust
Non-Executive Director and 21/09/2019 30/11/2021
Chair, Audit & Risk
Committee, One Housing
Group
Non-Executive Director and 1/12/2021 19/04/2023
Chair, Group Audit
Committee, The Riverside
Group
Non-Executive Director Board 06/01/2023 Present
Member, NHS Supply Chain
Anne Rainsberry Non-Executive Advisor, Health Tech Partners 01/05/2021 Present
Director
Advisor, Carnal Farrar 01/04/2021 Present
Director, What if Consult Ltd 01/01/2021 Present Provision of
executive
coaching and
board
development
Sheila Doyle Non-Executive Employee, Deloitte 01/01/2016 Present I am a partner
Director and full time
employee at
Deloitte

London Ambulance Service NHS Trust 61

 Relevant Relevant
Name Role Description of Interest Comments
Date - From Date - To
Jill Anderson Associate Non- ViiV Healthcare Ltd, subsidiary 01/06/2020 31/12/2022
Executive Director of Glaxo SmithKline, Chief
Financial Officer

Ordinary shares in 01/06/2020 31/12/2022

GlaxoSmithKline awarded as
part of reward package and
long term incentives
Amit Khutti Non-Executive Board Director, Zava Global 01/12/2018 Present
Director BV
Karim Brohi Non-Executive Professor of Trauma Sciences, 01/03/2008 Present
Director Queen Mary University of
London. Honorary Consultant
Trauma Surgeon, Barts Health
NHS Trust

Clinical Director, London 01/10/2015 Present

Major Trauma System NHS
England (London)
Advisory Board Member to AI 01/05/2021 Present
Nexus who are in early phase
innovations of artificial
intelligence applications for
healthcare monitoring and
diagnosis.
Dr Mark Spencer Non-Executive GP in HMP Bullingdon, 01/04/2021 Present None of my
Director Buckinghamshire, activity produces
Subcontracted to Practice Plus a conflict of
(formerly CareUK) interest with my
role in LAS
Health care consultancy, 01/04/2021 Present None of my
varied, currently NEL LIS activity produces
a conflict of
interest with my
role in LAS
Fenella Wrigley Chief Medical Royal London Hospital, Barts 01/07/2008 Present
Director
Health Emergency Medicine
Consultant

Substantive NHS consultant,

Financial

Regional Professional lead for 01/08/2012 Present

Specialist Events, St John
Ambulance London Region
Non-Financial, Voluntary role
All England Lawn Tennis Club 01/09/2018 Present
Chief Medical Officer,
Financial
Clinical Advisor (remunerated), 01/04/2013 Present
HM Prison and Probate
Services (Ministry of Justice)

62 London Ambulance Service NHS Trust

 2. Accountability Report

Relevant Relevant
Name Role Description of Interest Comments
Date - From Date - To
Dr John Martin Chief Paramedic Bank Paramedic, East of 10/01/2021 Present
and Quality Officer England Ambulance service
NHS Trust, zero hours
contract.
President, Trustee, Director, 10/01/2021 Present
College of Paramedics,
voluntary position (Paramedic
professional body & charity)
Director, British Paramedic 10/01/2021 Present
Association, voluntary
position (Dormant original
paramedic professional body)
Director, Challenge your 10/01/2021 Present
thinking limited, not currently
an active company (Paramedic
consultancy)
Consultant Paramedic expert 10/01/2021 Present
witness for various legal firms
Antony Tiernan Director of Member of the HSJ (Health 01/01/2019 Ongoing Unpaid – non-
Communications Service Journal) Awards financial
and Engagement Advisory Board professional
interest
Trustee, NHS Charities 01/01/2019 Ongoing Unpaid – non-
Together financial
professional
interest
Daniel Elkeles Chief Executive Holding Director, London 17/11/2021 Present
Officer Ambulance Service Dormant
Companies
London Emergency Care ltd, 17/11/2021 Present
Holding Director Dormant
Company
London Urgent Care Ltd, 17/11/2021 Present
Holding Director Dormant
Company
Rakesh Patel Chief Finance NIL 01/12/2021 Present
Officer
Mark Easton Interim Director Trustee, Royal College of 01/01/2022 01/01/2024
Corporate Affairs Ophthalmologists- unpaid
two year post
Roger Davidson Director of NIL 01/04/2022 Present
Strategy and
Transformation
Damian Director of People NIL 01/04/2022 Present
McGuinness and Culture

London Ambulance Service NHS Trust 63

 Annual Governance Statement for

London Ambulance Service NHS Trust 2022/23

Scope of Responsibility Risk management is a key component of
enhancing patient and staff care and is an
As Accountable Officer, I am responsible for
integral part of the Trust’s strategic
maintaining a sound system of internal control that
management. It is the process whereby the Trust
supports the achievement of the NHS Trust’s policies,
methodically addresses the risks related to its
aims and objectives, whilst safeguarding the public
activities with the goal of achieving sustained
funds and departmental assets for which I am
benefits to patient care and outcomes through
personally responsible for in accordance with the
delivery of the LAS Strategy. The processes set
responsibilities assigned to me. I am also responsible
for ensuring that the NHS Trust is administered out in the Risk Management Strategy and Policy
prudently and economically and that resources are ensure clearly defined roles and responsibilities
applied efficiently and effectively. I also for the senior leadership team and clarity
acknowledge my responsibilities as set out in the around the arrangements and purpose of the
NHS Trust Accountable Officer Memorandum. Board Assurance Framework and Corporate Risk
Register.
The Purpose of the System of Internal 3 The policy aims to promote a positive culture
Control towards the management of risk and provides
clear, systematic approaches to ensure risk
The system of internal control is designed to assessment is integral to all clinical, managerial
manage risk to a reasonable level rather than to and financial processes. The focus of risk
eliminate all risk of failure to achieve policies, aims
management at LAS is about being aware of
and objectives; it can therefore only provide
emerging problems, working through what
reasonable and not absolute assurance of
impact they could have and implementing
effectiveness. The system of internal control is based
changes and plans to mitigate against the worst
on an ongoing process designed to identify and
case scenario. This is achieved through ensuring
prioritise the risks to the achievement of the
clear leadership and accountabilities throughout
policies, aims and objectives of London Ambulance
the Trust and encouraging cross directorate
Service NHS Trust, to evaluate the likelihood of
those risks being realised and the impact should working.
they be realised, and to manage them efficiently, 4 Operationally, responsibility for the
effectively and economically. The system of internal implementation of risk management has been
control has been in place in London Ambulance delegated to the Deputy Chief Executive and
Service NHS Trust for the year ended 31 March 2023 Chief Paramedic and Quality Officer, including
and up to the date of approval of the annual report responsibility for clinical risk management, and
and accounts. the Director of Corporate Affairs. The Chief
Medical Officer also holds responsibility for
Capacity to Handle Risk patient safety.
Leadership of Risk Management Process 5 The Chief Paramedic and Quality Officer is the
1 As Chief Executive, I am responsible for quality governance lead for the Trust and is
overseeing risk management across all responsible for the Trust’s Risk Management
organisational, financial and clinical activities. Strategy and Policy and Incident Management
All executive directors report to me and their Policy, including patient safety incidents. They
performance is held to account through both are also responsible for promoting and ensuring
individual and team objectives that also reflect implementation of Trust-wide systems and
the objectives of the Board. processes to enable the Trust to meet
requirements in relation to clinical governance
2 The Trust’s Risk Management Strategy and Policy
and risk, up to and including the Trust’s
sets out the accountability and reporting
Corporate Risk Register.
arrangements for risk management and the
processes that maintain sound internal control. 6 The Director of Corporate Affairs supports the

64 London Ambulance Service NHS Trust

 2. Accountability Report

Executive Committee in carrying out their personnel have a good understanding of the
responsibilities for risk management and takes risk management process.
the lead on behalf of the Trust Board for
10 Risk management training is provided to
maintaining the Board Assurance Framework.
Executive Committee and Board members every
7 The Board Assurance Framework aligns with two years, in respect to high level awareness of
national guidance and reflects assurance on the risk management and to ensure that risks
high-level risks that are deemed the most aligned to their remit are reviewed.
significant through the year. Executive
11 The Trust’s mandatory and statutory training
Committee members individually, and
programme is regularly refreshed to ensure that
collectively, have responsibility for providing
it remains responsive to the needs of Trust staff
assurance to the Trust Board on the controls in
and volunteers. There is a regular review of the
place to mitigate their associated risks to
requirements of the Trust’s Mandatory Training
achieving the Trust’s strategic objectives,
Policy and Training Needs Analysis (which
including compliance with all the Trust’s
includes elements of governance and risk
licences. The Trust Board’s Assurance
management training) and the duty of staff to
Committees have responsibility for providing
complete training deemed mandatory for their
assurance in respect of the effectiveness of these
role. Despite significant operational pressures,
controls through regular scrutiny of risks in their
the Trust has been able to achieve average
area, and associated controls.
target levels of 83% compliance with mandatory
Staff Training and statutory training requirements during
2022/23.
8 The Trust provides a comprehensive mandatory
and statutory training programme which 12 Monitoring and escalation arrangements are in
includes governance and risk management place to ensure that the Trust maintains its
awareness, ensuring that staff are trained and current good performance and can ensure
equipped to identify and manage risk in a targeted action in respect of areas or staff
manner appropriate to their authority, duties groups where performance is not at the
and experience. required level.

9 The Trust’s Risk Management Strategy and Policy

The Risk and Control Framework
sets out the approach that it takes to the
Risk Management Strategy and Policy
provision of training in relation to risk
management. An e-learning package 13 The Trust recognises that risk management is an
‘Introduction to Risk Management’ has been integral part of good management practice and
developed and is available to all staff through to be most effective, risk management should
ESR. All department leads/ managers that are become part of the Trust’s culture. The Board is
responsible for implementing the risk therefore committed to the identification,
management procedure locally receive more evaluation and treatment of risk as part of a
specialist training to enable them to fulfil their continuous process aimed at identifying threats
responsibilities. This training is generally offered and driving change. Risk management is a
on a one-to-one basis and tailored to be fundamental part of both the operational and
relevant to suit the responsibilities and risks strategic thinking of every part of the Trust’s
associated with their role. All risk management business including clinical, non-clinical,
training is recorded centrally in ESR. Staff have corporate and financial risk.
access to comprehensive risk guidance and
14 The Risk Management Strategy and Policy,
advice via Risk Management Leads in the
which was approved at the March 2023 Public
Quality Directorate, information embedded in
Board, underpins how the Trust manages risk,
the Risk Management page on the Trust’s
including ‘horizon scanning’ which focusses on
intranet and by referring to the Risk
identifying, evaluating and managing changes
Management Procedure. The Trust Risk Manager
in the risk environment, preferably before they
also supports staff in risk reviews and escalation
manifest as a risk or become a ‘threat’ to the
through monthly quality governance meetings.
business of the Trust.
The recent internal audit of Risk Management
indicated that overall key risk management 15 The Risk Management Strategy and Policy

London Ambulance Service NHS Trust 65

 provides the overarching principles, framework lead assurance committee, which reviews
and processes to support managers and staff in evidence and reports from lead executives on
the management of risk by ensuring that the performance, issues and risks. Alongside a
Trust is able to deliver its objectives by robust internal audit programme, this enables
identifying and managing risks, enhancing the Trust Board to be assured that risk
opportunities and creating an environment that management within the Trust is being managed
adds value to ongoing operational activities. appropriately.
The Trust has adopted a holistic approach to risk
21 In accordance with the Trust Board’s Scheme of
management incorporating both clinical and
Delegation, responsibility for the management
non-clinical risks. This includes but is not limited
and control of a particular risk rests with a
to; strategic, financial, operational, regulatory,
named Directorate / Sector / Station. However,
environmental and reputational risks.
where action to control a particular risk falls
16 The Trust’s Risk Management Strategy and Policy outside the control / responsibility of that
is an integral part of the Trust’s approach to domain, where local control measures are
continuous quality improvement and is intended considered to be potentially inadequate or
to support the Trust in delivering the Trust’s key require significant financial investment, or the
objectives as well as ensuring compliance with risk is ‘significant’ and simply cannot be dealt
external standards, duties and legislative with at that level, such issues are escalated to
requirements. the appropriate corporate committee, being the
RCAG, the Executive Committee or the Trust
Identifying and Reporting risk
Board for a decision to be made.
17 Risks are identified routinely from a range of
Embedding Risk Management and Incident Reporting
reactive/pro active and internal/external sources
including workplace risk assessments, analysis of 22 Risk management is embedded in the activity of
incidents, complaints / PALS, claims, external the organisation by virtue of robust
safety alerts and other standards, targets and organisational and committee structures which
indicators. These are reviewed to understand are reviewed and amended as necessary on an
the organisational impact and are then RAG annual basis.
rated for inclusion, if appropriate, in the Trust’s
23 Of fundamental importance to the early
Corporate Risk Register and/or the Board
identification, escalation and control of risk is
Assurance Framework (BAF).
the Trust’s commitment to the ongoing
18 A Risk, Compliance and Assurance Group (RCAG) development of a culture where incident
exists to review and monitor risks added to the reporting is openly and actively encouraged and
Risk Register and the BAF. In addition, regular the focus is on ‘what went wrong’, and not
update reports from the BAF are submitted to ‘who went wrong’, thus encouraging a
the relevant Board Assurance Committees and progressively ‘risk aware’ workforce.
the Trust Board. The Audit Committee has
24 In addition to standard incident reporting
delegated authority on behalf of the Trust
processes, the Trust has had a full-time Freedom
Board for ensuring effective arrangements for
To Speak Up (FTSU) guardian since 2018/19.
the identification and management of risk are
Concerns raised through FTSU are all
in place and remain appropriate. The Trust
investigated and many have led to
recognises that, as risks can change and new
improvements in processes in a number of
risks emerge over time, the review and updating
different parts of the Service.
of risks on the risk register and within the BAF is
an ongoing, dynamic process. 25 At Board level, Amit Khutti is the Non-Executive
lead for Freedom to Speak Up and the Executive
19 The Board Assurance Framework (BAF) for
Director lead is John Martin, Deputy Chief
2022/23 has been updated to align with LAS’s
Executive and Chief Paramedic and Quality
three strategic themes and ten key objectives in
Officer.
the Trust’s business plan. These objectives feed
into objective setting for the executive team 26 The Trust has 32 Freedom to Speak Up
and thereafter to staff. ambassadors, all of whom have received
training in how to promote the work of FTSU
20 Each objective within the BAF is assigned to a

66 London Ambulance Service NHS Trust

 2. Accountability Report

and support staff to raise concerns. In 2022/23, and at local Service/Sector Quality
252 concerns were raised compared to 138 in Governance meetings.
the previous financial year. The focus for the
 A Station/Service Accreditation programme
next financial year will be working with
has been developed which aims to drive
managers across the Trust to reduce the number
quality standards by empowering front line
of colleagues who feel they need to raise
staff to make improvements in line with the
concerns via the Guardian and improve other
Care Quality Commission’s (CQC)
pathways.
fundamental standards.
27 The Risk Appetite Statement is a written
 The Trust acts upon patient feedback from
articulation of the degree of risk exposure, or
complaints and concerns and from feedback
potential impact from an event, that the Trust is
from Patient & Public Council (PPC)
willing to accept in pursuit of its strategic goals
representatives (e.g. Health Watch).
and corporate objectives. The full risk
management statement is included within the  A Patient or Staff Story is presented at every
Trust’s Risk Management policy and strategy and meeting of the Trust Board.
is available to staff on the intranet.  The Trust has implemented the Patient Safety
28 LAS endeavours to establish a positive risk Incident Response Framework (PSIRF) as an
culture within the organisation, where unsafe early adopter. This approach allows the Trust
practice is not tolerated and where every to focus on continuously improving by
member of staff feels committed and addressing causal factors and the use of
empowered to identify and correct and/or improvement science to prevent or
escalate system weakness. continuously and measurably reduce
repeated patient safety risks and incidents.
29 The Trust also has in place a range of
mechanisms for managing and monitoring risks  The Trust has implemented the Learning from
in respect of quality including: Death process with an internally developed
digital platform to enable reviews and
 The Trust’s Quality Strategy is based on the oversight to be undertaken and reported on.
Care Quality Commission (CQC) fundamental
 The Trust has a safeguarding team and a
standards. The Trust Board also agrees
patient experience team to oversee
annual quality priorities.
safeguarding matters and patient experience
 The Trust has a Quality Assurance Committee respectively.
(a committee of the Board) which meets bi-
 To maintain safety throughout periods of
monthly and is chaired by a Non-Executive
industrial action additional senior clinical
Director who is a practising clinician. The
support was provided to the control rooms
Quality Assurance Committee is responsible
(999 and 111) and frontline crews.
for monitoring performance against the
agreed annual quality objectives and is 30 Throughout 2022/23, the Quality Improvement
supported by the bi-monthly Quality and Learning (QI&L) team has monitored both
Oversight Group as well as local the Trust’s Risk Management system, Datix and
Sector/Service Quality Governance meetings. data obtained from Business Intelligence (BI) to
The Quality Assurance Committee provides a identify and review patient safety incidents
report of each meeting to the Trust Board. arising from delays during periods of high
 The Trust publishes an Annual Quality demand, sharing learning where required.
Account.
Workforce Safeguards
 Performance against key quality indicators
31 The Trust ensures that short, medium and long-
are reported to the Trust Board in the Trust’s
term workforce strategies and staffing systems
Quality Report and Integrated Performance
are in place and provide the Trust Board with
Report.
assurance that staffing processes are safe,
 Quality improvements are progressed sustainable and effective. In compliance with
through the Trust’s Quality Improvement the recommendations of “Developing
Plan which is monitored at Sector Reviews Workforce Safeguards”, the Trust:

London Ambulance Service NHS Trust 67

  has formed a Workforce Development & report directly to the Trust Board and monitor
Planning Programme, which is chaired by our key performance indicators and challenge the
Deputy Chief Executive and Chief Paramedic Trust as an institution in terms of practice and
and Quality Officer, and has clear oversight approach to EDI issues.
of risk management.
Quality Strategy
 has produced a detailed workforce plan for
36 The Trust has a Quality Strategy to support
2023/2024 and a high level five year
quality governance and assurance from
workforce plan so that structural changes
ambulance station to the Trust Board. The
and new skill requirements can start to be
Quality Strategy aims to put patients and staff
modelled as early as possible in
at the centre of everything we do and is
management’s workforce plans
underpinned by the Care Quality Commission’s
 has a systematic approach to determining the definition of quality. Alongside this, is a
number of staff and range of skills required commitment to a just culture where reporting
to meet the needs of people using the of both clinical and non-clinical incidents is
Service and to keep them safe. central to continuous learning and
improvement.
32 In 2022/23, the Trust continued its focus on the
strategic risks associated with workforce, 37 Quality governance and assurance is supported
through the People and Culture Committee (a by reliable information systems including Datix
sub-committee of the Board) and the Executive and Health Assure. These systems are a rich
Committee. The People and Culture Committee source of data which informs the Trust of its
has continued to focus upon further performance against various quality indicators.
development of a workforce planning model, Each Sector has a dedicated Quality Governance
providing assurance to the Board on this. The and Assurance Manager (QGAM) and Sector
Executive Committee has received regular Senior Clinical Lead to oversee patient safety
reports on strategic workforce planning and the quality of service at Sector level. Their
activities, to provide additional oversight in this work is overseen by the Central Quality
area. Oversight Group.

