To provide a safe and effective healthcare service to all our communities in the East of England Integrated Performance Report Meeting Date: July 2016 Data: The month of June (May for Clinical & HART) Integrated Performance Report 1
Performance Trust Dashboard Workforce Finance Clinical Integrated Performance Report 2
Quality Patient Safety Description Trend Analysis Number of Serious Incidents Actual number of incidents (as defined in reporting and investigation of serious incidents procedure) reported within the month SI s increased in June. Integrated Performance Report 3
Quality Patient Safety Description Trend Analysis Vehicle Cleanliness The number of audits reaching the cleanliness target of 95% Vehicle cleanliness figures remain above the target Fill Stations Cleanliness The performance of station cleanliness audits reaching the target of 95% Station cleanliness is above the target performance in April Integrated Performance Report 4
Quality - Clinical Effectiveness Description Trend Analysis Cardiac Arrest ACQI - ROSC % of all patients who had resuscitation commenced/ continued by EEAST following an out-of-hospital cardiac arrest who had return of spontaneous circulation (ROSC) on arrival at hospital. There has been a marginal increase in those patients who have had a return of spontaneous circulation which remains above the current national average. Work continues with staff for cardiac arrest patients, including a successful ALS Bootcamp held at Melbourn and Luton recently, and the dissemination of the adult Cardiac Arrest Checklists designed with staff and the ACLs to ensure those patients with a ROSC receive optimal care. *The latest National Average available from NHS England is for February 2016. A solid red line (if shown) in the chart represents actual National Averages. Where the National Average line has red hashes, this indicates that the average for these months is not actual. Cardiac Arrest ACQI Survival to discharge % of all patients who had resuscitation commenced/ continued by EEAST following an out-ofhospital cardiac arrest who were discharged from hospital alive Survival to discharge figures have increased by four percent this month which is very pleasing. This is measured by the patient walking out of the hospital following their cardiac arrest. The cardiac focus that is continuing within the Trust will keep a focus on these care bundles in particular. *The latest National Average available from NHS England is for February 2016. A solid red line (if shown) in the chart represents actual National Averages. Where the National Average line has red hashes, this indicates that the average for these months is not actual. STEMI ACQI Care Bundle % of all patients suffering a ST elevation myocardial infarction (STEMI) who received an appropriate care bundle (aspirin, GTN, and analgesia administered and two pain scores recorded) There has been a very slight decrease in the care bundle compliance but we remain above the national average for our care of those suffering from a STEMI. Historically, care bundle compliance has always been very high, but the ACLs are doing more granular work to ensure that any slip in compliance can be addressed and that measures to sustain performance are embedded. *The latest National Average available from NHS England is for February 2016. A solid red line (if shown) in the chart represents actual National Averages. Where the National Average line has red hashes, this indicates that the average for these months is not actual. Integrated Performance Report 5
Quality - Clinical Effectiveness Description Trend Analysis STEMI ACQI time to PPCI treatment within 150 minutes* % of all STEMI patients who received primary percutaneous coronary intervention (PPCI) following direct admission to a PPCI centre whose PPCI treatment took place within 150 minutes of call. Compliance for PPCI being delivered within 150 minutes of the event has increased by over 2%. This takes the trust above the national target and above the trust's own average so vital heart muscle and life-limiting heart attacks are less likely due to the timely transport of these patients. *The latest National Average available from NHS England is for February 2016. A solid red line (if shown) in the chart represents actual National Averages. Where the National Average line has red hashes, this indicates that the average for these months is not actual. Stroke ACQI care bundle % of all patients with suspected new stroke or transient ischaemic attack (TIA) who receive an appropriate care bundle (FAST assessment, blood pressure and blood glucose measurement) There has been no change in the compliance of this target this month. The trust remains above the national average and is still performing well against this target, although we will not let ourselves be complacent and will feedback to staff on how well they are delivering their care in challenging circumstances. *The latest National Average available from NHS England is for February 2016. A solid red line (if shown) in the chart represents actual National Averages. Where the National Average line has red hashes, this indicates that the average for these months is not actual. Stroke ACQI time to HASU within 60 minutes* % of all Face Arm Speech Test (FAST) positive stroke patients potentially eligible for stroke thrombolysis (within local guidelines) who arrived at a hyper acute stroke centre (HASU) within 60 minutes of call. Similar to PPCI figures, the Stroke compliance has increased but this has done so by over 9%. This is a really great achievement by staff and enables stroke patients to receive their diagnostic testing and potential treatment much earlier. This again takes the trust above the national average. *The latest National Average available from NHS England is for February 2016. A solid red line (if shown) in the chart represents actual National Averages. Where the National Average line has red hashes, this indicates that the average for these months is not actual. *There are recognised delays in producing these indicators, due to the complexity of collecting outcome data Integrated Performance Report 6
