NOT PROTECTIVELY MARKED Public Board Meeting May 2017 Item No 7 THIS PAPER IS FOR DISCUSSION

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1 NOT PROTECTIVELY MARKED Public Board Meeting May 2017 Item No 7 THIS PAPER IS FOR DISCUSSION TOWARDS 2020: TAKING CARE TO THE PATIENT AND PERFORMANCE INDICATORS Lead Director Author Action required Key points Pauline Howie, Chief Executive Executive Directors The Scottish Ambulance Service Board is asked to discuss progress within the 2020 delivery programme and: In Part 1 1. Discuss actions taken to deliver further improvements in the 3 strategic work streams. In Part 2 1. Note performance against LDP standards for the period to end April Discuss actions being taken to improve performance. The paper brings together measurement for improvement with measurement for judgement as highlighted by the Scottish Government s Quality Improvement and Measurement for Non Executives guidance (January 2016). This paper highlights strategic work stream updates from:- Clinical Services Transformation The Service s New Clinical Response Model; Shifting the Balance of Care by looking after more people at home or in a homely settling; Developments to deliver improvements in Out of Hospital Cardiac Arrest (OHCA) Survival; Workforce Development Workforce planning targets have informed the development of recruitment and training plans for 2017/18, which are progressing with the agreement of this year s Training and Education Prospectus; Specialist Paramedic training in process and further recruitment plans in development to increase our current capacity and Advanced Paramedic role development being led by Clinical Service Transformation; All teams within the Service have now participated in the questionnaire phase of imatter; Doc: Towards 2020 TCTTP and Perf Indicators Page 1 Author: Dir of Care Quality & Strategic Development Date: Version 1.0 Review Date: July 2017

2 Timing Link to Corporate Objectives Enabling Technology Ambulance Telehealth Programme Phase 2 Electronic Patient Record Replacement is on track however other software and the SAS app are at risk of timescale slippage due to system integration difficulties; Emergency Service Network Programme Programme timescales are still under review due to reported slippage in the GB wide Emergency Service Mobile Communications Programme (ESMCP); Fleet Replacement Project Replacement vehicle provision is progressing in line with agreed plans; Defibrillator Replacement Project Work is ongoing to finalise the Initial Agreement document for the project. This is the first stage in the Scottish Government business case process. Performance against LDP standards The Service s new clinical response model has now been in place for 5 months and the observed activity is broadly as predicted by the model design. This paper is presented bi-monthly for information and assurance to the Board, highlighting progress in the implementation of key programmes of work for the 2020 Strategy. The Corporate Objectives this paper relates to are:- 1.1 Engage with partners, patients and the public to design and co-produce future service. 1.2 Engaging with patients, carers and other providers of health and care services to deliver outcomes that matter to people. 1.3 Enhance our telephone triage and ability to see and treat more patients at home through the provision of senior clinical decision support. 2.1 Develop a bespoke ambulance patient safety programme aligned to national priorities. Early priorities are Sepsis and Chest Pain. 2.4 Develop our mobile telehealth and diagnostic capability. 3.1 Lead a national programme of improvement for out of hospital cardiac arrest. 3.2 Improve outcomes for stroke patients. 3.4 Develop our education model to provide more comprehensive care at the point of contact. 3.5 Offer new role opportunities for our staff within a career framework. 4.1 Develop appropriate alternative care pathways to provide more care safely, closer to home building on the work with frail elderly fallers - early priorities being mental health and COPD. 5.1 Improve our response to patients who are vulnerable in our communities. 6.2 Use continuous improvement methodologies to ensure we Doc: Towards 2020 TCTTP and Perf Indicators Page 2 Author: Dir of Care Quality & Strategic Development Date: Version 1.0 Review Date: July 2017

