MEETING OF THE EAST OF ENGLAND AMBULANCE · PDF fileTo Approve the minutes of the previous...

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MEETING OF THE EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST BOARD (PUBLIC SESSION)

TO BE HELD ON WEDNESDAY 25 JANUARY 2017 AT 13.30, GROUND FLOOR MEETING ROOM, TRUST HQ, MELBOURN STATION, WHITING LANE,

OFF BACK LANE, MELBOURN, CAMBRIDGESHIRE SG8 6EN

AGENDA: PUBLIC SESSION (Disclosable)

ITEM SUBJECT REPORT TIMINGS

1. Welcome and Board Membership Verbal: Trust Chair

2. Apologies for Absence

Verbal: Trust Chair

3. Declarations of Interest To receive any new or amended declarations of interest from Board Members

Verbal: Board Members

4. Minutes To Approve the minutes of the previous meeting (public session) held on 30 November 2016

Herewith: Trust Chair

5. Matters Arising Not Addressed Elsewhere on the Agenda To consider the action checklist arising from previous minutes

Herewith: Trust Chair

6. i) Chair’s Report ii) Chief Executive’s Report To receive and note

Herewith: Trust Chair Herewith: Chief Executive

QUALITY GOVERNANCE

7. Patient Experience/Story: PTS

Herewith: Director of Nursing and Clinical Quality

PERFORMANCE MONITORING

8. Integrated Performance Report Herewith: Executive Team

i) Finance Report – Month 09, December 2016

Herewith: Director of Finance & Commissioning

. ii) Report from the Chair of Quality Governance Committee, 10 January 2017

Herewith: Chair of QGC

iii) Report from Chair of Performance and Finance Committee, a) 7 December 2016 and b) 11 January 2017

Herewith: Chair of P&FC

iv) Report from Chair of the Audit Committee, 7 December 2016

Herewith: Chair of AC

v) Report from Chair of Remuneration Committee, 10 January 2017

Herewith: Chair of RemCom

STRATEGY AND BUSINESS PLANNING

9. Strategic Priorities / Strategy on a Page Herewith: Director of Strategy and Sustainability

10. International Recruitment Herewith: Director of People and Culture

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GOVERNANCE 11. Cultural Audit Update Herewith: Director of People and

Culture

12. Board Assurance Framework Herewith: Director of Nursing and Clinical Quality

SERVICE IMPROVEMENTS/ PROJECTS

13. TUG presentation Herewith: TUG members

OTHER MATTERS

14. Items Referred to/from Other Committees Verbal: Trust Chair

15. Key Messages and Risks Identified Verbal: Trust Chair

16. Any Other Urgent Business To consider any other matters which, in the opinion of the Chair, should be considered by reason of special circumstance as a matter of urgency

Verbal: Trust Chair

17. Date of Next Meeting: 29 March 2017 Venue: Trust HQ, Melbourn

Verbal: Trust Chair

Copies of the reports and other relevant papers are available for public inspection on the Trust’s Internet site: www.eastamb.nhs.uk. If you are unable to attend the public session, but would like to raise any issues regarding the Trust, you can write to the Trust Secretary, East of England Ambulance Service NHS Trust, Ambulance Headquarter, Whiting Way, Melbourn. Cambridgeshire SG8 6EN

http://www.eastamb.nhs.uk/

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East of England Ambulance Service NHS Trust Page 1 of 8 Minutes of Trust Board (Public Session)

30th November 2016

UNCONFIRMED (Disclosable)

MINUTES OF THE EAST OF ENGLAND AMBULANCE SERVICE NHS TRUST BOARD MEETING (PUBLIC SESSION) HELD ON WEDNESDAY 30 NOVEMBER 2016 AT 13:30 AT

GROUND FLOOR MEETING ROOOM, TRUST HQ, WHITING WAY, OFF BACK LANE, MELBOURN, CAMBRIDGESHIRE SG8 6NA

Present:

Mrs Sarah Boulton Ms Valerie Morton Mr Peter Kara Mrs Sheila Childerhouse Mr Tony McLean Mr Dean Parker Dr Mark Patten Mr Andrew Egerton-Smith Mr Robert Morton Ms Lindsey Stafford-Scott Mr Kevin Brown Mr Wayne Bartlett-Syree Mr Kevin Smith Mr Sandy Brown

Non-Executive Director (Chair of Trust) Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Non-Executive Director Medical Director Associate Non-Executive Director Chief Executive Officer Director of People and Culture Director of Service Delivery Director of Strategy and Sustainability Director of Finance and Commissioning Director of Nursing and Clinical Quality

In Attendance: Mrs Laila Abraham Mr Aaron Taylor Members of Staff Members of the Public

Trust Secretary Interim Committees Secretary (minute-taker)

PUBLIC SESSION (Disclosable)

P266/16 WELCOME Mrs Sarah Boulton welcomed everyone. She reported that Mr. Keith Marshall, a well-known and popular member of the Trust User Group and a CFR, had recently died. A minute’s silent reflection was observed to commemorate him.

P267/16 APOLOGIES FOR ABSENCE

Mrs Laila Abraham confirmed that all members of the Board were present.

P268/16 DECLARATIONS OF INTEREST

There were no new declarations of interest.

P269/16 MINUTES OF THE MEETING HELD ON 28 SEPTEMBER 2016

(i) Mrs Sarah Boulton requested that in the fourth paragraph on page 3, ‘individuals’ be changed to ‘the system’.

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(ii)

On page 7, third paragraph, “by c. 0.5% for red activity” ought to read “to c. 0.5% for red activity”. The minutes as amended were agreed as an accurate record of the meeting.

P270/16 MATTERS ARISING Action Checklist from the Previous Minutes

Item P251/16 – (Accuracy of Profession Update figures). Miss Stafford-Scott advised that the Profession Update figures shown in the Integrated Performance Report were incorrect, and explained that this was as a result of a corrupt formula. This had now been rectified.

Item P253/16 - (Discussion of charitable funds). Mrs. Sarah Boulton said that the discussion as to how best to utilise the charitable funds be would be on the agenda for a future Board Development Session. Item 259/16 – (Publication of CQC documents). Mrs. Sarah Boulton advised that the CQC Report and the minutes from the CQC Quality Summit were available to view through the Trust’s website. General. Mrs. Boulton said that all other Matters Arising from previous meetings had been completed. She then asked whether anybody present had any questions; none were forthcoming.

P271/16 CHAIR AND CHIEF EXECUTIVE’S REPORT

Trust Chair’s Report

The Directors noted the Chair’s Report, contained in the Board Pack.

Mrs. Sarah Boulton advised the Board that in the time since she had written the Report, she had attended a meeting of the All-Party Parliamentary Group of Air Ambulances. She said that the Group had a real sense that the three Air Ambulance charities were working together in a very positive and collaborative way. Mrs. Boulton also congratulated staff of the Trust who had won awards recently, including:

i.) Tara Rose – shortlisted for the ‘Emerging Leader Award’ at the Health Education East Leadership Awards; and

ii.) Navrita Atwal – won the ‘Inclusive Leader Award’ at the Health Education East Leadership Awards.

Chief Executive’s Report The Directors noted the Chief Executive’s Report, contained in the Board Pack. Mr. Robert Morton advised that in the time since he had written the Report, the situation regarding the level of funding for the Trust for 2017-2019 had changed. He had met with the Commissioners on 24 November 2016 and a further meeting would be held shortly to see an agreement could be reached. In the event that this did not happen, a paper must be submitted for mediation by 5 December 2016. He further advised that he had met the previous day with representatives from NHS Improvement, NHS England, and the 17 local Accident & Emergency boards to develop a protocol to safeguard Red Category patients from handover delays. The Board noted that there had been a trend towards a rise in complaints about PTS. Mr.

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Morton explained that some specific matters had been identified, and measures to mitigate these would be implemented by 15 December 2016. It was noted that Mr. Morton would attend a meeting with the Trust User Group on general communication matters and ways in which better integration could be achieved given the wide geographical area covered by the Trust. The TUG would present proposals and ideas at this meeting, to be held in January 2017. Mr. Morton said that since writing the Report, he had met with the Lead Commissioner and NHSI and therefore the meeting referred to in the Report would now be delayed. Mr. McLean highlighted the reference in the Report to correspondence with the Commissioner, and asked that this be circulated to the Board. Mr. McLean further requested that the Trust’s Quality Governance Committee be with any developments regarding PTS, and this was also agreed. Action: Mr Robert Morton to circulate the correspondence with the Commissioner to Board members. Action: Update to be provided by Mr Sandy Brown to the QGC in relation to developments regarding PTS. Mr. Egerton-Smith asked what measures could be taken to expand 111 contact without reducing quality. Mr. Robert Morton explained that the Trust was in competition with the private sector and, in his opinion, it might be beneficial to strengthen the team to improve medicine management. Also, Mr. Morton pointed out that the Trust operated with a different cost model to the private sector. Mr. Egerton-Smith suggested that it was hard to see how the Trust could compete for 111 contracts while maintaining the same level of quality, to which Mr. Morton replied that a suitable approach might be to identify contracts which were failing to meet KPIs, and to then emphasise that the Trust provides a high level of quality, and that the contract is not solely based on cost. The Trust Board noted the report.

P272/16 PATIENT EXPERIENCE/ STORY

Dr. Mark Patten advised the Board that Mr. Oki, the subject of the Patient Experience Report, was unable to be present for medical reasons. He explained that the story of this patient’s experience had been chosen as it brought to the fore a number of current issues. Mr. Patten explained that most stations now carry out three dialysis procedures per day, and it was therefore time-critical that PTS transport Mr. Oki to the station in good time, to avoid knock-on effects. While Mr. Oki had encountered some issues with PTS, overall he and his wife were happy with the service provided. Dr. Patten invited any questions. Mr. Tony McLean said that he was pleased to see positive comments, particularly in light of the background of rising complaints about PTS. Mrs. Sarah Boulton advised that she personally had sight of all complaints, and that the majority of these were around punctuality issues. Mr. McLean said that contracts were based on usage, and that actual activities were often significantly higher than contracted for. In his opinion, part of the issue was that what CCG have allowed for may not be sufficient for what is actually required. Mr. Sandy Brown advised the Board that when a new contract was put in place, a spike in complaints was usual, while the terms of the contract bedded in. Also, he explained that PTS staff were often on lower pay-bandings and that this had caused some recruitment issues.

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Another issue that Mr. Brown highlighted was communication around managing the expectations of patients; quite often they expected to be collected immediately from the renal unit and dislike having to wait, while the Trust has a two-hour tolerance on patient collection. The Board noted that there were also some issues with difficulties in contacting the booking centre to get more information. Mr. Sandy Brown advised that work with PTS was ongoing in this area, and that an escalation meeting was scheduled for later in the week to discuss this further. Dr. Mark Patten stated that there was a current trend for dialysis units to be removed from hospitals to stand-alone sites with no real consideration given to travel times. Mrs. Sarah Boulton agreed that this was an issue, and that it was important that the Trust should ensure that its voice was heard. Mr. Robert Morton said that there had been complaints about the new eligibility criteria for using PTS which had been put in place by the CCGs; patients incorrectly assumed that the changes had been made by ambulance staff. Many patients who have used PTS for years were now struggling to understand why they were being screened for eligibility. Mr. Morton advised that he had recently been out with staff in Huntingdon and he had been struck by the compassion of frontline staff, observing that they took the time needed to deal with elderly patients in a caring manner, but this unfortunately impacted negatively on journey times. He said that it is important to ensure that the CCGs see the patients as people rather than just ‘jobs’. The Trust Board noted the report.

P273/16 NEW CLINICAL PHONE APP Mrs. Sarah Boulton informed the Board that the purpose of the presentation was to showcase

the new Clinical Manual app for mobile devices. She then introduced Lewis Andrews and Tracy Nicholls to present to the Board. Ms Nicholls explained that the idea for the new app originated from staff feedback., It was developed to support clinical staff and to share the existing clinical manual and other relevant documents in a more convenient way to paper, which was felt to be quite cumbersome. Mr. Andrews explained that the team had worked with Class Publishing since January 2016 to develop the app, and over 50 staff had been involved during the development process which had involved live trials with the developer and end user. The outcome was successful, and the content had been brought by other businesses and organisations, including Qatar and St. John’s Ambulance. Mr. Andrews told the Board that although the app provided staff and volunteers with a means by which they could refresh their knowledge, it was not to be used as an initial training manual. The app also included live clinical notices, and was therefore another tool that could be used to disseminate these notices. He stated that over 1,500 patient-facing staff had logged into the app, which represented a very high take-up rate. Mr. Andrews said that the Trust was the first trust to have developed such a tool, and that the app was truly pioneering. It allowed access to information 24/7 to staff, without them having to carry the paper manual and that it was dual-use, including both the local manual and national guidelines. Further, there was an opportunity to build on the current model, possibly by issuing a personal tablet device to relevant staff. Mr. Robert Morton thanked Mr. Andrews and Ms. Nicholls, and said that the app was very exciting and offered chances for progress. Mrs. Childerhouse said that it was important that intellectual property should be robustly managed; it was important to share the information, but also to control the process. She agreed with Mr. Morton that the app was truly innovative and said that she would not be

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surprised if it won awards in the future. Mr. Sandy Brown congratulated the team behind the development of the app, and said that the Trust should focus on realising the potential that the app offered to further improve patient care. Mr. Tony McLean agreed, saying that following the launch of the app, there had been a real desire among staff to be involved with it, and that this momentum could be built upon

P274/16 DEMENTIA STRATEGY Mrs. Sarah Boulton introduced Mr. Duncan Moore to give a presentation to the Board.

He provided the Board with some statistics, advising that 80,000 people in the area covered by the Trust had been diagnosed with dementia, and that with an ageing population, this would only increase. To demonstrate this, on the Sunday prior to the meeting there had been 3,372 incidents for the Trust, 1,343 of which related to those over the age of 65 and 12 over the age of 100, compared to the same Sunday in 2007, of which 565 of 2125 incidents related to those aged over 65 and only 4 to those aged over 100. The Board noted that care for dementia sufferers should be community-based; such patients were extremely vulnerable and the Trust should aim to integrate its role with other statutory bodies and also with volunteers and carers who have contact with the patient. The Trust had shared its strategy with other bodies at a national level, to develop the strategy and try to enhance a consistent approach. It was agreed that in dealing with dementia sufferers, it was vital to adopt a person-focused, rather than a task-focused, approach. The presentation highlighted the need to develop the workforce, and particularly the importance of modernising approaches to communicating with relevant sectors of the workforce. It was noted that a ‘Dementia Lead’ would be appointed to both emphasise the importance of awareness of dementia, and to drive forward developments such as modifications to the Fleet in future purchases to accommodate as best as possible the needs of patients suffering from dementia. Mr. Robert Morton said that it was becoming increasingly apparent that the Commissioners were seeking to treat people in their own homes with dignity, rather than having a default position of taking people to hospital. Mr. Duncan agreed that this was a strategy that could be developed and that he was actively engaged on an ongoing basis with the Alzheimer’s Society, which approved of this approach. He noted that 25% of hospital beds were occupied by patients with dementia, many of whom presented with symptoms that would not require them to remain in hospital if they were not suffering from dementia. In terms of cost it would be cheaper to support these patients with domiciliary care, and in terms of their health, there was significant evidence that being hospitalised is detrimental to such patients. Mrs. Valerie Morton said that the fact that the Trust had such a Dementia Strategy was very reassuring. She told the Board of her first-hand experience of having been in an acute care hospital when a patient with dementia was admitted, and had not been treated with the appropriate level of care for the condition. She had expressed her thoughts to the hospital, and found that they also had a ‘Dementia Strategy’ in place. Mrs. Morton emphasised the need to ensure that the strategy was in fact being put into effect in day-to-day practice, and queried how this would be evaluated. Mr. Duncan said that engaging with dementia sufferers is more difficult than with other patients, by virtue of their condition. He advised that ideally, post-event, feedback should be

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sought in person rather than by sending out paperwork but that this was not always possible. Mrs. Childerhouse suggested that staff could self-evaluate their interaction with the patient, which could serve to focus their minds on what went well and what could be improved. Mr. McLean said that he had had the opportunity to see many different strategies for dealing with dementia and that in his opinion this was one of the best. He asked whether consideration had been given to appointing ‘Dementia Champions’ for the stations. Mr. Duncan replied that the Alzheimer’s Society will be giving training to staff and that some locality-based ‘Dementia Champions’ would be appointed. The Trust Board received the presentation.

P275/16 INTEGRATED PERFORMANCE REPORT Mr. Sandy Brown introduced the Integrated Performance Report, which was taken as read.

He highlighted the reduction in the number of SIs, with the type of SIs remaining similar to previous periods, and the positive trend in the Ambulance Quality Indicators. He asked if Board members had any questions. Mrs. Valerie Morton asked for information on HealthAssure. Mr. Sandy Brown replied that at present there were a whole series of work streams focused on quality, which would be integrated to give a fuller picture, so he would be better-placed to inform Mrs. Morton at the next meeting. Mr. McLean agreed that HealthAssure was a big issue. The Trust must ensure that it could demonstrate that information was recorded accurately and in a timely manner. He acknowledged that there had been issues around PCR compliance with details not always being fully recorded, but that the Operations Team are working to rectify this. Mr. McLean noted the real successes over the past couple of years in the recording of SIs, and that there had been a great deal of progress in medicine management. He suggested that the Trust should apply the same level of management to PTS complaints as was given to complaints regarding emergency care vehicles. Mr. Peter Kara asked what the situation was regarding progress with ePCR. Mr. Bartlett-Syree replied that this was significantly behind schedule.. The delays had largely been caused by technical issues which had now been addressed, and ePCR would be rolled out in early 2017. The introduction would likely take a couple of months, depending on how fast the devices could be distributed to staff. Miss Stafford-Scott advised the Board that the downward trend in staff turnover had continued, and now was at around 9%. She further advised that sickness levels were still high, particularly at present with the usual seasonal upturn, but that efforts were being made to reduce this. In particular, support staff had low levels of sickness, at around 4%, which was encouraging. The split between long-term and short-term sickness was around 50:50. The carrying out of staff appraisals had slipped behind schedule because of the operational pressures on managers. Recruitment was encountering some difficulties but that substantial effort was underway to address this, and this would continue at least until the end of the financial year. Mr. Robert Morton said that the Commissioners are heavily focused on sickness levels; the Trust currently has the second-highest level in the country and he enquired as to whether other Trusts measure sickness levels in the same way. Miss Stafford-Scott said that she would raise this at the next national forum. Action: Miss Lindsey Stafford-Scott to ascertain whether other Trusts measure sickness levels in the same way as EEAST.

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Mr. Kevin Smith spoke about the finance section of the document. He told the Board that since the last meeting, an action plan had been agreed. He pointed out that the Trust had spent c. £9million on PAS and agency staff, but only half of this amount had been funded by the Commissioners. Also, the efforts to increase the ‘Hear and Treat’ system had necessitated a significant amount of overtime pay while additional staff were being recruited. The Board noted that the ultimate level of deficit was dependent upon the RAP achieved but there was likely to be a deficit of around £7.5million. Mr. Dean Parker said that with regards to the capital spend budget, only around £800,000 had been spent from the budget of £4.8m. However, some estate developments had been agreed but had yet to be undertaken; efforts were being made to push these through so in effect there was around £1million of the budgeted amount as yet unallocated. Mrs. Sarah Boulton said that to achieve income under the RAP, it was necessary to spend on Operations, and asked whether normal cost-cutting was being undertaken as far as possible. Mr. Kevin Smith said that it was, highlighting the £52million achieved in the past 5 years. He explained that his view was that the main cause of the deficit was that the increased spend on PAS and agency staff had not been properly funded by the CCGs. Mrs. Boulton said that the deficit would be discussed in detail at the upcoming meeting of the Performance & Finance Committee to ensure that the Trust is doing all that it can. Mrs. Boulton drew the attention of the Board to the Report from the Chairs of the Remuneration Committee and the Quality Governance Committee, which was taken as read. The Trust Board noted the report.

P276/16

BOARD ASSURANCE FRAMEWORK The Board considered the Board Assurance Framework. Mr. Robert Morton noted that the BAF was not dynamic in the movement of risk and, where risk had travelled, it was to the higher end of the spectrum. He queried whether all of the risks still existed, pointing out that with regard to SR2C the risk had not changed despite the great changes to the Trust’s leadership over the past couple of years. Mrs. Childerhouse agreed that some of the risks appeared to need revision. It was agreed that the workshop due to be held on Monday 5 December would consider the risks set out in the BAF and look at how best to streamline the report, given that some risks seemed to be obsolete, and others completely interdependent on one another.

P277/16

CULTURAL AUDIT REVIEW

Miss Stafford-Scott advised that matters were progressing on the Cultural Audit Review, although operational pressures had meant that finding sufficient resources to dedicate to this had been challenging. She explained that a set of reports had been produced, and that she had attended meetings with Unison on the Steering Group, and that these had been productive and had taken place in a co-operative manner. Miss Stafford-Scott explained that this exercise was not simply a survey, but was rather a comprehensive programme around Health & Wellbeing and that she would bring the results to the Board in January. Mrs. Boulton asked that in the January Board meeting evidence be included about the levels of staff engagement. Action: Miss Lindsey Stafford-Scott to provide a report on the results of the Cultural Audit Review, and include evidence of the levels of staff engagement.

