integrated quality and performance report · 16:00 jul-18 aug-18 sep-18 oct-18 nov-18 dec-18 jan-19...

July 2019

Integrated Quality and Performance

Report

Performance Summary – June 2019

Key Points:• The majority of reporting has now been reinstated following the implementation of the new integrated CAD system in early April 2019, with work

progressing to re build NHS 111 data. IUC KPIs are not included in this report and will be shared as soon as possible. Data relating to April, May and June 2019 contain known data quality issues relating to the implementation of the integrated CAD system affecting response times, outcomes and incident demand.

• C1 national response standards have been achieved for June 2019, with C2 and C3 remaining a challenge, putting at risk the achievement of our locally agreed trajectories for the year. C4 response times have been revised and now include times from patients responded to by Scheduled Care vehicles, this has improved response times for HCP and IFT incidents, however C4 times are now reporting above the national target.

• The conveyance rate target is on track for Q1, only missing the target by 0.1%. The locally agreed targets from Q2 onwards becoming more challenging and further improvement will be needed in order to achieve the Q4 target.

• While significant improvements have been made in our average handover to clear times during 2018/19, further work is needed in order to achieve our locally agreed target for 2019/20.

• Sickness absence for June 2019 at 6.28%, is in line with the previous year, however remains above the trajectory to reach 5% YTD.• Appraisal compliance remains significantly below the 95% target, with improvement needed from all areas of the Trust. Data quality is being reviewed

to ensure all completed appraisals are accounted for. • Forecast underachievement of CIP, if further action is not undertaken during this financial year we may end up approximately £0.90m behind the

target overall and even more so in FYE recurrent terms.• The agency expenditure YTD overspend has increased leading to NHSI monthly Use of Resources score of 3. An action plan has been developed and is

being implemented alongside HR.

Performance Improvement Actions:• Implementation of the new rosters has begun, with the first phase in place from 17 June. Delays to the delivery of new vehicles puts at risk the plan

for all new rosters to be in place by October 2019. Work is being undertaken to find alternative solutions.• C2 Deep Dive has been held, with further areas for investigation identified. A report of the findings will be shared at the September Board.• An action plan has been developed to focus on the safe reduction of avoidable conveyances, which includes training and support for clinicians in

EOC and Unscheduled Care, learning from best practice, assessment of alternative dispatch options and specific project to focus on improved access and assessment for residential and nursing homes.

• Live operational observations are also planned for July 2019 to cover dispatch, EOC clinicians, and crew productivity in order to identify further areas for improvement.

• Review of long wait activity is being undertaken to assess how resources may be best used to reduce the time waited by patients for a response.• Processes for recording handover to clear are being reviewed to eliminate outliers and improve the overall average times. Work is also being

progressed in partnership with ECIST, CDDFT, Northumbria Hospitals and Sunderland Royal to improve overall turnaround times. • Senior Management Team now regularly receive detailed lists of staff waiting for appraisals to be completed and they are working with their teams

to drive an increase in compliance rates. 2

Sickness MTD –• Trust – 6.28% • EOC – 6.5%• Ops North and South –6.8%• Support Services – 2.5%

Staff Turnover MTD• Trust – 0.34% • EOC – 0.43%• Ops North and South – 0.31%• Support Services – 0.35%

Workforce - Sickness, Turnover and Vacancies

3

*May 2019 Establishment In post Vacancy wte Vacancy %

EOC 519.66 513.66 6.00 1.2%

Scheduled Care 438.52 420.86 17.66 4.0%

Unscheduled Care 1327.00 1185.94 141.06 10.6%

Other Operational 159.24 133.28 25.96 16.3%

Support Services 265.25 257.83 7.42 2.8%

Trust Total 2709.67 2511.58 198.09 7.3%

*Data is reported a month in arrears (Vacancies).

0.34%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Turnover MTD - all staff

2018/19 2019/20 Target

92.69%

90%

91%

92%

93%

94%

95%

96%

97%

Staff In Post - May 2019

6.28%

0%

1%

2%

3%

4%

5%

6%

7%

8%


Sickness MTD - all staff

2018/19 2019/20 Target

Workforce - Statutory and Mandatory/Appraisal

Statutory and Mandatory Compliance:• Trust – 84.31%• EOC – 88.33% • Operations North and South – 82.41% • Support Services – 90.17%

4

Appraisal Compliance:• Trust – 70.68% • EOC – 53.22% • Operations North and South – 75.55% • Support Services – 78.46%

Operations Centre – Call Performance

5

NEAS Mean NEAS 90th Centile England Average Mean England Average 90th Centile National Standard

Unscheduled Care – Response Times

C1 - M C1 - 90th C2 - M C2 - 90th C3 – M* C3 - 90th C4 - M C4 - 90th

Variance from target -0:00:50 -0:04:19 0:09:03 0:16:39 0:30:45 1:50:14 - 0:06:41

Change from previous month -0:00:02 0:00:06 0:02:09 0:04:19 0:11:44 0:29:16 0:07:03 0:07:28

National Ranking Position(out of 11)

2nd 1st 8th 9th 9th 9th 4th 6th

Calculated using NHS England published AQI data and may be subject to periodic revision. Additional quality information can be found at https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/AQI-Quality-Statement-2015-v1.2.pdfNB. Response times may be different to published AQI data.

