LAS Integrated Performance Report
Last updated: 21 November 2023 15:08.
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Executive Summary
An executive summary will be included in later versions of this report.
What Is Statistical Process Control?
Statistical process control (SPC) is an analytical technique that automatically identifies changes in data over time. SPC analysis uses statistical principles first developed in engineering to more robustly distinguish improvement from random variation. It helps us to understand meaningful variation in data, focusing our attention on areas most appropriate for action.
The use of SPC to support decision making is a key component of the Model for Improvement widely used across the NHS. NHSE have developed documentation describing best practices around the use of SPCs. The SPC charts below have been produced using the NHSR Plot The Dots package.
In this report, we have used this method as a tool for rapidly assessing a wide variety of service measures. The SPC charts below use a standard notation to identify types of variation and assurance. An assurance indicator is only shown if a target has been specified. Assurance and Causes are summarised in the section Assurance & Cause Identification.
Assurance & Cause Identification
The table below categorises each measure in the IPR depending on the assurance relative to a specified target (Consistent Fail, Consistent Pass, Inconsistent, and No Target) and whether the SPC method has identified meaningful variation (Common Cause, Special Cause Concern, Special Cause Improvement). In later sections this table is reproduced with only the variables in specific areas.
| Variation | Consistent Pass | Inconsistent | Consistent Fail | No Target |
|---|---|---|---|---|
| Special Cause Improvement | Trust Turnover, Ambulance Operations Turnover, Ambulance Operations Stat and Man Training (%), Hand Hygiene Compliance (%) | Call Answering Mean, Category 3 Mean, Calls Abandoned (%), Average Speed To Answer, Speed To Answer 95th Centile, Trust Sickness Absence, Ambulance Operations Sickness Absence, Trust Stat and Man Training (%), IUC Stat and Man Training (%) | Time Lost at Hospital 15 Minutes (Hours), IUC Turnover, 999 Emergency Operations Sickness Absence, Trust Appraisal Compliance (%), Ambulance Operations Appraisal Compliance (%), 999 Emergency Operations Appraisal Compliance (%), IUC Appraisal Compliance (%) | EOC Contacts, Calls Answered, Category 4 Mean, Calls Offered, Cases With ED Outcome (%), Cases Closed With No Onward Referral Via DOS (%), Trust Staff In Post, Ambulance Operations Staff In Post, 999 Emergency Operations Staff In Post, Trust BME Staff (%), Ambulance Operations BME Staff (%), 999 Emergency Operations BME Staff (%), IUC BME Staff (%), Complaints, Complaints Within Target (%), Excellence Reports |
| Common Cause | Premises Cleaning Audit (%) | Category 1 Mean, Category 2 Mean, Ambulance Cases Validated (%), STEMI, Vehicle Deep Clean (%) | Clinical Ringbacks Within Target (%), P1 Ringbacks Within 20 Minutes (%), EOC Turnover, IUC Sickness Absence, 999 Emergency Operations Stat and Man Training (%) | Face to Face Incidents, Hear and Treat (%), Calls Answered, Star 5 Cases, IUC Staff In Post, ROSC, ROSC Utstein, 30 Day Survival, Survival, 30 Day Survival Utstein, Survival Utstein, Stroke, PSII Incidents Declared, PSR Incidents Declared, Patient Safety (Moderate-Severe Harm), Patient Safety (Death), New Inquests Notified, Calls from Frequent Callers, Rate of Physical Assaults on Staff per 1000 AandE Face To Face Incidents, RIDDOR Reports, MSK RIDDOR, Sharps Incidents, Physical Assaults, Physical Assaults on Staff per 1000 AandE F2F Incidents |
| Special Cause Concern | ED Cases Validated (%) | See and Treat (%), ED Conveyance (%), Hours Released To Ambulance Operations By Cohorting, Cases With Ambulance Outcome (%), Patient Safety (No-Low Harm), Child Safeguarding, Adult Safeguarding, Adult Welfare, Control Drugs Incident Reports, Body Fluid Exposure |
Latest Data & Analysis
The following sections show the latest data for measures in Performance, People and Quality. Commentary for the SPC charts has been provided by each area. Most data is at a monthly interval covering the last two years. There are exceptions where reporting is quarterly or improvement is being assessed over a shorter timeframe.