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P278/16

EMERGENCY CARE TRIAGE CENTRE Mrs. Sarah Boulton introduced Dr Tom Davis and Ms Sandra Treacher, to give a presentation to the Board. A detailed slideshow was presented, with the Board members asking questions throughout. It was noted that CQUIN had been agreed in April although only signed in September, and that doctors should be in place in January 2017. Progress had been very good, with a new hub in Bedford, and the Board noted that some G2 cases in addition to G3 and G4 cases were being triaged.. The new centre was integrating very well with other areas of the Trust, and was also engaging externally, for instance with 111 providers. Levels of triage were noted to be already double the levels of January 2016 and, to meet the terms of the CQUIN, in place until March 2017, would continue to increase. Mrs. Valerie Morton said that in her opinion, the Triage Centre was providing patients with the care that they needed and avoided unnecessary ambulance journeys. However, she noted that there were similarities to the 111 service and queried whether people would use this service in place of 111, as it became more well-known. The presenters replied that patients chose individually how they accessed healthcare from a number of options, including 999, 111, GPs, A&E, although their selection was not necessarily the most appropriate for example there were patients who did not require face-to-face contact dialling 999. The purpose of the Triage service was to assist in relieving pressure on ambulances not a replacement for 111, and would be used accordingly, with the Board being advised that this was a bespoke element of healthcare in a 999 context. Mr. Sandy Brown said that there would be a change to patient perception when they come to realise that dialling 999 does not immediately result in an ambulance being sent. He asked what feedback had been received on this. Mr. Sandy Brown was advised that there would be an official launch, with a drive to raise awareness of how the service would work. Mr. Robert Morton said that the Ambulance Chief Executives’ Report had been very positive, and that triage was an integral part of the operating model that the Trust intended to develop. He suggested that the public did not want multiple points of contact, and that triage would assist with the flow of work between 999 and 111, and ensure that traffic was not all in one direction. The Trust Board received the presentation.

P279/16 DATE OF THE NEXT MEETING The next scheduled meeting will be on 25 January 2017.

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TRUST BOARD: ACTION CHECKLIST ARISING FROM PREVIOUS MINUTES TO BE CONSIDERED BY THE TRUST BOARD AT ITS MEETING (PUBLIC SESSION) TO BE HELD ON 25 JANUARY 2017

AGENDA ITEM: 5 (Disclosable) Key: red – new items arising at last meeting, black – outstanding items, grey – completed items

OUTSTANDING MATTERS FOR FUTURE CONSIDERATION FOLLOW UP ACTION FROM PREVIOUS MEETINGS

ACTION BY DEADLINE STATUS Meeting date

Min Ref Action

30 11 16 P277/16 Miss Lindsey Stafford-Scott to provide a report on the results of the Cultural Audit Review, and include evidence of the levels of staff engagement.

LSS Circulated to LSS: 10 01 17

30 11 16 P275/16 Miss Lindsey Stafford-Scott to ascertain whether other Trusts measure sickness levels in the same way as EEAST.

LSS Circulated to LSS: 10 01 17

30 11 16 P271/16 Update to be provided by Mr Sandy Brown to the QGC in relation to developments regarding PTS.

SB Mar-17 Circulated to AB: 10 01 17

253/ 16 Arrange for a discussion of charitable funds at a Board Development Session.

LA September 2017 To be arranged at a future date.

COMPLETED ITEMS

OUTSTANDING MATTERS FOR FUTURE CONSIDERATION FOLLOW UP ACTION FROM PREVIOUS MEETINGS

ACTION BY DEADLINE STATUS Meeting date

Min Ref Action

30 11 16

P271/16 Mr Robert Morton to circulate the correspondence with the Commissioner to Board members

RM

Mediation/arbitration paperwork circulated to Board colleagues. Completed.

Item 5.

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265/16 • Speak with Peter Blackman, Community First Responder (CFR), on how the Trust plans to better support CFRs

KB November 2016 Kevin Brown spoke to Peter Blackman on 14 October 2016 and addressed all of his concerns re. CFRs Completed

257/16 • Arrange for discussion of the NHSI Single Oversight Programme at a Board Development Session

LA November 2016 Completed on 26 October 2016

251/16 • Confirm the accuracy of the Professional Update (PU) totals in the Integrated Performance Report (IPR)

LSS November 2016 The was a corruption in the formula which has now been corrected. COMPLETE

255/ 16 • Arrange for discussion as to the progress of the Cultural Audit to be a standing item on the agenda for future meetings

LA November 2016 Complete

259/16 • Arrange for CQC report and minutes from the CQC Quality Summit to be published on the Trust website

RM November 2016 Complete

239/16 • Arrange review of the agendas for September board meetings by Executive Team

LA September 2016 Draft agendas for 28 Sept 2016 were sent out to executive team for review COMPLETE

234/16 • a) review the role of face-to-face communications in the Tools and Methods section of the Communications Strategy and generally in the Strategy

• b) identify in the Communications Strategy the impact of any delays caused by Regulators

CH

CH

September 2016

September 2016

a) The relevant section has been updated to include face-to-face messaging and the strategy amended. COMPLETE

b) The audience section has been updated to take this into account. COMPLETE

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233/16 • a) Recognise disagreements between different Regulators as a Risk in SR1 of the BAF

• b) Review the risk rating in the BAF in respect of the Trust’s failure to deliver financial targets.

• c) Arrange a virtual board meeting before the September board if required because the RAP has not been agreed.

AB/ Emma De Carteret (EdC)

KS

SB/LA

September 2016

September 2016

Before 28/09/16

b) This has been completed & reflected in the latest version of the BAF. COMPLETE

COMPLETE

231/16 • a) Arrange for PFC to investigate the growth in Red Calls attended and monitor the trend.

• b) Ensure the Patient Transport Service information in the Integrated Performance Report shows the percentage of patients arriving any time prior to appointment (as well as showing as combined information those that arrive any time prior to appointment and within 30 minutes of appointment time)

• c) Include information on high performing areas or areas of concern in the Statutory/Mandatory Training information section of the Integrated Performance Report

LA

KB

KB

September 2016

September 2016

September 2016

The action was added to the September agenda for PFC for inclusion in the Operational Performance Report. COMPLETE. The requested information is now contained in the report. COMPLETE. There is currently no training being undertaken due to the high student abstractions rates, however, the A&E area is above 80% compliance on the 18 month rolling programme for PU with programme due to start again in October. High performing areas are Essex and Cambridgeshire, there are no areas of concern at this time. Full information will be contained within the IPR going forwards. COMPLETE

213/16 Revise the SFI document to require additional Board approval for charity sign-off amounts in excess of £25K.

LA June 2016 Updated the SFI document and the approved version is on the Trust website COMPLETE

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211/16 a) incorporate the potential UNISON industrial action into the BAF as a potential risk, and b) review medicines management risks and transfer to the remit of the ELB.

AB July 2016 the BAF would be considered later in this meeting and b) the review of medicines management risks had been transferred to the remit of the Executive Leadership Board (ELB). COMPLETE

209/16 Ensure that student abstraction level reports are routinely presented at future Performance and Finance Committee meetings. Arrange for the IPR to be reviewed at ELB to ensure that sufficient contextual narrative and background explanation is included. Mr Sandy Brown to ensure that there is sufficient quality assurance on the report.

RA/LA LA/AB

Sept 2016 July 2016

Next P&F meeting is in September when this report will be presented COMPLETE ELB reviewed and updated the IPR for June 2016 COMPLETE

158/16 • Review of the finance report regarding detail of content required for Board.

• To be reviewed with Executives.

KS March 2016 Mr Kevin Smith said that the Finance Report review would be picked up as part of the Board development programme. He said that the action should remain in place until the Board development work is complete. Complete

138/15 RA to complete a deep dive on disciplinary and

dignity at work cases in Essex to identify themes and future learning

RA July 2016 Mr Rob Ashford reported that in the period January 2015 to May 2016 the main disciplinary themes have been around staff attitude and behaviour. However, a more detailed report will be produced for a later meeting. Complete

173/16 • Ms Ruth McAll to produce a staff

turnover and retention issues report for presentation at the Performance and Finance Committee.

RMc May 2016 Mr Peter Kara confirmed that a staff turnover and retention report had been presented at the Performance and Finance Committee. COMPLETE

159/16 • Business Continuity Policy to return in 2 months with confirmation of whether it is for decision or information.

LA April 2016 COMPLETE The Business Continuity Manager has confirmed that this item was for decision, i.e. approval by the Board.

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157/16 • Amendments to the Integrated Board Report as detailed in the minutes

AB/KE/LA March 2016 COMPLETE Comments were incorporated in the IBPR.

155/16 • Review of the Flu vaccination campaigns from other Trusts which achieve greater compliance.

• To be reviewed at the Infection Prevention Committee and reported to the Quality Governance Committee.

AB June 2016 Mr Sandy Brown said that this action has been discharged to the Infection Prevention and Control Group, and will be monitored via the Quality Governance Committee. COMPLETE

154/16 • Deep dive on PTS through the Quality Governance Committee and issues arising to be addressed.

. • To investigate in particular the process of

booking transport and the time taken to answer the phone

TN September 2016 Mr Sandy Brown pointed out that this action should be in his name rather than Tracy Nicholls’. He said that a PTS deep-dive will be conducted in conjunction with other review work, and reported back via the ELB. COMPLETE.

151/16 Mr Brown to present the findings of a deep dive completed by the risk team following an increase in tail breaches. This will be reported at the next meeting on the 24th of February 2016. This report has already been presented to the Quality Governance Committee

AB February 2016 Included on March Agenda. COMPLETE

157/16 • Amendments to the Integrated Board Report as detailed in the minutes

AB/KE/LA March 2016 COMPLETE Comments were incorporated in the IBPR.

155/16 • Review of the Flu vaccination campaigns from other Trusts which achieve greater compliance.

• To be reviewed at the Infection Prevention Committee and reported to the Quality Governance Committee.

AB June 2016 Mr Sandy Brown said that this action has been discharged to the Infection Prevention and Control Group, and will be monitored via the Quality Governance Committee. COMPLETE

Item 5.

Page 6 of 7

154/16 • Deep dive on PTS through the Quality Governance Committee and issues arising to be addressed.

. • To investigate in particular the process of

booking transport and the time taken to answer the phone

TN September 2016 Mr Sandy Brown pointed out that this action should be in his name rather than Tracy Nicholls’. He said that a PTS deep-dive will be conducted in conjunction with other review work, and reported back via the ELB. COMPLETE.

151/16 Mr Brown to present the findings of a deep dive completed by the risk team following an increase in tail breaches. This will be reported at the next meeting on the 24th of February 2016. This report has already been presented to the Quality Governance Committee

AB February 2016 Included on March Agenda. COMPLETE

120/15 AB to circulate Board Assurance Framework updates to the Board members

AB COMPLETE

85/15

LA to ensure that reports and documents for information are sent electronically and not printed in future.

L Abraham COMPLETE

38/15 Draft Annual Plan, Annual Budget and Capital Expenditure

• Mr Smith to ensure that the confirmed key priorities are fully reflected in the final version of the annual plans.

K Smith 28.05.15 COMPLETE

45/15 Trust Board 2015/16 Agenda Plan • Mrs Abraham to ensure that the Trust

Board Plans align with the committee plans and to add in the Performance and Finance committee back into the agenda plan.

L Abraham 28.05.15 COMPLETED– Went to the Performance and Finance Committee on the 9th of September

Item 5.

Page 7 of 7

46/15 HR Policies • Ms McAll/Mrs Abraham to circulate a

complete list of all policies pertaining to the Trust along with the review dates and persons responsible.

• Ms McAll to reform a Policy Committee to ensure that all Policies requiring sign off are reviewed within the correct timeframes, these will then go to an appropriate sub-committee of the Board and then the Board for ratification.

R McAll/L Abraham

28 05 15 COMPLETE

48/15 Hard Truths report • Ms Boulton to arrange a full Board

Discussion at the next Board Development session on the Mid Staffordshire Public Enquiry and what actions need to be embedded into this organisation.

S Boulton Next Board Development Day

COMPLETE

52/15 Questions from the Public • Dr Marsh and Mr Brown to look into the

circumstances of the incident reported at Board through the Patient Story and ascertain what the factors were leading to the delay in attendance.

• Mr Ashford to contact Mr P Blackman regarding assistance with the hospital delay issues in Essex.

A Marsh/S Brown

R Ashford

28.05.15

28.05.15

COMPLETE

101/14 Workforce Performance • Detailed report on sickness levels to be

provided at next meeting.

K Barry

26.11.14

COMPLETE

Item 6i

Page 1 of 2

Report Title: Chair’s Report

Report Author(s): Sarah Boulton Chair

Sponsoring Director:

Purpose:

Decision Assurance For Information Disclosable X X Non-Disclosable

Executive Summary:

This paper updates the board on

• EEAST events • Governance and assurance meetings • Networking meetings • Stakeholder events

Other Key Issues to Draw to the Board’s Attention:

Action Required by the Board: The report is to provide the board with assurance about the involvement and engagement of the Chair

Previously Considered By and Recommendation(s) Made:

Related Trust Strategic Objective(s): Please highlight those applicable

Sub-Objective(s): Please highlight those applicable

Improving Operational, Quality and Safety Performance

• Commence implementation of the Trust’s Remedial Action Plan

• Commence Implementation of a Revised Operating Model including a new Clinical Career Pathway

• Continue to roll out the Trust’s Quality Strategy Shaping our Future • Create a stable Executive Leadership Team

• Develop a Trust Strategy for approval by end of Quarter 1 to be followed by supporting Strategies for Workforce, IM&T, Fleet, Finance and Estate for approval by end of Quarter 3

• Exploit all Collaboration Opportunities including engaging in all Vanguard Projects

Creating a Positive and Engaging Culture • Undertake a Cultural Audit and Embed our Vision and Values

• Implement Staff Leadership Development and Aspiring Manager Programmes

• Develop and implement a Staff Retention Plan

TRUST BOARD (Public Session)

25 JANUARY 2017 AGENDA ITEM 6i.

Page 2 of 2

• Roll out a Staff Engagement Plan

Legal Implications/Regulatory Requirements:

EEAST Events I attended the Emergency Services Carol Service in Bury St Edmunds just before Christmas, at which our new cohort of chaplains was commissioned by the Bishop of Bedford. It was great to be a part of their commissioning ceremony and to formally welcome them into the Trust. The chaplains will be based in different localities around the region and will provide pastoral support primarily to staff. I also had the pleasure of attending part of the day with a cohort of the Leadership and Management course, which was, as ever, illuminating and highly rewarding to hear how the participants were using their learning to enhance their effectiveness in their role. All three cohorts have also undertaken a group project, each of which has benefitted the Trust as a whole. Governance and assurance meetings In the middle of December, we held a board development session and in the same week I chaired the Equality, Diversity and Inclusion Steering Group. We are working collaboratively with the other ambulance trusts through AACE on a small number of agreed EDI priorities to maximise the benefit we should feel. Networking meetings I attended two national events, the NHS Providers Chairs and Chief Executives quarterly meeting and the annual HFMA Chairs meeting. I also joined the chair of NHS Improvement for dinner hosted by NHS Providers together with a small number of other chairs and chief executives from across the country. These networking events provide invaluable opportunities to hear directly from a range of national bodies, to compare notes with peers and to exchange full and frank views on issues of the day. Stakeholder events Just before Christmas, in the very busy run up to the festive period I visited Bedford Hospital with the Head of IMT to observe patient handovers in the emergency department. This was in support of an assignment for her MSc in Healthcare Management and it gave us a good opportunity to see some of the pressures and to reflect on the quality of patient care, which was reassuringly high. Last week I spent a day with the Chair and governors of West Suffolk Hospital, interviewing five candidates for their vacant non-executive director role.

Item 6ii

Page 1 of 5

Report Title: CHIEF EXECUTIVE’S REPORT

Report Author(s): Robert Morton Chief Executive


Sarah Boulton Chair

Purpose:

Decision Assurance For Information Disclosable X x Non-Disclosable

Executive Summary:

The purpose of this paper is to update the Board on issues, and matters the Chief Executive has been addressing or involved in since the last Trust Board meeting on 30 November 2016.


None

Action Required by the Board: The Board is asked to note the content of the Chief Executive’s report












• Develop and implement a Staff Retention Plan • Roll out a Staff Engagement Plan



25 January 2017 AGENDA ITEM 6ii

Item 6ii

Page 2 of 5

Chief Executive Report Single Oversight Framework The Trust has now met with the new NHS Improvement relationship team and on-going dialogue has continued over the festive period. The Trust is now receiving mandated support as provided for in the Oversight Framework. The most apparent support at this stage is our participation in the Financial Improvement Programme. NHSI Sustainability Review NHSI are currently undertaking a Sustainability Review of all ambulance services in England. At this stage, the review will cover a range of areas including potential consolidation or reorganisation. The Trust is engaging with NHSI on the review as required. Commissioning Intentions 2016/2017 Following negotiations with commissioners on the 2017/2019 contract, the parties reached the point of contractual dispute. The fundamental principle in dispute is the need to rebase EEAST’s emergency contract and fund the evidence based clinical capacity gap which is supported by analysis from ORH and a review by the Association of Ambulance Chief Executives (AACE). The Trust and the Lead Commissioner having exhausted negotiation opportunities, the Trust and Lead Commissioner entered the NHS Contractual Dispute Resolution process. At the time of writing this report, further meetings with both commissioners and regulators are planned to seek a way forward to resolve the issues in dispute. The key risks associated with this situation are that we cannot: • Complete the Annual Operational Plan submission to NHS Improvement • Consider the NHS Improvements Control Totals • Identify the scale of the CIP Challenge (Financial Improvement Programme) • Plan our Tactical Approach to Service Delivery and PAS support Remedial Action Plan (RAP) Funding Appeal In relation to the Quarter 3 RAP appeal, at the time of writing, the Trust has not received an outcome. Financial Improvement Programme The Trust has a significant financial gap between the cost of delivering services to patients and the income received from Commissioners. Consequently, at the request of NHS Improvement, EEAST has entered their Financial Improvement Programme (FIP). The FIP Team have been at the Trust since mid-December 2016, meeting with the senior managers and gathering/analysing information. Commencing on the 5th January 2017, the FIP Team are meeting with the Executive Team on a weekly basis to review progress and delivery on the FIP findings. At the time of writing the first work streams have been commenced with each one being assigned to a senior manager within the Trust. PTS Contract Cambridgeshire The PTS leadership team have put in place a plan to address issues in the Cambridgeshire contract and are continuing to engage with CCGs in Essex about overspends driven by over contracted activity. The Trust has agreed to a CCG invitation to extend the PTS contract in South East Essex. This is welcome news for all the staff involved and who are employed by the Trust by virtue of this contract. STP Footprints Since September 2016, the Trust has been trialling an interim leadership structure aligned to the 6 STP footprints.

Item 6ii

Page 3 of 5

The Trust is now satisfied that this structure is fit for purpose and will enable the Trust to support the work of the 6 STPs in our area. The work to facilitate the substantive filling of this structure will commence shortly. Local A&E Delivery Boards EEAST has experienced a significant increase in lost hours due to Arrival to Handover delays which were particularly challenging across the festive season. As a consequence of this EEAST has had to develop and implement a number of additional actions to ensure that we were able to respond to our sickest patients. Across the festive period, the Executives and senior managers were involved in multiple escalation calls to support a system response to winter pressures. Employment Relations Update Employee Relations remain challenged with UNISON launching a public campaign related to Student Paramedic Delays. The Trust consider they have been reasonable in recognising the delays and ensuring no financial detriment for affected students, albeit the delays were out of the Trust’s control. Whilst UNISON maintain that they wish to pursue a collective Grievance they had not provided details of those individuals who wished to raise a grievance in accordance with the Collective Grievance policy. This information was only received following repeated correspondence on behalf of the Trust on 13th January 2017. The Trust remains of the view that pay progression arrangements for newly qualified paramedics will be addressed via the implementation, in partnership, of the national banding agreement, namely the introduction of the band 5 newly Qualified Paramedic (NQP) and associated consolidation of learning programme. Work is underway to take forward implementation of the national banding agreement which is being overseen by a national implementation board to ensure consistency of application across all 10 Ambulance Trusts. The Trade dispute related to late finishes and disturbed and missed meal breaks has yet to be resolved. The Trust has agreed to extend the Intelligent x-ray (IX) pilot and to reduce IX from 30 minutes to 15 minutes. However, due to the Financial Improvement Programme (FIP) any further developments will be subject to the work undertaken by NHSI FIP in the Emergency Operations Centres. UNISON have expressed their displeasure with this arrangement although a meeting is planned between UNISON and NHSI FIP on 16th January 2017. In the meantime UNISON has reiterated the threat to ballot for strike action should IX not continue and is maintaining pressure via the Health and Safety Executive. Health and Safety Executive The Trust was issued with two Health and Safety Executive (HSE) Improvement notices in November 2016 relating to the Trust’s failure to demonstrate appropriate systems to ensure that working time was managed in accordance with the Working Time Directive. The Trust must respond to the HSE by 2nd February 2017 to provide assurance that sufficient action has been taken to remedy the contravention. In order to deliver the required improvements, the Director of People and Culture has set up a multidisciplinary working group which has undertaken a range of actions. These include asking all staff to complete an ‘opt out’ form should they wish to work over 48 hours and recording responses, developing reporting and monitoring systems for working time against the 48 hour limit and associated rest periods, amending timesheet processes to accurately record incidental overtime and secondary employment, monitoring systems to ensure staff take appropriate breaks, annual leave and the development of a working time policy. UNISON has been invited to be part of the working group and work continues in partnership via existing consultation arrangements.

