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Integrated Performance Report

Meeting: Trust Board – Public Meeting

Date: 08.05.2024

Report Title: Integrated Performance Report

Agenda Item: PUB24/05/2.1

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

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 on 02.04.2024

Recommendation: Note the areas of improvement and decline and seek assurance on plans to improve.

Purpose: To provide the Integrated Performance Report with March 2024 data. The paper enables the Board to discuss the performance areas identified and the actions offered to gain assurance or sufficient oversight.

Executive summary

The Integrated Performance Report (IPR) this month comprises of March 2024 data across the key areas of the Trust.

The overall picture of performance, as the Trust closes its fiscal year, continues to show a positive and sustainable change. On balance, performance improvements in most areas remain incremental without any remarkable change, and Trust performance is in a better position when compared to the same time last year. Such improvement can be attributed to the diverse programmes of work over the last year, as well as improved business as usual implementation and clear improvements is staff culture across the Trust. Key to this has been:

  1. EOC transformation programme
  2. Time to lead programme
  3. Operational improvement programme
  4. Culture improvement programme
  5. People improvement programme

However, for key areas of performance, we remain among the lowest performance when compared to ambulance trusts. For example, C2 mean performance, and we continue to be impacted by delays in hospital handovers.
The Trust recognises there is still more opportunity to improve. This additional performance improvement will be delivered through continuous improvement at a local level, and the Trusts planned key transformation programmes, such as OPIP.

The OPIP programme has now completed its 2023/24 work and has set its 2024/25 ambitions and benefits to be realised. This includes a set of clear performance targets with trajectories to monitor progress. The more detailed plans for change will be completed by mid-May for delivery throughout the year. The key areas of focus in the first instance are sickness, on scene time, fleet availability and further improved use of the unscheduled care hubs. The delivery of the OPIP will form the key focus for monitoring the success of all programmes of change and subsequent actions, at all levels of governance.

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 summary in the attached appendix. 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 for 12 months and are approaching target levels.
    • Sickness performance remains at target, with recent negative trends reversed.
    • Staff turnover has continued to reduce for 12 consecutive months, better than target.
  • Areas of focus: Employee relations, while recovering in March, still remain off target and against 12-month trend. While improving in the previous two months, appraisal compliance remains low.

Goal 2 - Providing Outstanding Care and Performance to Our Patients

  • Areas of positive performance: Overall clinical indicators show the Trust is performing against expectations. Compliments remain at highest levels for the year. Safeguarding training compliance remains high and at or above target in all areas. Demand is reducing when considering daily contacts and daily average calls. The number of incidents has increased across C1 to C4 categories. Overall operational performance remains sustainable with less fluctuation when compared to previous years. Call pickup performance remains positive. Most aspects of mandatory and statutory training compliance are above target.
  • Areas of focus: IPC compliance is below target for vehicles and stations. Open safeguarding allegations remain above target. Drug errors while improving in the last month, remain off target. Overall response times remain sustainable but not remarkable. Performance for key categories such as C2 on scene times remain a concern when compared to other Ambulance Trusts. IG training compliance is remains below target with 3 months of static performance.

Goal 3 - Be Excellent Collaborators and Innovators as System Partners

  • Areas of positive performance: Unscheduled care hubs are now in and working with plans to increase call handover. This is a key area of focus in the 2024-25 OPIP. Call acceptance rates continue to increase.
  • Areas of focus: Volunteer hours remain below the mean and an underutilised.

Goal 4 - Be an Environmentally and Financially Sustainable Organisation

  • Areas of positive performance: The Trust delivered exceeded its plan to break even by £0.9 million. The capital plan was delivered against forecast with a focus on estate and fleet replacement. Increases in carbon footprint are aligned to expectations for this time of year.
  • Areas of focus: The QCIP programme has delivered the required saving, however the majority of the saving is non-recurrent because of vacancies across the Trust, and not from greater efficiency or cost reductions. Fleet improvements, while making a difference, have not yet moved the Trust into a more positive overall performance. Our carbon footprint for our buildings is increasing and higher than the same time in the previous year.

In the Executive Summary slide, the executive team have identified nine critical underlying issues, that impact across multiple measures and therefore our ability to deliver on the organisational objectives. These are in the process of being updated and aligned to the OPIP programme for 2024-25. These are as follows:

  1. Recruitment and training capacity to support the expedited workforce plan
  2. Leadership capacity and capability both in terms of delivery against role and the associated impact upon culture
  3. The challenge associated with efficiency and improvement delivery
  4. Risk to delivery of compliance with clinical training whilst balancing the need to maximise patient facing staff hours
  5. The impact of multiple external factors, in particular handover delays, has upon our ability to deliver a safe service
  6. Lack of oversight of critical compliance and priority improvement areas – risk of derailment
  7. Culture across the organisation – inappropriate behaviour and lack of values-based behaviour
  8. Issues with fleet availability impacting operational delivery
  9. Impact of time to lead implementation on BAU function whilst consultation and progression of the programme takes place

Introduction / Background

The Integrated Performance Report 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.

Options

Note the areas of progress. Consider critical issue areas highlighted to gain assurance on the plans for mitigation.

Integrated performance report links

Trust board

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