3 Contribution to the 2020 vision for Health and Social Care Benefit to Patients Equality and Diversity work smarter to improve quality, efficiency and effectiveness. 6.3 Invest in technology and advanced clinical skills to deliver the change. This programme of work underpins the Scottish Government s 2020 Vision. This report highlights the Service s national priority areas and strategy progress to date. These programmes support the delivery of the Service s quality improvement objectives within the Service s annual Local Delivery Plan. This whole systems programme of work is designed to support the Scottish Ambulance Service to deliver on the key quality ambitions within Scottish Government s 2020 Vision and our internal Strategic Framework Towards 2020: Taking Care to the Patient, which are to deliver safe, person-centred and effective care for patients, first time, every time. A comprehensive measurement framework underpins the evidence regarding the benefit to patients, staff and partners and supports the Service s transition towards Our work identifies the contribution of each of the key work streams to the overarching outcomes for patients to Hear and Treat, See and Treat and reduced conveyance to hospital to patient experience and quality of care. This paper highlights progress to date across a number of work streams and programmes. Each individual programme is required to undertake Equality Impact Assessments at appropriate stages throughout the life of that programme. In terms of the overall approach to equality and diversity, key findings and recommendations from the various Equality Impact Assessment work undertaken throughout the implementation of Towards 2020: Taking Care to the Patient are regularly reviewed and utilised to inform the equality and diversity needs. Doc: Towards 2020 TCTTP and Perf Indicators Page 3 Author: Dir of Care Quality & Strategic Development Date: Version 1.0 Review Date: July 2017

4 Clinical Services Transformation 1 Shifting the Balance of Care Aim: National policy is to shift the balance of care by appropriately looking after people in a home or homely setting where this is in line with their wishes and is clinically appropriate. There are two key parts to the Service s contribution : 30% of calls being referred to other health and social care providers by 2020; and 30% of patients being assessed, treated and referred (where necessary) at home by Both these aims will be heavily dependent on the development of enhanced care pathways within the Health and Social Care Partnerships throughout Scotland. Status: The definitions of both these measures have now been finalised. Each are calculated as a proportion of total call demand (e.g. a fixed denominator) and this enables us to combine the Hear and Treat and See and Treat figures for the purpose of reporting against the T1 Reduce Hospital Attendances performance indicator. Current performance is 32% against the milestone target for 2017/18 of 32% (refer to chart 1). Improvement Data shows that the system, while tending to move in a positive direction, is still variable. A structured approach, taking a whole system view of shifting the balance of care is currently being designed to ensure that we make progress in a way that is clinically safe and enjoys wide patient and staff support. The last Board paper referred to some tests of change relating to developing models to ensure appropriate use of our emerging cohort of Specialist Paramedic Practitioners. A test of change relating to Ambulance Control Centre (ACC) Dispatchers tasking Specialist Paramedics utilising codes identified through the new clinical response model team was carried out across 5 different ACC teams in the East and North ACC. Initial feedback from the Dispatchers and Specialist Paramedics identified that utilisation increased with tasking being appropriate. Analysis of the data is underway to ensure that there were no implications to patient experience or data although none were identified at the time. This experience will then be mapped against our new clinical response model codes and consideration will be given to making adjustments to the guidance available to Dispatchers to utilise a specialist where available. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 4 Author: Director of Care Quality & Strategic Development

5 Chart 1 35% SAS T1 Reduce Hospital Admissions % of unscheduled cases managed by telephone or face-to-face assessment Aim 32% 30% 25% SAS T1 Measure Value % (p) UCL Upper 3rd Aim Control Line (Pbar) LCL Lower 3rd Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 5 Author: Director of Care Quality & Strategic Development