Item 6ii

Page 4 of 5

Blue Light Collaboration EEAST now has Fire Service co-responder schemes in each of the 6 counties and since signing up have attended 100s of calls across the Trust. Work continues to increase the numbers responding and improve the dispatch process. An evaluation of the Scheme will commence in February. Senior managers are engaging with police and fire colleagues at Business Case Strategic Governance groups and Steering groups in Norfolk, Suffolk and Cambridge to further explore collaborative working in the coming year. Stakeholder Engagement* Stakeholder Location Date EEAST TRiM Training

Harlow Station Staff meeting Harlow Station

06/12/2016 13/12/2016 09/01/2017

CCG Contract Meeting with Lead Commissioner Contract Mediation meeting Call with Lead Commissioner Call with Lead Commissioner Call with Lead Commissioner Call with Lead Commissioner Call with Lead Commissioner Meeting with Lead Commissioner Meeting with Lead Commissioner

02/12/2016 08/12/2016 09/12/2016 12/12/2016 22/12/2016 12/01/2017 16/01/2017 17/01/2017 20/01/2017

NHS Trusts Essex System Conference Call Essex System Conference Call morning and evening Norfolk System Conference Call

02/01/2017 03/01/2017 03/01/2017

HOSC

MPs

CQC CQC Ambulance Workshop 19/01/2017

NHSI Call with Mark Cubbon Contract Mediation meeting Call with Mark Cubbon Contract Mediation call with Mark Cubbon Call with Mark Cubbon Call with Mark Cubbon Conference call with NHSI and other Ambulance CEOs Contract Mediation with Mark Cubbon PRM - Melbourn FIP Progress Review FIP Progress Review

02/12/2016 08/12/2016 09/12/2016 14/12/2016 20/12/2016 06/01/2017 10/01/2017 17/01/2017 24/01/2017 05/01/2017 11/01/2017

NHSE Contract Mediation meeting Contract Mediation meeting Contract Mediation meeting

08/12/2016 14/12/2016 17/01/2017

UNISON

Item 6ii

Page 5 of 5

GMB Blue Light Partners

Healthwatch/ TUGs

Media

Health Education England

RAF

Dept. of Health

AACE AACE Meeting – Teleconference AACE Meeting – London

22/12/2016 19/01/2017

Other Providers

Host a visit from the National Ambulance Service, Ireland. Demonstration of telephone systems in Chelmsford EOC Faculty of Health and Medicine University of East Anglia

01/12/2016 13/12/2016

British Heart Foundation

*Correct at the time of submission, any subsequent changes will be verbally reported to the Board at the meeting

Item 7.

Page 1 of 6

Report Title: Patient Experience/Story: PTS

Report Author(s): K Gaskin PTS Quality Manager


S Brown Director of Nursing & Clinical Quality

Purpose:


Executive Summary: The purpose of this quality report is to provide the Trust Board with assurance on the quality of service provided with clear demonstration of learning and identifying areas and associated actions for improvement. To discuss Non-Emergency Patient Transport Service patient experiences; complaints and compliments and how we are working on ways to improve patient experience. The presentation will include a story resulting from a compliment where the patient is congratulating the patient transport service on the brilliant service, the crew members go above and beyond there to ensure the patients’ needs are met; a patient was interviewed on 18th January.


Action Required by the Board: The Board is asked to consider and discuss the reported performance with particular emphasis on the areas of underperformance, and confirm that sufficient detail and assurance has been provided.

Previously Considered By and Recommendation(s) Made: N/A

Related Trust Strategic Objective(s): SO1: To be the market leader in providing patients the gateway to urgent and emergency healthcare services.

Sub-Objective(s): CO2: To develop and enhance Trust systems and staff to meet nationally and locally agreed quality standards.











25 JANUARY 2017 AGENDA ITEM 7.

Item 7.

Page 2 of 6


Health and Social Care Act 2012 (regulated activities) Regulations 2009 – Regulation 9 (Outcome 4) and Regulation 10 (Outcome 16)

Item 7.

Page 3 of 6

1 Complaints

Historically PTS has always had a low level of complaints. During 2016/17 this increased in April, with a peak in September in respect of the following;

• Mobilisation of North East Essex Contract and the introduction of Eligibility Screening

in April 2016 • Mobilisation of the Cambridgeshire Contract and the introduction of Eligibility

Screening in September 2016 • Increased use of private providers in Suffolk and Essex to cover a change of

contracting arrangements in relation to Addenbrooks and Papworth • Increased use of private providers to cover vacancies in Cambridgeshire

Number of complaints received per 10,000 PTS journeys

Mar 16

April 16

May 16

June 16

July 16

Aug 16

Sept 16

Oct 16

Nov 16

Complaints per 10,000 journeys

5.68 7.58 7.03 8.74 5.82 7.73 15.54 12.25

12.57

% of PTS Patients complaining

0.06 0.08 0.07 0.09 0.06 0.08 0.16 0.12

0.13

Complaints are on a steady decline and are monitored and discussed at monthly PTS Governance Meetings. Trends identified include:

• Delays in collection of patients • Attitude of staff • Driving concerns

Item 7.

Page 4 of 6

These meetings provide an opportunity to discuss Incidents and complaints and put in place processes for improvement. During these meetings the following actions have been agreed and implemented:

• Locality Business Managers (LBMs) to email staff confirming the outcome of the complaint

• Locality monthly newsletters are being established and will include a section on complaints, with feedback

• With outstanding Datix, LBMs in each region allocate 1 day per week to investigate and respond to complaints and incidents

• The same process is applied to incidents

2 Compliments

2.1 The number of compliments saw a slight reduction in August, but has since increased from September as demonstrated below

2.2 A patient experience interview will be presented to the Board on 25th January. A patient from Cambridgeshire has congratulated PTS for always delivering a brilliant experience stating "staff/crew always go above and beyond to ensure needs are met and my experience is the best it possibly can be".

3 Patient Satisfaction

3.1 Patient satisfaction surveys are undertaken quarterly on all PTS contracts as well as the Eligibility Call Centre. Outcomes of the surveys are reviewed by the local management team and actions undertaken. This can be demonstrated via the “You said, we did” reporting template. Please see two examples below:

Item 7.

Page 5 of 6

You said… 16742044- Better side support for the patient trolley would be useful. On a couple of occasions I felt as though I was going to come off the trolley as we turned corners at even relatively slow speeds.

We did… EEAST reviewed harness restraints as well as bariatric and support equipment for specialist cases. Staff have been reminded to communicate with patients, ensuring the patient feels safe before travelling.

You said…

1387- Phone patients to notify what time you need them ready for collection the night before. It confirms that they will be picked up and they can be ready. We did… The planners contact patients the day before to ensure they still wish to travel. Crews now call patients to make them aware of ETA. EEAST are currently setting up a text confirmation system with response availability. EEAST pays a phone allowance to the voluntary car drivers so they can call patients.

3.2 Outcome of the Patient Satisfaction Survey are detailed below by PTS Contract:

Q2 – July 2016 to September 2016

% Patients experience very satisfactory/ satisfactory

% Friends and Family extremely likely/likely

PTCAAS (Call Centre) Non Eligible Patients

95.4% 92.5%

PTCAAS (Call Centre) Eligible Patients

87.9% 87.9%

Suffolk Patient Transport 94.5% 96.3% West Essex Patient Transport

91.3% 93.4%

South Essex Patient Transport

92.6% 94.7%

North Essex Patient Transport

94.9% 94.9%

Gt Yarmouth & Waveney Patient Transport

95.6% 97.0%

Cambridgeshire Patient Transport (New contract)

92.6% 90.6%

Item 7.

Page 6 of 6

4 External arrangements

There are also regular monthly discussions in the form of monthly contract meeting which review complaints and incidents with Commissioners and the major Acute hospitals. Meetings are also held with specific patient groups, mainly renal. PTS continue to gather the views of, and engage with service users and the Communities served to ensure they remain the centre of all we do and that we continue to be an open, honest and learning organisation focussing on quality of care.

Integrated Board Report

Data: December 2016 Meeting Date: January 2017

*All available data is correct as of 15th of every month

Integrated Performance Report 1


Summary for December 2016

Integrated Performance

Workforce

Clinical (November)

Performance

Finance

Indicator Standing

YTD Sickness (A&E) 6.62%

PDR Rate (12 month rolling) 39.39%

PU compliance (rolling 18 months) 79.46%

Workbook (rolling 12month comp) 39.62%

Indicator Standing Q3 Trajectory Q4

Trajectory

Red 1 70.17%

71.7%

73.0%

73.6%

73.9% 72.8%

(+0.5% tolerance)

Red 2 62.22%

Red 19 91.11%

Red Tail breach

0.4% Target: tail breaches under 1%

Indicator Standing

Income

Expenditure

CIPs

Balance Sheet

Indicator Standing

ROSC at hospital - Overall 32.4%

Cardiac Arrest Survival to discharge - Overall 7.0%

STEMI – Care bundle 89.4%

Stroke Care Bundle 98.0%

(Full table on slide 7)


Quality – Patient Safety

Serious Incidents

Description Actual number of incidents (as defined in reporting and investigation of serious incidents procedure) reported within the month Analysis There was 9 SI’s reported in December

Vehicle Cleanliness

Description The number of audits reaching the cleanliness target of 95% Analysis Vehicle cleanliness was at 97.30% for December

Station Cleanliness

Description The number of audits reaching the cleanliness target of 95% Analysis Station cleanliness was at 97.30% for December


Quality – Patient Safety

Number of Emergency Service Complaints

Description Actual number of Emergency Service complaints received in full calendar month. Analysis There was 95 Emergency Service complaints in December

Number of PTS Complaints

Description Actual number of Patient Transport Services complaints received in full calendar month. Analysis There was 47 PTS complaints in December. An increase was seen in relation to the mobilisation of a new contract in Cambridgeshire. Ongoing discussions with the CCG.

Number of Primary Care Service Complaints

Description Actual number of Primary Care Service complaints received in full calendar month. Analysis There was 0 Primary Care Service complaints in December for the fifth month running


Clinical

Cardiac Arrest ACQI - ROSC

Description % of all patients who had resuscitation commenced/ continued by EEAST following an out-of-hospital cardiac arrest who had return of spontaneous circulation (ROSC) on arrival at hospital. Analysis Our highest cohort at 102 patients and highest ROSC achieved at 32.4% This is a great achievement in those patients who have had a return of spontaneous circulation following treatment from our volunteers and staff. Work continues with staff for cardiac arrest patients, including the Consultant Paramedic and ACLs reviewing the successes in more detail.

Cardiac Arrest ACQI – Survival to discharge

Description % of all patients who had resuscitation commenced/ continued by EEAST following an out-of-hospital cardiac arrest who were discharged from hospital alive Analysis Survival to discharge figures have decreased from last month and are just below the national average. Elements of this bundle are also dependant on factors outside of EEASTs control. The cardiac care focus that is continuing within the Trust will keep an awareness on these care bundles in particular.

STEMI ACQI – Care bundle

Description % of all patients suffering a ST elevation myocardial infarction (STEMI) who received an appropriate care bundle (aspirin, GTN, and analgesia administered and two pain scores recorded) Analysis An ongoing increase in the care bundle compliance which maintains we remain well above the national average for our care of those suffering from a STEMI. Historically, care bundle compliance has always been very high, focus on areas of non compliance are undertaken and reviewed allowing any slip in compliance to be addressed at a local level to ensure sustainability and high performance is embedded and continues.

Actions • Access and review of the OHCA dataset. • Cardiac Arrest Bootcamp developed, initial programme run,

feedback received and planning future training opportunities.

• Discussion with JK surrounding putting on some RC(UK) ALS courses in house, planning for them to be delivered from April.

• Cardiac arrest strategy being formed through the cardiac arrest and cardiac care management group.

• Cardiac arrest checklist available including on PU and deployed throughout operations and on stores order.

• Pit Stop CPR being delivered on PU, Video has been produced and in final stages of editing. This will go onto the Clinical App.

• Podcasts produced throughout the cardiac month.

Actions • As above, DA/AR liaising with clinical audit

surrounding formalising an audit in airway management (with view to improvement in oxygenation/ventilation and airway management - hoping to publish.

• Review of gaps in Survival to Discharge dataset. • Starting to write back to crews who have had a

survival to discharge.

Actions • Celebration of achievement against national

average. • Monthly review of non-compliance with deep dives

where appropriate to the commissioners - feedback provided through ops to individuals involved.

• Ongoing monitoring.


Clinical

STEMI ACQI – Time to PPCI treatment within 150 minutes

Description % of all STEMI patients who received primary percutaneous coronary intervention (PPCI) following direct admission to a PPCI centre whose PPCI treatment took place within 150 minutes of call. Analysis Compliance for PPCI being delivered within 150 minutes of the event has decreased. The Trust remains above the national target however has dropped below the Trust's own average, vital heart muscle and life-limiting heart attacks are less likely due to the timely transport of these patients.

Stroke ACQI – Care bundle

Description % of all patients with suspected new stroke or transient ischaemic attack (TIA) who receive an appropriate care bundle (FAST assessment, blood pressure and blood glucose measurement) Analysis The compliance against the Stroke care bundle has decreased this month to 98% for a cohort of around 500 patients. The Trust remains above the national average and is still performing well against this target, although we will not let ourselves be complacent and will feedback to staff on how well they are delivering their care in challenging circumstances.

Stroke ACQI – Time to HASU within 60 minutes

Description % of all Face Arm Speech Test (FAST) positive stroke patients potentially eligible for stroke thrombolysis (within local guidelines) who arrived at a hyper acute stroke centre (HASU) within 60 minutes of call. Analysis The compliance has dropped for the month also dropping below both the Trust and national average . Work is on going with the wider health system in monitoring impacts of HASU's closing or changes in hours of operation.

Actions • Staff reminded of short on scene times.

Actions • On-going monitoring • Access and review of care bundle non compliance • Ops are provided with non-compliance for

feedback to clinicians on an individual basis. • Detail in CQM. • Cardiac themed month in November with lots of

learning opportunities for staff.

Actions • Close monitoring of missed stroke 60, particularly

within drive zones which are achievable • Monitoring of on scene times as this is within the

gift of the clinician • Work with EOC on deployment to strokes (sending

a transportable resource)


Clinical

n = total patient group 1 = Overall group - Cardiac Arrest patients where resuscitation has been attempted 2 = Comparator group - Cardiac Arrest patients where resuscitation has been attempted, VF/VT arrest, presumed cardiac aetiology, bystander witnesses 3 = PPCI - Primary Percutaneous Coronary Intervention 4 = STEMI Care Bundle - Aspirin, GTN, 2 pain scores, analgesia administered 5 = Stroke Care Bundle - FAST, Blood Glucose and Blood pressure recorded 6 = Asthma Care Bundle - Respiratory Rate, Peak Flow, SPO2 recorded and Salbutamol administered


Clinical


Clinical

CLINICAL PERFORMANCE SUMMARY

Serious Incidents To date, the Trust has reported 64 Serious Incidents in the 2016/17 financial year. This is a reduction compared to previous quarters but is significantly higher than the same period in previous years (30 in 2015/16). It should be noted however that the NHS SI Framework now includes a near miss category which is contributing to the increase in cases. Those cases subsequently downgraded have been removed from the table. Complaints Of the 133 complaints received in November 2016, 81 (60%) complaints related to the Emergency Services and 48(36%) complaints related to our Patient Transport Services. Ambulance Clinical Quality Indicators (ACQIs) Four of the eight ACQI targets have been achieved for the month of October 2016. ROSC for both patient categories reduced in October to just below the respective targets and although PPCI < 150 minutes and Stroke HASU < 50 minutes both increased during this month, they remained below the target of 95.0% and 56.0% respectively. Safeguarding Safeguarding referrals have again hit through the 3000 barrier to 3043, a decrease marginally on the previous month due to a shorter calendar month. However, per 10,000, 999 calls have increased by 4.3% on the previous month and by an outrounding 53% from this time last year. Medicines Management The Medicines Management Policy and Standard Operating Procedures are under review and are continuing to be developed working alongside an appointed Duty Locality Officer (DLO) from each area to work as part of the Clinical Team. A new member of the team commenced with the Trust at the end of November and an Auditor has also been appointed who will join the team shortly. The Medicines Management team has continued to participate in the Quality Roadshow visits, and continues to work with staff at stations. Work continues with the DLO-Medicines Management Leads on the Rule book, which is a work in progress, and two successful Operational Medicines Management Group meetings have been held since it was developed. The action plan continues to be a focus to ensure CQC compliance. Inquests The Trust received a Preventing Future Death report from Mr Geoffrey Sullivan, Coroner for Hertfordshire, on 17th November 2016 in relation to delays. The Trust responded on 11th January 2017 to outline to the Coroner the action the Trust is taking to improve service delivery.


Clinical

The following annual reports were approved by the

Quality Governance Committee on behalf of the

Board Safeguarding Medicines Management Local Security Management


Performance

Key Measures Sub-Section Comment Oct Nov Dec

Red 1

Red 1 performance continues to be a challenging target with 33% growth quarter on quarter , 43% year on year. However; EEAST remains in the top 3 in the national context of reporting Trusts. December was particularly challenging with the Trust receiving over 100 R1 calls per day over the Christmas period. All clinical managers were deployed to Red 1 support .

Red 2 Red 2 performance fell slightly during December as expected in relation to seasonal pressures., however; it also remains a strong position in the national context.

Red 19 Red 19 performance below the 95% national target and marginally below the November months outturn. Strong in the national context.

Demand (responses)

Overall demand (responses) has risen by over 31% in December compared to the previous 4 weeks. A significant proportion of the increase has been seen in the Red categories.

Red Demand Red demand (responses) have risen again in December to 55% of all calls received. Over 21 % of our Red volume was from 111 providers with notable spikes on weekends and bank holidays

Hospital Delays

Arrival to Handover hours lost over 15 minutes increased by 28% during December compared to the previous month. This is equivalent to 682 ambulance shifts lost in month. Peak delays per day reached over 500 hours of lost time (ie upwards of 40-50 shifts)

EOC – Call pick up

5 second call answering for September was at 91.02% which is below the 95% target, however; the Trust remains consistently in the top three for this AQI and is a national leader in the BT tables for pick ups exceeding 2 minutes. During December the Trust handled 107,497calls.

Hear & Treat

H&T has significantly improved for December 2016 compared to the previous month and now sits above the 7% CQUIN target. In demand growth terms, these represent significantly increased numbers

70.56%

63.66%

91.37%

74,122

90.55%

6422

2675

AtoH HtoC

32,787

6.24%

71.47%

65.92%

92.31%

72,804

92.97%

5578

2567

31,797

6.89%

70.16%

62.22%

91.11%

78,812

91.02%

7841

2466

36,924

7.64%

12

Red 8 Performance (R1/R2)

Overall Red (8minutes) performance for the month of December 2016 was 62.71% which is the highest of the financial year to date and regularly in the top three nationally. The following factors may have contributed towards this:

• Demand –has been increasing since mid September and has continued into the period of seasonal pressures with a notable shift in the share of Red/Green. Red 1 activity during the month of December was 55% of the total demand which put extreme pressure on the Trusts ability to meet the commissioned performance standards. On 27/12/16, the Trust received over 4000 calls in one 24 hour period and of these, 3000 responses were made.

• Capacity – UHP has steadily improved in line with the RAP

actions. RRV provision remains high priority focus to enable us to respond to our most sickest patients fastest. There are some areas with skill mix challenges making production to RRV difficult. RRV UHP continues to be improved and now meets ORH modelled levels. All clinical managers are providing additional capacity to support getting to our sickest patients. There continues to be the high student paramedic abstraction rates in line with the staffing plans and some of this is offset with PAS provision.

• Efficiency – Average call cycle time has increased for the

trust compared to last year. This is a nationally reflected position and due to extended hospital delays and on scene times reflective of a higher percentage of high acuity calls. A strong focus on keeping rapid response available for critically ill patients and reducing this from the urgent work is supporting improvement. A number of efficiency areas are being focussed upon which reflect improved Red performance.

