MEETING OF THE EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST BOARD
(PUBLIC SESSION)
TO BE HELD ON WEDNESDAY 25 JANUARY 2017 AT 13.30,
GROUND FLOOR MEETING ROOM, TRUST HQ, MELBOURN STATION, WHITING LANE,
OFF BACK LANE, MELBOURN, CAMBRIDGESHIRE SG8 6EN
AGENDA: PUBLIC SESSION (Disclosable)
ITEM
SUBJECT
REPORT
1.
Welcome and Board Membership
Verbal: Trust Chair
2.
Apologies for Absence
Verbal: Trust Chair
3.
Declarations of Interest
Verbal: Board Members
To receive any new or amended declarations of interest
from Board Members
4.
Herewith: Trust Chair
Minutes
To Approve the minutes of the previous meeting (public
session) held on 30 November 2016
5.
Matters Arising Not Addressed Elsewhere on the
Agenda
Herewith: Trust Chair
To consider the action checklist arising from previous
minutes
6.
Herewith: Trust Chair
Herewith: Chief Executive
i) Chair’s Report
ii) Chief Executive’s Report
To receive and note
QUALITY GOVERNANCE
7.
Herewith: Director of Nursing and
Clinical Quality
Patient Experience/Story: PTS
PERFORMANCE MONITORING
8.
.
Herewith: Executive Team
Integrated Performance Report
i)
Finance Report – Month 09, December
2016
ii) Report from the Chair of Quality
Governance Committee, 10 January 2017
Herewith: Director of Finance &
Commissioning
Herewith: Chair of QGC
iii) Report from Chair of Performance and
Finance Committee, a) 7 December 2016
and b) 11 January 2017
Herewith: Chair of P&FC
iv) Report from Chair of the Audit Committee, 7
December 2016
Herewith: Chair of AC
v) Report from Chair of Remuneration
Committee, 10 January 2017
Herewith: Chair of RemCom
STRATEGY AND BUSINESS PLANNING
9.
Strategic Priorities / Strategy on a Page
Herewith: Director of Strategy and
Sustainability
10.
International Recruitment
Herewith: Director of People and
Culture
Page 1 of 2
TIMINGS
GOVERNANCE
11.
Cultural Audit Update
Herewith: Director of People and
Culture
12.
Board Assurance Framework
Herewith: Director of Nursing and
Clinical Quality
SERVICE IMPROVEMENTS/ PROJECTS
13.
Herewith: TUG members
TUG presentation
OTHER MATTERS
14.
Items Referred to/from Other Committees
Verbal: Trust Chair
15.
Key Messages and Risks Identified
Verbal: Trust Chair
16.
Any Other Urgent Business
Verbal: Trust Chair
To consider any other matters which, in the opinion of
the Chair, should be considered by reason of special
circumstance as a matter of urgency
17.
Verbal: Trust Chair
Date of Next Meeting: 29 March 2017
Venue: Trust HQ, Melbourn
Copies of the reports and other relevant papers are available for public inspection on the Trust’s Internet site: www.eastamb.nhs.uk. If you are
unable to attend the public session, but would like to raise any issues regarding the Trust, you can write to the Trust Secretary, East of England
Ambulance Service NHS Trust, Ambulance Headquarter, Whiting Way, Melbourn. Cambridgeshire SG8 6EN
Page 2 of 2
Item 4.
UNCONFIRMED (Disclosable)
MINUTES OF THE EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST BOARD
MEETING (PUBLIC SESSION) HELD ON WEDNESDAY 30 NOVEMBER 2016 AT 13:30 AT
GROUND FLOOR MEETING ROOOM, TRUST HQ, WHITING WAY, OFF BACK LANE,
MELBOURN, CAMBRIDGESHIRE SG8 6NA
Present:
In Attendance:
Mrs Sarah Boulton
Ms Valerie Morton
Mr Peter Kara
Mrs Sheila Childerhouse
Mr Tony McLean
Mr Dean Parker
Dr Mark Patten
Mr Andrew Egerton-Smith
Mr Robert Morton
Ms Lindsey Stafford-Scott
Mr Kevin Brown
Mr Wayne Bartlett-Syree
Mr Kevin Smith
Mr Sandy Brown
Non-Executive Director (Chair of Trust)
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Non-Executive Director
Medical Director
Associate Non-Executive Director
Chief Executive Officer
Director of People and Culture
Director of Service Delivery
Director of Strategy and Sustainability
Director of Finance and Commissioning
Director of Nursing and Clinical Quality
Mrs Laila Abraham
Mr Aaron Taylor
Members of Staff
Members of the Public
Trust Secretary
Interim Committees Secretary (minute-taker)
PUBLIC SESSION (Disclosable)
P266/16 WELCOME
Mrs Sarah Boulton welcomed everyone. She reported that Mr. Keith Marshall, a well-known
and popular member of the Trust User Group and a CFR, had recently died. A minute’s silent
reflection was observed to commemorate him.
P267/16 APOLOGIES FOR ABSENCE
Mrs Laila Abraham confirmed that all members of the Board were present.
P268/16 DECLARATIONS OF INTEREST
There were no new declarations of interest.
P269/16 MINUTES OF THE MEETING HELD ON 28 SEPTEMBER 2016
(i)
Mrs Sarah Boulton requested that in the fourth paragraph on page 3, ‘individuals’ be changed
to ‘the system’.
East of England Ambulance Service
NHS Trust
Page 1 of 8
Minutes of Trust Board (Public Session)
th
30 November 2016
(ii)
Item 4.
On page 7, third paragraph, “by c. 0.5% for red activity” ought to read “to c. 0.5% for red
activity”.
The minutes as amended were agreed as an accurate record of the meeting.
P270/16
MATTERS ARISING
Action Checklist from the Previous Minutes
Item P251/16 – (Accuracy of Profession Update figures). Miss Stafford-Scott advised that
the Profession Update figures shown in the Integrated Performance Report were incorrect,
and explained that this was as a result of a corrupt formula. This had now been rectified.
Item P253/16 - (Discussion of charitable funds). Mrs. Sarah Boulton said that the discussion
as to how best to utilise the charitable funds be would be on the agenda for a future Board
Development Session.
Item 259/16 – (Publication of CQC documents). Mrs. Sarah Boulton advised that the CQC
Report and the minutes from the CQC Quality Summit were available to view through the
Trust’s website.
General. Mrs. Boulton said that all other Matters Arising from previous meetings had been
completed. She then asked whether anybody present had any questions; none were
forthcoming.
P271/16
CHAIR AND CHIEF EXECUTIVE’S REPORT
Trust Chair’s Report
The Directors noted the Chair’s Report, contained in the Board Pack.
Mrs. Sarah Boulton advised the Board that in the time since she had written the Report, she
had attended a meeting of the All-Party Parliamentary Group of Air Ambulances. She said
that the Group had a real sense that the three Air Ambulance charities were working
together in a very positive and collaborative way.
Mrs. Boulton also congratulated staff of the Trust who had won awards recently, including:
i.)
ii.)
Tara Rose – shortlisted for the ‘Emerging Leader Award’ at the Health Education
East Leadership Awards; and
Navrita Atwal – won the ‘Inclusive Leader Award’ at the Health Education East
Leadership Awards.
Chief Executive’s Report
The Directors noted the Chief Executive’s Report, contained in the Board Pack.
Mr. Robert Morton advised that in the time since he had written the Report, the situation
regarding the level of funding for the Trust for 2017-2019 had changed. He had met with the
Commissioners on 24 November 2016 and a further meeting would be held shortly to see an
agreement could be reached. In the event that this did not happen, a paper must be
submitted for mediation by 5 December 2016. He further advised that he had met the
previous day with representatives from NHS Improvement, NHS England, and the 17 local
Accident & Emergency boards to develop a protocol to safeguard Red Category patients from
handover delays.
The Board noted that there had been a trend towards a rise in complaints about PTS. Mr.
East of England Ambulance Service
NHS Trust
Page 2 of 8
Minutes of Trust Board (Public Session)
th
30 November 2016
Item 4.
Morton explained that some specific matters had been identified, and measures to mitigate
these would be implemented by 15 December 2016.
It was noted that Mr. Morton would attend a meeting with the Trust User Group on general
communication matters and ways in which better integration could be achieved given the
wide geographical area covered by the Trust. The TUG would present proposals and ideas
at this meeting, to be held in January 2017.
Mr. Morton said that since writing the Report, he had met with the Lead Commissioner and
NHSI and therefore the meeting referred to in the Report would now be delayed.
Mr. McLean highlighted the reference in the Report to correspondence with the
Commissioner, and asked that this be circulated to the Board. Mr. McLean further requested
that the Trust’s Quality Governance Committee be with any developments regarding PTS,
and this was also agreed.
Action: Mr Robert Morton to circulate the correspondence with the Commissioner to
Board members.
Action: Update to be provided by Mr Sandy Brown to the QGC in relation to
developments regarding PTS.
Mr. Egerton-Smith asked what measures could be taken to expand 111 contact without
reducing quality. Mr. Robert Morton explained that the Trust was in competition with the
private sector and, in his opinion, it might be beneficial to strengthen the team to improve
medicine management. Also, Mr. Morton pointed out that the Trust operated with a different
cost model to the private sector. Mr. Egerton-Smith suggested that it was hard to see how
the Trust could compete for 111 contracts while maintaining the same level of quality, to
which Mr. Morton replied that a suitable approach might be to identify contracts which were
failing to meet KPIs, and to then emphasise that the Trust provides a high level of quality, and
that the contract is not solely based on cost.
The Trust Board noted the report.
P272/16
PATIENT EXPERIENCE/ STORY
Dr. Mark Patten advised the Board that Mr. Oki, the subject of the Patient Experience Report,
was unable to be present for medical reasons. He explained that the story of this patient’s
experience had been chosen as it brought to the fore a number of current issues.
Mr. Patten explained that most stations now carry out three dialysis procedures per day, and
it was therefore time-critical that PTS transport Mr. Oki to the station in good time, to avoid
knock-on effects. While Mr. Oki had encountered some issues with PTS, overall he and his
wife were happy with the service provided. Dr. Patten invited any questions.
Mr. Tony McLean said that he was pleased to see positive comments, particularly in light of
the background of rising complaints about PTS.
Mrs. Sarah Boulton advised that she personally had sight of all complaints, and that the
majority of these were around punctuality issues.
Mr. McLean said that contracts were based on usage, and that actual activities were often
significantly higher than contracted for. In his opinion, part of the issue was that what CCG
have allowed for may not be sufficient for what is actually required.
Mr. Sandy Brown advised the Board that when a new contract was put in place, a spike in
complaints was usual, while the terms of the contract bedded in. Also, he explained that PTS
staff were often on lower pay-bandings and that this had caused some recruitment issues.
East of England Ambulance Service
NHS Trust
Page 3 of 8
Minutes of Trust Board (Public Session)
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30 November 2016
Item 4.
Another issue that Mr. Brown highlighted was communication around managing the
expectations of patients; quite often they expected to be collected immediately from the renal
unit and dislike having to wait, while the Trust has a two-hour tolerance on patient collection.
The Board noted that there were also some issues with difficulties in contacting the booking
centre to get more information. Mr. Sandy Brown advised that work with PTS was ongoing in
this area, and that an escalation meeting was scheduled for later in the week to discuss this
further.
Dr. Mark Patten stated that there was a current trend for dialysis units to be removed from
hospitals to stand-alone sites with no real consideration given to travel times. Mrs. Sarah
Boulton agreed that this was an issue, and that it was important that the Trust should ensure
that its voice was heard.
Mr. Robert Morton said that there had been complaints about the new eligibility criteria for
using PTS which had been put in place by the CCGs; patients incorrectly assumed that the
changes had been made by ambulance staff. Many patients who have used PTS for years
were now struggling to understand why they were being screened for eligibility. Mr. Morton
advised that he had recently been out with staff in Huntingdon and he had been struck by the
compassion of frontline staff, observing that they took the time needed to deal with elderly
patients in a caring manner, but this unfortunately impacted negatively on journey times. He
said that it is important to ensure that the CCGs see the patients as people rather than just
‘jobs’.
The Trust Board noted the report.
P273/16
NEW CLINICAL PHONE APP
Mrs. Sarah Boulton informed the Board that the purpose of the presentation was to showcase
the new Clinical Manual app for mobile devices. She then introduced Lewis Andrews and
Tracy Nicholls to present to the Board.
Ms Nicholls explained that the idea for the new app originated from staff feedback., It was
developed to support clinical staff and to share the existing clinical manual and other relevant
documents in a more convenient way to paper, which was felt to be quite cumbersome. Mr.
Andrews explained that the team had worked with Class Publishing since January 2016 to
develop the app, and over 50 staff had been involved during the development process which
had involved live trials with the developer and end user. The outcome was successful, and
the content had been brought by other businesses and organisations, including Qatar and St.
John’s Ambulance.
Mr. Andrews told the Board that although the app provided staff and volunteers with a means
by which they could refresh their knowledge, it was not to be used as an initial training
manual. The app also included live clinical notices, and was therefore another tool that could
be used to disseminate these notices. He stated that over 1,500 patient-facing staff had
logged into the app, which represented a very high take-up rate.
Mr. Andrews said that the Trust was the first trust to have developed such a tool, and that the
app was truly pioneering. It allowed access to information 24/7 to staff, without them having
to carry the paper manual and that it was dual-use, including both the local manual and
national guidelines. Further, there was an opportunity to build on the current model, possibly
by issuing a personal tablet device to relevant staff.
Mr. Robert Morton thanked Mr. Andrews and Ms. Nicholls, and said that the app was very
exciting and offered chances for progress.
Mrs. Childerhouse said that it was important that intellectual property should be robustly
managed; it was important to share the information, but also to control the process. She
agreed with Mr. Morton that the app was truly innovative and said that she would not be
East of England Ambulance Service
NHS Trust
Page 4 of 8
Minutes of Trust Board (Public Session)
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30 November 2016
Item 4.
surprised if it won awards in the future.
Mr. Sandy Brown congratulated the team behind the development of the app, and said that
the Trust should focus on realising the potential that the app offered to further improve patient
care.
Mr. Tony McLean agreed, saying that following the launch of the app, there had been a real
desire among staff to be involved with it, and that this momentum could be built upon
P274/16
DEMENTIA STRATEGY
Mrs. Sarah Boulton introduced Mr. Duncan Moore to give a presentation to the Board.
He provided the Board with some statistics, advising that 80,000 people in the area covered
by the Trust had been diagnosed with dementia, and that with an ageing population, this
would only increase. To demonstrate this, on the Sunday prior to the meeting there had been
3,372 incidents for the Trust, 1,343 of which related to those over the age of 65 and 12 over
the age of 100, compared to the same Sunday in 2007, of which 565 of 2125 incidents related
to those aged over 65 and only 4 to those aged over 100.
The Board noted that care for dementia sufferers should be community-based; such patients
were extremely vulnerable and the Trust should aim to integrate its role with other statutory
bodies and also with volunteers and carers who have contact with the patient. The Trust had
shared its strategy with other bodies at a national level, to develop the strategy and try to
enhance a consistent approach. It was agreed that in dealing with dementia sufferers, it was
vital to adopt a person-focused, rather than a task-focused, approach.
The presentation highlighted the need to develop the workforce, and particularly the
importance of modernising approaches to communicating with relevant sectors of the
workforce.
It was noted that a ‘Dementia Lead’ would be appointed to both emphasise the importance of
awareness of dementia, and to drive forward developments such as modifications to the Fleet
in future purchases to accommodate as best as possible the needs of patients suffering from
dementia.
Mr. Robert Morton said that it was becoming increasingly apparent that the Commissioners
were seeking to treat people in their own homes with dignity, rather than having a default
position of taking people to hospital.
Mr. Duncan agreed that this was a strategy that could be developed and that he was actively
engaged on an ongoing basis with the Alzheimer’s Society, which approved of this approach.
He noted that 25% of hospital beds were occupied by patients with dementia, many of whom
presented with symptoms that would not require them to remain in hospital if they were not
suffering from dementia. In terms of cost it would be cheaper to support these patients with
domiciliary care, and in terms of their health, there was significant evidence that being
hospitalised is detrimental to such patients.
Mrs. Valerie Morton said that the fact that the Trust had such a Dementia Strategy was very
reassuring. She told the Board of her first-hand experience of having been in an acute care
hospital when a patient with dementia was admitted, and had not been treated with the
appropriate level of care for the condition. She had expressed her thoughts to the hospital,
and found that they also had a ‘Dementia Strategy’ in place. Mrs. Morton emphasised the
need to ensure that the strategy was in fact being put into effect in day-to-day practice, and
queried how this would be evaluated.
Mr. Duncan said that engaging with dementia sufferers is more difficult than with other
patients, by virtue of their condition. He advised that ideally, post-event, feedback should be
East of England Ambulance Service
NHS Trust
Page 5 of 8
Minutes of Trust Board (Public Session)
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30 November 2016
Item 4.
sought in person rather than by sending out paperwork but that this was not always possible.
Mrs. Childerhouse suggested that staff could self-evaluate their interaction with the patient,
which could serve to focus their minds on what went well and what could be improved.
Mr. McLean said that he had had the opportunity to see many different strategies for dealing
with dementia and that in his opinion this was one of the best. He asked whether
consideration had been given to appointing ‘Dementia Champions’ for the stations. Mr.
Duncan replied that the Alzheimer’s Society will be giving training to staff and that some
locality-based ‘Dementia Champions’ would be appointed.
The Trust Board received the presentation.
P275/16 INTEGRATED PERFORMANCE REPORT
Mr. Sandy Brown introduced the Integrated Performance Report, which was taken as read.
He highlighted the reduction in the number of SIs, with the type of SIs remaining similar to
previous periods, and the positive trend in the Ambulance Quality Indicators. He asked if
Board members had any questions.
Mrs. Valerie Morton asked for information on HealthAssure. Mr. Sandy Brown replied that at
present there were a whole series of work streams focused on quality, which would be
integrated to give a fuller picture, so he would be better-placed to inform Mrs. Morton at the
next meeting.
Mr. McLean agreed that HealthAssure was a big issue. The Trust must ensure that it could
demonstrate that information was recorded accurately and in a timely manner. He
acknowledged that there had been issues around PCR compliance with details not always
being fully recorded, but that the Operations Team are working to rectify this. Mr. McLean
noted the real successes over the past couple of years in the recording of SIs, and that there
had been a great deal of progress in medicine management. He suggested that the Trust
should apply the same level of management to PTS complaints as was given to complaints
regarding emergency care vehicles.
Mr. Peter Kara asked what the situation was regarding progress with ePCR. Mr. BartlettSyree replied that this was significantly behind schedule.. The delays had largely been
caused by technical issues which had now been addressed, and ePCR would be rolled out in
early 2017. The introduction would likely take a couple of months, depending on how fast the
devices could be distributed to staff.
Miss Stafford-Scott advised the Board that the downward trend in staff turnover had
continued, and now was at around 9%. She further advised that sickness levels were still
high, particularly at present with the usual seasonal upturn, but that efforts were being made
to reduce this. In particular, support staff had low levels of sickness, at around 4%, which
was encouraging. The split between long-term and short-term sickness was around 50:50.
The carrying out of staff appraisals had slipped behind schedule because of the operational
pressures on managers. Recruitment was encountering some difficulties but that substantial
effort was underway to address this, and this would continue at least until the end of the
financial year.
Mr. Robert Morton said that the Commissioners are heavily focused on sickness levels; the
Trust currently has the second-highest level in the country and he enquired as to whether
other Trusts measure sickness levels in the same way. Miss Stafford-Scott said that she
would raise this at the next national forum.
Action: Miss Lindsey Stafford-Scott to ascertain whether other Trusts measure
sickness levels in the same way as EEAST.
East of England Ambulance Service
NHS Trust
Page 6 of 8
Minutes of Trust Board (Public Session)
th
30 November 2016
Item 4.
Mr. Kevin Smith spoke about the finance section of the document. He told the Board that
since the last meeting, an action plan had been agreed. He pointed out that the Trust had
spent c. £9million on PAS and agency staff, but only half of this amount had been funded by
the Commissioners. Also, the efforts to increase the ‘Hear and Treat’ system had
necessitated a significant amount of overtime pay while additional staff were being recruited.
The Board noted that the ultimate level of deficit was dependent upon the RAP achieved but
there was likely to be a deficit of around £7.5million. Mr. Dean Parker said that with regards
to the capital spend budget, only around £800,000 had been spent from the budget of £4.8m.
However, some estate developments had been agreed but had yet to be undertaken; efforts
were being made to push these through so in effect there was around £1million of the
budgeted amount as yet unallocated.
Mrs. Sarah Boulton said that to achieve income under the RAP, it was necessary to spend on
Operations, and asked whether normal cost-cutting was being undertaken as far as possible.
Mr. Kevin Smith said that it was, highlighting the £52million achieved in the past 5 years. He
explained that his view was that the main cause of the deficit was that the increased spend on
PAS and agency staff had not been properly funded by the CCGs. Mrs. Boulton said that the
deficit would be discussed in detail at the upcoming meeting of the Performance & Finance
Committee to ensure that the Trust is doing all that it can.
Mrs. Boulton drew the attention of the Board to the Report from the Chairs of the
Remuneration Committee and the Quality Governance Committee, which was taken as read.
The Trust Board noted the report.
P276/16 BOARD ASSURANCE FRAMEWORK
The Board considered the Board Assurance Framework. Mr. Robert Morton noted that the
BAF was not dynamic in the movement of risk and, where risk had travelled, it was to the
higher end of the spectrum. He queried whether all of the risks still existed, pointing out that
with regard to SR2C the risk had not changed despite the great changes to the Trust’s
leadership over the past couple of years. Mrs. Childerhouse agreed that some of the risks
appeared to need revision.
It was agreed that the workshop due to be held on Monday 5 December would consider
the risks set out in the BAF and look at how best to streamline the report, given that
some risks seemed to be obsolete, and others completely interdependent on one
another.
P277/16
CULTURAL AUDIT REVIEW
Miss Stafford-Scott advised that matters were progressing on the Cultural Audit Review,
although operational pressures had meant that finding sufficient resources to dedicate to this
had been challenging. She explained that a set of reports had been produced, and that she
had attended meetings with Unison on the Steering Group, and that these had been
productive and had taken place in a co-operative manner.
Miss Stafford-Scott explained that this exercise was not simply a survey, but was rather a
comprehensive programme around Health & Wellbeing and that she would bring the results
to the Board in January.
Mrs. Boulton asked that in the January Board meeting evidence be included about the levels
of staff engagement.
Action: Miss Lindsey Stafford-Scott to provide a report on the results of the Cultural
Audit Review, and include evidence of the levels of staff engagement.
East of England Ambulance Service
NHS Trust
Page 7 of 8
Minutes of Trust Board (Public Session)
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30 November 2016
Item 4.
P278/16 EMERGENCY CARE TRIAGE CENTRE
Mrs. Sarah Boulton introduced Dr Tom Davis and Ms Sandra Treacher, to give a presentation
to the Board.
