Integrated Performance Report - July 2024
Meeting: Trust Board – Public Meeting
Date: 10 July 2024
Report Title: Integrated Performance Report and OPIP
Agenda Item: PUB24/07/2.1
Author: Executive Leadership Team; Darren Gray – Deputy Director of Performance and Programmes
Lead Director: Jo Cripps, Interim Director of Corporate Affairs and Performance
Purpose: Discussion/review
Assurance: Reasonable
Link to CQC domain:
- Caring
- Responsive
- Effective
- Well Led
- Safe
Link to strategic objective(s):
- Be an exceptional place to work, volunteer and learn
- Provide outstanding quality of care and performance
- Be excellent collaborators and innovators as system partners
- Be an environmentally and financially sustainable organisation
Link to strategic risk(s):
- SR1a: If we do not ensure our people are safe and their wellbeing prioritised, there is a risk that we will be unable to attract, retain and keep all our people safe and well
- SR1b: If we do not ensure our leaders are developed and equipped, there is a risk that we will not be able to change our culture, and value, support, develop and grow our people
- SR2: If we do not deliver operational and clinical standards then there is a risk of poor patient outcomes and experience
- SR3: If we do not ensure we have the ability to plan, influence and deliver across our systems to secure change, we will not be able to meet the needs of our public and communities
- SR4: If we do not resolve long standing organisational inefficiencies we will be unable to deliver an effective, sustainable, value for money service to our public
- SR5: If we do not clearly define our strategic plans we will not have the agility to deliver the suite of improvements needed
- SR6: If we do not deliver sustainable regulatory compliance and develop positive relationships, we will have limited ability to deliver our strategy.
Equality impact assessment: No negative impact identified
Previously considered by: Executive Leadership Team
Recommendation: The Board is asked to note the areas of improvement and decline and seek assurance on plans to improve.
Purpose: The purpose of this paper is to provide the Integrated Performance Report with May 2024 data. The paper enables the Board to discuss the performance areas identified and the actions offered to gain assurance or sufficient oversight.
Introduction/background
The Integrated Performance Report (IPR) consists of core metrics to monitor the performance across all main functions of the organisation in the pursuit of achievement of our strategic goals. Each of the relevant Executive Directors will provide a short overview of the key critical areas outlined in the section below and in the first executive summary page of the IPR document.
Executive summary
The IPR this month comprises of May 2024 data across the key areas of the Trust. The Organisational Improvement Programme OPIP is now revised and in place from May 2025, with supportive governance giving oversight of delivery and assurance to committees and the Trust Board. There are four main areas of focus for improvement:
- Job cycle time (time on scene and time at hospital)
- Patient facing staff hours (PFSH performance), this includes operational sickness for both operations front line and the EOCs. As well as other keys areas where non-productive hours can be reduced.
- Vehicle availability (VOR and crews without vehicles)
- Hear and treat levels (CAS, Access to the Stack and making bets use of urgent care hubs in partnership with ICS)
The Trust’s success in the delivery of these performance improvements is dependent on 10 key assumptions that are embedded in our performance forecast for 2024-25. These are as follows:
Demand:
- Face-to-face responses will experience +3.10% growth over the next 2 years.
Capacity:
- The clinical workforce plan v0.10 (low road) is delivered at month end. Year-end total: 3,690, A&e: 3,589 (work effective 3,591).
- Staff take on average 12 weeks from starting to become work-effective.
- Our weekly abstractions average 42.5% gross / 37.0% net.
- Turnover must not exceed 10.5%
- Private ambulance provision provides: Q1&2 6,762 per week (tender 1&2) and Q3&4: 3,220 per week (tender 1 only).
- Operational overtime will average ~6,167 hours/wk.
Efficiency:
- Time lost to hospital handover delays does not exceed 2,000 hours per week over 15 minutes.
- Our total job cycle time (JCT) remains <02:19:20 of which on scene times average 00:41:00 conveyed / 00:67:00 non-conveyed.
- VOR is measured and managed.
Progress against these assumptions can be seen in the Key Assumption section of the attached Appendix 2 – OPIP Performance Dashboard. This new developed dashboard also details the first two months performance for the OPIP programme across all key indicators used to measure and monitor progress.
It is important to note that the dashboard is a live document and refreshed regularly. It should also be noted the data relates to Operation front-line and EOC performance and not organisation-wide.
Our performance improvement for 2024-25 is also supported by the Trust’s Integrated Performance Report (Appendix 1) with some modifications to support better scrutiny and oversight now implemented. This includes:
- Newly colour-coded assurance matrix at the beginning of each section. This enables the easy identification of key areas that should be focussed on. And areas where performance is positive.