45.00%

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

80.00%

R8 Performance Monthly

2015/16 2016/17 National Target

45.00%

50.00%

55.00%

60.00%

65.00%

70.00%

75.00%

80.00%

R8 Performance Weekly

2015/16 2016/17 National Target

13

Red Performance

Performance in December 2016 dipped slightly for Red 1, Red 2 and Red 19, as expected during the festive period and in line with national trend. The Trust continues to get to more Red 1 patients within 8 minutes than before and has kept tail breaches well under 1% consistently. It should be noted that the significant increase in high acuity activity means longer waits for some lower acuity patients.

• Red 1 – 70.16% • Red 2 – 62.22% • Red 19 – 91.11%

45.00%

55.00%

65.00%

75.00%

85.00%

April May June July August September October November December January February March

Red 1 Performance Monthly

2015/16 2016/17 National Target Trajectory

45.00%

55.00%

65.00%

75.00%

85.00%




75.00%

80.00%

85.00%

90.00%

95.00%

100.00%




14

Green Performance

45.00%

55.00%

65.00%

75.00%

85.00%

95.00%


Green 1 Performance Monthly

2015/16 2016/17

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%



2015/16 2016/17

45.00%

55.00%

65.00%

75.00%

85.00%

95.00%



2015/16 2016/17

45.00%

55.00%

65.00%

75.00%

85.00%

95.00%



2015/16 2016/17


Demand

Overall Call demand was up +16% in December 2016 compared to the same month last year. Incident response demand was also up + 5%. Red 1 calls are up +41.35% in 2016 compared to the same month last year. Red 2 calls were up by +18.60% In December 2016 the proportion of red responses to green remained nearly equal with days when Red demand was significantly higher, this is a notable shift from the early part of the year. This puts significant strain on capacity and capability to mange resources proactively and has an impact on the length of time lower acuity patients have to wait for a response.

50,000

60,000

70,000

80,000

90,000

100,000

110,000

Demand - All Calls & Responses

2015/16 Calls 2016/17 Calls 2015/16 Responses 2016/17 Responses

800

1,300

1,800

2,300

2,800

Demand - Red 1 Calls

2015/16 Red 1 Calls 2016/17 Red 1 Calls

10,000

20,000

30,000

40,000Demand - Red 2 Calls

2015/16 Red 2 Calls 2016/17 Red 2 Calls

46.85% 47.34%

30.00%

50.00%

70.00%


Demand - Red Vs. Green Responses

Red Responses Green Responses


Capacity

Overall DSA & RRV capacity are up on the previous year to c80k per week .There remains a fundamental gap between funded capacity and required capacity to meet demand. Capacity is impacted by vacancy and student paramedic abstraction. There is a very strong focus on increasing RRV cover to modelled levels in each locality as part of the RAP plan and the R1 sub action plan which is based around managing our sickest patients as safely as possible. The use of PAS remains necessary to ensure patient safety.

50,000

55,000

60,000

65,000

70,000

75,000

80,000

85,000

Capacity - UHP (DSA & RRV Only)

2015/16 2016/17 2016/17 Budget

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Capacity - PAS

2015/16 2016/17


Efficiency

00:08:38

00:23:02

00:37:26

00:51:50

01:06:14

01:20:38

01:35:02

01:49:26

02:03:50

Efficiency - Average Job Cycle Time (All Cat) Conveyed Vs. Non-Conveyed

Conveyed Non-Conveyed

1.00

1.20

1.40

1.60

1.80

2.00

Efficiency - Responses Per Incident

Red 1 Red 2

The Trust continues to focus on the drive to reduce conveyances and is strong nationally in this area. However, with the increase in high acuity demand there will naturally be an increase in conveyance. The time to discharge from scene or into an alternative pathway safely also adds time but supports the system overall. The Trust continues to actively recruit to the ECAT (former Clinical Hub) and this will improve our opportunity to improve on our Hear and Treat rates which, again, should naturally impact on conveyance rates. High acuity workload share means that multiple resource responses are occurring, which in turn impacts on available capacity. Clinical mangers are supporting this by responding to Red 1 calls. Green RPI is marginally higher due to RRV assignments to Green calls where there has been a delay in deploying due to demand increase. Hospital delays lost 682 full ambulance shifts in December alone, which has a significant impact on capacity and capability to deliver required performance standards. There is little evidence within the wider system that delays will reduce significantly. During December, delays rose to levels which required the Trust to be under significant operational pressure. The Trust implemented the Safeguarding Life Threatened Patient protocol and a no send script for a defined code set during this period under the oversight of the Trust Medical Director and Gold Commander.


EOC

5 Second Call Answering %

Month 2015/1 2016/17

April 99.00% 96.56%

May 98.66% 97.24%

June 98.21% 96.77%

July 96.49% 94.37%

August 95.20% 94.68%

September 94.72% 94.11%

October 94.16% 90.55%

November 94.02% 92.97%

December 95.25% 91.02%

January 94.78%

February 93.96%

March 92.88%

• Call pick up within 5 seconds is showing a downward trend this financial year. Call demand is significantly above plan

• There is increased absence levels and high numbers of repeat calls on delayed responses.

• There is sustained pressure on staff within EOC with the increase in demand and the protracted times at highest surge levels.

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

100.00%

EOC - 5 Second Call Answering % (R1-G4)

2015/16 2016/17

86.00%

88.00%

90.00%

92.00%

94.00%

96.00%

98.00%

EOC - 5 Second Call Answering % (Red Vs. Green)

Red Green

19

Hospital Delays

Delays over 15 minutes during December totalled 7841 hours which equals 682 full twelve hour Ambulance shifts – the following slides show the top 5 contributing hospitals;

20

Tail Breaches - Red

0.32% 0.35% 0.34% 0.41% 0.31% 0.22% 0.28% 0.13%

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%

10.00%

R2 breaches % >40mins

0.28% 0.30% 0.45% 0.60% 0.21% 0.20% 0.16% 0.22% 0.18%

0.00%1.00%2.00%3.00%4.00%5.00%6.00%7.00%8.00%9.00%

10.00%


12.33%

10.48% 10.66% 10.97%

9.18%

8.02% 8.65%

7.71%

8.93%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%


37.83% 36.64%

39.58% 40.88% 39.90% 40.18%

41.96% 40.32%

41.60%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

40.00%

45.00%

R19T breaches % >60mins

21

Tail Breaches - Green

3.68% 2.81%

2.16%

3.68% 2.79% 2.75%

6.20%

9.06%

11.55%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

G1 breaches % >60mins

6.71% 5.18%

6.86%

11.97% 9.92%

11.22%

15.57%

12.56%

19.72%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%


4.00% 3.09% 3.11%

5.29% 4.51%

5.51%

7.86% 8.91%

12.41%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%


8.88% 7.74% 8.18%

12.21%

10.25% 9.52%

12.34%

8.21%

11.28%

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

18.00%

20.00%


• In summary, December and in particular the festive season has seen EEAST experience

exceptionally high call demand, with particular spikes on weekends and bank holiday related to

transferred demand relating to primary care.

• Extended hospital handover delays led to decisions to enact patient safety mitigating actions.

• Some acute Trusts declared major incidents and the Trust was engaged in system support.

• EEAST put in place full command structures to manage over this period.

• There were prolonged periods of use of the surge plan at levels red and black.

• PAS capacity was increased at financial risk to support these challenges.

• The Operations Team continues to meet with our Commissioner leads bi-weekly to provide

assurance, share information on performance and challenges openly and convey key messages.

22

Operations Summary

23

Patient Transport Service

% patients arriving any time prior to appointment

The target percentage

is 95%

% of patients collected within 60 minutes of

scheduled made ready time

The target percentage is

95%

Time on vehicle should not exceed 90 minutes

The target percentage is

95%

Analysis

The data provides an overall view of PTS performance

however has not been broken down by contract. PTS have

30 contracts all with different KPI’s, some having no KPI’s at all. Whilst some KPI’s will be

common, such as vehicle cleanliness and access to hand gel, others will be contract dependent. For

example West Essex contract arrival standard is “90% of

patients shall arrive on time or up to 60 minutes before

the appointment”. The Suffolk contract states “90% of

patients to arrive between 60 minutes before and 10

minutes before the appointment time”. North

Essex is “85% of patients on time or up to 60 minutes

before”. Gt Yarmouth and Waveney require “98% to arrive at or prior to their

appointment time”. As such it is impossible to determine a single reporting KPI on the

Trust PTS performance”

93.00%

94.00%

95.00%

96.00%

97.00%


Arrivals - Early or up to 30mins later for Appointment

2015/16 2016/17

75.00%

80.00%

85.00%

90.00%

95.00%


Collections

2015/16 2015/16

60.00%

70.00%

80.00%

90.00%

100.00%


Time on Vehicle

2015/16 2016/17


Workforce

TURNOVER

Turnover is monitored on a monthly basis using the principle described below.

Currently the whole trust rolling year turnover is at 7.59% which equates to an

average 29.02 wte staff leaving the Trust per month. A&E Turnover is at 6.17%

which equates to on average 14.31 wte A&E staff leaving the Trust per month. A&E

Monthly Turnover is now moved out of downward trend

NOTE: Staff leaving via a TUPE are not included for the purposes of calculating

turnover

DEFINITIONS:

Employee turnover refers to the proportion of employees who leave an organisation

over a set period (often on a year-on-year basis), expressed as a percentage of total

workforce numbers.

CIPD.(2014). Employee turnover and retention. Available: https://www.cipd.co.uk/hr-

resources/factsheets/employee-turnover-retention.aspx. Last accessed 20th May

2015.

SICKNESS

In trend terms sickness is currently running as seasonably expected and it

should be noted that the next 1-3 months will see the usual seasonal up-

turn . Dependant on the size and extent of the up-turn we could be

heading for a year end average position similar or slightly higher than last

year . The Trust undertakes a constructive and consistent focus on

managing sickness absence, both long and short term. This is supported

by comprehensive questioning from Day One* clinicians towards the staff

who call in and a targeted approach from Occupational Health in

conjunction with line managers & HR in relation to chronic sick absence cases.

Appraisal & Development Review (ADR)

EEAST's Appraisal & Development Review (ADR) process is an important

workforce tool which allows for meaningful dialogue about work

performance, development and career aspirations between an individual

and their manager. The ADR takes place over and 12 month cycle

individual to each individual member of staff, therefore compliance is

recorded over a rolling 12 months. The graph shows the % of staff

compliant at the month end. The end of year Target is 95%

NOTE: Operations support is now shown under Shared Support


Workforce – Statutory/Mandatory Training

Mandatory Training

Delivery of Mandatory training as currently via by the Mandatory

Workbook, and is delivered on a twelve month cycle. When a member of

staff successfully completes their Mandatory Workbook they will be

compliant for twelve months from that point. Therefore the graph show

details of the percentage of staff that have completed it during the

preceding 12 months.

Professional Update (PU)

The length of cycle for delivery of the Professional Update programme is 18 months (from the previous 12 months). This decision has been taken to

accommodate the increased training commitment that the Trust has made to new Student Paramedics and the Senior Paramedic and Senior EMT

programmes.


Workforce – Vacancies & Sickness

VACANCIES

This graph shows the Trust's current month's vacancy rates

by function. It should be noted that Locality vacancies in

this graph cover all A&E staff.

The known challenges of recruiting into Hertfordshire and

large swathes of Essex are reflected in these

figures. Additionally it is hoped that future recruitment to the

Associate & Intermediate Practioner roles will start to

address vacancies in the non registered staff element of the

skills mix in A&E

A&E Frontline Vacancies Dec-16

Positions Afc BandBudgeted

Establishment

Finance

Adjusted Staff

in post

VacanciesVacancies (ORH

Establishment)

ECPs 6 149.72 59.97 89.75 603.63

Sups, Sen Paras, Paras & Student Paras 6 & 5 1682.32 1776.46 -94.14 -217.66

Sen Techs, Techs, AAPs, ECAs, IAPs & HRCs 5, 4 & 3 904.48 775.24 129.24 362.66

Total 2736.52 2611.67 124.85 748.63


Workforce – Vital Signs


Special Operations & Resilience

Local Resilience Forum (CCA) EPRR Framework

. 56 regional LRF meetings engaged with

. 11 multi agency exercises completed

since

. Senior management engagement with

strategic groups have improved

. First sight of the draft EPRR changes to

the Ambulance Service Framework

The Trust has replied with comment on

the draft document

Business Continuity JESIP

. Work continues to gain compliance with

the ISO standard

. New sign off process in place to assist

with Business Impact Assessment

delivery

. BC plans across all areas still awaiting

completion and testing

. Actions in place to address all

outstanding issues

.

3 JESIP regional meetings have taken

place

. Strategy being worked through around

delivery of refresher command training

. National JESIP team visiting the Trust in

February 2017



• HART responses include:-

– Safe Working At Height

– Water related

– Confined Space

– Chemical Incidents

– Explosive Incidents

– Support to frontline crews

– Assistance to conventional 999 calls whilst remaining available for HART incidents

HART Team incidents Attended

Air Operations incidents Attended • Air Operations responses include assets from all

three HEMS charities

• Deployments include those where a team deploy by

car as well as the Air Ambulance incidents

• An increase in deployments was seen in November

• EAAA is currently running a trial for new CCP only

car on night shifts out of the Norwich location

• EHAAT is currently running a trial for a night/late car

on Friday and Saturday shifts

• The key requirement is to ensure a full team of six is

deployed for each HART team, this is impacted by

short notice sickness on occasion

• Mitigation is provided utilising the HART managers

or members from the training teams whenever

possible to ensure the live team maintains at the

required levels

HART compliance with KPI availability requirements



• The Trust meets the specified requirement to provide

63 MTFA trained additional staff.

• Presently we are unable to increase this to 100 as

per the Trust Board request due to insufficient staff to

deliver the training and financial constraints.

However plans are in place to recruit and train further

members of the team from April 2017 to bring it to full

strength

MTFA Trained Staff

HART Training Compliance

Staff Grade

Training Training Planned

% of Staff who have completed Training

Mop Up Course Planned for

New

Sta

ff

Breathing Apparatus 100% n/a (national initial course)

Completing IRU Course 100% n/a (national initial course)

Ballistic Training 100% n/a (national initial course)

Water Training 78% January 2017

Safe Working at Height 100%

Confined Space 100%

Exis

ting S

taff Ballistic Training Summer 2017 100%

Water Training Winter 2016 93% January 2017

Safe Working at Height Summer 2017 100%

Confined Space Summer 2017 81% January 2017

PU Training Autumn 2016 98%

Breathing Apparatus Spring 2017 91% January 2017

CR1 and PRPS Spring 2017 100%


Finance

Item 8i.

Report Title: Finance Report – Month 09, December 2016

Report Author(s): Heather Madden, Head of Finance


Kevin Smith, Director of Finance & Commissioning

Purpose:

Decision Assurance For Information Disclosable X Non-Disclosable

Executive Summary:

The Trust had a deficit for the month of December of £(0.4)m against the planned position for a surplus of £0.5m. This position includes estimated RAP income for the three quarters of the financial year so far at £6.4m of which £0.8 is for M9, December. This brings the YTD deficit for the 9 month period to £(6.2)m against the planned surplus of £1.6m. This gives a budgeted deficit of £(7.8)m. The Trust has amended its forecast out turn at M9. At the time of writing this report this would be an increase in the predicted deficit from £(6.2)m to £(10.6)m. However, the level of income underpinning this figure remains under discussion. This change in forecast has been communicated to NHSI via the M9 key data return which was submitted on 17 January 2017.

Principle adverse variances: 1. PAS £(0.8)m over budget for the Trust in December, cumulatively £(10.9)m over budget (Emergency

Operations £(10.2)m and PTS £(0.7)m). 2. Emergency Operations Front line agency staff costs are £(0.3)m for the month, £(1.7)m for the 9

months to December 2016. 3. CIPs are progressing although patient facing work pressure has slowed some elements. The Trust is

£(0.9)m behind target for 9 months. £4.1m achievement for the 9 months. The full year target is £6.7m.

4. PTS continues with a small deficit to plan in the month, cumulatively now at £(0.5)m ytd, but the position is improving with focused management action.

5. Primary Care remains with the deficit to budget of £(0.1) due to the use of bank staff. 6. Additional Legal and professional costs are £(0.5)m over budget for the Trust.

Principle favourable variances:

7. Additional activity over contract, £0.1m for December for Emergency Operations, £1.8m YTD. 8. RAP Income at £0.8m for December, £6.4m YTD.

Other Key Issues to Draw to the Trust Board’s Attention:

RAP – The Trust has now reached agreement with Commissioners for funding towards the RAP. The funding mechanism is shown in detail at Appendix 1. The Trust only receives 83p of every £1 spent which makes achievement of CIPs even more important. The Trust has significantly curtailed its use of PAS due to the deficit financial position, but some PAS is still being engaged for patient safety issues. The Trust has an appeal for additional RAP income outstanding with regulators and it is hoped a decision will be communicated to the Trust imminently. Any additional income would improve the deficit forecast to the Trust. The RAP is designed as a temporary stopgap whilst the Trust negotiates on its capacity gap and the new operating model. Expenditure for the 9 months on PAS and agency staff for Emergency operations sits at a total of £(11.9)m. The RAP income received for quarter 1 was £1.6m, quarter 2, £2.4m and this, together with the estimated income for quarter 3 gives a total so far of £6.4m. The October-December income of £2.4m is included in the position.


25th January 2016 AGENDA ITEM 8i

Item 8i.

2

EOCs, PTS, Workforce, Special Operations, Primary Care and Patient Safety all now have issues to be addressed as stated in the Executive summary below –

- The EOCs have a budgeted deficit at Month 9 of £(0.5)m. - PTS shows a budget deficit at M9 of £(0.5)m. - Workforce has an issue on legal fees and the PAM contract

with expenditure currently £(0.3)m adrift of budget. - Primary Care has a budget deficit of £(0.1)m due to the use of

bank staff, overtime and additional hours.

CQUIN - £3.8m of the CQUIN costs are towards the set-up of the Clinical Hub. The Trust has so far spent £(1.7)m and we have accrued income at this level. The remaining 20% of the CQUIN is for national schemes around the flu prevention programme and staff wellbeing programmes. These are currently being worked upon

Activity – Activity is above contract by overall with some wide variations across different CCGs. This has generated £1.8m of additional income. The activity schedule is shown at Appendix 2.

Action Required by the Trust Board: The Trust Board is asked to note the financial position.

Related Trust Strategic Objective(s): All

Previously Considered By and Recommendation(s) Made: Not previously considered.


None

Report dated 17 January 2016

Item 8i.

1. Executive Summary

The tables below show the key financial measures for the organisation including discussion on current and forecast performance together with a RAG rating of the position. Further detail is provided in the sections below.

Key Performance Indicators to 31st December 2016 (Month 9 FY15/16)

Plan Actual Variance

1 Turnover £m 234.9 238.8 179.3 185.9 6.6 247.7

2a EBITDA £m 8.7 8.7 7.0 (0.3) (7.3) (2.8)

2b EDITDA % 3.7% 3.6% 3.9% (0.1%) (4.0%) (1.1%)

3a Surplus £m 1.5 1.5 1.6 (6.2) (7.8) (10.6)

3b Surplus % 0.6% 0.6% 0.9% (3.3%) (4.2%) (4.3%)

4 CIP £m 6.7 6.7 5.0 4.0 (1.0) 4.9

5a Pay £m 169.5 175.4 131.0 132.1 (1.1) 178.5

5b WTE 4,518 4,518 4,518 4,237 (281) 4,090

5c Non-Pay £m 56.7 54.8 41.2 54.1 (12.9) 72.0

6 Capital budget £m Delivery of capital plan 8.5 8.5 6.4 1.6 (4.8) 7.2

7a Cash balance £m 16.8 16.8 17.4 6.0 (11.4) 1.4

7b Debtors >90 days £m 0.2 0.2 0.2 0.1 (0.1) 0.2

7b BPPC % Non-NHS 95.0% 95.0% 95.0% 88.9% (6.1%) 95.0%

8 Rate of return % Asset utilisation 3.5% 3.5% 3.5% 3.5% 0.0% 3.5%

9 Continuity of Services Rating Risk rating 3 3

Delivery of revenue plan

Management of working capital

KEY PERFORMANCE INDICATORS

KPI Relevance of indicator Opening plan

Year to date position YTD RAG Rating

F/cast Outturn

Current Plan

Item 8i.