Quality Patient Safety Description Trend Analysis Number of Emergency Service Complaints Actual number of Emergency Service complaints received in full calendar month. Complaints decreased in June Number of PTS Complaints Actual number of Patient Transport Services complaints received in full calendar month. In June PTS saw a rise in the number of complaints received. Number of Primary Care Service Complaints Actual number of Primary Care Service complaints received in full calendar month. In June Primary Care services received 3 complaints. Integrated Performance Report 7
Performance Summary Challenging few weeks particularly at weekends with increased demand and significantly increased Red demand. PIAG meetings being held weekly. Joint PIAG meetings with commissioners to provide assurance on actions being taken by the Trust and to gain assurance from CCGs on actions being taken to reduce hospital delays. Trust focused actions Increase in UHP solo provision to enable capacity to use for Red category response Decrease in RRV run times Increase total UHP for core DSA Reduce lost capacity at ED through improved handover times Reduce lost capacity at ED through improved clear times Reduce the gap of missed Red compliance between 8 and 9 minutes. Integrated Performance Report 8
Performance Monthly Performance YTD 999 Call Pick Up (Within 5 seconds) Hear & Treat: 3.3% 3206 Red 1 67.70% YTD 63.24% Red 2 60.46% YTD 56.64% Target 75% Target 75% Number of 999 Calls: 86060 Picked up within 5 sec: 95.05% Average Pick Up Time: 00:00:03 See & Treat: 51.3% 50473 Red 19 89.67% YTD 88.69% Green 1 74.78% YTD 74.21% Target 95% Target 75% In 20mins Green 2 69.80% YTD 69.18% Target 75% In 30mins See & Convey: 45.5% 44741 Urgent 70.60% YTD 68.80% Target 75% Integrated Performance Report 9
Performance Description Trend Analysis Red 1 Performance % of Red 1 ambulance Calls resulting in an emergency response arriving within 8 minutes. Target of 75% of Red 1 incidents receiving an on scene response within 8 minutes Red 1 performance is below 75% so far in 2016/17 Red 2 Performance % of Red 2 ambulance Calls resulting in an emergency response arriving within 8 minutes. Target of 75% of Red 2 incidents receiving an on scene response within 8 minutes Red 2 performance is below 75% so far in 2016/17 Red 19 Performance % of Red 1 or Red 2 ambulance Calls resulting in an emergency response (conveying response) arriving within 19 minutes. Target of 95% of Red 1 incidents receiving a conveying resource on scene within 19 minutes Red 19 performance is below 75% so far in 2016/17 Integrated Performance Report 10
Performance Description Trend Analysis Green 1 % of Green 1 ambulance calls resulting in an emergency response arriving within 20 minutes. Target of 75% of Green 1 incidents receiving an on scene response within 20 minutes. Green 1 performance was below the national target this month Green 2 Red 2 Performance Green 3 % of Green 2 ambulance calls resulting in an emergency response arriving within 30 minutes. Target of 75% of Green 2 incidents % receiving of Red an 2 ambulance on scene response Calls resulting within in 30 an minutes. emergency response arriving within 8 minutes. Target of 75% of Red 2 incidents receiving an on scene response within 8 % of Green minutes 3 ambulance calls resulting in a telephone assessment within 20 minutes. Target of 75% of Green 3 incidents receiving a telephone assessment within 20 minutes. Green 2 performance was below the 75% target this month. Red 2 performance dropped below the target for the 7 th time in 2015/16 with the target of 75% not being achieved last month Green 3 performance was below the 75% target this month. Green 4 % of Green 4 ambulance calls resulting in a telephone assessment within 60 minutes. Target of 75% of Green 4 incidents receiving a telephone assessment within 60 minutes. Red 19 performance remains below target for the Green 6 th time 4 performance in 2015/16 was with the below target the of 75% 95% target not being this achieved month. last month Integrated Performance Report 11
Performance Description Trend Analysis Urgent % of Urgent ambulance Calls resulting in a response arriving within the agreed pickup time There is a target of meeting the criteria in 75% of cases Hospital Handover & Turnaround A 15 minute arrival to handover (where the patient is handed over to the receiving hospital or facility) and a 15 minute Handover to Clear (where the crews are able to clean the vehicle and make ready for the next incident). Turnaround time is total AtoH & HtoC The AtoH and HtoC times in April exceed the target time of 15minutes. The total turnaround time also exceeds the 30minute target Post Handover Breaches Measures as above where the Handover to Clear has exceeded 30 & 60 minutes >30 & >60 minute delays for June Integrated Performance Report 12
