Monthly Yorkshire Ambulance Trust Board Integrated Performance Report August 2011

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1 Monthly Yorkshire Ambulance Trust Board Integrated Performance Report

2 Contents 1 Executive Summary 3.6 Safety - Staff related Incidents & Rate Based Business Plan Objectives 3.7 Safety - RIDDOR reportable Incidents 1.2 Board Assurance Framework 3.8 Safety - RIDDOR reportable Incidents 2 Performance 3.9 Safety - SUI Incidents by area 2a A&E Performance 3.10 Safeguarding Children and Vulnerable Adults 2.1 Performance Summary 3.11 Clinical Effectiveness - National 2.2 Cat R1 & R2 8 Minute Performance Cat R1 & R2 19 Minute Performance 3.12 Clinical Effectiveness - Local 3.13 Clinical Effectiveness - Local (Cont) 2.3 Total Demand Resource Hours 3.14 Clinical Audit 3.15 Patient Experience & Involvement - Complaints,Concerns & Compliments A&E / A&R 2.4 Monthly System Performance 3.16 Patient Experience & Involvement - Complaints,Concerns & Compliments PTS 2.5 Operational Improvement Plan 3.17 Patient Experience & Involvement - Complaints & Concerns response times 2.6 Operational Improvement Plan 3.18 Patient Experience 2.7 Demand and Performance by PCT and CBU (Incidents) 3.19 Care Quality Commission and Other Registration Legislation Standards 2.8 Clinical Quality Indicators 3.20 CQUIN Schemes 2.9 Call Abandoned Rate & Time to Answer Calls Calls closed with telephone advice or managed without transport to A&E 3.21 Information Governance 3.22 Clinical Indicators - Outcome ROSC & Outcome Acute STEMI 2.10 Time to Treatment 3.23 Clinical Indicators - Outcome Stroke & Outcome Cardiac Arrest Re-Contact Rates 4 Workforce 2.11 Resilience 4.1 Workforce Summary 2b PTS Performance 4.2 Recruits and Leavers 2.12 PTS Performance - PTS Inward Journeys (Measured) PTS Performance - PTS Outward Journeys (Measured) Leavers YTD 4.3 PDR's 2.13 PTS Punctuality - Arrive within 60 minutes before appointment PTS Waiting Time - 60 Minutes for Transport Home Statutory and Mandatory Training 4.4 Short and Long Term Absence 2.14 PTS Journey Time - 60 Minutes on Vehicle Reason for Absence Total Delivered Journeys 4.5 Absence Management Process 2.15 PTS Call Answering - 80% of Calls to be answered within 30 seconds Grievances / Disciplinary 2c GPOOH Performance 5 Finance 2.16 GPOOH Call Answering Performance GPOOH Abandoned Call Performance GPOOH Telephone Engaged Call Performance 5.1 Business Plan Objective Status 5.2 Income and Expenditure Position Summary 5.3 Revenue Position - Variances Against Budget - Functional View 2d Support Services Performance 5.4 Expenditure - Variances Against Budget - Subjective View 2.17 ICT Summary 5.5 Finance - Forecast Outturn Service Line Reporting 2.18 Estates and Procurement 5.6 Cost Improvement Programme (CIP) 2.19 Fleet /2012 Contracting Reporting (KA34 Definition vehicle arrive at scene) 3 Quality Analysis 5.8 Capital Expenditure Analysis 3.1 Quality Summary 5.9 Balance Sheet 3.2 Safety - Infection Prevention and Control 5.10 Balance Sheet Cont'd 3.3 Safety - New Incidents Reported & Rate Based 5.11 Cash Flow Statement 3.4 Safety - Patient Related Incidents & Rate Based 5.12 Finance - Risk / Assurance Ratings 3.5 Safety - Medication Related Incidents & Rate Based 5.13 Finance - Risk Summary Contents

3 Section 1 Executive Summary 1

4 Yorkshire Ambulance Service - Executive Summary BUSINESS PLAN ECTIVES Lead Director KPI Strategic Goal - Continuously Improving Patient Care Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast 1.1 Improve the quality of staff engagement and involvement throughout YAS Stephen Moir AMBER Improve patient outcomes mapped against the areas identified in the operating 1.2 Alison Walker AMBER framework 2 Improve the quality of patient care through delivery of the CQUINS schemes Alison Walker AMBER AMBER Strategic Goal - High Performing 3 Achieve and maintain a Monitor governance risk rating of Green by Q Steve Page AMBER 4 Fulfilment of requirements as a Category 1 responder Sarah Fatchett AMBER AMBER AMBER Strategic Goal - Always Learning 5.1 To build a sufficient membership to support a credible and successful FT application Steve Page The Board and YAS staff have sufficient skills and capacity to operate successfully as a 5.2 Dave Whiting Foundation Trust 6 Improve staff skills and knowledge against the agreed mandatory training requirements Stephen Moir Strategic Goal - Delivers Value for Money Description Delivery Risk as per 2011/12 Business Plan 7.1 Achieve and sustain a Monitor financial risk rating of 3 or above Caroline Wood AMBER AMBER 7.2 Active progression of the agreed service developments in the Integrated Business Plan Caroline Wood 8.1 To increase YAS contribution to public health in the Yorkshire and Humber region Alison Walker AMBER AMBER AMBER AMBER 8.2 Design the ambulance commissioning arrangements with GP Consortia Caroline Wood AMBER AMBER AMBER AMBER AMBER AMBER NHS Performance Framework - Current Assessment Service Performance Performing Finance Performing Quality and Safety Performing Business Objective 4 is Amber rated due to the continued work on testing business continuity plans throughout the organisation. The training requirements and associated abstraction impacts of these are continuing to be actively managed. Business Objective 8.1 continues to be Amber rated whilst collaborative plans to increase YAS contribution to the public health agenda continue to emerge. There remains a lack of clarity of the respective roles of local authorities, commissioning boards and Clinical Commissioning Groups in relation to public health. YAS is continuing to work with the Strategic Health Authority on these developments. Business Objective 8.2 again, continues to be Amber rated to reflect the lack of definitive Clinical Commissioning Groups (CCG) aspirations and expectations in relation to ambulance commissioning. It has been confirmed by the lead Commissioner (NHS Bradford and Airedale) that one year contracts for the period will be entered into for both A&E and PTS services for the region, with CCG's taking the lead on contractual negotiations for 2013 onwards. KPI Page AMBER 2.11 AMBER AMBER AMBER 3.20 AMBER Section 5 Business Objective 2 - The commissioners have requested additional information from the Trust before formally signing off completion of the first quarter CQUINS schemes hence the Amber rating. Business Objective The month to date and year to date rating has been changed from Green to Amber this month to reflect that although the year to date income and expenditure position is slightly off plan, within this position are a number of CIP schemes which have not delivered and this non delivery is being offset by non recurrent underspends against other expenditure lines and other in year pressures have been identified. The year end forecast remains green as work is ongoing to deliver additional CIP schemes both within the Directorates affected and across the Trust to manage the additional pressures. 1.1

5 Yorkshire Ambulance Service - Board Assurance Framework/Corporate Risk Register Update BAF Approved Jun-11 BAF Formally Reviewed May-11 Commentary Board Assurance Framework (BAF) There are 7 principal risks to the objectives detailed in the Annual Business Plan for There is an adequate level of assurance against each of them. The summary pages in the iteration of the BAF indicates that there have been no changes notified this month. Detail is also provided for all 7 principal risks with adequate level of assurance that have remained unchanged along with supporting commentary. Some changes have been made to the gaps in control column; where gaps in control have been converted into corporate risks. Further work will be undertaken with individual Director leads to quality check the content of the document. This will be informed by discussions in the Audit Committee assurance session. Corporate Risk Register (CRR) The CRR contains the details of 29 extreme (Red) rated risks. At the latest meeting of the Risk & Assurance Group (R&AG) on the 26, the Group undertook a comprehensive review of each risk on the CRR. Several minor changes were made to reflect progress against risk treatment plans. The proposed changes to the status of a number of risks related to finance and business development has been carried over to the next meeting. It was decided in the absence of the Associate Director for Business Development not to remove or add any of these risks at this stage pending further discussion on specific issues between the Risk Manager and risk leads outside of the meeting. The changes made to reflect these discussions will be taken to the August Risk & Assurance Group and subsequently reported in the September IPR. There has been just one new addition to the CRR in August. CRR 76 - Adverse impact on clinical outcomes due to delayed activation/response to red emergency calls, as a consequence of failings in the CAD system. Four risks have been removed this month; CRR 7 - Regulatory penalty by the Environmental Agency due to non compliance with the labelling of clinical waste CRR 51 - Harm to patients due to failure to adhere to procedural documents relating to vehicle medical equipment resulting in a lack of control on equipment assets. CRR 56 - Failure to meet the requirements of external regulators due to non-completion of the A&E Performance Improvement Plan within specified timeframes, leading to an adverse impact on Category A response time standards. CRR64 - Financial risk of up to 150,000 from costs incurred at the end of lease for Distington House. 1.2

6 Section 2 Performance 2

7 Yorkshire Ambulance Service - Performance Summary Strategic Goal - High Performing KPI 3 Strategic Aim - Achieve and maintain a Monitor governance risk rating of Green by Q Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Description Forecast Operations A&E Performance PTS Performance AMBER GPOOH Performance Emergency Planning / Resilience Support Services ICT Estates and Procurement Fleet PTS In August we received a Performance notice issued for the South Yorkshire PTS contract in relation to poor waiting times for patients. Performance in the South Yorkshire area had shown a decline in July as a consequence of the loss of a number of front line staff hours due to the 121 processes initiated following the loss of the renal element of the contract. Performance in August had already started to recover when the notice was received. The definitive value of the loss of the South Yorkshire renal contract remains unresolved. Cost Improvement Programs in PTS are showing early signs of risk. Recovery plans are in place. 2.1