4

Executive Summary of Performance - December 2016

Key Measure Summary of PerformanceCurrentMonth

Cumulative Position

The Trust has a deficit of £(6.2)m for the nine months, three quarters, of the financial year, 2016/2017.This is against the planned position for a surplus of £1.6m - an adverse variance to the plan of£(7.8)m.Significant contributing items to the position are as follows:-Expenditure1. PAS usage in Emergency Operations. The expenditure for December was £(0.7)m. This additionalexpenditure which was approved by the Trust Executive in order to engage additional resource towardsimproving Trust Performance was significantly curtailed in December due to the adverse financial position ofthe Trust. This expenditure still falls under the terms the RAP and income for Q1 at £1.6m and Q2 at £2.4mincome has been agreed and invoiced. This did not cover all costs as the for the final agreement as EEASThas to contribute the contingency(£1.2m) and budgeted surplus (£1.5m). This works out at a ratio of 83:17, sofor every £1 spent EEAST receives 83p. The RAP is based on R1 trajectories. If the trajectory for a Quarter isnot achieved, then the level of additional activity is considered (above 6% year on year) together with aschedule for hear and treat performance. For the third quarter the estimation is that the terms of the RAP willyield £0.8m income (October), £0.9m (November) and £0.8m for December, a total for the quarter of £2.5m.PAS and agency expenditure for the quarter has been £4.5m.This is an estimation at this point based on theperformance and this amount has been accrued into the position. This needs to be confirmed and agreed withCCG colleagues and then we will raise the invoices. More flexibility over the use of PAS was able to beincluded in the procurement for PAS for December and a lower expenditure of £(0.7)m was incurred. PAScontinues to be engaged due to patient safety concerns.

2. EOC has a further deficit to budget for Month 9 of £64k, cumulatively the deficit to budget now stands at£515k. Costs of spoilt meal breaks continue to be a problem as they continue to accumulate with anexpenditure of £(89)k in December. Overtime incurred in December was £(81)k, an small increase fromNovember. 3. NES has a surplus for M9, December of £78k. This is a budgeted deficit of £(14)k for the month, giving abudgeted deficit for the year so far of £(465)k. This continues to be due to the costs of PAS and taxis. Month9 sees expenditure for taxis of £(74)k and for PAS £(174)k against a combined budget for the 2 items of £90k.There is some extra income towards these costs and their usage has declined since M8 which showsprogress from the plans from the Head of Service for NES. The team are working hard to rectify issues and get the Directorate back into a regular surplus.4. The Workforce Directorate has a further deficit to budget at Month 9 of £(113)k, with a cumulative deficit tobudget position rising to £(329)k. The deficit is due the costs of legal fees which are now cumulatively £(220)kover budget. The legal fees budget was identified as a cost pressure for 2016/2017, but no funds wereavailable to cover this pressure. Workforce staffing also show an adverse variance to budget, cumulatively at£(87)k, with additional support engaged in recruitment. A further issue this month is an overspend on our PAMcontract. However since the end of the month some costs for well being have been identified as relevant to theCQUIN and so will be transferred in January's accounts.5. Strategy and Sustainability shows a surplus for M9 of £33k to budget. This is a return to surplus from the deficit in M8. SAS retains a cumulative surplus, now at £279k. A continuing cost pressure is for datapointlicences which were raised as a cost pressure for the year, but remained unfunded. 4. Trust CIP. The CIP target for the Trust for 2016-2017 is £6.7m. There was initially £4.1m of schemestowards this target provisionally identified, with the remaining £2.6m still outstanding. £0.4m of this £2.6m hasbeen top sliced from budgets. Nine months of our target, £4.9m, has fed into the financial position. We haveachieved £4.0m so far towards our target. Plans to cover the unidentified amount have been progressing andthe Trust is now part of the Financial Improvement Programme (FIP) with NHSI and SSG Healthcare havecommenced work on opportunity identification and projections for potential savings.

5. CQUIN. We are still working with Commissioners on the Clinical Hub and have spent £(1.7)m for the 9months ytd. We have accrued the appropriate level of income from commissioners for these costs for M9.The remaining 20% of the CQUIN is for national schemes. Terms are agreed with the lead Commissioner andexpenditure is progressing at pace now. More costs have been identified and will be updated for January'saccounts.

6. Primary Care. Due to the use of bank staff above funded establishment, Primary Care has a budgeteddeficit of £(86)k. The deficit has risen from Month 8 and is due to the costs of additional staffing. 7. CEO. This budget has a deficit to budget of £(231)k due to additional costs of pay, expenditure with ORHand some legal costs.

£(6.2)mActual DeficitItem 3 £(0.4)m

Item 8i.

5

Executive Summary of performance – December 2016 continued (2 of 3)

Income Income in total shows a favourable variance in M9. The income for M9 was £21.2m on a budget of £20.5m, soa favourable variance of £0.7m.1. CCG contracted Income is lower than budget in Emergency Operations for the month of December, by asmall £30k deficit. RAP income needs to be verified by CCGs and then the Trust will invoice for payment.Income due to additional activity increased in December so the ytd total increased to £1.8m in EmergencyOperations with another £0.2m in PTS, so £2.0m in total.2. CQUIN. The Clinical Hub CQUIN is for 80% of the full CQUIN value at £3.9m. We have accrued income upto the level of expenditure for the nine months for the Clinical Hub at £2.3m. The National schemes cover theremaining 20% of the CQUIN value and relate to two items. Firstly the Flu vaccinations and then staffwellbeing. We are progressing well on these schemes and £0.3m income has been included in the M9position. more costs have been identified and will be allocated in the January accounts.3. HEE (Health Education East of England). A large proportion of this income will be invoiced on studentnumbers. We have an agreement for funding for 228 SAP students in 2016-17 and we are invoicing HEE onthe schedule of when students are actually starting their courses with us. We also had agreement for £1m ofinfrastructure costs which has been paid. This gives a slight surplus position for HEE with £2.5m incomecurrently included in our financial position. We anticipate to break even on this matter. 4. NES has additional non-contracted income in December for ECRs. NES therefore has £0.6m favourablevariance on income ytd. This should cover the additional cost of this activity but the PAS and taxi costs arecurrently exceeding the income achieved leading to the £0.5m deficit to budget position.

Expenditure Deficit to Budget

Item 5

Income Surplus to BudgetItem 4

Expenditure was £(21.6)m for December 2016. This was against the budget of £(20.0)m, so a significant £(1.6)m adverse variance. The items contributing to this position are described at Item 3 above. Additional PAS, overtime and frontline agency staff remain the main contributing factors to the adverse variance position to plan for the Trust. Additional PAS continues in Emergency Operations, but has been reduced and is more controlled since 1 December when the 5 month mini tender ended. The RAP income is not covering all costs so CIPs have become more critical, and recent progression on CIPs has been reasonable. Trust performance for December means the Trust is eligible for a proportion of the RAP income for the quarter and this is in verification mode with the CCGs prior to the Trust issuing invoices. The income has been accrued into the position. Performance is monitored constantly to make sure the Trust has the best chance possible of gaining the income available, and costs are under heavy scrutiny to make sure the Trust receives the best possible value for money that it can.

£(1.6)m

£0.7m £6.6m

£(14.4)m

Item 8i.

6

Executive Summary of performance – December 2016 continued (3 of 3)

Overall the Trust's Statement of Financial Position remains stable. NHSI have changed the ratio that they lookat from "Financial Sustainability Risk Rating" ratio to "Use of Resource" metric, as a result of the SingleOversight Framework being published. This metric is rated out of 4, 1 being the highest score and 4 being thelowest score. The Trusts Use of Resource rating remains at 3 YTD and Forecast. There are some movements in current assets notably in cash (see below) and current liabilities compared tothe plan, however other than cash none of these are considered a major risk.

CashItem 7

Cash balances stand at £6.0m which is below plan. Cash is being reviewed continually and the followingsteps are in place to maximise our cash balance: reduce pay runs to two weekly (to be timed so afterreceiving SLA income from CCG), review non urgent capital work & increase our current efforts in creditcontrol. Cash management steps are continuing.Capital expenditure increased by £426k for the month to £1,670k YTD. This is behind plan however this is dueto temporary delays and it is forecast that we will meet our CRL of £7.2m.

Our forecast has increased from £7.1m to £7.2m as a result of securing additional funds from the DoH formental health street triage vehicles for the Bedfordshire multi-agency project. This is a 2 year scheme totally£200k.The forecast for December has increased for the year to a deficit of £(10.6)m. The Performance and FinanceCommittee met on 11 January to consider the forecast for the Trust and the key data return to NHSI on 17January has included the new forecast for a £(10.6)m deficit. The Trust still has an appeal outstanding withregulators which requests factors be considered that are outside the control of the Trust when calculating RAPincome due from CCGs. The forecast position will be altered if there is a positive outcome to this appeal. Theoriginal plan for the Trust was set for the control total target from NHSI for a surplus of £1.5m. The deficit tothis plan is down to the additional expenditure on additional resource towards the RAP comprising of costsincurred between April-December and those forecast for January to March 2017. The income for Quarters 1 &2 and the income due for quarter three is included in the overall position. A further risk remains for the Trustdue to the challenging £6.7m CIP target for the Trust. This target was set after reducing all budgets whereverpossible from last year and recently progress has been good up to M9 with achievement of £4.0m against thenine month target of £4.9m. The Trust is now part of the NHSI FIP (Financial Improvement programme) andSSG Health have commenced work on CIP identification with the Trust. With the Trust currently focusing allpossible resource towards front line operations, there is a risk that other work, such as CIP progress may slipbehind target.

As mentioned above, The Trust has a significant CIP target of £6.7m for the 2016-17 financial year, butfollowing the meeting of 20 October progress was good with additional work streams coming on line whichachieve additional savings for the Trust. SSGHealth have now started work at the Trust and it is hoped theywill identify opportunities to push CIP achievement further.

£4.9mCost Improvement

PlansItem 10

£4.0m

CapitalItem 8

Financial RisksItem 9

Statement ofFinancialPositionItem 6

Item 8i.

7

Key Financial Metrics

Plan Actual Variance Plan Actual Variance Plan Forecast Variance£000 £000 £000 £000 £000 £000 £000 £000 £000

Surplus 494 (417) (911) 1,621 (6,212) (7,833) 1,500 (10,624) (12,124)

Suppliers paid within 30 days - NHS 95% 62% (33%) 95% 86% (9%) 95% 95% 0%Suppliers paid within 30 days - Non NHS 95% 90% (5%) 95% 89% (6%) 95% 95% 0%

3 3

FY 2016/17

Supplier Days (No. Invoices paid)

Financial Sustainability Risk Rating

Month 9 - December 2016Description

Year to Date

(7,000,000)

(6,000,000)

(5,000,000)

(4,000,000)

(3,000,000)

(2,000,000)

(1,000,000)

0

1,000,000

2,000,000

3,000,000

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Operating Surplus

2016-17 Actual 2016-17 Plan

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17

Cash Balance

2016-17 Actual 2016-17 Plan

Item 8i.

8

2. Statement of Comprehensive Income

Plan Actual Variance Plan Actual Varianceg

Plan Current Plan Forecast Variance£000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Income20,014 19,899 (115) Revenue from patient care activities 175,331 176,084 753 229,888 233,558 234,564 1,006

437 1,266 829 Other Operating revenue 3,950 9,803 5,853 5,009 5,259 13,116 7,85720,451 21,165 714 179,281 185,887 6,606 234,897 238,817 247,680 8,863

Operating Expense(14,759) (14,892) (133) Pay (131,042) (132,103) (1,061) (169,523) (175,365) (178,537) (3,172)(4,599) (5,667) (1,068) Non Pay (41,234) (54,060) (12,826) (56,696) (54,774) (71,987) (17,213)

(19,358) (20,559) (1,201) (172,276) (186,163) (13,887) (226,219) (230,139) (250,524) (20,385)

1,093 606 (487) 7,005 (276) (7,281) 8,678 8,678 (2,844) (11,522)5.3% 2.9% (68.2%) EBITDA margin 3.9% (0.1%) (110.2%) 3.7% 3.6% (1.1%) (130.0%)

Depreciation & Financial(495) (507) (12) Depreciation (4,454) (4,583) (129) (5,938) (5,938) (6,100) (162)(100) (125) (25) PDC Dividend (900) (925) (25) (1,200) (1,200) (1,225) (25)

4 6 2 Financing Income 38 23 (15) 50 50 18 (32)(8) (8) 0 Financing Costs (68) (68) 0 (90) (90) (90) 0

0 (389) (389) Other Gains & Losses 0 (383) (383) 0 0 (383) (383)(599) (1,023) (424) (5,384) (5,936) (552) (7,178) (7,178) (7,780) (602)

494 (417) (911) 1,621 (6,212) (7,833) 1,500 1,500 (10,624) (12,124)2.4% (2.0%) (127.6%) 0.9% (3.3%) (118.6%) 0.6% 0.6% (4.3%) (136.8%)

Net Surplus/(Deficit)


FY 2016/17

Subtotal

Subtotal

EBITDA

Subtotal

Year to Date

Item 8i.

9

3. Divisional Expenditure

Divisional Expenditure

Plan Actual Variance Plan Actual Variance Original Plan Current Plan Forecast Variance£000 £000 £000 £000 £000 £000 £000 £000 £000 £000

Service Delivery10,584 11,804 (1,220) Emergency Operations 95,326 108,039 (12,713) 127,059 127,073 144,473 (17,400)1,417 1,483 (66) EOCs 12,748 13,266 (518) 17,011 17,000 17,843 (843)

702 680 22 Special Operations 6,424 6,436 (12) 8,322 8,531 8,538 (7)1,483 1,604 (121) Patient Transport 12,902 13,977 (1,075) 13,662 17,352 18,903 (1,551)

32 50 (18) Primary Care 285 381 (96) 378 380 483 (103)14,218 15,621 (1,403) 127,685 142,099 (14,414) 166,432 170,336 190,240 (19,904)

Support Services204 210 (6) Chief Executive 1,874 2,106 (232) 2,616 2,487 2,783 (296)252 556 (304) Financial 2,303 2,479 (176) 2,926 3,061 3,247 (186)73 75 (2) Commercial Services 683 657 26 1,087 904 849 55

3,241 3,204 37 Strategy & Sustainability 28,807 28,647 160 38,652 38,544 38,297 247230 343 (113) Workforce & OD 2,053 2,404 (351) 2,754 2,742 3,684 (942)732 727 5 Patient Safety 6,476 6,474 2 8,578 8,672 8,879 (207)602 640 (38) Depreciation 5,391 5,575 (184) 7,228 7,198 7,415 (217)99 0 99 CQUIN - National 295 16 279 1,074 591 136 455

470 212 258 CQUIN - Clinical Hub 2,428 1,665 763 0 3,882 2,792 1,090(217) 0 (217) Unallocated CIP (1,600) 0 (1,600) (2,600) (2,250) 0 (2,250)

57 0 57 Trust Reserves 1,303 0 1,303 4,700 1,200 0 1,2005,743 5,967 (224) 50,013 50,023 (10) 67,015 67,031 68,082 (1,051)

19,961 21,588 (1,627) 177,698 192,122 (14,424) 233,447 237,367 258,322 (20,955)

20,455 21,171 716 Income Memorandum 179,319 185,910 6,591 234,947 238,867 247,698 8,831

494 (417) (911) 1,621 (6,212) (7,833) 1,500 1,500 (10,624) (12,124)

Month 9 - December 2016 Description

Net Position Memorandum

FY 2016/17

Subtotal

Support Services (inc. Reserves)

TOTAL

Year to Date

Item 8i.

10

4. Statement of Financial Position

Statement of Position

Mar-16 Oct-16 Nov-16 Dec-16Actual Actual Actual Actual Plan Variance %£000 £000 £000 £000 £000 £000

Non Current AssetsProperty, Plant & Equip 45,715 42,990 42,883 42,729 46,024 (3,295) (7.16%)Investment Property 880 880 880 880 880 0 0.00%Trade & Other Receivables 0 0 0 0 0 0

46,595 43,870 43,763 43,609 46,904 (3,295) (7.02%)Current Assets

Inventories 1,305 1,204 1,173 1,159 1,875 (716) (38.19%)Trade & Other Receivables 20,488 23,821 18,831 18,569 18,326 243 1.33%Cash & Cash Equivalents 17,015 3,910 8,025 6,038 17,435 (11,397) (65.37%)

38,808 28,935 28,029 25,766 37,636 (11,870) (31.54%)

85,403 72,805 71,792 69,375 84,540 (15,165) (17.94%)

Current LiabilitiesTrade & Other Payables (30,652) (22,684) (23,170) (21,183) (30,000) 8,817 (29.39%)Provisions (1,122) (2,177) (2,112) (2,100) (1,750) (350) 20.00%

(31,774) (24,861) (25,282) (23,283) (31,750) 8,467 (26.67%)

53,629 47,944 46,510 46,092 52,790 (6,698) (12.69%)Non Current Liabilities

Provisions (5,061) (3,736) (3,736) (3,736) (4,250) 514 (12.09%)(5,061) (3,736) (3,736) (3,736) (4,250) 514 (12.09%)

48,568 44,208 42,774 42,356 48,540 (6,184) (12.74%)

Financed by Taxpayers EquityPublic Dividend Capital 64,591 64,591 64,591 64,591 64,591 0 0.00%Retained Earnings (16,441) (20,794) (22,227) (22,642) (16,530) (6,112) 36.98%Revaluation Reserve 1,831 1,823 1,823 1,820 1,892 (72) (3.81%)Other Reserves (1,413) (1,413) (1,413) (1,413) (1,413) 0 0.00%

48,568 44,207 42,774 42,356 48,540 (6,184) (12.74%)

Dec-16

Total Non Current Assets

Total Assets Employed

Total Taxpayers Equity

Total Current Assets

Total Assets

Net Current LiabilitiesNon Current Assets plus/less current assets/Liabilities

Total Non Current Liabilities

Item 8i.

11

5. Cash Flow Statement

YTD Move YTD Plan VarianceOct-16 Nov-16 Dec-16 Dec-16 Dec-16 Dec-16Actual Actual Actual£000 £000 £000 £000 £000 £000

5,200 3,910 8,025 17,015 17,015 0

Operating Surplus (1,367) (573) 98 (4,859) 2,477 (7,336)(Increase)/decrease in current assets 237 4,276 276 790 1,079 (289)(Increase)/decrease in current liabilities (656) 1,250 (3,196) (7,183) 482 (7,665)(Increase)/decrease in provisions 0 (65) (12) (347) (1,005) 658

(1,786) 4,888 (2,834) (11,599) 3,033 (14,632)

Returns on investments and servicing finance 0 (2) 6 23 45 (22)Depreciation & amortisation 506 507 507 4,583 4,221 362Capital Expenditure (10) (678) (915) (4,642) (6,372) 1,730Impairments and reversals 0 0 0 0 0Proceeds from disposal of plant, property and equipment 0 0 649 658 0 658Dividend paid 0 (600) 600 (507) 507

496 (773) 847 622 (2,613) 3,235

Movement (1,290) 4,115 (1,987) (10,977) 420 (11,397)

3,910 8,025 6,038 6,038 17,435 (11,397)Closing Cash Balance

In Month Movement

Opening Balance

Cash inflow/outflow from operating activities

Cash inflow/outflow from financing

Item 8i.

12

6. Capital Expenditure


Capital Expenditure48 192 (144) IT Projects 431 229 202 575 414 161

273 855 (582) *1 Make Ready Projects 2,456 1,042 1,414 3,275 2,182 1,093150 22 128 *2 Other Building Projects 1,350 269 1,081 1,800 1,202 59871 0 71 Plant & Equipment Projects 639 50 589 850 458 392

500 0 500 *3 Transport Projects 1,500 723 777 2,000 1,521 4790 0 0 General Reserve 0 0 0 0 2,135 (2,135)

1,042 1,069 (27) 6,376 2,313 4,063 8,500 7,912 588

Asset Disposals (NBV)0 (684) 684 General 0 (684) 684 0 (684) 6840 (684) 684 0 (684) 684 0 (684) 684

1,042 385 657 6,376 1,629 4,747 8,500 7,228 1,272

*Key projects within category include:*1 Stevenage Ambulance Station £1.6m - purchase of new building to create Make Ready facility. Spend forecast Sept 16 - Jan 17.*2 Bulk Fuel sites installation £0.9m - project c/fwd from 2016/15: Southend, Stevenage & Luton.*3 HART Vehicle replacement £1.6m - revised down, due to national procurement process, from the original estimate of £2m

Depreciation


109 114 (5) IT 981 1,034 (53) 1,308 1,376 (68)79 80 (1) Land & Buildings 705 721 (16) 939 960 (21)3 2 1 Fixtures & Fittings 28 23 5 37 30 7

283 301 (18) Plant & Equipment 2,545 2,718 (173) 3,393 3,621 (228)22 10 12 Transport 196 87 109 261 110 151

496 507 (11) 4,455 4,583 (128) 5,938 6,097 (159)

FY 2016/17

Subtotal

Subtotal

Net Capital Expenditure

Month 9 - December 2016 Description Year to Date

Plan and Forecast Variance: A review of asset lives will be carried out over the coming month, to ensure assets are depreciated over the correct term.

Total

Current month and YTD transactions: The asset swap relating to the depots in Chelmsford, Coval Lane and Lawnside was completed this month. This involved the disposal of Coval Lane plus £150k cash. IT costs relating to the completed Virtual Telephony project of £160k were invoiced from BT. HART vehicles are now due to be delivered in February, spend is therefore delayed.