6 2. Conveyance: Out of Hospital Cardiac arrest (OHCA) - OHCA remains a significant healthcare challenge in Scotland. Aim Working in partnership with organisations and volunteers, as set out in the National Out of Hospital Cardiac Arrest Strategy, increase survival rates after OHCA by 10% across the country within 5 years. Status Note the new target measure of 40% (Chart 2) applied from April The system, currently stable, represents a good platform to build further improvements in the coming year and is currently 33.3%. Improvement (i) 3RU expansion a. The 3RU model has been implemented in Glasgow. Currently operating 10hrs per day with plans to extend to 24hr cover. b. Training for West Lothian 3RU has been completed and will go live on 5 June Staff engagement sessions are ongoing. East Central will be the next area for 3RU to be developed. (ii) Co-responding Partnerships. Scotland s OHCA Strategy has at its base an assets optimised approach, seeking to utilise the Service s professional staff, volunteers such as our Community First Responder teams and Wildcat responders, and statutory partners such as Scottish Fire and Rescue Service (SFRS) and Police Scotland. a. The SFRS co-responder to OHCA evaluation report is complete with evidence indicating a reduction in response times and increased Return of Spontaneous Circulation (ROSC) rates within the trial areas. b. Police co-responders have been deployed to a number of incidents with positive feedback. c. Sandpiper Wildcat has been deployed to over 40 incidents since launch. (iii) General a. The enhanced defibrillator locator module is now live, as is the first responder module. b. OHCA best practice Clinical guideline has been drafted. This will be tabled at the clinical guideline group. c. Our OHCA work streams, as laid out within the National OHCA strategy, have been audited by the internal auditors with largely positive feedback. This report has now been completed. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 6 Author: Director of Care Quality & Strategic Development

7 Chart 2 SAS H1 Save More Lives Return of Spontaneous Circulation for VF/VT patients Aim 40% 70% 60% 50% 40% 30% 20% 10% 0% VF/VT ROSC Mean UCL LCL Upper 3rd Lower 3rd Aim Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 7 Author: Director of Care Quality & Strategic Development

8 Enabling Technology 1. Ambulance Telehealth Programme Aim The Ambulance Telehealth Programme will replace and enhance the cab-based technology in the emergency ambulance fleet. The programme will be delivered over two overlapping phases and will be complete by autumn Status - Ambulance Telehealth Phase 1 Completed New tablets, communications hubs and printers have been installed throughout the Emergency Ambulance Fleet. A very favourable internal audit assessment has been received; the audit report highlighted the benefits provided by robust programme and project management. Ambulance Telehealth Phase 2 Phase 2 involves the procurement and design of a new electronic patient report (epr) application and other supporting software app. The current plan is to implement the new epr during late summer of 2017 and testing has gone well. However, getting the app and other non-terrafix software working on the Getac tablets has proven more complex than first planned and the delay is likely to be at least 3 months. A paper outlining the various options available is currently being prepared. The draft training needs analysis for the epr and SAS app is now complete, the plan will be finalised once the final versions of the epr and the app are available. Improvement - Improved ease of use, additional functionality, increased clinical data collection and data quality, ready access to additional relevant information, increased productivity, improved patient care and experience. Ease of use is being measured through surveying users before and after the new tablets and epr are rolled out. Data collection quantity and quality is being measured through a combination of automated and manual epr database analysis. Other Considerations Work is underway with colleagues from the Clinical Services Transformation Programme (and others) to develop content for the new SAS app and to develop the care pathways required to take full advantage of the new capabilities delivered through the Telehealth Programme. Ubiquitous access to mobile broadband data (as will be delivered by the Emergency Service Network Programme) will be a key enabler for maximising the benefits derived from the Ambulance Telehealth Programme. Benefit Realisation / Return on Investment - Delivery of the expected benefits from the Ambulance Telehealth Programme is being overseen by the Enabling Technology Programme Board. Benefits include lower like for like costs, improved electronic patient record completion rates and data quality, as well as timeous and efficient mapping updates. A comprehensive benefits realisation plan is in place and the delivery of key benefits is being actively progressed by the Programme Business Change Manager. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 8 Author: Director of Care Quality & Strategic Development