8 Section 2a A&E Performance 2a

9 Performance % Performance % Yorkshire Ambulance Service - Performance - A&E Category Red 1 & 2 8 Minute Performance HQU03_01 3 YTD Category Red 1 & 2 19 Minute Performance HQU03_02 3 YTD MTD AMBER MTD Red 1 & 2-8 Minute Performance Red 1 & 2-19 Minute Performance 100.0% 100.0% 95.0% 90.0% 90.0% 80.0% 85.0% 70.0% 80.0% 60.0% 75.0% 50.0% 70.0% 40.0% 65.0% 30.0% 60.0% 20.0% 55.0% 10.0% 50.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar Actual % ( ) Target Planned % Last Year % ( ) Actual % ( ) Target Planned % Last Year % ( ) April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD Target 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% Target 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% Actual % ( ) 77.3% 78.3% 75.8% 75.5% 75.6% 76.5% Actual % ( ) 98.0% 98.6% 97.9% 98.1% 97.9% 98.1% Planned % 78.7% 77.5% 77.6% 75.6% 76.0% 75.8% 75.1% 75.1% 65.0% 75.3% 75.0% 75.3% 75.0% Planned % 98.0% 98.0% 98.0% 96.0% 96.0% 96.0% 95.0% 95.0% 82.0% 95.0% 95.0% 95.0% 95.0% Last Year % ( ) 76.0% 75.9% 74.6% 77.8% 78.8% 76.8% 75.3% 73.7% 58.4% 70.5% 74.7% 76.3% 73.7% Last Year % ( ) 97.7% 97.6% 97.7% 98.0% 98.2% 97.6% 97.7% 97.6% 94.0% 97.0% 98.1% 98.1% 97.4% Forecast % ( ) 78.7% 77.5% 77.6% 75.6% 76.0% 75.8% 75.1% 75.1% 65.0% 75.3% 75.0% 75.3% 75.0% Forecast % ( ) 98.0% 98.0% 98.0% 96.0% 96.0% 96.0% 95.0% 95.0% 82.0% 95.0% 95.0% 95.0% 95.0% During August the Trust delivered 75.6% Red 8 minute performance, which is once again above the national target level of 75%. Performance was slightly below the plan of 76.0% for the month by 0.4%. Performance was adversely impacted by a power supply issue which affected one day's performance and a CAD system issue which affected another day's performance. It is calculated that without these two days performance would have been at 75.95%. Year to date performance remains above the national target level of 75% at 76.5%, which is slightly below the business plan level target at 77.1%. The year to date performance is equal to the national average for year to date at 76.5%. 2.2

10 Total Demand Total Resource Unit Hours Demand Yorkshire Ambulance Service - Performance - A&E Total Demand 3 YTD Resource Hours 3 YTD MTD MTD Total Demand Resource Hours 70,000 1, , ,000 1, , ,000 1, , ,000 1,750 Avg Demand per Day 120, , ,000 1,700 80, ,000 1,650 60, ,000 1,600 40,000 0 Total Actual Demand ( ) Total Demand Last Yr ( ) Forecast Demand ( ) Planned Demand ( ) Avg Demand per day ( ) Actual Resource Hours ( ) Planned Resource Hours Total Resource Last Yr ( ) Demand April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Planned Demand ( ) 53,461 56,610 54,734 57,093 55,698 54,288 58,669 56,611 65,397 60,630 53,423 55,385 Planned Resource Hours 164, , , , , , , , , , , ,534 Total Actual Demand ( ) 56,159 55,970 55,160 57,247 54,910 Actual Resource Hours ( ) 159, , , , ,603 Avg Demand per day ( ) 1,872 1,805 1,839 1,847 1,771 Avg Resource Hours per day 5,326 5,331 5,308 5,220 5,084 Total Demand Last Yr ( ) 52,386 56,033 54,046 55,384 53,949 53,199 56,666 54,764 63,460 58,267 51,044 56,826 Total Resource Last Yr ( ) 162, , , , , , , , , , , ,236 Forecast Demand ( ) 53,461 56,610 54,734 57,093 55,698 54,288 58,669 56,611 65,397 60,630 53,423 55,385 Forecast Resource Hours 164, , , , , , , , , , , ,534 Demand for August was slightly below planned levels for the month by 1.4%, which equates to 25 less incidents per day on average. The lower than expected demand levels had a 1.06% positive impact on performance. Resource levels were 1.5% lower than expected in the plan, which had a negative impact on performance of 1.13%. Resource levels were impacted by higher abstraction levels than planned as noted in section 2.5. The board to note the significant impact of the challenge and efficiency plans by March 2011, as performance has to be achieved with 22,700 less hours a month in March 2012 compared to March For illustrate purposes this equates to 128 less FTE. 2.3

11 Performance % Yorkshire Ambulance Service - Performance - A&E Monthly System Performance 3 YTD MTD AMBER Monthly System Performance 12.0% Performance Summary 11.0% 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% Month Planned Performance Impact on Performance of Demand Impact On Performance of Resource Impact of Systems Efficiency April 78.69% -3.79% -2.29% 4.70% Actual Performance 77.31% May 77.50% 0.85% -2.22% 2.20% 78.33% June 77.60% -0.58% -1.89% 0.66% 75.79% July 75.60% -0.20% -1.31% 1.42% 75.51% August 76.00% 1.06% -1.13% -0.30% September October November December January February March 75.63% 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar Year to Date 77.10% -0.50% -1.77% 1.69% 76.52% % System Efficiency ( ) Planned % % System Efficiency ( ) Planned % Forecast % April May June July Aug Sept Oct Nov Dec Jan Feb Mar 6.4% 3.9% 2.8% 4.7% 3.2% 0.0% 0.9% 1.8% 2.7% 3.6% 4.5% 5.4% 6.4% 7.3% 8.2% 9.1% 10.0% 0.0% 0.9% 1.8% 2.7% 3.6% 4.5% 5.4% 6.4% 7.3% 8.2% 9.1% 10.0% Actual System Efficiency Progress has continued with the new rotas following the implementation in July of three Clinical Business Units, with final preparations for the two remaining - Leeds Wakefield and Bradford, Calderdale and Kirklees currently underway. The % of calls to Clinical Hub not requiring transport has improved to 10.21% from 8.66% in July. This is a substantial improvement and moves towards achieving the target by year end. Work has been continuing on the measurement of utilisation of alternative pathways and this will be available for reporting in the September report. The performance improvement plans have been reviewed and the detailed actions for delivery have been drilled down to support each element to deliver and a performance management process is in place. This links directly to the Cost Improvement Plan and overall Operational Improvement Plan delivery. This is overseen by a fortnightly meeting regional meeting chaired by the Executive Director of Operations. The G1 and G2 activation times have improved from Amber in July to Green in August. This was an improvement of five seconds taking the activation time to 113 seconds, only two seconds higher than the target time of 111 seconds. Both the Red, G1 and G2 activation times have improved in August as noted in section

12 Yorkshire Ambulance Service - Performance - A&E Operational Improvement Plan 3 YTD N/A MTD AMBER Item Plan Demand Actual Demand Plan Systems Efficiency % Actual Systems Efficiency Plan Staff in Post Actual Staff in Post Plan Abstraction Rate Actual Abstraction Rate Plan Overtime Hours (Unit) Actual Overtime Hours (Unit) Plan Total Hours (Unit) Actual Total Hours (Unit) Plan Red 1 & 2-8 Min Performance Actual Red 1 & 2-8 Min Performance Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar 53,461 56,610 54,734 57,093 55,698 54,288 58,669 56,611 65,397 60,630 53,423 55,385 56,159 55,970 55,160 57,247 54, % 0.9% 1.8% 2.7% 3.6% 4.5% 5.4% 6.4% 7.3% 8.2% 9.1% 10.0% 6.4% 3.9% 2.8% 4.7% 3.2% 2,038 2,032 2,026 2,020 2,014 2,008 2,002 1,996 1,990 1,984 1,978 1,972 2,022 2,022 2,005 2,005 1, % 30.6% 31.0% 31.5% 32.4% 31.5% 30.6% 30.6% 32.4% 31.0% 32.4% 32.4% 28.2% 28.1% 30.0% 31.4% 33.2% 17,143 18,157 17,571 15,500 13,286 10,714 13,729 12,400 22,143 17,714 9,114 4,871 14,746 16,017 17,389 17,759 17, , , , , , , , , , , , , , , , , , % 77.5% 77.6% 75.6% 76.0% 75.8% 75.1% 75.1% 65.0% 75.3% 75.0% 75.3% 77.3% 78.3% 75.8% 75.5% 75.6% Current Trend Variance AMBER RED AMBER The overall month to date is Amber as systems efficiency and Red 8 minute performances are marginally below planned for the month. This is only slightly off plan so the overall year to date remains green. Overtime hours have a Red status as they are higher than the planned levels for August. The overtime for the year to date is 1.6% higher than planned, which is offset against the lower than expected staff in post levels. There was a rise in the abstraction rate, which although still Green was above plan for the first time this year. This was caused by an increase in annual leave with both the summer holidays and honouring of annual leave following the implementation of the new rotas. August saw an above average leaver rate of 27 against 7 the year before. All other measures are Green. 2.5

13 Yorkshire Ambulance Service - Performance - A&E A&E Operational Improvement Plan 3 YTD MTD AMBER AMBER Key Improvement Areas Improvement Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast New Rotas A&E Rota Review Amber Amber Amber Amber Amber Green New Targets & Deployment Stand By Amber Amber Amber Amber Amber Green % Conveyed by A & E Support Red Red Red Red Red Amber Increase Clinical Triage Red Red Red Red Red Amber Increase in Utilisation of alternative pathways Developing reporting Reducing Response Demand Indirect Response % Contribution Green Green Green Green Green Green % Calls to NHS Direct Green Green Green Green Green Green % Calls to Clinical Hub Red Red Red Red Red Amber % Calls to Clinical Hub not Requiring Transport Red Red Red Red Red Amber Non Conveyance Rates (Face to Face) Green Green Green Green Green Green % Hospital Turnarounds Green Green Green Green Green Green Abstraction Management Green Green Green Green Green Green Reducing Time Red Activation Times Green Green Green Green Green Green G1 & G2 Activation Times Green Green Green Amber Green Green Reduction in On Day Hours Lost Developing reporting Time at Scene Amber Amber Amber Amber Amber Green Commentary Progress has continued with the new rotas following the implementation in July of three CBU's, with final preparations for the two remaining CBU's of Leeds Wakefield and Bradford, Calderdale and Kirklees The % of calls to Clinical Hub not requiring transport has improved to 10.21% from 8.66% in July. This is a substantial improvement and moves towards achieving the target by year end. Work has been continuing on the measurement of utilisation of alternative pathways and this will be available for reporting in next month's report. The performance improvement plans have been reviewed and the detailed actions for delivery have been drilled down to support each element to deliver and a performance management process is in place. This will link directly to the Cost Improvement Plan and overall Operational Improvement Plan delivery. This is overseen by a fortnightly meeting regional meeting chaired by the Executive Director of Operations. The G1 and G2 activation times have improved from Amber in July to Green in August. This was an improvement of five seconds taking the activation time to 113 seconds, only two seconds higher than the target time of 111 seconds. Both the Red, G1 and G2 activation times have improved in August as noted in section