33 Control measures are in place to ensure that 38 Every year, the Trust sets specific quality
obligations under equality, diversity and human priorities which are reported in the annual
rights legislation are complied in line with the Quality Account. These priorities are identified
requirements of the Public Sector Equality in consultation with both internal and external
Duties under the Equality Act 2010. We are stakeholders to ensure they are relevant and
working towards ensuring our workforce better robust for the coming year. The Trust routinely
reflects the diversity of the population it serves reviews its performance against its quality
in London. We end 2022/23 having recruited priorities and this is reported through the
more than 400 BME staff, representing over governance structures which include, sector
32% of all our new starters. We now have governance meetings, the Quality Oversight
more than 1,600 BME staff which is 21% Group, the Quality Assurance Committee and
representation. There is still more to do to the Trust Board.
increase these numbers and we will continue to 39 There are processes in place to review
put time, effort and attention into this work. performance regularly across the year to ensure
34 We have also worked hard to increase gender that gains are consolidated and any learning is
diversity and our female representation utilised as part of the wider quality
Trust-wide has increased to 51%. improvement plan. These processes include a
series of Sector peer reviews and quality
35 To champion the Trust’s plans in relation to the
performance reviews which are designed to test
equality agenda and monitor compliance with
how well the Trust is doing against the CQC’s
legislative and regulatory requirements relating
key lines of enquiry. The outcome of these
to EDI, the Trust agreed to establish a new
reviews are reported to relevant teams and
committee of the Board – the Equality, Diversity
meetings to guide decisions and actions.
and Inclusion Committee, which will be chaired
by a Non-Executive Director. The Committee will

68 London Ambulance Service NHS Trust

 2. Accountability Report

CQC Registration as the Serious Incident Reports, Quality

Oversight Group, and claims and inquests
40 During 2022/23, CQC inspection activities at the
updates and is able to have oversight and
Trust included regular engagement calls and
challenge the Trust in relation to the quality of
virtual monitoring meetings.
patient care. The Trust’s Chief Medical Officer,
41 The CQC’s overall rating of the Trust remains Chief Paramedic and Quality Officer and the
“Good”. Director of Corporate Affairs attend all
meetings of the Committee. In addition, the
Compliance with the NHS Provider Licence
Committee is chaired by a clinician who is a
42 The Board reviews the terms of reference of its Non-Executive Director of the Trust.
assurance committees on an annual basis to
ensure their effectiveness. The Audit Committee Roles and Responsibilities
meets once a year with the internal and 46 The Trust Board holds overall responsibility for
external auditors without the presence of the management of risks within the Trust. The
executive directors or staff. In addition, the Board ensures significant risks to the Trust’s
Local Counter Fraud Specialist presents a report ability to provide a quality service are identified
to every meeting of the Audit Committee on and managed. The Board reviews all significant
measures to tackle fraud, bribery and corruption risks at each formal meeting.
and also the importance of reporting concerns
47 Non-Executive Directors seek assurance in
as appropriate. The Trust also has a
relation to the performance of the Executives in
Remuneration and Nominations Committee
meeting agreed goals and objectives. They are
consisting of the Non-Executive Directors,
required to satisfy themselves as to the integrity
joined, when appropriate, by the Chief
of financial, clinical and other information, and
Executive, the Director of People and Culture
that financial and clinical quality controls and
and the Director of Corporate Affairs. In
systems of risk management and governance are
addition, the Board has established a number of
robust and implemented.
assurance committees which focus on key
aspects of the Trust’s work. Each Committee is 48 The Chief Executive is responsible for ensuring
chaired by a Non-Executive Director. All that a system is in place for reporting of all
assurance committees undertake an annual self- incidents.
assessment of their effectiveness, which is
49 All Executive Committee members hold
reported to the Board. The Audit Committee
responsibility for the identification and
also submits an Annual Report to the Trust
management of their risks and ensure they are
Board and reviews the Standing Financial
documented, registered and updated in a timely
Instructions and Scheme of Delegation.
manner for the relevant forums to review. They
43 The terms of reference also serve to define the are responsible for the risk management process
responsibilities, accountabilities and reporting within the Trust and as such ensure:
lines of each assurance committee. The Board
 the review of risk and risk registers is
receives a report following each assurance
maintained in accordance with the Trust
committee meeting, and is therefore able to
strategy.
both receive assurance but also challenge any of
the decisions made. Each assurance committee  all staff have the ability to identify risks and
also has an identified lead Executive Director. propose they are assessed and entered onto
the relevant section of the Trust Risk Register.
44 Key performance reports covering corporate,
clinical, quality, workforce, finance and  monitoring and timely review of the Risk
operational performance are received at each Management Strategy and associated
formal meeting of the Board and an annual policies.
report from the Audit Committee, these are
 provision of expert advice into the incident
made available on the Trust’s website.
reporting process.
45 The Quality Assurance Committee receives
 all managers within their Directorate are
regular reports from clinical and operational
familiar and act in accordance with Trust
staff and through a number of documents such
policies.

London Ambulance Service NHS Trust 69

  incidents are reported and investigated in 54 The Finance and Investment Committee has
accordance with the Trust’s Incident responsibility for monitoring and reviewing the
Reporting Process. adequacy and utilisation of resources to assure
the Board upon the risks relating to the efficient
 Learning is shared and embedded through a
and effective delivery of strategic and
range of modalities including Core Skills
operational plans and objectives. It monitors
Refreshers, Clinical Update and Insight
financial risks and reviews the BAF for its
bulletins and podcasts.
responsibilities advising the Board of any
Reporting Lines and Accountabilities material risks arising.
50 The Board Assurance Committees and Executive 55 The Quality Assurance Committee has
Committee provide a process for the assessment responsibility for providing the Trust Board with
of the assurance given in relation to mitigating assurance on the achievement of strategic
any identified risks for the organisation, and for objectives in relation to the provision of a high
the escalation of risk if necessary. quality, safe, and effective service. The Trust’s
51 The purpose of the weekly Executive Committee definition of quality encompasses three equally
is to lead and manage the performance of the important elements:
Trust within the strategic framework established
 Care that is safe – working with patients and
by the Trust Board. The Executive Committee
their families to reduce avoidable harm and
makes recommendations to the Trust Board on
improve outcomes.
key policy and service issues for the Trust Board’s
decision.  Care that is clinically effective – not just in
the eyes of clinicians but in the eyes of
52 The Executive Committee has established the
patients and their families.
following sub-groups:
 Care that provides a positive experience – to
 The Risk Compliance and Assurance Group – patients and their families.
to oversee the governance of the risk
management process and management of 56 The People and Culture Committee has
risks rated greater than 15; responsibility for providing the Trust Board with
assurance on all aspects of people management
 The Information Governance Group – to
and organisational development, including the
ensure that the Trust has clear management
identification, mitigation and escalation of
of information governance and compliance
people-related risks.
with the Data Security and Protection
Toolkit; 57 The newly formed EDI Committee will have
responsibility for ensuring that the Trust is
 The Capital Programme Board (CPB),
fulfilling all legislative and regulatory
formerly the Asset Replacement and Capital
requirements relating to the equality, diversity,
Board (ARC), to oversee and manage the
inclusion and human rights agenda, including
provision of the Trust’s capital programme;
compliance with mandatory reporting and
 The Supply Chain Management Board – to action planning and CQC standards.
monitor compliances with standing orders,
58 The Data and Digital Quality Assurance
standing financial instructions and scheme of
Committee was agreed this year to provide the
delegation regarding procurement and
Board with assurance on achievement of LAS’s
management of the supply chain and oversee
strategic objective in relation to the
development and implementation of third
development and delivery of its digital strategy
party supply category strategy plans.
and assurance on non-financial data quality.
53 The Audit Committee monitors risks and reviews 59 The Audit Committee reviews risk arrangements
the BAF. It critically reviews the robustness of broadly through the Trust and commissions the
the governance structures and assurance audit and counter fraud programme. It has
processes on which the Board places reliance. specific responsibility for cyber and information
The committee also receives the internal and security and receives regular updates from the
external audit report and ensures that all responsible directors.
recommendations and actions are followed up.

70 London Ambulance Service NHS Trust

 2. Accountability Report

Public Stakeholders’ Involvement in Managing Risk that they meet the standards set out in the NHS
England well-led framework. (Published at
60 The Trust Board meets at least six times a year in
https://www.england.nhs.uk/well-led-
public and its papers are available on the Trust’s
framework/)
website. Members of the public are invited to
watch the Board meetings and submit questions Compliance Statements
on matters of concern or interest, via a link on
The Trust is fully compliant with the registration
the Trust’s website.
requirements of the Care Quality Commission.
61 In early 2020, the Service launched the London
Ambulance Service Public and Patients Council The Trust has published on its website an up-to-date
(LASPPC). The LASPPC brings together a wide register of interests, including gifts and hospitality, for
range of patient and public representatives decision-making staff (as defined by the Trust with
from across London at regular intervals to reference to the guidance) within the past twelve
provide feedback on the services we provide months, as required by the ‘Managing Conflicts of
and to help shape the way care is delivered. It Interest in the NHS’ guidance.
also advises on ways for the Service to gain
broader engagement. Dame Christine Beasley As an employer with staff entitled to membership of
continues to chair the Council and, in 2021, we the NHS Pension Scheme, control measures are in
appointed Michael Bryan as Co-Chair. The place to ensure all employer obligations contained
proceedings of the Council are reported within the Scheme regulations are complied with. This
regularly to the Board. includes ensuring that deductions from salary,
employer’s contributions and payments into the
62 During 2021/22, we appointed public and
Scheme are in accordance with the Scheme rules, and
patient representatives to key committees
that members Pension Scheme records are accurately
including infection control and prevention,
updated in accordance with the timescales detailed in
frequent callers, research and development, and
the Regulations.
charity operations. In addition, we have
involved public and patient representatives in Control measures are in place to ensure that all the
key events. organisation’s obligations under equality, diversity and
63 In late 2020, the Board agreed a ‘patients and human rights legislation are complied with.
communities engagement and involvement
The Trust has undertaken risk assessments and has
strategy’ which was developed in partnership
plans in place which take account of the ‘Delivering a
with the LASPPC and sets out a range of
Net Zero Health Service’ report under the Greener
priorities to further enhance the way we involve
NHS programme. The Trust ensures that its obligations
and listen to patients and communities. This
under the Climate Change Act and the Adaptation
includes working with Healthwatch England,
Reporting requirements are complied with.
local Healthwatch and the LASPPC to co-design
a visits (enter and view) programme – giving Review of Economy, Efficiency and Effectiveness of
patient and public representatives access to our the Use of Resources
999,111 and ambulance services so they can
66 The Trust secures the economic, efficient and
provide constructive feedback.
effective use of resources through a variety of
64 The Service’s comprehensive website provides means:
the public with access to information about all
areas of our activity and we have a number of  A well-established policy framework with
public-facing newsletters to keep people up-to- compliance (including Standing Financial
date with new developments and items of Instructions) monitored through the Supply
interest. We are also active on social media Chain Management Board and reported to
including X (formerly known as Twitter), the Finance and Investment Committee.
Instagram, LinkedIn and Facebook.  An organisational structure which ensures
accountability and challenge through the
Corporate Governance Statement
committee structure.
65 The Trust has kept its corporate governance
 A clear planning process.
arrangements under review in 2022/23 to ensure

London Ambulance Service NHS Trust 71

  Effective corporate directorates responsible (LCFS) supported as required by other qualified
for workforce, revenue and capital planning LCFS. Any concerns can be directed to the team
and control. and, any information is treated in the strictest
confidence.
 Detailed monthly financial reporting
72 External Auditors, Internal Auditors and Counter
including progress on achievement of Cost
Fraud report to each meeting of the Audit
Improvement Programmes and year-end
Committee, and also meet the members of the
forecasting. Audit Committee without Management present.
 Monthly Operational Performance meeting Information Governance
between Directorates and the Executive
Team. 73 The Trust has a robust programme of
information governance improvements and
67 The Trust has in place a performance awareness and a governance framework to
management framework aligned to both the monitor and assure the security of its
corporate and sector divisional management information. An executive-led Information
structure. The framework includes a
Governance Group exists as well as an
performance dashboard which includes a series
Information Governance Policy framework.
of performance metrics and reflects metrics
based on the Carter Report recommendations. 74 Information governance incidents are reported
The Trust Board reviews the operational, on DatixWeb and the Information Governance
productivity and financial performance, and use Manager is alerted by email whenever an
of resources both at Trust and Divisional level.
incident is reported on the system. Where there
More details of the Trust’s performance and
some specific Trust projects aimed at increasing has been an incident, such as where we become
efficiency are included in the quality and aware of a loss of information outside the LAS,
performance report provided to each Board or there is a risk that personal data has been
meeting. accessed or disclosed by one or more members
68 The Board’s business includes comprehensive of the public, a report is made on the Data
reviews of performance against clinical, Security and Protection Toolkit (DSPT) portal
operational, workforce, corporate and financial within 72 hours of the notification of the
indicators through the quality and performance incident reaching the IG Manager. Each of these
report at each formal meeting. Any emerging reportable incidents is assessed using the 5x5
issues are identified and mitigating action Breach Assessment Grid in the Guide to the
implemented. Notification of Data Security and Protection
69 The Finance and Investment Committee, which Incidents. This document provides detailed
meets monthly, is chaired by a Non-Executive guidance on the reporting of these incidents
Director with other Non-Executive Directors as and should be read by all staff who have
members. The committee provides assurance to reporting rights in the Toolkit before any report
the Trust Directors as to the achievement of the
is made. The senior information risk owner
Trust’s financial plan and priorities and, in
(SIRO) reports breaches to the Audit Committee.
addition, acts as the key forum for the scrutiny
of the robustness and effectiveness of all cost 75 Dependent on the nature of the incident, the
efficiency opportunities. It interfaces with the information provided on the DSPT is sent to the
other Board assurance committees, in particular Information Commissioner’s Office, the
the Audit Committee, as appropriate. This
Department of Health and Social Care, NHS
Committee also has responsibility for providing
England and the National Cyber Security Centre.
assurance with regard to the Trust’s
procurement policies and procedures. 76 During 2022/23, four incidents were notified via
70 The Trust’s commitment to value for money is the data security incident reporting portal. All
strengthened by the effective and focused use four were reported to the ICO and one was also
of its Internal Audit service. The Trust engages reported to the Department of Health and
Internal Auditors to provide an independent Social Care and NHS England. This incident
and objective assurance to the Board that the specifically related to an external cyber-attack
Trust’s risk management, governance and upon a third party software supplier used by the
internal control processes are operating
Trust. Of the four incidents reported, two have
effectively.
now been fully investigated and the cases are
71 The Trust has a Local Counter Fraud Specialist now closed with the ICO.
72 London Ambulance Service NHS Trust
 2. Accountability Report

77 In August 2022, the Trust received an alert that 83 Data quality is a subject that is regularly
Advanced, a third-party software supplier, had reviewed at Information Governance Committee
been subject to an external cyber-attack. via a report from the Head of Data Quality.
Advanced isolated all services and took them
84 Introduction of the new CAD system identified
offline to mitigate the risk of further impact.
an issue in relation to the accurate reporting of
There was no immediate cyber security threat to
C1 response times. We identified that due to a
the Trust identified as a result of this
coding error C1 performance times had been
ransomware attack. This led to an adequacy
misreported by up to 210 seconds giving an
breach within the Trust, as data could not be
unduly positive view of the Trust’s performance.
accessed for a period of time.
The error was identified by a member of the
78 In December 2022, the ICO requested additional corporate team and escalated to NHS England.
information regarding the Advanced An external review was commissioned into the
Ransomware Incident. The additional circumstances of the misreporting with the Trust
information was returned to the ICO by SIRO on as a key participant. There was a period of two
21 December 2022. On 27 February 2023, the months when we did not publish C1 data in
ICO requested further information regarding order to gain assurance that we had correctly
the Advanced Ransomware Incident, which was identified the problem and rectified it.
sent on 13 March 2023. There has been no
85 Progress on the review into C1 response times
further response from the ICO to date.
has been regularly monitored by the Quality
79 23 February 2023, a breach occurred relating to Assurance Committee (QAC) and the Trust
unauthorised records access by a staff member. Board. Recommendations from the review will
Due to the nature of the breach, the incident be implemented to improve assurance on data
was reported to the ICO on 10 March 2023. The quality although a number of changes have
case is subject to an external investigation and already been made, including the establishment
the ICO has been made aware of the steps taken of a Board level committee with responsibility
by the Trust. The ICO has requested an update for gaining assurance on data quality and digital
on the incident by 21 April 2023. strategy and revised arrangements for ensuring
data quality. In addition, an audit was
80 The Trust has an action plan to achieve
commissioned to determine whether the Trust
‘standards met’ for the DSPT for the June 2023
had a systematic problem with data reporting or
deadline.
if the C1 issue was a one-off caused by mis-
Data Quality and Governance coding.
81 Data quality and governance within the Trust is 86 Although the C1 error constitutes a breach in
headed up by the Data Quality Assurance team. control, we concluded that it did not meet the
In addition to its regular Integrated threshold for a significant breach. The reasons
Performance Report to its Board, the Trust has in for this are: our in-house scrutiny identified the
place a Data Quality Strategy which includes a issue, reported it, and escalated it appropriately;
governance structure, policy and the C1 issue was identified as being due to one
implementation plan. specific error in coding, confined to one area of
performance, it was not indicative of a systemic
82 The Trust has a range of policies, processes and
problem; the error was not one of integrity and
staff guidance in place in relation to data
the incident has been handled with full
quality. Specifically, the Data Quality Policy was
transparency; the error was corrected and
updated for 2022/23 to set out the requirements
accurate reporting resumed once assurance was
on the Trust and governance processes for
gained.
assuring data quality. The draft policy was
reviewed by the Information Governance Group Review of Effectiveness
prior to formal approval. The purpose of the
As Accountable Officer, I have responsibility for
Policy is to support delivery of the governance
reviewing the effectiveness of the system of internal
and principles around data quality and is
control. My review of the effectiveness of the system
designed to ensure that all staff employed by
of internal control is informed by the work of the
the Trust understand the importance of data
internal auditors, clinical audit and the executive
quality.

London Ambulance Service NHS Trust 73

 managers and clinical leads within the NHS Trust who environment.
have responsibility for the development and
 Financially, the Trust has reported a full year
maintenance of the internal control framework. I have
Income and Expenditure (I&E) surplus for
drawn on the information provided in this annual
2022/23 of £0.1m against the NHS
report and other performance information available
performance target of a break even position,
to me. My review is also informed by comments made
a favourable variance of £0.1m and
by the external auditors in their management letter
marginally exceeding the previous forecasts
and other reports. I have been advised on the
to deliver the year end plan to breakeven.
implications of the result of my review of the
The Trust invested £40.7m on capital
effectiveness of the system of internal control by the
expenditure in 2022/23, and by the end of
Board, the Audit Committee and Quality Assurance
the year had brought itself back on track so
Committee and a plan to address weaknesses and
that it had utilised all its available capital
ensure continuous improvement of the system is in
funding.
place.
 The results of our work were generally
87 The Trust received the following Head of positive. Two of the assurance audits issued
Internal Audit Opinion for 2022/23: to date provided substantial assurance in
both the design of the controls and
Head of Internal Audit Opinion
operational effectiveness, with the other six
The role of internal audit is to provide an opinion to providing moderate assurance. There were
the Board, through the Audit Committee (AC), on the some significant findings in the business
adequacy and effectiveness of the internal control continuity and disaster recovery audit, but
system to ensure the achievement of the action has been taken in year to address
organisation’s objectives in the areas reviewed. The these. The Trust has had some issues with
annual report from internal audit provides an overall data quality and commissioned an internal
opinion on the adequacy and effectiveness of the audit review on data integrity. We identified
organisation’s risk management, control, and some areas for improvement but did not find
governance processes, within the scope of work any significant errors in the data we
undertaken by our firm as outsourced providers of the reviewed.
internal audit service. It also summarises the activities
 For the advisory HFMA Financial
of internal audit for the period.
Sustainability review, the Trust scored very
favorably overall compared to other Trusts
Based upon the work completed to date for London
within the benchmarking sample, averaging
Ambulance Service NHS Trust, my current expectation
a score of 4.3 across the eight categories
is that I will be able to provide overall moderate
compared to the average of 4. LAS was able
assurance (our second highest level of assurance) that
to demonstrate good compliance with the
there is a sound system of internal control, designed
questions set out in the assessment,
to meet the Trust’s objectives and that controls are
providing sufficient evidence to justify their
being applied consistently. In forming my view, I have
scoring of 4 and 5 for 86% of the questions.
accounted for:
The implementation of the action plans and
 Since the end of the global Covid-19 embedding of new arrangements will enable
pandemic, the Trust has managed to the Trust to demonstrate a maturity level of
maintain a focus on its key objectives for the continual improvement. The Trust set out
year with the continuation of strong clearly the areas that can be strengthened
governance arrangements and management and actions taken for the new financial year.
of key risks, as shown through the results of
At the year end, the Trust had successfully closed all
our reviews of HFMA Financial Sustainability,
except one of the prior year recommendations made
Patient Safety Incident Reporting Framework
by the previous internal audit providers, which is in
and the Key Financial Systems audits of
progress. At the time of reporting, the BDO has issued
Payroll, Recruitment and Procurement. There
14 final reports resulting in three high and 76 medium
are clearly considerable operational
recommendations. We have confirmed with reference
challenges, but these do not appear to have
to evidence that 41 of the 46 high and medium
impacted adversely on the control

74 London Ambulance Service NHS Trust

 2. Accountability Report

recommendations made by the BDO and falling due Integrated Performance Report to the Trust
by 31 March 2023 have been implemented. We have Board, which covers a combination of specific
management assurances that a further four licence and key contractual obligations and
recommendations are in progress. including the identification of key risks to
future performance and mitigating actions.
88 Maintenance and review of the effectiveness of
the system of internal control has been provided 89 The Trust advised of no significant control issues
by comprehensive mechanisms already referred as part of its Annual Report for 2022/23.
to in this statement. Further measures include: 90 The validity of the Corporate Governance
Statement has been provided to me by the
 Regular reports to the Trust Board from the
relevant Board assurance committees, most
Trust’s BAF and Risk Register including Non-
notably the Audit Committee, which have
Executive Director review / challenge.
considered and commented on this statement,
 Regular risk management activity reports to and by the external auditors.
the Trust Board covering incidents,
91 All of the above measures serve to provide
complaints/PALS and claims analysis and
ongoing assurance to me, the Executive
including details of lessons learned / changes
Committee and the Trust Board of the
in practice.
effectiveness of the system of internal control.
 Receipt by the Trust Board of minutes /
reports from key forums including the Audit Conclusion
Committee, Finance & Investment Committee 92 To the best of my knowledge, there are no
and the Quality Assurance Committee. significant internal control issues that have been
 The ongoing development of the BAF. identified in 2022/23.