Year to Date FY 2016/17

Plan and Forecast Variance: The revised completion date for Stevenage has resulted in a delay in spend and forecast spend compared to budget. The forecast expenditure includes and a £500k purchase of land for a make ready site at Hinchingbrooke. General reserve remains high at £2.1m. CPMG have a potential £180k to approve and have requested new capital bids to be presented to the January meeting.

Item 8i.

13

7. Workforce Information

Plan Contract PaidWTE WTE WTE

Service DeliveryA&E 3,010 2,856 3,259HEOCs 468 450 475Special Operations 127 123 137Patient Transport 479 402 456Primary Care 32 26 34

4,116 3,857 4,361

Support ServicesChief Executive 33 31 32Finance 33 27 27Commercial Services 37 28 36Strategy & Sustainability 121 105 118Workforce & OD 40 36 36Patient Safety 138 118 121CQUIN 0 35 39

402 380 409

4,518 4,237 4,770TOTAL

DescriptionMonth 9 - December 2016

Subtotal

Support Services

Item 8i.

14

8. Trust Cost Improvement Programme

2016-17 CIP SCHEMES - Current Progress - Dec 2016

Proposed CIP SchemeOriginal

Revised Plan £000

CurrentRevised

Value£000

CurrentRAG

Rating

Planned Target YTD

Achieved YTDVariance to

Plan YTD

Achieved & Banked for

2016/17R / NR Comments

Sickness Management 1,000 1,000 750 442 -308 442 R To be delivered through a reduction in A&E sickness levels.

Income - Additional PTS and Commercial Services opportunities

200 200 114 114 0 200 RAdditional contribution associated with the retention of the Cambs & Peterborough CCG PTS Contract

Southend Dilapidations Savings 0 0 0 80 80 80 NR

Productivity CIP 1,000 1,000 750 1,000 250 1,000 NRTo be achieved through overactivity (income) delivered with no additional expenditure.

Supplies Expenditure 400 0 300 0 -300 0 RManagement of Controlled Drugs 100 100 75 0 -75 0 RMedicines Management Project 0 0 0 756 756 756 R Reduction from downscaling scopeTelephone / Mobile Usage 100 100 75 0 -75 0 RReview of IT Equipment Purchases 200 200 150 75 -75 75 RIT Cost Recovery 0 0 0 169 169 223 NR VAT recovery on prior year expenditureBulk Fuel Use / Cease Purchase of Premium Rate Fuel

200 200 150 0 -150 0 R

Unsocial / On-call / Mgrs Overtime 400 400 300 0 -300 0 R

Training Efficiencies 500 500 375 54 -321 54 NRUniforms 0 0 0 62 62 62 RStock Control 0 400 0 400 400 400 RSale of Surplus Medical Equipment 0 50 0 9 9 9 NRVarious Fleet Projects 0 49 0 141 141 151 RFleet Operating Leases 0 500 0 250 250 250 NRLine-by-line Review of Budgets 2,600 2,001 1,950 450 -1,500 450 NR

TOTAL 6,700 6,700 4,989 4,002 -987 4,152 -

£ £5,500 R 2,086

0 NR 2,0661,200 4,1526,700

R / NR Totals -Actuals 16/17RAG TOTALS

Item 8i.

15

Month 9 Forecast Report The Trust forecast has been restated at Month 9 for a deficit stated at £10.6m. An increase from the previously reported £(6.2)m. This decision has been ratified at the Performance and Finance Committee held on 11 January 2017. This figure has been reported to NHSI via the key data return submitted on 17 January 2017.

Decisions concerning the appeal on the RAP income levels are due to be communicated to the Trust imminently. The outcome of this appeal may alter the forecast deficit.

Item 8i.

16

Appendix 1

Item 8i.

17

Appendix 2

A&E CONTRACT ACTIVITY SCHEDULE

Dec-16

CCG Hear & Treat See & TreatSee Treet &

ConveyTotal

ActivityHear & Treat See & Treat

See Treet & Convey

16-17 TotalActivity

Contract Variance

Contract Variance %

Value

Bedfordshire CCG 1,810 13,004 25,011 39,825 1,989 12,807 25,670 40,466 641 1.61% £128,971Luton CCG 1,508 7,576 15,037 24,121 1,591 7,734 15,188 24,513 392 1.63% £87,620

Bedfordshire Cluster Total 3,318 20,580 40,048 63,946 3,580 20,541 40,858 64,979 1,033 1.62% £216,591East and North Hertfordshire CCG 2,304 16,520 33,099 51,923 2,368 16,460 33,301 52,129 206 0.40% £46,045Herts Valleys CCG 2,417 17,257 31,756 51,430 2,400 16,605 32,662 51,667 237 0.46% £52,974

Hertfordshire Cluster Total 4,721 33,777 64,855 103,353 4,768 33,065 65,963 103,796 443 0.43% £99,019Beds & Herts Total 8,039 54,357 104,903 167,299 8,348 53,606 106,821 168,775 1,476 0.88% £315,610

Cambridgeshire and Peterborough CCG 4,064 29,624 55,140 88,828 4,240 29,576 55,909 89,725 897 1.01% £193,736Cambridgeshire Cluster Total 4,064 29,624 55,140 88,828 4,240 29,576 55,909 89,725 897 1.01% £193,736

Great Yarmouth & Waveney CCG 1,152 11,509 16,914 29,575 1,287 11,418 17,959 30,664 1,089 3.68% £229,890North Norfolk CCG 705 6,656 12,233 19,594 759 6,194 12,915 19,868 274 1.40% £45,766Norwich CCG 1,150 8,978 16,268 26,396 1,202 8,248 15,307 24,757 -1,639 -6.21% -£226,873South Norfolk CCG 940 8,461 15,116 24,517 1,054 8,182 15,536 24,772 255 1.04% £42,748West Norfolk CCG 824 7,145 13,559 21,528 819 6,996 13,598 21,413 -115 -0.53% -£25,705

Norfolk Cluster Total 4,771 42,749 74,090 121,610 5,121 41,038 75,315 121,474 -136 -0.11% £65,827Ipswich and East Suffolk CCG 1,383 14,398 24,938 40,719 1,616 14,207 25,305 41,128 409 1.00% £68,565West Suffolk CCG 963 8,472 14,398 23,833 876 8,656 14,208 23,740 -93 -0.39% -£20,787

Suffolk Cluster Total 2,346 22,870 39,336 64,552 2,492 22,863 39,513 64,868 316 0.49% £47,777Norfolk, Suffolk & Cambridgeshire Total 11,181 95,243 168,566 274,990 11,853 93,477 170,737 276,067 1,077 0.39% £307,340

North East Essex CCG 1,834 13,488 24,198 39,520 2,102 13,328 23,941 39,371 -149 -0.38% -£33,304Mid Essex CCG 1,913 13,518 22,648 38,079 1,918 13,473 24,059 39,450 1,371 3.60% £250,566West Essex CCG 1,446 9,551 18,867 29,864 1,498 10,372 19,042 30,912 1,048 3.51% £208,265

North Essex Cluster Total 5,193 36,557 65,713 107,463 5,518 37,173 67,042 109,733 2,270 2.11% £425,526Basildon and Brentwood CCG 1,314 8,357 17,021 26,692 1,382 8,474 18,101 27,957 1,265 4.74% £248,945Castle Point and Rochford CCG 917 6,455 11,213 18,585 969 6,121 11,745 18,835 250 1.35% £55,880Southend CCG 1,313 8,884 14,409 24,606 1,326 8,555 15,386 25,267 661 2.69% £147,747Thurrock CCG 995 5,047 8,856 14,898 999 5,306 10,011 16,316 1,418 9.52% £258,221

South Essex Cluster Total 4,539 28,743 51,499 84,781 4,676 28,456 55,243 88,375 3,594 4.24% £710,794Essex Total 9,732 65,300 117,212 192,244 10,194 65,629 122,285 198,108 5,864 3.05% £1,136,320

TOTAL 28,952 214,900 390,681 634,533 30,395 212,712 399,843 642,950 8,417 1.33% £1,759,270

TRUE TRUE TRUE TRUE TRUE

Contracted Activity Actual Activity

Item 8ii.

Page 1 of 2

Report Title: Quality Governance Committee

Report Author(s): S Brown Director of Nursing & Clinical Quality

Sponsoring Director: Tony McLean Non-Executive Director

Purpose:


Executive Summary: CARE QUALITY COMMISSION UPDATE The action plan was progressing and progress has been made uploading evidence onto the existing systems (HealthAssure) and this will enhance compliance with the CQC obligations. The HealthAssure system has been aligned to the CQC action plan. The quality review programme recommenced and will continue throughout the year. SERIOUS AND ADVERSE INCIDENT REPORT The Committee were informed that although there had been a large rise in Serious Incidents, having increased for the same period the previous year, this could be a symptom of a more robust reporting process and a culture in which staff were more aware of the benefits of reporting such occurrences. There was a concern regarding delays with regards to increasing demands and hospital handover. This has been raised as an issue to the regulators and commissioners. The concern regarding the level of adverse incidents was highlighted and the risk team were working with operational colleagues to resolve. The risk team have been listing the incidents and resolving the simplistic incidents. CQUIN The projects are progressing well. This includes hear and treat, Flu and wellbeing. Surge Plan The revised Surge Plan was presented, with changes reflecting agreement between the operational and clinical directorates. Infection Prevent and Control There was an on-going concern raised with regard to deep cleaning of vehicles. There has been some improvement but this still requires some scrutiny. The real time audit system is now in place and will give more timely results on progress. Terms of Reference The Terms of Reference were reviewed with minor changes.


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KEY MESSSAGES AND RISKS IDENTIFIED Healthassure process progressing Effective QIA process for CIPs in place Identified work being carried out on the reasons behind RIDDOR non-compliance ECAT working well but a briefing paper required at the next meeting Surge plan review undertaken. IP&C; PTS deep cleans still requires work to provide assurance to the committee. The ePCR project to recommence to reduce the risk of utilising paper PCRs


N/A

Action Required by the Board: For Noting.

Previously Considered By and Recommendation(s) Made: N/A.




• Commence implementation of the Trust’s Remedial Action Plan.

• Commence Implementation of a Revised Operating Model including a new Clinical Career Pathway.

• Continue to roll out the Trust’s Quality Strategy. Shaping our Future • Create a stable Executive Leadership Team.

• Develop a Trust Strategy for approval by end of Quarter 1 to be followed by supporting Strategies for Workforce, IM&T, Fleet, Finance and Estate for approval by end of Quarter 3.

• Exploit all Collaboration Opportunities including engaging in all Vanguard Projects.

Creating a Positive and Engaging Culture • Undertake a Cultural Audit and Embed our Vision and Values. • Implement Staff Leadership Development and Aspiring

Manager Programmes. • Develop and implement a Staff Retention Plan. • Roll out a Staff Engagement Plan.


Health and Social Care Act 2012 (regulated activities) Regulations 2009 – Regulation 9 (Outcome 4) and Regulation 10 (Outcome 16).

Item 8iii

Page 1 of 2

Report Title: Report from Chair of Finance and Performance Committee

Report Author(s): Peter Kara Chair of Performance and Finance Committee


Purpose:


Executive Summary: The meeting discussed financial and operational performance, workforce matters and IM&T projects, as well as reviewing its terms of reference and agenda plan.

The fundamental issue faced by the Trust of under-performance against budget and agreed targets, and the associated risks arising therefrom, were interrogated in depth.

At a further meeting on the 11th of January, the Committee were updated on the latest figures and progress (or lack thereof) on the RAP mediation and sought assurance on the viability of the projected deficit.

A useful presentation was also made by SSG on the potential for performance and financial improvement following their initial review, and a report, following discussions with management, will be presented to the next P&F meeting evidencing implementation and improvement initiated with their help.


N/A

Action Required by the Board: The Trust Board are asked to note the report.

Previously Considered By and Recommendation(s) Made: N/A







• Develop a Trust Strategy for approval by end of


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Quarter 1 to be followed by supporting Strategies for Workforce, IM&T, Fleet, Finance and Estate for approval by end of Quarter 3






Item 8iv.

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Report Title: Report from the Chair of the Audit Committee

Report Author(s): Dean Parker Chair of Audit Committee


Purpose:


Executive Summary:

The Audit Committee held its latest meeting on 7 December 2016. Key issues discussed at the meeting were as follows: 1) Board Assurance Framework (BAF) – The Committee reviewed the latest version of the BAF and

agreed that it should be refreshed and put into a new format for the January Board meeting. The Committee also noted the role of the Senior Leadership Board in risk management going forward. The Committee also received a deep dive presentation from the Director of People and Culture on SR2a “failure to create and embed a culture of performance and accountability”.

2) Internal Audit – the Committee received the report on IT Change Management and noted that it had received Limited Assurance. The Committee received assurance from the Director of Strategy and Sustainability that actions are in hand to deal with the weaknesses identified. The Committee also received a report in response to a request from NHS Improvement for assurance over the Trust’s monthly financial reporting procedures. The Committee was pleased to note that the report had not identified any significant weaknesses in our procedures.

3) Freedom of Information Act requests – the Committee received a report detailing the number and trends in Freedom of Information requests received by the Trust. It was agreed that the Committee will continue to monitor trends in this area going forward.


None

Action Required by the Board: To note this report.

Previously Considered By and Recommendation(s) Made: None.





• Commence Implementation of a Revised Operating


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Model including a new Clinical Career Pathway • Continue to roll out the Trust’s Quality Strategy

Shaping our Future • Create a stable Executive Leadership Team • Develop a Trust Strategy for approval by end of

Quarter 1 to be followed by supporting Strategies for Workforce, IM&T, Fleet, Finance and Estate for approval by end of Quarter 3






None

Item 8v

Page 1 of 2

Report Title: Remuneration Committee Report

Report Author(s): Valerie Morton Non-Executive Director


Sarah Boulton Chair

Purpose:


Executive Summary:

The Remuneration and Terms of Service Committee met formally on 10th January 2017. The substantive item discussed related to a potential employment tribunal case including the learnings for EEAST. In consideration of current Trust priorities it was agreed that the future role and remit of the committee should be discussed at a future meeting.


Action Required by the Board:














25 JANUARY 2017 AGENDA ITEM 8v

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Item 9.

Page 1 of 2

Report Title: Strategic Priorities / Strategy on a Page

Report Author(s): Wayne Bartlett-Syree Sponsoring Director:

Wayne Bartlett-Syree, Director of Strategy and Sustainability

Purpose:


Executive Summary:

Urgent and Emergency care systems are under enormous and increasing pressure. This pressure is not unique to urgent and emergency care, the whole NHS is facing a considerable challenge in achieving the triple aim of improved health and wellbeing, transformed quality of care delivery, and sustainable finances. This year we have already seen our busiest day ever, where we treated over 4000 people. Despite the increase in the number of patients we have made significant improvement in moving towards achieving key performance targets, treating more of our sickest patients within the 8 min target than ever before. Unfortunately, for the first time in a number of years the trust will end the year with a significant financial deficit. All of this clearly demonstrates that as a trust we are not immune to wider pressures across the NHS. Over the past 12-18 months a considerable amount of work has taken place to create a stable leadership team. This team has the unenviable task of helping navigate the Trust through what is going to be a significantly challenging period in the NHS. The leadership team has already started on this journey, with the development of the trust vision and values that will underpin the strategic priorities for the next 2 years. We have also overseen the establishment of the new operating model, whereby we have introduced the Emergency Call and Triage service to treat more patients at the point of their call. We now need to build on these successes and create the stable platform for the trust to advance and succeed as part of a sustainable NHS. The development of the strategic priorities has been achieved through consultation with Board members, members of the executive and senior leadership teams. In addition, in parallel with the cultural audit focus groups have been undertaken with staff around the region. A number of 1:1 conversations with a wide range of internal and external stakeholders. For the next 2 years the trust will have 5 strategic objectives that align to the trust vision and values. These 5 strategic objectives will be achieved through the delivery of 19 key priorities. The overall outcome of these priorities will enable the Trust to be in a stable position in terms of our ability to balance deliver of Quality, Finance and Performance.


There are few key issues that pose a risk to the delivery of the strategic priorities

1. There is currently not the operating environment that allows the time and space for transformation to occur, something


25 JANUARY 2017 AGENDA ITEM

Item 9.

Page 2 of 2

that is not unique to this trust. 2. We currently do not have the any portfolio or

transformational project management capability to support the delivery of the objectives.

3. The 2017/19 contract has not yet been agreed therefore we do not know the financial envelope or the required levels of performance that we are required to deliver.

Action Required by the Board: The Board are asked to consider and adopt the 5 strategic objectives and 19 key priorities for the Trust in line with previously agreed vision and values.

Previously Considered By and Recommendation(s) Made: The Trust Board and Executive Leadership Board have provided feedback on the draft elements of the strategic objectives along with the feedback from other stakeholder engagement.

Related Trust Strategic Objective(s):

Sub-Objective(s):











Adoption of the strategic objectives will support the trust in the well lead domain of the NHS I/CQC Single Oversight framework.

Strategic Objectives 2017-2019Strategic Objectives 2017-2019

Responsive High Quality Care Responsive High Quality Care

Mision Mision

Values Values

Strategic Objectives

Strategic Objectives

Key Priorities

Key Priorities

To Provide a safe and effective healthcare service to all of our communities in the East of England

TeamworkTogether as one we work with Pride and commitment to achieve our vision

Quality We Strive to Consistently

achieve high standards through continuous

improvement

Care We value warmth,

empathy and compassion in all our relation ships

Honesty We Value a culture that has trust integrity and transparency at the centre of everything we do.

Respect

We Value individuals including our patients,

our staff and our partners in every interaction

Putting into place a

new Responsive operating model to deliver sustainable performance and improved outcomes for patients .

Maintaining the focus on delivering

Excellent high quality care to the patients

Guarantee we have

a Patient Focused and engaged workforce

Delivering

Innovative

solutions to ensure we are an efficient, effective and economic Service

Playing our part in the urgent and emergency care system being

community focused in delivering the 5yr forward view

1) Establish an efficient and effective operational delivery structures

2)Improve our ability to Forecast and Plan for the best utilisation of our staff (UHP)

3)Put into the place the operational delivery of the new operating model

4)Introduction of ARP (subject to national sign off)

8)Deliver a recruitment and retention plan that ensures a suitably skilled and competent workforce is available to deliver the new operation model

9) Deliver innovative ‘whole person’ wellbeing approaches to ensure the physical, mental and social wellbeing of our people

10) Develop a supportive and inclusive culture to match the vision and values of the organisation

11)Undertake a Fleet transformation project that delivers an efficient utilising the latest innovation to support the delivery of the new model

12) Have “Make Ready” implemented across the trust

13) Review EOC function and delivery model to create a future proof environment

14) Provide an “Agile” working environment that meets the demands of a modern mobile health care provider

15) Deliver a sustainable CIP/FIP programme creating efficiencies not only short term saving but longer financial stability

17) Continue the active engagement with staff and external stakeholder to gain support for the organisation and sees EEAST as a valuable local service.

18) Work with urgent and emergency care systems to increase our use of /availability of alternative care pathway (see and treat/ See and refer)

19) Increase the benefit of our volunteers include CRF, armed forces and

blue light collaboration

5) Continued delivery of the quality and safety strategy establishing the quality framework to support organisational delivery 6)Deliver the statutory requirements associated with CQC regulation including the completion of the CQC Action Plan

7)Undertake reviews of clinical practice and outcomes in order to address unwarranted variation

OUR MISSION REMAINS

THROUGH CONTINUED EMBODIMENT THE CORE VALUES OF

WE WILL ACHIEVE OUR PRINCIPLE VISION

DELIVERING THE KEY PRIORITIES FOR THE NEXT 2 YEARS.

Item 10.

Page 1 of 6

Report Title: International Recruitment Update

Report Author(s): Rebecca Lancaster Recruitment Project Support Officer


Lindsey Stafford-Scott Director of People and Culture

Purpose:


Executive Summary: The Trust has challenging recruitment targets for paramedics against a backdrop of a UK shortage of qualified paramedics. This paper seeks to provide an update and assurance to the Trust Board that the necessary steps are being taken to explore the international market as a source of qualified staff.


Action Required by the Board: For noting

Previously Considered By and Recommendation(s) Made: Executive Leadership Board has considered this paper and agreed to continue to explore international recruitment options.


Sub-Objective(s):










25 JANUARY 2017 AGENDA ITEM 10.

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All recruitment will be carried out in accordance with NHS and legislative requirements

Background In partnership with Hays Recruitment, 12 representatives from EEAST travelled to Warsaw and carried out assessment days for fully qualified Paramedics on 25th and 26th November 2016. Hays are an experienced international recruitment agency who have previously carried out similar recruitment weekends with South Central Ambulance Service. Over the two days, 14 candidates attended Hays office in Warsaw. The candidates undertook the following assessments- • Interview - Panel made up of one Polish speaking member of staff and one Education and Training

Officer. • Clinical Assessment - Made up of an ECG Recognition test, practical sling assessment and Whole

Patient Care Episode. All assessed by the ETO. • Driving Assessment - Practical driving assessment in a larger vehicle. Assessed by either a member

of the Trust’s DTU team or a driving assessor provided by Hays.