A detailed slideshow was presented, with the Board members asking questions throughout. It
was noted that CQUIN had been agreed in April although only signed in September, and that
doctors should be in place in January 2017.
Progress had been very good, with a new hub in Bedford, and the Board noted that some G2
cases in addition to G3 and G4 cases were being triaged.. The new centre was integrating
very well with other areas of the Trust, and was also engaging externally, for instance with
111 providers. Levels of triage were noted to be already double the levels of January 2016
and, to meet the terms of the CQUIN, in place until March 2017, would continue to increase.
Mrs. Valerie Morton said that in her opinion, the Triage Centre was providing patients with the
care that they needed and avoided unnecessary ambulance journeys. However, she noted
that there were similarities to the 111 service and queried whether people would use this
service in place of 111, as it became more well-known.
The presenters replied that patients chose individually how they accessed healthcare from a
number of options, including 999, 111, GPs, A&E, although their selection was not
necessarily the most appropriate for example there were patients who did not require face-toface contact dialling 999. The purpose of the Triage service was to assist in relieving
pressure on ambulances not a replacement for 111, and would be used accordingly, with the
Board being advised that this was a bespoke element of healthcare in a 999 context.
Mr. Sandy Brown said that there would be a change to patient perception when they come to
realise that dialling 999 does not immediately result in an ambulance being sent. He asked
what feedback had been received on this.
Mr. Sandy Brown was advised that there would be an official launch, with a drive to raise
awareness of how the service would work.
Mr. Robert Morton said that the Ambulance Chief Executives’ Report had been very positive,
and that triage was an integral part of the operating model that the Trust intended to develop.
He suggested that the public did not want multiple points of contact, and that triage would
assist with the flow of work between 999 and 111, and ensure that traffic was not all in one
direction.
The Trust Board received the presentation.
P279/16 DATE OF THE NEXT MEETING
The next scheduled meeting will be on 25 January 2017.
East of England Ambulance Service
NHS Trust
Page 8 of 8
Minutes of Trust Board (Public Session)
th
30 November 2016
Item 5.
TRUST BOARD: ACTION CHECKLIST ARISING FROM PREVIOUS MINUTES TO BE CONSIDERED BY THE TRUST BOARD AT ITS MEETING (PUBLIC
SESSION) TO BE HELD ON 25 JANUARY 2017
AGENDA ITEM:
5 (Disclosable)
Key: red – new items arising at last meeting, black – outstanding items, grey – completed items
OUTSTANDING MATTERS FOR FUTURE CONSIDERATION
FOLLOW UP ACTION FROM PREVIOUS MEETINGS
Meeting
Min Ref
Action
date
30 11 16
P277/16 Miss Lindsey Stafford-Scott to provide a
report on the results of the Cultural Audit
Review, and include evidence of the levels of
staff engagement.
30 11 16
P275/16 Miss Lindsey Stafford-Scott to ascertain
whether other Trusts measure sickness
levels in the same way as EEAST.
30 11 16
P271/16 Update to be provided by Mr Sandy Brown to
the QGC in relation to developments
regarding PTS.
253/ 16
Arrange for a discussion of charitable funds
at a Board Development Session.
ACTION BY
DEADLINE
STATUS
LSS
Circulated to LSS: 10 01 17
LSS
Circulated to LSS: 10 01 17
SB
Mar-17
Circulated to AB: 10 01 17
LA
September 2017
To be arranged at a future date.
COMPLETED ITEMS
OUTSTANDING MATTERS FOR FUTURE CONSIDERATION
FOLLOW UP ACTION FROM PREVIOUS MEETINGS
Meeting
Min Ref
Action
date
30 11 16
P271/16
Mr Robert Morton to circulate the
correspondence with the Commissioner to
Board members
ACTION BY
RM
DEADLINE
STATUS
Mediation/arbitration paperwork circulated to
Board colleagues.
Completed.
Page 1 of 7
Item 5.
265/16
•
Speak with Peter Blackman, Community
First Responder (CFR), on how the Trust
plans to better support CFRs
KB
November 2016
257/16
•
LA
November 2016
251/16
•
LSS
November 2016
The was a corruption in the formula which has now
been corrected. COMPLETE
255/ 16
•
LA
November 2016
Complete
259/16
•
RM
November 2016
Complete
239/16
•
LA
September 2016
Draft agendas for 28 Sept 2016 were sent out to
executive team for review COMPLETE
234/16
•
Arrange for discussion of the NHSI
Single Oversight Programme at a Board
Development Session
Confirm the accuracy of the Professional
Update (PU) totals in the Integrated
Performance Report (IPR)
Arrange for discussion as to the progress
of the Cultural Audit to be a standing
item on the agenda for future meetings
Arrange for CQC report and minutes
from the CQC Quality Summit to be
published on the Trust website
Arrange review of the agendas for
September board meetings by Executive
Team
a) review the role of face-to-face
communications in the Tools and
Methods section of the Communications
Strategy and generally in the Strategy
b) identify in the Communications
Strategy the impact of any delays caused
by Regulators
CH
September 2016
CH
September 2016
•
Kevin Brown spoke to Peter Blackman on 14
October 2016 and addressed all of his concerns re.
CFRs
Completed
Completed on 26 October 2016
a) The relevant section has been updated to
include face-to-face messaging and the
strategy amended. COMPLETE
b) The audience section has been updated to
take this into account. COMPLETE
Page 2 of 7
Item 5.
233/16
•
•
a) Recognise disagreements between
different Regulators as a Risk in SR1 of
the BAF
AB/
Emma De
Carteret
(EdC)
September 2016
KS
September 2016
b) Review the risk rating in the BAF in
respect of the Trust’s failure to deliver
financial targets.
b) This has been completed & reflected in
the latest version of the BAF.
COMPLETE
SB/LA
Before 28/09/16
•
231/16
•
•
•
213/16
COMPLETE
c) Arrange a virtual board meeting before
the September board if required because
the RAP has not been agreed.
a) Arrange for PFC to investigate the
growth in Red Calls attended and
monitor the trend.
b) Ensure the Patient Transport Service
information in the Integrated
Performance Report shows the
percentage of patients arriving any time
prior to appointment (as well as showing
as combined information those that
arrive any time prior to appointment and
within 30 minutes of appointment time)
LA
September 2016
KB
September 2016
The requested information is now contained in the
report. COMPLETE.
KB
September 2016
c) Include information on high performing
areas or areas of concern in the
Statutory/Mandatory Training information
section of the Integrated Performance
Report
Revise the SFI document to require additional
Board approval for charity sign-off amounts in
excess of £25K.
The action was added to the September agenda for
PFC for inclusion in the Operational Performance
Report. COMPLETE.
LA
June 2016
There is currently no training being undertaken due
to the high student abstractions rates, however, the
A&E area is above 80% compliance on the 18 month
rolling programme for PU with programme due to
start again in October. High performing areas are
Essex and Cambridgeshire, there are no areas of
concern at this time. Full information will be
contained within the IPR going forwards.
COMPLETE
Updated the SFI document and the approved version
is on the Trust website
COMPLETE
Page 3 of 7
Item 5.
211/16
a) incorporate the potential UNISON industrial
action into the BAF as a potential risk, and b)
review medicines management risks and
transfer to the remit of the ELB.
AB
July 2016
the BAF would be considered later in this meeting
and b) the review of medicines management risks
had been transferred to the remit of the Executive
Leadership Board (ELB). COMPLETE
209/16
Ensure that student abstraction level reports are
routinely presented at future Performance and
Finance Committee meetings.
RA/LA
Sept 2016
Next P&F meeting is in September when this report
will be presented COMPLETE
Arrange for the IPR to be reviewed at ELB to
ensure that sufficient contextual narrative and
background explanation is included. Mr Sandy
Brown to ensure that there is sufficient quality
assurance on the report.
LA/AB
July 2016
ELB reviewed and updated the IPR for June 2016
COMPLETE
158/16
•
•
138/15
Review of the finance report regarding
detail of content required for Board.
To be reviewed with Executives.
RA to complete a deep dive on disciplinary and
dignity at work cases in Essex to identify themes
and future learning
173/16
•
159/16
•
Ms Ruth McAll to produce a staff
turnover and retention issues report for
presentation at the Performance and
Finance Committee.
Business Continuity Policy to return in 2
months with confirmation of whether it is
for decision or information.
KS
March 2016
Mr Kevin Smith said that the Finance Report review
would be picked up as part of the Board
development programme. He said that the action
should remain in place until the Board development
work is complete.
Complete
RA
July 2016
Mr Rob Ashford reported that in the period January
2015 to May 2016 the main disciplinary themes have
been around staff attitude and behaviour. However,
a more detailed report will be produced for a later
meeting.
Complete
RMc
May 2016
Mr Peter Kara confirmed that a staff turnover and
retention report had been presented at the
Performance and Finance Committee. COMPLETE
LA
April 2016
COMPLETE
The Business Continuity Manager has confirmed that
this item was for decision, i.e. approval by the Board.
Page 4 of 7
Item 5.
157/16
•
Amendments to the Integrated Board
Report as detailed in the minutes
155/16
•
•
154/16
•
.
•
151/16
157/16
155/16
AB/KE/LA
March 2016
Review of the Flu vaccination campaigns
from other Trusts which achieve greater
compliance.
To be reviewed at the Infection
Prevention Committee and reported to
the Quality Governance Committee.
AB
June 2016
Deep dive on PTS through the Quality
Governance Committee and issues
arising to be addressed.
TN
September 2016
AB
February 2016
AB/KE/LA
March 2016
AB
June 2016
To investigate in particular the process of
booking transport and the time taken to
answer the phone
Mr Brown to present the findings of a deep
dive completed by the risk team following
an increase in tail breaches. This will be
reported at the next meeting on the 24th
of February 2016. This report has
already been presented to the Quality
Governance Committee
• Amendments to the Integrated Board
Report as detailed in the minutes
•
•
Review of the Flu vaccination campaigns
from other Trusts which achieve greater
compliance.
To be reviewed at the Infection
Prevention Committee and reported to
the Quality Governance Committee.
Page 5 of 7
COMPLETE
Comments were incorporated in the IBPR.
Mr Sandy Brown said that this action has been
discharged to the Infection Prevention and Control
Group, and will be monitored via the Quality
Governance Committee. COMPLETE
Mr Sandy Brown pointed out that this action should
be in his name rather than Tracy Nicholls’. He said
that a PTS deep-dive will be conducted in conjunction
with other review work, and reported back via the
ELB. COMPLETE.
Included on March Agenda. COMPLETE
COMPLETE
Comments were incorporated in the IBPR.
Mr Sandy Brown said that this action has been
discharged to the Infection Prevention and Control
Group, and will be monitored via the Quality
Governance Committee. COMPLETE
Item 5.
154/16
•
.
•
151/16
120/15
85/15
38/15
45/15
Deep dive on PTS through the Quality
Governance Committee and issues
arising to be addressed.
TN
September 2016
AB
February 2016
To investigate in particular the process of
booking transport and the time taken to
answer the phone
Mr Brown to present the findings of a deep dive
completed by the risk team following an increase
in tail breaches. This will be reported at the next
meeting on the 24th of February 2016. This
report has already been presented to the Quality
Governance Committee
AB to circulate Board Assurance Framework
updates to the Board members
LA to ensure that reports and documents for
information are sent electronically and not
printed in future.
Draft Annual Plan, Annual Budget and
Capital Expenditure
• Mr Smith to ensure that the confirmed
key priorities are fully reflected in the
final version of the annual plans.
Trust Board 2015/16 Agenda Plan
• Mrs Abraham to ensure that the Trust
Board Plans align with the committee
plans and to add in the Performance and
Finance committee back into the agenda
plan.
Mr Sandy Brown pointed out that this action should
be in his name rather than Tracy Nicholls’. He said
that a PTS deep-dive will be conducted in conjunction
with other review work, and reported back via the
ELB. COMPLETE.
Included on March Agenda. COMPLETE
AB
COMPLETE
L Abraham
COMPLETE
K Smith
28.05.15
COMPLETE
L Abraham
28.05.15
COMPLETED– Went to the Performance and
Finance Committee on the 9th of September
Page 6 of 7
Item 5.
46/15
48/15
52/15
101/14
HR Policies
• Ms McAll/Mrs Abraham to circulate a
complete list of all policies pertaining to
the Trust along with the review dates and
persons responsible.
• Ms McAll to reform a Policy Committee
to ensure that all Policies requiring sign
off are reviewed within the correct
timeframes, these will then go to an
appropriate sub-committee of the Board
and then the Board for ratification.
Hard Truths report
• Ms Boulton to arrange a full Board
Discussion at the next Board
Development session on the Mid
Staffordshire Public Enquiry and what
actions need to be embedded into this
organisation.
Questions from the Public
• Dr Marsh and Mr Brown to look into the
circumstances of the incident reported at
Board through the Patient Story and
ascertain what the factors were leading
to the delay in attendance.
• Mr Ashford to contact Mr P Blackman
regarding assistance with the hospital
delay issues in Essex.
Workforce Performance
• Detailed report on sickness levels to be
provided at next meeting.
R McAll/L
Abraham
28 05 15
COMPLETE
S Boulton
Next Board
Development Day
COMPLETE
A Marsh/S
Brown
28.05.15
COMPLETE
R Ashford
28.05.15
K Barry
26.11.14
Page 7 of 7
COMPLETE
Item 6i
TRUST BOARD
(Public Session)
Report Title:
Chair’s Report
Report Author(s):
Sarah Boulton
Chair
Decision
Purpose:
25 JANUARY 2017
AGENDA ITEM
6i.
Sponsoring
Director:
Assurance
X
For Information Disclosable
Non-Disclosable
X
Executive Summary:
This paper updates the board on
•
•
•
•
EEAST events
Governance and assurance meetings
Networking meetings
Stakeholder events
Other Key Issues to Draw to the
Board’s Attention:
Action Required by the Board:
The report is to provide the board with assurance about the involvement and engagement of the Chair
Previously Considered By and Recommendation(s) Made:
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and Safety
Performance
Shaping our Future
Creating a Positive and Engaging Culture
Sub-Objective(s):
Please highlight those applicable
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
Page 1 of 2
• Roll out a Staff Engagement Plan
Legal Implications/Regulatory
Requirements:
EEAST Events
I attended the Emergency Services Carol Service in Bury St Edmunds just before Christmas, at which
our new cohort of chaplains was commissioned by the Bishop of Bedford. It was great to be a part of
their commissioning ceremony and to formally welcome them into the Trust. The chaplains will be
based in different localities around the region and will provide pastoral support primarily to staff.
I also had the pleasure of attending part of the day with a cohort of the Leadership and Management
course, which was, as ever, illuminating and highly rewarding to hear how the participants were using
their learning to enhance their effectiveness in their role. All three cohorts have also undertaken a
group project, each of which has benefitted the Trust as a whole.
Governance and assurance meetings
In the middle of December, we held a board development session and in the same week I chaired the
Equality, Diversity and Inclusion Steering Group. We are working collaboratively with the other
ambulance trusts through AACE on a small number of agreed EDI priorities to maximise the benefit we
should feel.
Networking meetings
I attended two national events, the NHS Providers Chairs and Chief Executives quarterly meeting and
the annual HFMA Chairs meeting. I also joined the chair of NHS Improvement for dinner hosted by
NHS Providers together with a small number of other chairs and chief executives from across the
country. These networking events provide invaluable opportunities to hear directly from a range of
national bodies, to compare notes with peers and to exchange full and frank views on issues of the
day.
Stakeholder events
Just before Christmas, in the very busy run up to the festive period I visited Bedford Hospital with the
Head of IMT to observe patient handovers in the emergency department. This was in support of an
assignment for her MSc in Healthcare Management and it gave us a good opportunity to see some of
the pressures and to reflect on the quality of patient care, which was reassuringly high.
Last week I spent a day with the Chair and governors of West Suffolk Hospital, interviewing five
candidates for their vacant non-executive director role.
Page 2 of 2
Item 6ii
TRUST BOARD
(Public Session)
25 January 2017
Report Title:
CHIEF EXECUTIVE’S REPORT
Report Author(s):
Robert Morton
Chief Executive
Purpose:
Decision
AGENDA ITEM
6ii
Sponsoring Sarah Boulton
Director:
Chair
Assurance
For Information Disclosable
x
Non-Disclosable
X
Executive Summary:
The purpose of this paper is to update the Board on issues, and matters the Chief Executive has been
addressing or involved in since the last Trust Board meeting on 30 November 2016.
Other Key Issues to Draw to the
Board’s Attention:
None
Action Required by the Board:
The Board is asked to note the content of the Chief Executive’s report
Previously Considered By and Recommendation(s) Made:
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and
Performance
Shaping our Future
Creating a Positive and Engaging Culture
Sub-Objective(s):
Please highlight those applicable
Safety
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
Legal Implications/Regulatory
Requirements:
Page 1 of 5
Item 6ii
Chief Executive Report
Single Oversight Framework
The Trust has now met with the new NHS Improvement relationship team and on-going dialogue
has continued over the festive period. The Trust is now receiving mandated support as provided for
in the Oversight Framework. The most apparent support at this stage is our participation in the
Financial Improvement Programme.
NHSI Sustainability Review
NHSI are currently undertaking a Sustainability Review of all ambulance services in England. At this
stage, the review will cover a range of areas including potential consolidation or reorganisation. The
Trust is engaging with NHSI on the review as required.
Commissioning Intentions 2016/2017
Following negotiations with commissioners on the 2017/2019 contract, the parties reached the point
of contractual dispute. The fundamental principle in dispute is the need to rebase EEAST’s
emergency contract and fund the evidence based clinical capacity gap which is supported by
analysis from ORH and a review by the Association of Ambulance Chief Executives (AACE). The
Trust and the Lead Commissioner having exhausted negotiation opportunities, the Trust and Lead
Commissioner entered the NHS Contractual Dispute Resolution process. At the time of writing this
report, further meetings with both commissioners and regulators are planned to seek a way forward
to resolve the issues in dispute.
The key risks associated with this situation are that we cannot:
•
•
•
•
Complete the Annual Operational Plan submission to NHS Improvement
Consider the NHS Improvements Control Totals
Identify the scale of the CIP Challenge (Financial Improvement Programme)
Plan our Tactical Approach to Service Delivery and PAS support
Remedial Action Plan (RAP) Funding Appeal
In relation to the Quarter 3 RAP appeal, at the time of writing, the Trust has not received an
outcome.
Financial Improvement Programme
The Trust has a significant financial gap between the cost of delivering services to patients and the
income received from Commissioners. Consequently, at the request of NHS Improvement, EEAST
has entered their Financial Improvement Programme (FIP). The FIP Team have been at the Trust
since mid-December 2016, meeting with the senior managers and gathering/analysing information.
Commencing on the 5th January 2017, the FIP Team are meeting with the Executive Team on a
weekly basis to review progress and delivery on the FIP findings. At the time of writing the first work
streams have been commenced with each one being assigned to a senior manager within the Trust.
PTS Contract Cambridgeshire
The PTS leadership team have put in place a plan to address issues in the Cambridgeshire contract
and are continuing to engage with CCGs in Essex about overspends driven by over contracted
activity. The Trust has agreed to a CCG invitation to extend the PTS contract in South East Essex.
This is welcome news for all the staff involved and who are employed by the Trust by virtue of this
contract.
STP Footprints
Since September 2016, the Trust has been trialling an interim leadership structure aligned to the 6
STP footprints.
Page 2 of 5
Item 6ii
The Trust is now satisfied that this structure is fit for purpose and will enable the Trust to support the
work of the 6 STPs in our area. The work to facilitate the substantive filling of this structure will
commence shortly.
Local A&E Delivery Boards
EEAST has experienced a significant increase in lost hours due to Arrival to Handover delays which
were particularly challenging across the festive season. As a consequence of this EEAST has had
to develop and implement a number of additional actions to ensure that we were able to respond to
our sickest patients. Across the festive period, the Executives and senior managers were involved in
multiple escalation calls to support a system response to winter pressures.
Employment Relations Update
Employee Relations remain challenged with UNISON launching a public campaign related to
Student Paramedic Delays. The Trust consider they have been reasonable in recognising the
delays and ensuring no financial detriment for affected students, albeit the delays were out of the
Trust’s control. Whilst UNISON maintain that they wish to pursue a collective Grievance they had
not provided details of those individuals who wished to raise a grievance in accordance with the
Collective Grievance policy. This information was only received following repeated correspondence
on behalf of the Trust on 13th January 2017. The Trust remains of the view that pay progression
arrangements for newly qualified paramedics will be addressed via the implementation, in
partnership, of the national banding agreement, namely the introduction of the band 5 newly
Qualified Paramedic (NQP) and associated consolidation of learning programme. Work is
underway to take forward implementation of the national banding agreement which is being
overseen by a national implementation board to ensure consistency of application across all 10
Ambulance Trusts.
The Trade dispute related to late finishes and disturbed and missed meal breaks has yet to be
resolved. The Trust has agreed to extend the Intelligent x-ray (IX) pilot and to reduce IX from 30
minutes to 15 minutes. However, due to the Financial Improvement Programme (FIP) any further
developments will be subject to the work undertaken by NHSI FIP in the Emergency Operations
Centres. UNISON have expressed their displeasure with this arrangement although a meeting is
planned between UNISON and NHSI FIP on 16th January 2017. In the meantime UNISON has
reiterated the threat to ballot for strike action should IX not continue and is maintaining pressure via
the Health and Safety Executive.
Health and Safety Executive
The Trust was issued with two Health and Safety Executive (HSE) Improvement notices in
November 2016 relating to the Trust’s failure to demonstrate appropriate systems to ensure that
working time was managed in accordance with the Working Time Directive. The Trust must
respond to the HSE by 2nd February 2017 to provide assurance that sufficient action has been
taken to remedy the contravention. In order to deliver the required improvements, the Director of
People and Culture has set up a multidisciplinary working group which has undertaken a range of
actions. These include asking all staff to complete an ‘opt out’ form should they wish to work over
48 hours and recording responses, developing reporting and monitoring systems for working time
against the 48 hour limit and associated rest periods, amending timesheet processes to accurately
record incidental overtime and secondary employment, monitoring systems to ensure staff take
appropriate breaks, annual leave and the development of a working time policy. UNISON has been
invited to be part of the working group and work continues in partnership via existing consultation
arrangements.
Page 3 of 5
Item 6ii
Blue Light Collaboration
EEAST now has Fire Service co-responder schemes in each of the 6 counties and since signing up
have attended 100s of calls across the Trust. Work continues to increase the numbers responding
and improve the dispatch process. An evaluation of the Scheme will commence in February.
Senior managers are engaging with police and fire colleagues at Business Case Strategic
Governance groups and Steering groups in Norfolk, Suffolk and Cambridge to further explore
collaborative working in the coming year.
