Last updated: 25 March 2024 15:24.

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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.

NHSE have produced the following guide to interpreting the variation and assurance symbols.

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	ED Cases Validated (%) Local, Ambulance Cases Validated (%) Local, Trust Turnover, Ambulance Operations Turnover, Ambulance Operations Stat and Man Training (%)	Call Answering Mean, Calls Abandoned (%), Average Speed To Answer, Trust Stat and Man Training (%), IUC Stat and Man Training (%)	Time Lost at Hospital 15 Minutes (Hours), EOC Turnover, IUC Turnover, 999 Emergency Operations Sickness Absence, Trust Appraisal Compliance (%), Ambulance Operations Appraisal Compliance (%), IUC Appraisal Compliance (%), 999 Emergency Operations Stat and Man Training (%)	Category 4 Mean, 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 Within Target (%), Excellence Reports
Common Cause	Hand Hygiene Compliance (%), Premises Cleaning Audit (%)	Category 1 Mean, Category 3 Mean, Speed To Answer 95th Centile, Trust Sickness Absence, Ambulance Operations Sickness Absence, STEMI	Category 2 Mean, Clinical Ringbacks on all Priorities Within Target (%) Local, IUC Sickness Absence	EOC Contacts, Calls Answered, Face to Face Incidents, Hear and Treat (%), ED Conveyance (%), Calls Offered, Cases With ED Outcome (%) Local, Cases With Ambulance Outcome (%) Local, Cases Closed With No Onward Referral Via DOS (%) Local, 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, Complaints, Calls from Frequent Callers, RIDDOR Reports, MSK RIDDOR, Body Fluid Exposure, Sharps Incidents, Physical Assaults, Physical Assaults on Staff per 1000 AandE F2F Incidents
Special Cause Concern		Vehicle Deep Clean (%)	999 Emergency Operations Appraisal Compliance (%)	See and Treat (%), Hours Released To Ambulance Operations By Cohorting, Patient Safety (No-Low Harm), Child Safeguarding, Adult Safeguarding, Adult Welfare, Controlled Drugs Incident Reports

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	Inconsistent	Consistent Fail	No Target
Special Cause Improvement	Call Answering Mean	Time Lost at Hospital 15 Minutes (Hours)	Category 4 Mean
Common Cause	Category 1 Mean, Category 3 Mean	Category 2 Mean	EOC Contacts, Calls Answered, Face to Face Incidents, Hear and Treat (%), ED Conveyance (%)
Special Cause Concern			See and Treat (%), Hours Released To Ambulance Operations By Cohorting

EOC Activity & Performance

EOC Contacts

There is no target set for number of contacts into EOC. A reduction in the number of contacts relates to less pressure of the service. Common cause variation in contacts is reported following the sharp increase in contacts in December 2023 which follows expected seasonal variation. The volume of calls dropped below the median in January and February 2024 and again is in line with expectations of seasonal variation.

Calls Answered

There is no target for calls answered.

The system remains stable and shows common cause variation with close corelation to contacts into the service. As a consequence there was a similar increase above the median in December 2023 which has dropped back in the following months and is in line with expectations for seasonal variation. The previous year saw some variation in pattern and is linked to the national strikes during this period.

Call Answering Mean

The national target for the call answering mean is set at 10 seconds which across the 24 data points of the SPC has been inconsistently hit. There has been special cause improvement shown since January 2023.

The improvement at the start of this period was partially driven by the drop in the number of contacts. Across the remainder of 2023 there has been a sustained recruitment programme to increase the number of call handling staff which has maintained the improvements even as contact increased.

January and February saw the Call Answering Mean target met and full establishment of call handling staff is expected to be met by the end of April 2024. If improvements continue in line with current trajectory consideration will be given to re-baseline the SPC chart from Aril 2024 onwards.

