Bundle Finance and Resources Committee 20 September 2018
1 PROCEDURAL MATTERS 1.1 09:00 - Welcome and Apolgies For Absence 1.2 09:01 - Declarations of Interest Members are reminded that they should declare any personal or business interests which they have in any matter or item to be considered at the meeting which may influence, or may be perceived to influence their judgement, including interests relating to the receipt of any gifts or hospitality received. Declarations should include as a minimum, personal direct and indirect financial interests, and normally also include such interests in the case of close family members. Any declaration must be made before the matter is considered or as soon as the Member becomes aware that a declaration is required. 1.3 09:02 - Minutes/Action Log Minutes
1 To confirm as a correct record the minutes of the open session of the Finance and Resources Committee held on 5 July 2018.
Matters Arising
2 To consider any matters arising from the minutes which are not dealt with elsewhere on the agenda. (The Committee Action Log is attached at Annex 2). The Committee are to note that the actions were not due till the next officially scheduled meeting of FRC (25 October 2018), however if updates are available they will be provided at today’s meeting.
RECOMMENDED: That
(1) the Minutes of the meeting held on 5 July 2018 be confirmed as a correct record; and
(2) the actions within the action log be considered. ITEM 1 3a FRC Minutes Open 5 July 2018 v3.doc ITEM 1.3b FRC Action Log Open and completed.xlsx 2 REGULAR UPDATE REPORTS 2.1 09:12 - Finance Performance - Month 5, 2018/19 and Savings Delivery (Interim Director of Finance and ICT) To provide the Committee with an update on the financial performance and savings delivery of the Trust for the first five Months of 2018/19 ITEM 2.1 Finance Report M5 18-19 FINAL.doc 2.2 09:32 - Update on 2018/19 Capital Programme (Interim Director of Finance and ICT) To provide the Finance and Resources Committee with the recommendations for the allocation of the remaining 2018/19 discretionary capital funding (Round 2) ITEM 2.2 FRC 20 09 18 Discretionary Capital Programme 2018-19 - final.docx 2.3 09:52 - Monthly Integrated Quality and Performance Report (Director of Partnerships and Engagement and Interim Director of Planning and Pefrormance) To consider the Trust’s performance and improvement actions ITEM 2.3 SBAR MIQPR June 18 Final FRC.DOCX ITEM 2.3a Annex 1 - MIQPR June 18 WD2.pdf ITEM 2.3b Annex2NEPTSPerformanceAQIs.xlsx 3 PROJECTS AND BUSINESS CASES 3.1 10:12 - A Strategic Outline Case for Electronic Patient Clinical Records (Medical Director) For endorsement of SOC to be submitted to Trust Board for endorsement ITEM 3.1 SBAR EPCR SOC for Finance & Resources Committee V1.docx ITEM 3.1a Annex 1 - EPCR SOC V1.0.pdf 4.1 10:32 - NHS Wales Capability Policy And Procedure (Director of Workforce and OD) To note the report and formally adopt the revised NHS Wales Policy for WAST on behalf of the Trust Board ITEM 4.1 Covering SBAR FRC NHS Wales Capablity Policy Procedure.docx ITEM 4.1a Capability Policy Version FINAL (Jun 2018 v21) - WAST.docx 5 DATE OF NEXT MEETING 25 October 2018
1.3 Minutes/Action Log 1 ITEM 1 3a FRC Minutes Open 5 July 2018 v3.doc
WELSH AMBULANCE SERVICES NHS TRUST
UNCONFIRMED MINUTES OF THE OPEN SESSION OF THE MEETING OF THE FINANCE AND RESOURCES COMMITTEE (FRC) HELD ON 5 JULY 2018 AT VANTAGE POINT HOUSE, CWMBRAN WITH VC FROM HM STANLEY SITE, ST ASAPH
PRESENT :
James Mycroft Non Executive Director and Interim Chair of FRC JM Professor Kevin Davies Non Executive Director KD Pam Hall Non Executive Director (VC St Asaph) PH
IN ATTENDANCE:
Keith Cox Board Secretary KC Richard Davies Assistant Director of Capital and Estates RD Hannah Evans Director of Planning and Performance HE Mark Harris NEPTS General Manager South East MH Fflur Jones Wales Audit Office (VC St Asaph) FJ Gwen Kohler Interim Deputy Director of Finance GK Richard Lee Director of Operations RL Osian Lloyd Internal Audit OL Nick Morgan Trade Union Partner NM Steve Owen Corporate Governance Officer SO Paul Seppmann Trade Union Partner PS Chris Turley Interim Director of Finance & ICT CT Claire Vaughan Director of Workforce and OD CV
APOLOGIES
Nathan Holman Trade Union Partner Bleddyn Roberts Trade Union Partner
40/18 PROCEDURAL MATTERS
The Chairman welcomed all to the meeting and reminded attendees that the meeting was being audio recorded. He gave an overview of the approach he expected the agenda to follow. Apologies were received from Nathan Holman and Bleddyn Roberts.
