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Learning from Winter 2023-24

Meeting: Trust Board – Public Meeting

Date: 08.05.2024

Report Title: Learning from Winter 2023-24

Agenda Item: PUB24/05/3.1

Author: Regional Business Continuity and EPRR Compliance Manager

Lead Director: Melissa Dowdeswell, Chief of Clinical Operations

Purpose: Information

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

Link to Strategic Risk:

  • SR1: Failure to deliver a timely service to our patients in line with commissioned national standards, to ensure a safe level of service
  • SR2: Failure to achieve continuous quality improvements and high-quality care delivery
  • SR3: Failure to embed a culture focused on staff safety and wellbeing
  • SR4: Failure to deliver an efficient, effective and economic service
  • SR6: Ability to ensure sufficient capacity and capability to ensure sustainable change

Equality Impact Assessment: No negative impact identified

Purpose: The purpose of this paper is to provide the Trust Board with a detailed report of the learnings from the Winter period 2023-24.

Introduction / Background:

The East of England Ambulance Service Operational Winter Plan was published on 31 October 2023 and covered the period 01 November 2023 through to 31 March 2024 inclusive.

So as to ensure continued improvement, a structured debrief process was undertaken during March 2024. A pre-debrief questionnaire was published for all staff to complete where wishing to do so. The information gathered from the questionnaire was then used to inform structured discussions.

Three debrief sessions were held, one for Corporate Services and the wider organisation, one specifically for the Operations Support Services, and the last for the Clinical Operations Directorate. The last of these debriefs was delivered on 27 March and a summary of initial findings was presented to the Trust Board in April.

This report aims to provide a detailed summary of key themes raised during the debrief sessions and pre-debrief questionnaire, key areas of good practice, lessons identified and recommendations for future planning and delivery of Winter service delivery.

Key Issues / Risks:

  • Planning needs to be started earlier and include the wider organisation, not just operational and clinical delivery departments.
  • Business resilience needs to be more robust and focused on enabling rapid movement of staff to support service delivery where required.
  • Vehicle availability must be prioritised to ensure appropriate resource is available and scalable during challenging periods.

Options:

N/A

Summary:

The structure of the debrief follows three key areas, what went well, what didn’t go so well and what can be done better/differently. Please note, the key findings are not exhaustive but represent the majority of views.

The recommendations are for consideration for future planning and delivery of service during the historically challenging Winter period and are high-level recommendations which will require further detail to be developed to ensure successful implementation of future plans. We will look to put in a multi-directorate Winter Planning Group to take care of working through the actions recommended and draft 2024 Winter Plan.

EEAST Winter Debrief

October 2024 to March 2024

Date of report: 22nd April 2024

Introduction

The Deputy Chief of Clinical Operations, Jon Moore, initiated a structured debrief of the Winter Delivery Plan.

Parameters

The purpose of this debrief was to explore what when well, what didn’t go so well and what can be done in the future to improve the plans for Service Delivery during the, historically, challenging winter months and the two week festive period.

Debrief facilitation team

  • Darya Wotherspoon: Structured Debrief Facilitator – Certified by the College of Policing. EEAST Regional Business Continuity and EPRR Compliance Manager.
  • Matt Barrett: Support to the Facilitator – Regional Business Continuity Advisor
  • Lucy Goddard: Scribe – Business Support Officer to the Deputy Chief of Clinical Operations

There were three debrief sessions undertaken as follows;

  • Support Services – Thursday 21st March 2024
  • Operations Support – Friday 22nd March 2024
  • Clinical Operations – Wednesday 27th March 2024

Executive Summary

The Regional Business Continuity and EPRR Compliance Manager was requested to facilitate the EEAST Winter Service Delivery Structured Debrief. There was a total of 73 participants over the three sessions and a total of 47 responses to the pre-debrief questionnaire.

The detail of this report captures points raised within the debrief process in addition to those captured from the questionnaires.

The following points raised in this summary and in the attached spreadsheet have been drawn from comments made by participants during their feedback and discussion during the structured debrief process.

Areas for development and improvement are highlighted, together with he main areas that went well. Based upon the debrief outcomes a number of recommendations have been made to assist EEAST and its partners to prepare for and coordinate ways to improve service provision during winter months and the festive period.