Performance Year to Date Red performance by CCG (June 16) National Targets Red 1 = 75%, Red 2 = 75%, Red 19 = 95% Integrated Performance Report 13
Resourcing Monthly Total Month Coverage (Rostered) Planned Overtime Worked Planned OT worked in A&E Abstractions SICKNESS BY FUNCTION Target Apr-16 May-16 Jun-16 A&E Total PLEASE NOTE: This incs. all LT 3.21% 3.23 3.95 3.17 locality sickness & the absence of A&E ST 1.79% 3.43 2.63 2.48 staff who do not fall under the 3 localities Total 5.00% 6.66 6.58 5.65 LT 3.10 3.40 3.77 EOC Total ST 3.43 2.76 2.37 Total 5.00% 6.53 6.16 6.14 LT 4.06 4.09 5.59 NES Total ST 2.64 2.02 2.69 Total 5.00% 6.70 6.11 8.28 LT 1.52 8.85 8.86 Primary Care Total ST 3.49 0.89 1.94 Total 5.00% 5.01 9.74 10.80 LT 1.94 3.61 2.07 Operations Support, Air Operations & ST 3.07 1.85 1.66 Special Operations Total Total 5.00% 5.01 5.46 3.73 LT 1.18 0.94 1.52 Shared Support ST 0.72 1.42 2.02 Total 5.00% 1.90 2.36 3.54 LT 3.12 3.74 3.37 Trust Total ST 3.18 2.47 2.42 Total 5.00% 6.30 6.21 5.79 June 16 37483 Vacancies VACANCIES This graph show the Trust's current month's vacancy rates by function. It should also be noted that Locality vacancies in this graph cover all A&E staff. The known challenges of recruiting into Hertfordshire and large swathes of Essex are reflected in these figures. Additionally it is hoped that future recruitment to the Associate & Intermediate Practitioner roles will start to address vacancies in the non registered staff element of the skills mix in A&E Integrated Performance Report 14
RED Tail Breaches Red Breaches Red Tail breaches There has been a drop in >30 & >60 minute delays for November compared to the previous 2 months Integrated Performance Report 15
Green Tail Breaches Green Breaches Green tail breaches There has been a drop in >30 & >60 minute delays for November compared to the previous 2 months Integrated Performance Report 16
PTS Description Trend Analysis Arrivals (%) Outward Collection (%) Travel Time (IN/OUT) % patients arriving any time prior to appointment and up to 30 minutes late The target percentage is 95% % of patients collected within 60 minutes of scheduled made ready time The target percentage is 95% Time on vehicle should not exceed 90 minutes The target percentage is 95% The data provides an overall view of PTS performance however has not been broken down by contract. PTS have 30 contracts all with different KPI s, some having no KPI s at all. Whilst some KPI s will be common, such as vehicle cleanliness and access to hand gel, others will be contract dependent. For example West Essex contract arrival standard is 90% of patients shall arrive on time or up to 60 minutes before the appointment. The Suffolk contract states 90% of patients to arrive between 60 minutes before and 10 minutes before the appointment time. North Essex is 85% of patients on time or up to 60 minutes before. Gt Yarmouth and Waveney require 98% to arrive at or prior to their appointment time. As such it is impossible to determine a single reporting KPI on the Trust PTS performance Integrated Performance Report 17
Workforce Description Trend Turnover Rate (%) TURNOVER Turnover is monitored on a monthly basis using the principle described below. The Trust rolling 12 month turnover is calculated over a 12 month rolling period and displays the number of staff leaving the employ of the trust as a percentage of all staff. it should be noted that staff leaving via a TUPE are not included for the purposes of calculating turnover DEFINITIONS: Employee turnover refers to the proportion of employees who leave an organisation over a set period (often on a year-on-year basis), expressed as a percentage of total workforce numbers. CIPD.(2014). Employee turnover and retention. Available: https://www.cipd.co.uk/hrresources/factsheets/employee-turnoverretention.aspx. Last accessed 20th May 2015. 6.26% YTD Sickness Trust Sickness (%) SICKNESS The Trust undertakes a constructive and consistent focus on managing sickness absence, both long and short term. This is supported by comprehensive questioning from Day One* clinicians towards the staff who call in and a targeted approach from PAM* in conjunction with line managers and HR in relation to chronic sickness absence cases. *PAM is the Trust's Occupational Health Service provider, part of this service is the "Day ONE" 40.66% PDR Rate ADR Rate (%) APPRAISAL & DEVELOPMENT REVIEW (ADR) EEAST's Appraisal & Development Review (ADR) process is an important workforce tool which allows for meaningful dialogue about work performance, development and career aspirations between an individual and their manager. The ADR takes place over and 12 month cycle individual to each individual member of staff, therefore compliance is recorded over a rolling 12 months. The graph shows the % of staff compliant at the month end. The end of year Target is 95% Integrated Performance Report 18
Statutory/Mandatory Training There has been a drop in >30 & >60 minute delays for November compared to the previous 2 months Integrated Performance Report 19
Finance There has been a drop in >30 & >60 minute delays for November compared to the previous 2 months Integrated Performance Report 20
Ambulance Benchmarking CQI Data There has been a drop in >30 & >60 minute delays for November compared to the previous 2 months Integrated Performance Report 21
Trust Benchmarking Performance Red1 Trust comparison Last 4 weeks Red2 Trust comparison Last 4 weeks Red19 Trust comparison Last 4 weeks Integrated Performance Report 22