9 2. Emergency Service Network Programme Background - Radio and Short Data Communications are provided to the Service, and all other GB Emergency Services, by Airwave Solutions Limited (ASL). The service is commonly known as Airwave. The original Airwave contracts were due to expire on a phased basis from 2016 to 2020; however a National Shutdown Date of 31 December 2019 has now been negotiated for all Airwave customers. The UK Government established the Emergency Service Mobile Communications Programme (ESMCP) in 2011 to identify a replacement for Airwave. The programme will deliver a voice and broadband data network that will be known as the Emergency Services Network (ESN). The main ESMCP contracts were awarded in The Service was due to transition to the ESN from late 2018 through to late 2019 but this timescale will slip by at least nine months due to wider programme slippage. Aim - The Emergency Service Network Programme aims to deliver a mobile communications capability that will, as a minimum, match Airwave in terms of functionality, availability and geographic coverage. It also aims to provide an enhanced mobile broadband capability. Status - The ESMCP Programme Board in April approved a nine month slippage in the proposed Ready for Service date, however there is no clarity on what this means in terms of service transition dates. The internal project team are still working on the assumption that the Service ESN transition start date will slip by at least 12 months from late 2018 to late 2019 or even early In addition to the reported delays in the service ready date for the core ESN service, there is considerable uncertainty, and therefore risk, around a number of the related projects that are required to complement the core ESN solution, these include ESN devices (e.g. handheld, vehicle devices) and the provision of an Air-to-Ground network for use in aircraft. As a result of ESMCP timescale slippage, there is now a requirement to extend Airwave contracts beyond the National Shutdown date of 31 December Significant work is required nationally to debate and agree the impact of this contract extension, this includes assessing the risk of considerable cost pressures for the Service. There is further risk around ESMCP relating to the viability of the Airwave infrastructure beyond spring 2020, Airwave are due to report back to the ESMCP Team on this issue during June Internal work is ongoing to assess whether or not the Service should remain part of the control room system procurement being run by the Ambulance Radio Programme on behalf of the Department of Health. The system would replace the current Airwave control room solution. The Service is named on the contract but ideally need to commit one way or the other by mid July Improvement - Reduced like for like costs, ubiquitous access to mobile broadband data to support the effective and efficient delivery of clinical services out with the hospital environment. Improvements will be measured through before and after data analysis and through the use of user surveys. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 9 Author: Director of Care Quality & Strategic Development

10 Other Considerations It is worthy of note that the delivery of the internal ESN Programme relies on the corresponding delivery of a highly complex GB-wide multi-agency programme (ESMCP). 3. Fleet Replacement Project Background Three fleet related projects are currently being governed through the Enabling Technology Programme; they are the Fleet Replacement Project, the Telematics Project and the Fleet Management System Replacement Project. Aim The Fleet Project aims to manage the annual fleet replacement activities in line with the approved Fleet Replacement Business Case. They also aim to take advantage of technology to improve the operation and management of the Service fleet. Status - The 2017/18 replacement is progressing in line with expected timescales. Work is underway to prepare for the visit in July of a Scottish Government Team as they plan to follow up on the gateway review they carried out on the Project during November Project initiation activities have recently been started in relation to the Telematics Project and the Fleet Management System Replacement Project. Improvement - Reduced running costs, improved reliability and vehicle availability, improved vehicle specifications, improved management information. Improvements will be measured through before and after data analysis and through the use of user surveys. Planned Activities - The main areas of focus from a programme management perspective are continuing to integrate the Fleet Replacement Project into the overall Enabling Technology Programme and project initiation activities in relation to the Telematics Project and the Fleet Management System Replacement Project. Completing the actions to address the recommendations made in the Gateway Review report from late Other Considerations There are a number of inter-dependencies between the Fleet Replacement Project and other Service Programmes e.g. Clinical Service Transformation and Future Mobile Communications. 4. Enabling Technology Other Projects The scope of the Enabling Technology Programme currently extends beyond the previously mentioned programmes and projects. It also includes the Defibrillator Replacement Project and a number of projects related to the delivery of the Service ehealth Strategy e.g. an epr transfer capability, video conferencing solutions etc. Further details regarding these additional projects and initiatives are available via the Enabling Technology Programme Team as required. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 10 Author: Director of Care Quality & Strategic Development