 The provision and scrutiny of a monthly

Daniel Elkeles
Chief Executive Date: 27 / 06 / 23

London Ambulance Service NHS Trust 75

 Remuneration and Staff Report
Remuneration Executive Directors are subject to normal terms and
conditions of employment. They are employed on
Our Remuneration and Nominations Committee
permanent contracts which can be terminated by
consists of the Chair and the six Non-Executive
either party with six months’ notice.
Directors. The Chief Executive is usually in attendance
but is not present when their own remuneration is Their performance is assessed against individually set
discussed. objectives and monitored through an appraisal
process.
The Remuneration and Nominations Committee is
responsible for advising the Board about appropriate For the purposes of this report, the disclosure of
remuneration and terms of service for the Chief remuneration to senior managers is limited to our
Executive and Executive Directors. It makes Executive and Non-Executive Directors. Details of
recommendations to the Board on all aspects of salary, remuneration, including salaries and pension
provisions for other benefits (including pensions and entitlements, are published on pages 63 to 69.
cars), as well as arrangements for termination of
employment and other contractual terms. Percentage Change in Remuneration of Highest Paid
Director
In formulating their recommendations to the Board, Reporting bodies are required to disclose the
the Committee takes into account a number of percentage change in remuneration for the highest
factors, including the requirements of the role, the paid director between financial years, along with the
performance of the individuals, market rates, percentage change for employees of the entity as a
affordability, and the NHS Very Senior Managers Pay whole. The below table provides a comparison of
Framework. these changes for Salary and Allowances, and for
Performance Pay and Bonuses.

Percentage Change for Percentage Change for

Highest Paid Director Employees as a Whole
Salary and Allowances 2% 9%

The highest paid Director was in place for part of the against the 25th percentile, median and 75th
year in 2021/22, and the majority of that time percentile of remuneration of the organisation’s
seconded in from another organisation. He was not workforce. Total remuneration is further broken down
entitled to performance related pay when on to show the relationship between the highest paid
secondment. director’s salary component of their total
remuneration against the 25th percentile, median and
Performance related pay for 2021/22 therefore related 75th percentile of salary components of the
to one month only and for 2022/23 for twelve months. organisation’s workforce.
As a result of this, the percentage year on year change
in performance pay is 1,241%. However, on an The banded remuneration of the highest paid director
annualised basis this would be 12%. / member in the London Ambulance Service NHS Trust
in the financial year 2022/23 was £225,000 to £230,000
Pay Ratio Information
(2021/22, £210,000 to £215,000 on an annualised
Reporting bodies are required to disclose the basis). The relationship to the remuneration of the
relationship between the remuneration of the organisation’s workforce is disclosed in the below
highest-paid director / member in their organisation table.

76 London Ambulance Service NHS Trust

 2. Accountability Report

2022/23 25th percentile Median 75th percentile

Total remuneration (£) 34,709 46,859 57,917
Salary component of total
34,709 46,859 57,917
remuneration (£)
Pay ratio information 6.6:1 4.9:1 3.9:1

2021/22 25th percentile Median 75th percentile

Total remuneration (£) 33,188 43,224 54,033
Salary component of total
33,188 43,224 54,033
remuneration (£)
Pay ratio information 6.2:1 5.0:1 4.1:1

In 2022/23, no employee (2021/22, NIL) received

remuneration in excess of the highest-paid director /
member.

Total remuneration includes salary, non-consolidated

performance-related pay, latest government pay offer,
benefits-in-kind, but not severance payments. It does
not include employer pension contributions and the
cash equivalent transfer value of pensions.

The range of staff remuneration is £25,158 to

£230,000 (2021/22 £20,001 to £215,000).

London Ambulance Service NHS Trust 77

 Annual Report and Accounts 2022/23

Banded Remuneration Analysis

The information contained below in the Salary and Pension Entitlement of Senior Managers has been audited by our external auditors.

Salary and Pension Entitlements of Senior Managers

A) Remuneration 2022/23 (Audited)

78 London Ambulance Service NHS Trust

Expense payments Performance pay All pension related
Salary Total
Name and Title (taxable) total and bonuses benefits
(bands of £5,000) (bands of £5,000)
to nearest £100 (bands of £5,000) (bands of £2,500)

Heather Lawrence (to July 2022) £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Andrew Trotter, Chair (from July 2022) £40,001 - £45,000 £200 £0 - £5,000 £0 £40,001 - £45,000
Rommel Pereira, Deputy Chair £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Robert Alexander, Non-Executive Director £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Sheila Doyle, Non-Executive Director £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Mark Spencer, Non-Executive Director £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Anne Rainsberry, Non-Executive Director £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Karim Brohi, Non-Executive Director £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Amit Khutti, Non-Executive Director £10,001 - £15,000 £0 £0 - £5,000 £0 £10,001 - £15,000
Line De Decker, Associate Non-Executive Director (to May 2022) £0 - £5,000 £0 £0 - £5,000 £0 £0 - £5,000
Daniel Elkeles, Chief Executive Officer £210,001 - £215,000 £0 £15,001 - £20,000 £90,001 - £92,500 £320,001 - £325,000
Roger Davidson, Director of Strategy and Transformation £130,001 - £135,000 £0 £5,001 - £10,000 £60,001 - £62,500 £200,001 - £205,000
John Martin, Deputy Chief Executive and
£130,001 - £135,000 £0 £20,001 - £25,000 £22,501 - £25,000 £175,001 - £180,000
Chief Paramedic and Quality Officer
Rakesh Patel, Chief Finance Officer £150,001 - £155,000 £0 £15,001 - £20,000 £0 £170,001 - £175,000
Damian McGuinness, Director of People and Culture £130,001 - £135,000 £0 £10,001 - £15,000 £5,001 - £7,500 £150,001 - £155,000
Fenella Wrigley, Deputy Chief Executive and Chief Medical Oficer £140,001 - £145,000 £0 £0 - £5,000 £0 £145,001 - £150,000
Mark Easton, Director of Corporate Affairs £110,001 - £115,000 £0 £0 - £5,000 £0 £110,001 - £115,000
Anthony Tiernan, Director of Communication and Engagement
£60,001 - £65,000 £0 £0 - £5,000 £0 £60,001 - £65,000
(to October 2022)
 2. Accountability Report

Taxable expenses and benefits in kind are expressed to

the nearest £100. The values and bands used to
disclose sums in this table are prescribed by the
Cabinet Office through Employer Pension Notices and
replicated in the HM Treasury Financial Reporting
Manual.

The performance pay payments noted relate to the

financial year 2022/23.

The value of pension benefits accrued during the year

is calculated as the real increase in pension multiplied
by 20, less, the contributions made by the individual.
The real increase excludes increases due to inflation or
any increase or decrease due to a transfer of pension
rights. This value does not represent an amount that
will be received by the individual. It is a calculation
that is intended to convey to the reader of the
accounts an estimation of the benefit that being a
member of the pension scheme could provide. The
pension benefit table provides further information on
the pension benefits accruing to the individual.

(1) Heather Lawrence, salary for four months, the full

year equivalent is £44,000
(2) Andrew Trotter, salary for nine months, the full
year equivalent is £55,000
(3) Line De Decker, salary for two months, the full year
equivalent is £15,000
(4) Anthony Tiernan was on secondment to NHS
England from October 2022

London Ambulance Service NHS Trust 79

 Annual Report and Accounts 2022/23

A) Remuneration 2021/22 (Audited)

Long term
Expense payments Performance pay All pension
Salary performance pay Total
Name and Title (taxable) total to and bonuses related benefits
(bands of £5,000) and bonuses (bands of £5,000)
nearest £100* (bands of £5,000)** (bands of £2,500)****
(bands of £5,000)
Heather Lawrence, Chair £40,001 - £45,000 £0 £0 £0 £40,001 - £45,000
Rommel Pereira, Deputy Chair £10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
Sheila Doyle, Non-Executive Director £10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
Jayne Mee, Non-Executive Director
£0 - £5,000 £0 £0 £0 £0 £0 - £5,000
(1 April 2021 to 1 July 2021) (1)
Amit Khutti, Associate Non-Executive Director £10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
Karim Brohi, Non-Executive Director £10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000

80 London Ambulance Service NHS Trust

Mark Spencer, Non-Executive Director £10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
Anne Rainsberry, Non-Executive Director
£10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
(from 1 May 2021) (2)
Robert Alexander, Non-Executive Director
£5,001 - £10,000 £0 £0 £0 £0 £5,001 - £10,000
(from 1 September 2021) (3)
Jill Anderson, Associate Non-Executive Director £10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
Line De Decker, Associate Non-Executive Director
£10,001 - £15,000 £0 £0 £0 £0 £10,001 - £15,000
(from 1 June 2021) (4)
Garrett Emmerson, Chief Executive Officer
£170,001 - £175,000 £0 £0 - £5,000*** £0 £0 £170,001 - £175,000
(1 April 2021 to 31 August 2021) (5)
Daniel Elkeles, Chief Executive Officer
£130,001 - £135,000 £0 £0 - £5,000 £0 £35,001 - £37,500 £165,001 - £170,000
(from 1 September 2021) (6)
Lorraine Bewes, Chief Finance Officer
£120,001 - £125,000 £0 £5,001 - £10,000 £0 £0 £130,001 - £135,000
(1 April 2021 to 5 December 2021) (7)
Rakesh Patel, Chief Finance Officer
£45,001 - £50,000 £0 £0 - £5,000 £0 £0 £50,001 - £55,000
(from 6 December 2021) (8)
John Martin, Chief Paramedic and Quality Officer,
£135,001 - £140,000 £0 £0 £0 £0 £85,001 - £87,500 £220,001 - £225,000
and Deputy Chief Executive (from 1st October 2021)
Fenella Wrigley, Chief Medical Officer, and
£120,001 - £125,000 £0 £5,001 - £10,000 £0 £70,001 - £72,500 £200,001 - £205,000
Deputy Chief Executive (from 1st October 2021)
Khadir Meer, Chief Operating Officer
£80,001 - £85,000 £0 £10,001 - £15,000 £0 £0 £90,001 - £95,000
(1 April 2021 to 24 September 2021) (9)
Kim Nurse, Director of People and Culture
£45,001 - £50,000 £0 £0 £0 £0 £45,001 - £50,000
(1 April 2021 to 13 June 2021) (10)
Damian McGuinness, Director of People and Culture
£100,001 - £105,000 £0 £0 £0 £52,501 - £55,000 £155,001 - £160,000
(from 14 June 2021) (11)
 2. Accountability Report

* Taxable expenses and benefits in kind are expressed

to the nearest £100. The values and bands used to
disclose sums in this table are prescribed by the
Cabinet Office through Employer Pension Notices and
replicated in the HM Treasury Financial Reporting
Manual.

**The performance pay payments noted relate to the

financial year 2020/21 and 2021/22.

***Includes recovery of bonus payment of £10,490

paid twice in error in 2020/21.

**** The value of pension benefits accrued during the

year is calculated as the real increase in pension
multiplied by 20, less, the contributions made by the
individual. The real increase excludes increases due to
inflation or any increase or decrease due to a transfer
of pension rights. This value does not represent an
amount that will be received by the individual. It is a
calculation that is intended to convey to the reader of
the accounts an estimation of the benefit that being a
member of the pension scheme could provide. The
pension benefit table provides further information on
the pension benefits accruing to the individual.

1 Jayne Mee, salary for four months, the full

year equivalent is £13,000
2 Anne Rainsberry, salary for eleven months, the
full year equivalent is £13,000
3 Robert Alexander, salary for seven months, the
full year equivalent is £13,000
4 Line De Decker, salary for ten months, the full
year equivalent is £13,000
5 Garrett Emmerson, salary for five months, the
full year equivalent is £211,969
6 Daniel Elkeles, salary for seven months, the full
year equivalent is £221,276 assumes
achievement of performance related pay
(£14,476)
7 Lorraine Bewes, salary for nine months, the
full year equivalent is £160,498 assumes
achievement of performance related pay
(£10,548)
8 Rakesh Patel, salary for four months, the full
year equivalent is £164,950 assumes
achievement of performance related (£15,000)
9 Khadir Meer, salary for six months, the full
year equivalent is £160,000 assumes
achievement of performance related
pay(£6,941)
10 Kim Nurse, salary for two and half months, the
full year equivalent is £195,000
11 Damian McGuinness, salary for nine and half
months, the full year equivalent is £130,000

London Ambulance Service NHS Trust 81

 Annual Report and Accounts 2022/23

Lump sum at
Total accrued Employer’s
Real increase in Real increase in pension Cash Equivalent Real Increase in Cash Equivalent
pension at contribution to
Name and title pension at pension lump sum age related to Transfer Value at Cash Equivalent Transfer Value at
pension age at stakeholder
pension age at pension age accrued pension at 1 April 2021 Transfer Value 31 March 2022
31 March 2022 pension
31 March 2022
(bands of £2,500) (bands of £2,500) (bands of £5,000) (bands of £5,000)

Daniel Elkeles, Chief Executive

£5,001 - £7,500 £2,501 - £5,000 £70,001 - £75,000 £115,001 - £120,000 £1,033,138 £73,927 £1,170,940 £0
Officer (from 1 September 2021)
Roger Davidson, Director of
£2,501 - £5,000 £2,501 - £5,000 £35,001 - £40,000 £50,001 - £55,000 £594,289 £59,758 £691,833 £0
Strategy and Transformation
John Martin, Chief Paramedic
£0 - £2,500 £0 - £2,500 £35,001 - £40,000 £60,001 - £65,000 £479,435 £22,420 £522,297 £0
and Quality Officer

82 London Ambulance Service NHS Trust

Damian McGuinness, Director of
People and Culture (from 14 £0 - £2,500 £0 £25,001 - £30,000 £35,001 - £40,000 £317,502 £9,049 £338,011 £0
June 2021)***
Fenella Wrigley,
£0 £0 £65,001 - £70,000 £130,001 - £135,000 £1,190,831 £0 £1,229,543 £0
Chief Medical Officer****

Rakesh Patel, Mark Easton and Anthony Tiernan chose not to be covered by the pension arrangements during the reporting year.
** Non-Executive Directors do not receive pensionable remuneration; there are no disclosures in respect of pensions for Non-Executive Directors.

***Fenella Wrigley, pension has been recalculated by the NHS Pensions Agency to correct an overpayment, the figures presented in the table are after the
correction.

****Damian McGuinness has opted out from pension scheme from 1 May 2022.

A Cash Equivalent Transfer Value (CETV) is the actuarially assessed capital value of the pension scheme benefits accrued by a member at a particular point in time.
The benefits valued are the member’s accrued benefits and any contingent spouse’s (or other allowable beneficiary’s) pension payable from the scheme. CETVs are
calculated in accordance with SI 2008 No. 1050 Occupational Pension Schemes (Transfer Values) Regulations 2008 (23).

Real increase in CETV reflects the increase in CETV effectively funded by the employer. It takes account of the increase in accrued pension due to inflation,
contributions paid by the employee (including the value of any benefits transferred from another scheme or arrangement) and uses common market valuation
factors for the start and end of the period.
 Annual Report and Accounts 2022/23

Table 1: Exit packages (audited) 2022/23

Number of Number of Cost of special

Exit Package cost band
Number of compulsory Cost of compulsory other Cost of other Total number of exit Total cost of exit departures where payment element
(including any special
redundancies redundancies departures departures agreed packages packages special payments included in exit
payment element)
agreed have been made packages
£000s £000s £000s £000s
£10,000 - £25,000 4 62 4 62

£25,001 - £50,000 2 75 2 81 4 156

£50,001 - £100,000 1 50 4 298 5 348

£100,001 - £150,000

£150,001 - £200,000

>£200,000

Totals 7 187 6 379 13 566

Redundancy and other departure costs have been paid in accordance with the provisions of Agenda for Change. Exit costs in this note are accounted for in full in the
year of departure. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS pensions scheme. Ill-health retirement
costs are met by the NHS pensions scheme and are not included in the table.

This disclosure reports the number and value of exit packages taken by staff leaving in the year.

London Ambulance Service NHS Trust

2. Accountability Report

83
 Annual Report and Accounts 2022/23

Table 2 - Exit packages (audited) 2021/22

Number of departures Cost of special

Exit Package cost band Number of
Cost of compulsory Number of other Cost of other Total number of exit Total cost of exit where special payment element
(including any special compulsory
redundancies departures agreed departures agreed packages packages payments have been included in exit
payment element) redundancies
made packages

£000s £000s £000s £000s

£10,000 - £25,000 2 43 2 43

£50,001 - £100,000 1 71 1 71

84 London Ambulance Service NHS Trust

£100,001 - £150,000

£150,001 - £200,000

>£200,000 1 250* 1 250

Totals 4 364 4 364

* The Trust resolved an outstanding employment tribunal in this financial year relating to a dismissal that took place in 2018. Whilst this is an historical case, the
learning has been shared internally as well with the ambulance sector, to mitigate such events happening again.

Redundancy and other departure costs have been paid in accordance with the provisions of Agenda for Change. Exit costs in this note are accounted for in full in the
year of departure. Where the Trust has agreed early retirements, the additional costs are met by the Trust and not by the NHS pensions scheme. Ill-health retirement
costs are met by the NHS pensions scheme and are not included in the table.

This disclosure reports the number and value of exit packages taken by staff leaving in the year.

Note: The expense associated with these departures may have been recognised in part or in full in a previous period.
 Annual Report and Accounts 2022/23

Reporting of other compensation schemes – Exit packages

2022/23 2021/22

Agreements Total value of agreements Agreements Total value of agreements

Number £000s Number £000s

Voluntary redundancies including early retirements contractual costs 2 81 0 0

Mutually agreed resignations (MARS) contractual costs 4 294 0 0

Early retirements in the efficiency of the service contractual costs 0 0 0 0

0
Contractual payments in lieu of notice 0 3 114

Exit payments following Employment Tribunals or court orders 0 0 0 0

Non-contractual payments requiring HMT approval 0 0 1 250

Total 6 375 4 364

As a single exit package can be made up of several components each of which will be counted separately in this Note, the total number above will not necessarily
match the total numbers in Table 1 which represents the number of individuals.

The Remuneration Report includes disclosure of exit payments payable to individuals named in that Report

London Ambulance Service NHS Trust

2. Accountability Report

85
 Off-Payroll Engagements

Table 1: Length of all highly paid off-payroll engagements

For all off-payroll engagements as of 31 March 2023, for more than £245* per day:

Number
Number of existing engagements as of 31 March 2023 0
Of which, the number that have existed:
for less than one year at time of reporting 0
for between one and two years at time of reporting 0
for between two and three years at the time of reporting 0
for between three and four years at the time of reporting 0
for four or more years at the time of reporting 0

Note

* The £245 threshold is set to approximate the minimum point of the pay scale for a Senior Civil Servant.

Table 2: Off-Payroll workers engaged at any point during the financial year

For all off-payroll engagements between 1 April 2022 and 31 March 2023, for more than £245* per day:

Number
Numbers of temporary off-payroll workers engaged between 1 April 2021 and 31 March 2022 0
Of which:
Numbers not subject to off-payroll legislation**
Numbers subject to off-payroll legislation and determined as in-scope of IR35** 0
Numbers subject to off-payroll legislation and determined as out of scope of IR35** 0

Numbers of engagements reassessed for compliance or assurance purposes during the year 0
Of which:
Numbers of engagements that saw a change to IR35 status following review 0

Note

* The £245 threshold is set to approximate the minimum point of the pay scale for a Senior Civil Servant.

** A worker that provides their services through their own limited company or another type of intermediary to
the client will be subject to off-payroll legislation and the Department must undertake an assessment to
determine whether that worker is in-scope of Intermediaries legislation (IR35) or out-of-scope for tax purposes.

86 London Ambulance Service NHS Trust

 2. Accountability Report

Table 3: Off-payroll board member/senior official engagements

For any off-payroll engagements of board members, and/or, senior officials with significant financial
responsibility, between 1 April 2022 and 31 March 2023.

Number of off-payroll engagements of board members, and/or

senior officers with significant financial responsibility, during the 0
financial year.*
Total number of individuals on payroll and off-payroll that have been
deemed “board members, and/or, senior officials with significant
17
financial responsibility”, during the financial year. This figure must
include both on payroll and off-payroll engagements **

Note

* There should only be a very small number of off-payroll engagements of board members and/or senior
officials with significant financial responsibility, permitted only in exceptional circumstances and for no more
than six months.

