NOT PROTECTIVELY MARKED Public Board Meeting September 2016 Item No 7 THIS PAPER IS FOR DISCUSSION

Transcription

1 NOT PROTECTIVELY MARKED Public Board Meeting September 2016 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 HEAT for the period to end June Discuss actions being taken to improve performance. Following agreement from Board members at the Board Development Event on 29 April 2016, this paper combines the 2020 Strategy Update paper (Part 1) with the National Performance Indicators (Part 2). 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 3 strategic work stream updates from:- Clinical Services Transformation Over the past 2 months work within the Ambulance Control Centre to align driver diagrams, develop a measurement system along with the conversion of data to control charts in order to further develop the Service s Hear and Treat capability to increase this to 10% in 2016/17; Further operational definition work to establish how we describe and measure See and Treat pathways will be undertaken once the evaluation of the Hawick Clinical Decision Making pilot is complete. This evaluation will be concluded by November Ongoing work will include further engagement with front line staff and focus on divisional leadership; Doc: Towards 2020 TCTTP Page 1 Author: Dir of Care Quality & Strategic Dev

2 Developing our Future Workforce Increasing workforce resource by commencing a further 59 Technicians on the Vocational Qualification (VQ) training model and selection of over 80 new Paramedics for August/September training intakes; Building on our work with Community Paramedic and Paramedic Practitioners, we have commenced the process of matching existing Practitioners, and recruitment of new staff to 51 Specialist Paramedic roles. As part of this process 20 staff members have been selected for September PG Cert programme, with a further cohort planned for January. Improving staff engagement through progressing the imatter roll out programme. Enabling technology Broadening the scope of the Enabling Technology Programme Board to progress the full programme set out in our ehealth Strategy, approved by the Board earlier this year. Ambulance Telehealth Programme Phase 2 (Electronic Patient Record Replacement) Development Cycle 1 is more than 50% complete in line with plan. Future Mobile Communications Programme - The takeover of Airwave Solutions Limited by Motorola is now complete and implementation team resources are currently being finalised. Timing Contribution to the 2020 vision for Health and Social Care Benefit to Patients Performance against LDP standards Part two shows that our contribution to improving survival from cardiac arrest remains above target. The clinical services transformation programme is resulting in fewer A & E attendances in line with trajectory and Infection Control compliance is above target. Employee engagement scores remain strong and sickness absence for July is at a lower level to the same period last year. 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. This programme of work underpins the Scottish Government s 2020 Vision. This report highlights our national priority areas and strategy progress to date. These programmes support the delivery of our quality improvement objectives within the Service s annual Local Delivery Plan. This integrated programme of work is designed to support 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 is being developed Doc: Towards 2020 TCTTP Page 2 Author: Dir of Care Quality & Strategic Dev

3 Equality and Diversity which will evidence the benefit to patients, staff and partners and support the Service s transition towards This will focus on the contribution of each of the key work streams to the overarching measures around Hear and Treat, See and Treat and reduced conveyance to hospital to enhance the experience and outcomes for patients. This paper summarises 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 Page 3 Author: Dir of Care Quality & Strategic Dev

4 Clinical Services Transformation 1 Hear and Treat The Scottish Ambulance Service has identified an aim to achieve 30% Hear and Treat by December This will include an increase in the number of calls that can safely and appropriately be dealt with by the Ambulance Control Centre as an alternative to ambulance response. To redesign Scottish Ambulance Control Centres call handling to improve patient experience and outcome through effective triaging in order to send the right response to the patient. The milestone by the end of 2016/17 is to increase the percentage of Hear and Treat calls to 10%. Status Hear and Treat definition agreed as the proportion of emergency incidents that have been resolved by providing advice over the phone and/ or referring to third party. Ongoing training and support for the Clinical Advisors. Improvement The run chart shows the percentage of all emergency incidents with a Hear and Treat outcome. The Quality Improvement changes tested so far have increased Hear and Treat by around 10% in the group of calls dealt with by the Clinical Services Desk. The introduction of additional Clinical Advisors and Supervisors has improved the resilience of this function however there has been some variation in practice as new staff learn new working practices resulting in the performance dip visible on the chart. This is expected to be a short term issue and is being monitored closely in line with improvement methodologies. 11% % Hear and Treat 10% 10% 9% 8% 7% 6% Measure Value % (p) Control Line UCL Lower 3rd Doc: Item 7_Towards 2020 & Perf Ind Page 4 Author: Director of Care Quality & Strategic Development