The themes highlighted in the debrief process have assisted in the compilations of a total of 8 themes around areas for consideration for improvement for the future planning and response to similar events.

Common themes raised, what went well, what didn’t go so well and what can be improved.

  • Local Operations Oversight Cells
  • Wellbeing
  • Access to stack
  • Collaborative working
  • End of shift arrangements
  • RRV back-up trial
  • Management of annual leave
  • Fleet availability.
  • Support from wider Trust/more inclusive planning.
  • Overtime and incentives
  • Communication

Key areas of good practice

Local Operations Oversight Cells

  • LOOCs generally worked very well and helped to keep the system informed and running smoothly. There were some issues getting these established with problems in the recruitment of the individuals to the agreed posts, this should be considered much more in advance. Once established the support and oversight they provided was extremely good and should be considered for permanent establishment.
  • LOOCs freed up with capacity from Senior Managers, LOOCs needed all year round in N&W not just over winter.
  • LOOCs useful and welcomed for Ops.
  • LOOCs provide effective relief within challenged systems to attend escalation calls.
  • LOOCs were really well received by the system.
  • The LOOC's really work well and should be a sustained option in my opinion. I have covered the LOOC for shifts and think that having it covered even if by LOM's on relief/overtime would be useful.
  • Colocation and collaboration with wider system at ICS premises.
  • General consensus that there was more and better collaborative working across the region and within localities.

Access to the stack

  • The ability for the system/ICBs to see the Trust stack and identify alternative pathways to definitive care without the need for and Ambulance response has been a great benefit where used.
  • Increase in A2S numbers and referrals.

Wellbeing

  • Wellbeing seemed to be really considered this year with snack trolleys, the welfare waggons and hot meals for staff who worked on Christmas day.
  • Staffing of welfare wagon with AWD staff for support at acutes, management of AL for staff, 24 hour LOM cover, offering staff preferred shifts for key dates to help accommodate their needs
  • On call managers not routinely doing additional shifts, which I think has been a great support to the welfare of the management teams.
  • Staff were able to take A/L whilst training centres closed and support OPS on OT if they wish, which hugely is hugely supportive to staff and for resilience, because staff do not then need to take leave when the centres are open and courses are running.
  • Staff teamwork and welfare checks worked really well.
  • Better shift arrangements with pool cars available to facilitate staff movements.

Emergency Operations Centres

  • EOC assistant role was well received.
  • Christmas incentive which meant staffing was the best it could be with very little gaps in the rota on incentivised days.
  • Weekly touch point meetings between EOC senior staff and EOC BC to rectify any issues.
  • Senior Managers completed support training which greatly assisted in resilience for the rooms.
  • Good use of EOC specific plan.

Fleet

  • Fleet reporting process established before Christmas and was extremely useful form that time on.
  • The Operations Support Teams worked tirelessly to improve resource and equipment availability.

Lessons identified

Planning

  • Winter plans to be developed earlier – should be ready for August/September.
  • Winter plan needs to be a two-way conversation between systems and EEAST
  • Business and Partnerships team to be involved within winter planning – not previously involved.
  • Winter plan to be an organisational plan and not just ops focused.
  • Need to be clear on winter issues vs. general operational pressure issues.
  • EOC BC attended all winter planning meetings – ops didn’t attend the meetings frequently. Planning meetings need better attendance from ops.
  • The plan wasn’t followed or adhere to. Senior team did not push adhering to the winter plan and made excuses to not use the plan.
  • EOC training dates to be planned and organised in advance.
  • Earlier engagement required with corporate services – share awareness of how others can get involved to support service delivery over winter.
  • Winter plan to be much more inclusive to the whole organisation and not solely clinical operations focussed.
  • Better coordinated approach – clinical operations need to be clear on what we need.
  • Too much last-minute planning – needs to be better planned in advance. Give people more notice to attend training courses and plan work around to support this.
  • Maybe set up a T&FG for one member of each department to be involved in the initial planning process and then report back to their teams to bring ideas forward to future meetings.
  • EEAST are a regional provider – could support other systems plans.•

Recruitment

  • Recruitment process for short term change of roles over winter, i.e. LOOC roles, need to be smoother and quicker.