** As both on payroll and off-payroll engagements are included in the total figure, no entries here should be
blank or zero.

In any cases where individuals are included within the first row of this table the department should set out:

 Details of the exceptional circumstances that led to each of these engagements.

 Details of the length of time each of these exceptional engagements lasted.

London Ambulance Service NHS Trust 87

 Staff report
Average Staff Numbers (FTE)
The average number of permanent staff employed was 6,827. During 2022/23 the Trust brought in-house the
make-ready team and continued to recruit additional ambulance and 999 and 111 call handling staff.

Total Permanently Other

Staff Category
Number Employed number Number
Medical and Dental 7 5 2
Ambulance Service 2,944 2,909 35
Administration and Estates 2,557 2,382 175
Healthcare Assistants and other Support Staff 1,510 1,505 5
Nursing, Midwifery and Heath Visiting Staff 28 24 4
Scientific, Therapeutic and Technical 2 2 0
Total 7,048 6,827 221

The average number of employees is calculated as the whole time equivalent number of employees under
contract of service in each week in the financial year, divided by the number of weeks in the financial year. The
“contracted hours” method of calculating whole time equivalent number should be used, that is, dividing the
contracted hours of each employee by the standard working hours.

Staff Composition Staff Sickness

At the end of March 2023, we had a workforce Our Supporting Attendance Group, comprised of
headcount of 7,480 staff, made up of 3,779 women People and Culture, Wellbeing and Operational
and 3,701 men. This was broken down as follows: colleagues, has overseen the approach to supporting
improving attendance across the Trust. This has
Total Female Male included the introduction and embedding of the first
Directors 12 5 7 day absence reporting service, launched in September
2022, provided by our partner GoodShape. This has
Senior Managers 209 88 121
been a core enabler to facilitate colleagues back to
Employees 7,259 3,686 3,573 work and has developed close links with our new
Total 7,480 3,779 3,701 Occupational Health provider in fast-tracking
occupational health referrals and with our Employee
We are proud to have been able to recruit over 900 Assistance Programme and Wellbeing Teams as part of
frontline ambulance staff and over 350 call handling an integrated approach we are taking to employee
staff across our 999 and 111 services this year. During health and wellbeing. The sickness absence figures are
this time, a total of 811 people left the Service – a reported on a calendar year basis for 2022 (January to
turnover rate of 12 per cent, compared to 13 per cent December) and are shown below.
in 2021/2022.

Figures Converted by DH to Best Statistics Published by NHS Digital

Estimates of Required Data Items from ESR Data Warehouse

Adjusted FTE
FTE-Days lost
Average FTE days lost to FTE-Days Average Sick
to Sickness
for 2022 Cabinet Office Available Days per FTE
Absence
definitions

6,652 129,680 2,427,855 210,369 19.5

88 London Ambulance Service NHS Trust

 2. Accountability Report

Staff Policies
We embrace our obligations under equalities
legislation, including the Equality Act 2010. Our aim is
to ensure that equality and inclusion is integral to
everything we do.

We welcome people to our organisation from any

background, who are committed to providing high-
quality care that meets the needs of the diverse
communities we serve. We aim to provide innovative
and responsive healthcare which meets the needs of
all these communities, providing better healthcare for
Staff Survey
all.
2022 NHS Staff Survey Results
Our policy is to treat everyone fairly and without
discrimination, and we want to ensure that: The National NHS Staff Survey was held between
September and November 2022. All staff in
 patients and customers receive fair and equal substantive roles on 1 September 2022 were invited to
access to our healthcare service; take part in the survey. The LAS achieved a response
 everyone is treated with dignity and respect; rate of 62%, meaning 4,394 colleagues responded to
and the survey. The LAS had the highest response rate
amongst ambulance services.
 staff experience fairness and equality of
opportunity and treatment in their workplace. The survey results are reported against the seven
elements of the NHS People Promise, and the themes
We want to be an employer of choice and attract the
of “Morale” and “Staff Engagement”. Each element
best and most talented people from all walks of life to
and theme is given a score between 0 and 10,
a career where they can develop to their full
depending on the positivity of the questions in that
potential.
area. The graph below shows that our scores are
As an employer, we are focusing on: within 0.1 of the ambulance sector average for all
elements/themes, except for We Work Flexibly, which
 celebrating and encouraging the diversity of our is 0.2 above average, and We are Safe and Healthy,
workforce and creating a working environment which is 0.2 below average.
where everyone feels included and appreciated
for their work; Work Done Since Last Year’s Survey
 promoting and providing training and The ‘Our LAS’ Cultural Transformation Programme has
employment opportunities regardless of age, made a significant impact on this year’s results,
disability, gender reassignment, marital status, especially around appraisals and career development.
pregnancy or maternity, race, religion or belief, For example the 62% of colleagues feel that there are
sex, sexual orientation or any other aspect of an opportunities to develop their career in this
individual person’s background; and organisation, a 4% improvement on the 2021 results,
 fostering creativeness and innovation in our and placing us 11% above the ambulance sector
working environment, so that all staff can average. We have also seen improvements in both the
deliver to the best of their ability and help us number of colleagues who have had an appraisal, and
take forward our equality and inclusion goals. the quality of those appraisals.

Trade Union Facility Time

The following information is published in accordance
with The Trade Union (Facility Time Publication
Requirements) Regulations. The relevant period is 1
April 2022 to 31 March 2023. A total of 14 employees
were engaged in TU activities. These 14 employees
spend a total of 15,643 hours on Facility Time at a cost

London Ambulance Service NHS Trust 89

 of £0.4 million. The Trust has a reasonable allocation
of time off arrangements with all the recognised trade
unions. This has served the employee relations climate
very well over recent years particularly given all the
difficult and sensitive issues arising from the pandemic
since March 2020 and more recently the strike period
at end of 2022. The Staff Side and management work
well together both formally through the usual
consultative arrangements, such as the Partnership
Forum, as well as informally through regular
discussions that take place most weeks and less
frequently at Regional level.

Next Steps
At a Service-wide level, the next stages of the ‘Our
LAS’ programme involve leadership and teamwork,
with the launch of the ‘Our LAS, Our Leaders’ scheme
which will see 100 line managers undertake a NVQ
level 6 management qualification and the embedding
of Teams-Based Working across our Ambulance
Services group stations.

People and Culture colleagues are also working with

leadership teams across the Service to help them
understand what their results are telling them and
form action plans to address the issues raised by
colleagues.

90 London Ambulance Service NHS Trust

 2. Accountability Report

3. Annual Accounts 2022/23

Statement of the chief executive’s responsibilities as the accountable officer of the Trust

The Chief Executive of NHS England has designated

that the Chief Executive should be the Accountable
Officer of the trust. The relevant responsibilities of
Accountable Officers are set out in the NHS Trust
Accountable Officer Memorandum. These include
ensuring that:

 there are effective management systems in

place to safeguard public funds and assets and
assist in the implementation of corporate
governance
 value for money is achieved from the resources
available to the trust
 the expenditure and income of the trust has
been applied to the purposes intended by
Parliament and conform to the authorities
which govern them
 effective and sound financial management
systems are in place and
 annual statutory accounts are prepared in a
format directed by the Secretary of State to give
a true and fair view of the state of affairs as at
the end of the financial year and the income
and expenditure, other items of comprehensive
income and cash flows for the year.

As far as I am aware, there is no relevant audit

information of which the trust’s auditors are unaware,
and I have taken all the steps that I ought to have
taken to make myself aware of any relevant audit
information and to establish that the entity’s auditors
are aware of that information.

To the best of my knowledge and belief, I have

properly discharged the responsibilities set out in my
letter of appointment as an Accountable Officer.

Daniel Elkeles
Chief Executive Date: 27/06/23

London Ambulance Service NHS Trust 91

 Statement of directors’ responsibilities in respect of the accounts

The directors are required under the National Health

Service Act 2006 to prepare accounts for each financial
year. The Secretary of State, with the approval of HM
Treasury, directs that these accounts give a true and
fair view of the state of affairs of the trust and of the
income and expenditure, other items of comprehen-
sive income and cash flows for the year. In preparing
those accounts, the directors are required to:

 apply on a consistent basis accounting policies

laid down by the Secretary of State with the
approval of the Treasury
 make judgements and estimates which are
reasonable and prudent
 state whether applicable accounting standards
have been followed, subject to any material
departures disclosed and explained in the
accounts and
 prepare the financial statements on a going
concern basis and disclose any material
uncertainties over going concern.

The directors are responsible for keeping proper

accounting records which disclose with reasonable
accuracy at any time the financial position of the trust
and to enable them to ensure that the accounts
comply with requirements outlined in the above
mentioned direction of the Secretary of State. They
are also responsible for safeguarding the assets of the
trust and hence for taking reasonable steps for the
prevention and detection of fraud and other
irregularities.

The directors confirm to the best of their knowledge

and belief they have complied with the above
requirements in preparing the accounts.

The directors confirm that the annual report and

accounts, taken as a whole, is fair, balanced and
understandable and provides the information
necessary for patients, regulators and stakeholders to
assess the NHS trust’s performance, business model
and strategy

By order of the Board

92 London Ambulance Service NHS Trust

 2. Accountability Report

Duties as the accountable officer of the Trust

The Chief Executive of NHS England has designated

that the Chief Executive should be the Accountable
Officer of the trust. The relevant responsibilities of
Accountable Officers are set out in the NHS Trust
Accountable Officer Memorandum. These include
ensuring that:

 there are effective management systems in

place to safeguard public funds and assets and
assist in the implementation of corporate
governance
 value for money is achieved from the resources
available to the trust
 the expenditure and income of the trust has
been applied to the purposes intended by
Parliament and conform to the authorities
which govern them
 effective and sound financial management
systems are in place and
 annual statutory accounts are prepared in a
format directed by the Secretary of State to give
a true and fair view of the state of affairs as at
the end of the financial year and the income
and expenditure, other items of comprehensive
income and cash flows for the year.

As far as I am aware, there is no relevant audit

information of which the trust’s auditors are unaware,
and I have taken all the steps that I ought to have
taken to make myself aware of any relevant audit
information and to establish that the entity’s auditors
are aware of that information.

To the best of my knowledge and belief, I have

properly discharged the responsibilities set out in my
letter of appointment as an Accountable Officer.

London Ambulance Service NHS Trust 93

94 London Ambulance Service NHS Trust
 1. Performance
3. Annual Accounts
report

Annual
accounts
for the year ended
31 March 2023

LondonReport
Annual Ambulance Service NHS
and Accounts Trust
2022/23 95
95
 3 Annual Accounts

INDEPENDENT AUDITOR’S REPORT TO THE BOARD OF DIRECTORS

OF LONDON AMBULANCE SERVICE NHS TRUST

REPORT ON THE AUDIT OF THE FINANCIAL STATEMENTS

Opinion
We have audited the financial statements of London approval of the financial statements (“the going
Ambulance Service NHS Trust (“the Trust”) for the year concern period”).
ended 31 March 2023 which comprise the Statement
of Comprehensive Income, Statement of Financial In our evaluation of the Directors’ conclusions, we
Position, Statement of Changes in Equity and considered the inherent risks associated with the
Statement of Cash Flows, and the related notes, continuity of services provided by the Trust over the
including the accounting policies in note 1. going concern period.

In our opinion the financial statements: Our conclusions based on this work:

 give a true and fair view of the state of the  we consider that the Directors’ use of the going
Trust’s affairs as at 31 March 2023 and of its concern basis of accounting in the preparation
income and expenditure for the year then of the financial statements is appropriate: and
ended; and  we have not identified, and concur with the
 have been properly prepared in accordance with Directors’ assessment that there is not, a
the accounting policies directed by the Secretary material uncertainty related to events or
of State for Health and Social Care with the conditions that, individually or collectively, may
consent of HM Treasury on 23 June 2022 as cast significant doubt on the Trust’s ability to
being relevant to NHS Trusts in England and continue as a going concern for the going
included in the Department of Health and Social concern period.
Care Group Accounting Manual 2022/23; and
However, as we cannot predict all future events or
 have been prepared in accordance with the
conditions and as subsequent events may result in
requirements of the National Health Service Act
outcomes that are inconsistent with judgements that
2006 (as amended).
were reasonable at the time they were made, the
above conclusions are not a guarantee that the Trust
Basis for opinion will continue in operation.
We conducted our audit in accordance with Fraud and breaches of laws and regulations - ability
International Standards on Auditing (UK) (“ISAs (UK)”) to detect
and applicable law. Our responsibilities are described
below. We have fulfilled our ethical responsibilities Identifying and responding to risks of material
under, and are independent of the Trust in accordance misstatement due to fraud
with, UK ethical requirements including the FRC
Ethical Standard. We believe that the audit evidence To identify risks of material misstatement due to fraud
we have obtained is a sufficient and appropriate basis (“fraud risks”) we assessed events or conditions that
for our opinion. could indicate an incentive or pressure to commit
fraud or provide an opportunity to commit fraud. Our
Going concern risk assessment procedures included:

The directors have prepared the financial statements  Enquiring of management, the Audit Committee
on the going concern basis as they have not been and internal audit and inspection of policy fraud,
informed by the relevant national body of the including the internal audit function, and the
intention to either cease the Trust’s services or dissolve Trust’s channel for “whistleblowing”, as ,well as
the Trust without the transfer of its services to another whether they have knowledge of any actual,
public sector entity. They have also concluded that suspected or alleged fraud.
there are no material uncertainties that could have
 Assessing the incentives for management to
cast significant doubt over its ability to continue as a
manipulate reported financial performance as a
going concern for at least a year from the date of
96 London Ambulance Service NHS Trust
 Annual Accounts 3

result of the need to achieve financial We identified areas of laws and regulations that could
performance targets delegated to the Trust by reasonably be expected to have a material effect on the
NHS England. financial statements from our general sector experience
and through discussion with the directors and other
 Reading Board and Audit Committee minutes.
management (as required by auditing standards), and
 Using analytical procedures to identify any
from inspection of the Trust’s regulatory and legal
unusual or unexpected relationships.
correspondence and discussed with the directors and
other management the policies and procedures
We communicated identified fraud risks throughout
regarding compliance with laws and regulations.
the audit team and remained alert to any indications
of fraud throughout the audit. We communicated identified laws and regulations
throughout our team and remained alert to any
As required by auditing standards, we performed
indications of non-compliance throughout the audit.
procedures to address the risk of management
override of controls in particular the risk that Trust The potential effect of these laws and regulations on
management may be in a position to make the financial statements varies considerably.
inappropriate accounting entries. On this audit we did
not identify a fraud risk related to revenue Firstly, the Trust is subject to laws and regulations that
recognition due to the block nature of the funding directly affect the financial statements, including the
provided to the Trust during the year. We therefore financial reporting aspects of NHS legislation. We
assessed that there was limited opportunity for the assessed the extent of compliance with these laws and
Trust to manipulate the income that was reported. regulations as part of our procedures on the related
financial statement items.
We also identified a fraud risk related to expenditure
recognition in response to the pressure arising from Secondly, the Trust is subject to many other laws and
the Trust’s breakeven duty, which could create an regulations where the consequences of non-
incentive for management to fraudulently understate compliance could have a material effect on amounts
the value of expenditure recorded in relation to non- or disclosures in the financial statements, for instance
pay expenditure, and accrued pay expenditure. through the imposition of fines or litigation. We
identified the following areas as those most likely to
We also performed procedures including: have such an effect: employment law, recognising the
regulated nature of the Trust’s activities. Auditing
 Identifying journal entries to test based on risk
standards limit the required audit procedures to
criteria and comparing the identified entries to
identify non-compliance with : these r laws and
supporting documentation. These included
regulations to enquiry of the directors and
journals posted as part of the year-end closure
other management and inspection of regulatory and
process that reduced expenditure.
legal correspondence, if any. Therefore if a breach of
 Assessing whether the judgements made in operational regulations is not disclosed to us or
making accounting estimates are indicative of a evident from relevant correspondence, an audit will
potential bias, in particular accruals relating to not detect that breach.
workforce obligations.
Context of the ability of the audit to detect fraud or
 Selecting a sample of invoices received and
breaches of law or regulation
payments made in April and May 2023 to assess
whether they related to the financial year and, Owing to the inherent limitations of an audit, there is
if so, whether they were recorded in that an unavoidable risk that we may not have detected
period. some material misstatements in the financial
 Re-calculating a sample of accruals relating to statements, even though we have properly planned
staff bonuses, the non-consolidated pay award, and performed our audit in accordance with auditing
and overtime. standards. For example, the further removed non-
compliance with laws and regulations is from the
events and transactions reflected in the financial
Identifying and responding to risks of material
statements, the less likely the inherently limited
misstatement related to non-compliance with laws
procedures required by auditing standards would
and regulations
identify it.

Annual Report and Accounts 2022/23 97

 3 Annual Accounts

In addition, as with any audit, there remained a Directors’ and Accountable Officer’s responsibilities
higher risk of non-detection of fraud, as these may
involve collusion, forgery, intentional omissions, As explained more fully in the statement set out on
misrepresentations, or the override of internal page [A], the directors are responsible for the
controls. Our audit procedures are designed to detect preparation of financial statements that give a true
material misstatement. We are not responsible for and fair view. They are also responsible for: such
preventing non-compliance or fraud and cannot be internal control as they determine is necessary to
expected to detect non compliance with all laws and enable the preparation of financial statements that
regulations. are free from material misstatement, whether due to
fraud or error; assessing the Trust’s ability to continue
Other information in the Annual Report as a going concern, disclosing, as applicable, matters
related to going concern; and using the going concern
The Directors are responsible for the other basis of accounting unless they have been informed by
information, which comprises the information the relevant national body of the intention to either
included in the Annual Report, other than the cease the services provided by the Trust or dissolve the
financial statements and our auditor’s report thereon. Trust without the transfer of its services to another
Our opinion on the financial statements does not public sector entity. As explained more fully in the
cover the other information and, accordingly, we do statement of the Chief Executive’s responsibilities, as
not express an audit opinion or, except as explicitly the Accountable Officer of the Trust, on Page [BJ the
stated below, any form of assurance conclusion Accountable Officer is responsible for ensuring that
thereon. annual statutory accounts are prepared in a format
directed by the Secretary of State.
Our responsibility is to read the other information
and, in doing so, consider whether, based on our Auditor’s responsibilities
financial statements audit work, the information
therein is materially misstated or inconsistent with the Our objectives are to obtain reasonable assurance ab
financial statements or our audit knowledge. Based ut whethe the financial 1statembnts as a whole are
solely on that work: free from material misstatement, whether due to
fraud or error, and to issue our opinion in an auditor’s
 we have not identified material misstatements report. Reasonable assurance is a high level of
in the other information; and assurance, but does not guarantee that an audit
 in our opinion the other information included in conducted in accordance with ISAs (UK) will always
the Annual Report for the financial year is detect a material misstatement when it exists.
consistent with the financial statements. Misstatements can arise from fraud or error and are
considered material if, individually or in aggregate,
they could reasonably be expected to influence the
Annual Governance Statement
economic decisions of users taken on the basis of the
We are required by the Code of Audit Practice financial statements.
published by the National Audit Office in April 2020
A fuller description of our responsibilities is provided
on behalf of the Comptroller and Auditor General (the
on the FRC’s website at
“Code of Audit Practice”) to report to you if the
www.frc.orq.uk/auditorsresponslbilities.
Annual Governance Statement has not been prepared
in accordance with the requirements of the REPORT ON OTHER LEGAL AND REGULATORY
Department of Health and Social Care Group MATTERS
Accounting Manual 2022/23. We have nothing to
report in this respect. Report on the Trust’s arrangements for securing
economy, efficiency and effectiveness in its use of
Remuneration and Staff Reports resources

In our opinion the parts of the Remuneration and Under the Code of Audit Practice, we are required to
Staff Reports subject to audit have been properly report if we identify any significant weaknesses in the
prepared in all material respects, in accordance with arrangements that have been made by the Trust to
the Department of Health and Social Care Group secure economy, efficiency and effectiveness in its use
Accounting Manual 2022/23. of resources.

98 London Ambulance Service NHS Trust

 Annual Accounts 3

We have nothing to report in this respect. made, a decision which involves or would involve the
body incurring unlawful expenditure, or is about to
Respective responsibilities in respect of our review of take, or has begun to take a course of action which, if
arrangements for securing economy, efficiency and followed to its conclusion, would be unlawful and
effectiveness in the use of resources likely to cause a loss or deficiency.