5 2 See and Treat The Scottish Ambulance Service aims to take more care to patients in their homes and communities and has an aim of 30% See and Treat by The milestone indictor for 2016/17 is 18%. These aims will be heavily dependent on the development of enhanced care pathways within the Health and Social Care Integrated Joint Boards (IJBs) throughout Scotland. To develop new care pathways and decision support to safely manage patients at home or in a homely setting. Status The Scottish Ambulance Service s application of See and Treat procedures are included in the chart below. Planned Activities Include Working with NHS Boards and IJBs to develop alternative care pathways. Test and spread of enhanced clinical decision support. Further operational definition work to establish how we describe and measure See and Treat pathways will be undertaken once the evaluation of the Hawick Clinical Decision Making pilot is complete. This evaluation will be concluded by November Ongoing work will include further engagement with front line staff and focus on divisional leadership. 20% % See and Treat 18% 19% 18% 17% 16% 15% 14% Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd Doc: Item 7_Towards 2020 & Perf Ind Page 5 Author: Director of Care Quality & Strategic Development

6 3 Conveyance: Out of Hospital Cardiac arrest (OHCA) - OHCA remains a significant healthcare challenge in Scotland. 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 Testing and Implementation Planning. Improvement As seen in the chart, improvement exceeds the target for 2016/17 of 35%. 70% SAS H1 Save More Lives Return of Spontaneous Circulation for VF/VT patients 35% 60% 50% 40% 30% 20% 10% 0% SAS H1 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd Planned Activities Include The definition and drafting process for mapping Public Access Defibrillators (PADs). Following the review of the pilot co-responder model in West Lothian with Scottish Fire and Rescue Service (SFRS), a plan is currently being developed to implement this as business as usual. The Scottish Ambulance Service will begin a Health Foundation sponsored pilot of co responding with SFRS in remote and rural Scotland. There will be further engagement with Police Scotland regarding a co responding model similar to the SFRS model. Continued rollout training of Community First responders in new bespoke ScotPos programme. Doc: Item 7_Towards 2020 & Perf Ind Page 6 Author: Director of Care Quality & Strategic Development

7 Enabling Technology Update 1 Ambulance Telehealth Programme Phase 1 Completed. 2 Ambulance Telehealth Programme Phase 2 - includes the procurement and design of a new electronic patient report application. The epr contract was awarded to Terrafix in March 2016 and the current plan is to implement the new epr during the summer of The scope includes the specification, development and implementation of a Scottish Ambulance Service app which will provide crews with Service information. It also includes implementing other software applications on the new Getac tablets, those under consideration include , intranet, Datix and rostering systems. Status Development Phase 1 for the new epr is more than 50% complete. The Development Cycle 2 specifications are now being produced. Development of the SAS app is ongoing, the evaluation of the prototype version has been largely positive. A near-final version is due to be delivered by October. The new SAS app is due to be rolled out by the end of Improvement Improved ease of use, additional functionality, increased clinical data collection & data quality, ready access to additional relevant information, increased productivity. Planned Activities Include Iterative development of new epr solution in partnership with Terrafix, iterative development of SAS app in partnership with Screenmedia, conduct training needs analysis, plan roll-out of new epr and SAS app. Development Phase Specification Agreed By Beta Version Delivered By Iterative software testing & development Period and Training Development Period 1 May 2016 July 2016 July, August & September October 2016 December 2016 December 2016 until March 2017 Training Delivery Period September, October & November 2016 April, May & June 2017 Doc: Item 7_Towards 2020 & Perf Ind Page 7 Author: Director of Care Quality & Strategic Development National Go-Live Late November 2016 Late June 2017 Other Considerations Work is underway with colleagues from the Clinical Services Transformation Programme (and others) to develop content for the new SAS app. Ubiquitous access to mobile broadband data (as will be delivered by the Future Mobile Communications Programme) will be a key enabler for maximising the benefits derived from the Ambulance Telehealth Programme. Benefit Realisation / Return on Investment - The expected benefits from the Ambulance Telehealth Programme are being managed by the Programme Board, they include lower like for like costs, improved electronic patient record completion rates and data quality, as well as timeous and efficient mapping updates.