Stakeholder Engagement*
Stakeholder
Location
TRiM Training
Harlow Station
Staff meeting Harlow Station
Contract Meeting with Lead Commissioner
Contract Mediation meeting
Call with Lead Commissioner
Call with Lead Commissioner
Call with Lead Commissioner
Call with Lead Commissioner
Call with Lead Commissioner
Meeting with Lead Commissioner
Meeting with Lead Commissioner
Essex System Conference Call
Essex System Conference Call morning and evening
Norfolk System Conference Call
Date
06/12/2016
13/12/2016
09/01/2017
02/12/2016
08/12/2016
09/12/2016
12/12/2016
22/12/2016
12/01/2017
16/01/2017
17/01/2017
20/01/2017
02/01/2017
03/01/2017
03/01/2017
CQC
CQC Ambulance Workshop
19/01/2017
NHSI
Call with Mark Cubbon
Contract Mediation meeting
Call with Mark Cubbon
Contract Mediation call with Mark Cubbon
Call with Mark Cubbon
Call with Mark Cubbon
Conference call with NHSI and other Ambulance CEOs
Contract Mediation with Mark Cubbon
PRM - Melbourn
FIP Progress Review
FIP Progress Review
02/12/2016
08/12/2016
09/12/2016
14/12/2016
20/12/2016
06/01/2017
10/01/2017
17/01/2017
24/01/2017
05/01/2017
11/01/2017
NHSE
Contract Mediation meeting
Contract Mediation meeting
Contract Mediation meeting
08/12/2016
14/12/2016
17/01/2017
EEAST
CCG
NHS Trusts
HOSC
MPs
UNISON
Page 4 of 5
Item 6ii
GMB
Blue Light
Partners
Healthwatch/
TUGs
Media
Health
Education
England
RAF
Dept. of
Health
AACE
AACE Meeting – Teleconference
AACE Meeting – London
Other
Providers
Host a visit from the National Ambulance Service, 01/12/2016
Ireland. Demonstration of telephone systems in
Chelmsford EOC
Faculty of Health and Medicine University of East
13/12/2016
Anglia
22/12/2016
19/01/2017
British Heart
Foundation
*Correct at the time of submission, any subsequent changes will be verbally reported to the
Board at the meeting
Page 5 of 5
Item 7.
TRUST BOARD
(Public Session)
25 JANUARY 2017
Report Title:
Patient Experience/Story: PTS
Report Author(s):
K Gaskin
PTS Quality Manager
Purpose:
Decision
AGENDA ITEM
7.
Sponsoring S Brown
Director:
Director of Nursing & Clinical Quality
Assurance
x
For Information Disclosable
Non-Disclosable
X
Executive Summary:
The purpose of this quality report is to provide the Trust Board with assurance on the quality of service
provided with clear demonstration of learning and identifying areas and associated actions for
improvement. To discuss Non-Emergency Patient Transport Service patient experiences; complaints and
compliments and how we are working on ways to improve patient experience.
The presentation will include a story resulting from a compliment where the patient is congratulating the
patient transport service on the brilliant service, the crew members go above and beyond there to ensure
the patients’ needs are met; a patient was interviewed on 18th January.
Other Key Issues to Draw to the
Board’s Attention:
Action Required by the Board:
The Board is asked to consider and discuss the reported performance with particular emphasis on the
areas of underperformance, and confirm that sufficient detail and assurance has been provided.
Previously Considered By and Recommendation(s) Made:
N/A
Related Trust Strategic Objective(s):
SO1: To be the market leader in providing
patients the gateway to urgent and emergency
healthcare services.
Improving Operational, Quality and Safety
Performance
Shaping our Future
Creating a Positive and Engaging Culture
Sub-Objective(s):
CO2: To develop and enhance Trust systems and
staff to meet nationally and locally agreed quality
standards.
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
Page 1 of 6
Item 7.
Legal Implications/Regulatory
Requirements:
Health and Social Care Act 2012 (regulated activities) Regulations
2009 – Regulation 9 (Outcome 4) and Regulation 10 (Outcome 16)
Page 2 of 6
Item 7.
1
Complaints
Historically PTS has always had a low level of complaints. During 2016/17 this
increased in April, with a peak in September in respect of the following;
•
•
•
•
Mobilisation of North East Essex Contract and the introduction of Eligibility Screening
in April 2016
Mobilisation of the Cambridgeshire Contract and the introduction of Eligibility
Screening in September 2016
Increased use of private providers in Suffolk and Essex to cover a change of
contracting arrangements in relation to Addenbrooks and Papworth
Increased use of private providers to cover vacancies in Cambridgeshire
Number of complaints received per 10,000 PTS journeys
Mar
16
Complaints per
10,000 journeys
% of PTS Patients
complaining
April
16
May
16
June
16
July Aug
16
16
5.68
7.58
7.03
8.74
5.82
7.73
0.06
0.08
0.07
0.09
0.06
0.08
Sept
16
Oct
16
Nov
16
15.54 12.25 12.57
0.16
0.12
0.13
Complaints are on a steady decline and are monitored and discussed at monthly PTS
Governance Meetings. Trends identified include:
•
•
•
Delays in collection of patients
Attitude of staff
Driving concerns
Page 3 of 6
Item 7.
These meetings provide an opportunity to discuss Incidents and complaints and put in place
processes for improvement. During these meetings the following actions have been agreed and
implemented:
•
•
•
•
2
Locality Business Managers (LBMs) to email staff confirming the outcome of the
complaint
Locality monthly newsletters are being established and will include a section on
complaints, with feedback
With outstanding Datix, LBMs in each region allocate
1 day per week to
investigate and respond to complaints and incidents
The same process is applied to incidents
Compliments
2.1
The number of compliments saw a slight reduction in August, but has since
increased from September as demonstrated below
2.2
A patient experience interview will be presented to the Board on 25th January. A
patient from Cambridgeshire has congratulated PTS for always delivering a brilliant
experience stating "staff/crew always go above and beyond to ensure needs are met and my
experience is the best it possibly can be".
3
Patient Satisfaction
3.1
Patient satisfaction surveys are undertaken quarterly on all PTS contracts as well as
the Eligibility Call Centre. Outcomes of the surveys are reviewed by the local management
team and actions undertaken. This can be demonstrated via the “You said, we did” reporting
template. Please see two examples below:
Page 4 of 6
Item 7.
You said…
16742044- Better side support for the patient trolley would be useful. On a couple of
occasions I felt as though I was going to come off the trolley as we turned corners at
even relatively slow speeds.
We did…
EEAST reviewed harness restraints as well as bariatric and support equipment for
specialist cases. Staff have been reminded to communicate with patients, ensuring the
patient feels safe before travelling.
You said…
1387- Phone patients to notify what time you need them ready for collection the night
before. It confirms that they will be picked up and they can be ready.
We did…
The planners contact patients the day before to ensure they still wish to travel. Crews
now call patients to make them aware of ETA. EEAST are currently setting up a text
confirmation system with response availability. EEAST pays a phone allowance to the
voluntary car drivers so
they can call patients.
3.2
Outcome of the Patient Satisfaction Survey are detailed below by PTS Contract:
Q2 – July 2016 to
September 2016
PTCAAS (Call Centre) Non
Eligible Patients
PTCAAS (Call Centre)
Eligible Patients
Suffolk Patient Transport
West Essex Patient
Transport
South Essex Patient
Transport
North Essex Patient
Transport
Gt Yarmouth & Waveney
Patient Transport
Cambridgeshire Patient
Transport (New contract)
% Patients experience very % Friends and Family
satisfactory/ satisfactory
extremely likely/likely
95.4%
92.5%
87.9%
87.9%
94.5%
91.3%
96.3%
93.4%
92.6%
94.7%
94.9%
94.9%
95.6%
97.0%
92.6%
90.6%
Page 5 of 6
Item 7.
4
External arrangements
There are also regular monthly discussions in the form of monthly contract meeting which
review complaints and incidents with Commissioners and the major Acute hospitals.
Meetings are also held with specific patient groups, mainly renal.
PTS continue to gather the views of, and engage with service users and the Communities
served to ensure they remain the centre of all we do and that we continue to be an open,
honest and learning organisation focussing on quality of care.
Page 6 of 6
Integrated Board Report
Data:
December 2016
Meeting Date: January 2017
*All available data is correct as of 15th of every month
Integrated Performance Report
1
Summary for December 2016
Performance
Indicator
Standing
Q4
Trajectory
Q3 Trajectory
71.7
%
Red 1
Workforce
73.0
%
73.6
%
70.17%
Indicator
73.9%
72.8%
(+0.5% tolerance)
Red 2
62.22%
Red 19
91.11%
Red Tail
breach
0.4%
Standing
YTD Sickness (A&E)
6.62%
PDR Rate (12 month rolling)
39.39%
PU compliance (rolling 18 months)
79.46%
Workbook (rolling 12month comp)
39.62%
Target: tail breaches under 1%
Integrated
Performance
Finance
Clinical
(November)
Indicator
Income
Expenditure
CIPs
Balance Sheet
Standing
Indicator
Standing
ROSC at hospital - Overall
32.4%
Cardiac Arrest Survival to discharge - Overall
7.0%
STEMI – Care bundle
89.4%
Stroke Care Bundle
98.0%
(Full table on slide 7)
Integrated Performance Report
2
Quality – Patient Safety
Serious Incidents
Description
Actual number of incidents (as defined in reporting and investigation of serious incidents
procedure) reported within the month
Analysis
There was 9 SI’s reported in December
Vehicle Cleanliness
Description
The number of audits reaching the cleanliness target of 95%
Analysis
Vehicle cleanliness was at 97.30% for December
Station Cleanliness
Description
The number of audits reaching the cleanliness target of 95%
Analysis
Station cleanliness was at 97.30% for December
Integrated Performance Report
3
Quality – Patient Safety
Number of Emergency Service Complaints
Description
Actual number of Emergency Service complaints received in full calendar month.
Analysis
There was 95 Emergency Service complaints in December
Number of PTS Complaints
Description
Actual number of Patient Transport Services complaints received in full calendar month.
Analysis
There was 47 PTS complaints in December. An increase was seen in relation to the
mobilisation of a new contract in Cambridgeshire. Ongoing discussions with the CCG.
Number of Primary Care Service Complaints
Description
Actual number of Primary Care Service complaints received in full calendar month.
Analysis
There was 0 Primary Care Service complaints in December for the fifth month running
Integrated Performance Report
4
Clinical
Cardiac Arrest ACQI - ROSC
Actions
Description
% of all patients who had resuscitation commenced/ continued by EEAST following an out-ofhospital cardiac arrest who had return of spontaneous circulation (ROSC) on arrival at hospital.
Analysis
Our highest cohort at 102 patients and highest ROSC achieved at 32.4% This is a great achievement
in those patients who have had a return of spontaneous circulation following treatment from our
volunteers and staff. Work continues with staff for cardiac arrest patients, including the Consultant
Paramedic and ACLs reviewing the successes in more detail.
•
•
•
•
•
•
•
Access and review of the OHCA dataset.
Cardiac Arrest Bootcamp developed, initial programme run,
feedback received and planning future training
opportunities.
Discussion with JK surrounding putting on some RC(UK) ALS
courses in house, planning for them to be delivered from
April.
Cardiac arrest strategy being formed through the cardiac
arrest and cardiac care management group.
Cardiac arrest checklist available including on PU and
deployed throughout operations and on stores order.
Pit Stop CPR being delivered on PU, Video has been
produced and in final stages of editing. This will go onto the
Clinical App.
Podcasts produced throughout the cardiac month.
Cardiac Arrest ACQI – Survival to discharge
Description
% of all patients who had resuscitation commenced/ continued by EEAST following an
out-of-hospital cardiac arrest who were discharged from hospital alive
Analysis
Survival to discharge figures have decreased from last month and are just below the national
average. Elements of this bundle are also dependant on factors outside of EEASTs control. The
cardiac care focus that is continuing within the Trust will keep an awareness on these care bundles
in particular.
Actions
•
As above, DA/AR liaising with clinical audit
surrounding formalising an audit in airway
management (with view to improvement in
oxygenation/ventilation and airway management hoping to publish.
•
Review of gaps in Survival to Discharge dataset.
•
Starting to write back to crews who have had a
survival to discharge.
STEMI ACQI – Care bundle
Description
% of all patients suffering a ST elevation myocardial infarction (STEMI) who received an
appropriate care bundle (aspirin, GTN, and analgesia administered and two pain scores
recorded)
Analysis
An ongoing increase in the care bundle compliance which maintains we remain well above the
national average for our care of those suffering from a STEMI. Historically, care bundle compliance
has always been very high, focus on areas of non compliance are undertaken and reviewed allowing
any slip in compliance to be addressed at a local level to ensure sustainability and high performance
is embedded and continues.
Integrated Performance Report
Actions
•
Celebration of achievement against national
average.
•
Monthly review of non-compliance with deep dives
where appropriate to the commissioners feedback provided through ops to individuals
involved.
•
Ongoing monitoring.
5
Clinical
STEMI ACQI – Time to PPCI treatment within 150 minutes
Description
% of all STEMI patients who received primary percutaneous coronary intervention (PPCI)
following direct admission to a PPCI centre whose PPCI treatment took place within 150 minutes
of call.
Actions
•
Staff reminded of short on scene times.
Analysis
Compliance for PPCI being delivered within 150 minutes of the event has decreased. The Trust
remains above the national target however has dropped below the Trust's own average, vital
heart muscle and life-limiting heart attacks are less likely due to the timely transport of these
patients.
Stroke ACQI – Care bundle
Description
% of all patients with suspected new stroke or transient ischaemic attack (TIA) who
receive an appropriate care bundle (FAST assessment, blood pressure and blood
glucose measurement)
Analysis
The compliance against the Stroke care bundle has decreased this month to 98% for a cohort of
around 500 patients. The Trust remains above the national average and is still performing well
against this target, although we will not let ourselves be complacent and will feedback to staff on
how well they are delivering their care in challenging circumstances.
Actions
•
On-going monitoring
•
Access and review of care bundle non compliance
•
Ops are provided with non-compliance for
feedback to clinicians on an individual basis.
•
Detail in CQM.
•
Cardiac themed month in November with lots of
learning opportunities for staff.
Stroke ACQI – Time to HASU within 60 minutes
Description
% of all Face Arm Speech Test (FAST) positive stroke patients potentially eligible for
stroke thrombolysis (within local guidelines) who arrived at a hyper acute stroke
centre (HASU) within 60 minutes of call.
Analysis
The compliance has dropped for the month also dropping below both the Trust and
national average . Work is on going with the wider health system in monitoring
impacts of HASU's closing or changes in hours of operation.
Integrated Performance Report
Actions
•
Close monitoring of missed stroke 60, particularly
within drive zones which are achievable
•
Monitoring of on scene times as this is within the
gift of the clinician
•
Work with EOC on deployment to strokes (sending
a transportable resource)
6
Clinical
n = total patient group
1 = Overall group - Cardiac Arrest patients where resuscitation has been attempted
2 = Comparator group - Cardiac Arrest patients where resuscitation has been attempted, VF/VT arrest, presumed cardiac aetiology, bystander witnesses
3 = PPCI - Primary Percutaneous Coronary Intervention
4 = STEMI Care Bundle - Aspirin, GTN, 2 pain scores, analgesia administered
5 = Stroke Care Bundle - FAST, Blood Glucose and Blood pressure recorded
6 = Asthma Care Bundle - Respiratory Rate, Peak Flow, SPO2 recorded and Salbutamol administered
Integrated Performance Report
7
Clinical
Integrated Performance Report
8
Clinical
CLINICAL PERFORMANCE SUMMARY
Serious Incidents
To date, the Trust has reported 64 Serious Incidents in the 2016/17 financial year. This is a reduction compared to previous quarters but is significantly
higher than the same period in previous years (30 in 2015/16). It should be noted however that the NHS SI Framework now includes a near miss category
which is contributing to the increase in cases. Those cases subsequently downgraded have been removed from the table.
Complaints
Of the 133 complaints received in November 2016, 81 (60%) complaints related to the Emergency Services and 48(36%) complaints related to our Patient
Transport Services.
Ambulance Clinical Quality Indicators (ACQIs)
Four of the eight ACQI targets have been achieved for the month of October 2016. ROSC for both patient categories reduced in October to just below the
respective targets and although PPCI < 150 minutes and Stroke HASU < 50 minutes both increased during this month, they remained below the target of
95.0% and 56.0% respectively.
Safeguarding
Safeguarding referrals have again hit through the 3000 barrier to 3043, a decrease marginally on the previous month due to a shorter calendar month.
However, per 10,000, 999 calls have increased by 4.3% on the previous month and by an outrounding 53% from this time last year.
Medicines Management
The Medicines Management Policy and Standard Operating Procedures are under review and are continuing to be developed working alongside an
appointed Duty Locality Officer (DLO) from each area to work as part of the Clinical Team.
A new member of the team commenced with the Trust at the end of November and an Auditor has also been appointed who will join the team shortly.
The Medicines Management team has continued to participate in the Quality Roadshow visits, and continues to work with staff at stations.
Work continues with the DLO-Medicines Management Leads on the Rule book, which is a work in progress, and two successful Operational Medicines
Management Group meetings have been held since it was developed.
The action plan continues to be a focus to ensure CQC compliance.
Inquests
The Trust received a Preventing Future Death report from Mr Geoffrey Sullivan, Coroner for Hertfordshire, on 17th November 2016 in relation to delays. The
Integrated
Performance
Report
9
Trust responded on 11th January 2017 to outline to the Coroner
the action
the Trust is taking
to improve service delivery.
Clinical
The following annual reports were approved by the
Quality Governance Committee on behalf of the
Board



Safeguarding
Medicines Management
Local Security Management
Integrated Performance Report
10
Performance
Key
Measures
Sub-Section
Comment
Oct
Nov
Dec
Red 1
Red 1 performance continues to be a challenging target with 33%
growth quarter on quarter , 43% year on year. However; EEAST
remains in the top 3 in the national context of reporting Trusts.
December was particularly challenging with the Trust receiving
over 100 R1 calls per day over the Christmas period. All clinical
managers were deployed to Red 1 support .
70.56%
Red 2
Red 2 performance fell slightly during December as expected in
relation to seasonal pressures., however; it also remains a strong
position in the national context.
63.66%
Red 19
Red 19 performance below the 95% national target and marginally
below the November months outturn. Strong in the national
context.
91.37%
92.31%
Demand
(responses)
Overall demand (responses) has risen by over 31% in December
compared to the previous 4 weeks. A significant proportion of the
increase has been seen in the Red categories.
74,122
72,804
78,812
Red Demand
Red demand (responses) have risen again in December to 55% of
all calls received. Over 21 % of our Red volume was from 111
providers with notable spikes on weekends and bank holidays
32,787
31,797
36,924
Hospital Delays
Arrival to Handover hours lost over 15 minutes increased by 28%
during December compared to the previous month. This is
equivalent to 682 ambulance shifts lost in month. Peak delays per
day reached over 500 hours of lost time (ie upwards of 40-50
shifts)
71.47%
65.92%
70.16%
62.22%
91.11%
AtoH
6422
5578
7841
HtoC
2675
2567
2466
EOC – Call pick up
5 second call answering for September was at 91.02% which is
below the 95% target, however; the Trust remains consistently in
the top three for this AQI and is a national leader in the BT tables
for pick ups exceeding 2 minutes. During December the Trust
handled 107,497calls.
90.55%
92.97%
91.02%
Hear & Treat
H&T has significantly improved for December 2016 compared to
the previous month and now sits above the 7% CQUIN target. In
demand growth terms, these represent
significantly
increased
Integrated
Performance
Report
numbers
6.24%
6.89%
7.64%
11
Red 8 Performance (R1/R2)
Overall Red (8minutes) performance for the month of December 2016
was 62.71% which is the highest of the financial year to date and
regularly in the top three nationally.
R8 Performance Monthly
The following factors may have contributed towards this:
• Demand –has been increasing since mid September and
has continued into the period of seasonal pressures with a
notable shift in the share of Red/Green. Red 1 activity
during the month of December was 55% of the total
demand which put extreme pressure on the Trusts ability
to meet the commissioned performance standards. On
27/12/16, the Trust received over 4000 calls in one 24
hour period and of these, 3000 responses were made.
80.00%
75.00%
70.00%
65.00%
60.00%
55.00%
50.00%
45.00%
2015/16
2016/17
National Target
R8 Performance Weekly
80.00%
75.00%
70.00%
65.00%
60.00%
55.00%
50.00%
45.00%
2015/16
2016/17
National Target
• Capacity – UHP has steadily improved in line with the RAP
actions. RRV provision remains high priority focus to
enable us to respond to our most sickest patients fastest.
There are some areas with skill mix challenges making
production to RRV difficult. RRV UHP continues to be
improved and now meets ORH modelled levels. All clinical
managers are providing additional capacity to support
getting to our sickest patients. There continues to be the
high student paramedic abstraction rates in line with the
staffing plans and some of this is offset with PAS provision.
• Efficiency – Average call cycle time has increased for the
trust compared to last year. This is a nationally reflected
position and due to extended hospital delays and on scene
times reflective of a higher percentage of high acuity calls.
A strong focus on keeping rapid response available for
critically ill patients and reducing this from the urgent work
is supporting improvement. A number of efficiency areas
are being focussed upon which reflect improved Red
performance.
12
Red Performance
85.00%
Red 1 Performance Monthly
75.00%
65.00%
55.00%
45.00%
April
May
June
July
August September October November December January
2015/16
2016/17
85.00%
National Target
February
March
Trajectory
Performance in December 2016 dipped slightly for Red 1, Red 2
and Red 19, as expected during the festive period and in line
with national trend.
The Trust continues to get to more Red 1 patients within 8
minutes than before and has kept tail breaches well under 1%
consistently.
It should be noted that the significant increase in high acuity
activity means longer waits for some lower acuity patients.
• Red 1 – 70.16%
• Red 2 – 62.22%
• Red 19 – 91.11%
Red 2 Performance Monthly
75.00%
65.00%
55.00%
45.00%
April
May
June
July
2015/16
August September October November December January
2016/17
100.00%
National Target
February
March
Trajectory
Red 19 Performance Monthly
95.00%
90.00%
85.00%
80.00%
75.00%
April
May
2015/16
June
July
August
2016/17
September
October
November
National Target
December
January
February
Trajectory
March
13
Green Performance
Green 1 Performance Monthly
Green 2 Performance Monthly
95.00%
90.00%
85.00%
80.00%
75.00%
70.00%
65.00%
60.00%
55.00%
50.00%
45.00%
April
May
June
July
August
September
2015/16
October
November December
January
February
March
40.00%
April
May
July
2016/17
August
September
2015/16
Green 3 Performance Monthly
October
November December
January
February
March
2016/17
Green 4 Performance Monthly
95.00%
95.00%
85.00%
85.00%
75.00%
75.00%
65.00%
65.00%
55.00%
55.00%
45.00%
June
April
May
June
July
August
September
2015/16
October
November December
2016/17
January
February
March
45.00%
April
May
June
July
August
September October November December
2015/16
January
February
March
2016/17
14
Demand
Overall Call demand was up +16% in December 2016 compared to the
same month last year. Incident response demand was also up + 5%.