11 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Workforce Development Update 1 Workforce Planning/Recruitment The Scottish Ambulance Service has reviewed and updated front line recruitment targets for in order to build capacity and progress towards its workforce profile targets by December Chart 3 Aim To recruit and retain staff to ensure Scottish Ambulance Service has the necessary skills to deliver its 2020 workforce profile and improve staff experience. Status Implementation. Improvement With 2017/18 prospectus approval confirmed, recruitment and training of further Care Assistants, Technicians and Paramedics is in process to meet Divisional workforce targets (59/207/224 respectively). Workforce targets incorporate an adjustment for the staff turnover rate. Chart 3 shows turnover rates since April 2015, which confirms turnover rates have continued to fall. Turnover above 6% would potentially require the Service to increase its recruitment and training capacity to avoid any risk of workforce target shortfall. Turnover has remained within target tolerance level, but will continue to be monitored. 7.5% Staff Turnover (rolling year) 7.0% 6.5% 6.0% 5.5% 5.0% 4.5% Staff Turnover Mean UCL LCL Upper 3rd Lower 3rd Aim Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 11 Author: Director of Care Quality & Strategic Development

12 Planned Activities Include Completion of 17/18 workforce planning has informed recruitment and training targets. This and improvements to the Technician VQ delivery model have informed the approval of this year s Training and Education Prospectus. The Workforce Development Operational Group is now progressing the delivery of the associated recruitment and training plans. The present position is that 56 Technicians have been recruited with 133 in the pipeline (towards 207 target). Recruitment is in progress for a potential 200 additional Paramedics commencing training August to November 2017 against a 224 target. Other Considerations Work continues to mitigate the risk associated with developing and maintaining a candidate pipeline to support continued high volume Paramedic training through to Recruitment Process improvement work arising from review of the Service s 2016/17 plan is moving to test of change during the current recruitment cycle. Benefit Realisation/Return on Investment ensuring the Service has the right mix of skill and resources will enable it to effectively contribute in an integrated health and social care system. 2 Development of Frontline Roles Specialist/Advanced Paramedics The Scope of Practice framework document has been developed which defines how all of the Service s frontline roles will operate to support our 2020 Strategy. The main focus has been on the development and deployment of the Service s new Specialist Paramedic role, but 2017/18 plans will also consider the development of Advanced Practitioner roles. Aim - to recruit Specialist Paramedics and develop Advanced Paramedic role for recruitment/training of staff in line with Workforce Plan in order to achieve 2020 target numbers. Status Spread (for Specialists) Planning (for Advanced). Improvement The Specialist Paramedic role will be a key element underpinning the increase in use of See and Treat. The Advanced role is both a key component of clinical supervision and leadership within urgent and emergency care, and in the enhanced critical care response to major trauma. Planned Activities Include Completion of Specialist Paramedic training for 50 staff on the Post Graduate Certificate programme and developing the framework for the current 29 Specialist Paramedics. Recruitment planning for 2017/18 and review of training programme will inform intakes in September 2017 and/or January Initial target of 37 Specialists in line with our 2020 Workforce model, although this is under review in light of discussions with partners in terms of Primary Care support. Development of Advanced Paramedic role being led by Clinical Services Transformation. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 12 Author: Director of Care Quality & Strategic Development