8 3 Future Mobile Communications Programme Radio and Short Data Communications are provided to the Scottish Ambulance Service, and all other GB Emergency Services, by Airwave Solutions Limited (ASL). The service is commonly known as Airwave. The various Airwave contracts expire on a phased basis from 2016 to The UK Government established the Emergency Service Mobile Communications Programme (ESMCP) in 2011 to identify a replacement for Airwave. The scope of the programme was extended beyond the current capability in order to procure products that will provide a national wireless broadband data network. The programme will deliver a voice and broadband data network that will be known as the Emergency Services Network (ESN). The procurement for the main ESMCP contract Lots was completed during The Scottish Ambulance Service is currently due to transition to the ESN from late 2018 through to late In 2013, the Scottish Ambulance Service established the internal Future Mobile Communications Programme (FMCP) to govern, oversee and ultimately deliver the transition from Airwave to a replacement emergency service network. As a minimum, the new network will match Airwave in terms of availability and geographic coverage. Status - The takeover of ASL by Motorola has been completed. The ESMCP Programme Team is now focused on mobilisation with a view to transitioning user organisations across Great Britain from Airwave to the ESN from 2017 through to The main areas of focus for the Service are currently Air-to-Ground (A2G) service provision, ESMCP value engineering proposals and the potential for ESMCP timeline slippage. Improvement Reduced like for like costs, ubiquitous access to mobile broadband data to support remote delivery of clinical services. Planned Activities Include - Recruitment of dedicated full-time programme staff is ongoing. Active engagement with Scottish Government, Police Scotland, SFRS and the ESMCP team at both strategic and tactical levels continues. Other Considerations The delivery of the Future Mobile Communications Programme is very heavily reliant on the corresponding delivery of a highly complex GB-wide multi-agency programme (ESMCP). Benefit Realisation/Return on Investment The expected benefits from the Future Mobile Communications Programme are being managed by the Enabling Technology Programme Board, they include lower like for like costs and more effective and efficient clinical services facilitated by faster and more widespread mobile data services. Doc: Item 7_Towards 2020 & Perf Ind Page 8 Author: Director of Care Quality & Strategic Development

9 Developing our Future Workforce Update 1 Recruitment The Scottish Ambulance Service has identified front line recruitment targets for in order to build capacity and progress towards its workforce profile targets by December To recruit and retain staff to build the platform for Scottish Ambulance Service to ensure there is sufficient staff with the necessary skills to deliver its 2020 workforce profile and improve staff experience. Status Implementation. Improvement The run chart below shows turnover rates since April 2014, which confirms turnover rates have continued to fall. Turnover above 6% would require the Service to increase its recruitment and training capacity to avoid any risk of workforce target shortfall. 7.5% Turnover Rate 7.0% 6.5% 6.0% 5.5% 5.0% 4.5% 4.0% Measure Value (i) Control Line (Ibar)* UCL (Ibar + (2.66*Adj MRbar) UCL (Ibar - (2.66*Adj MRbar) Planned Activities Include Continued roll out of the Regional Technician VQ model to support increased training requirements. Six additional programmes have commenced across the regional centres with 59 students. These students will progress to practice placement in early September Another intake of 67 students is due to commence during September/October bringing the total number of new staff entering the Service to over 200 since April The additional capacity at Glasgow Caledonian University has allowed a further 80 Paramedics to commence training with further cohorts Doc: Item 7_Towards 2020 & Perf Ind Page 9 Author: Director of Care Quality & Strategic Development