Business Resilience

  • Need to establish clear priorities for winter.
  • Need clear direction on what can be stopped in order to support winter delivery.
  • Need early identification of what support is required so that support staff can be clear on what expectations are and have suitable training put in place in plenty of time before winter starts.
  • Given a list of staff that can support in EOC – very poor uptake. Extra training courses put on with no uptake. No one took up the support function due to being paid Band 2.
  • People applied to support in EOC, and the training was moved at short notice – people then unable to attend due to other commitments – need to ensure offers of support are captured early so that people can plan their workload around any training requirements.
  • Further use of the ‘people skills survey’ – utilise colleagues that are willing to come forward and support. Comms to encourage others to support too – case studies of roles that support services have undertaken eg. HR Advisor doing Non-Clinical Driver shifts.
  • REAP/Escalation action cards – too little, too late. Actions have very little impact when they are utilised.

Support services and staff

  • People happy to accommodate additional work to support winter, with prior notice.
  • Need clear expectations for what is required from corporate services to support winter service delivery.
  • Need to identify roles that corporate services can help with eg. Back-office functions rather than operational delivery support – this could be assistance with welfare checks, staff sickness management etc.
  • Staff may be happy to assist outside of their working day if this was an option. The workload is significant most days for us all.
  • Support can come in many forms – over those demanding times, local managers in operations are mostly out of the office supporting patients, staff, incidents etc, which gives them less time to undertake the ‘administrative’ arm of their role – perhaps support from wider teams could come in the form of helping with, for example, Datix investigations, complaint investigations etc…. although not patient facing, this would take the pressure off of completing these other tasks?
  • Do we want to put advanced practitioners out on vehicles or whether to utilise them better within the control rooms.

Vehicle availability

  • Vehicle availability was extremely challenged which resulted in some areas not being able to put out sufficient resource even where staff were available and rostered on shift.
  • Fleet needs to be better spread across the Trust – balancing pressure across all systems, rather than one area not having enough fleet and the rest of the sectors are at capacity.
  • High levels of VOR massively affect the delivery of operations.
  • More dynamic use of Make Ready – help with out of service reasons.

Incentives/Overtime

  • Need to be mindful of what has been agreed during business planning in relation of funding for additional roles during this period.
  • Careful not to max out resources – struggling to get the day job done without additional work being put onto teams.
  • Winter incentives – those with bank contracts, have been impacted by incentive shifts.
  • Winter incentives put out last minute – received very late notice, which will then have little uptake.
  • Better utilisation and planning of the use of winter incentives. (Appreciate the unforeseen sickness elements that need covering).
  • Do we have any evidence of the uptake of the incentives? Evidence of the success of incentives? Do we have an evidential baseline?
  • Incentives to be used throughout operations support. May be different shifts to operations.
  • Incentives take ages to approve and sign off – not signed off quick enough to have much benefit in real time.
  • Pre-approvals/ sign offs for winter incentives would be helpful and welcomed as the sign off process is time consuming.
  • Uniformed incentives across operations support – fleet and medical devices to be included.
  • Lessen the time for incentives – offer incentives for eg. 4 hours instead of 10 hours. Potential for shorter shifts in EOC eg. 4 hours. Shorter shifts are better than nothing.
  • Culturally incentives aren’t a great thing to do. If we are planning and foreseeing demand – incentives should not be required.
  • Lots of people wait for the winter incentives to come out within ops and hold off taking up shifts.
  • Winter incentives are hugely expensive – compared to the output we get from them.
  • Staff wait to find out what shifts contain an incentive before taking up OT.
  • Incentives a couple of years ago were more effective – incentives now don’t seem to increase OT – just increases basic PFSHs.
  • Need to consider the use of incentives. The longer we run incentives, the less effective they become.
  • Incentives have ‘run their course’. Not be routinely offered unless targeted at specific shifts.
  • NHSE expect EEAST to do ‘everything they possibly can’ to support PFSHs (including incentives). NHSE may push EEAST to use incentives.
  • Incentives used to give something extra – now we are just paying more for shifts we already need to fill.
  • Incentives are culturally not helpful – creates a divide within the operational staff groups.
  • Rewards for being present instead of incentives?