6

6:19

6:08

6:13

6:14

6:13 6:29

6:17

6:11

6:08

6:15

6:12

6:10

10:5

1

10:2

2

10:3

7

10:3

4

10:4

7

11:1

7

10:5

4

10:3

7

10:5

0

10:3

5

10:3

5

10:4

1

-

2:00

4:00

6:00

8:00

10:00

12:00

14:00

16:00

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19

Category 1

18:4

5

19:0

0

20:1

5

20:4

0

23:4

1

26:3

5

26:5

4

26:1

1

23:5

1

25:5

5

24:5

4

27:0

30:37

:40

0:38

:41

0:41

:18

0:43

:08

0:48

:44

0:54

:50

0:56

:19

0:54

:47

0:48

:28

0:54

:32

0:52

:20

0:56

:39

-

0:10:00

0:20:00

0:30:00

0:40:00

0:50:00

1:00:00


Category 2

1:09

:00

1:05

:27

1:11

:49

1:08

:43

1:21

:35

1:36

:24

1:34

:17

1:31

:19

1:19

:12

1:23

:32

1:19

:01

1:30

:45

2:45

:22

2:33

:26

2:51

:51

2:42

:49

3:10

:14

3:46

:35

3:54

:07

3:46

:38

3:13

:31

3:49

:36

3:20

:58

3:50

:14

-

0:30:00

1:00:00

1:30:00

2:00:00

2:30:00

3:00:00

3:30:00

4:00:00


Category 3

1:10

:01

1:09

:03

1:19

:31

1:13

:22

1:24

:02

1:27

:04

1:28

:31

1:17

:35

1:17

:27

1:02

:49

1:11

:54

1:18

:572:

33:5

2

2:52

:46 3:41

:53

3:06

:29

3:37

:55

3:44

:09

3:45

:37

2:56

:31

3:14

:37

2:50

:46

2:59

:13

3:06

:41

-

0:30:00

1:00:00

1:30:00

2:00:00

2:30:00

3:00:00

3:30:00

4:00:00

4:30:00


Category 4

https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2013/04/AQI-Quality-Statement-2015-v1.2.pdf

Unscheduled Care - Conveyance Rate

60%

62%

64%

66%

68%

70%

72%


Conveyance Rate (local definition)

2018/19 Baseline 2019/20 Forecast 2019/20 Draft

70.3%68.0% 67.9%

70.2%

66.4%68.8%

65.3%

69.1%

64.8%

50%

55%

60%

65%

70%

75%

Bas

elin

e

Act

ual

QTD

Loca

l Tar

get

Bas

elin

e

Act

ual

QTD

Loca

l Tar

get

Bas

elin

e

Act

ual

QTD

Loca

l Tar

get

Bas

elin

e

Act

ual

QTD

Loca

l Tar

get

Q1 Q2 Q3 Q4

Conveyance Targets 2019/20

0%

2%

4%

6%

8%

10%


Hear and Treat (local definition)

20%

22%

24%

26%

28%

30%


See and Treat (local definition)