Summary of Candidates From these assessments the panels determined that 5 of the 14 were definitely not suitable for employment with EEAST at this time. This was either due to English language ability, clinical skills, experience or a combination of these elements. The Trust has made 9 offers of employment. These 9 candidates have a variety of different experience levels, skill levels and qualifications. Some have very recently qualified and therefore lack practical experience, others who have been practicing for longer still have a very different level of experience in comparison to UK trained Paramedics. There are significant differences in how Paramedics practice in Poland, many are hospital based or are paired on frontline vehicles with higher clinical grades of staff such as Doctors. For these reasons, it was considered that the planned international induction course was not adequate for many of the candidates. Some have a lot of potential to operate as Paramedics for the Trust but would need further support before they could work autonomously. A more robust program has been drafted to support these individuals. Observations on the service provided by Hays • It was hoped that we would be able to see more candidates over the weekend than we did and we

had the resources to see up to 18 candidates per day but saw just 15 in total and were nto aware of that prior to attending.

• 5 candidates did not attend despite booking in for a timeslot. We know Hays had awareness that at least one of these had been a previous no show for SCAS.

Item 10.

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• These low numbers could be due to other Ambulance Trusts having exhausted the market previously. For example we know that SCAS have made several trips out to Warsaw already and have an established training program up and running for successful candidates.

• Several of the candidates that did attend have previously been shortlisted and/or interviewed by SCAS. One individual already had a place secured on a training course with them.

• Hays attraction methods are largely centred on their job boards and it may be that they are not reaching the optimum number of people.

• Although we know the candidates that did attend travelled significant distances, holding recruitment in an alternative location to Warsaw may have attracted better numbers.

• The quality of some of the candidates provided by Hays was questionable. The English level of some was very poor and it brings in to question how stringently Hays assess them before inviting to interview. However, Hays stress that the quality of candidates submitted to EEAST was comparable to those offered to SCAS.

• Since our return we have looked into options to increase the cohort number. For example, Hays had previously mentioned that they would be able to source some Paramedics qualified in Poland who were currently living in the UK but not practicing as Paramedics here. So far they have not been able to source any viable candidates from this.

• We have communicated our areas of disappointment to Hays and have managed to negotiate the agency fee down slightly from 17% to 15% of the starting salary for each individual.

Changes to the Training Plan

As mentioned above we have had to make some changes to the training plan as a result of the level of experience the candidates had. It will now follow the below:-

• 5 weeks initial clinical core course in training school • 6 weeks ops development under mentorship with a PAD • 1 week back in training centre for PAD sign off, any learning plan issues and summative

assessments • 4 weeks Blue Light Driving course • 2 week UK road familiarisation course The initial course is very similar to what was originally predicted in regards to time in the training school. However, there will be a longer period of mentorship and it is expected that some candidates will remain Student Paramedics for longer than originally anticipated. The timescales for this are completion of all competencies (including driving and HCPC registration) within 6 months of employment. Learning and Next Steps Overall we felt the trip was a worthwhile exercise. Although we may only have a small number of candidates, the team that went out to Warsaw learnt a lot from the experience and we will be a more informed customer in the market going forward. The Director of People and Culture was particularly impressed with the professionalism and commitment of all of the staff who took part in the recruitment event. The passion and commitment to quality to source the very best candidates for EEAST was universal. We have not had a wholly positive experience with Hays and now know what we would expect from an agency should we use one in the future. We would also like to consider the possibility of using skype to pre-screen candidates, to get a better idea of clinical knowledge and English Language level prior to them and us being subject to the expense of travelling to interview.

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It is becoming increasingly apparent that there are pools of qualified paramedics in various countries and different approaches we could take to tap in to these as part of our wider recruitment strategy. We are currently exploring several different options to explore these markets- Eastern Europe • From our experiences in Poland we do believe there is potential to source applicants from Eastern

Europe. While it is clear that the pool of qualified Paramedics in Poland has been exhausted to a degree by other services, there are other countries we could explore.

• We had one candidate who had travelled from Lithuania to attend the interviews in November. She

was a strong candidate and her experience more closely matched the role of a Paramedic in the UK. There may be a benefit in exploring Lithuania and also gaining a better understanding of the roles in other Eastern European countries as we believe that roles with slightly differing job titles may be more similar to what we would expect a Paramedic to be in the UK.

• Hays seemed unwilling to explore this but there are other agencies we have met or been in

communication with that may be able to provide a more widespread and bespoke service. For example, Lion Recruitment who have contacts in 15 different countries throughout Europe and are currently looking at several countries outside of the EU as well.

Australia • We have been looking in to recruiting from Australia for some time and have spoken with several

universities regarding the availability and expectations of their Graduate Paramedics. • Many Australian states are currently in a position were only 1 in 4 graduates are able to secure a job

in their home country. Despite the fact that some states will be advertising in the New Year, there is still likely to be a large pool of candidates in the country and other ambulances services have been tapping in to this for some time. There are some challenges associated with employing inexperienced graduates from outside of the EU, with gaining a C1 licence being perhaps the largest obstacle. However, other ambulance services have been able to overcome these.

• We have recently been exploring a possible collaboration opportunity with LAS. They have been

running a recruitment campaign in Australia for a couple of years and have recruited over 450 people, a mixture of graduates and experienced paramedics. They recruit these individuals in country and usually make over 100 offers during each trip. They have claimed that they will not need such large numbers from their planned trip in March, but would like to keep their pipeline open and may be open to working with us on this trip. We have written to LAS shortly to confirm whether or not they wish to collaborate.

• We met recently with a LAS paramedic who has set up his own consultancy for international

paramedic recruitment.. He has a lot of experience in International recruitment, particularly from Australia, and has set up pathways for other ambulances services. We are currently exploring ways in which we could engage with this individual using his knowledge and experience to develop our own direct international recruitment approach.

• A commercial proposal has been circulated by AACE regarding a joint international paramedic

recruitment programme. We have indicated that as a Trust we would be interested in exploring this further.

Budget / Workforce Implications

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• The costs above compare recruitment of Polish Paramedics with current UK Graduate Paramedics. • The larger incentives for UK grads make the cost per appointment higher. However, it is important

to note that they do not all take the full £8,000. • Due to our issues with the performance of Hays we have negotiated the price down to 15% of the

starting salary from the previously agreed 17%. This only applies to the candidates from this trip. If we were to do any further recruitment with Hays it is likely that the 17% would apply. Other agency fees may differ and are subject to negotiation. The figure for 15% is included in the above.

• Although the individuals recruited from Poland will potentially not be on the road practicing autonomously for 6 months, they will be on the road significantly faster than a Student Paramedic.

• Unfortunately we cannot break down the costs of our UK based Student Paramedic Recruitment due to the funding received from HEE (£8,600 per student). This funding is absorbed in to the training costs and finance cannot give any separate total costs.

• The actual costs for Polish Paramedic recruitment are slightly less than predicted in the original paper in submitted in August. This is due to the reduction in the fee to Hays and cheaper working party costs.

• The predicted costs of future international recruitment are likely to differ greatly depending on where and how we do it.

• LAS estimated that their initial trip to Australia cost them £86,000. They view this as good value for money due to the significant number of Paramedics they recruited.

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• The incentives offered to Australian Paramedics differ between services with SCAS offering £3,500 and LAS up to £8,000.

• The training costs are very comparable no matter the recruitment and will likely only differ by a week here and there.

• In future, we may also have to factor in the potential need to offer accommodation during training due to the geography of available training centres. These locations may conflict with both the desired locations of the candidates and the areas with the highest vacancies where we would most want to place them.

All recruitment process associated with international recruitment will follow the NHS International recruitment of healthcare professional code of practice and the NHS recruitment check standards. The options to take international recruitment forward require significant commitment and expenditure to attract international applicants and all have different challenges associated with them. However, most Ambulance Trusts are sourcing staff from overseas as part of their overall recruitment mechanism and believe this is necessary as a partial solution to the capacity gap and current UK recruitment is not yielding the necessary candidate numbers. Therefore the Trust continues to explore different options for overseas recruitment and evaluate the outcomes for inclusion as a permanent strand of the Trust’s Recruitment strategy and in light of future staffing projections.

Item 11.

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Report Title: Cultural audit

Report Author(s): Dr Antonio Zarola Zeal Solutions Ltd


Lindsey Stafford-Scott Director of People and Culture

Purpose:


Executive Summary: The Trust has undertaken a cultural audit to understand staff perceptions of EEAST as an organisation and to determine how the experience of work influences staff health and well-being. A series of focus groups were held to inform the development of a cultural audit survey for staff. More than 1,700 responses were received and the results were analysed.

The analysis explored the combined impact of both workplace features and cultural dimensions in health outcomes, to identify seven priority areas to target for enhancing the health and well-being of staff. These are split into two categories; those areas that need to be promoted and protected and those areas that need to be tackled. These were:

• Supportive leadership (promote and protect) • Positive work experience (promote and protect) • Quality and learning (promote and protect) • Home work conflict (tackle) • Decision – low confidence (tackle) • Violence (tackle) • Blame and fear (tackle)

The steering group, made up of staff from across the Trust, has reviewed the results and developed prioritised actions for each of these high impact areas, as laid out in the report. These actions have been set as being realistic and achievable in the immediate future, with some being quick wins to help build ongoing momentum for the cultural audit. The final report will be submitted to the Board in February. The steering group will meet again in February to agree an appropriate strategy for initiating action. The group will also agree an evaluation strategy for these actions so the value and impact can be clearly demonstrated.


Action Required by the Board:

• To note the report • To agree to the high impact areas and actions • To support the continuation of the cultural audit programme


25 JANUARY 2017 AGENDA ITEM 11

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Previously Considered By and Recommendation(s) Made: Cultural Audit Steering Group on 19/12/16 and 13/01/17.













N/A

Organisational Risk Assessment A summary progress report for East of England Ambulance Service NHS Trust (EEAST)

Culture and Health Audit: Board Progress Report

Published: January 2017 This report was produced by Zeal Solutions Ltd Author: Dr Antonio Zarola PhD CPsychol AFBPsS

EEAST – CULTURE AND HEALTH AND WELL-BEING AUDIT | PROGRESS SUMMARY |Page 2 of 13

Contents

Scope of this report ...................................................................... 3

Project aims ................................................................................. 3

Approach taken ............................................................................ 3

High level results .......................................................................... 4

Psychosocial workplace features ......................................................................................... 4 The prevailing culture and its impact .................................................................................. 6 The important role of leaders .............................................................................................. 7 Highest impact factors ......................................................................................................... 8

Translation – staff feedback and validation of results .................... 8

Prioritised actions for each high impact area ................................. 9

High impact areas and actions ........................................................................................... 10

Next steps and final reporting ..................................................... 11


Scope of this report This report, provides the board with a high level overview and progress update on the cultural audit. The focus of this update is to inform the board of the actions that have been agreed by the steering group. Detailed and technical information (e.g. benchmarking) on the key findings is not included in this high level summary and will be made available in the final reports that will be submitted to the Trust in February 2017.

Project aims The purpose of the audit was to establish a foundation for understanding staff perceptions of EEAST as an organisation and determining how the experience of work influences staff health and well-being. The objective of this audit is to provide the Trust with evidence that can be used to identify what action, if any, is required to ensure EEAST continues to develop a workplace and culture that can be considered psychologically healthy and well.

Approach taken A series of focus groups were held with EEAST staff to inform the development of a tailored survey. The survey process was used to help answer the following questions:

o Which ‘negative’ and ‘positive’ aspects of their psychosocial work environment do staff within EEAST most frequently experience? This psychosocial work environment comprises features of both the content of the job, e.g. the nature and flow of the tasks undertaken, and the interpersonal and organisational context within which it is undertaken, e.g. relations with supervisors and colleagues, the opportunity for career progression, etc.

o Which aspects of this ‘psychosocial work environment’ are most strongly and consistently associated with employee well-being?

o What is the prevailing culture within EEAST? o What role does the organisational culture have to play in influencing employee

well-being? o What ‘sources of support’ do employees see as being available to them in trying to

deal with the experience of work? o Which sources of support are most advantageous in terms of maintaining individual

and organisational well-being? o What role do leaders have to play in terms of influencing the experience of work

(e.g. culture) as well as the health and well-being of staff? To help answer the above questions, The ORA methodology (see Figure 1), developed by Zeal, was used to create an accurate understanding of the impact of the workplace on staff health and well-being.


Figure 1: Diagrammatic representation of the ORA method for assessing the workplace, culture and the impact on employee health and well-being As a basis for auditing, then, there are at least four important aspects, or elements, to understanding and assessing the impact of works. As shown in Figure 1, these are:

1. Identifying both the ‘potentially’ positive and negative experience of work and establishing how often they are experienced by staff;

2. Profiling the health and well-being of staff as a whole, or significant and identifiable sub-groups thereof;

3. Demonstrating empirically the relationship between the experience of work and the utilised indicators of health and well-being;

4. Assessing how the relationship between the experience of work (1) and health and well-being (3) is possibly affected by salient intervening factors e.g. the availability of support in helping staff to cope.

Paper and online surveys were made available to staff and, in total, we received 1771 completed responses, 1194 were paper copies and 577 responses were received online. An overview of the demographic profile of the sample of staff completing this survey is provided below and at the end of the summary in the appendix.

High level results

Psychosocial workplace features

In the audit questionnaire, participants were asked how frequently each of 74 items deriving from the focus group discussion reflected their experience of work in EEAST. Responses to all questions were subsequently analysed to assess whether a more efficient (and reduced) number of high priority workplace features could be found within the existing items therefore supporting the translation of these results more readily into practice. Analyses of the results revealed 16 ‘workplace features’ as shown below in Table 1.


WORKPLACE FEATURE MEAN SAMPLE ITEM/DESCRIPTOR

Home-Work Conflict 3.66 Work/shift patterns having a negative impact on family life.

Poor Change & Communication / Information Management

3.58 Finding it difficult to keep up with the pace of change in the organisation.

Poor Career Development 3.40 Finding that there is a lack of career development/progression opportunities within the Trust.

Supportive Colleagues 3.30 Working with colleagues who can be relied upon to provide support if needed.

Equipment Issues 3.27 Experiencing problems with computers or IT.

Demands – Decision Confidence & Responsibility Worry 3.24 Not feeling confident about the

decisions you have to make.

Dealing with Unrealistic Expectations & Poor Understanding – External Users 3.23

Having to deal with unrealistic expectations from patients or their families/carers.

Positive Work Experience 3.22 Having a job that presents you with positive challenges.

Demands – Work Overload 3.13 Having too many things to do and not enough time in which to do them.

Supportive Leader Behaviour 3.12 Having a manager who listens.

Mentorship, Supervision & Training 2.96 Getting the training you need to do your job.

Influence & Engagement 2.82 Having the opportunity to influence the decisions that impact on your job/work.

Unsupportive Leader Behaviour 2.53 Having a manager who is quick to blame.

Valued Recognition 2.30 Receiving recognition for a job well done.

Violence – Outside Users 2.28

From a patient/service user/member of public – Experiencing face to face or telephone verbal abuse, physical assaults.

Violence – Inside Staff 1.84 From a member of staff/colleague - Experiencing face to face or telephone verbal abuse, physical assaults.

Scale range | 1 = never to 5 = always Table 1: Mean rank order of the 16 workplace features As shown above in Table 1, Home-Work Conflict (e.g. Work/shift patterns having a negative impact on family life) was the most frequently experienced workplace feature by EEAST staff. Exposure to work-related violence and aggression from the outside (e.g. service users) and inside (e.g. work colleagues) were the two workplace features that achieved the lowest mean scores. As a note of caution, it is important to state at the outset, the extent (frequency) to which staff have reported experiencing specific workplace


features should not be used to decide where action/intervention needs to be focussed. This can only be determined by further statistical analysis exploring the empirical relationship between the workplace features and measured health outcomes. This is outlined in section five of the report. Statistical analysis of the impact of the workplace features on measured health outcomes, revealed for EEAST employees, the major workplace features having the most extensive and detrimental impact upon individual and organisational well-being are:

• Home & work life conflict • Demands – decision confidence and responsibility worry • Unsupportive leader/manager behaviour • Violence and aggression: internal and/or external

In one way or another, these four workplace features are each associated with diminished individual well-being (e.g. symptoms of stress), attitudes to the job (e.g. job satisfaction), withdrawal (e.g. intention to quit), as well as performance of clinical care (e.g. patient care confidence). Conversely, and based upon the number of positive outcomes they are linked with, there are three major workplace features that have extensive and beneficial impacts upon individual and organisational well-being, these are:

• Positive work experience • Supportive leader/manager behaviour • Influence and engagement

In one way or another, these three workplace features are each associated with improved individual well-being (e.g. symptoms of stress), attitudes to the job (e.g. job satisfaction), withdrawal (e.g. intention to quit), as well as performance of clinical care (e.g. patient care confidence).

The prevailing culture and its impact In this audit, the EEAST culture was determined by assessing staff perspectives on 39 statements regarding the type of culture in EEAST. Analyses of these results revealed eight higher order ‘cultural dimensions’ list below in Table 2 in ‘mean’ rank order. CULTURAL DIMENSIONS MEAN SAMPLE ITEM/DESCRIPTOR

Blame & Fear 3.71 People are afraid to make mistakes.

Quality & Learning 3.34 Learning is an important part of the culture.

Authoritarian 3.14 It is important to stay on people's good side.

Affiliation/Team 3.08 People work like they are part of a team.


Facilitating Change 2.69 New and improved ways to work are continuously adopted.

Capability Building 2.67 The capabilities of people are viewed as an important source of organisational success.

Shared Vision 2.56 There is a clear strategy for the future.

Consensus/Agreement 2.42 It is easy to reach consensus/agreement, even on difficult issues.

Scale range 1 to 5 (1 = strongly disagree and 5 = strongly agree)

Table 2: Cultural dimensions – displayed in mean rank order The highest scoring cultural dimension Blame & Fear has negative health individual and organisational health impacts. This cultural dimension is linked with:

• Reduced levels of job satisfaction • Reduced levels of organisational commitment • Reduced levels of work engagement • Increased levels of symptoms of stress • Increased levels of PTSD symptomology • Increased levels of burnout (e.g. exhaustion, cynicism) • Increased levels of quitting intentions • Reduced levels of patient care confidence

Importantly, however, the audit also revealed that staff are also exposed to a range of positive cultural behaviours (dimensions) that, when experienced, lead to positive health benefits. The cultural dimension that had the most significant positive impacts was ‘Quality & Learning’. Combined, these results support the assertion that organisational culture is an important determinant of organisational health, effectiveness and performance. It also helps to confirm the critical importance of developing the positive cultural dimensions and minimising the impact of the negative cultural dimensions within EEAST. As with broader assessments of culture, one of the most influential and key determinants of enhancing the cultural dimensions measured in this audit is associated with leadership behaviour and the level of perceived support considered to be available from leaders.

The important role of leaders Scientific research is very clear in demonstrating the importance of ‘support’ in promoting both employee well-being and performance. It is the perceived availability of support from leaders/managers that was found to impact most significantly and beneficially on staff health outcomes. The data received from staff regarding supportive leadership behaviour was subsequently divided into those staff reporting high levels of perceived leadership/management supportive behaviour and those reporting low levels. Statistical comparisons were then conducted between the high and low support groups across the workplace features, health outcomes and cultural dimensions. In summary, this analysis revealed three key trends:


1. Leaders make a big difference to the way staff view their work. Such that, staff who are exposed to higher levels of supportive leadership behaviour also report a more positive experience across all work tasks and demands than those staff exposed to low levels of supportive leadership behaviour.

2. Leaders make a big difference to staff health and well-being. Such that, staff who are exposed to higher levels of supportive leadership behaviour also report improved health across all outcomes than those staff exposed to low levels of supportive leadership behaviour.

3. Leaders make a big difference to the way staff view the workplace and the cultural experience. Such that, staff who are exposed to higher levels of supportive leadership behaviour also report EEAST as having a significantly more positive culture than those staff who are exposed to lower levels of supportive leadership behaviour.

Highest impact factors Statistical analysis exploring the combined impact of the workplace features and cultural dimensions on health outcomes, identified seven (7) priority areas that EEAST should consider as primary targets for enhancing the health and well-being of staff. These high impact areas are shown below in Figure 2. Actions that are being considered for each of the priority areas can be seen below.

FIGURE 2: Illustrating the high impact priority areas of focus

Translation – staff feedback and validation of results The audit conducted here is a participative problem solving process. Therefore, and in keeping with best practice, employees were invited to participate in a second series of focus groups to review the key findings from the audit as well as to:

• Reflect and discuss how accurately the audit results represented their own experiences of the job;


• Assist in the interpretation of the findings from the audit and place these into everyday concrete examples based on their work experiences; and

• Act as a problem solving group generating potential and practical strategies and interventions that might be implemented to help manage stress or promote health within their own area.