13 Other Considerations The Specialist Paramedic Project Plan is now being led by Clinical Service Transformation and is focusing on developing the operational deployment model, clinical governance, evaluation and benefits realisation. Advanced Paramedic development is included within this plan to determine recruitment and training plans for these roles. Benefit Realisation/Return on Investment To support the delivery of the Service s See and Treat and Hear and Treat targets, with greater integration of health and social care, managing patient care at home, supporting anticipatory care planning for patients with long-term conditions, prescribing and referring directly to clinical services. 3 Staff Experience - imatter, the continuous improvement tool designed to improve staff experience, continues to be implemented across the Service. The tool encourages dialogue between teams and their managers, and encourages discussion on how to improve communication and engagement at local level. There is a clear link between high levels of staff engagement and improved staff experience, which in turn leads to improved patient experience. Aim to improve staff engagement in the Service. Measured by employee engagement index of 70% by /18 milestone is 60%. Status Spread Planning all teams have now had the opportunity to undertake the questionnaire stage. Improvement The Service has an overall completion rate of 70% so far for 2017 and an updated EEI score of 67%. Cohorts 1 (East Central and Corporate Areas) are in the action planning stage from their second anniversary. Cohort 2 (South East) action planning has improved significantly on their 2016 level (now over 90% completion). Cohort 3 (NRRD and Air Wing) are in their first anniversary and received positive returns of 88% and 80% respectively. Cohort 4 (North) are in the team checking stage of their first anniversary. The first run finished with 68% action plan return and changes have been made to team structure for the exercise to improve further. Cohort 5 (ACC) action planning was due for completion in February and has achieved a 90% completion rate. The reports for Cohort 6a (South West) and 6b (Lanarkshire) have been released and action planning now underway. There are 92% action plans agreed in South West and 100% in Lanarkshire. Cohort 7 (Glasgow) the final cohort commenced on 6 March 2017 and received a return rate of 51%. Planned Activities Include The imatter Implementation Group continues to oversee improvement work including:- o Assessing outputs of focus group work to determine possible improvement actions; o Staff Communications planning; Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 13 Author: Director of Care Quality & Strategic Development

14 o Development of patient stories to explain the explicit links between staff experience and patient experience; o Utilisation of complementary development tools such as Aston Team Work and Covey to support to teams to develop and take forward action planning. Through the imatter Implementation group, we are considering moving to one cohort for the whole Service and will discuss this over the next period. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 14 Author: Director of Care Quality & Strategic Development

15 Part 2 Performance Indicators SECTION 1: RECOMMENDATIONS The Board is asked to: 1. Feedback on the changes in design of this area of the paper. 2. Note performance against HEAT for the period to April Discuss actions being taken to improve performance. SECTION 2: DISCUSSION Performance to Date - Key Improvement Highlights The New Clinical Response Model (NCRM) was launched in late 2016 as a 12 month pilot and phase 1 has now been in operational practice for five months. NCRM was developed and modelled with an extensive clinical data set, allowing for a focused review of patients clinical need and matching this to the Service response, resource and skill. Since going live the model has proven to accurately identify patient groups as predicated, based on their clinical acuity. NCRM aim is to save more lives and improve outcomes. This can be demonstrated with an increase in Return of Spontaneous Circulation (ROSC) in the first quarter launch in comparison to the same quarter in 2015/2016 (See CST Section 2 Page 7 above). For patients who require access to an acute pathway i.e. Acute Myocardial Infarction or Acute Stroke Patients, this has been approached in the NCRM by sending the right conveying emergency ambulance resource first time, this has been achieved 93.7% of the time. There has been a steady volume of staff feedback to a dedicated address which has allowed themes to be identified and improvements to operating practice to be made. Since going live there have been no reported Significant Adverse Events. Phase 2 goes live in June and will involve the upgrade to the latest version of our triage software, MPDS, and introduction of dispatch on disposition with resources sent once the clinical coding in MPDS has been established. SAS H1 Save more lives - Return of Spontaneous Circulation (ROSC) for VF/VT patients (refer to pages 6/7) Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 15 Author: Director of Care Quality & Strategic Development