14 Yorkshire Ambulance Service - Performance - A&E Incident Demand and Performance by PCT and CBU (Vehicle Allocation) No. Of Incs All Incidents Outturn 10/11 % Incs Variance No. Of Incs Category Red 1 & 2 Incidents R1 R2 % in 8 Mins % in 19 Mins Category G1 Incidents Category G2 Incidents Category G3 Incidents Category G4 Incidents No. Of Incs No. Of Incs No. Of Incs No. Of Incs NORTH YORKSHIRE AND YORK PCT % % 94.1% NORTH YORKSHIRE CBU % % 94.1% EAST RIDING OF YORKSHIRE PCT % % 93.0% HULL PCT % % 99.8% EAST YORKSHIRE CBU % % 96.5% BRADFORD AND AIREDALE PCT % % 98.7% CALDERDALE PCT % % 98.6% KIRKLEES PCT % % 98.1% BRAD/CALD/KIRK CBU % % 98.5% WAKEFIELD DISTRICT PCT % % 98.6% LEEDS PCT % % 99.2% LEEDS AND WAKEFIELD CBU % % 99.0% BARNSLEY PCT % % 99.4% DONCASTER PCT % % 98.4% ROTHERHAM PCT % % 99.3% SHEFFIELD PCT % % 99.6% SOUTH YORKSHIRE CBU % % 99.2% PCT TOTAL % % 97.9% ECP OOA/UNKNOWN YORKSHIRE AMBULANCE SERVICE % % 97.9% Urgent Routine No. Of Incs No. Of Incs Demand for August is 1.8% higher than August last year. Hull and Calderdale PCT's have experienced an increase above 5%. Year to Date No. Of Incs All Incidents Outturn 10/11 % Incs Variance No. Of Incs Category Red 1 & 2 Incidents R1 R2 % in 8 Mins % in 19 Mins Category G1 Incidents Category G2 Incidents Category G3 Incidents Category G4 Incidents No. Of Incs No. Of Incs No. Of Incs No. Of Incs NORTH YORKSHIRE AND YORK PCT % % 94.9% NORTH YORKSHIRE CBU % % 94.9% EAST RIDING OF YORKSHIRE PCT % % 94.7% HULL PCT % % 99.9% EAST YORKSHIRE CBU % % 97.3% BRADFORD AND AIREDALE PCT % % 98.5% CALDERDALE PCT % % 98.4% KIRKLEES PCT % % 98.5% BRAD/CALD/KIRK CBU % % 98.5% WAKEFIELD DISTRICT PCT % % 98.7% LEEDS PCT % % 99.0% LEEDS AND WAKEFIELD CBU % % 98.9% BARNSLEY PCT % % 99.3% DONCASTER PCT % % 98.9% ROTHERHAM PCT % % 99.3% SHEFFIELD PCT % % 99.4% SOUTH YORKSHIRE CBU % % 99.2% PCT TOTAL % % 98.1% ECPs OOA/UNKNOWN YORKSHIRE AMBULANCE SERVICE % % 98.1% Urgent Routine No. Of Incs No. Of Incs Year to data demand is 2.8% above last year. Three PCT's are above 5% higher than last year - Bradford and Airedale, Calderdale and Doncaster. Three PCT's are below 75% for year to date - North Yorkshire and York PCT (with a 4.5% increase in demand compared to last year), Bradford and Airedale (with a 5.0% increase in demand compared to last year) and East Riding (with the same demand levels as last year). As noted previously the change in rotas for North Yorkshire and East Riding are expected to improve performance for these rural areas. 2.7

15 Yorkshire Ambulance Service - Performance - A&E August-11 Clinical Quality Indicators 1.2 YTD N/A MTD Strategic Goal - Continuously Improving Patient Care KPI 1.2 Delivery against the clinical quality outcomes in the operating framework Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Name Description Forecast HQU03_01 / 02 Response Times R1 & R2 8 Minute Response Times R1 & R2 19 Minute SQU03_01 Call Abandoned Rate SQU03_02 Re-contact Rates SQU03_03 SQU03_04 SQU03_05 SQU03_06 SQU03_07 Outcome from ROSC Service experience Outcome from Acute STEMI Outcome from Stroke Outcome from Cardiac Arrest SQU03_08 Time to Answer Calls SQU03_09 Time to Treatment SQU03_10 Calls Closed with Telephone Advice/No Transport Commentary = Under Development Year end forecasts have been included for all the process driven indicators, however, it is not possible to provide a year end forecast for the clinical quality indicators as these are designed to show progressive improvement over time. 2.8

16 Total Demand Total Resource Unit Hours Yorkshire Ambulance Service - Performance - A&E Call Abandoned Rate SQU03_01 and Time to Answer Calls SQU03_ Calls Closed with telephone advise or managed without transport to A&E SQU03_ Call Abandoned Rate and Time to Answer Calls Calls Closed with Telephone Advice / No transport 1.8% 00:01: % 1.6% 00:01: % 1.4% 1.2% 00:01: % 1.0% 00:00: % 0.8% 10.0% 0.6% 00:00:35 0.4% 5.0% 00:00:17 0.2% 0.0% 0.0% 00:00:00 April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Call Abandoned Rate Time to answer calls - Median Time to answer calls - 95 percentile Time to answer calls - 99 percentile Calls closed with telephone Advice Incidents managed without the need for transport to A&E (Face to Face) April May June July Aug Sept Oct Nov Dec Jan Feb Mar AVG YTD April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD Call Abandoned Rate 1.7% 1.0% 1.4% 1.5% 1.1% 1.3% Calls closed with telephone Advice 4.0% 4.0% 3.9% 4.1% 4.0% 4.0% Time to answer calls - Median 00:00:01 00:00:01 00:00:01 00:00:01 00:00:01 00:00:01 Incidents managed without the need for transport to A&E (Face to Face) 23.6% 22.6% 23.8% 23.9% 24.2% 23.6% Time to answer calls - 95 percentile 00:00:35 00:00:29 00:00:26 00:00:29 00:00:05 00:00:25 Time to answer calls - 99 percentile 00:01:36 00:00:48 00:01:05 00:01:10 00:01:13 00:01:10 Both call abandonment rate and time to answer calls 95 percentile have improved, this follows a review and change to the way Urgent calls are handled in July to August. The Trust remains within the National averages for Ambulance services for this measure. Calls closed with Triage remains stable at 4.0% and the trajectory is currently being developed for the rest of the year. The calls managed without the need for transport to A&E slightly improved in August, but the Trust remains near the bottom of national Ambulance services. 2.9

17 Yorkshire Ambulance Service - Performance - A&E Time to Treatment SQU03_ Re-Contact Rate following Discharge of Care SQU03_ :23:02 Time to Treatment (Red 1 & 2 Calls) 30.0% Re-contact Rates 00:20: % 00:17:17 00:14:24 00:11: % 15.0% 00:08: % 00:05:46 5.0% 00:02:53 00:00:00 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Time to Treatment - Median Time to Treatment - 95 percentile Time to Treatment - 99 percentile 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar Re-contact rate following discharge of Care by telephone Re-contact rate following discharge of care from treatment at the scene Proportion of calls from patients for whom a locally agreed frequent caller procedure is in place April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Time to Treatment - Median 00:05:22 00:05:14 00:05:13 00:05:24 00:05:13 Time to Treatment - 95 percentile 00:12:45 00:12:04 00:12:05 00:12:35 00:12:45 Time to Treatment - 99 percentile 00:19:26 00:17:24 00:17:39 00:18:57 00:19:29 Re-contact rate following discharge of Care by telephone Re-contact rate following discharge of care from treatment at the scene Proportion of calls from patients for whom a locally agreed frequent caller procedure is in place 26.8% 23.8% 26.0% 28.3% 24.8% 7.5% 8.7% 8.7% 8.1% 8.1% 1.0% 0.8% 0.7% 0.7% 0.9% The Trusts time to treatment figures remain near the top of the Ambulance Services levels and remain very consistent, meaning health professionals are getting to patients quickly. The re-contact rate for both telephone and face to face remains higher than average for Ambulance Services, a review of this information has been completed including detail at PCT level, crew skills and which chief complaints were leading to re-contacts. This work will inform improvements in this area in the future. 2.10

18 Yorkshire Ambulance Service - Performance Resilience 4 YTD MTD AMBER Strategic Aim - High Performing KPI 4 Fulfilment of requirements as a Category 1 responder Description Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast Risk Assessments Emergency Plans Business Continuity Plans AMBER AMBER AMBER AMBER AMBER AMBER Information Provision AMBER AMBER AMBER AMBER Co-operation with other responders Training AMBER AMBER AMBER AMBER AMBER AMBER Commentary Work has continued with the focus on Business Continuity plans for critical services and all plans will be completed by end of October. Exercises to test Business Continuity plans in A&R, Operations and Fleet have been scheduled for September and October. Exercise Albatross was completed in preparation for the Bank Holiday Weekend to test the Trust's Business continuity plans. A final report has been produced and the recommendations and actions are being acted upon. Winter planning is fully underway and two meetings have so far been held. There is no anticipated slippage. Information Provision: There has been a positive change to the rating for this criteria as there is enough evidence to demonstrate this year how we share / receive information and on the basis of that information plan together for events and incidents. Examples of this would be: The recent public disturbances; various English Defence League Demonstrations; supporting special operations for the Police over Bank Holiday weekend; representation at Local Resilience Forums etc. We will continue maintain our information provision objective over the coming months. A number of presentations to various health groups have also taken place on the subject of the Advanced Casualty Clearing station concept. 2.11

19 Section 2b PTS Performance 2b

20 Yorkshire Ambulance Service - Performance - PTS Percentage of PTS Inward Journeys (Measured) 3 YTD MTD Percentage of PTS Outward Journeys (Measured) 3 YTD MTD 100.0% PTS Inward Journeys 100.0% PTS Outward Journeys 90.0% 90.0% 80.0% 80.0% 70.0% 70.0% 60.0% 60.0% 50.0% 50.0% 40.0% 40.0% 30.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar 30.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar % of Measured Journeys Target for Measured Journeys % of Measured Journeys Target for Measured Journeys April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Delivered Journeys 39,393 42,182 44,336 38,233 39,563 Delivered Journeys 38,923 41,367 43,712 37,850 39,202 Measured Inward journeys 37,735 40,265 42,948 37,153 38,508 Measured Outward journeys 37,418 39,711 42,419 36,611 37,888 % of Measured Journeys 95.8% 95.5% 96.9% 97.2% 97.3% % of Measured Journeys 96.1% 96.0% 97.0% 96.7% 96.6% Target for Measured Journeys 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% Target for Measured Journeys 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% 85.0% Inward The percentage of measured inwards journeys in August was 97.3%, the highest figure YTD, and well above the target of 85%. The number of measured inward journeys increased by 3.6% compared to July, but remains below June and July levels. Outward The percentage of measured outwards journeys in August was 96.6%, well above the target of 85%. The number of Outward journeys increased by a similar rate to the measured inward journeys, 3.5% compared to July. 2.12

