north east ambulance service nhs foundation trust ... · sep 2013 oct 2013 nov 2013 dec 2013 jan...

8. Model Employer

7. Financial Summary

6. User Experience

5. Service Line Summary

4. Safety and Risk Management

3. Clinical Effectiveness

2. National Indicators

1. Exceptions

Contents Key & Early Warning Metrics Jul 2014 Aug 2014 Sep 2014 +/- Prev Month

Red 8 performance (%) 72.86 % 76.00 % 75.40 %

Red 19 performance (%) 94.69 % 95.78 % 95.05 %

Re-contact rate following discharge of care - on scene 4.76 % 5.24 % 5.43 %

Number of duty of candour referrals 2 0 0

Number of whistleblower referrals 1 0 0

Never Events 0 0 0

Quality Impact Assessments outstanding 3 0 1

New Complaints Received 71 48 61

Near Misses - Clinical 4 4 8

Serious Incidents 2 0 7

North East Ambulance Service NHS Foundation Trust: Integrated Quality & Performance Report

Financial Year: 2014/2015v1

23 Oct 2014 18:20 of 17Report Period: October Data Period:September

Page No/Name Indicator Current Situation Risk/Compliance Impact Comments/Actions Failure/Likely To Fail Review Date

Key & Early Warning Metrics

Serious Incidents 7 in September Litigation / financial impact There were seven Serious Incidents during September; five were in relation to an incorrect triage/delayed ambulance response and the other two relate to a data protection breach that has been identified and reported to the ICO.

The rate of SIs per 1000 calls continues to remain low and is constantly monitored.

Nov IQPR - Oct Data


Red Activity YTD is 9.16% above 2013/14

Patient safety and experiencePerformance - Quality

The year to date position for Red incidents shows that there has been an increase of 9.16% above the same period 2013/14. This leads to increased pressure for 8 minute responses.

A review of the drivers behind the increased Red incidents is in progress.

Nov IQPR - Oct Data


Survival to Discharge

3.9% in June 2014 Patient safety and experienceClinical Quality outcomes

Performance is below the locally agreed target of 10%. However, to date, the outcomes of 14 patients (35% of those identified) have not been reported to NEAS from the relevant acute providers and they are not reflected in these figures.

This has been raised with commissioners to apply pressure to acute providers to return data on all patients.

Nov IQPR - Jul Data


Survival to Discharge [UTSTEIN]


Performance is below the locally agreed target of 35%. However, to date, the outcomes of 14 patients (35% of those identified) have not been reported to NEAS from the relevant acute providers and they are not reflected in these figures.

This has been raised with commissioners to apply pressure to acute providers to return data on all patients.

Nov IQPR - Jul Data


FAST positive patients arriving at stroke centre within 60 minutes


Performance is below the locally agreed trajectory of 80%, though remains above the national average.

A clinical review of the incidents included within the sample is carried out and, to date, all patients that meet the full criteria for thrombolysis continue to be transported to a HASU within the locally agreed timeframe for treatment.

Nov IQPR - Jul Data

5. Service Lines 999 Call Answering Performance

88.18% in September Patient safety and experiencePerformance - Quality

During September, there was a deterioration in 999 call performance to 88.18%. There has been higher than expected attrition in the Contact Centre with recruitment rates lower than planned.

An update to the Contact Centre action plan will be shared with the Executive Team by the end of October and will include trajectories for recruitment and performance.

Nov IQPR - Oct Data

1. Exceptions



5. Service Lines 111 Call Answering Performance


During September, there was a deterioration in 11 call performance to 89.44%. There has been higher than expected attrition in the Contact Centre with recruitment rates lower than planned.

An update to the Contact Centre action plan will be shared with the Executive Team by the end of October and will include trajectories for recruitment and performance.

Nov IQPR - Oct Data

5. Service Lines 111 Warm Transfers


Warm Transfer performance is above the amber threshold of 94%, but is below the contract standard of 98%.

The formal contract management process has been implemented with our sub-contractors to improve performance in this area.

Nov IQPR - Oct Data

5. Service Lines 111 Call Backs within 10 minutes


This indicator has continually been below the 100% target. Call backs increased by 40% in September with 665 required.

The formal contract management process has been implemented with our sub-contractors to improve performance in this area.

Nov IQPR - Oct Data

5. Service Lines 111 calls transferred to 999

15.23% in September Performance - Quality This indicator continues to be above the contract standard of less than 10%. This is discussed and monitored through the contract meetings with commissioners on a monthly basis.

A sample of all calls transferred to 999 are audited for appropriateness.

Nov IQPR - Oct Data

5. Service Lines 111 calls referred to ED

6.95% in September Performance - Quality This indicator continues to fluctuate above the contract standard of less than 5%. This is discussed and monitored through the contract meetings with commissioners on a monthly basis.