Ambulance Activity & Performance

Face to Face Incidents

The number of face to face incidents shows the trend in activity where a resource is dispatched following clinical triage within EOC. As a consequence there is no defined target.

The overall system is stable which has resulted in common cause variation being demonstrated. The drop in January 2024 is minimal when compared with the same drop in EOC contacts for the same month. This is due to the number of calls during this period related to chest pain and breathing difficulties recorded in January and which subsequently reduced in February 2024. The consequent fall in face to face incidents in February is in line with seasonal variation, although use of future dispatch model in specific areas will have also reduced the need for a resource to be dispatched where the patient incident could be resolved over the telephone.

Category 1 Mean

The national target for Category 1 mean average is 7 minutes and has been inconsistently hit over the 24 data points.

There continues to be common cause variation. Over the past 12 months this has fluctuated between 7 and 8 minutes and category 1 patients continue to be prioritised as our sickest patients. Across the past 12 months we have looked at the mix of fast response vehicles and double crewed ambulances to ensure that we deliver the best response for this category of patients. Comparatively there has been an improvement in response times of circa 24 seconds when comparing January and February 2024 to 2023 especially when taking account the increase in demand.

LAS continues to deliver the second best Category 1 performance nationally. Acuity follows a seasonal trend pattern with increases through the winter months.

Category 2 Mean

The national standard for the Category 2 mean is 18 minutes, although the trajectory of the agreed operating plan has been to achieve a year to date outturn position of 34 minutes.

Common cause variation continues and there is a focus on actions to bring about improvements in our Category 2 response times. We continue to work with hospitals to minimise hospital handover times, linked to our 45 minute handover process.

Targeted, incentivised overtime is implemented to ensure consistent production of frontline operational hours based on forecast in demand.

In line with teams based working, we have aligned and "tethered" our fleet to operational groups to ensure that we maximise the number of deployable hours. As part of our fleet replacement programme we are increasing our DCA fleet by 50 vehicles which will be completed by end of March 2024. To support both the optimisation of overtime and the availability of vehicles, we have produced a tool within our scheduling system, to provide local ambulance operations teams greater visibility of peak vehicle requirements to ensure closer alignment.

A dashboard is now in production to provide greater visibility of performance to empower teams across the operations environment. This is being coupled with an education programme for all managerial roles within ambulance operations, to deliver high performing teams.

Category 3 Mean

The Category 3 mean national target is 60 minutes and this has been inconsistently met across the period. There has been a special cause improvement from early 2023 and was sustained into November 2023. However, we are now showing common cause variation as a result of performance in December 2023 related to the increase in demand. The improvements seen in January and February 2024 are consistent with the decrease in activity over the same period.

We continue to concentrate on maximising the use of other resources such as urgent community response and mental health cars and utilising NETS resources for clinically suitable Category 3 patients.

Category 4 Mean

There is no target for Category 4 response times.

There continues to be special cause improvement and Category 4 patients make up a relatively small component of our response profile.

As per our Category 3 response we continue to look to maximise use of urgent community response, mental health cars and NETS resources to attend clinically suitable Category 4 patients.

Patient Outcomes

Hear and Treat (%)

There is no target for hear and treat and we recognise that improvements in this metric will reduce the number of face to face incidents and therefore pressure on our frontline resources.

Hear and treat rates for January and February 2024 were 15.9% and 16.4% respectively and this continues to show common cause variation although there is continuing upward trend since July 2023. The national average for hear and treat was 14.3% in January and 14.2% in February.

The revised Dispatch Model (previously FDM), which has a Clinical Team Navigator working alongside a dispatch desk within EOC, has continued to support LAS sectors / ICS areas which have seen most pressure in the urgent and emergency system and where there was CHUB resource availability. For those sectors where future dispatch model was in operation in February an improvement in the hear and treat rate to 18.8% was achieved. Plans are now in place to embed consistent delivery of the future dispatch model, 24 hours per day, across all sectors in line with an agreed recruitment trajectory.