21 Yorkshire Ambulance Service - Performance - PTS PTS Punctuality - Arrive within 60 minutes before appointment 3 YTD AMBER PTS Waiting Time - 60 Minutes for Transport Home 3 YTD AMBER MTD AMBER MTD AMBER 100.0% PTS Punctuality 100.0% PTS Waiting Time 80.0% 80.0% 60.0% 60.0% 40.0% 40.0% 20.0% 20.0% 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar Actual ( ) Last Year ( ) Actual ( ) Last Year ( ) April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Actual ( ) 67.2% 64.7% 64.7% 62.4% 64.8% Actual ( ) 79.7% 77.1% 77.2% 72.9% 75.2% Last Year ( ) 58.7% 57.4% 58.5% 59.7% 63.2% 58.3% 60.4% 59.3% 51.5% 59.0% 62.4% 63.3% Last Year ( ) 76.3% 74.1% 74.7% 74.8% 76.9% 73.9% 74.8% 75.6% 72.1% 75.4% 77.2% 76.1% Planned ( ) Planned ( ) Forecast ( ) Forecast ( ) The percentage of patients arriving with the hour prior to their appointment increased by 2.4% in August. There was also an increase in the percentage of patients that received transport home within an hour of completing their treatment in August. This increased by 2.3%. There are significant concerns around long waiting times for patients waiting for transportation home. Service improvement plans are currently in negotiation with commissioners to address this issue. The scale of the Cost Improvement Program in PTS is such that a significant impact on performance is being experienced. The Business Intelligence department have designed and drafted a number of contract monitoring reports specifically designed for PTS. The West Yorkshire Consortia report is due to go live in September with the three other consortia coming online as contract KPI's are formally contractually signed off. This, combined by a new schedule of monthly contract monitoring review meetings between Contracts & Commissioning and Operations will now demonstrate the variance of compliance and is being monitored locally with PTS and contract managers. 2.13

22 Yorkshire Ambulance Service - Performance - PTS PTS Journey Time - 60 Minutes on Vehicle 3 Total Delivered Journeys % PTS Journey Time 110,000 PTS Total Delivered Journeys 80.0% 100,000 90, % 80, % 70,000 60, % 50, % April May June July Aug Sept Oct Nov Dec Jan Feb Mar 40,000 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Actual ( ) Last Year ( ) Actual Total Journeys ( ) Total Journeys Last Yr ( ) April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Actual ( ) 86.4% 87.7% 87.4% 86.0% 87.2% Actual Total Journeys ( ) 78,316 83,548 88,048 76,083 78,765 Last Year ( ) 84.6% 83.9% 84.6% 84.7% 86.7% 86.5% 87.0% 85.2% 82.5% 83.1% 84.5% 84.0% Total Journeys Last Yr ( ) 92,450 89,547 97,218 95,451 86,690 92,757 87,231 89,745 71,571 87,768 84,420 94,915 Planned ( ) Yr on Yr Variance -15.3% -6.7% -9.4% -20.3% -9.1% Forecast ( ) Planned Journeys ( ) Forecast Journeys ( ) Average journey times improved in August compared to July at 87.2% The number of journeys undertaken increased compared to July and was 9.1% lower than the previous year 2.14

23 Yorkshire Ambulance Service - Performance - PTS PTS Call Answering - 80% of Calls to be answered within 30 seconds 3 YTD MTD 95% Quality of Service Number of Calls 90% % 80% % % 65% % % 50% April May June July Aug Sept Oct Nov Dec Jan Feb Mar 0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Quality of Service Target Calls Offered Calls Answered Abandoned Calls Week Commencing April May June July Aug Sept Oct Nov Dec Jan Feb Mar Calls Offered Calls Answered Average Answer Delay 00:27 00:14 00:13 00:14 00:12 Max Answer Delay 26:26 16:29 28:22 29:33 21:54 Abandoned Calls Quality of Service 79% 89% 89% 88% 89% Target 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% Quality of service remained very consistent compared to May, June and July at 89%. The average answer delay improved by 2 seconds, while the number of calls answered decreased by 7.8% compared to July. 2.15

24 Section 2c GPOOH Performance 2c

25 Yorkshire Ambulance Service - Performance - GPOOH GPOOH Call Answering Performance 3 YTD GPOOH Abandoned & Engaged Call Performance 3 YTD MTD MTD GPOOH Call Answering Performance National Requirement = 95% calls answered within 60 seconds % 60.00% GPOOH Abandoned and Engaged Call Performance 50.00% % 50.00% 40.00% % 40.00% % 30.00% 30.00% 20.00% 20.00% % 10.00% 10.00% % 0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Actual calls ( ) Planned Performance ( ) Performance Last Year ( ) 0.00% 0.00% April May June July Aug Sept Oct Nov Dec Jan Feb Mar Engaged Call Performance ( ) Target > 0.1% Abandoned Call Performance ( ) Target >5% in < 45 secs Engaged Call Performance (Last Year ) Abandoned Call Performance (Last Year ) 0.00% April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Planned Engaged Call Performance ( ) Target > 0.1% 0.00% 0.00% 0.00% 0.00% 10.34% Actual calls ( ) Engaged Call Performance (Last Year ) 0.00% 0.00% 3.00% 0.00% 0.00% 0.00% 0.00% 0.00% 50.88% 3.78% 0.11% 0.00% Actual calls Last Year ( ) Performance ( ) 96.26% 97.02% 98.38% 98.75% 97.71% Performance Last Year ( ) 96.48% 96.63% 97.29% 96.87% 97.50% 96.96% 95.57% 97.02% 74.20% 87.75% 95.79% 95.90% Abandoned Call Performance ( ) Target >5% in < 45 secs Abandoned Call Performance (Last Year ) 0.31% 0.29% 0.14% 0.25% 0.30% 0.49% 0.49% 0.34% 0.42% 0.34% 0.56% 0.55% 0.30% 5.20% 1.90% 0.39% 0.30% Forecast Call volumes decreased in August compared to July, but were still 3% higher than planned levels. Performance remained high at 97.71% slightly higher than the 97.50% performance in August last year. 2.16

26 Section 2d Support Services Performance 2d

27 Yorkshire Ambulance Service - Performance - A&E ICT Summary 3 YTD MTD Key Areas Our Service Activity Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast SLA Amber Amber Amber Amber Amber Green 4C's Amber Green Green Green Green Green Customer Contact Amber Green Green Green Green Green Requests and Incidents Amber Amber Green Green Green Green Governance Green Green Green Green Amber Green Project Management Time frames Green Green Green Amber Amber Green Quality Green Green Green Green Green Green Budget Green Green Green Green Green Green Network Availability Green Green Green Green Amber Green Systems Availability Green Green Green Green Amber Green Infrastructure Telecoms Availability Green Green Green Green Amber Green Radio Availability Green Green Green Amber Green Green Change Control Green Green Green Green Green Green Budget Management Green Green Green Green Green Green Absence Management Green Green Green Green Green Green Our People Training Green Green Green Green Green Green PDR's Green Green Green Green Green Green Staff Engagement Green Green Green Green Green Green Commentary Our Service : The overall SLA continues its upward trend from in July to this month (target 90%). Additional support is expected in place late September. Project Management : Some projects are waiting sign off of the governance process and there is a delay in the go-live of the Invoice Scanning project. Infrastructure: A power failure following planned work on the 17 August led to a loss of some network, systems and telecoms availability. Some planned supplier work on the 24 August led to a short Computer Aided Dispatch (CAD) outage Our people : All green 2.17

28 Yorkshire Ambulance Service - Performance - Estates and Procurement Estates and Procurement 3 YTD MTD E2.1 Estates Status Empty Underused Fully used Overcrowded E2.1 Space Utilisation 0% 4% 88% 8% Status As New Acceptable Upgrade Req'd Unacceptable E2.1 Physical Condition 34% 60% 6% 0% E2.1 Statutory Compliance 88% 11% 1% 0% E2.1 Energy Performance 9% 75% 10% 6% E2.1 Functional Suitability 14% 82% 4% 0% E2.1 Quality 0% 100% 0% 0% Status E2.1 Capital Project Delivery E2.1 Station Egress Status E2.1 Supported Standby Points Notes Changes reflected by Improvements made to Emergency Lighting at a number of sites While there has been some slippage with the Bradford Station reconfiguration while confirming priority with Operation Senior Managers - This project has now been agreed and the tender process and works is now estimated for completion at March 2012 F2.1 Procurement Status F2.1 Auditors Local Evaluation (ALE) F2.1 Procurement Savings F2.1 Contracts awarded in period above 25K F2.1 Single Tender Waivers in period August 98, Year to date 282, Two contracts awarded above 25k during period (see below) none Status history Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Contracts awarded above 25k during June 4 x 4 Conversions, Mercedes Chassis awarded. A&E vehicles tender obtained Board approval on the 23/8/11. Single Tender Waiver None Springhill UPS upgrade work This planned work led to an unplanned power outage impacting upon services at Springhill on 17 August. 2.18