Red 1 calls are up +41.35% in 2016 compared to the same month last
year. Red 2 calls were up by +18.60%
In December 2016 the proportion of red responses to green remained
nearly equal with days when Red demand was significantly higher, this
is a notable shift from the early part of the year. This puts significant
strain on capacity and capability to mange resources proactively and
has an impact on the length of time lower acuity patients have to wait
for a response.
Demand - All Calls & Responses
110,000
100,000
90,000
80,000
70,000
70.00%
Demand - Red Vs. Green Responses
60,000
50,000
50.00%
2015/16 Calls
2016/17 Calls
2015/16 Responses
2016/17 Responses
30.00%
47.34%
46.85%
April
May
June
July
August September October November December January
Red Responses
February
March
Green Responses
Demand - Red 1 Calls
2,800
40,000
Demand - Red 2 Calls
2,300
30,000
1,800
20,000
1,300
10,000
800
2015/16 Red 1 Calls
2016/17 Red 1 Calls
2015/16 Red 2 Calls
Integrated Performance Report
2016/17 Red 2 Calls
15
Capacity
Overall DSA & RRV capacity are up on the previous
year to c80k per week .There remains a fundamental
gap between funded capacity and required capacity to
meet demand. Capacity is impacted by vacancy and
student paramedic abstraction. There is a very strong
focus on increasing RRV cover to modelled levels in
each locality as part of the RAP plan and the R1 sub
action plan which is based around managing our
sickest patients as safely as possible. The use of PAS
remains necessary to ensure patient safety.
Capacity - UHP (DSA & RRV Only)
Capacity - PAS
85,000
14,000
80,000
12,000
75,000
10,000
70,000
8,000
65,000
6,000
60,000
4,000
2,000
55,000
0
50,000
2015/16
2016/17
2016/17 Budget
Integrated Performance Report
2015/16
2016/17
16
Efficiency
Efficiency - Average Job Cycle Time (All Cat)
Conveyed Vs. Non-Conveyed
02:03:50
01:49:26
01:35:02
The Trust continues to focus on the drive to
reduce conveyances and is strong nationally in this
area. However, with the increase in high acuity
demand there will naturally be an increase in
conveyance. The time to discharge from scene or
into an alternative pathway safely also adds time
but supports the system overall.
01:20:38
The Trust continues to actively recruit to the ECAT
(former Clinical Hub) and this will improve our
opportunity to improve on our Hear and Treat
rates which, again, should naturally impact on
conveyance rates.
01:06:14
00:51:50
00:37:26
00:23:02
00:08:38
Conveyed
Non-Conveyed
Efficiency - Responses Per Incident
2.00
1.80
1.60
1.40
1.20
1.00
Red 1
Red 2
Integrated Performance Report
High acuity workload share means that multiple
resource responses are occurring, which in turn
impacts on available capacity. Clinical mangers are
supporting this by responding to Red 1 calls.
Green RPI is marginally higher due to RRV
assignments to Green calls where there has been a
delay in deploying due to demand increase.
Hospital delays lost 682 full ambulance shifts in
December alone, which has a significant impact on
capacity and capability to deliver required
performance standards. There is little evidence
within the wider system that delays will reduce
significantly. During December, delays rose to
levels which required the Trust to be under
significant operational pressure. The Trust
implemented the Safeguarding Life Threatened
Patient protocol and a no send script for a defined
code set during this period under the oversight of
the Trust Medical Director and Gold Commander.
17
EOC
EOC - 5 Second Call Answering % (R1-G4)
100.00%
98.00%
96.00%
94.00%
92.00%
90.00%
88.00%
86.00%
2015/16
2016/17
EOC - 5 Second Call Answering % (Red Vs. Green)
98.00%
96.00%
94.00%
92.00%
90.00%
88.00%
86.00%
Red
Green
Integrated Performance Report
5 Second Call Answering %
Month
2015/1
2016/17
April
99.00%
96.56%
May
98.66%
97.24%
June
98.21%
96.77%
July
96.49%
94.37%
August
95.20%
94.68%
September
94.72%
94.11%
October
94.16%
90.55%
November
94.02%
92.97%
December
95.25%
91.02%
January
94.78%
February
93.96%
March
92.88%
• Call pick up within 5 seconds is
showing a downward trend this
financial year. Call demand is
significantly above plan
• There is increased absence levels
and high numbers of repeat calls
on delayed responses.
• There is sustained pressure on
staff within EOC with the
increase in demand and the
protracted times at highest
surge levels.
18
Hospital Delays
Delays over 15 minutes during December totalled 7841 hours which equals 682 full twelve
hour Ambulance shifts – the following slides show the top 5 contributing hospitals;
19
Tail Breaches - Red
R1 breaches % >30mins
10.00%
9.00%
8.00%
7.00%
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
0.28%
0.30%
0.45%
0.60%
0.21%
0.20%
0.16%
0.22%
R2 breaches % >40mins
0.18%
10.00%
9.00%
8.00%
7.00%
6.00%
5.00%
4.00%
3.00%
2.00%
1.00%
0.00%
0.32% 0.35% 0.34% 0.41% 0.31% 0.22% 0.28% 0.13%
R19 breaches % >60mins
14.00%
12.00%
10.00%
45.00%
12.33%
40.00%
10.97%
10.48% 10.66%
6.00%
4.00%
37.83%
39.58%
40.88%
39.90%
40.18%
41.96%
40.32%
41.60%
36.64%
35.00%
9.18%
8.02%
8.00%
R19T breaches % >60mins
8.93%
8.65%
7.71%
30.00%
25.00%
20.00%
15.00%
10.00%
2.00%
5.00%
0.00%
0.00%
20
Tail Breaches - Green
G1 breaches % >60mins
G2 breaches % >90mins
25.00%
14.00%
11.55%
12.00%
15.00%
8.00%
4.00%
15.57%
9.06%
10.00%
6.00%
19.72%
20.00%
11.97%
6.20%
3.68%
2.81%
3.68%
2.16%
9.92%
10.00%
2.79%
2.75%
6.71%
5.18%
6.86%
5.00%
2.00%
0.00%
0.00%
G3 breaches % >120mins
20.00%
18.00%
16.00%
14.00%
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
12.56%
11.22%
G4 breaches % >120mins
12.41%
7.86%
4.00%
5.29%
3.09% 3.11%
4.51%
5.51%
8.91%
20.00%
18.00%
16.00%
14.00%
12.00%
10.00%
8.00%
6.00%
4.00%
2.00%
0.00%
12.34%
12.21%
8.88%
7.74% 8.18%
10.25% 9.52%
11.28%
8.21%
21
Operations Summary
•
In summary, December and in particular the festive season has seen EEAST experience
exceptionally high call demand, with particular spikes on weekends and bank holiday related to
transferred demand relating to primary care.
•
Extended hospital handover delays led to decisions to enact patient safety mitigating actions.
•
Some acute Trusts declared major incidents and the Trust was engaged in system support.
•
EEAST put in place full command structures to manage over this period.
•
There were prolonged periods of use of the surge plan at levels red and black.
•
PAS capacity was increased at financial risk to support these challenges.
•
The Operations Team continues to meet with our Commissioner leads bi-weekly to provide
assurance, share information on performance and challenges openly and convey key messages.
22
Patient Transport Service
Arrivals - Early or up to 30mins later for Appointment
97.00%
% patients arriving any
time prior to
appointment
96.00%
95.00%
94.00%
The target percentage
is 95%
93.00%
April
May
June
July
August
September October November December
2015/16
January
February
March
2016/17
Collections
95.00%
90.00%
% of patients collected
within 60 minutes of
scheduled made ready
time
85.00%
80.00%
75.00%
April
May
June
July
August
September
2015/16
October
November
December
January
February
March
The target percentage is
95%
2015/16
Time on Vehicle
100.00%
90.00%
Time on vehicle should
not exceed 90 minutes
Analysis
The data provides an overall
view of PTS performance
however has not been broken
down by contract. PTS have
30 contracts all with different
KPI’s, some having no KPI’s at
all. Whilst some KPI’s will be
common, such as vehicle
cleanliness and access to
hand gel, others will be
contract dependent. For
example West Essex contract
arrival standard is “90% of
patients shall arrive on time
or up to 60 minutes before
the appointment”. The Suffolk
contract states “90% of
patients to arrive between 60
minutes before and 10
minutes before the
appointment time”. North
Essex is “85% of patients on
time or up to 60 minutes
before”. Gt Yarmouth and
Waveney require “98% to
arrive at or prior to their
appointment time”. As such it
is impossible to determine a
single reporting KPI on the
Trust PTS performance”
80.00%
The target percentage is
95%
70.00%
60.00%
April
May
June
July
August
September
2015/16
October
November
2016/17
December
January
February
March
23
Workforce
TURNOVER
Turnover is monitored on a monthly basis using the principle described below.
Currently the whole trust rolling year turnover is at 7.59% which equates to an
average 29.02 wte staff leaving the Trust per month. A&E Turnover is at 6.17%
which equates to on average 14.31 wte A&E staff leaving the Trust per month. A&E
Monthly Turnover is now moved out of downward trend
NOTE: Staff leaving via a TUPE are not included for the purposes of calculating
turnover
DEFINITIONS:
Employee turnover refers to the proportion of employees who leave an organisation
over a set period (often on a year-on-year basis), expressed as a percentage of total
workforce numbers.
CIPD.(2014). Employee turnover and retention. Available: https://www.cipd.co.uk/hrresources/factsheets/employee-turnover-retention.aspx. Last accessed 20th May
2015.
SICKNESS
In trend terms sickness is currently running as seasonably expected and it
should be noted that the next 1-3 months will see the usual seasonal upturn . Dependant on the size and extent of the up-turn we could be
heading for a year end average position similar or slightly higher than last
year . The Trust undertakes a constructive and consistent focus on
managing sickness absence, both long and short term. This is supported
by comprehensive questioning from Day One* clinicians towards the staff
who call in and a targeted approach from Occupational Health in
conjunction with line managers & HR in relation to chronic sick absence
cases.
Appraisal & Development Review (ADR)
EEAST's Appraisal & Development Review (ADR) process is an important
workforce tool which allows for meaningful dialogue about work
performance, development and career aspirations between an individual
and their manager. The ADR takes place over and 12 month cycle
individual to each individual member of staff, therefore compliance is
recorded over a rolling 12 months. The graph shows the % of staff
compliant at the month end. The end of year Target is 95%
NOTE: Operations support is now shown under Shared Support
Integrated Performance Report
24
Workforce – Statutory/Mandatory Training
Mandatory Training
Delivery of Mandatory training as currently via by the Mandatory
Workbook, and is delivered on a twelve month cycle. When a member of
staff successfully completes their Mandatory Workbook they will be
compliant for twelve months from that point. Therefore the graph show
details of the percentage of staff that have completed it during the
preceding 12 months.
Professional Update (PU)
The length of cycle for delivery of the Professional Update programme is 18 months (from the previous 12 months). This decision has been taken to
accommodate the increased training commitment that the Trust has made to new Student Paramedics and the Senior Paramedic and Senior EMT
programmes.
Integrated Performance Report
25
Workforce – Vacancies & Sickness
A&E Frontline Vacancies
Dec-16
Positions
Afc Band
ECPs
Sups, Sen Paras, Paras & Student Paras
Sen Techs, Techs, AAPs, ECAs, IAPs & HRCs
Total
6
6&5
5, 4 & 3
Budgeted
Establishm ent
149.72
1682.32
904.48
2736.52
Finance
Adjusted Staff
in post
59.97
1776.46
775.24
2611.67
Vacancies
89.75
-94.14
129.24
124.85
Vacancies (ORH
Establishment)
603.63
-217.66
362.66
748.63
VACANCIES
This graph shows the Trust's current month's vacancy rates
by function. It should be noted that Locality vacancies in
this graph cover all A&E staff.
The known challenges of recruiting into Hertfordshire and
large swathes of Essex are reflected in these
figures. Additionally it is hoped that future recruitment to the
Associate & Intermediate Practioner roles will start to
address vacancies in the non registered staff element of the
skills mix in A&E
Integrated Performance Report
26
Workforce – Vital Signs
Integrated Performance Report
27
Special Operations & Resilience
Local Resilience Forum (CCA)
. 56 regional LRF meetings engaged with
. 11 multi agency exercises completed
since
. Senior management engagement with
strategic groups have improved
EPRR Framework
. First sight of the draft EPRR changes to
the Ambulance Service Framework
The Trust has replied with comment on
the draft document
Business Continuity
. Work continues to gain compliance with
the ISO standard
. New sign off process in place to assist
with Business Impact Assessment
delivery
. BC plans across all areas still awaiting
completion and testing
JESIP
.
3 JESIP regional meetings have taken
place
. Strategy being worked through around
delivery of refresher command training
. National JESIP team visiting the Trust in
February 2017
. Actions in place to address all
outstanding issues
Integrated Performance Report
28
Special Operations & Resilience
HART Team incidents Attended
Air Operations incidents Attended
•
HART responses include:– Safe Working At Height
– Water related
– Confined Space
– Chemical Incidents
– Explosive Incidents
– Support to frontline crews
– Assistance to conventional 999 calls whilst
remaining available for HART incidents
•
Air Operations responses include assets from all
three HEMS charities
Deployments include those where a team deploy by
car as well as the Air Ambulance incidents
An increase in deployments was seen in November
EAAA is currently running a trial for new CCP only
car on night shifts out of the Norwich location
EHAAT is currently running a trial for a night/late car
on Friday and Saturday shifts
•
•
•
•
HART compliance with KPI availability requirements
•
The key requirement is to ensure a full team of six is
deployed for each HART team, this is impacted by
short notice sickness on occasion
•
Mitigation is provided utilising the HART managers
or members from the training teams whenever
possible to ensure the live team maintains at the
required levels
Integrated Performance Report
29
Special Operations & Resilience
MTFA Trained Staff
•
The Trust meets the specified requirement to provide
63 MTFA trained additional staff.
•
Presently we are unable to increase this to 100 as
per the Trust Board request due to insufficient staff to
deliver the training and financial constraints.
However plans are in place to recruit and train further
members of the team from April 2017 to bring it to full
strength
HART Training Compliance
Existing Staff
New Staff
Staff
Training
Grade
Breathing Apparatus
Completing IRU Course
Ballistic Training
Water Training
Safe Working at Height
Confined Space
Ballistic Training
Water Training
Safe Working at Height
Confined Space
PU Training
Breathing Apparatus
CR1 and PRPS
Training
Planned
Summer 2017
Winter 2016
Summer 2017
Summer 2017
Autumn 2016
Spring 2017
Spring 2017
% of Staff
who have
completed
Training
100%
100%
100%
78%
100%
100%
100%
93%
100%
81%
98%
91%
100%
Mop Up Course Planned
for
n/a (national initial course)
n/a (national initial course)
n/a (national initial course)
January 2017
January 2017
January 2017
January 2017
Integrated Performance Report
30
Finance
Integrated Performance Report
31
Item 8i.
TRUST BOARD
(Public Session)
25th January 2016
AGENDA ITEM
Report Title:
Finance Report – Month 09, December 2016
Report Author(s):
Heather Madden, Head of
Finance
Decision
Purpose:
8i
Sponsoring Kevin Smith, Director of Finance &
Director:
Commissioning
Assurance
For Information Disclosable
X
Non-Disclosable
Executive Summary:
The Trust had a deficit for the month of December of £(0.4)m against the planned position for a surplus of
£0.5m. This position includes estimated RAP income for the three quarters of the financial year so far at
£6.4m of which £0.8 is for M9, December.
This brings the YTD deficit for the 9 month period to £(6.2)m against the planned surplus of £1.6m. This gives
a budgeted deficit of £(7.8)m.
The Trust has amended its forecast out turn at M9. At the time of writing this report this would be an increase
in the predicted deficit from £(6.2)m to £(10.6)m. However, the level of income underpinning this figure
remains under discussion. This change in forecast has been communicated to NHSI via the M9 key data
return which was submitted on 17 January 2017.
Principle adverse variances:
1. PAS £(0.8)m over budget for the Trust in December, cumulatively £(10.9)m over budget (Emergency
Operations £(10.2)m and PTS £(0.7)m).
2. Emergency Operations Front line agency staff costs are £(0.3)m for the month, £(1.7)m for the 9
months to December 2016.
3. CIPs are progressing although patient facing work pressure has slowed some elements. The Trust is
£(0.9)m behind target for 9 months. £4.1m achievement for the 9 months. The full year target is
£6.7m.
4. PTS continues with a small deficit to plan in the month, cumulatively now at £(0.5)m ytd, but the
position is improving with focused management action.
5. Primary Care remains with the deficit to budget of £(0.1) due to the use of bank staff.
6. Additional Legal and professional costs are £(0.5)m over budget for the Trust.
Principle favourable variances:
7. Additional activity over contract, £0.1m for December for Emergency Operations, £1.8m YTD.
8. RAP Income at £0.8m for December, £6.4m YTD.
Other Key Issues to Draw to the
Trust Board’s Attention:
RAP – The Trust has now reached agreement with Commissioners for
funding towards the RAP. The funding mechanism is shown in detail at
Appendix 1. The Trust only receives 83p of every £1 spent which makes
achievement of CIPs even more important. The Trust has significantly
curtailed its use of PAS due to the deficit financial position, but some PAS
is still being engaged for patient safety issues. The Trust has an appeal
for additional RAP income outstanding with regulators and it is hoped a
decision will be communicated to the Trust imminently. Any additional
The RAP is
income would improve the deficit forecast to the Trust.
designed as a temporary stopgap whilst the Trust negotiates on its
capacity gap and the new operating model.
Expenditure for the 9 months on PAS and agency staff for Emergency
operations sits at a total of £(11.9)m. The RAP income received for
quarter 1 was £1.6m, quarter 2, £2.4m and this, together with the
estimated income for quarter 3 gives a total so far of £6.4m. The OctoberDecember income of £2.4m is included in the position.
Item 8i.
EOCs, PTS, Workforce, Special Operations, Primary Care and Patient
Safety all now have issues to be addressed as stated in the Executive
summary below –
The EOCs have a budgeted deficit at Month 9 of £(0.5)m.
PTS shows a budget deficit at M9 of £(0.5)m.
Workforce has an issue on legal fees and the PAM contract
with expenditure currently £(0.3)m adrift of budget.
Primary Care has a budget deficit of £(0.1)m due to the use of
bank staff, overtime and additional hours.
CQUIN - £3.8m of the CQUIN costs are towards the set-up of the Clinical
Hub. The Trust has so far spent £(1.7)m and we have accrued income at
this level. The remaining 20% of the CQUIN is for national schemes
around the flu prevention programme and staff wellbeing programmes.
These are currently being worked upon
Activity – Activity is above contract by overall with some wide variations
across different CCGs. This has generated £1.8m of additional income.
The activity schedule is shown at Appendix 2.
Action Required by the Trust Board:
The Trust Board is asked to note the financial position.
Related Trust Strategic Objective(s):
All
Previously Considered By and Recommendation(s) Made:
Not previously considered.
Legal Implications/Regulatory
Requirements:
Report dated 17 January 2016
None
2
Item 8i.
1.
Executive Summary
The tables below show the key financial measures for the organisation including discussion on current and forecast performance together with a RAG
rating of the position. Further detail is provided in the sections below.
Key Performance Indicators to 31st December 2016 (Month 9 FY15/16)
KEY PERFORMANCE INDICATORS
KPI
Relevance of indicator
Year to date position
Opening
plan
Current
Plan
YTD RAG
Rating
F/cast
Outturn
Plan
Actual
Variance
238.8
179.3
185.9
6.6
247.7
1
Turnover £m
234.9
2a
EBITDA £m
8.7
8.7
7.0
(0.3)
(7.3)
(2.8)
2b
EDITDA %
3.7%
3.6%
3.9%
(0.1%)
(4.0%)
(1.1%)
3a
Surplus £m
1.5
1.5
1.6
(6.2)
(7.8)
(10.6)
3b
Surplus %
0.6%
0.6%
0.9%
(3.3%)
(4.2%)
(4.3%)
4
CIP £m
6.7
6.7
5.0
4.0
(1.0)
4.9
5a
Pay £m
169.5
175.4
131.0
132.1
(1.1)
178.5
5b
WTE
4,518
4,518
4,518
4,237
(281)
4,090
5c
Non-Pay £m
56.7
54.8
41.2
54.1
(12.9)
72.0
6
Capital budget £m
8.5
8.5
6.4
1.6
(4.8)
7.2
7a
Cash balance £m
16.8
16.8
17.4
6.0
(11.4)
1.4
7b
Debtors >90 days £m
0.2
0.2
0.2
0.1
(0.1)
0.2
7b
BPPC % Non-NHS
95.0%
95.0%
95.0%
88.9%
(6.1%)
95.0%
8
Rate of return %
Asset utilisation
3.5%
3.5%
3.5%
3.5%
0.0%
3.5%
9
Continuity of Services Rating
Risk rating
Delivery of revenue plan
Delivery of capital plan
Management of working capital
3
3
Item 8i.
Executive Summary of Performance - December 2016
Key Measure
Summary of Performance
Current
Month
Cumulative
Position
The Trust has a deficit of £(6.2)m for the nine months, three quarters, of the financial year, 2016/2017.
This is against the planned position for a surplus of £1.6m - an adverse variance to the plan of
£(7.8)m.
Significant contributing items to the position are as follow s:Expenditure
1. PAS usage in Emergency Operations. The expenditure for December was £(0.7)m. This additional
expenditure which was approved by the Trust Executive in order to engage additional resource towards
improving Trust Performance was significantly curtailed in December due to the adverse financial position of
the Trust. This expenditure still falls under the terms the RAP and income for Q1 at £1.6m and Q2 at £2.4m
income has been agreed and invoiced. This did not cover all costs as the for the final agreement as EEAST
has to contribute the contingency(£1.2m) and budgeted surplus (£1.5m). This works out at a ratio of 83:17, so
for every £1 spent EEAST receives 83p. The RAP is based on R1 trajectories. If the trajectory for a Quarter is
not achieved, then the level of additional activity is considered (above 6% year on year) together with a
schedule for hear and treat performance. For the third quarter the estimation is that the terms of the RAP will
yield £0.8m income (October), £0.9m (November) and £0.8m for December, a total for the quarter of £2.5m.
PAS and agency expenditure for the quarter has been £4.5m.This is an estimation at this point based on the
performance and this amount has been accrued into the position. This needs to be confirmed and agreed with
CCG colleagues and then we will raise the invoices.
More flexibility over the use of PAS was able to be
included in the procurement for PAS for December and a lower expenditure of £(0.7)m was incurred. PAS
continues to be engaged due to patient safety concerns.