This process of validation and translation is an exercise in sense making, whereby the results from the audit are explored by a sample of those from whom it was derived. First, the results of one data collection method (the survey) are put forward for scrutiny by those who are ‘experts by experience’ in the job (validation stage). Second, these same ‘experts by experience’ are then tasked with helping to translate the results into useful and practical intervention strategies, the role of the consultant being that of a facilitator. Within EEAST a series of face to face ‘translation’ focus groups, telephone interviews and sites visits were completed. In addition, Zeal Solutions provided staff with online access to key results so that any feedback to the findings could be submitted directly to Zeal. In total, 125 staff participated in the feedback sessions enabling Zeal to speak with staff across a number of roles/departments, including, but not limited to: dispatch team leaders; call handlers; community first responders; dispatchers; regional operations centre officer; CFD clinical, managers, frontline staff – paramedics and technicians, administrators, volunteer community first responders, finance, support services, suppliers and HR. We spoke with individuals from across localities Bedfordshire, Hertfordshire, Essex, Norfolk, Suffolk and Cambridgeshire. Employees confirmed or validated audit results as representing real issues for them. This is not so say that every employee had personally experienced each of the positive and/or negative workplace features identified in the audit but simply that, overall, the issues identified in the audit ‘made sense’ to staff and captured the principal threats to well-being or promoters of health as EEAST employees themselves construe them. Since all groups considered the same audit results – and made many similar points and observations on them – their deliberations were analysed and then summarised into an action list in an aggregate rather than on a group by group or role basis. The full list of actions was reviewed and discussed by the project Steering Group on Monday 19th December 2016. This process was utilised to help sense check the suggested actions as well as to help prioritise and streamline any suggested actions. A second action planning workshop was held with the steering group on Friday 13th January 2017. This meeting was used to review the updated action list and to establish key actions and any quick wins against the high impact areas listed above in Figure 2.

Prioritised actions for each high impact area The fact that the steering group only considered those workplace features or cultural dimensions that had the highest impact (i.e. a subset of all the possible workplace features and cultural dimensions) should not be read as suggesting that the remaining workplace features and cultural dimensions are of no concern, value or threat to EEAST. For some individuals, these other factors might be the greatest source of stress in their jobs. However, given the finite amount of resources (e.g. finance, time, etc.) available, group


discussion must necessarily be limited primarily to those workplace features shown by the audit data to be most significantly linked to improved or diminished health and wellbeing across EEAST as a whole. The key actions that were highlighted by the steering group as realistic and achievable in the immediate future are listed below. Also highlighted below are the actions the steering group voted as quick wins (i.e. something that could be announced and completed quickly).

High impact areas and actions

Supportive leadership is to be protected and promoted by the following actions:

• Development of the recruitment process • Review exit interview process and reinvigorate (quick win) • Develop and promote the leadership charter (quick win) • Develop and implement leadership strategy • Develop code of practise for interview panels • Offer every internal candidate the opportunity to receive feedback (quick win)

Positive work experience is to be protected and promoted by the following actions:

• Review appraisal process • Review and change reward and recognition programme (quick win)

Quality and learning is to be protected and promoted by the following actions:

• Review student paramedic mentoring • Learning from incidents:

o Use clinical variation panel process to develop staff o Look at how we can do the informal stage/feedback before formal process

clicks in • Senior managers responding on ambulances should be crewed with non-

management staff to help with mentoring, development and visible leadership (quick win)

Home/work conflict is to be tackled (prevented or reduced) by the following actions:

• Flexible working (quick win) o Look at data to see where flexible working is working and areas of low take

up. o See how we can embed it across Trust o Raise awareness internally and externally of staff stories who have been

able to work flexibly (a good opportunity for retention and recruitment) • Monitoring of annual leave at 7 and 9 month points through SPF • Late finishes programme

Demands: Decision - low confidence is to be tackled (prevented or reduced) by the following actions:

• See point above on learning from incidents • Evaluate the effectiveness of the clinical app (quick win) • Start to produce videos of equipment and how to use it (quick win) • Develop programme of CPD events linked to PU


• Reintegrating staff who have been away from the Trust for a while (either through maternity, career breaks or different jobs). Create a best practice approach for these staff.

Blame and fear is to be tackled (prevented or reduced) by the following actions:

• Ask the raising concerns group to investigate the possibilities of anonymous reporting

• See point on leadership charter; need to reflect a learning culture and not a blame culture

Violence and aggression - is to be tackled (prevented or reduced) by the following actions:

• Trust to sign up to campaign to change legislation about violence to NHS staff (quick win)

• Greater promotion of the anti-violence stance (quick win) • Review recruitment process for call handlers and EOC staff to improve retention.

Also look at the welfare, after care and support mechanisms available for EOC staff (quick win)

Next steps and final reporting Zeal Solutions are currently preparing the final audit reports and aim to submit these to the Trust in time for the next steering group meeting which is being scheduled for February 2017. In addition to receiving a full presentation of the results, the next steering group meeting will be used to finalise the list of actions against the high impact areas and also agree an appropriate strategy for initiating action. Furthermore, this meeting will also be used to ensure an appropriate evaluation strategy is agreed for the prioritised actions so that value and impact of any action can be clearly demonstrated to the organisation.


Appendix: Demographics Below are the demographic details of the sample of staff who participated in this survey. Sex Frequency Percentage Male 1006 56.8 Female 738 41.7 Missing 27 1.5 Total 1771 100.0 Age Frequency Percentage 16-20 12 0.7 21-30 269 15.2 31-40 388 21.9 41-50 527 29.8 51-65 505 28.5 66+ 40 2.3 Missing 30 1.7 Total 1771 100.0 Tenure Frequency Percentage Less than 1 year 120 6.8 1 to 3 years 290 16.4 More than 3 and up to 5 years 202 11.4 More than 5 years and up to 10 years 354 20.0 More than 10 years and up to 20 years 527 29.8 More than 20 years 250 14.1 Missing 28 1.6 Total 1771 100.0 Ethnicity Frequency Percentage White 1686 95.2 Mixed 13 0.7 Asian/Asian British 5 0.3 Black/Black British 17 1.0 Chinese & other ethnic background 3 0.2 Missing 47 2.7 Total 1771 100.0 County/Region Frequency Percentage Norfolk 326 18.4 Suffolk 217 12.3 Cambridgeshire 240 13.6 Bedfordshire 184 10.4 Hertfordshire 177 10.0 Essex 463 26.1 Regional 93 5.3 Missing 71 4.0


Total 1771 100.0 Staff Type Frequency Percentage Ambulance Care Asst/ Ambulance Transport Asst/ Patient Transport Driver

152 8.6

Emergency Care Asst 68 3.8 Emergency Care Practitioner 38 2.1 Emergency Control Staff/ Call Centre Staff 133 7.5

Managers. Administrative staff & Other Support Staff 192 10.8

Nurse/ Occupational Therapist/ Pharmacist 9 0.5

Paramedic Manager 77 4.3 Paramedic, Senior Paramedic, Paramedic Supervisor 527 29.8

Student Paramedic 180 10.2 Technician & Senior Technician 230 13.0 Volunteer 67 3.8 Missing 98 5.5 Total 1771 100.0 Function Frequency Percentage Accident & Emergency 1122 63.4 Air & Special Operations 44 2.5 Emergency Operations Centres 133 7.5 Non-Emergency Services - Commercial Services & Primary Care

22 1.2

Non-Emergency Services - Patient Transport Services 162 9.1

Operations Support 57 3.2 All Other Support Services 126 7.1 Missing 105 5.9 Total 1771 100.0

Item 12.

Page 1 of 8

Report Title: Board Assurance Framework

Report Author(s): E de Carteret, Safety and Risk Lead


Sandy Brown, Director of Nursing and Clinical Quality

Purpose:


Executive Summary: In the Board workshop in December 2016, there was agreement to transform the Board Assurance Framework – specifically, to give more oversight and assurance on the current position on the Strategic risks and to focus upon the strategic actions to be taken for further mitigation, rather than the document emphasising current controls already in place. In addition to this, red operational risks previously present on the BAF as individual risks have been absorbed for the purposes of this document into the relevant Strategic risks; however it is important to note that there is significant Trust focus on mitigation of these at the Senior Leadership Board level. The document therefore provides detail on the five strategic risks agreed in principle at the Board workshop, in line with the new organisational Strategic Objectives. These risks have been developed through the analysis of the previous strategic risks against the Strategic Objectives. As the January 2017 Board Assurance Framework has changed in layout and design, the following gives an overview of its intent:

• Page 1 – Board Assurance Framework Summary

o Provides an overview of the Strategic risks, in relation to current score, direction of travel and the anticipated timeframe for achieving the desired target risk score. This summary seeks to enable Board members to identify any risks moving ‘off track’ to prompt a deep dive or focussed discussion.

• Page 2-6 – Strategic Risks o Each page is dedicated to a single strategic risk and contains a number of details o ‘Risk description’ seeks to provide an overview of the current status of the risk, with key operational

risks currently impacting upon the scoring and risk status. o Risk Score detail provides information pertaining to the inherent (initial) risk score, current score and

the direction of travel from the preceding month. It also demonstrates the intended post-mitigation score and target timeframe.

o Assurance of controls provides a RAG rating of the perceived effectiveness of controls already in place. This score is provided by the Safety and Risk Lead based upon discussions with Executive Owners and review of evidence

o The mitigating actions section provides an overview of the key strategic actions being undertaken by the Trust to mitigate the risk and reduce the score further, along with a brief rationale for each action. Please note that previous BAF documents have provided an extensive list of non-strategic actions being taken which can detract from strategic discussions at Board. As such, whilst there is a reduction of actions cited on the BAF, this is to give strategic focus – operational level actions remain underway and are monitored through the relevant internal Trust groups, such as the Senior Leadership Board and Clinical Quality and Safety Group


25 JANUARY 2017 AGENDA ITEM 12

Item 12.

Page 2 of 8


Next steps in relation to the ongoing developments within Risk Management are to: 1. Complete refinement of the Senior Leadership Board risk register and establish

robust escalation and de-escalation 2. Review the Risk Management Strategy and Procedure in line with the processes

agreed in principle at the Board workshop 3. Liaison with all chairs of groups and committees in order to ensure a suitable

level of risk focus and discussion at each group meeting, in order for assurance and escalation to occur

Action Required by the Board: 1. Review the new layout and approve for onward utilisation 2. Formally confirm the five strategic risks for 2017 – 2019, as stated in the BAF 3. Review the information in relation to the Strategic risks and identify whether a deep dive into a specific

risk is required at the next meeting

Previously Considered By and Recommendation(s) Made: • Senior Leadership Board reviewed the Strategic Risks on 11 January 2017 and recommended them for

Escalation to the Board Assurance Framework. • Executive Leadership Board reviewed the BAF and Strategic Risks on 19 January 2017 and approved

document for recommendation to the Trust Board. • Discussion and determination on SR5 in relation to whether oversight should sit with the Quality

Governance Committee or the Trust Board


Sub-Objective(s):


• Commence implementation of the Trust’s Remedial Action Plan • Commence Implementation of a Revised Operating Model including a new

Clinical Career Pathway • Continue to roll out the Trust’s Quality Strategy

Shaping our Future • Create a stable Executive Leadership Team • Develop a Trust Strategy for approval by end of Quarter 1 to be followed

by supporting Strategies for Workforce, IM&T, Fleet, Finance and Estate for approval by end of Quarter 3


Creating a Positive and Engaging Culture

• Undertake a Cultural Audit and Embed our Vision and Values • Implement Staff Leadership Development and Aspiring Manager

Programmes • Develop and implement a Staff Retention Plan • Roll out a Staff Engagement Plan


Health and Social Care Act, Care Quality Commission, specifically Safe and Well-Led

Item 12.

Page 3 of 8

Board Assurance Framework Summary – January 2017

The following table gives an overview of the Trust’s Strategic risks, their current status and the anticipated date when the risk will be mitigated to the required level.

Risk Ref

Risk Owner Committee Change since last report

Inherent risk score

Current risk status

Target risk score

Date for mitigation

SR1 Failure to deliver agreed contractual targets – risk that the Trust cannot deliver a sustainable and responsive model in line with the commissioner performance contracts

Director of Service Delivery

Performance & Finance

25

20

10

March 2019

SR2 Failure to achieve continuous quality improvements and high quality care delivery – risk that the challenges within the Trust result in a lack of focus upon safe care for patients and that avoidable harm occurs

Director of Nursing and Clinical Quality

Quality Governance

15

9

6

September 2017

SR3 Failure to establish a culture of engagement and accountability that is patient focussed – risk that the Trust becomes a poor employer due to insufficient relationships with staff

Director of People and Culture

Quality Governance

16

12

8

January 2018

SR4 Failure to deliver an efficient, effective and economic service – risk that funding, systems and processes do not match the required pace of change for sustainable service delivery

Director of Finance and Commissioning

Performance and Finance

25

20

12

April 2018

SR5 Failure to maintain strategic relationships with national and local partners to deliver community focussed healthcare – risk that the Trust, working with the regional healthcare economy, does not fully implement the commitments in the Five Year Forward View

Director of Strategy and Sustainability

Quality Governance

20

12

8

January 2018

Item 12.

Page 4 of 8

SR1: Failure to deliver agreed contractual targets Risk Description Strategic Objective

Operational Performance to Constitutional Standards is intrinsically linked to quality, safety and patient experience. The Trust is not commissioned by CCGs to deliver the constitutional standards and as such the Trust is left with risks to performance, quality, finance and reputation. Failure to fully mitigate this risk could result in an inability to deliver a safe and effective service within the financial constraints of commissioned level and impact on the CQC assessment of the Service. Current risks underpinning SR1 include staff levels, student paramedic abstractions, increased activity and acuity, hospital handovers, capacity gap and appropriate funding of the service. It is important to note that NHSI have increased the Trust’s rating to satisfactory for quality.

Putting into place a new responsive operating model to deliver sustainable performance and improved outcomes for patients

Owner Committee Director of Service Delivery


Risk Score Detail to Date Assurance of controls Target Risk Score Post-Mitigation Likelihood Impact Score Likelihood Impact Score Inherent 5 5 25

Moderate When mitigated

2 5 10

Last month 4 5 20 Mitigated score to be achieved by

March 2019 This month 4 5 20

Mitigating Actions Owner Due Expansion of the ECAT functionality within the EOC through increased paramedic recruitment and other Health Care Professionals, especially GPs and Mental Health Practitioners. This will allow further opportunity for the clinical triage of calls, enabling patients to be directed to the most appropriate pathway for them and reducing the need for ambulance or hospital attendance. Project group in place.

Deputy Medical Director

April 2017

Continuation of recruitment within service delivery, especially at all clinical levels. This will increase ability to fully resource rotas to enable sufficient UHP to meet demand up to commissioned levels


April 2018

Implement amended Surge Plans following risk assessment and clinical review. This will enable robust decisions by Gold at earlier stages to minimise tail breaches and harm to patients

Medical Director

May 2017

Agree 2017/18 contractual performance targets with Commissioners, including the appropriate level of funding to enable in year delivery improvements. It should be noted that commissioners do not intend to address the capacity gap in 2017/18 or 18/19.


April 2017

Purchasing additional capacity from Private Ambulance Providers to support the low acuity transportation demands


April 2017

Item 12.

Page 5 of 8

SR2: Failure to achieve continuous quality improvements and high quality care delivery Risk Description Strategic Objective

Inability to successfully focus upon safety and quality improvements due to pressures financially and operationally would limit the progress made by the organisation in relation to governance, Sign up to Safety and the Quality and Safety Strategy. This could lead to an inability to provide safe, consistent and high quality care to patients across the region. This would have regulatory and reputational implications for the organisation. Current risks underpinning SR include non-conveyance decisions, current clinical scope of the workforce, and harm through delays. Lack of electronic PCR solution limits identification of issues for resolution.

Maintaining the focus on delivering excellent, high quality care to our patients

Owner Committee Director of Nursing and Clinical Quality

Quality Governance

Risk Score Detail to Date Assurance of controls

Target Risk Score Post-Mitigation Likelihood Impact Score Likelihood Impact Score Inherent 3 5 15

Moderate When mitigated 2 3 6


September 2017 This month 3 3 9

Mitigating Actions Owner Due Delivery of the CQC action plan will strengthen the quality care provision in the Trust through the mitigation of recognised gaps identified within the CQC inspection


September 2017

Roll out and re-establishment of ePCR will enable more real-time monitoring of clinical care and Quality Indicators, identifying areas of required improvement


June 2017

Improved clinical communications through the utilisation of wider, more varied communication techniques – podcasts, Clinical Quality Matters, focus months – will provide improved awareness for clinicians. Joint action with Medical Director

Director of Communications

September 2017

Delivery of mandatory training through workbooks and the Professional Update sessions is essential to maintaining the minimal expected standard


September 2017

Review and renew Risk Management Strategy and Procedure in order to underpin processes for consideration of new systems and processes and emerging clinical risks


April 2017

Redefine incident management policy and process to facilitate robust investigation and recognition of learning opportunities


May 2017

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SR3: Failure to establish a culture of engagement and accountability that is patient focussed Risk Description Strategic Objective

Failure to develop a robust culture in relation to accountability will have a detrimental effect on the culture within the organisation, This can lead to inconsistent practice and a lack of confidence in the management structure, leading in turn to patient safety and staff welfare issues. It is important to note the CQC’s rating of ‘outstanding’ for care from staff, identifying that whilst there are clear cultural issues requiring redress, staff continue to deliver consistently high standards. Current risks for SR3 include inconsistent practices across the Trust, lack of a robust performance management framework, backlog in employee relations cases, varied leadership application.

Guarantee we have a patient-focussed and engaged workforce

Owner Committee Director of People and Culture

Quality Governance



Moderate When mitigated 2 4 8


January 2018 This month 3 4 12

Mitigating Actions Owner Due Agreement and delivery of the culture action plan following the cultural review. This will enable focus on recognised areas of need and improvement to make tangible benefits

Director of People and Culture January 2018

Establishment of the Trust’s Culture Strategy will provide focus upon delivery against the Vision and Values of the organisation and will engender a consistently engaged, patient-focussed workforce


May 2017

Development of a performance management framework will enable robust monitoring and accountability processes, reducing inconsistencies across the organisation

Director of People and Culture June 2017

Establishment of Leadership Programmes in line with NHS Improvement and Leadership Development Framework, within the mandatory training portfolio will enable improvement in Leadership Practices

Director of People and Culture May 2017

Development of a Communication and Employee Engagement Strategy to help drive more staff focussed engagement and shape the culture of the organisation.

Directors of Communications and People and Culture

June 2017

Item 12.

Page 7 of 8

SR4: Failure to deliver an efficient, effective and economic service

Risk Description Strategic Objective Inability to deliver constitutional standards of effective and safe care within the agreed financial envelope will result in the Trust becoming an unsustainable organisation. This brings with it the risk of financial special measures and associated risks to patient safety and service delivery, and reputational damage. There is a need to resolve the immediate financial challenges as well as transform to long term efficiencies through innovative service redesign. Current risks impacting upon SR4 include in-year financial delivery, insufficient funding to deliver against demand, utilisation of PAS to off-set the capacity gap

Delivering innovative solutions to ensure we are an efficient, effective and economic service

Owner Committee Director of Finance and Commissioning




Low When mitigated 3 4 12


April 2018 This month 4 5 20

Mitigating Actions Owner Due Re-base 2017/18 and future contracts with commissioners to incorporate new business model and funding in line with activity


March 2017

Completion of arbitration in order to secure stakeholder commitment to reducing the clinical capacity gap

Chief Executive February 2017

Completion of phase 1a and 1b of SSG financial review, in order to reduce the financial deficit by the end of the current financial year


March 2017

Establish the Trust Strategy and Transformation plans in order to identify efficient and economic solutions


July 2017

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SR5: Failure to maintain strategic relationships with national and local partners to deliver community focussed healthcare

Risk Description Strategic Objective Failing to form strong strategic relationships will lead to a poor reputation for the trust with partner organisations within local health systems. This is likely to impact on investment in the current and new models of delivery. In turn, this will risk the long term financial sustainability of the Trust, resulting in a decrease in performance and the quality of care delivered to patients. Current risks underpinning SR5 include conflicting stakeholder views, and the alignment of STPs and the subsequent impact on delivery. It is important to note the NHSI’s increased rating of ‘Satisfactory’ for the Trust.

Playing our part in the urgent and emergency care system being community focussed in delivering the 5 year forward view

Owner Committee Director of Strategy and Sustainability

Quality Governance



Low When mitigated 2 4 8


October 2017 This month 3 4 12

Mitigating Actions Owner Due Development of the Trust’s 2 year Transformation Plan will enable recognition of work streams for community care delivery and create a platform to support EEAST and wider system sustainability.


April 2017

Negotiate mid to long term funding for delivery of the service, including the ongoing recruitment and commitment to aspects of the service which facilitate multi-organisational working (e.g. ECAT, HALOs)


January 2018

Secure Partner commitment to Transformation Plans to underpin the STP and CCG investment in EEAST


January 2018

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