29 Yorkshire Ambulance Service - Performance - Fleet Fleet 3 YTD MTD E1 Carbon Management Status Baseline 2007 Actual Last 12 Months Forecast 2010/11 Quarter 1 Actual Notes E1.1 Carbon Emissions Aim is to reach CO2 emissions of 11,487 tonnes of CO2 by 2015 E1.2 Corporate Citizen Rating (monitored quarterly) 59% E3 Fleet Status Vehicle Availability % Plan vs. Actual Plan YTD Actual YTD Var YTD Plan Mth Actual Mth Var Mth E3.1 A&E AMBER 95% 92% -3% 95% 92% -3% E3.1 PTS 95% 96% 1% 95% 94% -1% E3.1 Other Vehicle Age Status Plan YTD Number Over Age Var YTD E3.1 A&E - RRV 4 29 E3.1 A&E - DMA 5 38 E3.1 A&E - Other 7 2 E3.1 PTS RED New vehicles currently being rolled out will be complete by March 2012 Vehicles will be replaced by March 2012 Notes Below target due to a number of vehicles in the dealers. Also the high number of RRV's off road and in dealerships in the Central area along with larger repairs has affected vehicle availability. Below target due to a high number of breakdowns in North at the beginning of the month combined with larger repairs in the Central area during the last week of the month. Age profile will come into line when replacement front line DMA's are in place allowing 5 year old front line vehicles to be down graded to A&E Support Notes E3.1 Other AMBER 7 27 Status Vehicle Replacement Plan Plan Annual Forecast Annual E3.1 A&E - RRV E3.1 A&E - DMA E3.1 A&E - Other 0 0 On Plan On Plan P&E vehicles are awaiting business case and the remainder are workshop vans /other vehicles which are fully assessed for usage and condition. Notes E3.1 PTS RED 13 4 Currently insufficient funds available to replace all vehicles that are overdue this financial year. E3.1 Other 4 4 E3.2 Compliance / Safety Status Number % Total Notes E3.2 Safety Checks Outside "Window" at end of period 1 0.2% E3.2 Vehicle Services Outside "Window" at end of period % All vehicles had risk assessments carried out to ensure they are road worthy. The safety checks are now complete This KPI has not been met as the vehicles were unable to be released from operational duties. The services are now complete. E3.1 Vehicle Cleans Outside "Window" at end of period % Status history Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar 2.19

30 Section 3 Quality Analysis 3

31 Yorkshire Ambulance Service - Quality - Summary KPI Description Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast 3 Safety 1.2 Clinical Effectiveness 1.2 Patient Involvement and Experience 3 CQC and Other Registration / Legislation Standards 2 CQUIN Schemes AMBER AMBER Commentary Evidence collated at corporate and operational levels for the prospective CQC assessment, has been subject to quality checks to ensure that the Trust is adequately prepared for assessment. Quarter 1 CQUIN information submitted to commissioners and due for review in the September Clinical Review Group meeting. 3.1

32 % vehicles cleaned within specified time period % Compliance Yorkshire Ambulance Service - Quality - Safety - Infection, Prevention and Control YTD Vehicle Cleaning 3 Hand Hygiene 3 YTD AMBER MTD MTD 100 Percentage of Vehicles Cleaned within specified time period 100 Percentage Compliance Hand Hygiene Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 70 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % of vehicles cleaned within specified time period Target Vehicle Cleaning Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Hand Hygiene Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar % of vehicles cleaned within specified time period Percentage Compliance The deep cleaning schedule remains at a compliant level. 204 hand hygiene compliance audits have been completed during this period. There has been a significant increase in compliance for this period. The increase in compliance can be attributed to educational initiatives providing greater awareness and understanding of hand hygiene requirements. This is most notably demonstrated in compliance with bare below the elbows compliance. 3.2

33 Yorkshire Ambulance Service - Quality - Safety New Incidents Reported 3 New Incidents Reported Rate Based New Incidents Reported 0.18% New Incidents Rate Based 0.16% % 0.12% % % 0.06% % 0.02% 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E A&R PTS OTHER Ops - A&E A&R PTS Other New Incidents Reported Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar New Incidents Reported Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E Ops - A&E 0.12% 0.15% 0.13% 0.16% A&R A&R 0.05% 0.06% 0.04% 0.04% PTS PTS 0.04% 0.04% 0.05% 0.04% OTHER OTHER 0.13% 0.13% 0.13% 0.12% TOTALS Current Year Last Year 172 A breakdown of A&E Operational totals indicates that for this month, Bradford Calderdale and Kirklees - Leeds & Wakefield remain the business areas reporting the highest number of incidents. Out of a total figure of 516 incidents reported this month, 23 were reported as near miss. This is an encouraging indication of pro-active incident reporting and awareness. All of 14 of the RED graded incidents related to medicines management. All PTS incidents except two are graded as minor or negligible and include 8 near miss incidents. One PTS and two incidents reported within A&R are graded red and will be reviewed at the next Incident Review Group. The majority of incidents categorised as other relate to the fleet department, including Road Traffic Collision's and vehicle damage. 3.3

34 Yorkshire Ambulance Service - Quality - Safety Patient related Incidents 3 Patient Related Incidents Rate Based Indicator 3 Patient Related Incidents Patient Related Incidents Rate Based Indicator % % % % % 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E A&R PTS OTHER Ops - A&E A&R PTS OTHER Patient Related Incidents Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E Ops - A&E 0.01% 0.01% 0.02% 0.02% 0.02% A&R A&R 0.00% 0.00% 0.00% 0.00% 0.00% PTS PTS 0.02% 0.02% 0.02% 0.02% 0.02% OTHER OTHER 0.00% 0.00% 0.00% 0.00% 0.00% TOTALS Patient related incidents reported for August for A&E do not identify any specific themes, as the incidents categories are wide spread with only small numbers reported against each category. Patient related incidents reported by PTS identify 8 out of 27 as near miss. Of the 19 other incidents reported all except two relate to moving and handling. 3.4

35 Yorkshire Ambulance Service - Quality - Safety Medication Related Incidents 3 Medication Related Incidents Rate Based Indicator 3 Medication Related Incidents Medication Related Incidents Rate Based Indicator % 0.018% % % 0.012% % 0.008% % % 0.002% 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.000% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar North Yorkshire CBU East Riding of Yorkshire CBU Leeds & Wakefield CBU Bradford, Calderdale & Kirklees CBU South Yorkshire CBU North Yorkshire CBU East Riding of Yorkshire CBU Leeds & Wakefield CBU Bradford, Calderdale & Kirklees CBU South Yorkshire CBU Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar North Yorkshire CBU North Yorkshire CBU 0.001% 0.000% 0.003% 0.001% 0.002% East Riding of Yorkshire CBU East Riding of Yorkshire CBU 0.001% 0.002% 0.000% 0.001% 0.001% Leeds & Wakefield CBU Leeds & Wakefield CBU 0.016% 0.018% 0.010% 0.004% 0.006% Bradford, Calderdale & Kirklees CBU Bradford, Calderdale & Kirklees CBU 0.007% 0.006% 0.006% 0.011% 0.006% South Yorkshire CBU South Yorkshire CBU 0.000% 0.001% 0.003% 0.001% 0.001% TOTALS : 4 new morphine incidents reported: 1 vial missing in North Yorkshire. Due process followed and an investigation is consequently ongoing. 1 lost key, 1 lost register. Neither event has compromised morphine security. 1 broken vial reported. 1 ongoing incident involving the loss of a morphine requisition book in South Yorkshire now fully investigated and closed. No losses as a result of this incident. Processes now in place to invalidate requisition books if future losses occur. General reports relate to vehicle stock discrepancies but show a decreasing trend as the process of checking and accountability embeds in Leeds & Wakefield and Bradford Calderdale and Kirklees. 3.5

36 Yorkshire Ambulance Service - Quality - Safety Staff Related Incidents 3 Staff Related Incidents Rate Based Indicator 3 Staff Related Incidents Staff Related Incidents Rate Base Indicator % % % % % % 0.80% % % % 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0.00% Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E A&R PTS OTHER Ops - A&E ICT (includes A&R) PTS OTHER Staff Related Incidents Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Staff Related Incidents Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E Ops - A&E 1.04% 1.67% 1.51% 1.87% 1.33% A&R ICT (includes A&R) 0.07% 0.05% 0.09% 0.09% 0.11% PTS PTS 0.33% 0.47% 0.64% 0.25% 0.32% OTHER OTHER 0.21% 0.19% 0.19% 0.18% 0.07% TOTALS All except 8 incidents reported this month are graded as minor or negligible. The 8 others are graded as AMBER. Of the 81 incidents reported, 18 relate to moving and handling, 29 to violence and aggression and 15 to slips, trips and falls. Each of these subject areas are being managed through the Risk & Safety Workplan with progress reports to the Health & Safety Committee. 3.6

37 Yorkshire Ambulance Service - Quality - Safety RIDDOR Reportable Incidents RIDDOR Reportable Incidents There have been a further 4 reports submitted under RIDDOR this month. Of the 19 reports submitted so far this year, it is noted that 10 relate to injury sustained whilst handling, lifting or carrying Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar TOTALS RIDDOR reportable Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar North Yorkshire CBU East Riding of Yorkshire CBU Leeds & Wakefield CBU Bradford, Calderdale and Kirklees CBU South Yorkshire CBU Operations PTS Other Directorates TOTALS Current Year Contact with moving machinery or materials Hit by a moving, flying or falling object Hit by a moving vehicle Hit by something fixed or stationary Injured while handling, lifting or carrying Slip, trip or fall on the same level Fall from a height Trapped by something collapsing Drowned or asphyxiated Exposed to or in contact with a harmful substance Exposed to fire Exposed to an explosion Contact with electricity or an electrical discharge Injured by an animal Physically assaulted by a person Another kind of accident Total Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

38 Frequency Rate Incident Rate Incident Rate Frequenbcy Rate Yorkshire Ambulance Service - Health & Safety - RIDDOR Reportable Accident Incident Rate (RIDDOR) Frequency Rate (RIDDOR) April May June July Aug Sept Oct Nov Dec Jan Feb Mar 0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Incident Rate Frequency Rate April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Incident Rate Frequency Rate Frequency Rate Staff Related Accidents / Near Misses Incident Rate Per 1000 Employees April May June July Aug Sept Oct Nov Dec Jan Feb Mar 0.0 April May June July Aug Sept Oct Nov Dec Jan Feb Mar Frequency Rate Incident Rate April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar Frequency Rate Incident Rate

39 Yorkshire Ambulance Service - Quality - Safety SUI Incidents by Area 3 SUI Highlight Report SUI Incidents by Area The two SUIs reported this month relate to 2011/ Patient cannulation which is under investigation and 2011/ Loss of power during electrical maintenance work which caused issues with the Computer Aided Dispatch (CAD) system. Approx 6 hours to return to fully functioning CAD system Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E A&R PTS OTHER SUI Incidents Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Ops - A&E A&R PTS OTHER TOTALS

40 Yorkshire Ambulance Service - Quality - Safeguarding YTD Training Position 3 Number of Child and Adult Referrals MTD % Number of eligible workforce trained 350 Number of Referrals 90.0% % 70.0% % % 40.0% % % 10.0% % Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 0 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Child - Level 1 Child - Level 2 Adult Children Adults Training Position Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Referrals 10/11 Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Child - Level % 85.4% 87.9% 92.3% 91.9% CHILDREN Child - Level % 30.6% 36.2% 33.4% Referrals Adult 87.2% 85.1% 86.3% 91.2% 91.0% ADULTS Referrals TOTAL The safeguarding team have produced a Safeguarding Children level 2 distance learning pack and this has been approved for printing. The plan will be to implement from September 2011 once materials are available. The safeguarding referral process moved to the Clinical Hub on 17 May resulting in an increase in referrals. 3.10