2. EOC has a further deficit to budget for Month 9 of £64k, cumulatively the deficit to budget now stands at
£515k. Costs of spoilt meal breaks continue to be a problem as they continue to accumulate with an
expenditure of £(89)k in December. Overtime incurred in December was £(81)k, an small increase from
November.
Actual Deficit
Item 3
3. NES has a surplus for M9, December of £78k. This is a budgeted deficit of £(14)k for the month, giving a
budgeted deficit for the year so far of £(465)k. This continues to be due to the costs of PAS and taxis. Month
9 sees expenditure for taxis of £(74)k and for PAS £(174)k against a combined budget for the 2 items of £90k.
There is some extra income towards these costs and their usage has declined since M8 which shows
progress from the plans from the Head of Service for NES. The team are working hard to rectify issues and get
the Directorate back into a regular surplus.
4. The Workforce Directorate has a further deficit to budget at Month 9 of £(113)k, with a cumulative deficit to
budget position rising to £(329)k. The deficit is due the costs of legal fees which are now cumulatively £(220)k
over budget.
The legal fees budget was identified as a cost pressure for 2016/2017, but no funds were
available to cover this pressure. Workforce staffing also show an adverse variance to budget, cumulatively at
£(87)k, with additional support engaged in recruitment. A further issue this month is an overspend on our PAM
contract. However since the end of the month some costs for well being have been identified as relevant to the
CQUIN and so will be transferred in January's accounts.
£(0.4)m
£(6.2)m
5. Strategy and Sustainability shows a surplus for M9 of £33k to budget. This is a return to surplus from the
deficit in M8.
SAS retains a cumulative surplus, now at £279k.
A continuing cost pressure is for datapoint
licences which were raised as a cost pressure for the year, but remained unfunded.
4. Trust CIP. The CIP target for the Trust for 2016-2017 is £6.7m. There was initially £4.1m of schemes
towards this target provisionally identified, with the remaining £2.6m still outstanding. £0.4m of this £2.6m has
been top sliced from budgets. Nine months of our target, £4.9m, has fed into the financial position. We have
achieved £4.0m so far towards our target. Plans to cover the unidentified amount have been progressing and
the Trust is now part of the Financial Improvement Programme (FIP) with NHSI and SSG Healthcare have
commenced work on opportunity identification and projections for potential savings.
5. CQUIN. We are still working with Commissioners on the Clinical Hub and have spent £(1.7)m for the 9
months ytd. We have accrued the appropriate level of income from commissioners for these costs for M9.
The remaining 20% of the CQUIN is for national schemes. Terms are agreed with the lead Commissioner and
expenditure is progressing at pace now. More costs have been identified and will be updated for January's
accounts.
6. Primary Care. Due to the use of bank staff above funded establishment, Primary Care has a budgeted
deficit of £(86)k. The deficit has risen from Month 8 and is due to the costs of additional staffing.
7. CEO. This budget has a deficit to budget of £(231)k due to additional costs of pay, expenditure with ORH
and some legal costs.
4
Item 8i.
Executive Summary of performance – December 2016 continued (2 of 3)
Income
Income in total shows a favourable variance in M9. The income for M9 was £21.2m on a budget of £20.5m, so
a favourable variance of £0.7m.
1. CCG contracted Income is lower than budget in Emergency Operations for the month of December, by a
small £30k deficit. RAP income needs to be verified by CCGs and then the Trust will invoice for payment.
Income due to additional activity increased in December so the ytd total increased to £1.8m in Emergency
Operations with another £0.2m in PTS, so £2.0m in total.
2. CQUIN. The Clinical Hub CQUIN is for 80% of the full CQUIN value at £3.9m. We have accrued income up
to the level of expenditure for the nine months for the Clinical Hub at £2.3m. The National schemes cover the
Income Surplus to
remaining 20% of the CQUIN value and relate to two items. Firstly the Flu vaccinations and then staff
Budget
wellbeing. We are progressing well on these schemes and £0.3m income has been included in the M9
Item 4
position. more costs have been identified and will be allocated in the January accounts.
3. HEE (Health Education East of England). A large proportion of this income will be invoiced on student
numbers. We have an agreement for funding for 228 SAP students in 2016-17 and we are invoicing HEE on
the schedule of when students are actually starting their courses with us. We also had agreement for £1m of
infrastructure costs which has been paid. This gives a slight surplus position for HEE with £2.5m income
currently included in our financial position. We anticipate to break even on this matter.
£0.7m
£6.6m
4. NES has additional non-contracted income in December for ECRs. NES therefore has £0.6m favourable
variance on income ytd. This should cover the additional cost of this activity but the PAS and taxi costs are
currently exceeding the income achieved leading to the £0.5m deficit to budget position.
Expenditure was £(21.6)m for December 2016. This was against the budget of £(20.0)m, so a significant
£(1.6)m adverse variance. The items contributing to this position are described at Item 3 above. Additional
PAS, overtime and frontline agency staff remain the main contributing factors to the adverse variance position
to plan for the Trust. Additional PAS continues in Emergency Operations, but has been reduced and is more
Expenditure Deficit controlled since 1 December when the 5 month mini tender ended. The RAP income is not covering all costs
so CIPs have become more critical, and recent progression on CIPs has been reasonable. Trust performance
to Budget
for December means the Trust is eligible for a proportion of the RAP income for the quarter and this is in
Item 5
verification mode with the CCGs prior to the Trust issuing invoices. The income has been accrued into the
position. Performance is monitored constantly to make sure the Trust has the best chance possible of
gaining the income available, and costs are under heavy scrutiny to make sure the Trust receives the best
possible value for money that it can.
£(1.6)m
£(14.4)m
5
Item 8i.
Executive Summary of performance – December 2016 continued (3 of 3)
Statement of
Financial
Position
Item 6
Cash
Item 7
Capital
Item 8
Financial Risks
Item 9
Overall the Trust's Statement of Financial Position remains stable. NHSI have changed the ratio that they look
at from "Financial Sustainability Risk Rating" ratio to "Use of Resource" metric, as a result of the Single
Oversight Framework being published. This metric is rated out of 4, 1 being the highest score and 4 being the
lowest score. The Trusts Use of Resource rating remains at 3 YTD and Forecast.
There are some movements in current assets notably in cash (see below) and current liabilities compared to
the plan, however other than cash none of these are considered a major risk.
Cash balances stand at £6.0m which is below plan. Cash is being reviewed continually and the following
steps are in place to maximise our cash balance: reduce pay runs to two weekly (to be timed so after
receiving SLA income from CCG), review non urgent capital work & increase our current efforts in credit
control. Cash management steps are continuing.
Capital expenditure increased by £426k for the month to £1,670k YTD. This is behind plan however this is due
to temporary delays and it is forecast that we will meet our CRL of £7.2m.
Our forecast has increased from £7.1m to £7.2m as a result of securing additional funds from the DoH for
mental health street triage vehicles for the Bedfordshire multi-agency project. This is a 2 year scheme totally
£200k.
The forecast for December has increased for the year to a deficit of £(10.6)m. The Performance and Finance
Committee met on 11 January to consider the forecast for the Trust and the key data return to NHSI on 17
January has included the new forecast for a £(10.6)m deficit. The Trust still has an appeal outstanding with
regulators which requests factors be considered that are outside the control of the Trust when calculating RAP
income due from CCGs. The forecast position will be altered if there is a positive outcome to this appeal. The
original plan for the Trust was set for the control total target from NHSI for a surplus of £1.5m. The deficit to
this plan is down to the additional expenditure on additional resource towards the RAP comprising of costs
incurred between April-December and those forecast for January to March 2017. The income for Quarters 1 &
2 and the income due for quarter three is included in the overall position. A further risk remains for the Trust
due to the challenging £6.7m CIP target for the Trust. This target was set after reducing all budgets wherever
possible from last year and recently progress has been good up to M9 with achievement of £4.0m against the
nine month target of £4.9m. The Trust is now part of the NHSI FIP (Financial Improvement programme) and
SSG Health have commenced work on CIP identification with the Trust. With the Trust currently focusing all
possible resource towards front line operations, there is a risk that other work, such as CIP progress may slip
behind target.
As mentioned above, The Trust has a significant CIP target of £6.7m for the 2016-17 financial year, but
Cost Improvement following the meeting of 20 October progress was good with additional work streams coming on line which
Plans
achieve additional savings for the Trust. SSGHealth have now started work at the Trust and it is hoped they
Item 10
will identify opportunities to push CIP achievement further.
£4.0m
£4.9m
6
Item 8i.
Key Financial Metrics
Month 9 - December 2016
Description
Plan
£000
Surplus
Supplier Days (No. Invoices paid)
Suppliers paid within 30 days - NHS
Suppliers paid within 30 days - Non NHS
Actual
£000
Year to Date
Variance
£000
Plan
£000
Actual
£000
Variance
£000
Plan
£000
Forecast
£000
Variance
£000
494
(417)
(911)
1,621
(6,212)
(7,833)
1,500
(10,624)
(12,124)
95%
95%
62%
90%
(33%)
(5%)
95%
95%
86%
89%
(9%)
(6%)
95%
95%
95%
95%
0%
0%
3
Financial Sustainability Risk Rating
Operating Surplus
3,000,000
FY 2016/17
3
Cash Balance
25,000,000
2,000,000
1,000,000
20,000,000
0
(1,000,000)
Apr-16
May-16
Jun-16
Jul-16
Aug-16
Sep-16
Oct-16
Nov-16
Dec-16
Jan-17
Feb-17
Mar-17
15,000,000
(2,000,000)
(3,000,000)
10,000,000
(4,000,000)
5,000,000
(5,000,000)
(6,000,000)
0
(7,000,000)
Apr-16 May-16 Jun-16
2016-17 Actual
Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17
2016-17 Plan
2016-17 Actual
2016-17 Plan
7
Item 8i.
2.
Statement of Comprehensive Income
Month 9 - December 2016
Plan
£000
Actual
£000
Variance
£000
20,014
437
20,451
19,899
1,266
21,165
(115)
829
714
(14,759)
(4,599)
(19,358)
(14,892)
(5,667)
(20,559)
(133)
(1,068)
(1,201)
1,093
5.3%
606
2.9%
(487)
(68.2%)
(495)
(100)
4
(8)
0
(599)
(507)
(125)
6
(8)
(389)
(1,023)
(12)
(25)
2
0
(389)
(424)
494
2.4%
(417)
(911)
(2.0%) (127.6%)
Year to Date
Description
Plan
£000
Income
Revenue from patient care activities
Other Operating revenue
Subtotal
Operating Expense
Pay
Non Pay
Subtotal
EBITDA
EBITDA margin
Depreciation & Financial
Depreciation
PDC Dividend
Financing Income
Financing Costs
Other Gains & Losses
Subtotal
Net Surplus/(Deficit)
Actual
£000
Variance
£000
g
Plan
£000
FY 2016/17
Current Plan
£000
Forecast
£000
Variance
£000
176,084
9,803
185,887
753
5,853
6,606
229,888
5,009
234,897
233,558
5,259
238,817
234,564
13,116
247,680
1,006
7,857
8,863
(131,042) (132,103)
(41,234) (54,060)
(172,276) (186,163)
(1,061)
(12,826)
(13,887)
(169,523)
(56,696)
(226,219)
(175,365)
(54,774)
(230,139)
(178,537)
(71,987)
(250,524)
(3,172)
(17,213)
(20,385)
175,331
3,950
179,281
7,005
3.9%
(276)
(0.1%)
(7,281)
(110.2%)
8,678
3.7%
8,678
3.6%
(2,844)
(1.1%)
(11,522)
(130.0%)
(4,454)
(900)
38
(68)
0
(5,384)
(4,583)
(925)
23
(68)
(383)
(5,936)
(129)
(25)
(15)
0
(383)
(552)
(5,938)
(1,200)
50
(90)
0
(7,178)
(5,938)
(1,200)
50
(90)
0
(7,178)
(6,100)
(1,225)
18
(90)
(383)
(7,780)
(162)
(25)
(32)
0
(383)
(602)
1,621
0.9%
(6,212)
(3.3%)
(7,833)
(118.6%)
1,500
0.6%
1,500
0.6%
(10,624)
(4.3%)
(12,124)
(136.8%)
8
Item 8i.
3. Divisional Expenditure
Divisional Expenditure
Month 9 - December 2016
Plan
£000
Actual
£000
10,584
1,417
702
1,483
32
14,218
11,804
1,483
680
1,604
50
15,621
(1,220)
(66)
22
(121)
(18)
(1,403)
204
252
73
3,241
230
732
602
99
470
(217)
57
5,743
210
556
75
3,204
343
727
640
0
212
0
0
5,967
(6)
(304)
(2)
37
(113)
5
(38)
99
258
(217)
57
(224)
19,961
21,588
(1,627)
20,455
21,171
716
494
(417)
(911)
Plan
£000
Service Delivery
Emergency Operations
EOCs
Special Operations
Patient Transport
Primary Care
Subtotal
Support Services
Chief Executive
Financial
Commercial Services
Strategy & Sustainability
Workforce & OD
Patient Safety
Depreciation
CQUIN - National
CQUIN - Clinical Hub
Unallocated CIP
Trust Reserves
Support Services (inc. Reserves)
TOTAL
Income Memorandum
Net Position Memorandum
FY 2016/17
Year to Date
Description
Variance
£000
Actual
£000
Variance
£000
Original Plan Current Plan
£000
£000
Forecast
£000
Variance
£000
95,326
12,748
6,424
12,902
285
127,685
108,039
13,266
6,436
13,977
381
142,099
(12,713)
(518)
(12)
(1,075)
(96)
(14,414)
127,059
17,011
8,322
13,662
378
166,432
127,073
17,000
8,531
17,352
380
170,336
144,473
17,843
8,538
18,903
483
190,240
(17,400)
(843)
(7)
(1,551)
(103)
(19,904)
1,874
2,303
683
28,807
2,053
6,476
5,391
295
2,428
(1,600)
1,303
50,013
2,106
2,479
657
28,647
2,404
6,474
5,575
16
1,665
0
0
50,023
(232)
(176)
26
160
(351)
2
(184)
279
763
(1,600)
1,303
(10)
2,616
2,926
1,087
38,652
2,754
8,578
7,228
1,074
0
(2,600)
4,700
67,015
2,487
3,061
904
38,544
2,742
8,672
7,198
591
3,882
(2,250)
1,200
67,031
2,783
3,247
849
38,297
3,684
8,879
7,415
136
2,792
0
0
68,082
(296)
(186)
55
247
(942)
(207)
(217)
455
1,090
(2,250)
1,200
(1,051)
177,698
192,122
(14,424)
233,447
237,367
258,322
(20,955)
179,319
185,910
6,591
234,947
238,867
247,698
8,831
1,621
(6,212)
(7,833)
1,500
1,500
(10,624)
(12,124)
9
Item 8i.
4. Statement of Financial Position
Statement of Position
Non Current Assets
Property, Plant & Equip
Investment Property
Trade & Other Receivables
Total Non Current Assets
Current Assets
Inventories
Trade & Other Receivables
Cash & Cash Equivalents
Total Current Assets
Total Assets
Current Liabilities
Trade & Other Payables
Provisions
Net Current Liabilities
Mar-16
Oct-16
Nov-16
Dec-16
Actual
£000
Actual
£000
Actual
£000
Actual
£000
Dec-16
Plan
£000
Variance
£000
%
45,715
880
0
46,595
42,990
880
0
43,870
42,883
880
0
43,763
42,729
880
0
43,609
46,024
880
0
46,904
(3,295)
0
0
(3,295)
(7.16%)
0.00%
1,305
20,488
17,015
38,808
1,204
23,821
3,910
28,935
1,173
18,831
8,025
28,029
1,159
18,569
6,038
25,766
1,875
18,326
17,435
37,636
(716)
243
(11,397)
(11,870)
(38.19%)
1.33%
(65.37%)
(31.54%)
85,403
72,805
71,792
69,375
84,540
(15,165)
(17.94%)
(30,652)
(1,122)
(31,774)
(22,684)
(2,177)
(24,861)
(23,170)
(2,112)
(25,282)
(21,183)
(2,100)
(23,283)
(30,000)
(1,750)
(31,750)
8,817
(350)
8,467
(29.39%)
20.00%
(26.67%)
(7.02%)
Non Current Assets plus/less current
assets/Liabilities
Non Current Liabilities
Provisions
Total Non Current Liabilities
53,629
47,944
46,510
46,092
52,790
(6,698)
(12.69%)
(5,061)
(5,061)
(3,736)
(3,736)
(3,736)
(3,736)
(3,736)
(3,736)
(4,250)
(4,250)
514
514
(12.09%)
(12.09%)
Total Assets Employed
48,568
44,208
42,774
42,356
48,540
(6,184)
(12.74%)
64,591
(16,441)
1,831
(1,413)
48,568
64,591
(20,794)
1,823
(1,413)
44,207
64,591
(22,227)
1,823
(1,413)
42,774
64,591
(22,642)
1,820
(1,413)
42,356
64,591
(16,530)
1,892
(1,413)
48,540
0
(6,112)
(72)
0
(6,184)
0.00%
36.98%
(3.81%)
0.00%
(12.74%)
Financed by Taxpayers Equity
Public Dividend Capital
Retained Earnings
Revaluation Reserve
Other Reserves
Total Taxpayers Equity
10
Item 8i.
5.
Cash Flow Statement
In Month Movement
Opening Balance
Operating Surplus
(Increase)/decrease in current assets
(Increase)/decrease in current liabilities
(Increase)/decrease in provisions
Cash inflow/outflow from operating
activities
Returns on investments and servicing
finance
Depreciation & amortisation
Capital Expenditure
Impairments and reversals
Proceeds from disposal of plant,
property and equipment
Dividend paid
Cash inflow/outflow from financing
Movement
Closing Cash Balance
YTD Move
YTD Plan
Variance
Oct-16
Nov-16
Dec-16
Dec-16
Dec-16
Dec-16
Actual
£000
Actual
£000
Actual
£000
£000
£000
£000
5,200
3,910
8,025
17,015
17,015
0
(1,367)
237
(656)
0
(573)
4,276
1,250
(65)
98
276
(3,196)
(12)
(4,859)
790
(7,183)
(347)
2,477
1,079
482
(1,005)
(7,336)
(289)
(7,665)
658
(1,786)
4,888
(2,834)
(11,599)
3,033
(14,632)
0
506
(10)
0
(2)
507
(678)
0
6
507
(915)
0
23
4,583
(4,642)
45
4,221
(6,372)
0
(22)
362
1,730
0
0
0
0
(600)
649
600
658
0
(507)
658
507
496
(773)
847
622
(2,613)
3,235
(1,290)
4,115
(1,987)
(10,977)
420
(11,397)
3,910
8,025
6,038
6,038
17,435
(11,397)
11
Item 8i.
6.
Capital Expenditure
Month 9 - December 2016
Plan
£000
Actual
£000
48
273
150
71
500
0
1,042
192
855
22
0
0
0
1,069
(144)
(582)
128
71
500
0
(27)
0
0
(684)
(684)
684
684
1,042
385
657
Year to Date
Description
Variance
£000
Actual
£000
Plan
£000
Capital Expenditure
IT Projects
*1 Make Ready Projects
*2 Other Building Projects
Plant & Equipment Projects
*3 Transport Projects
General Reserve
Subtotal
Plan
£000
Forecast
£000
Variance
£000
431
2,456
1,350
639
1,500
0
6,376
229
1,042
269
50
723
0
2,313
202
1,414
1,081
589
777
0
4,063
575
3,275
1,800
850
2,000
0
8,500
414
2,182
1,202
458
1,521
2,135
7,912
161
1,093
598
392
479
(2,135)
588
0
0
(684)
(684)
684
684
0
0
(684)
(684)
684
684
6,376
1,629
4,747
8,500
7,228
1,272
Asset Disposals (NBV)
General
Subtotal
Net Capital Expenditure
FY 2016/17
Variance
£000
*Key projects within category include:
*1
Stevenage Am bulance Station £1.6m - purchas e of new building to create Make Ready facility. Spend forecas t Sept 16 - Jan 17.
*2
Bulk Fuel s ites ins tallation £0.9m - project c/fwd from 2016/15: Southend, Stevenage & Luton.
*3
HART Vehicle replacem ent £1.6m - revis ed down, due to national procurem ent proces s , from the original es tim ate of £2m
Current month and YTD transactions: The asset swap relating to the depots in Chelmsford, Coval Lane and Lawnside was completed this month. This involved the
disposal of Coval Lane plus £150k cash. IT costs relating to the completed Virtual Telephony project of £160k were invoiced from BT. HART vehicles are now due to be
delivered in February, spend is therefore delayed.
Plan and Forecast Variance: The revised completion date for Stevenage has resulted in a delay in spend and forecast spend compared to budget. The forecast
expenditure includes and a £500k purchase of land for a make ready site at Hinchingbrooke. General reserve remains high at £2.1m. CPMG have a potential £180k to
approve and have requested new capital bids to be presented to the January meeting.
Depreciation
Month 9 - December 2016
Plan
£000
109
79
3
283
22
496
Actual
£000
114
80
2
301
10
507
Variance
£000
(5)
(1)
1
(18)
12
(11)
Description
IT
Land & Buildings
Fixtures & Fittings
Plant & Equipment
Transport
Total
Year to Date
Plan
£000
981
705
28
2,545
196
4,455
Actual
£000
1,034
721
23
2,718
87
4,583
FY 2016/17
Variance
£000
(53)
(16)
5
(173)
109
(128)
Plan
£000
1,308
939
37
3,393
261
5,938
Forecast
£000
1,376
960
30
3,621
110
6,097
Variance
£000
(68)
(21)
7
(228)
151
(159)
Plan and Forecast Variance: A review of asset lives will be carried out over the coming month, to ensure assets are depreciated over the correct term.
12
Item 8i.
7. Workforce Information
Month 9 - December 2016
Description
Service Delivery
A&E
HEOCs
Special Operations
Patient Transport
Primary Care
Subtotal
Support Services
Chief Executive
Finance
Commercial Services
Strategy & Sustainability
Workforce & OD
Patient Safety
CQUIN
Support Services
TOTAL
Plan
WTE
Contract
WTE
Paid
WTE
3,010
468
127
479
32
4,116
2,856
450
123
402
26
3,857
3,259
475
137
456
34
4,361
33
33
37
121
40
138
0
402
31
27
28
105
36
118
35
380
32
27
36
118
36
121
39
409
4,518
4,237
4,770
13
Item 8i.
8.
Trust Cost Improvement Programme
2016-17 CIP SCHEMES - Current Progress - Dec 2016
Proposed CIP Scheme
Sickness Management
Current
Revised
Value
£000
Original
Revised Plan
£000
Current
RAG
Rating
Planned Target
Achieved YTD
YTD
Achieved &
Banked for
2016/17
Variance to
Plan YTD
R / NR
Comments
1,000
1,000
750
442
-308
442
R
To be delivered through a reduction in A&E sickness levels.