Improvements in the resourcing of the Clinical Hub has continued to deliver over 10,000 hours of clinical telephone assessment each month in January and February 2024 which represents an increase of 1,000 hours per month since August 2023.

The additional hours, along with focused support and development of the clinicians, has resulted in a continued increase in the number of clinical assessments month on month. In February 2024 15,300 clinical assessments were undertaken compared with 13,500 in November 2023 and only 9,604 in August 2023.

See and Treat (%)

There are no targets for See & Treat. Special cause concern continues to be shown.

There is a clear link between hear and treat volumes as well as acuity of patients that impacts upon the ability to see and treat patients. The level of clinical safety plan also impacts 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.

Indicators for acuity (percentage of incidents graded as Cat 1 & Cat 2, percentage of blue calls and NEWS 2 score) all show an increase in acuity .

ED Conveyance (%)

Emergency Department conveyance percentage has no target. We have seen common cause variation since September 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 and require conveying to hospital.

As stated on the see and treat SPC indicators on acuity 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)

The national standard for the handover of patients at hospital is 15 minutes and this shows all time lost after 15 minutes meaning that the target is set at 0. This target has not been met.

There continues to be special cause improvement which has been as a direct consequence in instigating the 45 minute handover process earlier in the financial year across all 5 ICS's.

Work continues to manage the handover process with partners and a case study of work focussed on a site in North East London as an exemplar of partnership working which has been shared nationally.

With the move of the 45 minutes handover into business as usual the focus has moved to the day to day management against this metric and in supporting acute trusts. There continues to be collaborative working where issues are established with individual Trusts.

Performance IUC

Variation	Consistent Pass	Inconsistent	Consistent Fail	No Target
Special Cause Improvement	ED Cases Validated (%) Local, Ambulance Cases Validated (%) Local	Calls Abandoned (%), Average Speed To Answer
Common Cause		Speed To Answer 95th Centile	Clinical Ringbacks on all Priorities Within Target (%) Local	Calls Offered, Calls Answered, Cases With ED Outcome (%) Local, Cases With Ambulance Outcome (%) Local, Cases Closed With No Onward Referral Via DOS (%) Local
Special Cause Concern

Call Handling Activity

Calls Offered

Description: There was a reduction in calls offered in Feb24 however this trend is in line with internal, regional, and national forecasting. The call volume in February was slightly above the forecast and represents continued high demand on the service.

Evaluation: The reduction is common cause variation.

Action: No actions are being taken as this is in line with the seasonal forecasts

Forecast Calls Offered

Description: In February, the calls offered reduced in line with the forecast but were above the expected volume.

Evaluation: The higher than expected demand profile is attributable to continued demand from our patients, ongoing pressure in the urgent and emergency care sector, and higher acuity.

Action: Going forward, the IUC team are reviewing and uplifting the rotas to meet demand. The recruitment pipeline is also being expanded with job adverts being refreshed, and different shift patterns explored

Calls Answered

Description: Calls answered reduced in February although this is common cause variation.

Evaluation: The trend of calls offered matches the calls answered trend and abandonment rate only increased slightly.

Action: Turnover will continue to be a focus to enable us to answer more calls and reduce the abandonment rate. Turnover reduced slightly to 20% and absence rates also decreased to 9% (the lowest rate in 2 years) which reflects the staff engagement work being completed and the focus on team working. During the month, engagement sessions have been conducted with the director team and staff as well as the introduction of new ways for staff to provide feedback and ask queries. The reduction in turnover is also attributable to the extensive improvement in appraisal compliance with 68.8% of the workforce having had a recent appraisal (compared to 27% 18-months ago). New staff bulletins have been developed and circulated and work is being planned to create a team away days.

Calls Abandoned (%)

Description: In February, abandonment rate increased and did not meet the target. This is still special cause improvement over the past 11 months.