10 currently being recruited for October and November. The final key element of this year s recruitment plan is the selection of our first Specialist cohort (see details below). Other Considerations Work continues to mitigate the risk associated with developing and maintaining a candidate pipeline to support significantly increased Technician and Paramedic training in 2016/17 and onwards. 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 - A Scope of Practice framework document has been developed which defines how all of our frontline roles will operate to support our 2020 strategy. The main focus at this stage is on the development and deployment of our new Specialist Paramedic role. - to recruit 51 Specialist Paramedics in 2016/17 in line with Divisional Workforce Plans to test the operational arrangements required in line with the development of our clinical model. Status Implementation. Improvement The Specialist Paramedic role will be a key element underpinning the increase in use of See and Treat. Planned Activities Include Selection of new Specialist Paramedics during August and September. This will inform the number of staff to form the first cohort of staff who will commence the PG Certificate in Specialist Paramedic Practice in September (first year of the new MSc programme at Glasgow Caledonian University). Other Considerations Work will be progressed with the Clinical Transformation Programme to develop our operational model in preparation for the introduction of the new roles. Benefit Realisation/Return on Investment To support the delivery of our See & Treat and Hear & Treat targets, with greater integration of health and social care, managing patient care at home, supporting anticipatory care planning for patients with longterm conditions, prescribing and referring directly to clinical services. Doc: Item 7_Towards 2020 & Perf Ind Page 10 Author: Director of Care Quality & Strategic Development

11 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. to improve staff engagement in the Service. Status Spread Planning it is expected that all staff will have been invited to participate by March Improvement Cohort 1 (East Central and Corporate departments) had their anniversary run in February 2016; Cohort 2 (South East, OMT and Board) is in the process of their anniversary run; Cohort 3 (NRRD and Air Wing) have just completed the action planning stage; Cohort 4 (North) are in the process of action planning; Cohort 5 (ACC) questionnaire will run on 3 October The overall Board response rate is 68% and the Employee Engagement Index is 68% which is in the upper quartile. Planned Activities Include The remaining divisions, South West and West Central, will run between October 2016 and March An imatter Implementation Group, chaired by Director of Care Quality and Strategic Development has met four times, with project planning and OD support being agreed. The Group is overseeing improvement work including: Assessing outputs of focus group work to determine possible improvement actions; Communications plan for staff, including consideration of linking imatter with CPD requirements; Development of patient stories to explain the explicit links between staff experience and patient experience; Select key managers from across operational functions and Ambulance Control Centres, and at different levels across the Service to participate in Covey development workshops as part of Phase 2 of the national implementation of imatter; Utilisation of Aston Team Work tools to provide support to teams to develop and take forward action planning; Other Considerations Derive lessons learned from implementation in operational divisions and spread these across the Service. Doc: Item 7_Towards 2020 & Perf Ind Page 11 Author: Director of Care Quality & Strategic Development

12 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 August Discuss actions being taken to improve performance. SECTION 2: DISCUSSION Performance to Date - Key Improvement Highlights Our contribution to improving survival from cardiac arrest remains above target and that response times for Category A, the higher acuity patients improved on the previous quarter in line with our improvement trajectory. The clinical services transformation programme is resulting in fewer A & E attendances in line with trajectory and Infection Control compliance is above target. Employee engagement scores remain strong and sickness absence for July is at a lower level to the same period last year. Doc: Item 7_Towards 2020 & Perf Ind Page 12 Author: Director of Care Quality & Strategic Development