41 Yorkshire Ambulance Service - Quality - Clinical Effectiveness Clinical Performance Indicators - National 1.2 : 3 ST Elevation Myocardial Infarction (STEMI) May 2010 Results % CYCLE 5 CYCLE 6 November 2010 National Average Z- Score National Average Results % M1 Aspirin M2 - GTN M3 - Two Pain Scores Recorded M4 - Morphine alone given Z- Score Cycle 6 national CPIs are now complete. Cardiac arrest outcome is the area of main concern (now a clinical Ambulance Quality Indicator) and is a clinical priority for the Trust moving forward. Continued engagement with clinical staff, reinforcing the importance of Clinical Performance Indicators is key to high quality clinical care. This is being driven through clinical audit, monitored at the Clinical Effectiveness Group and reported to Clinical Governance Committee. M5 - Analgesia given PILOT SpO2 recorded PILOT Care Bundle M1, M2, M3 and M Cardiac Arrest June 2010 Results % December 2010 National Average Z- Score National Average Z- Score Results % C1 - ROSC on arrival at hospital STEMI C2 - Advanced Life Support provider in attendance Stroke / TIA C3 - Response to cardiac arrest < 4 minutes Hypoglycaemia PILOT Care Bundle C2 and C Asthma Stroke July 2010 Results % Jan 2011 Results National Average Z- Score National Average % Z- Score S1 - Face, Arm, Speech Test (FAST) recorded S2 - Blood glucose recorded S3 - Blood pressure recorded PILOT Time of onset of stroke recorded PILOT Care Bundle S1, S2 and S Hypoglycaemia Aug 2010 Results % Feb 2011 Results National Average Z- Score National Average % Z- Score H1 - Blood Glucose Recorded before treatment H2 - Blood Glucose Recorded after treatment H3 - Treatment for Hypoglycaemia Recorded PILOT Direct referral made to an appropriate health professional PILOT Care Bundle H1, H2 and H Asthma Sept 2010 Results % March 2011 National Average Z- Score National Average Results % Z- Score A1 - Respiratory rate recorded A2 - PEFR (peak flow) recorded before treatment A3 - SpO2 recorded before treatment A4 - Beta 2 agonist recorded A5 - Oxygen administered PILOT Care Bundle A1, A2, A3 and A

42 Percentage Percentage Percentage Percentage Yorkshire Ambulance Service - Quality - Clinical Effectiveness Clinical Performance Indicators - Local 1.2 ; YAS Local STEMI CPI 100 YAS Local Cardiac Arrest CPI M1 Aspirin M2 GTN M3 Two Pain Scores recorded M4 Morphone Given M5 Analgesia Given M7 Spo2 Recorded Care Bundle M1. M2, M3 and M5 0 C1 ROSC on arrival at hospital C2 Als provider in attendance C3 response < 4 minutes Care Bundle C2 and C3 National Average Cycle 6 YAS April 11 YAS May 11 YAS June 11 National Average Cycle 6 YAS April 11 YAS May 11 YAS June 11 YAS Local STEMI CPI National Average Cycle 6 YAS April 11 YAS May 11 YAS June 11 YAS Local Cardiac Arrest CPI National Average Cycle 6 YAS April 11 YAS May 11 YAS June 11 M1 Aspirin C1 ROSC on arrival at hospital M2 GTN C2 Als provider in attendance M3 Two Pain Scores recorded C3 response < 4 minutes M4 Morphone Given Care Bundle C2 and C M5 Analgesia Given M7 Spo2 Recorded Care Bundle M1. M2, M3 and M YAS Local Stroke CPI YAS Local Asthma CPI S1 FAST Test recorded S2 Blood Glucose Recorded S3 Blood Press Recorded S4 Time of Onset Recorded Care Bundle S1, S2 and S3 0 A1 Resp rate recorded A2 PEFR recorded before Treatment A3 Spo2 recorded before Treatment A4 Beta 2 Agonist recorded A5 O2 administered Care bundles A1, A2, A3 and A4 National Average Cycle 6 YAS April 11 YAS May 11 YAS June 11 National Average Cycle 5 YAS April 11 YAS May 11 YAS June 11 YAS Stroke CPI Local National Average Cycle 6 YAS April 11 YAS May 11 YAS June 11 YAS Local Asthma CPI National Average Cycle 5 YAS April 11 YAS May 11 YAS June 11 S1 FAST Test recorded A1 Resp rate recorded S2 Blood Glucose Recorded A2 PEFR recorded before Treatment S3 Blood Press Recorded A3 Spo2 recorded before Treatment S4 Time of Onset Recorded A4 Beta 2 Agonist recorded Care Bundle S1, S2 and S A5 O2 administered Care bundles A1, A2, A3 and A

43 Percentage Yorkshire Ambulance Service - Quality - Clinical Effectiveness Clinical Performance Indicators - Local 1.2 ; YAS Local Hypoglycaemia CPI Local Clinical Performance Indicators continue to demonstrate good quality clinical delivery. Administration of analgesia and recording of pain scores in patients with STeMI remains a significant area for improvement. Continued engagement with clinical staff regarding the importance of Clinical Performance Indicators remains key to good clinical delivery H1 Blood Glucose Before Treatment H2 Blood Glucose After Treatment H3 Treatment for Hypoglycaemia Recorded H4 Direct Referrals made to an appropriate health Care Bundle H1, H2 and H3 National Average Cycle 5 YAS April 11 YAS May 11 YAS June 11 YAS Local Hypo CPI National Average Cycle 5 YAS April 11 YAS May 11 YAS June 11 H1 Blood Glucose Before Treatment H2 Blood Glucose After Treatment H3 Treatment for Hypoglycaemia Recorded H4 Direct Referrals made to an appropriate health Care Bundle H1, H2 and H

44 Yorkshire Ambulance Service - Quality - Effectiveness Clinical Audit Programme 1.2 : 2 : 3: 8.1 EXCEPTION REPORT SAFETY AND CLINICAL EFFECTIVENESS National Audit Programme AMBER National Ambulance CPIs: STeMI Stroke Hypoglycaemia Asthma National Ambulance CQIs: Cardiac arrest outcomes Stroke STeMI MINAP CMACE Engagement with acute trust partners regarding MINAP data remains challenging. Internal Clinical Audit Plan Monthly CPIs SHU/NT SN stroke audit Infection Control audit Cardiac Arrest outcomes Interfacility transfer audit The Clinical Audit Programme and Strategy have been reviewed and will be presented to Clinical Excellence Group in September. National audit programme Engagement with the national audits listed is ongoing. Timely data submission by some MINAP partners remains a challenge. Internal clinical audit plan Clinical audits to address individual elements of Clinical Performance Indicators are being developed jointly by the Clinical Excellence Managers and Clinical Managers. These will be reported to Clinical Excellence Group. Infection control audits take place examining hand hygiene, cannulation, estates and vehicles. Cardiac arrest outcomes will be audited using data collection for the national Clinical Quality Indicators with local action plans to improve outcomes. Interfacility transfer audit of Priority 1 requests is ongoing with local action plans to be drawn up by SQuIMs in conjunction with acute trusts. The following have been removed from the plan: Clinical standardisation audit was completed and presented to the Clinical Standardisation Group on 30th June Alternative care pathways' use is audited. However, there is no scope to perform clinical audit as patient disposition cannot be influenced by YAS once a referral has been made. 3.14

45 Yorkshire Ambulance Service - Quality - Patient Experience and Involvement Concerns, Complaints and Compliments 1.2 : 3 Complaints & Concerns 2011/12 CBU Area Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar BCK Hull & ER % A&E / A&R % Rate Attitude / Conduct Aspects of Clinical Care Leeds & Wakefield North Yorks South Yorks A & R BCK Hull & ER Leeds & Wakefield North Yorks South Yorks BCK % 0.10% Driving and Sirens Hull & ER Leeds & Wakefield North Yorks South Yorks Response A & R % Call Management A & R BCK Other Hull & ER % Leeds & Wakefield Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar North Yorks % Rate South Yorks A & R BCK Hull & ER Leeds & Wakefield SUB TOTALS North Yorks South Yorks A & R GRAND TOTAL Demand Activity % RATE 0.10% 0.09% 0.10% 0.10% 0.10% Compliments CBU Area Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar BCK Hull & ER Leeds & Wakefield North Yorks South Yorks A & R TOTAL As reported in July the information presented within the IPR has been reviewed in line with internal and external reporting requirements. The information relates to all concerns and complaints received by YAS. It is aligned to the national benchmarking information agreed by all ambulance services and will form part of the performance dashboards that the Clinical Business Units are producing on a monthly basis. Discussions are currently being held with Assistant Directors to agree a systematic approach through which data will be shared and owned by them. The numbers of concerns and complaints received for A&E has been fairly consistent from April - July, although Access & Response concerns and complaints have increased month on month. The majority of these relate to patients who have been triaged as nonserious or life threatening and passed to NHS Direct. Please note that the reduced number of compliments recorded in August is due to reduced capacity within the Patient Relations Department to process them, this will be rectified in September. 3.15

46 Yorkshire Ambulance Service - Quality - Patient Experience and Involvement Concerns, Complaints and Compliments 1.2 : 3 Attitude / Conduct 2011/12 PTS Area Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Aspects of Clinical Care Driving and Sirens Response Call Management Service to Service Other SUB TOTALS GRAND TOTAL Demand Activity % RATE Complaints & Concerns East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia East Consortia North Consortia South Consortia West Consortia % 0.16% 0.17% 0.21% 0.25% 0.30% 0.25% 0.20% 0.15% 0.10% 0.05% 0.00% PTS % Rate Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar PTS concerns and complaints originate from patients, carers and members of the public. Service to service issues are received from hospital departments, clinicians and commissioners. There has been a marked increase in service to service issues from April - August as the service to service procedure has been expanded to cover all of YAS. Service to service issues are those issues raised by the hospital directly to YAS and not those raised by patients. For good practice and account management we now have a formal process in place to log and address these. % Rate PTS Area East Consortia North Consortia South Consortia West Consortia TOTAL Compliments Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