As explained in the statement set out on page [A], the We have nothing to report in this respect.
Chief Executive, as the Accountable Officer, is
responsible for ensuring that value for money is THE PURPOSE OF OUR AUDIT WORK AND TO WHOM
achieved from the resources available to the Trust. We WE OWE OUR RESPONSIBILITIES
are required under section 21(2A) of the Local Audit
and Accountability Act 2014 to be satisfied that the This report is made solely to the Board of Directors of
Trust has made proper arrangements for securing London Ambulance Service NHS Trust, as a body, in
economy, efficiency and effectiveness in its use of accordance with Part 5 of the Local Audit and
resources. Accountability Act 2014. Our audit work has been
undertaken so that we might state to the Board of the
We are not required to consider, nor have we Trust, as a body, those matters we are required to
considered, whether all aspects of the Trust’s state to them in an auditor’s report and for no other
arrangements for securing economy, efficiency and purpose. To the fullest extent permitted by law, we do
effectiveness in its use of resources are operating not accept or assume responsibility to anyone other
effectively. than the Board of the Trust, as a body, for our audit
work, for this report or for the opinions we have
We have planned our work and undertaken our formed.
review in accordance with the Code of Audit Practice
and related statutory guidance having regard to CERTIFICATE OF COMPLETION OF THE AUDIT
whether the Trust had proper arrangements in place
to ensure financial sustainability, proper governance We certify that we have completed the audit of the
and to use information about costs and performance accounts of London Ambulance Service NHS Trust for
to improve the way it manages and delivers its the year ended 31 March 2023 in accordance with the
services. Based on our risk assessment, we undertook requirements of the Local Audit and Accountability
such work as we considered necessary. Act 2014 and the Code of Audit Practice.

Statutory reporting matters

We are required by Schedule 2 to the Code of Audit

Practice issued by the Comptroller and Auditor
General (‘the Code of Audit Practice’) to report to you Dean Gibbs
if we refer a matter to the Secretary of State under for and on behalf of KPMG LLP
section 30 of the Local Audit and Accountability Act Chartered Accountants
2014 because we have reason to believe that the Trust, 15 Canada Square London
or an officer of the Trust, is about to make, or has E14 5GL
27 June 2023

Annual Report and Accounts 2022/23 99

 3 Annual Accounts

Statement of Comprehensive Income

for the year ended 31 March 2023
2022/23 2021/22
Note £000 £000
Operating income from patient care activities 3 631,842 595,171
Other operating income 4 14,364 7,924
Operating expenses 6 (645,609) (601,832)
Operating surplus from continuing operations 597 1,263

Finance income 9 1,252 25

Finance expenses 10 (138) 83
PDC dividends payable (4,418) (4,890)
Net finance costs (3,304) (4,782)
Other gains / (losses) 12 (3,957) (626)
Deficit for the year (6,664) (4,145)

Other comprehensive income

Will not be reclassified to income and expenditure:
Impairments 7 (2,511) (441)
Revaluations 5,226 602
Total comprehensive expense for the period (3,949) (3,984)

100 London Ambulance Service NHS Trust

 Annual Accounts 3

Statement of Financial Position

as at 31 March 2023 31 March 2023 31 March 2022
Note £000 £000
Non-current assets
Intangible assets 13 9,893 13,612
Property, plant and equipment 16 212,403 211,485
Right of use assets 17 30,799
Receivables 19 33 54
Total non-current assets 253,128 225,151
Current assets
Inventories 18 3,867 6,869
Receivables 19 45,863 20,984
Cash and cash equivalents 20 27,887 47,875
Total current assets 77,617 75,728
Current liabilities
Trade and other payables 22 (88,191) (85,623)
Borrowings 24 (5,360) -
Provisions 26 (3,062) (3,485)
Other liabilities 23 (1,456) (2,791)
Total current liabilities (98,069) (91,899)
Total assets less current liabilities 232,676 208,980
Non-current liabilities
Borrowings 24 (23,320) (107)
Provisions 26 (22,323) (20,224)
Total non-current liabilities (45,643) (20,331)
Total assets employed 187,033 188,649

Financed by
Public dividend capital 86,936 85,097
Revaluation reserve 46,930 46,254
Other reserves (419) (419)
Income and expenditure reserve 53,586 57,717
Total taxpayers' equity 187,033 188,649

The notes on pages 104 to 137 form part of these

accounts.

Daniel Elkeles
Chief Executive Date: 26/06/23

Annual Report and Accounts 2022/23 101

 3 Annual Accounts

Statement of Cash Flows

for the year ended 31 March 2023
2022/23 2021/22
Note £000 £000
Cash flows from operating activities
Operating surplus 597 1,263
Non-cash income and expense:
Depreciation and amortisation 6 28,609 22,921
Net impairments 7 9,010 3,536
Income recognised in respect of capital donations 4 (209) -
(Increase) / decrease in receivables and other assets (25,245) 8,139
(Increase) / decrease in inventories 3,002 (429)
Increase / (decrease) in payables and other liabilities 4,244 9,931
Increase / (decrease) in provisions 501 7,856
Other movements in operating cash flows 10 -
Net cash flows from / (used in) operating activities 20,519 53,217
Cash flows from investing activities
Interest received 1,252 25
Purchase of intangible assets (1,056) (2,620)
Proceeds from sales of intangible assets 33 -
Purchase of PPE and investment property (32,923) (45,061)
Sales of PPE and investment property - 121
Initial direct costs or up front payments in respect of new right of use assets (lessee) (271)
Receipt of cash donations to purchase assets 209 -
Net cash flows from / (used in) investing activities (32,756) (47,535)
Cash flows from financing activities
Public dividend capital received 1,839 7,257
Movement on other loans (107) -
Capital element of lease liability repayments (4,232) -
Other interest - (2)
Interest element of lease liability repayments (258) -
PDC dividend (paid) / refunded (4,993) (4,849)
Net cash flows from / (used in) financing activities (7,751) 2,406
Increase / (decrease) in cash and cash equivalents (19,988) 8,088
Cash and cash equivalents at 1 April - brought forward 47,875 39,787
Cash and cash equivalents at 31 March 20 27,887 47,875

102 London Ambulance Service NHS Trust

 Annual Accounts 3

Statement of Changes in Equity

for the year ended 31 March 2023
Public Income and
Revaluation Other
dividend expenditure Total
reserve reserves
capital reserve
£000 £000 £000 £000 £000
Taxpayers' and others' equity
85,097 46,254 (419) 57,717 188,649
at 1 April 2022 - brought forward
Implementation of IFRS 16 on 1 April 2022 - - - 494 494
Deficit for the year - - - (6,664) (6,664)
Other transfers between reserves - (2,039) - 2,039 -
Impairments - (2,511) - - (2,511)
Revaluations - 5,226 - - 5,226
Public dividend capital received 1,839 - - - 1,839
Taxpayers' and others' equity at 31 March 2023 86,936 46,930 (419) 53,586 187,033

Statement of Changes in Equity

for the year ended 31 March 2022
Public Income and
Revaluation Other
dividend expenditure Total
reserve reserves
capital reserve
£000 £000 £000 £000 £000
Taxpayers' and others' equity
77,840 47,908 (419) 60,047 185,376
at 1 April 2021 - brought forward
Deficit for the year - - - (4,145) (4,145)
Other transfers between reserves - (1,813) - 1,813 -
Impairments - (441) - - (441)
Revaluations - 602 - - 602
Transfer to retained earnings on disposal of assets - (2) - 2 -
Public dividend capital received 7,257 - - - 7,257
Taxpayers' and others' equity at 31 March 2022 85,097 46,254 (419) 57,717 188,649

Information on reserves
Public dividend capital
Public dividend capital (PDC) is a type of public sector equity finance based on the excess of assets over liabilities at the time
of establishment of the predecessor NHS organisation. Additional PDC may also be issued to trusts by the Department of
Health and Social Care. A charge, reflecting the cost of capital utilised by the trust, is payable to the Department of Health
as the public dividend capital dividend.

Revaluation reserve
Increases in asset values arising from revaluations are recognised in the revaluation reserve, except where, and to the extent
that, they reverse impairments previously recognised in operating expenses, in which case they are recognised in operating
income. Subsequent downward movements in asset valuations are charged to the revaluation reserve to the extent that a
previous gain was recognised unless the downward movement represents a clear consumption of economic benefit or a
reduction in service potential.

Income and expenditure reserve

The balance of this reserve is the accumulated surpluses and deficits of the trust.

Annual Report and Accounts 2022/23 103

 3 Annual Accounts

Notes to the Accounts

Note 1 Accounting policies and other 2020/21 to 2024/25. This plan includes the continued
information provision of services by the Trust. No circumstances
were identified causing the Directors to doubt the
Note 1.1 Basis of preparation continued provision of NHS services.

The Department of Health and Social Care has This year the Trust reported a £6.7m accounting deficit
directed that the financial statements of the Trust and a £0.1m surplus adjusted financial performance.
shall meet the accounting requirements of the The majority of the Trust’s income from Commissioners
Department of Health and Social Care Group was based on block contracts. The closing cash balance
Accounting Manual (GAM), which shall be agreed was £27.9m at 31st March 2023.
with HM Treasury. Consequently, the following
financial statements have been prepared in The Trust is planning to break even in 2023/24. This
accordance with the GAM 2022/23 issued by the financial plan is predicated on receiving income of
Department of Health and Social Care. The accounting £651.0m. The Trust has sufficient cash to continue its
policies contained in the GAM follow International operations throughout 2023/24 financial year.
Financial Reporting Standards to the extent that they
Our going concern assessment is made up to
are meaningful and appropriate to the NHS, as
30/06/2024. The Trust has prepared a cash forecast
determined by HM Treasury, which is advised by the
modelled on the above expectations for funding
Financial Reporting Advisory Board. Where the GAM
during the going concern period to 30/06/2024 and
permits a choice of accounting policy, the accounting
these have been tested using a downside scenario
policy that is judged to be most appropriate to the
analysis with and without mitigation.
particular circumstances of the Trust for the purpose
of giving a true and fair view has been selected. The Interim support can be accessed if it were required,
particular policies adopted are described below. These but there is currently no such identified requirement.
have been applied consistently in dealing with items
considered material in relation to the accounts. In conclusion, these factors, and the anticipated future
provision of services in the public sector, support the
Accounting convention Trust’s adoption of the going concern basis for the
These accounts have been prepared under the preparation of the accounts.
historical cost convention modified to account for the
revaluation of property, plant and equipment, Note 1.3 Revenue from contracts with
intangible assets, inventories and certain financial customers
assets and financial liabilities.
Where income is derived from contracts with
customers, it is accounted for under IFRS 15. The GAM
Note 1.2 Going concern
expands the definition of a contract to include
These accounts have been prepared on a going legislation and regulations which enables an entity to
concern basis. The financial reporting framework receive cash or another financial asset that is not
applicable to NHS bodies, derived from the HM classified as a tax by the Office of National Statistics
Treasury Financial Reporting Manual, defines that the (ONS).
anticipated continued provision of the entity’s services
in the public sector is normally sufficient evidence of Revenue in respect of goods/services provided is
going concern. The directors have a reasonable recognised when (or as) performance obligations are
expectation that this will continue to be the case. satisfied by transferring promised goods/services to
the customer and is measured at the amount of the
The Directors of the Trust have considered whether transaction price allocated to those performance
there are any local or national policy decisions that are obligations. At the year end, the Trust accrues income
likely to affect the continued funding and provision of relating to performance obligations satisfied in that
services by the Trust. The Trust is a member of the year. Where the Trust’s entitlement to consideration
North West London Integrated Care System (ICS). The for those goods or services is unconditional a contract
ICS has published its Strategic Delivery Plan and NHS receivable will be recognised. Where entitlement to
Long Term Plan response for the five year period
104 London Ambulance Service NHS Trust
 Annual Accounts 3

consideration is conditional on a further factor other Note 1.4 Other forms of income
than the passage of time, a contract asset will be
Grants and donations
recognised. Where consideration received or
Government grants are grants from government
receivable relates to a performance obligation that is
bodies other than income from commissioners or
to be satisfied in a future period, the income is
Trusts for the provision of services. Where a grant is
deferred and recognised as a contract liability.
used to fund revenue expenditure it is taken to the
Revenue from NHS contracts Statement of Comprehensive Income to match that
The main source of income for the Trust is contracts expenditure. Where the grant is used to fund capital
with commissioners for health care services. expenditure, it is credited to the consolidated
statement of comprehensive income once conditions
Funding envelopes are set at an Integrated Care attached to the grant have been met. Donations are
System (ICS) level. The majority of the Trust’s income is treated in the same way as government grants.
earned from NHS commissioners in the form of fixed
payments to fund an agreed level of activity. Apprenticeship service income
The value of the benefit received when accessing
The Trust also receives income from contracts that are funds from the Government's apprenticeship service is
based on payment for the level of activity performed, recognised as income at the point of receipt of the
and contracts that are based on delivery of a level of training service. Where these funds are paid directly to
service. an accredited training provider from the Trust’s Digital
Apprenticeship Service (DAS) account held by the
Revenue from research contracts
Department for Education, the corresponding
Where research contracts fall under IFRS 15, revenue is
notional expense is also recognised at the point of
recognised as and when performance obligations are
recognition for the benefit.
satisfied. For some contracts, it is assessed that the
revenue project constitutes one performance Note 1.5 Expenditure on employee benefits
obligation over the course of the multi-year contract.
In these cases it is assessed that the Trust’s interim Short-term employee benefits
performance does not create an asset with alternative Salaries, wages and employment-related payments
use for the Trust, and the Trust has an enforceable such as social security costs and the apprenticeship levy
right to payment for the performance completed to are recognised in the period in which the service is
date. It is therefore considered that the performance received from employees. The cost of annual leave
obligation is satisfied over time, and the Trust entitlement earned but not taken by employees at the
recognises revenue each year over the course of the end of the period is recognised in the financial
contract. Some research income alternatively falls statements to the extent that employees are permitted
within the provisions of IAS 20 for government grants. to carry-forward leave into the following period.

NHS injury cost recovery scheme Pension costs

The Trust receives income under the NHS injury cost
NHS Pension Scheme
recovery scheme, designed to reclaim the cost of
Past and present employees are covered by the
treating injured individuals to whom personal injury
provisions of the two NHS Pension Schemes. Both
compensation has subsequently been paid, for
schemes are unfunded, defined benefit schemes that
instance by an insurer. The Trust recognises the income
cover NHS employer, general practices and other
when performance obligations are satisfied. In
bodies, allowed under the direction of Secretary of
practical terms this means that treatment has been
State for Health and Social Care in England and Wales.
given, it receives notification from the Department of
The scheme is not designed in a way that would
Work and Pension's Compensation Recovery Unit, has
enable employers to identify their share of the
completed the NHS2 form and confirmed there are no
underlying scheme assets and liabilities. Therefore, the
discrepancies with the treatment. The income is
scheme is accounted for as though it is a defined
measured at the agreed tariff for the treatments
contribution scheme: the cost to the Trust is taken as
provided to the injured individual, less an allowance
equal to the employer’s pension contributions payable
for unsuccessful compensation claims and doubtful
to the scheme for the accounting period. The
debts in line with IFRS 9 requirements of measuring
contributions are charged to operating expenses as
expected credit losses over the lifetime of the asset.
they become due.

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 3 Annual Accounts

Additional pension liabilities arising from early and maintenance is charged to the Statement of
retirements are not funded by the scheme except Comprehensive Income in the period in which it is
where the retirement is due to ill-health. The full incurred.
amount of the liability for the additional costs is
charged to the operating expenses at the time the Measurement
Trust commits itself to the retirement, regardless of Valuation
the method of payment. All property, plant and equipment assets are measured
initially at cost, representing the costs directly
Expenditure on other goods and services attributable to acquiring or constructing the asset and
Expenditure on goods and services is recognised when, bringing it to the location and condition necessary for
and to the extent that they have been received, and is it to be capable of operating in the manner intended
measured at the fair value of those goods and by management.
services. Expenditure is recognised in operating
expenses except where it results in the creation of a Assets are measured subsequently at valuation. Assets
non-current asset such as property, plant and which are held for their service potential and are in
equipment. use (ie operational assets used to deliver either front
line services or back office functions) are measured at
Note 1.6 Property, plant and equipment their current value in existing use. Assets that were
most recently held for their service potential but are
Recognition
surplus with no plan to bring them back into use are
Property, plant and equipment is capitalised where:
measured at fair value where there are no restrictions
on sale at the reporting date and where they do not
 it is held for use in delivering services or for
meet the definitions of investment properties or assets
administrative purposes
held for sale.
 it is probable that future economic benefits will
flow to, or service potential be provided to, the Revaluations of property, plant and equipment are
Trust performed with sufficient regularity to ensure that
carrying values are not materially different from those
 it is expected to be used for more than one
that would be determined at the end of the reporting
financial year
period. Current values in existing use are determined
 the cost of the item can be measured reliably as follows:
 the item has cost of at least £5,000, or
 Land and non-specialised buildings – market
 collectively, a number of items have a cost of at value for existing use
least £5,000 and individually have cost of more
 Specialised buildings – depreciated replacement
than £250, where the assets are functionally
cost on a modern equivalent asset basis.
interdependent, had broadly simultaneous
purchase dates, are anticipated to have similar For specialised assets, current value in existing use is
disposal dates and are under single managerial interpreted as the present value of the asset’s
control. remaining service potential, which is assumed to be at
least equal to the cost of replacing that service
Subsequent expenditure
potential. Specialised assets are therefore valued at
Subsequent expenditure relating to an item of
their depreciated replacement cost (DRC) on a modern
property, plant and equipment is recognised as an
equivalent asset (MEA) basis. An MEA basis assumes
increase in the carrying amount of the asset when it is
that the asset will be replaced with a modern asset of
probable that additional future economic benefits or
equivalent capacity and location requirements of the
service potential deriving from the cost incurred to
services being provided. Assets held at depreciated
replace a component of such item will flow to the
replacement cost have been valued on an alternative
enterprise and the cost of the item can be determined
site basis where the services provided from that asset
reliably. Where a component of an asset is replaced,
could also reasonably be delivered from an alternative
the cost of the replacement is capitalised if it meets
location and a suitable location has been identified.
the criteria for recognition above. The carrying
amount of the part replaced is de-recognised. Other Properties in the course of construction for service or
expenditure that does not generate additional future administration purposes are carried at cost, less any
economic benefits or service potential, such as repairs impairment loss. Cost includes professional fees. Assets

106 London Ambulance Service NHS Trust

 Annual Accounts 3

are revalued and depreciation commences when the gave rise to the loss is reversed. Reversals are
assets are brought into use. recognised in operating expenditure to the extent
that the asset is restored to the carrying amount it
IT equipment, transport equipment, furniture and would have had if the impairment had never been
fittings, and plant and machinery that are held for recognised. Any remaining reversal is recognised in
operational use are valued at depreciated historic cost the revaluation reserve. Where, at the time of the
where these assets have short useful lives or low original impairment, a transfer was made from the
values or both, as this is not considered to be revaluation reserve to the income and expenditure
materially different from current value in existing use. reserve, an amount is transferred back to the
revaluation reserve when the impairment reversal is
Depreciation
recognised.
Items of property, plant and equipment are
depreciated over their remaining useful lives in a Other impairments are treated as revaluation losses.
manner consistent with the consumption of economic Reversals of ‘other impairments’ are treated as
or service delivery benefits. Freehold land is revaluation gains.
considered to have an infinite life and is not
depreciated. De-recognition
Assets intended for disposal are reclassified as ‘held
Property, plant and equipment which have been for sale’ once the criteria in IFRS 5 are met. The sale
reclassified as ‘held for sale’ cease to be depreciated must be highly probable and the asset available for
upon the reclassification. Assets in the course of immediate sale in its present condition.
construction and residual interests in off-Statement of
Financial Position PFI contract assets are not Following reclassification, the assets are measured at
depreciated until the asset is brought into use or the lower of their existing carrying amount and their
reverts to the Trust, respectively. fair value less costs to sell. Depreciation ceases to be
charged and the assets are not revalued, except where
Revaluation gains and losses the 'fair value less costs to sell' falls below the carrying
Revaluation gains are recognised in the revaluation amount. Assets are de-recognised when all material
reserve, except where, and to the extent that, they sale contract conditions have been met.
reverse a revaluation decrease that has previously
been recognised in operating expenses, in which case Property, plant and equipment which is to be scrapped
they are recognised in operating expenditure. or demolished does not qualify for recognition as
‘held for sale’ and instead is retained as an
Revaluation losses are charged to the revaluation operational asset and the asset’s useful life is adjusted.
reserve to the extent that there is an available balance The asset is de-recognised when scrapping or
for the asset concerned, and thereafter are charged to demolition occurs.
operating expenses.
Donated and grant funded assets
Gains and losses recognised in the revaluation reserve Donated and grant funded property, plant and
are reported in the Statement of Comprehensive equipment assets are capitalised at their fair value on
Income as an item of ‘other comprehensive income’. receipt. The donation/grant is credited to income at
the same time, unless the donor has imposed a
Impairments
condition that the future economic benefits embodied
In accordance with the GAM, impairments that arise
in the grant are to be consumed in a manner specified
from a clear consumption of economic benefits or of
by the donor, in which case, the donation/grant is
service potential in the asset are charged to operating
deferred within liabilities and is carried forward to
expenses. A compensating transfer is made from the
future financial years to the extent that the condition
revaluation reserve to the income and expenditure
has not yet been met.
reserve of an amount equal to the lower of (i) the
impairment charged to operating expenses; and (ii) The donated and grant funded assets are
the balance in the revaluation reserve attributable to subsequently accounted for in the same manner as
that asset before the impairment. other items of property, plant and equipment.