Performance EOC & AMB
| Variation | Consistent Pass | Inconsistent | Consistent Fail | No Target |
|---|---|---|---|---|
| Special Cause Improvement | Call Answering Mean, Category 3 Mean | Time Lost at Hospital 15 Minutes (Hours) | EOC Contacts, Calls Answered, Category 4 Mean | |
| Common Cause | Category 1 Mean, Category 2 Mean | Face to Face Incidents, Hear and Treat (%) | ||
| Special Cause Concern | See and Treat (%), ED Conveyance (%), Hours Released To Ambulance Operations By Cohorting |
EOC Activity & Performance
EOC Contacts
EOC Contacts has risen from 162,008 for September to 163,129 for October 2023. This increase could be linked to the increase in Covid related sickness, and reduction in temperature which exacerbates many chronic illnesses. Half term and Halloween also falls within the Octobe rmonth and demand tends to increase during these times. The increase in Contacts is also directly linked to the pressures faced by other services such as 111/MPS who are able to send Calls automatically via ITK/CADLINK without the requirement of using 999.
Calls Answered
Calls answered has dropped from 128,329 in September to 127,158 in October.
Call Answering Mean
Call answering mean has dropped from 15 seconds in September, to 8 seconds in October, bringing us below the 10 second National target. This decrease in call answering mean may be linked to increase in call handling recruitment and therefore the call handling workforce. The adjustment and continuation of the New Entrants Rota targets areas of concern for performance and we have seen more call handlers moving onto this Rota in October. Although Overtime has been offered at time and a half, uptake has been good due to disruption payments offered.
Ambulance Activity & Performance
Face to Face Incidents
After a period of special cause improvement from summer 2022 this has now returned to a consistent position of common cause variation to a little over 88000 incidents in October 2023. Continuation of Category 2 validation ensures the most appropriate care pathways support patients however this has not had a significant impact on face to face incidents, particularly given the special cause improvement seen in contacts. This consistent demand continues to place pressure on our ability to respond in a timely manner.
Category 1 Mean
The national target for category 1 mean average is 7 minutes. The SPC shows common cause variation with a decrease in the response time from September 2023. This has been in response to significantly higher C1 patients as a proportion of total volume compared to other providers and ARP baselines. LAS continues to deliver the second best C1 performance nationally with common case variation between 7 and 8 minutes.
Category 2 Mean
The Category 2 mean national target is 18 minutes which we have not met between June 2021 and October 2023. The SPC shows common cause variation with a slight decrease in response time in October. Actions ongoing include reduction in hospital handover time & incentivised overtime targeted at key times. Significant focus has been applied to the C2 recovery trajectory which was 33 minutes for October against a trajectory of 31 minutes.
The 45 minute handover process is now implemented within all ICS areas. Targeted overtime is used to support the delivery of operational hours. Fleet availability remains a key limitation in delivering our recovery plan. There is a robust fleet replacement and growth plan that will continue to deliver improvement through Q3.
Category 3 Mean
The Category 3 mean national target is 60 minutes. There was special cause improvement from early 2023 and continues into October 2023. The target is not consistently hit however LAS continues to deliver the best performance nationally against this metric. Both UCR cars and NETS resources attend clinically suitable Category 3 patients.
Category 4 Mean
Category 4 continues to show special cause improvement with a decrease seen between September - October. Both UCR cars and NETS resources attend clinically suitable Category 4 patients.
Patient Outcomes
Hear and Treat (%)
The Hear and Treat figure has decreased slightly from 0.160 for September, to 0.154 for October. This could be linked to the completion of the Future Dispatch Model proof of concept, which saw clinicians co-located to Sector over a 5 week period on a particular Sector/Watch. Plans to implement this concept are ongoing. Decrease in hear and treat could also be linked to challenges with Clinical Hub staffing and recruitment.
See and Treat (%)
There are no targets for See & Treat, August - October there has been a decrease in patients seen face to face and not requiring conveyance to hospital. Special cause concern was seen between January and October 2023. There is a clear link between Hear and Treat volumes as well as operational demand levels that impacts upon the ability to see and treat. The level of Clinical Safety plan will also impact as lower acuity patients will already be directed to other pathways outside of either hear & treat or see & treat leading to a higher acuity group of patients who are responded to.