A sample of all calls referred to ED are audited for appropriateness.

Nov IQPR - Oct Data

8. Model Employer Sickness absence 6.46% in September Resource / Financial Implications.QRP - Outcome 14 - Supporting StaffOperational Performance (Category A Red 8-Minute)

Sickness absence decreased during September, though remained above 5% at 6.46%. A Sickness Absence Management System has been in place from 1st April 2014 and will allow for trends in absence to be monitored. Managers have access to reports on the system to assist them in understanding the sickness levels within their areas.

Sickness absence impacts upon the Trust capacity and the delivery of associated CIP schemes.

Nov IQPR - Oct Data




Red Activity by Year Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar2014 14,901 15,238 14,450 15,583 14,561 15,378

2013 13,714 14,086 13,262 14,181 13,836 13,473 14,441 14,099 15,030 14,457 13,519 14,837

Variance 1,187 1,152 1,188 1,402 725 1,905 - - - - - -



Apr 2014 May 2014 Jun 2014 +/- Prev Month

NEAS Trajectory

Var against

Traj

Nat Avg *

Trend

Cardiac Arrest: Patients with out of hospital cardiac arrest (no pulse).

Return of Spontaneous Circulation (ROSC) – palpable pulse on arrival at hospital following resuscitation attempt 29.0 % 23.4 % 33.9 % 30.0% 3.9 % 25.3%

Survival to Discharge % 3.7 % 2.5 % 3.9 % 10.0% -6.1 % 7.8%

Return of Spontaneous Circulation (ROSC) – palpable pulse on arrival at hospital following resuscitation attempt [UTSTEIN] 64.3 % 43.8 % 83.3 % 65.0% 18.3 % 46.6%

Survival to Discharge-Utstein % 25.0 % 13.3 % 25.0 % 35.0% -10.0 % 25.5%

ST Elevated MIs (Heart Attacks): Patients presenting with signs/symptoms of a suspected heart attack.

Care Bundle (Aspirin+GTN+Two Pain Scores+Analgesia given) 95.1 % 97.1 % 93.4 % 90.0% 3.4 % 81.1%

PPCI compliance: The number of patients receiving PPCI treatment within 150 minutes 87.7 % 89.2 % 89.9 % 95.0% -5.1 % 86.1%

Stroke: Patients presenting with signs/symptoms of stroke.

FAST positive patients (assessed face to face) potentially eligible for stroke thrombolysis within agreed local guidelines arriving at hospital with a hyperacute stroke centre within 60 minutes of call connect

82.3 % 73.8 % 74.3 % 80.0% -5.7 % 61.7%

Care Bundle (FAST + BM + BP recorded) 99.6 % 98.9 % 98.3 % 98.0% 0.3 % 97.1%

National Indicators - Continued

All patients who had resuscitation (Advanced or Basic Life Support) commenced/continued by ambulance service following an out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was VF or VT.

* NB. National averages displayed are one month behind NEAS performance data



3. Clinical Effectiveness

Safeguarding referral rate per 1000 calls answered (999 emergency, Urgent, PTS and 111) Jul 2014 Aug 2014 Sep 2014 YTD Prv YTD

Adult Referrals - NEAS (Trustwide) 4.10 4.57 4.08 4.13 3.50

Child Referrals - NEAS (Trustwide) 1.42 1.62 1.42 1.60 1.42

Total 5.52 6.19 5.50 5.74 4.92



Serious Incidents Jul 2014 Aug 2014 Sep 2014 YTD Prv YTD

Serious Incidents 2 0 7 17 139

Risks & Claims Jul 2014 Aug 2014 Sep 2014 YTD Prv YTD

Clinical Negligence Claim 1 0 0 4 4

Public Liability Claim 0 0 0 1 2

Employer Liability Claim 4 7 1 18 25

Near Misses - Clinical 4 4 8 42 54

Near Misses - Non Clinical 14 4 5 56 37

Never Events 0 0 0 0 -

4. Safety and Risk Management

Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 YTD Prv YTD

Handover Delays 1 Hours 43 93 85 110 179 153 119 112 86 69 87 63 94 511 1493

Handover Delays 2 Hours 6 10 6 26 23 27 7 16 9 4 5 2 8 44 167

NB. 1 hour delays do not include delays over 2 hours.