Evaluation: The higher abandonment rate is due to peaks in demand on specific days/hours and overall calls offered being above forecast throughout the month. Challenges with staff sickness have also continued throughout the month

Action: The team continue to focus on reducing the abandonment rate and have been conducting end-to-end reviews of the call handling pathway to align pathways and processes. There has also been an improvement of real-time performance management in the team with additional training provided and greater use of the Storm data to ensure that capacity is utilised across providers during peak periods. IVR messaging is being developed to reduce abandonment rate and staffing rotas are being adjusted to meet the demand. A new forecast has been developed for 2024/25.

Call Handling Performance

Average Speed To Answer

Description: In February, the average speed to answer increased slightly however this continues to be special cause improvement over the past 11 months.

Evaluation: Performance against this metric was impacted by periods of high demand, particularly on Mondays and Saturdays. Over 9k calls were offered on both Saturday 3rd and Saturday 10th of February and average answer time increased to 219 seconds on Mondays due to peaks from 8am. Challenges with reaching the full rota requirement as well as increased sickness impacted performance

Action: The rotas are currently being reviewed and an appraisal of the current forecasting process has been completed to ensure that rotas match demand as much as possible and resilience partners used to support. Weekly assurance meetings are also now in place to support with the identification and resolution of performance issues. Staff training will continue and staff engagement through in person events and newsletters is being put in place to improve the skills and performance of the team

Speed To Answer 95th Centile

Description: Speed to Answer 95th Centile reduced in February however this is still common cause variation so is not yet part of an improvement trend

Evaluation: Performance in this metric was impacted by peaks in demand as described above and the calls offered being above the forecast. In addition, increased staff sickness impacted the rota fill rates

Action: As described above, a rota review is underway to align demand and capacity. Additional recruitment is being undertaken and a review of the recruitment processes. Further staff training and staff engagement will be taking place.

Clinical Assessment (Local)

ED Cases Validated (%) Local

Description: ED Validation continues to show special case improvement for the 7th month. Furthermore, of the 4.38k ED validations completed in the month, 56.4% were directed to a different service.

Evaluation: This more effective use of system resources was achieved through continued training of the team, development of Clinical Guardian, and additional clinical floor walking and in-line support capacity. This work saved almost 2.5k Emergency Department attendances during the month.

Action: Continued focus on this metric

Cases With ED Outcome (%) Local

Description: Of cases referred into the CAS, a very low number are referred to ED. This is common cause variation

Evaluation: As outlined above, the number of patients with an ED outcome overall continues to be very low despite the high acuity received by the CAS during the month (7.74% of calls being triaged as respiratory symptoms and 3.44% being triaged as chest pain).

Action: No action to be taken currently due to good performance

Ambulance Cases Validated (%) Local

Description: Ambulance validation continues to show special cause improvement for the 7th month.

Evaluation: Of the 21.5k ambulance validations completed during the month, 83.2% were stood down. This more effective use of system resources was achieved through continued training of the team, development of Clinical Guardian, and additional clinical floor walking and in-line support capacity. This work saved almost 18k ambulance attendances during the month.

Action: Continued focus on this metric

Cases With Ambulance Outcome (%) Local

Description: The number of 111 cases with ambulance dispatch reduced in February which is common cause variation and means there is no longer special cause concern.

Evaluation: Referrals from 111 to an ambulance dispatch remained very low despite the high acuity of calls being presented. Of the 49k patients referred to the CAS (23.2%), only 9.5% received an ambulance disposition (reduced from 9.72% the previous month).

Action: continued monitoring of ambulance dispatch will take place as well as individual audits

Clinical Ringbacks on all Priorities Within Target (%) Local

Description: CAS call back performance declined in February and this represents common cause variation. The special cause improvement seen in January has not continued for this month

Evaluation: 729 hours of clinical time per day was provided by the CAS which equates to around 30 clinicians on duty at any one time. For 52% of the month, the CAS reported escalation level 1 and during the final two weeks of February, performance improved with escalation level 1 being declared 75% of the time. This shows the queue was clinically safe however performance was lower than required.