An impairment that arises from a clear consumption This includes assets donated to the Trust by the
of economic benefit or of service potential is reversed Department of Health and Social Care as part of the
when, and to the extent that, the circumstances that

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 3 Annual Accounts

response to the coronavirus pandemic. As defined in Useful lives of property, plant and equipment
the GAM, the Trust applies the principle of donated Useful lives reflect the total life of an asset and not
asset accounting to assets that the Trust controls and is the remaining life of an asset. The range of useful
obtaining economic benefits from at the year end. lives is shown in the table below:

Min life Max life

Years Years

Buildings, excluding dwellings 3 99

Plant & machinery 5 15

Transport equipment 2 10

Information technology 3 8

Furniture & fittings 3 10

Finance-leased assets (including land) are depreciated Measurement

over the shorter of the useful life or the lease term, Intangible assets are recognised initially at cost,
unless the Trust expects to acquire the asset at the end comprising all directly attributable costs needed to
of the lease term in which case the assets are create, produce and prepare the asset to the point
depreciated in the same manner as owned assets that it is capable of operating in the manner intended
above. by management. Subsequently intangible assets are
measured at current value in existing use. Where no
Note 1.7 Intangible assets active market exists, intangible assets are valued at
Recognition the lower of depreciated replacement cost and the
Intangible assets are non-monetary assets without value in use where the asset is income generating.
physical substance which are capable of being sold Revaluations gains and losses and impairments are
separately from the rest of the Trust’s business or treated in the same manner as for property, plant and
which arise from contractual or other legal rights. equipment. An intangible asset which is surplus with
They are recognised only where it is probable that no plan to bring it back into use is valued at fair value
future economic benefits will flow to, or service where there are no restrictions on sale at the
potential be provided to, the Trust and where the cost reporting date and where they do not meet the
of the asset can be measured reliably. definitions of investment properties or assets held for
sale.
Internally generated intangible assets
Internally generated goodwill, brands, mastheads, Intangible assets held for sale are measured at the
publishing titles, customer lists and similar items are lower of their carrying amount or fair value less costs
not capitalised as intangible assets. Expenditure on to sell.
research is not capitalised. Expenditure on
Amortisation
development is capitalised when it meets the
Intangible assets are amortised over their expected
requirements set out in IAS 38.
useful lives in a manner consistent with the
Software consumption of economic or service delivery benefits.
Software which is integral to the operation of Useful lives of intangible assets
hardware, eg an operating system, is capitalised as
Useful lives reflect the total life of an asset and not
part of the relevant item of property, plant and
the remaining life of an asset. The range of useful
equipment. Software which is not integral to the
lives is shown in the table below:
operation of hardware, eg application software, is
capitalised as an intangible asset.

108 London Ambulance Service NHS Trust

 Annual Accounts 3

Min life Max life

Years Years

Intangible assets – purchased

Information technology 3 7

Software licences 3 7

Note 1.8 Inventories items (such as goods or services), which are entered
into in accordance with the Trust’s normal purchase,
Inventories are valued at the lower of cost and net
sale or usage requirements and are recognised when,
realisable value. The cost of inventories is measured
and to the extent which, performance occurs, ie, when
using the first in, first out (FIFO) method.
receipt or delivery of the goods or services is made.
In 2021/22 and 2022/23, the Trust received inventories
Classification and measurement
including personal protective equipment from the
Financial assets and financial liabilities are initially
Department of Health and Social Care at nil cost. In
measured at fair value plus or minus directly
line with the GAM and applying the principles of the
attributable transaction costs except where the asset
IFRS Conceptual Framework, the Trust has accounted
or liability is not measured at fair value through
for the receipt of these inventories at a deemed cost,
income and expenditure. Fair value is taken as the
reflecting the best available approximation of an
transaction price, or otherwise determined by
imputed market value for the transaction based on
reference to quoted market prices or valuation
the cost of acquisition by the Department.
techniques.
Note 1.9 Cash and cash equivalents Financial assets and liabilities are classified as
Cash is cash in hand and deposits with any financial subsequently measured at amortised cost
institution repayable without penalty on notice of not
Financial assets and financial liabilities at amortised
more than 24 hours. Cash equivalents are investments
cost
that mature in 3 months or less from the date of
Financial assets and financial liabilities at amortised
acquisition and that are readily convertible to known
cost are those held with the objective of collecting
amounts of cash with insignificant risk of change in
contractual cash flows and where cash flows are solely
value.
payments of principal and interest. This includes cash
In the Statement of Cash Flows, cash and cash equivalents, contract and other receivables, trade and
equivalents are shown net of bank overdrafts that are other payables, rights and obligations under lease
repayable on demand and that form an integral part arrangements and loans receivable and payable.
of the Trust’s cash management. Cash, bank and
After initial recognition, these financial assets and
overdraft balances are recorded at current values.
financial liabilities are measured at amortised cost
Note 1.10 Financial assets and financial using the effective interest method less any
impairment (for financial assets). The effective interest
liabilities
rate is the rate that exactly discounts estimated future
Recognition cash payments or receipts through the expected life of
Financial assets and financial liabilities arise where the the financial asset or financial liability to the gross
Trust is party to the contractual provisions of a carrying amount of a financial asset or to the
financial instrument, and as a result has a legal right amortised cost of a financial liability.
to receive or a legal obligation to pay cash or another
financial instrument. The GAM expands the definition Interest revenue or expense is calculated by applying
of a contract to include legislation and regulations the effective interest rate to the gross carrying
which give rise to arrangements that in all other amount of a financial asset or amortised cost of a
respects would be a financial instrument and do not financial liability and recognised in the Statement of
give rise to transactions classified as a tax by ONS. Comprehensive Income and a financing income or
expense
This includes the purchase or sale of non-financial

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 3 Annual Accounts

Impairment of financial assets It also includes peppercorn leases where consideration

For all financial assets measured at amortised cost paid is nil or nominal (significantly below market
including lease receivables, contract receivables and value) but in all other respects meet the definition of
contract assets the Trust recognises an allowance for a lease. The trust does not apply lease accounting to
expected credit losses. new contracts for the use of intangible assets.

The Trust adopts the simplified approach to The Trust determines the term of the lease term with
impairment for contract and other receivables, reference to the non-cancellable period and any
contract assets and lease receivables, measuring options to extend or terminate the lease which the
expected losses as at an amount equal to lifetime Trust is reasonably certain to exercise.
expected losses.
The Trust as a lessee
For financial assets due from entities outside the DHSC
Recognition and initial measurement
group the loss allowance is initially measured at an
At the commencement date of the lease, being when
amount equal to 12-month expected credit losses
the asset is made available for use, the Trust
(stage 1) and subsequently at an amount equal to
recognises a right of use asset and a lease liability.
lifetime expected credit losses if the credit risk
assessed for the financial asset significantly increases The right of use asset is recognised at cost comprising
(stage 2). No such stage 1 and stage 2 allowance is the lease liability, any lease payments made before or
made for assets due from entities inside the DHSC at commencement, any direct costs incurred by the
group. lessee, less any cash lease incentives received. It also
includes any estimate of costs to be incurred restoring
For all financial assets that have become credit
the site or underlying asset on completion of the lease
impaired since initial recognition (stage 3), expected
term.
credit losses at the reporting date are measured as the
difference between the asset’s gross carrying amount The lease liability is initially measured at the present
and the present value of estimated future cash flows value of future lease payments discounted at the
discounted at the financial asset’s original effective interest rate implicit in the lease. Lease payments
interest rate. includes fixed lease payments, variable lease payments
dependent on an index or rate and amounts payable
For intra-DHSC debt not recognising level 1 and 2
under residual value guarantees. It also includes
expected credit losses for intra-DHSC debt
amounts payable for purchase options and
Expected losses are charged to operating expenditure termination penalties where these options are
within the Statement of Comprehensive Income and reasonably certain to be exercised.
reduce the net carrying value of the financial asset in
Where an implicit rate cannot be readily determined,
the Statement of Financial Position.
the Trust’s incremental borrowing rate is applied. This
De-recognition rate is determined by HM Treasury annually for each
Financial assets are de-recognised when the calendar year. A nominal rate of 0.95% applied to
contractual rights to receive cash flows from the assets new leases commencing in 2022 and 3.51% to new
have expired or the Trust has transferred substantially leases commencing in 2023.
all the risks and rewards of ownership.
The Trust does not apply the above recognition
Financial liabilities are de-recognised when the requirements to leases with a term of 12 months or
obligation is discharged, cancelled or expires. less or to leases where the value of the underlying
asset is below £5,000, excluding any irrecoverable VAT.
Note 1.11 Leases Lease payments associated with these leases are
expensed on a straight-line basis over the lease term.
A lease is a contract or part of a contract that conveys
Irrecoverable VAT on lease payments is expensed as it
the right to use an asset for a period of time in
falls due.
exchange for consideration. An adaptation of the
relevant accounting standard by HM Treasury for the Subsequent measurement
public sector means that for NHS bodies, this includes As required by a HM Treasury interpretation of the
lease-like arrangements with other public sector accounting standard for the public sector, the Trust
entities that do not take the legal form of a contract. employs a revaluation model for subsequent

110 London Ambulance Service NHS Trust

 Annual Accounts 3

measurement of right of use assets, unless the cost these financial statements with an initial application
model is considered to be an appropriate proxy for date of 1 April 2022. IFRS 16 replaces IAS 17 Leases,
current value in existing use or fair value, in line with IFRIC 4 Determining whether an arrangement contains
the accounting policy for owned assets. Where a lease and other interpretations.
consideration exchanged is identified as significantly
below market value, the cost model is not considered The standard has been applied using a modified
to be an appropriate proxy for the value of the right retrospective approach with the cumulative impact
of use asset. recognised in the income and expenditure reserve on
1 April 2022. Upon initial application, the provisions of
The Trust subsequently measures the lease liability by IFRS 16 have only been applied to existing contracts
increasing the carrying amount for interest arising where they were previously deemed to be a lease or
which is also charged to expenditure as a finance cost contain a lease under IAS 17 and IFRIC 4. Where
and reducing the carrying amount for lease payments existing contracts were previously assessed not to be
made. The liability is also remeasured for changes in or contain a lease, these assessments have not been
assessments impacting the lease term, lease revisited.
modifications or to reflect actual changes in lease
payments. Such remeasurements are also reflected in The Trust as lessee
the cost of the right of use asset. Where there is a For continuing leases previously classified as operating
change in the lease term or option to purchase the leases, a lease liability was established on 1 April 2022
underlying asset, an updated discount rate is applied equal to the present value of future lease payments
to the remaining lease payments. discounted at the Trust’s incremental borrowing rate
of 0.95%. A right of use asset was created equal to
The Trust as a lessor
the lease liability and adjusted for prepaid and
The Trust assesses each of its leases and classifies them accrued lease payments and deferred lease incentives
as either a finance lease or an operating lease. Leases recognised in the statement of financial position
are classified as finance leases when substantially all immediately prior to initial application. Hindsight has
the risks and rewards of ownership are transferred to been used in determining the lease term where lease
the lessee. All other leases are classified as operating arrangements contain options for extension or earlier
leases. termination.

Where the Trust is an intermediate lessor, classification No adjustments have been made on initial application
of the sublease is determined with reference to the in respect of leases with a remaining term of 12
right of use asset arising from the headlease. months or less from 1 April 2022 or for leases where
the underlying assets has a value below £5,000. No
Finance leases adjustments have been made in respect of leases
Amounts due from lessees under finance leases are previously classified as finance leases.
recorded as receivables at the amount of the Trust’s
net investment in the leases. Finance lease income is The Trust as lessor
allocated to accounting periods to reflect a constant
Leases of owned assets where the Trust is lessor were
periodic rate of return on the Trust’s net investment
unaffected by initial application of IFRS 16. For
outstanding in respect of the leases.
existing arrangements where the Trust is an
Operating leases intermediate lessor, classification of all continuing
Income from operating leases is recognised on a sublease arrangements has been reassessed with
straight-line basis or another systematic basis over the reference to the right of use asset.
term of the lease. Initial direct costs incurred in
2021/22 comparatives.
negotiating and arranging an operating lease are
added to the carrying amount of the leased asset and Comparatives for leasing transactions in these
recognised as an expense on a straight-line basis over accounts have not been restated on an IFRS 16 basis.
the lease term. Under IAS 17 the classification of leases as operating
or finance leases still applicable to lessors under IFRS
Initial application of IFRS 16
16 also applied to lessees. In 2021/22 lease payments
IFRS 16 Leases as adapted and interpreted for the made by the Trust in respect of leases previously
public sector by HM Treasury has been applied to classified as operating leases were charged to

Annual Report and Accounts 2022/23 111

 3 Annual Accounts

expenditure on a straight line basis. amount recognised in the Statement of Financial

Position is the best estimate of the resources required
Note 1.12 Provisions to settle the obligation.
The Trust recognises a provision where it has a present
Where the effect of the time value of money is
legal or constructive obligation of uncertain timing or
significant, the estimated risk-adjusted cash flows are
amount; for which it is probable that there will be a
discounted using HM Treasury’s discount rates
future outflow of cash or other resources; and a
effective from 31 March 2023:
reliable estimate can be made of the amount. The

Nominal rate Prior year rate

Short-term Up to 5 years 3.27% 0.47%
Medium-term After 5 years up to 10 years 3.20% 0.70%
Long-term After 10 years up to 40 years 3.51% 0.95%
Very long-term Exceeding 40 years 3.00% 0.66%

HM Treasury provides discount rates for general provisions on a nominal rate basis. Expected future cash flows
are therefore adjusted for the impact of inflation before discounting using nominal rates. The following
inflation rates are set by HM Treasury, effective from 31 March 2023:

Inflation rate Prior year rate

Year 1 7.40% 4.00%
Year 2 0.60% 2.60%
Into perpetuity 2.00% 2.00%

Early retirement provisions and injury benefit events whose existence will only be confirmed by one
provisions both use the HM Treasury's pension or more future events not wholly within the entity’s
discount rate of 1.70% in real terms (prior year: minus control) are not recognised as assets, but are disclosed
1.30%). where an inflow of economic benefits is probable.

Clinical negligence costs Contingent liabilities are not recognised, but are
NHS Resolution operates a risk pooling scheme under disclosed unless the probability of a transfer of
which the Trust pays an annual contribution to NHS economic benefits is remote.
Resolution, which, in return, settles all clinical
negligence claims. Although NHS Resolution is Contingent liabilities are defined as:
administratively responsible for all clinical negligence
 possible obligations arising from past events
cases, the legal liability remains with the Trust. The
whose existence will be confirmed only by the
total value of clinical negligence provisions carried by
occurrence of one or more uncertain future
NHS Resolution on behalf of the Trust is disclosed at
events not wholly within the entity’s control; or
note 26 but is not recognised in the Trust’s accounts.
 present obligations arising from past events but
Non-clinical risk pooling for which it is not probable that a transfer of
The Trust participates in the Property Expenses Scheme economic benefits will arise or for which the
and the Liabilities to Third Parties Scheme. Both are amount of the obligation cannot be measured
risk pooling schemes under which the Trust pays an with sufficient reliability.
annual contribution to NHS Resolution and in return
receives assistance with the costs of claims arising. The
annual membership contributions, and any excesses Note 1.14 Public dividend capital
payable in respect of particular claims are charged to
Public dividend capital (PDC) is a type of public sector
operating expenses when the liability arises.
equity finance based on the excess of assets over
Note 1.13 Contingencies liabilities at the time of establishment of the
predecessor NHS organisation. HM Treasury has
Contingent assets (that is, assets arising from past
112 London Ambulance Service NHS Trust
 Annual Accounts 3

determined that PDC is not a financial instrument Note 1.18 Losses and special payments
within the meaning of IAS 32.
Losses and special payments are items that Parliament
The Secretary of State can issue new PDC to, and would not have contemplated when it agreed funds
require repayments of PDC from, the Trust. PDC is for the health service or passed legislation. By their
recorded at the value received. nature they are items that ideally should not arise.
They are therefore subject to special control
A charge, reflecting the cost of capital utilised by the procedures compared with the generality of
Trust, is payable as public dividend capital dividend. payments. They are divided into different categories,
The charge is calculated at the rate set by HM Treasury which govern the way that individual cases are
(currently 3.5%) on the average relevant net assets of handled. Losses and special payments are charged to
the Trust during the financial year. Relevant net assets the relevant functional headings in expenditure on an
are calculated as the value of all assets less the value accruals basis.
of all liabilities, with certain additions and deductions
as defined in the PDC dividend policy issued by the The losses and special payments note is compiled
Department of Health and Social Care. This policy is directly from the losses and compensations register
available at which reports on an accrual basis with the exception
https://www.gov.uk/government/publications/guidance of provisions for future losses.
-on-financing-available-to-nhs-trusts-and-foundation-
trusts Note 1.19 Early adoption of standards,
amendments and interpretations
In accordance with the requirements laid down by the
Department of Health and Social Care (as the issuer of No new accounting standards or revisions to existing
PDC), the dividend for the year is calculated on the standards have been early adopted in 2022/23.
actual average relevant net assets as set out in the
Note 1.20 Standards, amendments and
“pre-audit” version of the annual accounts. The
dividend calculated is not revised should any interpretations in issue but not yet effective
adjustment to net assets occur as a result the audit of or adopted
the annual accounts.
IFRS 14 and IFRS 17 are in issue but not yet effective or
adopted by the Trust. Neither is forecasted to
Note 1.15 Value added tax
materially impact the Trust.
Most of the activities of the Trust are outside the
scope of VAT and, in general, output tax does not Note 1.21 Critical judgements in applying
apply and input tax on purchases is not recoverable. accounting policies
Irrecoverable VAT is charged to the relevant
The following are the judgements, apart from those
expenditure category or included in the capitalised
involving estimations (see below) that management
purchase cost of fixed assets. Where output tax is
has made in the process of applying the Trust’s
charged or input VAT is recoverable, the amounts are
accounting policies and that have the most significant
stated net of VAT.
effect on the amounts recognised in the financial
Note 1.16 Climate change levy statements:

Expenditure on the climate change levy is recognised 1. Non consolidation of immaterial controlled
in the Statement of Comprehensive Income as entities. Immaterial controlled entities are the
incurred, based on the prevailing chargeable rates for Trust’s related Charity and three dormant
energy consumption. trading companies.

Note 1.17 Third party assets Note 1.22 Sources of estimation uncertainty
Assets belonging to third parties in which the Trust The following are assumptions about the future and
has no beneficial interest (such as money held on other major sources of estimation uncertainty that
behalf of patients) are not recognised in the accounts. have a significant risk of resulting in a material
However, they are disclosed in a separate note to the adjustment to the carrying amounts of assets and
accounts in accordance with the requirements of HM liabilities within the next financial year:
Treasury’s FReM.

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 3 Annual Accounts

1. The Trust has a £12,365k provision relating to estate, and how this compares to a what
amounts retrospectively payable to past and would be expected of a modern new
present employees for work done in 2022/23 facility;
and prior years. The provision is forecast to be
paid no earlier than one year and not later than 3. The Trust also makes the following assumptions
five years from the balance sheet date. about the sources of estimation uncertainty that
could result in an immaterial adjustment to the
The Trust has valued this provision using the carrying amounts of assets and liabilities within
underlying employee payments made in the the next financial year:
years affected, the corrective settlement cost
incurred in other, similar, retrospective 1. The useful economic life of Trust assets is set
payments, and after considering independent by:
legal advice received.
a. Buildings: The Trust in line with its
There are a number of uncertainties around the accounting policies, informed by the
value of the provision. These uncertainties judgements made by the Trust’s
concern the number of years of employment independent third party valuers
any claim will cover, the types of existing payroll
b. Plant, equipment, and intangible assets:
payments that will be included in any claim, and
Trust professionals responsible for the
how the claim will interact with other, similar,
custody and maintenance of the assets.
retrospective payments already made.
No asset class is estimated to have a residual
The value of the provision is sensitive to the
value, with current fair value depreciated or
uncertainties set out above and whether any
amortised over its estimated useful life to £nil.
settlement will include the payment of interest
and legal costs. The timing of the settlement of 2. Accruals and deferred income are based on
is also sensitive to when claims are received and best estimates of the expenditure still to be
the time it takes to process these claims. incurred for this financial year and the
income received that relates to next financial
Other provisions are based on the best estimates
year. The element of accruals that requires
of future payments that will need to be made to
estimation is immaterial to the Trust’s
meet current obligations. The basis of these
financial statements.
estimates and the timing of the cash flows are
described in the relevant note. Provisions are 3. Income recognition – accrued income is
discounted and unwound using rates as set by estimated based on the level of services
HM Treasury. provided by the Trust in the year. The Trust
makes a provision for bad debts which is an
2. The Trust holds land and buildings at fair value
estimate of irrecoverable income based on
(as defined by our accounting policies).
historical recoverability.
The Trust has adopted a policy of commissioning
of a full land and building valuation every year.
This policy will be reviewed annually.

