Cover - Integrated Performance Report

Meeting:

 Public Board

Date:

 08.11.2023

Report Title:

 Integrated Performance Report

Agenda Item:

 2.1

Author:

Executive Leadership Team 

Lead Director:

 Emma de Carteret, Director of Corporate Affairs and Performance

X

SR1b: If we do not ensure our leaders are developed and equipped, there is a risk that we will not be able to change our culture, and value, support, develop and grow our people

X 

SR2: If we do not deliver operational and clinical standards then there is a risk of poor patient outcomes and experience

X 

SR3: If we do not ensure we have the ability to plan, influence and deliver across our systems to secure change, we will not be able to meet the needs of our public and communities

X 

SR4: If we do not resolve long standing organisational inefficiencies we will be unable to deliver an effective, sustainable, value for money service to our public

X 

SR5: If we do not clearly define our strategic plans we will not have the agility to deliver the suite of improvements needed

X 

SR6: If we do not deliver sustainable regulatory compliance and develop positive relationships, we will have limited ability to deliver our strategy

Equality Impact Assessment

No negative impact identified

 X

Recommendation:

 Note the areas of improvement and decline and seek assurance on plans to improve

Previously considered by:

 Executive Leadership Team

Purpose

The purpose of this paper is to provide the Integrated Performance Report with August 2023 data. The paper enables the Board to:

Discuss the performance areas identified and the actions offered to gain assurance or sufficient oversight.

Executive Summary

The Integrated Performance Report (IPR) this month comprises of September 2023 data across the key areas of the Trust.

Sustainability metrics are now included in the IPR going forward. Targets for these metrics will be developed in the coming months, where they are available and appropriate.

The overall picture of performance continues to show a positive and sustainable change in many areas over the last 12 months.  However, the Trust recognises there is more opportunity to improve.  This additional performance improvement will be delivered through continuous improvement at a local level, and the Trusts planned key transformation programmes. 

In this period, the Trust has reintroduced accountability forums to support sectors to deliver sustained performance and improve in areas that are not performing as well as they could. The new approach to these forums is led by sector senior leaders, is supportive, collaborative and positively challenging. They provide the right environment for appropriate conversations to share learning from sector interventions and discuss opportunities and ideas for improvement.

Key positives in month are as follows:

• New sustainability metrics are now developed. Targets will be developed to give a clearer picture of where performance is against expectations, where appropriate.
• People metrics continue to show a sustainable and improved position in most areas. Vacancy rates are reducing incrementally, and in September establishment whole time equivalents (WTE) increased by 156 WTE. Alongside this staff turnover rates have sustained improvements from 13.48% in February 2023 to 10.44% in September 2023, better than target.
• Deep dives into Access to the Stack has shown its initial success with 23000 calls transferred to system partners since December 2022, with a 55% acceptance rate. It has identified further opportunities to increase call handover.
• C1 and C2 response times remain special cause for improvement, as does C2 on scene times. C1 on scene times conveyed and non-conveyed have moved out of special cause improvement, into common cause.
• Hear and treat increased slightly in September from 8.74% to 8.91%.
• Employee relation live cases and number of staff on suspension also continue to show a sustainable improvement from interventions since January 2023.
• Sickness performance has increased slightly and remains special cause for improvement.
• Call pick-up and call answer times remain sustainable and improved, however rising call volumes and upcoming winter pressures will likely impact performance in coming months.
• Concerns per 10000 patients decreased significantly in September moving out of special cause concern and demonstrating new staff resource is having a positive impact.
• Mandatory training compliance is performing above the Trust target of 85% at 90%.
• The number of staff declaring disability and the percentage of BME staff continues to increase alongside initiatives to improve our approach to inclusivity and enhance staff networks.
• Safeguarding training continues to perform well, despite a dip in level 1 adults and children to 87%, the sustained performance improvements in both Level 1 and Level 2 continues.
• Clinical training compliance (Resus) training interventions are working to increase performance from 49% to 75% in a three-month period. These interventions should maintain an upwards trajectory.

Key areas of concern:

• Vehicle Off Road performance remains below expectations, however action plans for performance improvement are in place with regular oversight by Trust leaders.
• Despite further positive delivery against QCIP targets in the last month, the Trust remains off target against expectations.
• PAS expenditure continues to be above target.
• Staff vacancy rates remain in special cause for concern, however the trend is moving in the right direction.
• C2 incident demand has risen for four consecutive months. C3 and C4 incident demand continues to show special cause for concern. However, in both cases September has experienced a significant reduction.
• Patient Facing Staff Hours remain at minimum floor standard for September.
• Trust station and uniform Infection Prevention and Control performance continues to be special cause for concern.
• Volunteer hours remain below the mean and have decreased in September.
• Appraisal percentages remain in special cause concern with a downward trajectory. Interventions through all areas of the Trust are being put in place to rectify this trend.

In the executive summary slide, the executive team have identified nine critical underlying issues, that impact across multiple measures and therefore our ability to deliver on the organisational objectives. These are as follows:

1. Recruitment and training capacity to support the expedited workforce plan
2. Leadership capacity and capability both in terms of delivery against role and the associated impact upon culture
3. The challenge associated with efficiency and improvement delivery
4. Risk to delivery of compliance with clinical training whilst balancing the need to maximise patient facing staff hours
5. The impact of multiple external factors, in particular handover delays, has upon our ability to deliver a safe service
6. Lack of oversight of critical compliance and priority improvement areas – risk of de-railment
7. Culture across the organisation – inappropriate behaviour and lack of values-based behaviour
8. Issues with fleet availability impacting operational delivery
9. Impact of time to lead implementation on BAU function whilst consultation and progression of the programme takes place

Note the areas of progress.

Consider critical issue areas highlighted to gain assurance on the plans for mitigation