2018/19 Baseline 2019/20 Forecast 2019/20 Actual National Standard

Unscheduled Care – Long Waits

RAG

RAG

8

RAG

RAG rating set by NHS England in Ambulance Services Balanced Scorecard

3.1%2.7%

3.6%

3.0% 2.9%

3.8%

2.9%2.6% 2.7% 2.8% 2.8%

2.5%

0.1%

0.1%

0.1%

0.2% 0.2%

0.2%

0.1%

0.1%0.0% 0.1% 0.2%

0.1%

0.0%

0.0%

0.0%

0.1%0.0%

0.2%

0.0%

0.0% 0.0%0.0%

0.0%

0.0%

0%

1%

1%

2%

2%

3%

3%

4%

4%

5%


Category 1

8.8% 9.3%10.8%

9.2%

16.1%

20.4% 21.1%19.7%

16.0%19.1% 17.9%

21.1%1.2% 1.1%

1.2%1.4%

1.9%

3.0%3.3%

3.2%

2.0%

3.2%2.9%

3.5%

0.2%

0.3%0.3%

0.3%

0.4%

0.4%0.5%

0.5%

0.3%

0.7%0.6%

0.7%

0%

5%

10%

15%

20%

25%

30%


Category 2

18.6%16.3%

19.4% 18.3%

25.1%

31.3% 30.4%27.9%

22.9%

28.6%

22.2%26.7%

2.6%2.3%

3.5%2.2%

4.5%

8.2% 9.4%

8.7%

5.5%

8.7%

6.3%

9.1%

0.2%

0.1%

0.1%0.3%

0.4%

1.2% 1.0%

1.4%

0.5%

1.4%

1.5%

2.1%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%


Category 3

17.4%

11.1% 10.1% 9.4%

2.7%5.1% 6.1% 6.0%

9.2%12.0%

10.4%

13.9%

5.4%

1.5%1.7%

1.4%

0.2%

0.8% 0.9% 1.0%

1.5%

2.9%

1.5%

2.9%

2.0%

0.2%0.0%

0.2%

0.0%

0.0%0.0% 0.3%

0.0%

0.0%

0.2%

0.3%

0%

5%

10%

15%

20%

25%

30%


Category 4

RAG

Unscheduled Care – Response Distribution

9

0

500

1000

1500

2000

2500

0-10 10-20 20-30 30-40 40-50

C1

0

1000

2000

3000

4000

5000

6000

C2

0

100

200

300

400

500

600

700

800

900

1000

0-1

0

30

-40

60

-70

90

-10

0

12

0-1

30

15

0-1

60

18

0-1

90

21

0-2

20

24

0-2

50

27

0-2

80

30

0-3

10

33

0-3

40

36

0-3

70

39

0-4

00

42

0-4

30

45

0-4

60

48

0-4

90

51

0-5

20

55

0-5

60

60

0-6

10

64

0-6

50

84

0-8

50

C3

0

10

20

30

40

50

C4

Unscheduled Care – Handovers

10

20273 19547 19478 20059 19717 21041 21386 18553 20099 19198 19866 18840

802 803

1038

896 978

1476

1761

1184

921

1087

1292

1068

0

240

480

720

960

1200

1440

1680

1920

17000

17500

18000

18500

19000

19500

20000

20500

21000

21500

22000

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19

Jun-19

Hou

rs L

ost

Arr

ival

s

Arrivals and Time Lost to Handovers

Arrivals Hours Lost to Handover Linear (Hours Lost to Handover)

30:00

32:00

34:00

36:00

38:00

40:00

Apr-19 May-19 Jun-19 Jul-19 Aug-19 Sep-19 Oct-19 Nov-19 Dec-19 Jan-20 Feb-20 Mar-20

Average Turnaround time (Mins)

Hospital Handovers

Jun-19

Darlington Memorial 74.5% 54 0:13:43

James Cook 36.7% 115 0:19:47

NSECH 41.4% 389 0:21:02

Queen Elizabeth 85.5% 30 0:12:53

RVI 61.3% 92 0:14:32

South Tyneside 54.0% 95 0:18:43

Sunderland Royal 51.7% 137 0:16:53

University Hsp of North Durham 67.7% 109 0:14:55

University Hsp of North Tees 74.1% 44 0:12:54

Trust 59.5% 1068 0:16:26

% Completed

in 15 minsHours Lost

Average

Handover

(mins)

Post Handovers

Jun-19

Darlington Memorial 33.0% 174 0:21:07

James Cook 43.3% 107 0:17:56

NSECH 43.0% 303 0:18:15

Queen Elizabeth 29.1% 246 0:21:52

RVI 33.6% 267 0:20:35

South Tyneside 37.3% 97 0:19:22

Sunderland Royal 35.3% 225 0:19:49

University Hsp of North Durham 34.1% 247 0:20:47

University Hsp of North Tees 36.4% 154 0:19:59

Trust 36.4% 1825 0:19:54

% Completed

in 15 minsHours Lost

Average Post

Handover

(mins)

Unscheduled Care – Benchmarking (1)


11


Unscheduled Care – Benchmarking (2)


12


Scheduled Care – Timeliness Indicators

Arrival Time performance has improved in June 19 and is now the 2nd highest performance for 2019 due to a decrease in the number of early arrivals.

The number of patients collected within 60 minutes has decreased since May 19; although remains above target at 85.4%.

There has been a small decrease in performance for Time on Vehicle however this continues to consistently achieve local standard. There has also been a plateau in the percentage of completed journeys for a number of months..

13

78.50%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


Arrival Time

On Time Early Arrival Late Arrival

93.50%

50%

60%

70%

80%

90%

100%


Time On Vehicle < 60 mins

Time on Vehicle <60 Mins

85.4%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%


Collection within 60 Mins

Collection within 60 Mins

45862

50%

60%

70%

80%

90%

100%

30000

35000

40000

45000

50000

55000

Jul-1

8

Aug-

18

Sep-

18

Oct

-18

Nov

-18

Dec

-18

Jan-

19

Feb-

19

Mar

-19

Apr-

19

May

-19

Jun-

19

Completed Journeys

Completed Journeys - Total Completed Journeys - %

Scheduled Care – Planned vs Same Day

There has been a decrease in the proportion of completed same day journeys in June, although there has been an increase in performance for the proportion of completed planned journeys.