ED Conveyance (%)
Emergency Department conveyance percentage has no target. Special cause concern is shown throughout 2023, ED conveyance has increased during October to just under 52%. There is a clear link between Hear and Treat volumes as well as operational demand levels that impacts upon the ability to see and treat. The level of Clinical Safety plan will also impact as lower acuity patients will already be directed to other pathways outside of either hear & treat or see & treat leading to a higher acuity group of patients who are responded to. Whilst robust data that identifies the acuity level of patients is not available all the proxy indicators (ARP category, NEWS2 scoring & percentage of blue call activity) are increasing which is suggestive that patients we attend are more sick. This clearly restricts the ability to safely manage the patient in another setting rather than ED.
Time Lost at Hospital 15 Minutes (Hours)
Time lost at hospital over 15 minutes continues to show common cause improvement. Hours lost at hospital have increased between September - October. Arrangements to rapidly offload patients are now in place across London. The implementation of the 45 minute handover process in all of the 5 ICS areas has been instrumental in achieving this success.
Performance IUEC
| Variation | Consistent Pass | Inconsistent | Consistent Fail | No Target |
|---|---|---|---|---|
| Special Cause Improvement | Calls Abandoned (%), Average Speed To Answer, Speed To Answer 95th Centile | Calls Offered, Cases With ED Outcome (%), Cases Closed With No Onward Referral Via DOS (%) | ||
| Common Cause | Ambulance Cases Validated (%) | Clinical Ringbacks Within Target (%), P1 Ringbacks Within 20 Minutes (%) | Calls Answered, Star 5 Cases | |
| Special Cause Concern | ED Cases Validated (%) | Cases With Ambulance Outcome (%) |
Call Handling Activity
Calls Offered
Calls offered have seen a falling trajectory for some time now, and this aligns with the national picture. A small uptick in calls offered during the last reporting period may indicate an upturn in winter related illness,
Forecast Calls Offered
Calls Answered
Calls answered have increased in the last period - this is due to a number of factors - calls offered have increased, and work on reducing absence rates has started to have a positive impact.
Calls Abandoned (%)
Focused work on reducing the call abandonment rate has continued to show improvements. A multidisciplinary group consisting of 111 Ops management, network and voice engineers is investigating some anomolous data points with regard to the number of calls being abandoned inside the first 30 seconds. Improved absence rates have also helped improve this metric.
Call Handling Performance
Average Speed To Answer
Average speed of answer is also showing an improving trajectory. Reduced absence rates and a continual liaison with the 111 scheduling team to enable more rapid staff movements are driving the improvement seen. Staff engagement sessions across both the IUC call centres have been held to inform colleagues about the current and future IUC landscape, and how colleagues individual performance contributes to patient care. These were well received and will be continued at stages throughout the year. The LAS consistently performs better than the national average for speed to answer, and also is almost 2 minutes quicker in average handle time in pathways than the national position.
Speed To Answer 95th Centile
An improvement in the 95th centile time is welcomed, but there remains more to do with this. The measures taken to improve attendance and more responsive rostering have been factors in this improvement.
Clinical Assessment
ED Cases Validated (%)
Validation of ED Cases has to be considered alongside validation of ambulance cases, P1 priorities and *5 response therefore if any or all of these elements have increased there is likely to be pressure on being able to validate as many ED dispositions. It is also dependent on demand patterns vs staffing and the proportion of injuries to illness. This is being monitored and reviewed to ensure performance is optimised
Cases With ED Outcome (%)
Work has been taking place to look at outlier Clinicians with high ED outcomes and understand how they can be supported to ensure they are utilising all options on the DOS and only using ED when necessary. The aim is to reduce unnecessary ED outcomes , provided clinical audits are ensuring clinical safety for the service overall.