200
200
114
114
0
200
R
Additional contribution associated with the retention of the
Cambs & Peterborough CCG PTS Contract
0
0
0
80
80
80
NR
1,000
1,000
750
1,000
250
1,000
NR
Supplies Expenditure
Management of Controlled Drugs
Medicines Management Project
Telephone / Mobile Usage
Review of IT Equipment Purchases
IT Cost Recovery
Bulk Fuel Use / Cease Purchase of Premium Rate
Fuel
400
100
0
100
200
0
0
100
0
100
200
0
300
75
0
75
150
0
0
0
756
0
75
169
-300
-75
756
-75
-75
169
0
0
756
0
75
223
R
R
R
R
R
NR
200
200
150
0
-150
0
R
Unsocial / On-call / Mgrs Overtime
400
400
300
0
-300
0
R
Training Efficiencies
Uniforms
Stock Control
Sale of Surplus Medical Equipment
Various Fleet Projects
Fleet Operating Leases
Line-by-line Review of Budgets
500
0
0
0
0
0
2,600
500
0
400
50
49
500
2,001
375
0
0
0
0
0
1,950
54
62
400
9
141
250
450
-321
62
400
9
141
250
-1,500
54
62
400
9
151
250
450
TOTAL
6,700
6,700
4,989
4,002
-987
4,152
Income - Additional PTS and Commercial Services
opportunities
Southend Dilapidations Savings
Productivity CIP
RAG TOTALS
£
5,500
0
1,200
6,700
To be achieved through overactivity (income) delivered with
no additional expenditure.
Reduction from downscaling scope
VAT recovery on prior year expenditure
NR
R
R
NR
R
NR
NR
-
R / NR Totals -Actuals 16/17
R
NR
£
2,086
2,066
4,152
14
Item 8i.
Month 9 Forecast Report
The Trust forecast has been restated at Month 9 for a deficit stated at £10.6m. An increase from the previously reported £(6.2)m.
This decision has been ratified at the Performance and Finance Committee held on 11 January 2017.
This figure has been reported to NHSI via the key data return submitted on 17 January 2017.
Decisions concerning the appeal on the RAP income levels are due to be communicated to the Trust imminently. The outcome of this appeal may alter
the forecast deficit.
15
Item 8i.
Appendix 1
16
Item 8i.
Appendix 2
A&E CONTRACT ACTIVITY SCHEDULE
Dec-16
CCG
Bedfordshire CCG
Luton CCG
Hear & Treat
Contracted Activity
See Treet &
See & Treat
Convey
13,004
25,011
7,576
15,037
20,580
40,048
16,520
33,099
17,257
31,756
33,777
64,855
54,357
104,903
Total
Activity
39,825
24,121
63,946
51,923
51,430
103,353
167,299
Hear & Treat
16-17 Total
Activity
40,466
24,513
64,979
52,129
51,667
103,796
168,775
Contract
Variance
641
392
1,033
206
237
443
1,476
Contract
Variance %
1.61%
1.63%
1.62%
0.40%
0.46%
0.43%
0.88%
£128,971
£87,620
£216,591
£46,045
£52,974
£99,019
£315,610
Value
Bedfordshire Cluster Total
East and North Hertfordshire CCG
Herts Valleys CCG
Hertfordshire Cluster Total
Beds & Herts Total
1,810
1,508
3,318
2,304
2,417
4,721
8,039
Cambridgeshire and Peterborough CCG
Cambridgeshire Cluster Total
Great Yarmouth & Waveney CCG
North Norfolk CCG
Norwich CCG
South Norfolk CCG
West Norfolk CCG
Norfolk Cluster Total
Ipswich and East Suffolk CCG
West Suffolk CCG
Suffolk Cluster Total
Norfolk, Suffolk & Cambridgeshire Total
4,064
4,064
1,152
705
1,150
940
824
4,771
1,383
963
2,346
11,181
29,624
29,624
11,509
6,656
8,978
8,461
7,145
42,749
14,398
8,472
22,870
95,243
55,140
55,140
16,914
12,233
16,268
15,116
13,559
74,090
24,938
14,398
39,336
168,566
88,828
88,828
29,575
19,594
26,396
24,517
21,528
121,610
40,719
23,833
64,552
274,990
4,240
4,240
1,287
759
1,202
1,054
819
5,121
1,616
876
2,492
11,853
29,576
29,576
11,418
6,194
8,248
8,182
6,996
41,038
14,207
8,656
22,863
93,477
55,909
55,909
17,959
12,915
15,307
15,536
13,598
75,315
25,305
14,208
39,513
170,737
89,725
89,725
30,664
19,868
24,757
24,772
21,413
121,474
41,128
23,740
64,868
276,067
897
897
1,089
274
-1,639
255
-115
-136
409
-93
316
1,077
1.01%
1.01%
3.68%
1.40%
-6.21%
1.04%
-0.53%
-0.11%
1.00%
-0.39%
0.49%
0.39%
£193,736
£193,736
£229,890
£45,766
-£226,873
£42,748
-£25,705
£65,827
£68,565
-£20,787
£47,777
£307,340
1,834
1,913
1,446
5,193
1,314
917
1,313
995
4,539
9,732
13,488
13,518
9,551
36,557
8,357
6,455
8,884
5,047
28,743
65,300
24,198
22,648
18,867
65,713
17,021
11,213
14,409
8,856
51,499
117,212
39,520
38,079
29,864
107,463
26,692
18,585
24,606
14,898
84,781
192,244
2,102
1,918
1,498
5,518
1,382
969
1,326
999
4,676
10,194
13,328
13,473
10,372
37,173
8,474
6,121
8,555
5,306
28,456
65,629
23,941
24,059
19,042
67,042
18,101
11,745
15,386
10,011
55,243
122,285
39,371
39,450
30,912
109,733
27,957
18,835
25,267
16,316
88,375
198,108
-149
1,371
1,048
2,270
1,265
250
661
1,418
3,594
5,864
-0.38%
3.60%
3.51%
2.11%
4.74%
1.35%
2.69%
9.52%
4.24%
3.05%
-£33,304
£250,566
£208,265
£425,526
£248,945
£55,880
£147,747
£258,221
£710,794
£1,136,320
28,952
214,900
390,681
634,533
30,395
212,712
399,843
642,950
8,417
1.33%
£1,759,270
North East Essex CCG
Mid Essex CCG
West Essex CCG
North Essex Cluster Total
Basildon and Brentwood CCG
Castle Point and Rochford CCG
Southend CCG
Thurrock CCG
South Essex Cluster Total
Essex Total
TOTAL
TRUE
1,989
1,591
3,580
2,368
2,400
4,768
8,348
Actual Activity
See Treet &
See & Treat
Convey
12,807
25,670
7,734
15,188
20,541
40,858
16,460
33,301
16,605
32,662
33,065
65,963
53,606
106,821
TRUE
TRUE
TRUE
TRUE
17
Item 8ii.
TRUST BOARD
(Public Session)
25 JANUARY 2017
Report Title:
Quality Governance Committee
Report Author(s):
S Brown
Director of Nursing &
Clinical Quality
Purpose:
Decision
AGENDA ITEM
Sponsoring Director:
Assurance
8ii
Tony McLean
Non-Executive Director
For Information Disclosable
Non-Disclosable
X
Executive Summary:
CARE QUALITY COMMISSION UPDATE
The action plan was progressing and progress has been made uploading evidence onto the existing
systems (HealthAssure) and this will enhance compliance with the CQC obligations. The HealthAssure
system has been aligned to the CQC action plan.
The quality review programme recommenced and will continue throughout the year.
SERIOUS AND ADVERSE INCIDENT REPORT
The Committee were informed that although there had been a large rise in Serious Incidents, having
increased for the same period the previous year, this could be a symptom of a more robust reporting
process and a culture in which staff were more aware of the benefits of reporting such occurrences. There
was a concern regarding delays with regards to increasing demands and hospital handover. This has been
raised as an issue to the regulators and commissioners.
The concern regarding the level of adverse incidents was highlighted and the risk team were working with
operational colleagues to resolve. The risk team have been listing the incidents and resolving the simplistic
incidents.
CQUIN
The projects are progressing well. This includes hear and treat, Flu and wellbeing.
Surge Plan
The revised Surge Plan was presented, with changes reflecting agreement between the operational and
clinical directorates.
Infection Prevent and Control
There was an on-going concern raised with regard to deep cleaning of vehicles. There has been some
improvement but this still requires some scrutiny. The real time audit system is now in place and will give
more timely results on progress.
Terms of Reference
The Terms of Reference were reviewed with minor changes.
Page 1 of 2
Item 8i.
KEY MESSSAGES AND RISKS IDENTIFIED
Healthassure process progressing
Effective QIA process for CIPs in place
Identified work being carried out on the reasons behind RIDDOR non-compliance
ECAT working well but a briefing paper required at the next meeting
Surge plan review undertaken.
IP&C; PTS deep cleans still requires work to provide assurance to the committee.
The ePCR project to recommence to reduce the risk of utilising paper PCRs
Other Key Issues to Draw to the
Board’s Attention:
N/A
Action Required by the Board:
For Noting.
Previously Considered By and Recommendation(s) Made:
N/A.
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and Safety
Performance
Shaping our Future
Creating a Positive and Engaging Culture
Legal Implications/Regulatory
Requirements:
Sub-Objective(s):
Please highlight those applicable
• Commence implementation of the Trust’s Remedial Action
Plan.
• Commence Implementation of a Revised Operating Model
including a new Clinical Career Pathway.
• Continue to roll out the Trust’s Quality Strategy.
• Create a stable Executive Leadership Team.
• Develop a Trust Strategy for approval by end of Quarter 1 to
be followed by supporting Strategies for Workforce, IM&T,
Fleet, Finance and Estate for approval by end of Quarter 3.
• Exploit all Collaboration Opportunities including engaging in all
Vanguard Projects.
• Undertake a Cultural Audit and Embed our Vision and Values.
• Implement Staff Leadership Development and Aspiring
Manager Programmes.
• Develop and implement a Staff Retention Plan.
• Roll out a Staff Engagement Plan.
Health and Social Care Act 2012 (regulated activities)
Regulations 2009 – Regulation 9 (Outcome 4) and
Regulation 10 (Outcome 16).
Page 2 of 2
Item 8iii
TRUST BOARD
(Public Session)
25 JANUARY 2017
AGENDA ITEM
Report Title:
Report from Chair of Finance and Performance Committee
Report Author(s):
Peter Kara
Chair of Performance and
Finance Committee
Purpose:
Decision
8iii
Sponsoring
Director:
Assurance
For Information Disclosable
Non-Disclosable
X
Executive Summary:
The meeting discussed financial and operational performance, workforce matters and IM&T projects, as
well as reviewing its terms of reference and agenda plan.
The fundamental issue faced by the Trust of under-performance against budget and agreed targets, and
the associated risks arising therefrom, were interrogated in depth.
At a further meeting on the 11th of January, the Committee were updated on the latest figures and
progress (or lack thereof) on the RAP mediation and sought assurance on the viability of the projected
deficit.
A useful presentation was also made by SSG on the potential for performance and financial improvement
following their initial review, and a report, following discussions with management, will be presented to the
next P&F meeting evidencing implementation and improvement initiated with their help.
Other Key Issues to Draw to the
Board’s Attention:
N/A
Action Required by the Board:
The Trust Board are asked to note the report.
Previously Considered By and Recommendation(s) Made:
N/A
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and Safety
Performance
Shaping our Future
Sub-Objective(s):
Please highlight those applicable
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Page 1 of 2
Item 8ii
•
Creating a Positive and Engaging Culture
•
•
•
•
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
Undertake a Cultural Audit and Embed our Vision and
Values
Implement Staff Leadership Development and Aspiring
Manager Programmes
Develop and implement a Staff Retention Plan
Roll out a Staff Engagement Plan
Legal Implications/Regulatory
Requirements:
Page 2 of 2
Item 8iv.
TRUST BOARD
(Public Session)
25 JANUARY 2017
AGENDA ITEM
Report Title:
Report from the Chair of the Audit Committee
Report Author(s):
Dean Parker
Chair of Audit Committee
Purpose:
Decision
8iv
Sponsoring
Director:
Assurance
X
For Information Disclosable
Non-Disclosable
X
Executive Summary:
The Audit Committee held its latest meeting on 7 December 2016. Key issues discussed at the meeting
were as follows:
1) Board Assurance Framework (BAF) – The Committee reviewed the latest version of the BAF and
agreed that it should be refreshed and put into a new format for the January Board meeting. The
Committee also noted the role of the Senior Leadership Board in risk management going forward.
The Committee also received a deep dive presentation from the Director of People and Culture on
SR2a “failure to create and embed a culture of performance and accountability”.
2) Internal Audit – the Committee received the report on IT Change Management and noted that it had
received Limited Assurance. The Committee received assurance from the Director of Strategy and
Sustainability that actions are in hand to deal with the weaknesses identified. The Committee also
received a report in response to a request from NHS Improvement for assurance over the Trust’s
monthly financial reporting procedures. The Committee was pleased to note that the report had not
identified any significant weaknesses in our procedures.
3) Freedom of Information Act requests – the Committee received a report detailing the number and
trends in Freedom of Information requests received by the Trust. It was agreed that the Committee
will continue to monitor trends in this area going forward.
Other Key Issues to Draw to the
Board’s Attention:
None
Action Required by the Board:
To note this report.
Previously Considered By and Recommendation(s) Made:
None.
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and Safety
Performance
Sub-Objective(s):
Please highlight those applicable
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Page 1 of 2
Shaping our Future
Creating a Positive and Engaging Culture
Legal Implications/Regulatory
Requirements:
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
None
Page 2 of 2
Item 8v
TRUST BOARD
(Public Session)
25 JANUARY 2017
Report Title:
Remuneration Committee Report
Report Author(s):
Valerie Morton
Non-Executive Director
Purpose:
Decision
AGENDA ITEM
8v
Sponsoring Sarah Boulton
Director:
Chair
Assurance
For Information Disclosable
x
Non-Disclosable
X
Executive Summary:
The Remuneration and Terms of Service Committee met formally on 10th January 2017.
The substantive item discussed related to a potential employment tribunal case including the learnings
for EEAST.
In consideration of current Trust priorities it was agreed that the future role and remit of the committee
should be discussed at a future meeting.
Other Key Issues to Draw to the
Board’s Attention:
Action Required by the Board:
Previously Considered By and Recommendation(s) Made:
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and Safety
Performance
Shaping our Future
Creating a Positive and Engaging Culture
Sub-Objective(s):
Please highlight those applicable
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
Page 1 of 2
Item 8v
Legal Implications/Regulatory
Requirements:
Page 2 of 2
Item 9.
TRUST BOARD
(Public Session)
Report Title:
Report Author(s):
Purpose:
25 JANUARY 2017
AGENDA ITEM
Strategic Priorities / Strategy on a Page
Wayne Bartlett-Syree
Decision
X
Sponsoring Wayne Bartlett-Syree, Director of
Director:
Strategy and Sustainability
Assurance
For Information Disclosable
Non-Disclosable
X
Executive Summary:
Urgent and Emergency care systems are under enormous and increasing pressure. This pressure is
not unique to urgent and emergency care, the whole NHS is facing a considerable challenge in
achieving the triple aim of improved health and wellbeing, transformed quality of care delivery, and
sustainable finances.
This year we have already seen our busiest day ever, where we treated over 4000 people. Despite the
increase in the number of patients we have made significant improvement in moving towards achieving
key performance targets, treating more of our sickest patients within the 8 min target than ever before.
Unfortunately, for the first time in a number of years the trust will end the year with a significant financial
deficit. All of this clearly demonstrates that as a trust we are not immune to wider pressures across the
NHS.
Over the past 12-18 months a considerable amount of work has taken place to create a stable
leadership team. This team has the unenviable task of helping navigate the Trust through what is going
to be a significantly challenging period in the NHS. The leadership team has already started on this
journey, with the development of the trust vision and values that will underpin the strategic priorities for
the next 2 years. We have also overseen the establishment of the new operating model, whereby we
have introduced the Emergency Call and Triage service to treat more patients at the point of their call.
We now need to build on these successes and create the stable platform for the trust to advance and
succeed as part of a sustainable NHS.
The development of the strategic priorities has been achieved through consultation with Board
members, members of the executive and senior leadership teams. In addition, in parallel with the
cultural audit focus groups have been undertaken with staff around the region. A number of 1:1
conversations with a wide range of internal and external stakeholders.
For the next 2 years the trust will have 5 strategic objectives that align to the trust vision and values.
These 5 strategic objectives will be achieved through the delivery of 19 key priorities. The overall
outcome of these priorities will enable the Trust to be in a stable position in terms of our ability to
balance deliver of Quality, Finance and Performance.
Other Key Issues to Draw to the
Board’s Attention:
There are few key issues that pose a risk to the delivery of the
strategic priorities
1. There is currently not the operating environment that allows
the time and space for transformation to occur, something
Page 1 of 2
Item 9.
that is not unique to this trust.
2. We currently do not have the any portfolio or
transformational project management capability to support
the delivery of the objectives.
3. The 2017/19 contract has not yet been agreed therefore we
do not know the financial envelope or the required levels of
performance that we are required to deliver.
Action Required by the Board:
The Board are asked to consider and adopt the 5 strategic objectives and 19 key priorities for the Trust in
line with previously agreed vision and values.
Previously Considered By and Recommendation(s) Made:
The Trust Board and Executive Leadership Board have provided feedback on the draft elements of the
strategic objectives along with the feedback from other stakeholder engagement.
Related Trust Strategic Objective(s):
Sub-Objective(s):
Improving Operational, Quality and Safety
Performance
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
Shaping our Future
Creating a Positive and Engaging Culture
Legal Implications/Regulatory
Requirements:
Adoption of the strategic objectives will support the trust in the well
lead domain of the NHS I/CQC Single Oversight framework.
Page 2 of 2
Strategic Objectives 2017-2019
Responsive High Quality Care
OUR MISSION REMAINS
Mision
Mision
To Provide a safe and effective healthcare service to all of our communities in the East of England
THROUGH CONTINUED EMBODIMENT THE CORE VALUES OF
Values
Values
Teamwork
Quality
Respect
Together as one we work
with
Pride
and
commitment to achieve
our vision
We Strive to Consistently
achieve high standards
through continuous
improvement
We Value individuals
including our patients,
our staff and our partners
in every interaction
Honesty
We Value a culture that
has trust integrity and
transparency at the
centre of everything we
do.
Care
We value warmth,
empathy and compassion
in all our relation ships
WE WILL ACHIEVE OUR PRINCIPLE VISION
Strategic
Strategic
Objectives
Objectives
Putting into place a
new Responsive
operating model to
deliver sustainable
performance and
improved outcomes
for patients .
Maintaining the
focus on delivering
Excellent high
quality care to the
patients
Guarantee we have
a Patient Focused
and engaged
workforce
Delivering
Innovative
solutions to ensure
we are an efficient,
effective and
economic Service
Playing our part in
the urgent and
emergency care
system being
community
focused in
delivering the 5yr
forward view
DELIVERING THE KEY PRIORITIES FOR THE NEXT 2 YEARS.
1) Establish an efficient
and effective operational
delivery structures
Key
Key
Priorities
Priorities
2)Improve our ability to
Forecast and Plan for the
best utilisation of our
staff (UHP)
3)Put into the place the
operational delivery of
the new operating model
4)Introduction of ARP
(subject to national sign
off)
5) Continued delivery of
the quality and safety
strategy establishing the
quality framework to
support organisational
delivery
6)Deliver the statutory
requirements associated
with CQC regulation
including the completion
of the CQC Action Plan
7)Undertake reviews of
clinical practice and
outcomes in order to
address unwarranted
variation
8)Deliver a recruitment
and retention plan that
ensures a suitably skilled
and competent
workforce is available to
deliver the new
operation model
11)Undertake a Fleet
transformation project
that delivers an efficient
utilising the latest
innovation to support the
delivery of the new
model
17) Continue the active
engagement with staff
and external stakeholder
to gain support for the
organisation and sees
EEAST as a valuable local
service.
9) Deliver innovative
‘whole person’ wellbeing
approaches to ensure the
physical, mental and
social wellbeing of our
people
12) Have “Make Ready”
implemented across the
trust
18) Work with urgent and
emergency care systems
to increase our use of /
availability of alternative
care pathway (see and
treat/ See and refer)
10) Develop a supportive
and inclusive culture to
match the vision and
values of the organisation
13) Review EOC function
and delivery model to
create a future proof
environment
14) Provide an “Agile”
working environment
that meets the demands
of a modern mobile
health care provider
15) Deliver a sustainable
CIP/FIP programme
creating efficiencies not
only short term saving
but longer financial
stability
19) Increase the benefit
of our volunteers include
CRF, armed forces and
blue light collaboration
Item 10.
TRUST BOARD
(Public Session)
25 JANUARY 2017
Report Title:
International Recruitment Update
Report Author(s):
Rebecca Lancaster
Recruitment Project
Support Officer
Purpose:
Decision
AGENDA ITEM
10.
Lindsey Stafford-Scott
Sponsoring
Director of People and Culture
Director:
Assurance
x
For Information Disclosable
Non-Disclosable
X
Executive Summary:
The Trust has challenging recruitment targets for paramedics against a backdrop of a UK shortage of
qualified paramedics. This paper seeks to provide an update and assurance to the Trust Board that the
necessary steps are being taken to explore the international market as a source of qualified staff.
Other Key Issues to Draw to the
Board’s Attention:
Action Required by the Board:
For noting
Previously Considered By and Recommendation(s) Made:
Executive Leadership Board has considered this paper and agreed to continue to explore international
recruitment options.
Related Trust Strategic Objective(s):
Sub-Objective(s):
Improving Operational, Quality and Safety
Performance
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision and
Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
Shaping our Future
Creating a Positive and Engaging Culture
Page 1 of 6
Item 10.
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
Legal Implications/Regulatory
Requirements:
All recruitment will be carried out in accordance with NHS and
legislative requirements
Background
In partnership with Hays Recruitment, 12 representatives from EEAST travelled to Warsaw and carried
out assessment days for fully qualified Paramedics on 25th and 26th November 2016. Hays are an
experienced international recruitment agency who have previously carried out similar recruitment
weekends with South Central Ambulance Service.
Over the two days, 14 candidates attended Hays office in Warsaw. The candidates undertook the
following assessments• Interview - Panel made up of one Polish speaking member of staff and one Education and Training
Officer.
• Clinical Assessment - Made up of an ECG Recognition test, practical sling assessment and Whole
Patient Care Episode. All assessed by the ETO.
• Driving Assessment - Practical driving assessment in a larger vehicle. Assessed by either a member
of the Trust’s DTU team or a driving assessor provided by Hays.
Summary of Candidates
From these assessments the panels determined that 5 of the 14 were definitely not suitable for
employment with EEAST at this time. This was either due to English language ability, clinical skills,
experience or a combination of these elements.