13 Scottish Ambulance Service Vector of Measures August % SAS H1 Save More Lives Return of Spontaneous Circulation for VF/VT patients 35% 85% SAS H2 Cat A Cardiac Arrest Patients % of cardiac arrest patients responded to within 8 minutes 80% 80% SAS H3 Response to Cat A Incidents % of category A incidents responded to within 8 minutes 75% 60% 80% 75% 50% 40% 30% 20% 10% 75% 70% 65% 60% 70% 65% 60% 0% 55% 55% SAS H1 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd SAS H2 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd SAS H3 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd 100% SAS H3 Response to Cat B Incidents % of category B incidents responded to within 19 minutes 95% 9% SAS E2 Sickness Absence Rate of sickness absence 5% 85% SAS T3 Infection Control % of recorded use of PVC insertion care bundle 78% 95% 90% 8% 7% 80% 85% 80% 75% 6% 5% 75% 70% 70% 4% 65% SAS H3 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd SAS E2 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd SAS T3 Measure Value % (p) Control Line (Pbar) UCL LCL Upper 3rd Lower 3rd Doc: Item 7_ Towards 2020 & Perf Indicators Page Author: Director of Care Quality & Strategic Development `

14 SAS H1 Save more lives - Return of Spontaneous Circulation (ROSC) for VF/VT patients (refer to page 6) SAS H2 Category A cardiac arrest patients - % of cardiac arrest patients responded to within 8 minutes Variation in performance is within upper and lower control limits indicating that the level of performance is stable and fluctuation within this is not statistically significant. The recent upward trend in terms of response back to the levels of early 2015 is evident and reflects the general improvement in Category A performance over recent times. Other influencing factors include: As mentioned in H1, the Service continues to triple respond to cardiac arrest patients. Work in Ambulance Control to introduce system improvements to enable further improvements in technology systems and staff training. These developments will enhance the early recognition of patients in cardiac arrest, support to bystander CPR, Public Access Defibrillator mapping and utilisation, and enable the increasingly complex options re co-responder provision. SAS H3 Response to Category A incidents - % Category A incidents responded to within 8 minutes Despite an increase in Category A and B demand of 2.1% in August compared to the same period last year, performance was 66.4%. Response times remain very quick and amongst the best in the world. For the financial year to date 74.3% of Category A calls were responded to within 9 minutes and 79.5% within 10 minutes. The average service time for emergency incidents (the time taken to deal with a call from start to finish) increased by 3.3% in August 2016 compared to the August previous which is an additional 2 minutes 23 seconds per incident. Over half of this increase is due to hospital turnaround times. Comparing August 2016 the average national turnaround time was 26 minutes 43 seconds, compared to 25 minutes 19 seconds in August last year a difference of 1 minute 24 seconds. Extrapolated over the course of the whole month, the extra time spent at hospital nationally equates to over 900 additional hours. This means that ambulances are spending more time at hospital reducing their availability to respond to Category A demand. This has undoubtedly placed additional pressure on the Service s resources, particularly in West Central Division which has experienced the worst turnaround times. West Central Division is introducing a model for 3 months in collaboration with NHS Greater Glasgow & Clyde to introduce 3 Performance Managers to address issues impacting on patient flows, minimise hospital turnaround times and optimise patient discharges. A report is currently being produced with the support of Scottish Government Unscheduled Care team outlining proposals to invest in Hospital Ambulance Liaison Officers (HALOs) and additional discharge resources across Scotland which should contribute to improving unscheduled care and align to the 6 Essential Actions. Other work which is ongoing to improve operational performance is outlined below: Collaborative partnership working with Scottish Fire and Rescue Service (SFRS) is continuing. Maryhill, Clydesmill and Calton Fire Stations are being used as full time 24hr satellite stations. Clarkston, Castlemilk and Bathgate Fire stations have been progressed as far as possible in service, however SFRS is engaging with the Service at a senior level to agree a facilities sharing agreement before these stations can progress any further. Doc: Item 7_ Towards 2020 & Perf Indicators Page Author: Director of Care Quality & Strategic Development `