Ambulance Cases Validated (%)
Cases With Ambulance Outcome (%)
Clinical Ringbacks Within Target (%)
P1 Ringbacks Within 20 Minutes (%)
Cases Closed With No Onward Referral Via DOS (%)
Star 5 Cases
People
| Variation | Consistent Pass | Inconsistent | Consistent Fail | No Target |
|---|---|---|---|---|
| Special Cause Improvement | Trust Turnover, Ambulance Operations Turnover, Ambulance Operations Stat and Man Training (%) | Trust Sickness Absence, Ambulance Operations Sickness Absence, Trust Stat and Man Training (%), IUC Stat and Man Training (%) | IUC Turnover, 999 Emergency Operations Sickness Absence, Trust Appraisal Compliance (%), Ambulance Operations Appraisal Compliance (%), 999 Emergency Operations Appraisal Compliance (%), IUC Appraisal Compliance (%) | Trust Staff In Post, Ambulance Operations Staff In Post, 999 Emergency Operations Staff In Post, Trust BME Staff (%), Ambulance Operations BME Staff (%), 999 Emergency Operations BME Staff (%), IUC BME Staff (%) |
| Common Cause | EOC Turnover, IUC Sickness Absence, 999 Emergency Operations Stat and Man Training (%) | IUC Staff In Post | ||
| Special Cause Concern |
Staff In Post
Trust Staff In Post
Recruitment to the Trust Workforce plan continues at a positive rate. The current pipeline is at over 850 candidates at conditional offer stage (580 of these are for frontline roles, and 190 call handlers). A 100% course fill rate was achieved during Q2 and 95% was achieved in October.
Corporate/Specialist recruitment – there continues to be significant recruitment activity to support the frontline including recruitment into Advanced Paramedic Practitioners, CRU, TRU, HART, HEMS, PCN Programme, Mental Health and Community Resuscitation roles. We currently have over 80 candidates at conditional offer stage.
Retention remains high across all areas of LAS and recruitment pipelines are very healthy in all disciplines. Areas that are experiencing abnormal levels of leavers (EOC) are taking part in pilot scheme of stay interviews.
Ambulance Operations Staff In Post
The current level of registered and non-registered staff within Ambulance Operations has improved month on month. Retention levels are high and this could be attributed to the model of teams based working that has now been implemented across all sectors.
Paramedic recruitment - Year to date we have filled 250 of the 254 training places which is four behind plan. The international pipeline remains strong with over 200 candidates offered which includes 150 offers from the international trip and 41 from our ‘Rest of the World’ campaign.
Our engagement schedule which started in August has been well received by our pipeline with guest speakers from key teams including the CEO, the international liaison team, OPC, Clinical Link Tutors and our well-being team). We have also started discussions with candidates at ten Australian and New Zealand Universities.
Our recent international adverts from Australia and the Rest of the world have positively generated over 200 applications. Work continues to explore opportunities to recruit international paramedics from other countries, for example Jordan and South Africa. Planning has commenced for next Australia recruitment campaign February/March 2024, to support the 2024/2025 pipeline.
We have achieved 100% fill rates for the UK graduate training places this year with over 200 offers.
AAP Recruitment - Year to date we have filled 136 of the 144 training places which is eight behind plan. The pipeline is positive with over 100 candidates offered. The team have attended a number of recruitment events to continually improve the pipeline numbers.
999 Emergency Operations Staff In Post
Positive fill rate of 100% achieved in EOC call handling. The pipeline is strong with 90 candidates at offer stage and this will continue to grow with Super Saturday and assessment events on-going. Forecast to end the year with minimal vacancies.
IUC Staff In Post
We achieved a 96% fill rate in October and the pipelines have improved with over 100 candidates at offer stage. The recruitment team have attended community events where they actively promote 111 and 999 roles to boost the pipelines and work continues with outreach events in the South, to boost the pipeline for Croydon.
Turnover
Trust Turnover
Turnover has stabilised in October (currently 10.3% in October) and the number of frontline leavers has remained positively below plan (-34fte). The stability rate which measures the ‘stay’ rate for staff over a 12 month period averages 85% for the year.
There are a number of key retention initiatives in progress covering flexible retirement, stay conversations and personalised holistic health plans (piloting in 999 and 111 call handling) and a review of the internal exit interview process to improve intelligence on reasons for leaving.
Ambulance Operations Turnover
Month on month turnover is decreasing across all sectors for registered and non-registered staff.