Communications

  • Communication methods between directorates could be improved to ensure collective working across the Trust. People tend to work silo in periods of pressure and stress.
  • Communications internally within EEAST and stakeholders needs to be improved.
  • Communications weren’t asked to support media messages internally.
  • Communications team need to be involved in the planning from the beginning so they can develop appropriate pre-agreed internal and external communications.

Other

  • EOC outbreak management – Estates not involved in planning however IPC were. Estates and facilities expected to increase the cleaning to mitigate the outbreak risks.
  • Planning and preparation could be better for the management of illness outbreaks within EOC. Including pre-planned budgeted costs.
  • Additional daily cleans across the winter period within the EOCs?
  • Data could better support the response to winter.
  • Winter plan must be adhered to so as to ensure appropriate and resilient service delivery. All involved should be fully aware of and committed to the plan.
  • Daily battle rhythm meetings need to be must attend.
  • Identify how useful the PowerBI reports are used – is it user friendly? Is the data reliable? Is the data accessible to all? Informatics happy to fill the gaps that ops need.

Recommendations

Planning and preparation for winter and developing the winter plan.

  • Personnel involved in the planning for the 2024/25 period to use the output from this debrief to inform the development of the plan and identification of what needs to be included.
  • Establish a set of priorities for winter service delivery with associated agreement on what stops in order to deliver said priorities.
  • Create a working group with members from across all departments across the organisation to establish what is required of the winter plan and how to achieve high levels of resilience and focused service delivery.
  • Consider how EEAST can be more instrumental in supporting the wider system in their winter planning in order to improve understanding of the challenges EEAST face and to identify further opportunities to improve coordinated plans for the winter period.

Business Resilience

  • Embed a staff mapping system as part of BAU to ensure accurate and up to date information on staff skill sets and allocation of resilience roles across the organisation. Different groups of staff or individuals will have their day to day role but will also be trained in a resilience role for times of challenge.
  • Identify what roles our corporate and support service colleagues can undertake during the winter period, which are not clinical functions, in order to inform what courses and training will need to be delivered.
  • Establish, early within the planning phase, what courses/training is required to enhance agreed roles and plan for this training to be completed across the year not just in the month before the winter period starts. This needs to be a year long cycle of training and competency CPD.
  • EOC to identify/scope what roles they require support with and plan in early dates for training and CPD for the staff for these roles – linked to item above.
  • Consider the use and relevance of REAP levels against CSP levels with the potential to add support service actions under CSP levels in support of service delivery.
  • Consider how to enhance or support the Clinical Advise Service during times of increased pressure.

Incentives

  • It is recommended that a full review of the uptake of incentives is undertaken in each department. This is to establish a baseline of how effective different incentives are.
  • Consideration should be given to alternative methods of increasing resource during periods of high activity and winter pressures where incentives are found to be ineffective.
  • Consideration should also be given to which staff groups are included in incentive programmes and whether bank staff should be included in incentive schemes.
  • Processes for approving incentives in a timely manner should be developed and put into business-as-usual work practices.

Recruitment

  • Consider whether it is possible to put in place a shortened recruitment process for short term roles which are put in place for periods of challenge such as the winter period.

This document has been produced as a result of the structured debrief conducted specifically in response to a request from the Deputy Chief of Clinical Operations – Jon Moore.

The process was conducted in accordance with recognised College of Policing structured debrief procedures and the terms of reference agreed with EEAST.

Darya Wotherspoon Regional Business Continuity and EPRR Compliance Manager East of England Ambulance Service

EEAST Winter Debrief

October 2024 to March 2024

Date of report: 22nd April 2024

Introduction

The Deputy Chief of Clinical Operations, Jon Moore, initiated a structured debrief of the Winter Delivery Plan.

Parameters

The purpose of this debrief was to explore what when well, what didn’t go so well and what can be done in the future to improve the plans for Service Delivery during the, historically, challenging winter months and the two week festive period.

Debrief facilitation team

  • Darya Wotherspoon: Structured Debrief Facilitator – Certified by the College of Policing. EEAST Regional Business Continuity and EPRR Compliance Manager.
  • Matt Barrett: Support to the Facilitator – Regional Business Continuity Advisor
  • Lucy Goddard: Scribe – Business Support Officer to the Deputy Chief of Clinical Operations

There were three debrief sessions undertaken as follows;

  • Support Services – Thursday 21st March 2024
  • Operations Support – Friday 22nd March 2024
  • Clinical Operations – Wednesday 27th March 2024

Executive Summary

The Regional Business Continuity and EPRR Compliance Manager was requested to facilitate the EEAST Winter Service Delivery Structured Debrief. There was a total of 73 participants over the three sessions and a total of 47 responses to the pre-debrief questionnaire.