47 Yorkshire Ambulance Service - Quality - Patient Experience and Involvement Concerns and Complaints - A&E / A&R Concerns and Complaints - PTS 1.2 : /12 A&E / A&R Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 2011/12 PTS Area Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Response Within 1 Working Day Response 2-25 Working Days Response > 25 Working Days Average Response Time (Working Days) Re-opened Complaints & Concerns Referrals to Ombudsman BCK Response Within East 1 Working Consortia Day Hull & ER Response North Consortia Within 1 Working Leeds & Wakefield Day South Consortia North Yorks West Consortia South Yorks East Consortia A & R Response 2-25 Working North Consortia BCK Response Days 2-25 South Working Consortia Days Hull & ER West Consortia Leeds & Wakefield East Consortia North Yorks Response > 25 Working North Consortia South Yorks Days South Consortia A & R West Consortia BCK East Consortia TBC Hull & ER Average Response Time North Consortia TBC Leeds & Wakefield (Working Days) South Consortia X 16 North Yorks West Consortia 10 X South Yorks East Consortia A & R Re-Opened Complaints & North Consortia BCK TBC Concerns South Consortia Hull & ER 27 TBC 16 TBC West Consortia Leeds & Wakefield TBC TBC North Yorks TBC Referrals to Ombudsman South Yorks 24 TBC TBC TBC PTS - Service to Service Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar A & R TBC East Consortia N/A 20 (100%) 32 (100%) 35 (100% 25 (100%) BCK Acknowledged North Consortia N/A N/A 1 (100%) 4 (100%) 16 (100%) Within 2 Working Hull & ER Days South Consortia 7 (100%) 8 (100%) 11 (100%) 9 (100%) 20 (100%) Leeds & Wakefield West Consortia 5 (100%) 28 (100%) 23 (100% 27 (100%) 58 (100%) North Yorks East Consortia N/A 0 (0%) 13 (41%) 27 (77%) TBC South Yorks North Consortia N/A N/A 0 (0%) 0 (0%) TBC A & R Response Within South Consortia 10 Working Days 7 (100%) 1 (13%) 3 (27%) 2 (22%) TBC A&E / A&R West Consortia 5 (100%) 6 (21%) 7 (30%) 9 (100%) TBC PTS Area The quality standards for PTS service to service issues are to be acknowledged by the Patient Services team within two working days and then responded to by the relevant PTS Manager within ten working days. North Consortia 3.17

48 Yorkshire Ambulance Service - Quality - Patient Experience Local Involvement Networks/Overview & Scrutiny Committees 1.2 : 3 YTD MTD A&E Patient Experience Survey 1.2 : 3 YTD MTD Description Description Local Involvement Networks A&E Service-User Experience Overview and Scrutiny committees PTS Service-User Experience AMBER Engagement with LINks Yorkshire-Wide LINks Ambulance Group The next meeting of this group is scheduled for 8 September PTS will be the main item on the agenda with a number of LINks wishing to share concerns and receive responses about the waiting times for transport and the impact of the recent strengthening of the application of the escort eligibility rules. Working with this group YAS has developed a PTS Patient Charter and this will be launched at YAS's AGM in September. Rotherham We have contributed to the review of the LINks current work and the development of a proposal to move forward to HealthWatch Rotherham. Richmondshire Richmondshire LINk have raised concerns about response times in their area, age of PTS vehicles and use of community responders in rural areas. An initial response has been provided and the area's Locality Manager will be attending the group's next meeting to respond to these concerns. Richmondshire LINk have also asked for YAS to provide information about stroke pathways in its areas and the hospitals to which stroke patients have been taken over the past year. This is the result of a PCT-led review of stroke services in the area to which YAS is contributing via our Clinical Pathways Adviser for stroke. Engagement with OSCs Richmondshire OSC The Locality Manager for the area attended an OSC meeting looking as part of the review of stroke services and will be attending a follow-up meeting in September. Detailed figures about YAS's conveyance of stroke patients to Darlington Memorial Hospital and James Cook University Hospital have been requested. Engagement with other patient groups North Yorkshire Physical and Sensory Impairment Board This group has raised their concerns about the impact on patients and carers of the new way the eligibility criteria are being applied. Representatives of PTS, Patient Experience and the PCT PTS Commissioner attended their meeting on 1 September to discuss their concerns. A&E Service-User Experience Survey The postal survey of A&E Service User Experience was completed in. Surveys were sent to a random sample of 570 addresses to which ambulances had been called in June 2011 (this included calls to which we sent an ambulance response and those where the call was referred to NHS Direct or to the YAS Clinical Advisers). 570 is approximately 1% of the average number of incidents responded to in a month (based on figures) The postal survey is in addition to the online survey, which continues to be available via the YAS website. In, 55 people completed the online survey and 153 have (to date) responded to the postal survey (a response rate of 27%). The results from the postal survey were compared to the online results. Overall the postal survey showed a significantly higher satisfaction level. Results from key questions: Overall how would you rate the service you received from the ambulance service? May % excellent/good; 6.1% poor/very poor (143 responses) June % excellent/good; 0.0% poor/very poor (78 responses) July 2011 (online) 92.0% excellent/good; 4.0% poor/very poor (40 responses) July 2011 (postal) 95.6% excellent/good; 2.6% poor/very poor (124 responses) (online) 90.6% excellent/good; 9.4% poor/very poor (32 responses) (postal) 98.6% excellent/good; 1.4% poor/very poor (148 responses) Overall, how would you rate whether the ambulance staff treated with dignity and respect? May % excellent/good; 8.5% poor/very poor June % excellent/good; 12.5% poor/very poor July 2011 (online) 100% excellent/good; 0.0% poor/very poor July 2011 (postal) 95.5% excellent/good; 1.8% poor/very poor (online) 90.9% excellent/good; 9.1% poor/very poor (postal) 98.0% excellent/good; 2.0% poor/very poor Themes from the narrative information received via the A&E patient survey: Call-handling/triage: Dissatisfaction with call prioritisation. Dissatisfaction with manner of call handler. Staff attitude positive: This was the most common piece of feedback. Thank you for excellent care provided by YAS clinicians. Staff attitude negative: Call taker felt to be dismissive of symptoms Delayed response/extended journey time: Dissatisfaction with waiting time for ambulance response. Progress with actions agreed: The results of the A&E survey are presented to the Operations Performance Board every month. The following actions have been agreed: - Posters have been sent out to all stations with a summary of the first two months' survey results - this will be repeated every two months - A detailed review looking at the experience of callers being transferred to a clinical adviser or to NHS Direct has been agreed. A project specification has been drafted and is currently being reviewed by those involved. The work is due to be completed by the end of Oct PTS Service-User Experience Discussions are ongoing with the PTS team to develop a deliverable plan to obtain patient feedback from all areas of the Trust, to monitor the themes and trends and to develop action plans. Further to themes from patient experience information a customer care programme is being developed for PTS training and will be delivered in the apprentice courses scheduled for Autumn

49 Yorkshire Ambulance Service - Quality - Care Quality Commission and Other Registration Legislation Standards Registration Regulations & Outcomes 3 YTD MTD N/A N/A NHS Litigation Authority 3 YTD MTD COMPLIANCE CQC Quality and Risk Profile Rating Internal Rating Outcome Feb-11 Mar-11 Apr-11 Jun-11 Jul-11 Aug-11 Mar-11 Actions Changes since last Report Current Level LEVEL ONE 10/11 1 Respecting and involving people who use services No significant changes to QRP Proposed Level LEVEL TWO 11/12 2 Consent to care and treatment No data available in QRP Advisory Visit 2011 TBC 4 Care and welfare of people who use services No new data added to QRP Formal Assessments March 2012 (TBC) 5 Meeting nutritional needs No data available in QRP 6 Cooperating with other providers No data available in QRP 7 Safeguarding people who use services from abuse Insufficient data in QRP 8 Cleanliness and infection control No significant changes in QRP Developments since last report CQC REGISTRATION Quality checks continue on corporate evidence. Systematic approach to developing local evidence shared with local leads. 9 Management of medicines No significant changes in QRP Notifications to CQC None 10 Safety and suitability of premises No further data to report. Actions for ET To continue to promote local understanding of CQC requirements. 11 Safety, availability and suitability of equipment The 'low amber' rating relates to SMS report requirements rather than equipment issues 12 Requirements relating to staff No further data to report. 13 Staffing Insufficient data in QRP Compliance Assurance Group - Progress report The Compliance Assurance Group has continued to support CQC compliance and is 14 Supporting workers No significant changes in QRP also focussing on NHSLA level 1 and 2 requirements 16 Assessing/Monitoring quality No significant changes in QRP 17 Complaints No significant changes in QRP 18 Records No significant changes in QRP The Trust has received updated QRP information and the report shows the updated risk profile to the latest update published on 17. The change in profile for Outcome 11 relates to reported non or late submission of LSMS reports. Reports were submitted by the due date and the Trust is querying this with the SMS 3.19

50 Yorkshire Ambulance Service - Quality - CQUIN Schemes CQUIN Schemes 2 YTD N/A MTD Description Provision of a comprehensive clinical hub Clinical leadership & clinical assessment skills development The research & preparation of the Electronic Care System Develop & implement alternative care pathways Management of frequent callers Proactive service user feedback Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast AMBER AMBER AMBER AMBER AMBER AMBER Commentary The commissioners have provided feedback on the Quarter 1 report and have requested additional information. This has now been provided and will be discussed at the Clinical Review Group on

51 Yorkshire Ambulance Service - Performance - ICT Information Governance 3 YTD MTD Freedom of Information (FOI) Requests This Month New FOI requests received 20 Number of FOI requests due a response in month 19 Number responded to within 20 days 16 Number responded to outside 20 days 3 Year to Date 74 Data Protection Act (DPA) Requests This Month Subject Access Requests 45 Solicitor Requests Police requests 99 Coroner Requests 14 Witness Statements / Police Interviews 48 In Time Out of Time Year to Date The number of Subject Access Requests received this month reflect an average monthly figure. A risk rating process has now been developed to monitor compliance against Data Protection legislation, with regards to the timeliness of response. The Department of Health supplementary guidance regarding the release of information relating to the detection and prevention of crime is now being incorporated into the Trusts' handling of Section 29 Data Protection Act (1998) requests. Information was submitted to support 10 Inquests during August, with YAS Staff attending at 2 of these. No issues were identified for the Trust. FOI Request Reason for Delay Slow internal response to data requests Two requests were submitted by the same individual for slightly different information cohorts. This increased the complexity of the request and could not be delivered against the timetable Internal capacity 3.21