The Trust has made 9 offers of employment. These 9 candidates have a variety of different experience
levels, skill levels and qualifications. Some have very recently qualified and therefore lack practical
experience, others who have been practicing for longer still have a very different level of experience in
comparison to UK trained Paramedics. There are significant differences in how Paramedics practice in
Poland, many are hospital based or are paired on frontline vehicles with higher clinical grades of staff
such as Doctors.
For these reasons, it was considered that the planned international induction course was not adequate
for many of the candidates. Some have a lot of potential to operate as Paramedics for the Trust but
would need further support before they could work autonomously. A more robust program has been
drafted to support these individuals.
Observations on the service provided by Hays
• It was hoped that we would be able to see more candidates over the weekend than we did and we
had the resources to see up to 18 candidates per day but saw just 15 in total and were nto aware of
that prior to attending.
• 5 candidates did not attend despite booking in for a timeslot. We know Hays had awareness that at
least one of these had been a previous no show for SCAS.
Page 2 of 6
Item 10.
• These low numbers could be due to other Ambulance Trusts having exhausted the market
previously. For example we know that SCAS have made several trips out to Warsaw already and
have an established training program up and running for successful candidates.
• Several of the candidates that did attend have previously been shortlisted and/or interviewed by
SCAS. One individual already had a place secured on a training course with them.
• Hays attraction methods are largely centred on their job boards and it may be that they are not
reaching the optimum number of people.
• Although we know the candidates that did attend travelled significant distances, holding recruitment
in an alternative location to Warsaw may have attracted better numbers.
• The quality of some of the candidates provided by Hays was questionable. The English level of
some was very poor and it brings in to question how stringently Hays assess them before inviting to
interview. However, Hays stress that the quality of candidates submitted to EEAST was
comparable to those offered to SCAS.
• Since our return we have looked into options to increase the cohort number. For example, Hays had
previously mentioned that they would be able to source some Paramedics qualified in Poland who
were currently living in the UK but not practicing as Paramedics here. So far they have not been
able to source any viable candidates from this.
• We have communicated our areas of disappointment to Hays and have managed to negotiate the
agency fee down slightly from 17% to 15% of the starting salary for each individual.
Changes to the Training Plan
As mentioned above we have had to make some changes to the training plan as a result of the level of
experience the candidates had. It will now follow the below:• 5 weeks initial clinical core course in training school
• 6 weeks ops development under mentorship with a PAD
• 1 week back in training centre for PAD sign off, any learning plan issues and summative
assessments
• 4 weeks Blue Light Driving course
• 2 week UK road familiarisation course
The initial course is very similar to what was originally predicted in regards to time in the training
school. However, there will be a longer period of mentorship and it is expected that some candidates
will remain Student Paramedics for longer than originally anticipated. The timescales for this are
completion of all competencies (including driving and HCPC registration) within 6 months of
employment.
Learning and Next Steps
Overall we felt the trip was a worthwhile exercise. Although we may only have a small number of
candidates, the team that went out to Warsaw learnt a lot from the experience and we will be a more
informed customer in the market going forward. The Director of People and Culture was particularly
impressed with the professionalism and commitment of all of the staff who took part in the recruitment
event. The passion and commitment to quality to source the very best candidates for EEAST was
universal.
We have not had a wholly positive experience with Hays and now know what we would expect from an
agency should we use one in the future. We would also like to consider the possibility of using skype to
pre-screen candidates, to get a better idea of clinical knowledge and English Language level prior to
them and us being subject to the expense of travelling to interview.
Page 3 of 6
Item 10.
It is becoming increasingly apparent that there are pools of qualified paramedics in various countries
and different approaches we could take to tap in to these as part of our wider recruitment strategy. We
are currently exploring several different options to explore these marketsEastern Europe
• From our experiences in Poland we do believe there is potential to source applicants from Eastern
Europe. While it is clear that the pool of qualified Paramedics in Poland has been exhausted to a
degree by other services, there are other countries we could explore.
• We had one candidate who had travelled from Lithuania to attend the interviews in November. She
was a strong candidate and her experience more closely matched the role of a Paramedic in the
UK. There may be a benefit in exploring Lithuania and also gaining a better understanding of the
roles in other Eastern European countries as we believe that roles with slightly differing job titles
may be more similar to what we would expect a Paramedic to be in the UK.
• Hays seemed unwilling to explore this but there are other agencies we have met or been in
communication with that may be able to provide a more widespread and bespoke service. For
example, Lion Recruitment who have contacts in 15 different countries throughout Europe and are
currently looking at several countries outside of the EU as well.
Australia
• We have been looking in to recruiting from Australia for some time and have spoken with several
universities regarding the availability and expectations of their Graduate Paramedics.
• Many Australian states are currently in a position were only 1 in 4 graduates are able to secure a job
in their home country. Despite the fact that some states will be advertising in the New Year, there is
still likely to be a large pool of candidates in the country and other ambulances services have been
tapping in to this for some time.
There are some challenges associated with employing
inexperienced graduates from outside of the EU, with gaining a C1 licence being perhaps the
largest obstacle. However, other ambulance services have been able to overcome these.
• We have recently been exploring a possible collaboration opportunity with LAS. They have been
running a recruitment campaign in Australia for a couple of years and have recruited over 450
people, a mixture of graduates and experienced paramedics. They recruit these individuals in
country and usually make over 100 offers during each trip. They have claimed that they will not
need such large numbers from their planned trip in March, but would like to keep their pipeline open
and may be open to working with us on this trip. We have written to LAS shortly to confirm whether
or not they wish to collaborate.
• We met recently with a LAS paramedic who has set up his own consultancy for international
paramedic recruitment.. He has a lot of experience in International recruitment, particularly from
Australia, and has set up pathways for other ambulances services. We are currently exploring ways
in which we could engage with this individual using his knowledge and experience to develop our
own direct international recruitment approach.
• A commercial proposal has been circulated by AACE regarding a joint international paramedic
recruitment programme. We have indicated that as a Trust we would be interested in exploring this
further.
Budget / Workforce Implications
Page 4 of 6
Item 10.
• The costs above compare recruitment of Polish Paramedics with current UK Graduate Paramedics.
• The larger incentives for UK grads make the cost per appointment higher. However, it is important
to note that they do not all take the full £8,000.
• Due to our issues with the performance of Hays we have negotiated the price down to 15% of the
starting salary from the previously agreed 17%. This only applies to the candidates from this trip. If
we were to do any further recruitment with Hays it is likely that the 17% would apply. Other agency
fees may differ and are subject to negotiation. The figure for 15% is included in the above.
• Although the individuals recruited from Poland will potentially not be on the road practicing
autonomously for 6 months, they will be on the road significantly faster than a Student Paramedic.
• Unfortunately we cannot break down the costs of our UK based Student Paramedic Recruitment
due to the funding received from HEE (£8,600 per student). This funding is absorbed in to the
training costs and finance cannot give any separate total costs.
• The actual costs for Polish Paramedic recruitment are slightly less than predicted in the original
paper in submitted in August. This is due to the reduction in the fee to Hays and cheaper working
party costs.
• The predicted costs of future international recruitment are likely to differ greatly depending on where
and how we do it.
• LAS estimated that their initial trip to Australia cost them £86,000. They view this as good value for
money due to the significant number of Paramedics they recruited.
Page 5 of 6
Item 10.
• The incentives offered to Australian Paramedics differ between services with SCAS offering £3,500
and LAS up to £8,000.
• The training costs are very comparable no matter the recruitment and will likely only differ by a week
here and there.
• In future, we may also have to factor in the potential need to offer accommodation during training
due to the geography of available training centres. These locations may conflict with both the
desired locations of the candidates and the areas with the highest vacancies where we would most
want to place them.
All recruitment process associated with international recruitment will follow the NHS International
recruitment of healthcare professional code of practice and the NHS recruitment check standards.
The options to take international recruitment forward require significant commitment and expenditure to
attract international applicants and all have different challenges associated with them.
However, most Ambulance Trusts are sourcing staff from overseas as part of their overall recruitment
mechanism and believe this is necessary as a partial solution to the capacity gap and current UK
recruitment is not yielding the necessary candidate numbers.
Therefore the Trust continues to explore different options for overseas recruitment and evaluate the
outcomes for inclusion as a permanent strand of the Trust’s Recruitment strategy and in light of future
staffing projections.
Page 6 of 6
Item 11.
TRUST BOARD
(Public Session)
Report Title:
Cultural audit
Report Author(s):
Dr Antonio Zarola
Zeal Solutions Ltd
Purpose:
Decision
X
25 JANUARY 2017
AGENDA ITEM
11
Sponsoring Lindsey Stafford-Scott
Director:
Director of People and Culture
Assurance
For Information Disclosable
Non-Disclosable
X
Executive Summary:
The Trust has undertaken a cultural audit to understand staff perceptions of EEAST as an organisation and
to determine how the experience of work influences staff health and well-being. A series of focus groups
were held to inform the development of a cultural audit survey for staff. More than 1,700 responses were
received and the results were analysed.
The analysis explored the combined impact of both workplace features and cultural dimensions in health
outcomes, to identify seven priority areas to target for enhancing the health and well-being of staff. These
are split into two categories; those areas that need to be promoted and protected and those areas that
need to be tackled. These were:
•
•
•
•
•
•
•
Supportive leadership (promote and protect)
Positive work experience (promote and protect)
Quality and learning (promote and protect)
Home work conflict (tackle)
Decision – low confidence (tackle)
Violence (tackle)
Blame and fear (tackle)
The steering group, made up of staff from across the Trust, has reviewed the results and developed
prioritised actions for each of these high impact areas, as laid out in the report. These actions have been
set as being realistic and achievable in the immediate future, with some being quick wins to help build
ongoing momentum for the cultural audit.
The final report will be submitted to the Board in February. The steering group will meet again in February
to agree an appropriate strategy for initiating action. The group will also agree an evaluation strategy for
these actions so the value and impact can be clearly demonstrated.
Other Key Issues to Draw to the
Board’s Attention:
Action Required by the Board:
• To note the report
• To agree to the high impact areas and actions
• To support the continuation of the cultural audit programme
Page 1 of 2
Item 11.
Previously Considered By and Recommendation(s) Made:
Cultural Audit Steering Group on 19/12/16 and 13/01/17.
Related Trust Strategic Objective(s):
Please highlight those applicable
Improving Operational, Quality and Safety
Performance
Shaping our Future
Creating a Positive and Engaging Culture
Legal Implications/Regulatory
Requirements:
Sub-Objective(s):
Please highlight those applicable
• Commence implementation of the Trust’s Remedial
Action Plan
• Commence Implementation of a Revised Operating
Model including a new Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of
Quarter 1 to be followed by supporting Strategies for
Workforce, IM&T, Fleet, Finance and Estate for
approval by end of Quarter 3
• Exploit all Collaboration Opportunities including
engaging in all Vanguard Projects
• Undertake a Cultural Audit and Embed our Vision
and Values
• Implement Staff Leadership Development and Aspiring
Manager Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
N/A
Page 2 of 2
Organisational Risk Assessment
A summary progress report for East of England
Ambulance Service NHS Trust (EEAST)
Culture and Health Audit: Board Progress Report
Published: January 2017
This report was produced by Zeal Solutions Ltd
Author: Dr Antonio Zarola PhD CPsychol AFBPsS
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 2 of 13
Contents
Scope of this report ...................................................................... 3
Project aims ................................................................................. 3
Approach taken ............................................................................ 3
High level results .......................................................................... 4
Psychosocial workplace features ......................................................................................... 4
The prevailing culture and its impact .................................................................................. 6
The important role of leaders .............................................................................................. 7
Highest impact factors ......................................................................................................... 8
Translation – staff feedback and validation of results .................... 8
Prioritised actions for each high impact area ................................. 9
High impact areas and actions ........................................................................................... 10
Next steps and final reporting ..................................................... 11
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 3 of 13
Scope of this report
This report, provides the board with a high level overview and progress update on the
cultural audit. The focus of this update is to inform the board of the actions that have been
agreed by the steering group. Detailed and technical information (e.g. benchmarking) on
the key findings is not included in this high level summary and will be made available in the
final reports that will be submitted to the Trust in February 2017.
Project aims
The purpose of the audit was to establish a foundation for understanding staff perceptions
of EEAST as an organisation and determining how the experience of work influences staff
health and well-being. The objective of this audit is to provide the Trust with evidence that
can be used to identify what action, if any, is required to ensure EEAST continues to
develop a workplace and culture that can be considered psychologically healthy and well.
Approach taken
A series of focus groups were held with EEAST staff to inform the development of a tailored
survey. The survey process was used to help answer the following questions:
o Which ‘negative’ and ‘positive’ aspects of their psychosocial work environment do
staff within EEAST most frequently experience? This psychosocial work
environment comprises features of both the content of the job, e.g. the nature and
flow of the tasks undertaken, and the interpersonal and organisational context
within which it is undertaken, e.g. relations with supervisors and colleagues, the
opportunity for career progression, etc.
o Which aspects of this ‘psychosocial work environment’ are most strongly and
consistently associated with employee well-being?
o What is the prevailing culture within EEAST?
o What role does the organisational culture have to play in influencing employee
well-being?
o What ‘sources of support’ do employees see as being available to them in trying to
deal with the experience of work?
o Which sources of support are most advantageous in terms of maintaining individual
and organisational well-being?
o What role do leaders have to play in terms of influencing the experience of work
(e.g. culture) as well as the health and well-being of staff?
To help answer the above questions, The ORA methodology (see Figure 1), developed by
Zeal, was used to create an accurate understanding of the impact of the workplace on staff
health and well-being.
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 4 of 13
Figure 1: Diagrammatic representation of the ORA method for assessing the workplace,
culture and the impact on employee health and well-being
As a basis for auditing, then, there are at least four important aspects, or elements, to
understanding and assessing the impact of works. As shown in Figure 1, these are:
1. Identifying both the ‘potentially’ positive and negative experience of work and
establishing how often they are experienced by staff;
2. Profiling the health and well-being of staff as a whole, or significant and identifiable
sub-groups thereof;
3. Demonstrating empirically the relationship between the experience of work and the
utilised indicators of health and well-being;
4. Assessing how the relationship between the experience of work (1) and health and
well-being (3) is possibly affected by salient intervening factors e.g. the availability
of support in helping staff to cope.
Paper and online surveys were made available to staff and, in total, we received 1771
completed responses, 1194 were paper copies and 577 responses were received online. An
overview of the demographic profile of the sample of staff completing this survey is
provided below and at the end of the summary in the appendix.
High level results
Psychosocial workplace features
In the audit questionnaire, participants were asked how frequently each of 74 items
deriving from the focus group discussion reflected their experience of work in EEAST.
Responses to all questions were subsequently analysed to assess whether a more efficient
(and reduced) number of high priority workplace features could be found within the
existing items therefore supporting the translation of these results more readily into
practice. Analyses of the results revealed 16 ‘workplace features’ as shown below in Table
1.
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 5 of 13
WORKPLACE FEATURE
MEAN SAMPLE ITEM/DESCRIPTOR
Home-Work Conflict
3.66
Poor Change & Communication /
Information Management
3.58
Poor Career Development
3.40
Supportive Colleagues
3.30
Equipment Issues
3.27
Demands – Decision Confidence &
Responsibility Worry
3.24
Dealing with Unrealistic Expectations &
Poor Understanding – External Users
3.23
Positive Work Experience
3.22
Demands – Work Overload
3.13
Supportive Leader Behaviour
3.12
Mentorship, Supervision & Training
2.96
Influence & Engagement
2.82
Unsupportive Leader Behaviour
2.53
Valued Recognition
2.30
Violence – Outside Users
2.28
Violence – Inside Staff
1.84
Work/shift patterns having a negative
impact on family life.
Finding it difficult to keep up with the
pace of change in the organisation.
Finding that there is a lack of career
development/progression opportunities
within the Trust.
Working with colleagues who can be
relied upon to provide support if needed.
Experiencing problems with computers
or IT.
Not feeling confident about the
decisions you have to make.
Having to deal with unrealistic
expectations from patients or their
families/carers.
Having a job that presents you with
positive challenges.
Having too many things to do and not
enough time in which to do them.
Having a manager who listens.
Getting the training you need to do your
job.
Having the opportunity to influence the
decisions that impact on your job/work.
Having a manager who is quick to
blame.
Receiving recognition for a job well
done.
From a patient/service user/member of
public – Experiencing face to face or
telephone verbal abuse, physical
assaults.
From a member of staff/colleague Experiencing face to face or telephone
verbal abuse, physical assaults.
Scale range | 1 = never to 5 = always
Table 1: Mean rank order of the 16 workplace features
As shown above in Table 1, Home-Work Conflict (e.g. Work/shift patterns having a
negative impact on family life) was the most frequently experienced workplace feature by
EEAST staff. Exposure to work-related violence and aggression from the outside (e.g.
service users) and inside (e.g. work colleagues) were the two workplace features that
achieved the lowest mean scores. As a note of caution, it is important to state at the
outset, the extent (frequency) to which staff have reported experiencing specific workplace
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 6 of 13
features should not be used to decide where action/intervention needs to be focussed.
This can only be determined by further statistical analysis exploring the empirical
relationship between the workplace features and measured health outcomes. This is
outlined in section five of the report.
Statistical analysis of the impact of the workplace features on measured health outcomes,
revealed for EEAST employees, the major workplace features having the most extensive
and detrimental impact upon individual and organisational well-being are:
•
•
•
•
Home & work life conflict
Demands – decision confidence and responsibility worry
Unsupportive leader/manager behaviour
Violence and aggression: internal and/or external
In one way or another, these four workplace features are each associated with diminished
individual well-being (e.g. symptoms of stress), attitudes to the job (e.g. job satisfaction),
withdrawal (e.g. intention to quit), as well as performance of clinical care (e.g. patient care
confidence).
Conversely, and based upon the number of positive outcomes they are linked with, there
are three major workplace features that have extensive and beneficial impacts upon
individual and organisational well-being, these are:
•
•
•
Positive work experience
Supportive leader/manager behaviour
Influence and engagement
In one way or another, these three workplace features are each associated with improved
individual well-being (e.g. symptoms of stress), attitudes to the job (e.g. job satisfaction),
withdrawal (e.g. intention to quit), as well as performance of clinical care (e.g. patient care
confidence).
The prevailing culture and its impact
In this audit, the EEAST culture was determined by assessing staff perspectives on 39
statements regarding the type of culture in EEAST. Analyses of these results revealed eight
higher order ‘cultural dimensions’ list below in Table 2 in ‘mean’ rank order.
CULTURAL
DIMENSIONS
Blame & Fear
MEAN
SAMPLE ITEM/DESCRIPTOR
3.71
People are afraid to make mistakes.
Quality & Learning
3.34
Learning is an important part of the culture.
Authoritarian
3.14
It is important to stay on people's good side.
Affiliation/Team
3.08
People work like they are part of a team.
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 7 of 13
Facilitating Change
Capability Building
Shared Vision
Consensus/Agreement
2.69
2.67
2.56
2.42
New and improved ways to work are
continuously adopted.
The capabilities of people are viewed as an
important source of organisational success.
There is a clear strategy for the future.
It is easy to reach consensus/agreement, even
on difficult issues.
Scale range 1 to 5 (1 = strongly disagree and 5 = strongly agree)
Table 2: Cultural dimensions – displayed in mean rank order
The highest scoring cultural dimension Blame & Fear has negative health individual and
organisational health impacts. This cultural dimension is linked with:
•
•
•
•
•
•
•
•
Reduced levels of job satisfaction
Reduced levels of organisational commitment
Reduced levels of work engagement
Increased levels of symptoms of stress
Increased levels of PTSD symptomology
Increased levels of burnout (e.g. exhaustion, cynicism)
Increased levels of quitting intentions
Reduced levels of patient care confidence
Importantly, however, the audit also revealed that staff are also exposed to a range of
positive cultural behaviours (dimensions) that, when experienced, lead to positive health
benefits. The cultural dimension that had the most significant positive impacts was ‘Quality
& Learning’.
Combined, these results support the assertion that organisational culture is an important
determinant of organisational health, effectiveness and performance. It also helps to
confirm the critical importance of developing the positive cultural dimensions and
minimising the impact of the negative cultural dimensions within EEAST. As with broader
assessments of culture, one of the most influential and key determinants of enhancing the
cultural dimensions measured in this audit is associated with leadership behaviour and the
level of perceived support considered to be available from leaders.
The important role of leaders
Scientific research is very clear in demonstrating the importance of ‘support’ in promoting
both employee well-being and performance. It is the perceived availability of support from
leaders/managers that was found to impact most significantly and beneficially on staff
health outcomes. The data received from staff regarding supportive leadership behaviour
was subsequently divided into those staff reporting high levels of perceived
leadership/management supportive behaviour and those reporting low levels. Statistical
comparisons were then conducted between the high and low support groups across the
workplace features, health outcomes and cultural dimensions. In summary, this analysis
revealed three key trends:
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 8 of 13
1. Leaders make a big difference to the way staff view their work. Such that, staff who
are exposed to higher levels of supportive leadership behaviour also report a more
positive experience across all work tasks and demands than those staff exposed to
low levels of supportive leadership behaviour.
2. Leaders make a big difference to staff health and well-being. Such that, staff who
are exposed to higher levels of supportive leadership behaviour also report
improved health across all outcomes than those staff exposed to low levels of
supportive leadership behaviour.
3. Leaders make a big difference to the way staff view the workplace and the cultural
experience. Such that, staff who are exposed to higher levels of supportive
leadership behaviour also report EEAST as having a significantly more positive
culture than those staff who are exposed to lower levels of supportive leadership
behaviour.
Highest impact factors
Statistical analysis exploring the combined impact of the workplace features and cultural
dimensions on health outcomes, identified seven (7) priority areas that EEAST should
consider as primary targets for enhancing the health and well-being of staff. These high
impact areas are shown below in Figure 2. Actions that are being considered for each of the
priority areas can be seen below.
FIGURE 2: Illustrating the high impact priority areas of focus
Translation – staff feedback and validation of results
The audit conducted here is a participative problem solving process. Therefore, and in
keeping with best practice, employees were invited to participate in a second series of
focus groups to review the key findings from the audit as well as to:
• Reflect and discuss how accurately the audit results represented their own
experiences of the job;
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 9 of 13
•
•
Assist in the interpretation of the findings from the audit and place these into
everyday concrete examples based on their work experiences; and
Act as a problem solving group generating potential and practical strategies and
interventions that might be implemented to help manage stress or promote health
within their own area.
This process of validation and translation is an exercise in sense making, whereby the
results from the audit are explored by a sample of those from whom it was derived. First,
the results of one data collection method (the survey) are put forward for scrutiny by those
who are ‘experts by experience’ in the job (validation stage). Second, these same ‘experts
by experience’ are then tasked with helping to translate the results into useful and
practical intervention strategies, the role of the consultant being that of a facilitator.