We have low turnover rates across the Ambulance Sectors ranging from 6% to 10%, NETS (8%) and Resilience and Specialist Assets (5%).
EOC Turnover
The well-being team are piloting 'stay conversations' in the 999 and 111 call handling teams. Stay conversations scheduled at regular points throughout the employment journey can help to gather feedback about what is working well and any areas that could be improved. The aim of these conversations is to better understand why employees stay and what might cause them to leave, providing information needed to help retain staff. They can be one-to-one conversations between an employee and their line manager, a manager from another directorate/department, or by a member of the HR/retention team. Colleagues from the P&C team (principally wellbeing and HR) will run a pilot programme of stay conversations for new colleagues in 111 and EOC with the aim of better understanding why these areas have high numbers of leavers within their first year of employment. A sample of 50 new starters who are between 3 and 6 months of employment in any of the four contact centres will be recruited to the programme, having given their consent for the conversation to take place. The sample will be randomly chosen from a complete list of new starters provided by Workforce Intelligence.
IUC Turnover
Turnover is beginning to show a downward trend for the last 6 month period. A leaver's deep dive is in progress for call handling - turnover rates have improved from a high of 40% to 29% in October. The well-being team are piloting 'stay conversations' in the 999 and 111 call handling teams. Stay conversations scheduled at regular points throughout the employment journey can help to gather feedback about what is working well and any areas that could be improved. The aim of these conversations is to better understand why employees stay and what might cause them to leave, providing information needed to help retain staff. They can be one-to-one conversations between an employee and their line manager, a manager from another directorate/department, or by a member of the HR/retention team.
Sickness Absence
Trust Sickness Absence
Absence during October has climbed to 6.5%-7% and this is being picked up in FFRs. Over 32,000 calls have been made to the service from Sept 2022-date. The First Day Absence call handling times in early October were significantly compromised to the extent we had to formally escalate the matter. We have been receiving daily updates since mid-October from the company and calls are in the main, back within normal ranges.
The Wellbeing Hub continues to provide support to all colleagues and volunteers five days a week 0900-1700
Flu vaccines arrived in the Trust on 6th October with clinics set up in the following days. It has now been confirmed by NHSE that it will not be possible for the Trust to deliver an internal Covid-19 vaccination programme, but colleagues are able to access their vaccine through the NBS and hospital hubs.
The LAS Charity continues to support the Wellbeing Support vehicles and cafes, with £15,000 per quarter for consumables and holistic activities.
Keeping Well NWL will complete the Wellbeing Conversation Training at the end of October and will have delivered more than 20 sessions to managers across the Trust. A full evaluation will then take place.
The Ambulance Staff Charity (TASC) have run the first pilot session for EOC staff and the wellbeing team in recognising emotions and supporting each other. The aim of the training is to encourage colleagues to have a better understanding of why they are feeling a certain way and when they need support. The first session was a great success and wider roll out will now be considered.
Ambulance Operations Sickness Absence
Sickness levels are slightly above target with the top reason still stress, S10 Anxiety /stress/depression/other psychiatric illnesses, MSK and unknown. We have sent reminders to staff to update the details and requests to not use unknown where possible. Long term and short term sickness is lower than the same time last year, with LTS seeing an improvement from last month. STS is rising with more coughs/colds and throat infections being reported. We are promoting vaccinations in all sectors
999 Emergency Operations Sickness Absence
The sickness absence rate is are higher than the remain around the 10% level and the team are taking actions to reduce absences. As part of this process the team are introducing additional activities to improve management focus and activity in this area. Initiatives include; introducing weekly watch reporting, covering the full range of abstractions including sickness absence; twice weekly attendance review meetings with Watches to review attendance management activity and a monthly SLT assurrance meeting.
IUC Sickness Absence
The sickness absence trend is encouraging with a continued downward trajectory over recent months. The team have introduced a weekly meeting and reporting schedule which is chaired by a Deputy Director focussing on management activity and attendance management priorities.
BME Staff
Trust BME Staff (%)
Continued improvement in the % of BME staff at the Trust.
The EDI team have requested for the development of an EDI dashboard which will be used to identify themes and trends across the LAS and to make this information more readily accessible to managers and staff.
The Workforce Intelligence Team are leading on this work and they have proposed that the existing ESR Workforce Dashboard is used.