Minutes
The minutes of the open and closed meeting held on 10 May 2018 were considered by the Committee and confirmed as a correct record subject to a minor amendment; open minutes, removal of the phrase ‘tick box exercise’ at paragraph 3 on page 8.
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Action Log
The Committee considered the open items on the action log:
Action number 35: Savings delivery, item to be marked as completed Action number 36: Update on capital plan, to remain open and was earmarked for next meeting Action number 37: PADR completion deep dive, earmarked for next meeting and to remain on action log Action number 38: Cefn Coed/Conwy house project, item to be marked as completed
RESOLVED: That
(1) the Minutes of the meeting held on 10 May 2018 were confirmed as a correct record subject to the minor correction as stated; and
(2) the action log was discussed and updated as described above.
41/18 FORWARD PLAN
The Interim Director of Finance and ICT (CT), presented the forward plan and commented it was dynamic document. Members recognised that the next meeting was likely to be in the first two weeks of September; this date would better align with the Trust Board meeting scheduled for late September.
Following a query regarding ICT, CT agreed to clarify the wording to include the term strategy within the forward plan.
RESOLVED: That the current forward plan, accepting that it was a dynamic document likely to be updated at future meetings was reviewed and agreed.
42/18 MONTHLY INTEGRATED QUALITY AND PERFORMANCE REPORT (IPR)
The Director of Planning and Performance (HE), gave an overview of the report which provided the Committee with a summary of performance against key quality and performance indicators for the month of April 2018.
In presenting the report HE referred to the development of the IPR which would include Non Emergency Patient Transport Services (NEPTS) performance information and consideration of Annual Quality Indicators (AQI) which were now being published on a monthly basis. Delivery of the latter would be aligned with the publication of the All Wales statistics release. HE advised the Committee on the outcome of a recent Joint Executive Team meeting in which the Trust was shown in a positive light.
The following areas within the report were brought to the Committee’s attention:
1. Demand – verified incidents had increased by 4.4% from last year 2. 999 call volume in May – this was increasing and had increased by 10% from the month before and from the same time last year 3. Hear and Treat was being delivered above the Trust’s performance ambition 4. Conveyance to hospital rates were reducing; however there was still some variation within areas of Wales Page 2 of 12
5. Response time – this was over 65%; and the Committee recognised there were still challenges with the amber 95th percentile going forward 6. Staff sickness – this was still a challenge in terms of the Trust’s performance 7. Efficiencies measures – the challenge now was to enable the strategies and actions in order to reduce variation 8. Staff rosters management – more resource was being added to bolster sustainability going forward
The Committee considered the report in further detail; and raised the following matters:
1. Initiatives to improve performance during the winter months – the Committee held a detailed discussion which focused upon engaging third sector organisations in order to alleviate the pressures that were faced last winter. A discussion was also held in terms of Community First Responders and how they could be used more effectively going forward. HE suggested it would be helpful for the Medical Director to arrange for the issue to be added to the next agenda of the National Unscheduled Programme Board meeting. Furthermore the Chair asked Members to consider whether a representative from Public Health Wales be invited to the Committee. CT agreed to arrange this. 2. Members’ attention was drawn to a minor amendment required on page 87. The word ‘trial’ was to be removed at the top of the page. HE was to arrange for the correction to be made.