15 The West Central Unscheduled Care Short Life Working Group continues to meet weekly and it s anticipated that this will continue until performance has improved sustainably. The focus of the group remains a priority for the Director of Service Delivery, a verbal report on the progress of the group is provided at a weekly meeting. The Chief Executive continues to hold monthly National Performance Improvement meetings with the senior management cohort, Employee Director and Executive Team members to focus on improving the delivery of unscheduled care. Work is progressing on the Paramedic Response Unit backup process to enable a quicker release of resources to respond to other calls. Staff side engagement has taken place and a document has been circulated for comment. Further consultation is required to refine the process prior to implementation.. The Ambulance Control Centre is on schedule to meet its workforce plan for the recruitment of Call Handlers and Dispatchers and 31 of its projected 32 Clinical Advisors already appointed to post in line with the clinical response model. Clinical advisors are now consistently monitoring high acuity patients which are not responded to within 8 minutes. SAS H4 Response to Category B incidents - % Category B incidents responded to within 19 minutes (refer to Category A, page 14) SAS T1 Reduce hospital admissions - % of unscheduled calls not conveyed This indicator will measure patients who are not conveyed due to either hear and treat and see and treat protocols. Work is ongoing to define the calculation of this combined measure. For progress against the individual components of this measure please refer to pages 4/5. SAS T2 Hyper acute stroke - % of hyper acute stroke patients receiving pre-hospital care bundle Work is progressing well on the implementation of this indicator. The required changes have been made to the crew s epacer units to enable them to record when the bundle has been applied. The next stage is to educate staff to ensure they are recording this information using the new method and also bring this information into the Service s Data Warehouse where it can be measured. SAS T3 Infection control - % of recorded use of PVC insertion care bundle Service overall compliance for recorded use of the PVC insertion bundle has improved further over the past 2 months with a slight increase from 82.8% in June to 82.9% for the month of August. Compliance for August is the highest achieved to date with all Divisions scoring above the 75% target. Improvement work continues around implementation of a PVC insertion pack to further improve compliance with the PVC insertion bundle. Doc: Item 7_ Towards 2020 & Perf Indicators Page Author: Director of Care Quality & Strategic Development `

16 SAS E2 Sickness absence rate of sickness absence After falling to below 7% in April (6.9%), absence has risen slightly across the last three months with the July figure at 7.4%. Absence for year end 2015/16 was 7.6%. Absence for quarter 1 of this year (April to June 2016) was 7.1%. This compares to 7.0% for the same period last year. Issues to note: Long term absence continues to account for the highest proportion of absence. The most prevalent reasons for absence are musculoskeletal and respiratory, as well as a significant number of cases of anxiety/stress/depression. The Divisions with high absence levels last year and the first quarter of this year are West Central and South East. Improvements have been seen in levels of attendance in ACCs. Air Ambulance, Fleet, NHQ and ScotSTAR absence rates are below 5% with all other divisions above the HEAT target. It is recognised that to reduce absence levels the Service needs to focus on increasing employee engagement, looking after the wellbeing of staff and providing services to support staff that are off on long term absence. imatter has now been rolled out to over half of the Service and this provides managers with valuable information on employee engagement in their team, as well as the opportunity to develop an action plan to address any concerns. The Working Practices Steering Group has been working in partnership to address issues of concern to front line staff including vehicle checks, shift overruns and meal breaks. Over the past year, the Service has put in place considerable support for staff with regard to mental health, including Stress Policy, Specialist HR advice, Occupational Health and Employee Assistance Programme. Further planned work includes a Service wide stress survey, review of Global Rostering System (GRS) as an absence management tool and consideration of the outcome from a benefits realisation review of our Occupational Health arrangements. Doc: Item 7_ Towards 2020 & Perf Indicators Page Author: Director of Care Quality & Strategic Development `