Emergency Care Sep 2013 Oct 2013 Nov 2013 Dec 2013 Jan 2014 Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014 YTD

Total Activity 31,039 33,357 32,447 34,515 33,421 30,668 33,360 31,765 33,470 32,077 32,827 31,169 31,483 421,598

Total Contract Activity 29,179 32,060 31,102 33,600 31,051 28,186 30,458 31,989 32,670 31,600 33,190 32,146 31,359 408,590

Variance with Contract 1,860 1,297 1,345 915 2,370 2,482 2,902 -224 800 477 -363 -977 124 13,008

Total Activity(Inc OOA) 31,118 33,434 32,526 34,610 33,522 30,762 33,470 31,765 33,470 32,077 32,827 31,169 31,483 422,233

Total Forecast Activity 29,965 31,697 30,955 33,914 31,595 30,738 33,300 32,160 32,643 31,220 34,010 32,348 31,378 415,923

Variance with Forecast 1,074 1,660 1,492 601 1,826 -70 60 -395 827 857 -1,183 -1,179 105 5,675

Total Outturn(Last Year) 29,641 31,339 30,618 34,145 31,923 27,991 31,230 31,811 32,291 30,886 33,657 31,974 31,039 408,545

5. Service Lines



Service Lines - Continued

Aug 2014 Sep 2014 YTDActual (£'000)

Plan (£'000)

Actual (£'000)

Plan (£'000)

Actual (£'000)

Commercial Business Services Income Generated (Monthly)

£67,723 £77,454 £91,022 £128,506 £539,869

Commercial Business Services Surplus Generated (YTD)

£81,369 £46,115 £90,393 £89,571

Sep 2013

Oct 2013

Nov 2013

Dec 2013

Jan 2014

Feb 2014

Mar 2014

Apr 2014

May 2014

Jun 2014

Jul 2014 Aug 2014

Sep 2014

+/- Prev

Month

Ambulance calls closed with telephone advice 4.22% 3.99% 4.18% 4.84% 4.32% 4.58% 5.46% 5.40% 5.63% 5.25% 5.73% 6.10% 5.58%

Call Abandonment Rate 1.24% 1.25% 1.19% 2.49% 1.20% 1.62% 0.67% 0.35% 0.96% 1.92% 5.44% 1.99% 2.25%

Re-contact rate following discharge of care - on scene 4.24% 4.74% 4.69% 5.24% 5.81% 5.16% 5.05% 5.16% 4.89% 4.57% 4.76% 5.24% 5.43%

Re-Contact Rate following discharge of care by Telephone Advice 16.27% 15.89% 16.51% 13.11% 15.76% 13.71% 13.98% 16.53% 15.01% 14.66% 12.89% 14.95% 14.39%

Time to answer calls, 95th percentile (secs) 42 42 42 41 41 42 42 42 42 45 66 46 61

Time to answer calls, 99th percentile (secs) 42 55 71 41 41 85 79 85 84 98 119 100 111

Time to treatment, median (Seconds) 348 348 352 381 365 378 383 385 361 364 394 367 0

Ambulance calls managed without transport to A&E 31.11% 30.19% 30.71% 31.78% 30.57% 31.28% 31.18% 31.05% 31.18% 31.54% 32.25% 30.62% 32.87%



Service Lines - Continued

Feb 2014 Mar 2014 Apr 2014 May 2014 Jun 2014 Jul 2014 Aug 2014 Sep 2014

Hosp Times (mins) Avg 15-30 30+ Avg 15-30 30+ Avg 15-30 30+ Avg 15-30 30+ Avg 15-30 30+ Avg 15-30 30+ Avg 15-30 30+ Avg 15-30 30+

Handover 9.1 2,821 679 8.8 2,916 661 8.5 2,507 485 8.5 2,538 468 8.3 2,302 375 8.4 2,470 439 8.3 2,422 402 8.5 2,452 491

Post Handover 5.5 1,982 142 5.4 1,941 132 5.8 2,221 184 5.8 2,245 177 5.8 2,200 190 6.4 2,718 250 5.8 2,143 192 5.8 2,267 215



Service Lines Continued - NHS 111



Service Lines Continued - PTS



6. User Experience

Jul 2014 Aug 2014 Sep 2014 YTD Prev YTD

New Complaints received requiring a written response, rate per 1000 calls answered 0.53 0.38 0.46 0.42 0.36

Jul 2014 Aug 2014 Sep 2014 YTD Prv YTD

Referral to Ombudsman 0 1 0 6 7

Jul 2014 Aug 2014 Sep 2014 YTD Prev YTD

Appreciation Received rate per 1000 calls answered 0.30 0.29 0.27 0.29 0.31

Jul 2014 Aug 2014 Sep 2014 YTD Prv YTDComplaints with 2 or more response extensions 0 0 0 3 48

Friends And Family Test Score YTD

Emergency Care Service 74

Patient Transport Service 69

*Contact Centre refers to NHS 111 surverys only. Rollout of patient surveys to the whole of the Contact Centre will take place during 2014.