The Trust a professional third party valuer to

undertake a full revaluation of its land and
buildings as at 31 March 2023. The Trust and its
valuers have made a number of judgements
around the current and future use and
condition of the estate. These judgements
include:

• The Modern Equivalent size and location

of the Trust’s estate;

• The utility and condition of the Trust’s

114 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 2 Operating Segments

The Trust Board considers that the Trust has only one segment which is the provision of accident and
emergency services.

Note 3 Operating income from patient care activities

Note 3.1 Income from patient care activities (by nature)

All income from patient care activities relates to contract income recognised in line with accounting policy 1.3
2022/23 2021/22
£000 £000
Ambulance services
A & E income 539,838 579,766
Other income 759 900
All services
Additional pension contribution central funding** 16,746 14,411
Agenda for change pay award central funding*** 15,035 -
Other clinical income 59,464 94
Total income from activities 631,842 595,171

*Aligned payment and incentive contracts are the main form of contracting between NHS providers and their commissioners. More
information can be found in the 2022/23 National Tariff payments system documents.
https://www.england.nhs.uk/publication/past-national-tariffs-documents-and-policies/

**The employer contribution rate for NHS pensions increased from 14.3% to 20.6% (excluding administration charge) from 1 April 2019.
Since 2019/20, NHS providers have continued to pay over contributions at the former rate with the additional amount being paid over by
NHS England on providers' behalf. The full cost and related funding have been recognised in these accounts.

***In March 2023 the government announced an additional pay offer for 2022/23, in addition to the pay award earlier in the year.
Additional funding was made available by NHS England for implementing this pay offer for 2022/23 and the income and expenditure has
been included in these accounts as guided by the Department of Health and Social Care and NHS England. In May 2023 the government
confirmed this offer will be implemented as a further pay award in respect of 2022/23 based on individuals in employment at 31 March
2023

Note 3.2 Income from patient care activities (by source)

2022/23 2021/22
Income from patient care activities received from: £000 £000
NHS England 39,750 22,285
Clinical commissioning groups 143,466 568,162
Integrated care boards 441,654
Department of Health and Social Care - 55
Other NHS providers 1,830 862
NHS other 5 1
Local authorities - -
Non-NHS: private patients - -
Non-NHS: overseas patients (chargeable to patient) - -
Injury cost recovery scheme 759 900
Non NHS: other 4,378 2,906
Total income from activities 631,842 595,171
Of which:
Related to continuing operations 631,842 595,171
Related to discontinued operations - -

Annual Report and Accounts 2022/23 115

 3 Annual Accounts

Note 4 Other operating income 2022/23 2021/22

Contract Non-contract Contract Non-contract
Total Total
income income income income

£000 £000 £000 £000 £000 £000

Research and development 327 - 327 165 - 165

Education and training 8,976 2,050 11,026 3,922 748 4,670

Reimbursement and top up funding - - - 476 - 476

Income in respect of employee benefits accounted on a
1,672 - 1,672 1,310 - 1,310
gross basis
Receipt of capital grants and donations and peppercorn
- 209 209 - - -
leases
Charitable and other contributions to expenditure - 1,073 1,073 - 1,229 1,229

Other income - 57 57 - 74 74

Total other operating income 10,975 3,389 14,364 5,873 2,051 7,924

Of which:

Related to continuing operations 14,364 7,924

Related to discontinued operations - -

Note 5 Additional information on contract

revenue (IFRS 15) recognised in the period
2022/23 2021/22

£000 £000

Revenue recognised in the reporting period that was

included in within contract liabilities at the previous 2,791 251
period end

Revenue recognised from performance obligations

- -
satisfied (or partially satisfied) in previous periods

Revenue from existing contracts allocated to remaining 31 March 31 March

performance obligations is expected to be recognised: 2023 2022
£000 £000

within one year 1,456 2,791

after one year, not later than five years - -

after five years - -

Total revenue allocated to remaining performance
1,456 2,791
obligations

The trust has exercised the practical expedients permitted by IFRS 15 paragraph 121 in preparing this disclosure. Revenue
from (i) contracts with an expected duration of one year or less and (ii) contracts where the trust recognises revenue directly
corresponding to work done to date is not disclosed.

116 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 6 Operating expenses

2022/23 2021/22
£000 £000
Staff and executive directors costs 442,437 410,945
Remuneration of non-executive directors 174 165
Supplies and services - clinical (excluding drugs costs) 35,689 29,081
Supplies and services - general 38,787 40,975
Drug costs (drugs inventory consumed and purchase of non-inventory drugs) 672 924
Inventories written down 3 479
Consultancy costs 2,374 566
Establishment 14,623 12,289
Premises 19,839 14,519
Transport (including patient travel) 23,583 34,229
Depreciation on property, plant and equipment and right of use assets 25,968 20,761
Amortisation on intangible assets 2,641 2,160
Net impairments 9,010 3,536
Movement in credit loss allowance: contract receivables / contract assets (86) 400
Increase/(decrease) in other provisions - 417
Change in provisions discount rate(s) (2,085) 318
Fees payable to the external auditor
audit services- statutory audit 116 132
other auditor remuneration (external auditor only) - -
Internal audit costs 129 140
Clinical negligence 4,873 5,348
Legal fees 916 1,128
Insurance 998 1,218
Research and development 935 854
Education and training 18,244 10,920
Expenditure on short term leases (current year only) 1,125
Expenditure on low value leases (current year only) 264
Operating lease expenditure (comparative only) 7,039
Redundancy - 67
Car parking & security 618 423
Hospitality 3 2
Other 3,759 2,797
Total 645,609 601,832
Of which:
Related to continuing operations 645,609 601,832
Related to discontinued operations - -

Annual Report and Accounts 2022/23 117

 3 Annual Accounts

Note 6.1 Other auditor remuneration

There was no other auditor remuneration in 2022/23 (2021/22 nil).The external audit fee show in Note 6 is gross of VAT as
the Trust cannot recover VAT on external audit fees. The recipient of this fee pays this VAT to HMRC: the actual amount
payable for their services is £98,000.

Note 6.2 Limitation on auditor's liability

The limitation on auditor's liability for external audit work is £1 million (2021/22: £2 million).

Note 7 Impairment of assets

2022/23 2021/22
£000 £000
Net impairments charged to operating surplus / deficit resulting from:
Over specification of assets 2,589 -
Changes in market price 6,421 3,536
Total net impairments charged to operating surplus / deficit 9,010 3,536
Impairments charged to the revaluation reserve 2,511 441
Total net impairments 11,521 3,977

The impairment relating to an overspecification of assets relates to an IT scheme being brought into use in year. All other
impairment movements relate to the Trust's annual revaluation of its land and buildings.

Note 8 Staff and Employee benefits

2022/23 2021/22
Total Total
£000 £000
Salaries and wages 348,453 327,069
Social security costs 42,305 36,634
Apprenticeship levy 1,760 1,593
Employer's contributions to NHS pensions 55,223 47,505
Pension cost - other 44 41
Termination benefits - 67
Temporary staff (including agency) 8,284 6,513
Total gross staff costs 456,069 419,422
Recoveries in respect of seconded staff - -
Total staff costs 456,069 419,422
Of which
Costs capitalised as part of assets 674 783

Note 8.1 Retirements due to ill-health

During 2022/23 there were 4 early retirements from the trust agreed on the grounds of ill-health (1 in the year ended 31
March 2022). The estimated additional pension liabilities of these ill-health retirements is £305k (£95k in 2021/22).

These estimated costs are calculated on an average basis and will be borne by the NHS Pension Scheme.

118 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 8.2 Pension Costs liability in respect of the benefits due under the
schemes (taking into account recent demographic
Past and present employees are covered by the
experience), and to recommend contribution rates
provisions of the two NHS Pension Schemes. Details of
payable by employees and employers.
the benefits payable and rules of the Schemes can be
found on the NHS Pensions website at The latest actuarial valuation undertaken for the NHS
www.nhsbsa.nhs.uk/pensions. Both are unfunded Pension Scheme was completed as at 31 March 2016.
defined benefit schemes that cover NHS employers, GP The results of this valuation set the employer
practices and other bodies, allowed under the contribution rate payable from April 2019 to 20.6% of
direction of the Secretary of State for Health and pensionable pay.
Social Care in England and Wales. They are not
designed to be run in a way that would enable NHS The actuarial valuation as at 31 March 2020 is
bodies to identify their share of the underlying currently underway and will set the new employer
scheme assets and liabilities. Therefore, each scheme is contribution rate due to be implemented from April
accounted for as if it were a defined contribution 2024.
scheme: the cost to the NHS body of participating in
each scheme is taken as equal to the contributions
payable to that scheme for the accounting period.

In order that the defined benefit obligations

recognised in the financial statements do not differ
materially from those that would be determined at
the reporting date by a formal actuarial valuation, the
FReM requires that “the period between formal
valuations shall be four years, with approximate
assessments in intervening years”. An outline of these
follows:

a) Accounting valuation
A valuation of scheme liability is carried out annually
by the scheme actuary (currently the Government
Actuary’s Department) as at the end of the reporting
period. This utilises an actuarial assessment for the
previous accounting period in conjunction with
updated membership and financial data for the
current reporting period, and is accepted as providing
suitably robust figures for financial reporting
purposes. The valuation of the scheme liability as at 31
March 2023, is based on valuation data as 31 March
2022, updated to 31 March 2023 with summary global
member and accounting data. In undertaking this
actuarial assessment, the methodology prescribed in
IAS 19, relevant FReM interpretations, and the
discount rate prescribed by HM Treasury have also
been used.

The latest assessment of the liabilities of the scheme is

contained in the report of the scheme actuary, which
forms part of the annual NHS Pension Scheme
Accounts. These accounts can be viewed on the NHS
Pensions website and are published annually. Copies
can also be obtained from The Stationery Office.

b) Full actuarial (funding) valuation

The purpose of this valuation is to assess the level of

Annual Report and Accounts 2022/23 119

 3 Annual Accounts

Note 9 Finance income

Finance income represents interest received on assets and investments in the period.
2022/23 2021/22
£000 £000
Interest on bank accounts 1,252 25
Total finance income 1,252 25

Note 10 Finance expenditure

Finance expenditure represents interest and other charges involved in the borrowing of
money or asset financing.
2022/23 2021/22
£000 £000
Interest expense:
Interest on lease obligations 257 -
Interest on late payment of commercial debt - 2
Total interest expense 257 2
Unwinding of discount on provisions (119) (85)
Other finance costs - -
Total finance costs 138 (83)

Note 11 The late payment of commercial debts (interest)

Act 1998 / Public Contract Regulations 2015
2022/23 2021/22
£000 £000
Total liability accruing in year under this legislation as a result of late payments - -
Amounts included within interest payable arising from claims made under this legislation - 2
Compensation paid to cover debt recovery costs under this legislation - -

Note 12 Other gains / (losses)

2022/23 2021/22
£000 £000
Gains on disposal of assets 27 -
Losses on disposal of assets (3,984) (626)
Total gains / (losses) on disposal of assets (3,957) (626)

120 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 13 Intangible assets 2022/23

Internally
Intangible
Software generated
assets under Total
licences information
construction
technology
£000 £000 £000 £000
Valuation / gross cost at 1 April 2022 - brought forward 9,525 19,499 6,748 35,772
Additions - 949 207 1,156
Impairments (1) (2,588) - (2,589)
Reclassifications 3,070 3,166 (5,881) 355
Disposals / derecognition (398) (15,374) - (15,772)
Valuation / gross cost at 31 March 2023 12,196 5,652 1,074 18,922

Amortisation at 1 April 2022 - brought forward 4,216 17,944 - 22,160

Provided during the year 1,754 887 - 2,641
Reclassifications 74 (74) - -
Disposals / derecognition (398) (15,374) - (15,772)
Amortisation at 31 March 2023 5,646 3,383 - 9,029

Net book value at 31 March 2023 6,550 2,269 1,074 9,893

Net book value at 1 April 2022 5,309 1,555 6,748 13,612

Note 14 Intangible assets 2021/22

Internally
Intangible
Software generated
assets under Total
licences information
construction
technology

£000 £000 £000 £000

Valuation / gross cost at 1 April 2021 - as previously
8,479 20,142 5,388 34,009
stated
Additions 752 227 1,641 2,620
Reclassifications 615 21 (281) 355
Disposals / derecognition (321) (891) - (1,212)
Valuation / gross cost at 31 March 2022 9,525 19,499 6,748 35,772

Amortisation at 1 April 2021 3,182 17,737 - 20,919

Provided during the year 1,355 805 - 2,160
Disposals / derecognition (321) (598) - (919)
Amortisation at 31 March 2022 4,216 17,944 - 22,160

Net book value at 31 March 2022 5,309 1,555 6,748 13,612

Net book value at 1 April 2021 5,297 2,405 5,388 13,090

Annual Report and Accounts 2022/23 121

122
Note 15 Property, plant and equipment 2022/23

Buildings
Assets under Plant & Transport Information Furniture &
Land excluding Total
construction machinery equipment technology fittings
dwellings
£000 £000 £000 £000 £000 £000 £000 £000
3 Annual Accounts

Valuation/gross cost at 1 April 2022 -

52,781 66,990 32,199 21,902 75,177 38,700 2,142 289,891
brought forward
Additions - 6,465 23,050 379 127 1,993 506 32,520
Impairments (2,085) (8,578) - - - - - (10,663)
Revaluations 727 2,271 - - - - - 2,998
Reclassifications - 6,479 (19,632) 1,612 6,983 3,546 658 (354)

London Ambulance Service NHS Trust

Disposals / derecognition - (267) (2,711) (104) (647) (10,506) - (14,235)
Valuation/gross cost at 31 March 2023 51,423 73,360 32,906 23,789 81,640 33,733 3,306 300,157

Accumulated depreciation at 1 April 2022 -

- 205 - 15,957 44,267 17,450 527 78,406
brought forward
Provided during the year - 4,296 - 1,263 8,594 6,428 292 20,873
Impairments - (1,122) - - - - - (1,122)
Reversals of impairments - (674) - - - - - (674)
Revaluations - (2,195) - - - - - (2,195)
Disposals / derecognition - (267) - (90) (642) (6,535) - (7,534)
Accumulated depreciation at 31 March 2023 - 243 - 17,130 52,219 17,343 819 87,754

Net book value at 31 March 2023 51,423 73,117 32,906 6,659 29,421 16,390 2,487 212,403
Net book value at 1 April 2022 52,781 66,785 32,199 5,945 30,910 21,250 1,615 211,485
 Note 16 Property, plant and equipment 2021/22
Buildings
Assets under Plant & Transport Information Furniture &
Land excluding Total
construction machinery equipment technology fittings
dwellings
£000 £000 £000 £000 £000 £000 £000 £000
Valuation / gross cost at 1 April 2021 52,507 60,095 28,169 23,434 71,234 25,408 1,759 262,606
Additions - 6,960 28,456 166 1,029 5,681 8 42,300
Impairments - (7,244) - - - - - (7,244)
Reversals of impairments - (93) - - - - - (93)
Revaluations 274 (30) - - - - - 244
Reclassifications - 7,503 (24,426) 843 5,212 10,114 399 (355)
Disposals / derecognition - (201) - (2,541) (2,298) (2,503) (24) (7,567)
Valuation/gross cost at 31 March 2022 52,781 66,990 32,199 21,902 75,177 38,700 2,142 289,891

Accumulated depreciation at 1 April 2021 - 41 - 17,014 35,877 15,312 311 68,555

Provided during the year - 3,964 - 1,458 10,553 4,556 230 20,761
Impairments - (3,169) - - - - - (3,169)
Reversals of impairments - (191) - - - - - (191)
Revaluations - (358) - - - - - (358)
Disposals / derecognition - (82) - (2,515) (2,163) (2,418) (14) (7,192)
Accumulated depreciation at 31 March 2022 - 205 - 15,957 44,267 17,450 527 78,406

Net book value at 31 March 2022 52,781 66,785 32,199 5,945 30,910 21,250 1,615 211,485
Net book value at 1 April 2021 52,507 60,054 28,169 6,420 35,357 10,096 1,448 194,051

Annual Report and Accounts 2022/23

Annual Accounts 3

123
124
Buildings
Note 16.1 Property, plant and Assets under Plant & Transport Information Furniture &
Land excluding Total
equipment financing 2022/23 construction machinery equipment technology fittings
dwellings
£000 £000 £000 £000 £000 £000 £000 £000
Owned - purchased 51,423 73,117 32,906 6,631 29,371 16,390 2,487 212,325
3 Annual Accounts

Owned - donated/granted - - - 28 50 - - 78
Total net book value at 31 March 2023 51,423 73,117 32,906 6,659 29,421 16,390 2,487 212,403

Buildings
Note 16.2 Property, plant and Assets under Plant & Transport Information Furniture &
Land excluding Total
equipment financing 2021/22 construction machinery equipment technology fittings
dwellings
£000 £000 £000 £000 £000 £000 £000 £000

London Ambulance Service NHS Trust

Owned - purchased 52,781 66,785 32,199 5,906 30,835 21,250 1,615 211,371
Owned - donated/granted - - - 39 75 - - 114
Total net book value at 31 March 2022 52,781 66,785 32,199 5,945 30,910 21,250 1,615 211,485

A professional revaluation was undertaken on all land and buildings at 31 March 2023. The valuation was carried out by District Valuer Services of the Valuation Office Agency, an
executive arm of HMRC, out in accordance with the terms of the Royal Institution of Chartered Surveyors (RICS), insofar as these terms are consistent with the requirement of HM
Treasury, the National Services and the Department of Health. The valuation exercise was carried out in March 2023 with a valuation date of 31 March 2023 on a desktop
valuation basis.
This year the valuation is not reported as being subject to ‘material valuation uncertainty’ as defined by VPS 3 and VPGA 10 of the RICS Valuation – Global Standards.
The pandemic and the measures taken to tackle COVID-19 continue to affect economies and real estate markets globally. Nevertheless, as at the valuation date some property
markets have started to function again, with transaction volumes and other relevant evidence returning to levels where an adequate quantum of market evidence exists upon
which to base opinions of value. Accordingly, and for the avoidance of doubt, our valuation is not reported as being subject to ‘material valuation uncertainty’ as defined by VPS
3 and VPGA 10 of the RICS Valuation – Global Standards.
a) Specialised In Use (Operational) assets - buildings valued using depreciated replacement cost methodology
The majority of the trust buildings are valued using the depreciated replacement cost basis. There has been no diminution identified in the public sector's ongoing
requirement for these operational assets nor reduction in their ongoing remaining economic service potential as a result of the incidence of COVID-19.
b) Non - Specialised In Use (Operational) assets including the land element of the depreciated replacement cost valuation of specialised assets
The trust has a few non-specialised in use buildings. There has been no diminution identified in the public sector's ongoing requirement for these operational assets nor
reduction in their ongoing remaining economic service potential as a result of the incidence of COVID-19. Their basis of valuation is however current value in existing use,
having regard to comparable market evidence.
The values in the report have been used to inform the measurement of property assets at valuation in these financial statements.
The market value was used in arriving at fair value for the operational assets subject to the additional special assumptions that:
a) no adjustment has been made on the grounds of a hypothetical "flooding of the market" if a number of properties were to be marketed simultaneously
b) in the respect of the Market Value of non-operational asset only the NHS is assumed not to be in the market for the property interest and
c) regard has been had to appropriate lotting to achieve the best price.
The revaluation model set out in IAS 16 was applied to value the capital assets to fair value.
 Annual Accounts 3

Note 17 Right of use assets

This note details information about leases for which the Trust is a lessee.
The Trust agreed and signed 25 new leases during 2022/3, the most significant of which were new property leases at Brent
and Croydon.

The Trust has applied IFRS 16 to account for lease arrangements from 1 April 2022 without restatement of comparatives.
Comparative disclosures in this note are presented on an IAS 17 basis.

Of which:
Property
Transport leased from
(land and Total
equipment DHSC group
buildings)
bodies

£000 £000 £000 £000

Valuation / gross cost at 1 April 2022 - brought forward - - - -

Recognition of right of use assets for existing operating leases

27,377 214 27,591
on initial application of IFRS 16 on 1 April 2022

Additions 6,685 285 6,970 -

70 - 70 -
Movements in provisions for restoration / removal costs 1,294 - 1,294 -
Revaluations (81) - (81) -
Valuation/gross cost at 31 March 2023 35,345 499 35,844 -

Transfers by absorption - - - -
Provided during the year 4,944 151 5,095 -
Impairments 64 - 64 -
Revaluations (114) - (114) -
Accumulated depreciation at 31 March 2023 4,894 151 5,045 -

Net book value at 31 March 2023 30,451 348 30,799 -

Annual Report and Accounts 2022/23 125

 3 Annual Accounts

Note 17.1 Reconciliation of the carrying value of lease liabilities

Lease liabilities are included within borrowings in the statement of financial position.
2022/23
A breakdown of borrowings is disclosed in note 24.
£000
Carrying value at 31 March 2022 -
IFRS 16 implementation - adjustments for existing operating leases 26,141
Lease additions 6,700
Lease liability remeasurements 70
Interest charge arising in year 258
Lease payments (cash outflows) (4,489)
Carrying value at 31 March 2023 28,680

Lease payments for short term leases, leases of low value underlying assets and variable lease payments not dependent on
an index or rate are recognised in operating expenditure.
These payments are disclosed in Note 6. Cash outflows in respect of leases recognised on-SoFP are disclosed in the
reconciliation above.