The detail of this report captures points raised within the debrief process in addition to those captured from the questionnaires.

The following points raised in this summary and in the attached spreadsheet have been drawn from comments made by participants during their feedback and discussion during the structured debrief process.

Areas for development and improvement are highlighted, together with he main areas that went well. Based upon the debrief outcomes a number of recommendations have been made to assist EEAST and its partners to prepare for and coordinate ways to improve service provision during winter months and the festive period.

The themes highlighted in the debrief process have assisted in the compilations of a total of 8 themes around areas for consideration for improvement for the future planning and response to similar events.

Common themes raised, what went well, what didn’t go so well and what can be improved.

  • Local Operations Oversight Cells
  • Wellbeing
  • Access to stack
  • Collaborative working
  • End of shift arrangements
  • RRV back-up trial
  • Management of annual leave
  • Fleet availability.
  • Support from wider Trust/more inclusive planning.
  • Overtime and incentives
  • Communication

Key areas of good practice

Local Operations Oversight Cells

  • LOOCs generally worked very well and helped to keep the system informed and running smoothly. There were some issues getting these established with problems in the recruitment of the individuals to the agreed posts, this should be considered much more in advance. Once established the support and oversight they provided was extremely good and should be considered for permanent establishment.
  • LOOCs freed up with capacity from Senior Managers, LOOCs needed all year round in N&W not just over winter.
  • LOOCs useful and welcomed for Ops.
  • LOOCs provide effective relief within challenged systems to attend escalation calls.
  • LOOCs were really well received by the system.
  • The LOOC's really work well and should be a sustained option in my opinion. I have covered the LOOC for shirts and I think that having it covered even if the LOM's on relief/overtime would be useful.
  • Colocation and collaboration with wider system at ICS premises.
  • General consensus that there was more and better collaborative working across the region and within localities.

Access to the stack

  • The ability for the system/ICBs to see the Trust stack and identify alternative pathways to definitive care without the need for and Ambulance response has been a great benefit where used.
  • Increase in A2S numbers and referrals.

Wellbeing

  • Wellbeing seemed to be really considered this year with snack trolleys, the welfare waggons and hot meals for staff who worked on Christmas day.
  • Staffing of welfare wagon with AWD staff for support at acutes, management of AL for staff, 24 hour LOM cover, offering staff preferred shifts for key dates to help accommodate their needs
  • On call managers not routinely doing additional shifts, which I think has been a great support to the welfare of the management teams.
  • Staff were able to take A/L whilst training centres closed and support OPS on OT if they wish, which hugely is hugely supportive to staff and for resilience, because staff do not then need to take leave when the centres are open and courses are running.
  • Staff teamwork and welfare checks worked really well.
  • Better shift arrangements with pool cars available to facilitate staff movements.

Emergency Operations Centres

  • EOC assistant role was well received.
  • Christmas incentive which meant staffing was the best it could be with very little gaps in the rota on incentivised days.
  • Weekly touch point meetings between EOC senior staff and EOC BC to rectify any issues.
  • Senior Managers completed support training which greatly assisted in resilience for the rooms.
  • Good use of EOC specific plan.

Fleet

  • Fleet reporting process established before Christmas and was extremely useful form that time on.
  • The Operations Support Teams worked tirelessly to improve resource and equipment availability.