This is a platform which all managers can currently access and it includes staff in post profiles, joiners, leavers, vacancies, appraisal, stat and mand training and managers can drill into the data using the Trust organisation hierarchy.
It takes a daily feed from ESR and the dataset has been created and shared with BI colleagues. The work is expected to start in October with a view to completing the pages by the end of Q3. It is expected that the new EDI pages will be available for managers in Q4.
Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.
Ambulance Operations BME Staff (%)
Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.
999 Emergency Operations BME Staff (%)
BME representation in EOC remains positive. Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.
IUC BME Staff (%)
IUC have the highest BME representation of any service/team at the Trust. Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.
Appraisal
Trust Appraisal Compliance (%)
The ‘Our LAS’ appraisal process is underway to empower better, efficient conversations between leaders and their team members throughout the year, not just a one-off appraisal session. The 4S’s form – aiding discussion around an employees’ successes, struggles, setting goals and support requirements – is available on the intranet and colleagues are invited to 90-minute training sessions to convert their learning into practice.
There has been good progress with the design and development of the new ‘Our LAS’ e-appraisal & talent management system. We launched Phase 2: Initial roll out stage of the e-Appraisal system - for 345 people - on 26 September 2023. This includes all colleagues from Homerton and New Malden. The system has been met with positive response, which aligns to the feedback received from Phase 1: Trial stage, launched in August 2023, for 320 colleagues from the People and Culture Directorate, EDI Team, and all those that were part of the stakeholder engagement panels (including their manager and their direct line reports). The OD and Talent Team has run several drop-in sessions for colleagues, along with delivering one-to-one sessions to support colleagues over the two phases that have launched. A formal evaluation has been planned for December 2023. The OD and Talent team has also recorded a training video, which is currently being edited to support colleagues further.
Ambulance Operations Appraisal Compliance (%)
Appraisal rates are increasing week by week within Ambulance and there has been a real focus on this across all groups. Assurances have been provided by LGM's to ADO's that if an appraisal has not been completed there is a date booked within a 4 week period rosters allowing. Appraisals are at 77% which is an improvement from last month and on the same period last year which was 63%.
999 Emergency Operations Appraisal Compliance (%)
Appraisal rates have reduced during the summer period and the team will need to work on appraisal delivery over the coming months.
IUC Appraisal Compliance (%)
Appraisal rates for the Directorate have remained fairly static and off target for a number of months. The team will need to prioritise appraisal delivery in order to improve compliance.
Statutory & Mandatory Training
Trust Stat and Man Training (%)
Stat and mand rates positively above target at 89%.
Ambulance Operations Stat and Man Training (%)
Stat & Mand training remains high for all staff across all sectors. Stat & Mand training is a constant high level for Ambulance.
999 Emergency Operations Stat and Man Training (%)
Stat Man training is a focus area for the management team.
IUC Stat and Man Training (%)
The Stat Man training remains in a positive position for this Directorate.
Quality
| Variation | Consistent Pass | Inconsistent | Consistent Fail | No Target |
|---|---|---|---|---|
| Special Cause Improvement | Hand Hygiene Compliance (%) | Complaints, Complaints Within Target (%), Excellence Reports | ||
| Common Cause | Premises Cleaning Audit (%) | STEMI, Vehicle Deep Clean (%) | ROSC, ROSC Utstein, 30 Day Survival, Survival, 30 Day Survival Utstein, Survival Utstein, Stroke, PSII Incidents Declared, PSR Incidents Declared, Patient Safety (Moderate-Severe Harm), Patient Safety (Death), New Inquests Notified, Calls from Frequent Callers, Rate of Physical Assaults on Staff per 1000 AandE Face To Face Incidents, RIDDOR Reports, MSK RIDDOR, Sharps Incidents, Physical Assaults, Physical Assaults on Staff per 1000 AandE F2F Incidents | |
| Special Cause Concern | Patient Safety (No-Low Harm), Child Safeguarding, Adult Safeguarding, Adult Welfare, Control Drugs Incident Reports, Body Fluid Exposure |
ROSC
ROSC
The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest that had Return of Spontaneous Circulation (ROSC) on arrival at hospital.