16 SAS H2 Cardiac arrest patients - % of cardiac arrest patients responded to within 8 minutes Chart 4 SAS H2 Cardiac Arrest Patients % of cardiac arrest patients responded to within 8 minutes Aim 80% 85% 80% 75% 70% 65% Enhanced Defib Wildcat, Glasgow 3RU and Police co-responder go live New Clinical Response Model 60% 55% % CA Mean UCL LCL Upper 3rd Lower 3rd Aim The percentage of cardiac arrest patients to receive a response within 8 minutes has remained stable despite the increased pressures during the winter period. Variation is within upper and lower control limits, indicating that the level of performance is stable and fluctuation within this is not statistically significant. Work is being undertaken within the Ambulance Control Centres and Operations to identify opportunities to improve Cardiac Arrest performance and Immediately Life Threatening performance as a whole. These include initiatives to improve resourcing levels, allocation time, tactical deployment compliance and reduced hospital turnaround times. To further improve cardiac arrest patient outcomes the Out of Hospital Cardiac Arrest work stream and the New Clinical Response Model will introduce further enhancements to existing technology, systems and staff training which will improve early identification of Immediately Life Threatening, quicker hands on chest, public access to defibrillators and better coordination of the increasingly complex options for co-responder provision. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 16 Author: Director of Care Quality & Strategic Development

17 SAS H3 Response to Immediately Life Threatening incidents (ILT) -% ILT incidents responded to within 8 minutes Chart 5 SAS H3 Response to ILT Incidents % of ILT incidents responded to within 8 minutes Aim 75% 80% 75% 70% 65% 60% 55% 50% Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 % ILT Mean Aim UCL LCL Upper 3rd Lower 3rd The new clinical response model was implemented on 23 November 2016 and is progressing. We are monitoring the whole system continuously and Immediately Life Threatening performance remains stable. Chart 5 above illustrates current ILT performance at 66.5% (from November 2016). The data outlines how we have stabilised 8 minute performance. This follows a significant deteriorating trend over the previous year. This has been achieved during our busiest period and against a background of significant demand and associated capacity issues affecting the Service and our Primary and Acute sector partners. More work needs to be done to ensure we continue to optimise our response to these patients. Actions include optimising all parts of the response chain both in ACC and in Divisions, including shortening dispatch times, mobilisation times, maximising workforce availability and utilising tactical deployment points to best effect. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 17 Author: Director of Care Quality & Strategic Development

18 Avg. Turnaround Time Two main factors that continue to be addressed include:- 1. Reduce overall demand. This involves a range of actions within our ACC, maximising utilisation of Clinical Advisors to appropriately hear and treat patients, signposting them where appropriate to alternative care providers. This requires ongoing close work with our partners in NHS 24 and in communities. 2. Addressing pressures in the wider healthcare system. One area of continuing concerns is the increasing time it takes to turn round ambulances at hospitals (chart 6) Chart 6 29 Average National Emergency Turnaround Time Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 Month Turnaround Time Median These delays are not only inconvenient and uncomfortable for patients, but they significantly impact on our resource availability to respond to emergency calls. Through our partnership work with territorial boards, unscheduled care initiatives and the excellent work of our Hospital Ambulance Liaison Officers (HALOs) we are working very hard to improve this position. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 18 Author: Director of Care Quality & Strategic Development

19 Other actions to improve operational performance are outlined below:- Status Plan Management trial in West Central Division started on 19 April, dedicating Paramedic response units (PRUs) to additional locations where the geographic concentration of ILT calls cluster, therefore reducing the estimated travel time to ILT patients and improve the utilisation of PRUs. A full review of the Status Plans is in progress now we have 3 months data post the changes to the response profiles, in line with the pilot of the NCRM. Robust review of the Unit Hour provision across all Divisions and the ACC to ensure abstractions are kept to a minimum against the increased training needs in line with the training plans and higher than average absence rates. Continued focus on the challenging turnaround times at hospitals with Performance Managers being positioned appropriately at Glasgow hospitals prior to demand spikes. Supervisors within Ambulance Control continue to monitor allocation, mobilisation and hospital turnaround times. Divisions have identified a Head of Service as the named lead for performance in line with the weekly action plan to provide updates. The continued focus on operational performance and the ILT Action Plan is monitored weekly by the Executive Team. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 19 Author: Director of Care Quality & Strategic Development