Note 17.2 Maturity analysis of future lease payments at 2022/23 Of which leased
from DHSC
Total group bodies:
31 March 2023 31 March 2023
£000 £000
Undiscounted future lease payments payable in:
- not later than one year 5,683 -
- later than one year and not later than five years 15,399 -
- later than five years. 8,986 -
Total gross future lease payments 30,068 -
Finance charges allocated to future periods (1,388) -
Net lease liabilities at 31 March 2023 28,680 -
Of which:
- Current 5,360 -
- Non-Current 23,320 -

Note 17.3 Commitments in respect of operating leases 2021/2022

This note discloses costs incurred in 2021/22 and commitments as at 31 March 2022 for
leases the trust previously determined to be operating leases under IAS 17. 2021/22
£000
Operating lease expense
Minimum lease payments 7,039
Total 7,039

31 March 2022
£000
Future minimum lease payments due:
- not later than one year 5,593
- later than one year and not later than five years 13,410
- later than five years. 7,765
Total 26,768
Future minimum sublease payments to be received -

126 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 17.4 Initial application of IFRS 16 on 1 April 2022

IFRS 16 as adapted and interpreted for the public sector by HM Treasury has been applied to leases in these financial
statements with an initial application date of 1 April 2022.

The standard has been applied using a modified retrospective approach without the restatement of comparatives. Practical
expedients applied by the Trust on initial application are detailed in the leases accounting policy in note 1.

Lease liabilities created for existing operating leases on 1 April 2022 were discounted using the weighted average
incremental borrowing rate determined by HM Treasury as 0.95%.

Reconciliation of operating lease commitments as at 31 March 2022 to lease liabilities under IFRS 16 as at 1 April 2022

1 April 2022
£000
Operating lease commitments under IAS 17 at 31 March 2022 26,768
Impact of discounting at the incremental borrowing rate (730)
IAS 17 operating lease commitment discounted at incremental borrowing rate 26,038
Less:
Commitments for short term leases (545)
Commitments for leases of low value assets (468)
Irrecoverable VAT previously included in IAS 17 commitment (5,123)
Services included in IAS 17 commitment not included in the IFRS 16 liability (331)
Other adjustments:
Differences in the assessment of the lease term 3,276
Public sector leases without full documentation previously excluded from operating lease
2,399
commitments
Rent increases/(decreases) reflected in the lease liability, not previously reflected in the IAS 17
70
commitment
Other adjustments 827
Total lease liabilities under IFRS 16 as at 1 April 2022 26,143

Annual Report and Accounts 2022/23 127

 3 Annual Accounts

Note 18 Inventories
31 March 2023 31 March 2022
£000 £000
Drugs 65 55
Consumables 3,802 6,814
Total inventories 3,867 6,869
of which:
Held at fair value less costs to sell - -

Inventories recognised in expenses for the year were £15,915k (2021/22: £12,844k). Write-down of inventories recognised as
expenses for the year were £3k (2021/22: £479k).

In response to the COVID 19 pandemic, the Department of Health and Social Care centrally procured personal protective
equipment and passed these to NHS providers free of charge. During 2022/23 the Trust received £724k of items purchased
by DHSC (2021/22: £977k).

These inventories were recognised as additions to inventory at deemed cost with the corresponding benefit recognised in
income. The utilisation of these items is included in the expenses disclosed above.

The deemed cost of these inventories was charged directly to expenditure on receipt with the corresponding benefit
recognised in income.

Note 19 Receivables
31 March 2023 31 March 2022
£000 £000
Current
Contract receivables 28,406 11,294
Capital receivables - 9
Allowance for impaired contract receivables / assets (1,374) (1,460)
Prepayments (non-PFI) 12,705 8,623
PDC dividend receivable 1,242 667
VAT receivable 2,978 1,251
Other receivables 1,906 600
Total current receivables 45,863 20,984

Non-current
Other receivables 33 54
Total non-current receivables 33 54

Of which receivable from NHS and DHSC group bodies:

Current 23,575 6,332
Non-current 33 54

Note 19.1 Allowances for credit losses

31 March 2023 31 March 2022
£000 £000
Allowances as at 1 April 1,460 1,085
New allowances arising - 493
Changes in existing allowances (86) -
Reversals of allowances - (93)
Utilisation of allowances (write offs) - (25)
Allowances as at 31 March 1,374 1,460

All allowances relate to contract receivables and contract assets.

128 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 20 Cash and cash equivalents movements

Cash and cash equivalents comprise cash at bank, in hand and cash equivalents. Cash equivalents are readily convertible
investments of known value which are subject to an insignificant risk of change in value.

2022/23 2021/22
£000 £000
At 1 April 47,875 39,787
Net change in year (19,988) 8,088
At 31 March 27,887 47,875
Broken down into:
Cash at commercial banks and in hand 8 9
Cash with the Government Banking Service 27,879 47,866
Total cash and cash equivalents as in SoFP 27,887 47,875
Total cash and cash equivalents as in SoCF 27,887 47,875

Note 21 Third party assets held by the trust.

There are no third party assets held by the Trust.

Note 22 Trade and other payables

31 March 2023 31 March 2022
£000 £000
Current
Trade payables 7,089 9,742
Capital payables 7,507 10,518
Accruals 57,554 50,404
Social security costs 5,492 5,179
Pension contributions payable 5,643 4,916
Other taxes payable 4,770 4,386
Other payables 136 478
Total current trade and other payables 88,191 85,623

Of which payables from NHS and DHSC group bodies:

Current 1,478 2,593
Non-current - -

Note 22.1 Early retirements in NHS payables above

The payables note above includes amounts in relation to early retirements as set out below:

31 March 2023 31 March 2023 31 March 2022 31 March 2022

£000 Number £000 Number
- to buy out the liability for early retirements
305 -
over 5 years
- number of cases involved 4 -

Annual Report and Accounts 2022/23 129

 3 Annual Accounts

Note 23 Other liabilities

31 March 2023 31 March 2022

£000 £000
Current
Deferred income: contract liabilities 1,456 2,791
Total other current liabilities 1,456 2,791

Note 24 Borrowings
31 March 2023 31 March 2022

£000 £000
Current
Lease liabilities* 5,360 -
Total current borrowings 5,360 -

Non-current
Other loans - 107
Lease liabilities* 23,320 -
Total non-current borrowings 23,320 107

The Trust has applied IFRS 16 to lease arrangements within these accounts from 1 April 2022 without restatement of
comparatives. More information about leases and the impact of this change in accounting policy can be found in note 1.

Note 25.1 Reconciliation of liabilities arising from financing activities 2022/23

Other loans Lease Liability Total

£000 £000 £000
Carrying value at 1 April 2022 107 - 107
Cash movements:
Financing cash flows - payments and receipts of principal (107) (4,232) (4,339)
Financing cash flows - payments of interest - (257) (257)
Non-cash movements:
Impact of implementing IFRS 16 on 1 April 2022 - 26,141 26,141
Additions - 6,700 6,700
Lease liability remeasurements - 70 70
Application of effective interest rate - 258 258
Carrying value at 31 March 2023 - 28,680 28,680

Note 25.2 Reconciliation of liabilities arising from financing activities 2021/22

Other loans Lease Liability Total

£000 £000 £000
Carrying value at 1 April 2021 107 - 107
Carrying value at 31 March 2022 107 - 107

130 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 26 Provisions for liabilities and charges analysis

Pensions:
Pensions:
early Legal
injury Redundancy Other Total
departure claims
benefits
costs
£000 £000 £000 £000 £000 £000
At 1 April 2022 1,002 8,166 215 609 13,717 23,709
Change in the discount rate (93) (1,992) - - - (2,085)
Arising during the year 78 226 267 35 6,910 7,516
Utilised during the year (134) (423) (117) (170) (1,457) (2,301)
Reversed unused (88) - (137) (223) (887) (1,335)
Unwinding of discount (13) (106) - - - (119)
At 31 March 2023 752 5,871 228 251 18,283 25,385
Expected timing of cash flows:
- not later than one year 124 418 228 251 2,041 3,062
- later than one year and not later than five years 481 1,674 - - 13,630 15,785
- later than five years. 147 3,779 - - 2,612 6,538
Total 752 5,871 228 251 18,283 25,385

Injury Benefits provision of £5,871 relates to staff injured at work, whilst the Early Departure Costs provision of £752k
relates to staff who have taken early retirement. Both amounts are calculated by the NHS Pensions Agency following
assessment of the individuals' claims. The sum provided is recalculated annually based on changes in annual rates and life
expectancy it is adjusted for inflation and a discounting factor is applied.

The Legal Claims provision of £228k relates to Employers Liability Claims based on estimates of costs and settlements
provided by the NHS Litigation Authority.

The Redundancy provision of £251k relates to management restructures within the Trust.

Other provisions of £18,283k includes a provision relation to pending legal cases affecting calculation of holiday pay,
provisions for for lease dilapidations, and provisions for pending employment tribunal. Details of the estimation uncertainty
with these provisions is set out in Note 1.22 above

Annual Report and Accounts 2022/23 131

 3 Annual Accounts

Note 26.1 Clinical negligence liabilities

At 31 March 2023, £92,505k was included in provisions of NHS Resolution in respect of clinical negligence liabilities of
London Ambulance Service NHS Trust (31 March 2022: £126,345k).

Note 26.2 Contingent assets and liabilities

31 March 2023 31 March 2022
£000 £000
Value of contingent liabilities
NHS Resolution legal claims (87) (91)
Net value of contingent liabilities (87) (91)

Net value of contingent assets - -

Note 26.3 Contractual capital commitments

31 March 2023 31 March 2022
£000 £000
Property, plant and equipment 16,419 11,216
Intangible assets 21 35
Total 16,440 11,251

132 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 27 Financial instruments

Financial risk management
Financial reporting standard IFRS 7 requires disclosure
of the role that financial instruments have had during
the period in creating or changing the risks a body
faces in undertaking its activities. Due to the
continuing service provider relationship that the Trust
has with commissioners and the way those
commissioners are financed, the Trust is not exposed
to the degree of financial risk faced by business
entities. Also, financial instruments play a much more
limited role in creating or changing risk than would be
typical of listed companies, to which the financial
reporting standards mainly apply. The Trust has
limited powers to borrow or invest surplus funds and
financial assets and liabilities are generated by day-to-
day operational activities rather than being held to
change the risks facing the Trust in undertaking its
activities.

The Trust’s treasury management operations are

carried out by the finance department, within
parameters defined formally within the Trust’s
standing financial instructions and policies agreed by
the board of directors. Trust treasury activity is subject
to review by the Trust’s internal auditors.

Currency risk
The Trust is principally a domestic organisation with
the great majority of transactions, assets and liabilities
being in the UK and sterling based. The Trust has no
overseas operations. The Trust therefore has low
exposure to currency rate fluctuations.

Interest rate risk

The Trust has no outstanding loans and therefore has
no exposure to interest rate fluctuations.

Credit risk
Because the majority of the Trust’s revenue comes
from contracts with other public sector bodies, the
Trust has low exposure to credit risk. The maximum
exposures as at 31 March 2023 are in receivables from
customers, as disclosed in the trade and other
receivables note.

Liquidity risk
The Trust’s operating costs are incurred under
contracts with Integrated Care Boards (ICBs), which
are financed from resources voted annually by
Parliament. The Trust funds its capital expenditure
from funds obtained within its prudential borrowing
limit. The Trust is not, therefore, exposed to significant
liquidity risks.

Annual Report and Accounts 2022/23 133

 3 Annual Accounts

Note 28 Carrying values of financial assets

Held at Total
Carrying values of financial assets as at 31 March 2023
amortised cost book value
£000 £000
Trade and other receivables excluding non financial assets 28,971 28,971
Cash and cash equivalents 27,887 27,887
Total at 31 March 2023 56,858 56,858

Held at Total
Carrying values of financial assets as at 31 March 2022
amortised cost book value
£000 £000
Trade and other receivables excluding non financial assets 10,443 10,443
Cash and cash equivalents 47,875 47,875
Total at 31 March 2022 58,318 58,318

Note 29 Carrying values of financial liabilities

Held at Total
Carrying values of financial liabilities as at 31 March 2023
amortised cost book value
£000 £000
Obligations under leases 28,680 28,680
Trade and other payables excluding non financial liabilities 96,691 96,691
Total at 31 March 2023 125,371 125,371

Held at Total
Carrying values of financial liabilities as at 31 March 2022
amortised cost book value
£000 £000
Other borrowings 107 107
Trade and other payables excluding non financial liabilities 71,142 71,142
Total at 31 March 2022 71,249 71,249

Note 29.1 Maturity of financial liabilities

The following maturity profile of financial liabilities is based on the contractual undiscounted cash flows. This differs to the
amounts recognised in the statement of financial position which are discounted to present value.

31 March 2023 31 March 2022

£000 £000
In one year or less 80,051 71,142
In more than one year but not more than five years 31,184 107
In more than five years 15,524 -
Total 126,759 71,249

134 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 30 Losses and special payments

2022/23 2021/22
Total number Total value Total number Total value
of cases of cases of cases of cases
Number £000 Number £000

Losses
Cash losses - - - -
Bad debts and claims abandoned 2 4 - -
Stores losses and damage to property 2,682 1,574 2,273 1,749
Total losses 2,684 1,578 2,273 1,749
Special payments
Ex-gratia payments 86 2,043 25 1,948
Special severance payments - - 1 250
Total special payments 86 2,043 26 2,198
Total losses and special payments 2,770 3,621 2,299 3,947
Compensation payments received

Note 31 Related parties

The Department of Health and Social Care, as the London Ambulance Service NHS Trust's parent department, is considered
to be a related party. During the year none of the Department of Health and Social Care Ministers, London Ambulance
Service NHS Trust board members or members of key management staff, or parties related to any of them, has undertaken
any material transactions with the London Ambulance Service NHS Trust. The London Ambulance Service NHS Trust has had
a significant number of material transactions during the year with the Department, and with other entities for which the
Department is regarded as the parent Department. These entities are listed below where receipts exceed £10m.

Amounts owed Amounts due

Payments to Receipts from
to Related from Related
Related Party Related Party
Party Party
£000s £000s £000s £000s
NHS North West London ICB - 146,774 267 82
NHS North East London ICB - 94,183 152 160
NHS South East London ICB - 86,304 - 740
NHS North Central London ICB - 58,360 48 15
NHS South West London ICB - 56,600 - 477
NHS North West London CCG (demised 01/07/22) - 47,223 - -
NHS North East London CCG (demised 01/07/22) - 30,536 - -
NHS South East London CCG (demised 01/07/22) 10 28,174 - -
NHS England 21 24,504 907 20,072
NHS North Central London CCG (demised 01/07/22) - 19,358 - -
NHS South West London CCG (demised 01/07/22) - 18,227 - -

The London Ambulance Service NHS Trust acts as corporate trustee for the London Ambulance Service Charity. During the
financial year ending 31 March 2023 the Trust received grants of £10k (2021/22 £546k), reported a payable balance of £0k
(2021/22: £48k).

Annual Report and Accounts 2022/23 135

 3 Annual Accounts

Note 32 Better Payment Practice code

2022/23 2022/23 2021/22 2021/22
Non-NHS Payables Number £000 Number £000
Total non-NHS trade invoices paid in the year 52,111 333,558 52,477 295,967
Total non-NHS trade invoices paid within target 47,078 312,656 48,692 274,058
Percentage of non-NHS trade invoices paid within target 90.3% 93.7% 92.8% 92.6%

NHS Payables
Total NHS trade invoices paid in the year 900 7,413 560 3,778
Total NHS trade invoices paid within target 798 6,462 459 3,207
Percentage of NHS trade invoices paid within target 88.7% 87.2% 82.0% 84.9%

The Better Payment Practice code requires the NHS body to aim to pay all valid invoices
by the due date or within 30 days of receipt of valid invoice, whichever is later.

Note 33 External financing limit

The trust is given an external financing limit against which it is permitted to underspend
2022/23 2021/22
£000 £000
Cash flow financing 17,488 (831)
Other capital receipts
External financing requirement 17,488 (831)
External financing limit (EFL) 17,488 (831)
Under / (over) spend against EFL - -

Note 34 Capital Resource Limit

2022/23 2021/22
£000 £000
Gross capital expenditure 40,720 44,920
Less: Disposals (6,702) (669)
Less: Donated and granted capital additions (209) -
Plus: Loss on disposal from capital grants in kind - -
Charge against Capital Resource Limit 33,809 44,251

Capital Resource Limit 33,809 44,451

Under / (over) spend against CRL - 200

Note 35 Breakeven duty financial performance

2022/23
£000
Adjusted financial performance surplus / (deficit) (control total basis) 138
Remove impairments scoring to Departmental Expenditure Limit 2,589
Breakeven duty financial performance surplus / (deficit) 2,727

136 London Ambulance Service NHS Trust

 Annual Accounts 3

Note 36 Breakeven duty rolling assessment

2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 2014/15 2015/16

£000 £000 £000 £000 £000 £000 £000 £000
Breakeven duty in-year financial performance 1,425 1,002 2,751 262 262 6,048 (4,405)
Breakeven duty cumulative position 2,569 3,994 4,996 7,747 8,009 8,271 14,319 9,914
Operating income 279,864 283,617 281,731 303,109 303,827 324,052 319,992
Cumulative breakeven position as a
1.4% 1.8% 2.7% 2.6% 2.7% 4.4% 3.1%
percentage of operating income

2016/17 2017/18 2018/19 2019/20 2020/21 2021/22 2022/23

£000 £000 £000 £000 £000 £000 £000
Breakeven duty in-year financial performance 6,143 5,758 6,958 174 2,559 729 2,727
Breakeven duty cumulative position 16,057 21,815 28,773 28,947 31,506 32,235 34,962
Operating income 355,507 364,598 388,978 438,559 570,323 603,095 646,206
Cumulative breakeven position as a
4.5% 6.0% 7.4% 6.6% 5.5% 5.3% 5.4%
percentage of operating income

Annual Report and Accounts 2022/23 137

 History
In 1948 the National Health Service was
established, and with that, the requirement
for ambulances to be available for all those
who needed them.

London In the 1950s, the London County Council’s

Ambulance ambulance service moved to headquarters at
Charity Waterloo Road – close to the current HQ.

London Ambulance Service was created in

Helping support the 1965 when one single ambulance service

London Ambulance replaced the nine existing services working in

the city. Back then, we had nearly 1,000
Historic Collection vehicles and 2,500 members of staff. In April
1996, London Ambulance Service became an
NHS trust.

Just like the capital itself, we are continuing to

grow and develop. The London Ambulance
Service of today, and the skills and capabilities
of our staff, bear little resemblance to the
Service of even 20 years ago.

Historically, we designed our service around a

small number of our patients – those with life-
threatening conditions. But in fact, our largest
group of patients have conditions, whilst not
life-threatening, still need urgent medical
care. Many of these patients need different
treatment to that offered at a hospital’s
emergency department. This could be
treatment at home, referrals to a GP or social
Scan to donate or visit: services, or a local walk-in centre.
www.justgiving.com/campaign/
The way we respond to calls is changing too.
LondonAmbulanceHistory
Our staff now attend to patients in cars, on
motorbikes and bicycles, as well as in
Contact: ambulances. This enables us to reach patients
London Ambulance Charity
London Ambulance Service NHS Trust quicker in busy built-up areas. We are
220 Waterloo Road, London SE1 8SD
Email: [email protected]
Mobile: 07385 347446
increasing public access to defibrillators—
www.londonambulance.nhs.uk/charity
machines used to restart a patient’s heart
Registered Charity No. 1061191
when it has stopped beating—and are
providing training in how to use this
equipment, so that people in the community
Emergency Ambulance

can provide life-saving treatment our front

line clinicians make their way to a call.
#TeamLAS We play a vital role in the London trauma
system, treating and transferring patients with
life-threatening injuries to specialist centres
for treatment.

138 London Ambulance Service NHS Trust

 1. Performance report

London Ambulance Service NHS Trust 139

 © 2023 London Ambulance Service NHS Trust

London Ambulance Service NHS Trust

Headquarters
220 Waterloo Road
London. SE1 8SD
www.londonambulance.nhs.uk