Lessons identified

Planning

  • Winter plans to be developed earlier – should be ready for August/September.
  • Winter plan needs to be a two-way conversation between systems and EEAST
  • Business and Partnerships team to be involved within winter planning – not previously involved.
  • Winter plan to be an organisational plan and not just ops focused.
  • Need to be clear on winter issues vs. general operational pressure issues.
  • EOC BC attended all winter planning meetings – ops didn’t attend the meetings frequently. Planning meetings need better attendance from ops.
  • The plan wasn’t followed or adhere to. Senior team did not push adhering to the winter plan and made excuses to not use the plan.
  • EOC training dates to be planned and organised in advance.
  • Earlier engagement required with corporate services – share awareness of how others can get involved to support service delivery over winter.
  • Winter plan to be much more inclusive to the whole organisation and not solely clinical operations focussed.
  • Better coordinated approach – clinical operations need to be clear on what we need.
  • Too much last-minute planning – needs to be better planned in advance. Give people more notice to attend training courses and plan work around to support this.
  • Maybe set up a T&FG for one member of each department to be involved in the initial planning process and then report back to their teams to bring ideas forward to future meetings.
  • EEAST are a regional provider – could support other systems plans.

Recruitment

  • Recruitment process for short term change of roles over winter, i.e. LOOC roles, need to be smoother and quicker.

Business Resilience

  • Need to establish clear priorities for winter.
  • Need clear direction on what can be stopped in order to support winter delivery.
  • Need early identification of what support is required so that support staff can be clear on what expectations are and have suitable training put in place in plenty of time before winter starts.
  • Given a list of staff that can support in EOC – very poor uptake. Extra training courses put on with no uptake. No one took up the support function due to being paid Band 2.
  • People applied to support in EOC, and the training was moved at short notice – people then unable to attend due to other commitments – need to ensure offers of support are captured early so that people can plan their workload around any training requirements.
  • Further use of the ‘people skills survey’ – utilise colleagues that are willing to come forward and support. Comms to encourage others to support too – case studies of roles that support services have undertaken eg. HR Advisor doing Non-Clinical Driver shifts.
  • REAP/Escalation action cards – too little, too late. Actions have very little impact when they are utilised.

Support services and staff

  • People happy to accommodate additional work to support winter, with prior notice.
  • Need clear expectations for what is required from corporate services to support winter service delivery.
  • Need to identify roles that corporate services can help with eg. Back-office functions rather than operational delivery support – this could be assistance with welfare checks, staff sickness management etc.
  • Staff may be happy to assist outside of their working day if this was an option. The workload is significant most days for us all.
  • Support can come in many forms – over those demanding times, local managers in operations are mostly out of the office supporting patients, staff, incidents etc, which gives them less time to undertake the ‘administrative’ arm of their role – perhaps support from wider teams could come in the form of helping with, for example, Datix investigations, complaint investigations etc…. although not patient facing, this would take the pressure off of completing these other tasks?
  • Do we want to put advanced practitioners out on vehicles or whether to utilise them better within the control rooms.

Vehicle availability

  • Vehicle availability was extremely challenged which resulted in some areas not being able to put out sufficient resource even where staff were available and rostered on shift.
  • Fleet needs to be better spread across the Trust – balancing pressure across all systems, rather than one area not having enough fleet and the rest of the sectors are at capacity.
  • High levels of VOR massively affect the delivery of operations.
  • More dynamic use of Make Ready – help with out of service reasons.

Incentives/Overtime

  • Need to be mindful of what has been agreed during business planning in relation of funding for additional roles during this period.
  • Careful not to max out resources – struggling to get the day job done without additional work being put onto teams.
  • Winter incentives – those with bank contracts, have been impacted by incentive shifts.
  • Winter incentives put out last minute – received very late notice, which will then have little uptake.
  • Better utilisation and planning of the use of winter incentives. (Appreciate the unforeseen sickness elements that need covering).
  • Do we have any evidence of the uptake of the incentives? Evidence of the success of incentives? Do we have an evidential baseline?
  • Incentives to be used throughout operations support. May be different shifts to operations.
  • Incentives take ages to approve and sign off – not signed off quick enough to have much benefit in real time.
  • Pre-approvals/ sign offs for winter incentives would be helpful and welcomed as the sign off process is time consuming.
  • Uniformed incentives across operations support – fleet and medical devices to be included.
  • Lessen the time for incentives – offer incentives for eg. 4 hours instead of 10 hours. Potential for shorter shifts in EOC eg. 4 hours. Shorter shifts are better than nothing.
  • Culturally incentives aren’t a great thing to do. If we are planning and foreseeing demand – incentives should not be required.
  • Lots of people wait for the winter incentives to come out within ops and hold off taking up shifts.
  • Winter incentives are hugely expensive – compared to the output we get from them.
  • Staff wait to find out what shifts contain an incentive before taking up OT.
  • Incentives a couple of years ago were more effective – incentives now don’t seem to increase OT – just increases basic PFSHs.
  • Need to consider the use of incentives. The longer we run incentives, the less effective they become.
  • Incentives have ‘run their course’. Not be routinely offered unless targeted at specific shifts.
  • NHSE expect EEAST to do ‘everything they possibly can’ to support PFSHs (including incentives). NHSE may push EEAST to use incentives.
  • Incentives used to give something extra – now we are just paying more for shifts we already need to fill.
  • Incentives are culturally not helpful – creates a divide within the operational staff groups.
  • Rewards for being present instead of incentives?