In his summary the Chair noted that demand was trending back to regular levels; and there had been a year on year increase. In terms of conveyance and Hear and Treat, assurance had been provided that these were at the expected rates.
RESOLVED: That the Monthly Integrated Quality and Performance Report was noted.
43/18 FINANCE PERFORMANCE – MONTH 2 2018/19
The Interim Director of Finance and ICT (CT), reported that the financial position of the Trust as at month two was a small overspend of £0.048m. The current deficit was forecasted to be fully recovered over the remaining months of the financial year. He stressed it was important to note the variation within the report and the corrective actions the Trust was undertaking.
In terms of 2018/19 pay deal, the current financial position included costs of a 1% uplift, in line with the financial plan and funding provided and agreed within the IMTP; anything over this (which was likely) was assumed to be funded by Welsh Government (WG) going forward.
CT gave further details in terms of risks, capital expenditure and Public Sector Compliance (payment of invoices within 30 days). On the latter, it was noted that compliance for month two had slipped slightly under the WG target of 95%. This was due to a one off implementation impact of the new fleet management system and CT expected this target to be fully recovered over the coming months.
The Committee noted that the month three position would be reported to the Board on 19 July 2018.
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Members considered the update and noted that future reports would contain more detail in terms of savings and the cumulative non pay position going forward.
RESOLVED: That:
(1) the year to date revenue and capital financial position and performance of the Trust was noted; and
(2) it was noted that the month three position would be reported to Trust Board on 19 July 2018.
44/18 WORKFORCE PERFORMANCE REPORT QUARTER 4 2017/18
The Director of Workforce and OD (CV), in presenting the report informed the Committee that the data within it covered the period from 1 April 2018 to 31 May 2018.
CV informed the Committee of initiatives being undertaken in order to improve the position with regard to the completion of Personal Appraisal and Development Review (PADR)
In considering the update on PADR’s the following comment was raised:
It was stated that the quality of PADRs had significantly increased but what was the evidence to substantiate this? CV advised that the results of an ongoing survey should be able to evidence the increase in quality; anecdotally it appeared on the whole there was an improvement in the quality of PADRs.
In terms of sickness absence, CV informed the Committee that this was still a major cause for concern. Notwithstanding this, in quarter one of 2018/19, the monthly sickness rate decreased from 7.13% in April to 6.56% in May. The Workforce and OD Directorate has embarked on several well-being schemes in order to improve the situation. These have included the launch of Trauma Risk Management, a psychological intervention aimed at supporting mental and emotional wellbeing of colleagues who have been exposed to a traumatic incident.
CV briefed the Committee on other sickness absences including musculoskeletal injuries which represented approximately 25% of those currently absent through sickness. Members were given an overview of the initiatives in place to reduce this.
The Committee were advised that short term sickness rates had increased, especially during the weekend period and this was confirmed by the Director of Operations who added that this number of short term sickness had not been seen before.
Members considered the report in further detail and raised the following points:
1. Was the Trust still benchmarking sickness levels against other ambulance services? CV confirmed this was the case adding that ongoing discussions with other ambulance services were taking place in order to glean information from them regarding how they were able to reduce staff sickness levels. 2. Members discussed the veteran’s policy which provided a fast track service and it was suggested this could be explored for all staff going forward. KD informed the Committee of an MOD facility in St Athan in the Vale of Glamorgan which was used to rehabilitate military service personnel and it was mooted whether partnership working going forward was feasible. CV advised there was a network consisting of
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the police and fire service where the mutual use of rehabilitation centres was in place. The challenge going forward was to work with health boards to ensure there was consistent access to healthcare for staff across the whole health system
The Chair concluded there was clearly a fundamental problem; the current approach of setting a target for sickness levels was not working. In order to address the sickness issue the Trust must look at the current sickness levels, the initiatives in place to reduce sickness those levels and should those initiatives prove to be successful the impact they had. There needs to be a radically different approach in the way the Trust deals with sickness.
CV commented that it was an expectation in NHS Wales to set targets which were monitored against. Should the Trust have the capacity to scrutinise and analyse individual cases, this would result in clearly identifying the root causes which could be addressed, evaluated and managed more effectively going forward.