Action: TA new queue management process is being developed, and a review of the clinical prioritisation model has been completed. The team have also remapped a number of dispositions, completed additional training with clinical teams, added a clinical floor walker role, and introduced regular circuit breakers to manage periods of high demand. A large scale review of clinical rotas is being undertaken and a skill mapping exercise underway to ensure that the right clinicians are allocated to the right acuity of patient.

Cases Closed With No Onward Referral Via DOS (%) Local

Description: Despite the reduction in performance in February which is common cause variation, performance against this metric continues to be high.

Evaluation: The reduction in performance was related to the high acuity received by the service as highlighted above. Despite the increased number of cases closed with no onward referral, there was no increase in incidents or complaints which decreased by 17 from the previous month. In addition, overdue incidents have reduced to their lowest level of 36 in February (over 200 in April 2022).

Action: This metric will continue to be monitored and clinical/individual audits will continue to be completed to ensure that the CAS is working effectively. DoS reviews and engagement with staff regarding suggested improvements to pathways will continue.

People

Variation	Consistent Pass	Inconsistent	Consistent Fail	No Target
Special Cause Improvement	Trust Turnover, Ambulance Operations Turnover, Ambulance Operations Stat and Man Training (%)	Trust Stat and Man Training (%), IUC Stat and Man Training (%)	EOC Turnover, IUC Turnover, 999 Emergency Operations Sickness Absence, Trust Appraisal Compliance (%), Ambulance Operations Appraisal Compliance (%), IUC Appraisal Compliance (%), 999 Emergency Operations Stat and Man Training (%)	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		Trust Sickness Absence, Ambulance Operations Sickness Absence	IUC Sickness Absence	IUC Staff In Post
Special Cause Concern			999 Emergency Operations Appraisal Compliance (%)

Staff In Post

Trust Staff In Post

The Trust continues to show special cause improvement in the total number of staff employed.

Recruitment to the Trust workforce plan continues at a positive rate. The current pipeline is at circa 520 candidates at conditional offer stage (368 of these are for frontline roles, and 145 call handlers). Course fill rates remain positive across all roles with 96% during January and 92% in February.

Corporate/Specialist recruitment continues to see 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 90 candidates at conditional offer stage.

Consideration will be given to re-baselining this SPC in line with the new financial year.

Ambulance Operations Staff In Post

There continues to be special cause improvement in Ambulance Operations and generally is in line with our recruitment trajectory

The current level of registered and non-registered staff within Ambulance Operations has improved month on month.

Paramedic recruitment; year to date we have filled 360 of the 372 training places which is twelve behind plan. The international pipeline remains strong with over 140 candidates offered.

Following the most recent International trip to Australia in February, where interviews took place in Melbourne, Brisbane and Sydney. We have made an additional 160 offers to boost our International pipeline for our 2024/2025 workforce plan.

AAP Recruitment; year to date we have filled 218 of the 237 training places which is 19 behind plan. The pipeline is positive with over 90 candidates offered.

The team have attended a number of recruitment events to continually improve the pipeline numbers. During February the team also supported the Our LAS Inclusive Response Programme Event, where over 70 potential candidates attended with an interest to apply for the pre-apprenticeship programme, supporting them into AAP roles.

999 Emergency Operations Staff In Post

There continues to be special cause improvement in the recruitment and retention of 999 Emergency Operations staff and is in line with the agreed establishment aspirations for the area.

There have been positive fill rates during January and February in EOC call handling at 100%. The pipeline is strong with 84 candidates at offer stage and this will continue to grow with "Super Saturday" and assessment events planned.

IUC Staff In Post

The IUC staff in post has been on an upward trajectory since July 2023 and now shows common cause variation.