Communications

  • Communication methods between directorates could be improved to ensure collective working across the Trust. People tend to work silo in periods of pressure and stress.
  • Communications internally within EEAST and stakeholders needs to be improved.
  • Communications weren’t asked to support media messages internally.
  • Communications team need to be involved in the planning from the beginning so they can develop appropriate pre-agreed internal and external communications.

Other

  • EOC outbreak management – Estates not involved in planning however IPC were. Estates and facilities expected to increase the cleaning to mitigate the outbreak risks.
  • Planning and preparation could be better for the management of illness outbreaks within EOC. Including pre-planned budgeted costs.
  • Additional daily cleans across the winter period within the EOCs?
  • Data could better support the response to winter.
  • Winter plan must be adhered to so as to ensure appropriate and resilient service delivery. All involved should be fully aware of and committed to the plan.
  • Daily battle rhythm meetings need to be must attend.
  • Identify how useful the PowerBI reports are used – is it user friendly? Is the data reliable? Is the data accessible to all? Informatics happy to fill the gaps that ops need.

Recommendations

Planning and preparation for winter and developing the winter plan.

  • Personnel involved in the planning for the 2024/25 period to use the output from this debrief to inform the development of the plan and identification of what needs to be included.
  • Establish a set of priorities for winter service delivery with associated agreement on what stops in order to deliver said priorities.
  • Create a working group with members from across all departments across the organisation to establish what is required of the winter plan and how to achieve high levels of resilience and focused service delivery.
  • Consider how EEAST can be more instrumental in supporting the wider system in their winter planning in order to improve understanding of the challenges EEAST face and to identify further opportunities to improve coordinated plans for the winter period.

Business Resilience

  • Embed a staff mapping system as part of BAU to ensure accurate and up to date information on staff skill sets and allocation of resilience roles across the organisation. Different groups of staff or individuals will have their day to day role but will also be trained in a resilience role for times of challenge.
  • Identify what roles our corporate and support service colleagues can undertake during the winter period, which are not clinical functions, in order to inform what courses and training will need to be delivered.
  • Establish, early within the planning phase, what courses/training is required to enhance agreed roles and plan for this training to be completed across the year not just in the month before the winter period starts. This needs to be a year long cycle of training and competency CPD.
  • EOC to identify/scope what roles they require support with and plan in early dates for training and CPD for the staff for these roles – linked to item above.
  • Consider the use and relevance of REAP levels against CSP levels with the potential to add support service actions under CSP levels in support of service delivery.
  • Consider how to enhance or support the Clinical Advise Service during times of increased pressure.

Incentives

  • It is recommended that a full review of the uptake of incentives is undertaken in each department. This is to establish a baseline of how effective different incentives are.
  • Consideration should be given to alternative methods of increasing resource during periods of high activity and winter pressures where incentives are found to be ineffective.
  • Consideration should also be given to which staff groups are included in incentive programmes and whether bank staff should be included in incentive schemes.
  • Processes for approving incentives in a timely manner should be developed and put into business-as-usual work practices.

Recruitment

  • Consider whether it is possible to put in place a shortened recruitment process for short term roles which are put in place for periods of challenge such as the winter period.

This document has been produced as a result of the structured debrief conducted specifically in response to a request from the Deputy Chief of Clinical Operations – Jon Moore.

The process was conducted in accordance with recognised College of Policing structured debrief procedures and the terms of reference agreed with EEAST.

Darya Wotherspoon Regional Business Continuity and EPRR Compliance Manager East of England Ambulance Service

Trust board

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