Common cause variation is currently present in the process.
ROSC Utstein
The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT) that had Return of Spontaneous Circulation (ROSC) on arrival at hospital.
Common cause variation is currently present in the process.
Survival
30 Day Survival
The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest who were alive 30 days post arrest.
Common cause variation is currently present in the process.
30 Day Survival Utstein
The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT) who were alive 30 days post arrest.
Common cause variation is currently present in the process.
STEMI & Stroke
STEMI
The percentage of patients with a pre-hospital diagnosis of suspected ST elevation myocardial infarction (confirmed on ECG) who were provided with a STEMI care bundle.
Common cause variation is currently present in the process. Although the NHS England does not publish this data for June 2023, we are consistently performing under the LAS target for this measure (80%).
Stroke
The percentage of patients with a pre-hospital diagnosis of suspected stroke who were provided with a stroke diagnostic bundle.
Common cause variation is currently present in the process.
Patient Safety Incident Response Framework
PSII Incidents Declared
Common cause variation present in the system, no issues identified
PSR Incidents Declared
Common cause variation present in the system, no issues identified
Patient Safety Incident Management
Patient Safety (No-Low Harm)
A new category was introduced on Datix during this reporting period - 'clinical concern regarding an external provider'. Staff are directed to use this category and report cases as no harm in the event that they are concerned about an external providers care. Prior to this category being introduced and specific instructions, incidents of this nature may have been reported as moderate, severe or death. This change in reporting accounts for the sudden increase in no/low harm incidents. It should be noted that increased reporting of no/low harm incidents is a sign of a positive reporting culture.
Patient Safety (Moderate-Severe Harm)
Common cause variation present in the system, no issues identified
Patient Safety (Death)
Common cause variation present in the system. All incidents reported as Death will be the subject of a learning from death review. The harm grading of the incident may change depening on the outcome of the review.
Inquests & Prevention
New Inquests Notified
The number of new inquests notified remains high. This continues to be driven by a large backlog held by Coroners.
Complaints
Complaints
The number of complaints received by the Trust. There is no target but complaints received showed special cause improvement and remain under the median. The main themes of incoming complaints continue to relate to staff behaviour and delays (which includes delay in an ambulance attending, delay in 111 ringing back, delay on scene).
Complaints Within Target (%)
The Trust target is to respond to 75% of complaints within 35 working days. Special cause improvement has been maintained despite the team being impacted by short-staffing in recent months.
Safeguarding
Child Safeguarding
October has seen the highest total volume of child referrals over the period covered in this report. The stong upward trend has stabilized slightly in the last two quarters, but still shows increase. We have seen a very high number of referrals from EOC, which may be associated with changes to the way that referrals are made that were implenented in October. We will look to confirm this over the next month or two.
Previous high child totals have been associated with a very high share of referrals related to mental health / suicidality / self harm. There are some signs that this trend is slowing - in September the % of these referrals dropped for the firrst time in a year.
Otherwise these increases are largely driven by external forces - Local Authority partner organisations report similar trends.
Adult Safeguarding
Adult safegaurding referral volumes are historically high and the trend remains upwards, although showing signs of stabilising over the last few months.
There are no particular types of concern which are driving this increase - it's a general, across the board increase, and Local Authority partner organisations report similar trends.
Adult Welfare
Adult welfare referral volumes are historically high and the trend remains upwards.
There are no particular types of concern which are driving this increase - it's a general, across the board increase, and Local Authority partner organisations report similar trends.
Frequent Callers
Calls from Frequent Callers
Callls from frequent callers are not currently showing special cause drop, but similar drops in the number of callers in the same period, together with an increase in the % of FCs with Universal Care Plans, and some CCG / borough areas showing all three indicators in a steeper change, does suggest we are in a period where the overall picture is improving. It is plausible that the increase in UCPs is partly causal here, and we will be looking to work with a new Informatics colleague in the strategy team to test this hypothesis in coming weeks / months. We are working with ICB colleagues to improve awareness of the effectiveness of UCPs in this cohort and hope to see this trend strengthen.
Health & Safety
RIDDOR Reports
17 RIDDOR incidents were reported to HSE during October’23. 7 out of the 17 RIDDORs were reported within the 15 days timeframe during October'23. Manual Handling Incidents account for the highest number of RIDDORs reported across the Trust during 2023/24 (up to end of October'23).