We have achieved a 90% fill rate of courses in February 2024 and the pipelines have improved with over 60 candidates currently at offer stage.

To ensure continued improvement the recruitment team have attended community events where they actively promote 111 roles to boost the pipeline and work continues with outreach events in the South, to boost the pipeline for Croydon. We will be joined in April by a Secondee from the Prince’s Trust to support out call handler recruitment, and continue to boost both our EOC and 111 pipelines.

Turnover

Trust Turnover

Trust turnover has continued on a downward trajectory and show special cause improvement.

This improved to 9.8% in February and the number of frontline leavers and call handlers has remained positively below plan.

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, so that action plans can be implemented where necessary.

Ambulance Operations Turnover

Ambulance Operations turnover has now reached 7.7% in February 2024 and continues its downward trajectory showing special cause improvement.

We have low turnover rates across the Ambulance Sectors ranging from 6% to 10%, NETS (8%) and Resilience and Specialist Assets (6%).

Month on month turnover is decreasing across all sectors for registered and non-registered staff.

EOC Turnover

EOC turnover continues to show special cause improvement although has not met the Trust target of 13%. The turnover rate in February 2024 was 14.4%.

The well-being team are piloting 'stay conversations' with the 999 call handling team. 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.

Where improvements are identified these can lead to actions within the individual team.

IUC Turnover

Turnover has shown a downward trend for the last 11 months with continued special cause improvement. This has not met the Trust target of 13% with February 2024 hitting 20%; 10% lower than February 2023.

The well-being team are piloting 'stay conversations' with the 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

Trust sickness absence was above the target of 6% with February 2024 at 6.6%. This showed common cause variation and was linked to an uptick in sickness over the winter period.

The decrease in absence in February was largely due to reductions in anxiety, stress and depression (-7%), back problems (-29%), infectious diseases (-11%) and heart/cardiac problems (-40%).

Anxiety, stress and depression represents 21% of overall sickness followed by coughs/colds (11%) and back/musculoskeletal problems (9%).

Further supporting actions include the promotion of the Trust’s vaccination programme and the formation of a multi-disciplinary group to develop and pilot a new absence management process.

Ambulance Operations Sickness Absence

Ambulance Operations sickness absence in February 2024 was 6.3% and just above target which is set at 6%.

There is a common cause variation as a result of an increase in respiratory illnesses, which include coughs and colds across the winter period.

Fortnightly reviews take place with ADOs, Managers and HR to review and manage all periods of sickness absence. Anyone who has reached the triggers has an action plan and is supported in line with the Trust's policy.

999 Emergency Operations Sickness Absence

There is a special cause Improvement seen in February as a result of recent decreases with 999 Emergency Operations and as a result of the team taking robust actions. In February this was at 10.4% against the target of 6%.

The management team have been introducing additional activities to improve management focus including the review of abstractions, twice weekly meetings at Watch level to discuss attendance management and a team event focussing on how to improve in this area.

Future activities are to include regular attendance review deep dives by the Director and Deputy Director.

IUC Sickness Absence

There continues to be common cause variation in sickness absence. In February we saw sickness at its lowest point at 9% against the trust target of 6%.

The sickness absence trend is encouraging with a continued trajectory over the last few months. The team continue with their weekly monitoring and reporting schedule chaired by the Deputy Director; focussing on management activity and identifying priorities.

BME Staff

Trust BME Staff (%)

Trust BME staffing levels reached 23% and shows a continued upward trend we have seen since June 2022. We continue to show special cause improvement and consideration to rebase the SPC should be given at the start of the new financial year.

A data capture campaign is due to start in March 2024 to improve data completeness (currently averaging 90%).

The EDI dashboard has been built and this will be used to identify themes and trends across the LAS and to make this information more readily accessible to managers and staff.

Work is underway to include EDI data in the Feedback Focus Review packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.

Ambulance Operations BME Staff (%)

Special cause improvement continues to be shown in the Ambulance Operations domain which recorded 14.8% in February 2024.