Within EEAST a series of face to face ‘translation’ focus groups, telephone interviews and
sites visits were completed. In addition, Zeal Solutions provided staff with online access to
key results so that any feedback to the findings could be submitted directly to Zeal. In total,
125 staff participated in the feedback sessions enabling Zeal to speak with staff across a
number of roles/departments, including, but not limited to: dispatch team leaders; call
handlers; community first responders; dispatchers; regional operations centre officer; CFD
clinical, managers, frontline staff – paramedics and technicians, administrators, volunteer
community first responders, finance, support services, suppliers and HR. We spoke with
individuals from across localities Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk and
Cambridgeshire.
Employees confirmed or validated audit results as representing real issues for them. This is
not so say that every employee had personally experienced each of the positive and/or
negative workplace features identified in the audit but simply that, overall, the issues
identified in the audit ‘made sense’ to staff and captured the principal threats to well-being
or promoters of health as EEAST employees themselves construe them.
Since all groups considered the same audit results – and made many similar
points and observations on them – their deliberations were analysed and then summarised
into an action list in an aggregate rather than on a group by group or role basis. The full list
of actions was reviewed and discussed by the project Steering Group on Monday 19th
December 2016. This process was utilised to help sense check the suggested actions as well
as to help prioritise and streamline any suggested actions. A second action planning
workshop was held with the steering group on Friday 13th January 2017. This meeting was
used to review the updated action list and to establish key actions and any quick wins
against the high impact areas listed above in Figure 2.
Prioritised actions for each high impact area
The fact that the steering group only considered those workplace features or cultural
dimensions that had the highest impact (i.e. a subset of all the possible workplace features
and cultural dimensions) should not be read as suggesting that the remaining workplace
features and cultural dimensions are of no concern, value or threat to EEAST. For some
individuals, these other factors might be the greatest source of stress in their jobs.
However, given the finite amount of resources (e.g. finance, time, etc.) available, group
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 10 of 13
discussion must necessarily be limited primarily to those workplace features shown by the
audit data to be most significantly linked to improved or diminished health and wellbeing
across EEAST as a whole. The key actions that were highlighted by the steering group as
realistic and achievable in the immediate future are listed below. Also highlighted below
are the actions the steering group voted as quick wins (i.e. something that could be
announced and completed quickly).
High impact areas and actions
Supportive leadership is to be protected and promoted by the following actions:
• Development of the recruitment process
• Review exit interview process and reinvigorate (quick win)
• Develop and promote the leadership charter (quick win)
• Develop and implement leadership strategy
• Develop code of practise for interview panels
• Offer every internal candidate the opportunity to receive feedback (quick win)
Positive work experience is to be protected and promoted by the following actions:
• Review appraisal process
• Review and change reward and recognition programme (quick win)
Quality and learning is to be protected and promoted by the following actions:
• Review student paramedic mentoring
• Learning from incidents:
o Use clinical variation panel process to develop staff
o Look at how we can do the informal stage/feedback before formal process
clicks in
• Senior managers responding on ambulances should be crewed with nonmanagement staff to help with mentoring, development and visible leadership
(quick win)
Home/work conflict is to be tackled (prevented or reduced) by the following actions:
• Flexible working (quick win)
o Look at data to see where flexible working is working and areas of low take
up.
o See how we can embed it across Trust
o Raise awareness internally and externally of staff stories who have been
able to work flexibly (a good opportunity for retention and recruitment)
• Monitoring of annual leave at 7 and 9 month points through SPF
• Late finishes programme
Demands: Decision - low confidence is to be tackled (prevented or reduced) by the
following actions:
• See point above on learning from incidents
• Evaluate the effectiveness of the clinical app (quick win)
• Start to produce videos of equipment and how to use it (quick win)
• Develop programme of CPD events linked to PU
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 11 of 13
•
Reintegrating staff who have been away from the Trust for a while (either through
maternity, career breaks or different jobs). Create a best practice approach for
these staff.
Blame and fear is to be tackled (prevented or reduced) by the following actions:
• Ask the raising concerns group to investigate the possibilities of anonymous
reporting
• See point on leadership charter; need to reflect a learning culture and not a blame
culture
Violence and aggression - is to be tackled (prevented or reduced) by the following actions:
• Trust to sign up to campaign to change legislation about violence to NHS staff (quick
win)
• Greater promotion of the anti-violence stance (quick win)
• Review recruitment process for call handlers and EOC staff to improve retention.
Also look at the welfare, after care and support mechanisms available for EOC staff
(quick win)
Next steps and final reporting
Zeal Solutions are currently preparing the final audit reports and aim to submit these to the
Trust in time for the next steering group meeting which is being scheduled for February
2017.
In addition to receiving a full presentation of the results, the next steering group meeting
will be used to finalise the list of actions against the high impact areas and also agree an
appropriate strategy for initiating action. Furthermore, this meeting will also be used to
ensure an appropriate evaluation strategy is agreed for the prioritised actions so that value
and impact of any action can be clearly demonstrated to the organisation.
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 12 of 13
Appendix: Demographics
Below are the demographic details of the sample of staff who participated in this survey.
Sex
Male
Female
Missing
Total
Frequency
1006
738
27
1771
Percentage
56.8
41.7
1.5
100.0
Age
16-20
21-30
31-40
41-50
51-65
66+
Missing
Total
Frequency
12
269
388
527
505
40
30
1771
Percentage
0.7
15.2
21.9
29.8
28.5
2.3
1.7
100.0
Tenure
Less than 1 year
1 to 3 years
More than 3 and up to 5 years
More than 5 years and up to 10 years
More than 10 years and up to 20 years
More than 20 years
Missing
Total
Frequency
120
290
202
354
527
250
28
1771
Percentage
6.8
16.4
11.4
20.0
29.8
14.1
1.6
100.0
Ethnicity
White
Mixed
Asian/Asian British
Black/Black British
Chinese & other ethnic background
Missing
Total
Frequency
1686
13
5
17
3
47
1771
Percentage
95.2
0.7
0.3
1.0
0.2
2.7
100.0
County/Region
Norfolk
Suffolk
Cambridgeshire
Bedfordshire
Hertfordshire
Essex
Regional
Missing
Frequency
326
217
240
184
177
463
93
71
Percentage
18.4
12.3
13.6
10.4
10.0
26.1
5.3
4.0
EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 13 of 13
Total
1771
100.0
Staff Type
Ambulance Care Asst/ Ambulance
Transport Asst/ Patient Transport
Driver
Emergency Care Asst
Emergency Care Practitioner
Emergency Control Staff/ Call
Centre Staff
Managers. Administrative staff &
Other Support Staff
Nurse/ Occupational Therapist/
Pharmacist
Paramedic Manager
Paramedic, Senior Paramedic,
Paramedic Supervisor
Student Paramedic
Technician & Senior Technician
Volunteer
Missing
Total
Frequency
Percentage
152
8.6
68
38
3.8
2.1
133
7.5
192
10.8
9
0.5
77
4.3
527
29.8
180
230
67
98
1771
10.2
13.0
3.8
5.5
100.0
Function
Accident & Emergency
Air & Special Operations
Emergency Operations Centres
Non-Emergency Services Commercial Services & Primary
Care
Non-Emergency Services - Patient
Transport Services
Operations Support
All Other Support Services
Missing
Total
Frequency
1122
44
133
Percentage
63.4
2.5
7.5
22
1.2
162
9.1
57
126
105
1771
3.2
7.1
5.9
100.0
Item 12.
TRUST BOARD
(Public Session)
25 JANUARY 2017
Report Title:
Board Assurance Framework
Report Author(s):
E de Carteret, Safety and
Risk Lead
Purpose:
Decision
x
AGENDA ITEM
12
Sponsoring Sandy Brown, Director of Nursing and
Director:
Clinical Quality
Assurance
For Information Disclosable
Non-Disclosable
X
Executive Summary:
In the Board workshop in December 2016, there was agreement to transform the Board Assurance
Framework – specifically, to give more oversight and assurance on the current position on the Strategic
risks and to focus upon the strategic actions to be taken for further mitigation, rather than the document
emphasising current controls already in place.
In addition to this, red operational risks previously present on the BAF as individual risks have been
absorbed for the purposes of this document into the relevant Strategic risks; however it is important to note
that there is significant Trust focus on mitigation of these at the Senior Leadership Board level.
The document therefore provides detail on the five strategic risks agreed in principle at the Board
workshop, in line with the new organisational Strategic Objectives. These risks have been developed
through the analysis of the previous strategic risks against the Strategic Objectives.
As the January 2017 Board Assurance Framework has changed in layout and design, the following gives
an overview of its intent:
• Page 1 – Board Assurance Framework Summary
o Provides an overview of the Strategic risks, in relation to current score, direction of travel and the
anticipated timeframe for achieving the desired target risk score. This summary seeks to enable
Board members to identify any risks moving ‘off track’ to prompt a deep dive or focussed discussion.
• Page 2-6 – Strategic Risks
o Each page is dedicated to a single strategic risk and contains a number of details
o ‘Risk description’ seeks to provide an overview of the current status of the risk, with key operational
risks currently impacting upon the scoring and risk status.
o Risk Score detail provides information pertaining to the inherent (initial) risk score, current score and
the direction of travel from the preceding month. It also demonstrates the intended post-mitigation
score and target timeframe.
o Assurance of controls provides a RAG rating of the perceived effectiveness of controls already in
place. This score is provided by the Safety and Risk Lead based upon discussions with Executive
Owners and review of evidence
o The mitigating actions section provides an overview of the key strategic actions being undertaken by
the Trust to mitigate the risk and reduce the score further, along with a brief rationale for each action.
Please note that previous BAF documents have provided an extensive list of non-strategic actions
being taken which can detract from strategic discussions at Board. As such, whilst there is a
reduction of actions cited on the BAF, this is to give strategic focus – operational level actions remain
underway and are monitored through the relevant internal Trust groups, such as the Senior
Leadership Board and Clinical Quality and Safety Group
Page 1 of 8
Item 12.
Other Key Issues
to Draw to the
Board’s Attention:
Next steps in relation to the ongoing developments within Risk Management are to:
1. Complete refinement of the Senior Leadership Board risk register and establish
robust escalation and de-escalation
2. Review the Risk Management Strategy and Procedure in line with the processes
agreed in principle at the Board workshop
3. Liaison with all chairs of groups and committees in order to ensure a suitable
level of risk focus and discussion at each group meeting, in order for assurance
and escalation to occur
Action Required by the Board:
1. Review the new layout and approve for onward utilisation
2. Formally confirm the five strategic risks for 2017 – 2019, as stated in the BAF
3. Review the information in relation to the Strategic risks and identify whether a deep dive into a specific
risk is required at the next meeting
Previously Considered By and Recommendation(s) Made:
• Senior Leadership Board reviewed the Strategic Risks on 11 January 2017 and recommended them for
Escalation to the Board Assurance Framework.
• Executive Leadership Board reviewed the BAF and Strategic Risks on 19 January 2017 and approved
document for recommendation to the Trust Board.
• Discussion and determination on SR5 in relation to whether oversight should sit with the Quality
Governance Committee or the Trust Board
Related Trust Strategic
Objective(s):
Sub-Objective(s):
Improving Operational, Quality
and Safety Performance
• Commence implementation of the Trust’s Remedial Action Plan
• Commence Implementation of a Revised Operating Model including a new
Clinical Career Pathway
• Continue to roll out the Trust’s Quality Strategy
• Create a stable Executive Leadership Team
• Develop a Trust Strategy for approval by end of Quarter 1 to be followed
by supporting Strategies for Workforce, IM&T, Fleet, Finance and Estate
for approval by end of Quarter 3
• Exploit all Collaboration Opportunities including engaging in all Vanguard
Projects
• Undertake a Cultural Audit and Embed our Vision and Values
• Implement Staff Leadership Development and Aspiring Manager
Programmes
• Develop and implement a Staff Retention Plan
• Roll out a Staff Engagement Plan
Shaping our Future
Creating a Positive and
Engaging Culture
Legal Implications/Regulatory
Requirements:
Health and Social Care Act, Care Quality Commission, specifically
Safe and Well-Led
Page 2 of 8
Item 12.
Board Assurance Framework Summary – January 2017
The following table gives an overview of the Trust’s Strategic risks, their current status and the anticipated date when the risk will be mitigated
to the required level.
Risk Risk
Owner
Ref
SR1 Failure to deliver agreed contractual targets –
risk that the Trust cannot deliver a sustainable and Director
responsive model in line with the commissioner Service
performance contracts
Delivery
SR2
SR3
SR4
SR5
Committee
Current
risk status
Target
risk score
Date
for
mitigation
25
20
10
March 2019
15
9
6
September
2017
16
12
8
January
2018
Performance
and Finance
25
20
12
April 2018
Quality
Governance
20
12
8
January
2018
of Performance
& Finance
Failure to achieve continuous quality
improvements and high quality care delivery – Director
of Quality
risk that the challenges within the Trust result in a lack Nursing and Governance
of focus upon safe care for patients and that avoidable Clinical
harm occurs
Quality
Failure to establish a culture of engagement
and accountability that is patient focussed – Director
of Quality
risk that the Trust becomes a poor employer due to People and Governance
insufficient relationships with staff
Culture
Failure to deliver an efficient, effective and
economic service – risk that funding, systems and Director
of
processes do not match the required pace of change Finance and
for sustainable service delivery
Commissioni
ng
Failure to maintain strategic relationships with
national and local partners to deliver Director
of
community focussed healthcare – risk that the Strategy and
Trust, working with the regional healthcare economy, Sustainability
does not fully implement the commitments in the Five
Year Forward View
Page 3 of 8
Change since Inherent
last report
risk score
Item 12.
SR1: Failure to deliver agreed contractual targets
Risk Description
Strategic Objective
Operational Performance to Constitutional Standards is intrinsically linked to quality, Putting into place a new responsive operating model to
safety and patient experience. The Trust is not commissioned by CCGs to deliver deliver sustainable performance and improved
the constitutional standards and as such the Trust is left with risks to performance, outcomes for patients
quality, finance and reputation. Failure to fully mitigate this risk could result in an
inability to deliver a safe and effective service within the financial constraints of
Owner
Committee
commissioned level and impact on the CQC assessment of the Service. Current Director
of
Service Performance and Finance
risks underpinning SR1 include staff levels, student paramedic abstractions, Delivery
increased activity and acuity, hospital handovers, capacity gap and appropriate
funding of the service. It is important to note that NHSI have increased the Trust’s
rating to satisfactory for quality.
Risk Score Detail to Date
Assurance of controls
Target Risk Score Post-Mitigation
Likelihood Impact
Score
Likelihood Impact
Score
Inherent
When
5
5
25
2
5
10
mitigated
Moderate
Last month
Mitigated score to be
4
5
20
March 2019
achieved by
This month
4
5
20
Mitigating Actions
Owner
Due
Expansion of the ECAT functionality within the EOC through increased paramedic recruitment and other
Health Care Professionals, especially GPs and Mental Health Practitioners. This will allow further opportunity for Deputy
Medical April 2017
the clinical triage of calls, enabling patients to be directed to the most appropriate pathway for them and reducing Director
the need for ambulance or hospital attendance. Project group in place.
Continuation of recruitment within service delivery, especially at all clinical levels. This will increase ability to
fully resource rotas to enable sufficient UHP to meet demand up to commissioned levels
Implement amended Surge Plans following risk assessment and clinical review. This will enable robust
decisions by Gold at earlier stages to minimise tail breaches and harm to patients
Agree 2017/18 contractual performance targets with Commissioners, including the appropriate level of
funding to enable in year delivery improvements. It should be noted that commissioners do not intend to address
the capacity gap in 2017/18 or 18/19.
Purchasing additional capacity from Private Ambulance Providers to support the low acuity transportation
demands
Director of People and April 2018
Culture
Medical Director
May 2017
Director of Service April 2017
Delivery
Director of Finance and April 2017
Commissioning
Page 4 of 8
Item 12.
SR2: Failure to achieve continuous quality improvements and high quality care delivery
Risk Description
Strategic Objective
Inability to successfully focus upon safety and quality improvements due to pressures
financially and operationally would limit the progress made by the organisation in Maintaining the focus on delivering excellent, high
relation to governance, Sign up to Safety and the Quality and Safety Strategy. This quality care to our patients
could lead to an inability to provide safe, consistent and high quality care to patients
across the region. This would have regulatory and reputational implications for the
Owner
Committee
organisation. Current risks underpinning SR include non-conveyance decisions, Director of Nursing and Quality Governance
current clinical scope of the workforce, and harm through delays. Lack of electronic Clinical Quality
PCR solution limits identification of issues for resolution.
Risk Score Detail to Date
Assurance
of
Target Risk Score Post-Mitigation
controls
Likelihood Impact
Score
Likelihood Impact
Score
Inherent
When mitigated
3
5
15
2
3
6
Moderate
Last month
Mitigated
score
to
be
achieved
3
3
9
September 2017
by
This month
3
3
9
Mitigating Actions
Owner
Due
Delivery of the CQC action plan will strengthen the quality care provision in the Trust through Director of Nursing and September 2017
the mitigation of recognised gaps identified within the CQC inspection
Clinical Quality
Roll out and re-establishment of ePCR will enable more real-time monitoring of clinical care Director of Strategy and
and Quality Indicators, identifying areas of required improvement
Sustainability
June 2017
Improved clinical communications through the utilisation of wider, more varied Director
of
communication techniques – podcasts, Clinical Quality Matters, focus months – will provide Communications
September 2017
improved awareness for clinicians. Joint action with Medical Director
Delivery of mandatory training through workbooks and the Professional Update sessions is Director
of
Service September 2017
essential to maintaining the minimal expected standard
Delivery
Review and renew Risk Management Strategy and Procedure in order to underpin Director of Nursing and April 2017
processes for consideration of new systems and processes and emerging clinical risks
Clinical Quality
Redefine incident management policy and process to facilitate robust investigation and Director of Nursing and May 2017
recognition of learning opportunities
Clinical Quality
Page 5 of 8
Item 12.
SR3: Failure to establish a culture of engagement and accountability that is patient focussed
Risk Description
Strategic Objective
Failure to develop a robust culture in relation to accountability will have a detrimental effect Guarantee we have a patient-focussed and
on the culture within the organisation, This can lead to inconsistent practice and a lack of engaged workforce
confidence in the management structure, leading in turn to patient safety and staff welfare
issues. It is important to note the CQC’s rating of ‘outstanding’ for care from staff, identifying
Owner
Committee
that whilst there are clear cultural issues requiring redress, staff continue to deliver Director of People Quality Governance
consistently high standards. Current risks for SR3 include inconsistent practices across the and Culture
Trust, lack of a robust performance management framework, backlog in employee relations
cases, varied leadership application.
Risk Score Detail to Date
Assurance
of
Target Risk Score Post-Mitigation
controls
Likelihood Impact
Score
Likelihood Impact
Score
Inherent
When mitigated
4
4
16
2
4
8
Moderate
Last month
Mitigated score to be achieved January 2018
4
4
16
by
This month
3
4
12
Mitigating Actions
Owner
Due
Agreement and delivery of the culture action plan following the cultural review. This will Director of People and Culture January 2018
enable focus on recognised areas of need and improvement to make tangible benefits
Establishment of the Trust’s Culture Strategy will provide focus upon delivery against
the Vision and Values of the organisation and will engender a consistently engaged, patient- Director of People and Culture May 2017
focussed workforce
Development of a performance management framework will enable robust monitoring Director of People and Culture June 2017
and accountability processes, reducing inconsistencies across the organisation
Establishment of Leadership Programmes in line with NHS Improvement and Leadership Director of People and Culture May 2017
Development Framework, within the mandatory training portfolio will enable improvement in
Leadership Practices
Development of a Communication and Employee Engagement Strategy to help drive
Directors of Communications June 2017
more staff focussed engagement and shape the culture of the organisation.
and People and Culture
Page 6 of 8
Item 12.
SR4: Failure to deliver an efficient, effective and economic service
Risk Description
Strategic Objective
Inability to deliver constitutional standards of effective and safe care within the agreed Delivering innovative solutions to ensure we are an
financial envelope will result in the Trust becoming an unsustainable organisation. This efficient, effective and economic service
brings with it the risk of financial special measures and associated risks to patient safety
Owner
Committee
and service delivery, and reputational damage. There is a need to resolve the immediate Director of Finance Performance and Finance
financial challenges as well as transform to long term efficiencies through innovative and Commissioning
service redesign. Current risks impacting upon SR4 include in-year financial delivery,
insufficient funding to deliver against demand, utilisation of PAS to off-set the capacity
gap
Risk Score Detail to Date
Assurance
of
Target Risk Score Post-Mitigation
controls
Likelihood Impact
Score
Likelihood Impact
Score
Inherent
When mitigated
5
5
25
3
4
12
Low
Last month
Mitigated score to be achieved
4
5
20
April 2018
by
This month
4
5
20
Mitigating Actions
Owner
Due
Re-base 2017/18 and future contracts with commissioners to incorporate new business
Director of Finance and March 2017
model and funding in line with activity
Commissioning
Completion of arbitration in order to secure stakeholder commitment to reducing the clinical Chief Executive
February 2017
capacity gap
Completion of phase 1a and 1b of SSG financial review, in order to reduce the financial Director of Finance and March 2017
deficit by the end of the current financial year
Commissioning
Establish the Trust Strategy and Transformation plans in order to identify efficient and
Director of Strategy and July 2017
economic solutions
Sustainability
Page 7 of 8
Item 12.
SR5: Failure to maintain strategic relationships with national and local partners to deliver community
focussed healthcare
Risk Description
Failing to form strong strategic relationships will lead to a poor reputation for the trust
with partner organisations within local health systems. This is likely to impact on
investment in the current and new models of delivery. In turn, this will risk the long term
financial sustainability of the Trust, resulting in a decrease in performance and the
quality of care delivered to patients. Current risks underpinning SR5 include conflicting
stakeholder views, and the alignment of STPs and the subsequent impact on delivery. It
is important to note the NHSI’s increased rating of ‘Satisfactory’ for the Trust.
Strategic Objective
Playing our part in the urgent and emergency care
system being community focussed in delivering the 5
year forward view
Owner
Committee
Director of Strategy and Quality Governance
Sustainability
Risk Score Detail to Date
Assurance
of
Target Risk Score Post-Mitigation
controls
Likelihood Impact
Score
Likelihood Impact
Score
Inherent
When mitigated
5
4
20
2
4
8
Low
Last month
Mitigated score to be achieved
3
4
12
October 2017
by
This month
3
4
12
Mitigating Actions
Owner
Due
Development of the Trust’s 2 year Transformation Plan will enable recognition of work Director of Strategy and
streams for community care delivery and create a platform to support EEAST and wider Sustainability
April 2017
system sustainability.
Negotiate mid to long term funding for delivery of the service, including the ongoing
recruitment and commitment to aspects of the service which facilitate multi-organisational Director of Finance and January 2018
working (e.g. ECAT, HALOs)
Commissioning
Secure Partner commitment to Transformation Plans to underpin the STP and CCG Director of Strategy and January 2018
investment in EEAST
Sustainability
Page 8 of 8