1st Bi-Annual

Contact Centre* 44



7. Financial Summary

Continuity of Service Risk Rating 4.0



Financial Summary-Cost Improvement Plan September 2014

YTD Planned Savings (£)

YTD Actual Savings (£) Variance YTD (£) Variance YTD (%) Target 2014-2015 (£) % Annual Target

Achieved

Emergency Care Services 1,477,956 1,391,441 -86,515 -5.9 % 3,219,498 43.2 %

PTS 325,789 403,714 77,925 23.9 % 779,167 51.8 %

Contact Centre 277,782 190,743 -87,039 -31.3 % 560,088 34.1 %

Commercial Services 32,513 61,557 29,044 89.3 % 92,241 66.7 %

Total Service Lines 2,114,040 2,047,455 -66,585 -3.2 % 4,650,994 44.0 %

Fleet 107,064 82,512 -24,552 -22.9 % 226,610 36.4 %

Operations Directorate (Ops Mgmt & RSD)

15,130 40,087 24,957 165.0 % 30,259 132.5 %

Chief Executive 25,317 36,504 11,187 44.2 % 50,633 72.1 %

Clinical Care & Patient Safety 31,587 16,483 -15,104 -47.8 % 68,011 24.2 %

Finance & Resources 177,699 454,187 276,488 155.6 % 371,139 122.4 %

Strategy Directorate 79,786 97,127 17,341 21.7 % 225,789 43.0 %

Workforce & OD 63,750 47,873 -15,877 -24.9 % 192,879 24.8 %

Total Support Departments 500,333 774,773 274,440 54.9 % 1,165,320 66.5 %

Overall Savings 2,614,373 2,822,228 207,855 8.0 % 5,816,314 48.5 %



Jul 2014 Aug 2014 Sep 2014

% BME Staff 1.52% 1.78% 1.35%

% Registered Disabled staff 4.90% 4.93% 5.96%

Jul 2014 Aug 2014 Sep 2014 YTD

Absence % 7.00 % 6.60 % 6.46 % 6.57 %

Total work days available 65,487 65,866 63,794 388,437

Total Work Days Lost 4,584 4,348 4,118 25,510

Sickness value (£) 318,682 - - 1,220,332

Occupied rate 89.09 % 89.20 % 90.16 % -

Establishment 2,374 2,372 2,373 -

Staff in post 2,115 2,116 2,140 -

Headcount of Leavers 20 6 13 113

Staff Joining Trust 28 20 7 113

8. Model Employer



Indicator Definitions and TargetsSection 2 National indicatorsCategory A (Red 1 and Red 2) 8 – Life threatening emergency calls, presenting conditions which may be immediately life threatening and should receive an emergency response within 8 minutes irrespective of location in 75% of cases.Category A (Red) 19 – Life threatening emergency calls, presenting conditions which require a fully equipped ambulance vehicle to attend the incident, must have an ambulance vehicle arrive within 19 minutes in 95% of cases.

Section 5 Service LinesA&E Calls – Emergency calls to NEAS via 999 should be answered within 5 seconds in 95% of cases.111 Calls – Non-emergency calls to NEAS via 111 should be answered within 80 seconds in 95% of cases.PTS Calls – Patient Transport Service calls to NEAS should be answered within 30 seconds in 90% of cases.Average Handover & Post Handover Times - This is measured in minutesAbandonment Rate – The percentage of emergency and urgent calls abandoned before the call was answered.

Section 7 Financial SummaryEBITDA – Earnings before Interest, Tax, Depreciation and Amortisation, provides operational performance of the organisation, which allows the comparison between planned and actual position of the organisation. It also enables a comparison between other organisations.Income and Expenditure Surplus Margin – Surplus over Income, the surplus margin indicates how well an organisation controls its costs and/or the ability to generate additional income. Liquidity Ratio – Measures the organisations ability to pay off its short term debts, a higher ratio is usually viewed favourably

Section 8 Model EmployerAbsence% – This is the Trust wide percentage sickness absence and is calculated using the number of sick days lost and the number of available days.Total Work Days Available – The number of days available to workTotal Work Days Lost – Number of days lost due to sickness absenceSickness Value (£) – The amount of pounds lost due to sicknessOccupied Rate – this is the staff in post divided by the establishment (WTE)Establishment – Establishment is the funded number of position within an organisation (WTE)Staff in Post – Staff in post is the number of staff employed by the organisation (WTE)Headcount of Leavers – headcount of staff leaving the trustStaff Joining the Trust – headcount of staff joining the trust



north east ambulance service nhs foundation trust ... · sep 2013 oct 2013 nov 2013 dec 2013 jan...

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