999 Emergency Operations BME Staff (%)

Special cause improvement continues to be achieved with February 2024 recording 36%. This improvement is being driven in part by the large amount or recruitment being undertaken currently within 999 Emergency operations.

IUC BME Staff (%)

Special cause improvement continues with 62% being achieved as of February 2024.

Appraisal

Trust Appraisal Compliance (%)

In February 2024 our Trust appraisal compliance remains at 66% and continues to show special cause improvement. The target for the Trust is 85%.

There has been good progress with the design and development of the new ‘Our LAS’ e-appraisal & talent management system. A formal evaluation is currently being designed to ascertain feedback on the system to drive improvements before planning an LAS-wide roll-out.

We are also designing plans to increase system usage and revamp how we follow-up on appraisal compliance. Currently there are a total of 665 people that form part of the phase 1 and 2 of our implementation plan, which includes colleagues from the People and Culture Directorate, EDI Team, all those that were part of the stakeholder engagement panels (including their manager and their direct line reports), Homerton and New Malden.

The OD & Talent team has facilitated several group drop-in and 1 to 1 sessions for colleagues, as well as recorded a training video to support appraisal completion.

Ambulance Operations Appraisal Compliance (%)

We are currently missing the target of 85%, although we continue to see special cause improvement. Compliance in February 2024 was 77%.

To improve performance, line managers have been reminded of the value appraisals bring to individuals, the importance of development conversations and finding the time to conduct them.

Issues are being highlighted to the senior management team where these are identified.

999 Emergency Operations Appraisal Compliance (%)

Compliance in February 2024 was at 57%. This has been on a downward trajectory since July 2023 and is now showing special cause concern.

The Emergency Operations team is aware and are drawing up suitable plans, as part of the transformation work being undertaken with expected improvements in appraisal compliance as this area works towards the introduction of teams based working.

IUC Appraisal Compliance (%)

There continues to be special cause improvement with 69% being achieved in February 2024.

This still does not meet the target of 85% and the IUC management team are focussing on this activity in order to drive compliance in line with the target. This focus is being driven by the Deputy Directors for IUC with their management teams, who are required to develop improvement plans in this area.

Statutory & Mandatory Training

Trust Stat and Man Training (%)

The target for statutory and mandatory training for the Trust is set at 85%. We continue to see special cause improvement with 90% compliance being achieved in February 2024.

We will look to re-baseline the SPC chart in the new financial year based on significant improvement we have seen against this financial year.

Ambulance Operations Stat and Man Training (%)

Ambulance Operations achieved a compliance rate of 93.1% in February 2024 and above the target of 85%. We continue to see special cause improvement.

This improved trend is linked in part to the establishment of teams based working.

999 Emergency Operations Stat and Man Training (%)

999 Emergency Operations has achieved 83.4% in February 2024 and 1.6% below the target of 85%.

There has been an upward trend seen since October 2023 and see special cause improvement demonstrated in February. The expectation is that the move to teams based working will support the achievement in compliance on this metric.

IUC Stat and Man Training (%)

IUC has continued to show special cause improvement with the 91.4% achieved in February being 6.4% above the Trust target.

Quality

Variation	Consistent Pass	Inconsistent	No Target
Special Cause Improvement			Complaints Within Target (%), Excellence Reports
Common Cause	Hand Hygiene Compliance (%), Premises Cleaning Audit (%)	STEMI	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, Complaints, Calls from Frequent Callers, RIDDOR Reports, MSK RIDDOR, Body Fluid Exposure, Sharps Incidents, Physical Assaults, Physical Assaults on Staff per 1000 AandE F2F Incidents
Special Cause Concern		Vehicle Deep Clean (%)	Patient Safety (No-Low Harm), Child Safeguarding, Adult Safeguarding, Adult Welfare, Controlled Drugs Incident Reports

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.