Third Party Rate performance has increased for both Planned and Same Day journeys.

14

85.50%

74.90%

68%

70%

72%

74%

76%

78%

80%

82%

84%

86%

88%

0

5000

10000

15000

20000

25000

30000

35000

40000

45000

50000

Jul-

18

Au

g-1

8

Sep

-18

Oct

-18

No

v-1

8

De

c-1

8

Jan

-19

Feb

-19

Mar

-19

Ap

r-1

9

May

-19

Jun

-19

Completed Journeys - Same Day vs Planned

Completed Journeys (Planned) Completed Journeys (Same Day)

Completed Journeys (Planned) % Completed Journeys (Same Day) %

0%

10%

20%

30%

40%

50%

60%

70%

80%


Third Party Rate - Same Day vs Planned

Third Party Rate (Planned) % Third Party Rate (Same Day) %

Finance

The YTD SOCI position has marginally improved in Month 3. The positive YTD variance (of £0.302m) can be seen in the context of i) a non-recurrent saving on the non-consolidated pay reserve of £0.058m, ii) the depreciation/amortisation net underspend (of £0.098m), iii) some corporate reserves not yet being utilised (£0.072m) with most other service delivery factors effectively cancelling each other out. The FOT remains unchanged - the Trust still expects to meet its financial plan at this stage of the financial year.

The YTD CIP position has improved again since last month (from +15.2% to +16.8%). Although the FOT CIP position has improved by a further £0.15m it is anticipated to under-deliver by £0.90m (-14.4%) against the annual plan target. Consequently this requires continued focus to ensure that the CIP plan is delivered in full.

Capital expenditure is presently behind plan but anticipated to catch up by September 2019, with a view to spending the full planned sum by March 2020. However, NEAS has recently submitted a revised plan proposal, which if accepted by NHSI will reduce the FOT by £0.559m for future months.

The YTD cash position has slightly increased this month, and the FOT is unchanged. However this should improve if NHSI accept the revised capital plan.

The YTD agency expenditure position is causing considerable concern, as £0.399m has been incurred during the first three months, which has triggered a 4 for this metric presently. In turn is causing some concern in relation to whether we will remain within the cap (of £0.603m) as the current FOT is £0.773m (scoring a 3). An action plan has been developed and is being implemented. The year end forecast will remain under close scrutiny.

Due to the current agency expenditure overspend, this has triggered an overall YTD metric of 3. This is presently forecast to reduce to a 2 at the financial year end due to the agency expenditure run rate reducing.

Key Performance Indicator Apr 19 May 19 Jun 19 YTD

Capital service capacity (times) 6.2 5.5 5.8

12 month rolling

Liquidity days YTD 23.3 23.7 23.5

I&E margin 2.5% 0.0% 0.0%

I&E margin: distance from plan 3.1% 0.9% 0.8%

Agency spend cap % 12.0% 25.0% 75.0%

Use of Resources Rating (SOF) 1.0 1.0 3.0

SOCI (I&E) Summary YTD –Actual

(£k)

YTD –Variance

(£k)

FOT –Forecast

(£k)

FOT –Variance

(£k)

Total operating surplus / (deficit) 321 340 975 11

Surplus/(deficit) for the period/year 15 302 (95) 0

Adjusted financial performance surplus / (deficit)

15 302 75 0

I&E margin excluding PSF, FRF and MRET

(0.6%) 0.9% (1.0%) 0.0%

CIP YTD –Actual Savings

Achieved (£k)

YTD - % of Plan

Achieved

FOT –Variance from plan

(£k)

FOT - % of Plan

Anticipated

Recurrent 986 (18.2%) (1,527) (28.4%)

Non recurrent 991 103.1% 626 71.7%

Total efficiencies 1,976 16.8% (901) (14.4%)

Total efficiencies as a percentage of expenditure

5.4% (0.6%)

Capital YTD Actual

(£k)

YTD –Variance

from plan (£k)

YTD - % of Plan

Incurred

FOT –Variance

from plan (£k)

FOT - % of Plan

Anticipated

Gross capital expenditure

1,085 (1,401) 56.4% 0 0.0%

Cash Apr 19 May 19 Jun 19 ForecastMar 20

Cash 12,382 12,317 13,049 10,336

integrated quality and performance report · 16:00 jul-18 aug-18 sep-18 oct-18 nov-18 dec-18 jan-19...

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