MSK RIDDOR
Total of 12 MSK related RIDDOR incidents reported during October'23. 9 reported RIDDOR incidents occurred in Patients Home (n=9), 2 incidents occurred in Ambulance (In/Ext) (n=2) and 1 incident occurred in Public Place (n=1). 3 reported RIDDOR incidents involved Trolley Bed (n=3), 2 incidents involved Carry Chair (n=2), 1 incident involved LP15 (n=1), 1 incident involved Wheel Chair (n=1) and 5 incidents involved no equipment (n=5). 5 reported RIDDOR incidents resulted in Back injury (n=5), 3 incidents resulted in Wrist injury (n=3), 1 incident resulted in Ankle injury (n=1), 1 incident resulted in Arm injury (n=1), 1 incident resulted in Elbow injury (n=1) and 1 incident resulted in Shoulder injury (n=1). 7 reported RIDDOR incidents were occurred during Lifting & Carrying (n=7), 3 incidents were occurred during Pushing & Pulling (n=3), 1 incident occurred providing CPR (n=1) and 1 incident occurred due to Work related-CTS (n=1).
Control Drugs Incident Reports
The rise in controlled drugs (CD) incidents is likely due to two main factors. Firstly, we are now reporting all CD incidents rather than those relating to schedule 2 drugs as was previously the case. Adjustment of the thresholds for common cause variation may therefore be required going forward. Secondly, we have recently introduced a second CD in the form of midazolam and we have therefore doubled the number of CD safe withdrawals a paramedic is required to undertake at shift start/end. As a consequence it is likely that increased reporting of breakagaes, documentation issues and administration errors is in part explained by this.
Hand Hygiene Compliance (%)
Location errors within the new 'InPhase' audit system have now been resolved, enabling increased submissions from across the Trust. A 98% compliance score was achieved for October with only 1 group station omitting data.
Premises Cleaning Audit (%)
17/21 group stations submitted data for the month of October evidencing a 96% compliance achievement. Location errors within the new 'InPhase' audit system have now been resolved, enabling increased submissions and providing a more accurate picture across the Trust.
Vehicle Deep Clean (%)
Overall trust compliance for vehicle deep cleans was 91%, The trust target is 95% . Risk of cross-transmission of infection is reduced acknowledging crew cleaning undertaken autonomously between patients.
Body Fluid Exposure
A total of ten incidents relating to Body Fluid Exposures (BFE) were reported in October, consistent with recent months. Each incident is investigated locally and, overseen by the IPC team.
Sharps Incidents
A total of two contaminated sharps incidents were reported during this period, deemed within acceptable limits. Each incident is followed-up locally, overseen by the IPC Team.
Assaults
Physical Assaults
Total of 52 Physical assaults reported during October'23. There was a slight decrease in the number of physical assaults on staff related incidents in October'23 and the trend is down-ward. The most common underlying causes remain: intoxication (drugs/alcohol), Mental Health related issues, patients recovering from fits/seizures or reacting to medication
Physical Assaults on Staff per 1000 AandE F2F Incidents
The greatest number of reported physical assaults (57%) occur due to the clinical condition of the patient during 2023/24. Police attended 54% of physical assault incidents during 2023/24. 10 successful prosecution for assault have been recorded during 2023/24 (up to end October'23).
Excellence
Excellence Reports
Number of excellence reports continues to increase which is very positive.
Finance
Income & Expenditure
In month - £0.4m surplus; £0.1m favourable to plan.
Capital Expenditure
Year to date spend - £7.5m; £1.3m ahead of forecast.
CIP Savings
In month - £1.9m, on plan.
Cash
Closing cash balance - £43.6m; £3.6m ahead of plan.
Risks and Mitigations
| Risk | Description | Mitigation |
|---|---|---|
|
Block contracts with 4 ICB’s in dispute | LAS has formally raised dispute on proposed income |
|
Under-delivery against £25.0m CIP target | Developing recovery plan for Ambulance Services, 999 operations and 111 service |
|
Performance below trajectory submitted to NHSE | Identifying operational efficiencies |