Integrated Performance Report - September 2024
Meeting: Trust Board – Public Meeting
Date: 11 September 2024
Report Title: Integrated Performance Report
Agenda Item: PUB24/09/2.1
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:
- 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:
- 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: Failure to achieve continuous quality improvements and high-quality care delivery
- SR4: Failure to deliver an efficient, effective and economic service
- SR5: If we do not clearly define our strategic plans, we will not have the agility to deliver the suite of improvements needed
- SR6: Ability to ensure sufficient capacity and capability to ensure sustainable change
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 July 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.
Options:
Note the areas of progress.
Consider critical issue areas highlighted to gain assurance on the plans for mitigation.
Executive Summary:
The Integrated Performance Report (IPR) this month comprises of July 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.
Progress against these assumptions can be seen in the Key Assumption section of Appendix 2 – OPIP Performance Dashboard. This newly developed dashboard also details the first two-month’s 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 Operations front-line and EOC performance and not organisation-wide.
Our performance improvement for 2024/25 is also supported by the Trust 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. The People Committee IPR is now live, with the next focus being Finance and Sustainability Committee to have its own IPR.
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 | Areas of positive performance | Areas of focus |
|---|---|---|
| Goal 1 - Be an Exceptional Place to Work, Volunteer and Learn | People metrics continue to show a sustainable and improved position in most areas. Vacancy rates continue to reduce with a further significant positive shift in July of 7.18%, under the annual target of 10%. Overall sickness performance remains better than target and remained in common cause. Staff turnover continues to be better than target for 13 consecutive months at 8.23% with a Trust target of 10%. Establishment remains static since the previous months drop but this is as anticipated. Resus training compliance remains positive and above target. The number of suspensions has decreased to 19 in July. The Average Days Suspended also decreased to 154 days compared to 183 in April. Declared Disability and BME staff percentages continue an upwards trajectory. | Appraisal compliance remains low and decreased to 60% in July some way from the 80% target. This is a MUST DO for CQC. Statutory and mandatory training remained at 84% for the second month in a row, 85% is the target. Employee Relations Case volume increased showing special cause concern, The proportion of ER cases closed within recommended timescales is at 76% against a target of 70%. |
| Goal 2 - Providing Outstanding Care and Performance to Our Patients | ROSC for all patients fell by 1.1% to 29.6% but remains above target. ROSC – Utstein sits at 55.4% which is above target, having increased from 50% last month. Level 2 (adults and children) is 95% and is consistently exceeding the 90% compliance target.Average call pickup times decreased in July to 9.18 seconds compared to 14.42 seconds in June. This was alongside a decrease in call volumes from 2946 to 2875 average daily contacts.OOS as a %age of shift hours is now common cause variation at has improved slightly and is 7.34% for July 2024. This is the lowest it has been in the last 12 months.Safeguarding training compliance is at target of 90% for adults. | July 2024 saw an increase in complaints received (from 90 in June to 103 in July). It is noted that both of these numbers are based on the new definition of complaints where concerns are included. Compliance with timescales for complaint responses (which also includes concerns now) has decreased to 59% from 63% last month. Safeguarding training compliance is at 89% for children. Against a target of 90%. Mobilisation times for C1, C2 and C3 continue to show special cause concern, with C2 now sitting 10 seconds higher than it did a month ago. Hear-and-Treat, including Access to the Stack and Urgent Care Hubs, continues to decrease at 9.79% in July. Performance for key categories such as C2 on scene times remain a concern when compared to other Ambulance Trusts. |
| Goal 3 - Be Excellent Collaborators and Innovators as System Partners | In July CFRs attended 2037 jobs for EEAST and arrived first on scene at 88.6% of the calls they attended (51.2% for C1 activity). | Volunteer hours remain below the mean and this represents a probable underutilisation. Community First Responder volunteer daily hours within the Trust has seen a decline for the fourth month in a row having been 772 and now fallen to 677. While PTS costs remain above budget, there is a noticeably better position than last year. |
| Goal 4 - Be an Environmentally and Financially Sustainable Organisation | The plan for a surplus of £1.32m at Month 4 was exceeded by £0.25m. Capital spend at the end of July 2024 is £2.3m. Forecast capital spend at the end of March 2025 is £27.5m. The invoices paid within 30 days remains below target. Data produced by NHS England put NHS Providers on average around 90%, which we are almost in line with; we have a mean of 88.4% for this metric. The number of vehicles off road (VOR) has shown a decrease from 28.7% to 26.5%. | Cash balances of £16.7m are £12.7m below plan. The percentage throughput of Make Ready Vehicles has fallen since last month and now sits at a 2 year low at 38.53% |