20 SAS T1 Reduce hospital admissions - % of unscheduled calls not conveyed (refer to pages 4/5) SAS T2 Hyper acute stroke - % of hyper acute stroke patients receiving pre-hospital care bundle Chart 7 80% SAS T2 Hyper Acute Stroke % of patients who receive the pre hospital care bundle. Aim 80% 70% 60% 50% 40% Nov-16 Dec-16 Jan-17 % HAS Bundle Feb-17 Mar-17 Mean Apr-17 UCL LCL To achieve success in this measure, all elements of our Stroke Bundle need to be completed and accurately recorded on our eprf. Performance against the Pre-hospital Stroke Bundle remains strong in some divisions and sub-divisions across the Service, many of which regularly achieve 100% compliance. With the interim epr still in place, difficulties in achieving full compliance are still evident in certain areas of the Service with the measure at 51.9%. Detailed analysis shows that in most cases, this is due to a failure to accurately record the fourth standard of the Bundle, the pre-alert. The positioning of this field requires the user to navigate away from the stroke page. This technical difficulty will be eradicated with the introduction of the new epr software in the coming months, and we expect performance against this measure to improve significantly. Feedback from partners and colleagues across the wider stroke community is very positive with regards to the high standard of care delivered to stroke patients in the pre-hospital setting. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 20 Author: Director of Care Quality & Strategic Development

21 SAS T3 Infection control -% of recorded use of PVC insertion care bundle Chart 8 90% SAS T3 Infection Control % of recorded use of PVC insertion care bundle Aim 85% 85% 80% 75% 70% 65% % PVC Mean UCL LCL Upper 3rd Lower 3rd Aim The overall picture remains one of improvement with the target increasing to 85% from April Service overall compliance for recorded use of the PVC insertion bundle remained on track at 83.7%, with each Division having achieved above target to this point. A PVC insertion pack has been introduced with the aim of further improving PVC bundle compliance and is currently being trialled in Dumfries. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 21 Author: Director of Care Quality & Strategic Development

22 SAS E2 Sickness absence rate of sickness absence Chart 9 9% SAS E2 Sickness Absence Rate of sickness absence Aim Aim 5% 5% 8% 7% 6% 5% 4% % Absence Mean UCL LCL Upper 3rd Lower 3rd Aim Absence levels have fluctuated around the 8% level since August last year, however there has been some improvement across February and March (7.3% and 7.4% respectively). Absence for the fourth quarter of 2016/17 was 7.9% (it was also 7.9% in quarter four of 2015/16) and the full year performance for 2016/17 was 7.6%, the same as the previous year. Issues to note: The top four reasons for absence are:- o Gastro Gastro intestinal illness o Musc injuries affecting the muscles and skeletal structures of the body o Other uncategorised absence o Resp Respiratory illness The Divisions which continue to experience the highest absence levels are South East and West Central. This is a continuation Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 22 Author: Director of Care Quality & Strategic Development

23 of the trend throughout 2015/16. Air Ambulance, Fleet, National Headquarters and ScotSTAR absence rates are below 5% with all other divisions above the HEAT target. A comprehensive report was recently presented to the Executive Team looking at the detail behind the absence figures and providing options for how these can be addressed. An implementation plan for this is being drafted and will be reported on at the Staff Governance Committee. Doc: Towards 2020 TCTTP and Performance Indicatorsv2 Page 23 Author: Director of Care Quality & Strategic Development