52 Total Demand Total Resource Unit Hours Yorkshire Ambulance Service - Quality - Clinical Indicators Outcome from ROSC SQU03_03 3 Outcome from Acute STEMI SQU03_05 3 Outcome from ROSC Outcome from Acute STEMI 35.0% 100.0% 90.0% 30.0% 80.0% 25.0% 70.0% 60.0% 20.0% 50.0% 15.0% 40.0% 30.0% 10.0% 20.0% 5.0% 10.0% 0.0% 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar ROSC at time of arrival at hospital (Overall) ROSC at time of arrival at hospital (Ulstein Comparator Group) % of patients receiving thrombolysis within 60 mins from call % of patients transferred to a PPCI % of patients who receive an appropriate care bundle April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD ROSC at time of arrival at hospital (Overall) 13.3% 13.3% % of patients receiving thrombolysis within 60 mins from call 0.0% N/A ROSC at time of arrival at hospital (Ulstein Comparator Group) 31.8% 31.8% % of patients transferred to a PPCI 93.8% 93.8% % of patients who receive an appropriate care bundle 75.3% 75.3% 3.22

53 Total Demand Total Resource Unit Hours Yorkshire Ambulance Service - Quality - Clinical Indicators Outcome from Stroke SQU03_06 3 Outcome from Cardiac Arrest SQU03_07 3 Outcome from Stroke Outcome from Cardiac Arrest 100.0% 20.0% 90.0% 18.0% 80.0% 16.0% 70.0% 14.0% 60.0% 12.0% 50.0% 10.0% 8.0% 40.0% 6.0% 30.0% 4.0% 20.0% 2.0% 10.0% 0.0% 0.0% April May June July Aug Sept Oct Nov Dec Jan Feb Mar April May June July Aug Sept Oct Nov Dec Jan Feb Mar % of FAST positive stroke patients potentially eligible for stroke thrombolysis arriving at a hyper acute stroke centre Survival to discharge - Overall survival rate Survival to discharge - Ulstein Comparator Group survival rate April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD % of FAST positive stroke patients potentially eligible for stroke thrombolysis arriving at a hyper acute stroke centre 72.2% 72.2% Survival to discharge - Overall survival rate 6.3% 6.3% % of suspected stroke patients who receive an apprpriate care bundle 95.1% 95.1% Survival to discharge - Ulstein Comparator Group survival rate 18.2% 18.2% 3.23

54 Section 4 Workforce 4

55 Yorkshire Ambulance Service - Workforce Summary KPI Description Apr May Jun Jul Aug Sept Oct Nov Dec Jan Feb Mar Year End Forecast 1.1 Sickness / Absence % RED RED RED RED RED RED 1.1 Turnover % 1.1 PDR % AMBER AMBER AMBER AMBER AMBER 6 Statutory and Mandatory Training AMBER AMBER AMBER AMBER Commentary 4.1

56 Yorkshire Ambulance Service - Workforce Recruits & Leavers 1.1 Leavers 1.1 Recruits April May June July Aug Sept Oct Nov Dec Jan Feb Mar Chief Executive FTE ( ) Chief Executive FTE (Last Year) Clinical FTE ( ) Clinical FTE (Last Year) Finance FTE ( ) Finance FTE (Last Year) Workforce & Strategy FTE ( ) Human Resources FTE (Last Year) ICT FTE ( ) ICT FTE (Last Year) Operations A&E FTE ( ) Operations A&E FTE (Last Year) Operations PTS FTE ( ) Operations PTS FTE (Last Year) Standards & Compliance FTE ( ) Standards & Compliance FTE (Last Year) Total FTE ( ) Top Ten Reason April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD Total FTE (Last Year) Retirement Age Voluntary Resignation - Other/Not Known Dismissal - Capability Leavers April May June July Aug Sept Oct Nov Dec Jan Feb Mar End of Fixed Term Contract Chief Executive FTE ( ) Retirement - Ill Health Chief Executive FTE (Last Year) Voluntary Resignation - Relocation Clinical FTE ( ) Voluntary Resignation - Lack of Opportunities Clinical FTE (Last Year) Dismissal - Some Other Substantial Reason Finance FTE ( ) Death in Service Finance FTE (Last Year) Voluntary Early Retirement - no Actuarial Reduction Workforce & Strategy FTE ( ) Other Human Resources FTE (Last Year) ICT FTE ( ) ICT FTE (Last Year) Operations A&E FTE ( ) The category other is expanded below Operations A&E FTE (Last Year) Operations PTS FTE ( ) Voluntary Early Retirement - with Actuarial Reduction 5.9 Operations PTS FTE (Last Year) Voluntary Resignation - Child Dependants 2 Standards & Compliance FTE ( ) Voluntary Resignation - Health 2 Standards & Compliance FTE (Last Year) Voluntary Resignation - Other Public Sector 2 Total FTE ( ) Voluntary Resignation - Work Life Balance 1 Total FTE (Last Year) Other Dismissal - Some Other Substantial Reason Voluntary Resignation - Relocation Reasons for leaving - YTD Retirement Age Dismissal - Capability End of Fixed Term Contract Voluntary Resignation - Other/Not Known 4.2

57 Yorkshire Ambulance Service - Workforce YTD PDR's 1.1 Statutory and Mandatory Training (Workbooks) MTD AMBER 6 YTD MTD Directorate April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD Directorate April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD Chief Executive 15% 7% 0% 0% 45% Chief Executive 54% 55% 42% 42% 45% Clinical 83% 50% 56% 52% 64% Clinical 96% 96% 93% 93% 92% Finance & Performance 51% 54% 66% 79% 85% Finance & Performance 71% 70% 76% 85% 86% Workforce & Strategy 66% 67% 74% 82% 87% Workforce & Strategy 89% 86% 91% 93% 91% Operations 43% 43% 43% 47% 49% Operations 78% 79% 82% 87% 87% Standards & Compliance 36% 31% 43% 36% 50% Standards & Compliance 88% 92% 97% 95% 92% Overall Trust PDR compliancy for August is 52.6%. PDR compliance statistics have improved moderately in August across all Directorates, further work is required urgently to ensure that there is an exponential increase in the ratio of completions compared to the volume of PDR s that are expiring (over 12 months since last PDR) Workbook compliance statistics have improved slightly in August across all Directorates however the percentage increase needs to be higher to ensure compliance by December 11. The completion rates for the 2011/2012 Workbook sent out to staff in May 2011 are as follows: % Chief Exec 9.09 Clinical Finance & Performance Workforce & Strategy Operations Standards & Compliance

58 Yorkshire Ambulance Service - Workforce YTD Short/Long Term Absence 1.1 RED Reason for Absence 1.1 MTD RED 8.00% 7.00% 6.00% Absence (ESR) S18 Blood S17 Benign and malignant tumours, disorders, 2.9% cancers, 3.0% S16 Headache / migraine, 3.9% S15 Chest & respiratory problems, 6.1% Reason for Absence - YTD (Top 10 Reasons) S19 Heart, cardiac & circulatory problems, 2.5% S10 Anxiety/stress/depression/other psychiatric illnesses, 25.1% 5.00% 4.00% S14 Asthma, 7.7% 3.00% S13 Cold, Cough, Flu - Influenza, 9.0% S12 Other musculoskeletal problems, 9.1% S11 Back Problems, 11.0% 2.00% 1.00% Reason April May June July Aug Sept Oct Nov Dec Jan Feb Mar YTD 0.00% S10 Anxiety/stress/depression/other psychiatric illnesses 14.4% 13.1% 9.5% 10.5% 11.1% 25.1% April May June July Aug Sept Oct Nov Dec Jan Feb Mar S11 Back Problems 10.1% 9.2% 7.7% 10.2% 11.7% 11.0% Long Term (This Year) Short Term (This Year) Target Last Year Total S12 Other musculoskeletal problems 22.3% 24.9% 26.8% 22.3% 22.2% 9.1% S13 Cold, Cough, Flu - Influenza 2.8% 2.1% 2.0% 2.3% 2.0% 9.0% S14 Asthma 0.0% 0.0% 0.0% 0.2% 0.1% 7.7% April May June July Aug Sept Oct Nov Dec Jan Feb Mar S15 Chest & respiratory problems 4.3% 5.1% 4.4% 3.5% 3.6% 6.1% Target 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% 4.00% S16 Headache / migraine 1.5% 1.3% 2.1% 2.8% 2.5% 3.9% Long Term (This Year) 3.24% 3.18% 3.17% 3.66% 3.80% S17 Benign and malignant tumours, cancers 0.7% 0.7% 0.7% 0.6% 1.0% 3.0% Short Term (This Year) 2.04% 1.75% 1.81% 1.90% 1.76% S18 Blood disorders 0.3% 0.3% 0.4% 0.8% 1.4% 2.9% This Year Total 5.28% 4.93% 4.98% 5.56% 5.69% S19 Heart, cardiac & circulatory problems 5.7% 5.6% 3.8% 2.4% 2.3% 2.5% Last Year Total 5.50% 5.31% 5.15% 5.36% 5.76% 5.44% 5.61% 5.93% 6.92% 6.97% 5.77% 5.54% S20 Burns, poisoning, frostbite, hypothermia 0.0% 0.0% 0.0% 0.0% 0.2% 2.3% S21 Ear, nose, throat (ENT) 4.0% 3.4% 2.4% 2.3% 2.1% 2.2% S22 Dental and oral problems 0.6% 0.7% 0.4% 1.1% 0.3% 2.1% S23 Eye problems 1.3% 0.4% 1.3% 0.4% 0.3% 2.1% S24 Endocrine / glandular problems 0.0% 0.0% 0.0% 0.0% 0.0% 1.8% S25 Gastrointestinal problems 10.7% 9.9% 9.6% 10.0% 8.6% 1.5% S26 Genitourinary & gynaecological disorders 2.5% 2.6% 2.6% 3.1% 1.6% 1.4% S27 Infectious diseases 0.0% 0.0% 0.1% 1.1% 0.9% 1.3% S28 Injury, fracture 0.0% 0.0% 0.0% 1.3% 2.8% 1.3% S29 Nervous system disorders 1.3% 1.4% 1.8% 1.5% 1.1% 0.8% S30 Pregnancy related disorders 0.8% 0.8% 0.8% 0.8% 0.8% 0.7% S31 Skin disorders 0.3% 0.2% 1.1% 0.8% 0.8% 0.7% S32 Substance abuse 0.0% 0.0% 0.0% 0.0% 0.5% 0.7% S98 Other known causes - not elsewhere classified 1.9% 2.3% 5.1% 8.0% 11.2% 0.5% S99 Unknown causes / Not specified 14.7% 16.2% 17.6% 14.2% 11.2% 0.3% 4.4

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