- Metrics that are no longer appropriate are removed with new more appropriate metrics replacing them.
- Additional metrics that support better oversight and scrutiny.
- Process limits are refreshed, as normal annually. This may see sustained linear performance come out of special cause improvement as the limits of performance have narrowed alongside the indicator being above or not hitting target.
Work continues to create IPRs for each of the governance Committees in the Trust. Initial work to aggregate out relevant data from the Trust IPR is complete and this will enable conversations with Committee Chairs to understand additional data requirements of the Committee when considering performance oversight.
Looking forward into 2024-25 and focusing on the Trust’s four goals, the key high-level areas of positive performance and areas the Trust is or should focus on are below. This should be considered in conjunction with the more detailed executive summary and IPR in the attached Appendix 1, as follows
Goal 1 - Be an Exceptional Place to Work, Volunteer and Learn
Areas of positive performance:
People metrics continue to show a sustainable and improved position in most areas.
- Vacancy rates continue to reduce incrementally with a further significant positive shift in May.
- Overall sickness performance remains better than target.
- Staff turnover continues to be better than target for 13 consecutive months.
Establishment remains static since the previous months drop but this is as anticipated.
Employee relations cases closed within recommended timescales have improved to 85% from a low of 58% two months ago. Resus training compliance remains positive and above target.
Areas of focus:
Employee relations performance remains static for May. Number of days staff are suspended has increased significantly.
While improving three months in a row to 64%, appraisal compliance remains low and some way from the 80% target. This is a MUST DO for CQC.
EOC sickness remains above target in most areas and this may continue to impact ability to deliver some aspects of the Trust OPIP. Statutory and mandatory training compliance is now
IG training compliance remains well below target now at 74% against a target of 85%. While appraisal rates are recovering incrementally, overall performance remains well below target.
Goal 2 - Providing Outstanding Care and Performance to Our Patients
Areas of positive performance:
Overall clinical indicators show the Trust is performing against expectations and is comparable nationally. Being the best among Trusts in some key areas, eg. Cardiac Arrest outcomes. There is a notable decrease in complaints in May 2024. With compliments increasing. Uniform audit and Vehicle cleaning schedule remains 1% above target. Bare below the elbow compliance has also improved and is now at 90%. Overall operational performance remains sustainable with less fluctuation when compared to previous years. Call pickup performance remains positive. But it should be noted that the increase in demand has led to slightly worse performance in May. Overall, the Trust’s use of electricity for 2023-24 in its buildings reduced when compared to previous years.
Areas of focus:
Safeguarding training compliance has dipped below target for the second month. Premises IPC, and Vehicle audits continue to be below target, with Premises IPC being 9% below the April levels. Demand for May has increased when considering all categories of daily contacts and daily average calls. The number of incidents continues to increase across C1 to C4 categories in May. Hear and treat percentages have reduced to a 12-month low of 8.70%. C3 and C4 response times are seeing a noticeable increase over the last 3-months. Overall response times remain sustainable but not remarkable. Mobilisation times for C1 to C3 remain above target. Performance for key categories such as C2 on scene times remain a concern when compared to other Ambulance Trusts. Overall the Trusts use of gas for 2023-24 in its buildings increased when compared to previous years.
Goal 3 - Be Excellent Collaborators and Innovators as System Partners
Areas of positive performance:
Unscheduled Care Hubs call acceptance rates remain high but have dipped for the first month. The Trust Blue Light Collaboration, with the RAF supporting 67 shifts in May and Fire with 15 live, is supporting the Trust to meet patient needs in key areas.
Areas of focus:
Volunteer hours remain below the mean and an underutilised. Call pass through to the unscheduled care hubs has reduced significantly in recent months. While PTS costs remain above budget, there is a noticeably better position than last year.
Goal 4 - Be an Environmentally and Financially Sustainable Organisation
Areas of positive performance:
The plan for a surplus of £0.7m at Month 2 was exceeded by £0.4m. The capital plan 2023-24 was delivered against forecast. The capital plan for 2024-25 is set and is forecast to deliver against the plan. Consumption of fuel has reduced from April levels to 4.4 average miles per litre in May. Overall building carbon footprint is reduced by 2.9% on the previous year.
Areas of focus:
Month 2 QCIP savings remain mainly non-recurrent and there is a risk that the Trust target of £16.2 million will be challenging to deliver recurrently. Cash balances of £14.1m are £17.5m below plan. New fleet delivery continues to be impacted by snagging in new vehicles and this is impacting performance.
Summary
The Board is asked to note the areas of progress and consider the critical issues highlighted to gain assurance on the plans for mitigation.
Appendix 1 – Integrated Performance Report