The Committee discussed at great length the issues surrounding staff sickness. It recognised there were still several challenges going forward and noted the initiatives in place to address the problem. Attention was drawn to a recent Internal Audit report on sickness which had given rise to limited assurance. CV gave details in terms of how the Trust had responded to the actions required which had arisen from the report.
Concern was expressed in terms of the number of short term sicknesses, the impact this had upon the Trust, and how this would be dealt with.
CV further informed the Committee that progress had been made in reducing sickness levels from three years ago; however the target for this year had not been attained.
Going forward CV referred to the Bradford Factor or Bradford Formula which was used in human resource management as a means of measuring worker absenteeism which the Trust was applying in order to spot sickness patterns.
RESOLVED: That
(1) the update was noted; and
(2) it was noted that the Committee expressed concern regarding the limited assurance
45/18 QLIK SENSE
A verbal update was provided by the Interim Director of Finance and ICT (CT), in which he advised the Committee that various demonstrations have taken place and confirmed that it would be rolled out in the near future. Qlik Sense is a revolutionary product in the business intelligence (BI) market. Its intuitive, responsive design works seamlessly across all devices - allowing both guided analytics and self-service BI capabilities to be delivered across the organisation.
The Committee will receive a further update report at the next full meeting.
RESOLVED: That the update was noted.
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46/18 NEPTS COMMISSIONING FRAMEWORK
The NEPTS General Manager, South East (MH) gave the Committee an update by way of a PowerPoint presentation in which he drew attention to the following points:
1. Priorities going forward; managing quality and cost, managing demand and improving how the allocation of resources was managed 2. The Delivery Assurance Group (DAG) – Chaired by an EASC Director and should be attended by all Health Boards 3. The Quality and Delivery Assurance Framework – consisted of several schedules in line with the Ambulance Quality Indicators 4. Transfer of work timelines – scheduled for completion by July 2019
The Committee noted the update and recognised the risks involved and the poor attendance of Health Boards at the DAG meetings. Members noted that any impact on staff thus far had been minimal.
The Board Secretary (KC), informed the Committee that at the next Board meeting approval would be sought for FRC to be delegated authority to approve contracts going forward.
RESOLVED: That the update was noted.
47/18 COMPUTER AIDED DISPATCH – UPDATE
The Director of Operations (RL), provided a verbal update informing the Committee that the project was up and running and was performing as expected.
RESOLVED: That the update was noted.
48/18 CEFN COED/CONWY HOUSE BUSINESS CASE
The Director of Planning and Performance (HE), gave an overview of the business case which was specifically designed to:
1. Seek approval for an allocation of £916.5k from the Trust’s remaining 2018-19 discretionary capital allocation, to refurbish Matrix One, the preferred option; and to 2. Seek approval to give notice to terminate the lease of Conwy House through the break clause
The Trust has been aware for some time that the Abertawe Bro Morgannwg University Health Board had an intention to dispose of large areas of the Cefn Coed site including the building which the Trust owns. No formal notice had been given to the Trust but the intent had been made clear by ABMU and in Capital Review Meetings with Welsh Government. Building work has already commenced around the Cefn Coed site which was having a detrimental effect on the staff due to raised noise levels and the general surroundings. The building itself was not in very good state of repair.
In addition to the need to relocate from the Cefn Coed site an opportunity was available until 10 July 2018 to serve the break notice clause within the lease for Conwy House Once served, the service had until 10 January 2019, to vacate the building, otherwise the term of the lease would continue for a further two years.
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It was accepted that this development would result in a recurring revenue cost pressure for the Trust, especially over the medium term, being in effect the premium cost of the rental and running costs of Matrix One (the preferred option) when compared to that currently spent on Conwy House. However Matrix One would house up to 100 staff compared with the 35 currently accommodated at Conwy House.
The Committee noted that both from a Trade Union and Estates perspective, it was a real opportunity going forward.
A discussion ensued which took into account the recommendations the Committee was being asked to approve and the following points were raised:
1. Was there any opportunity to enhance the well-being of staff in the new building? In terms of well-being CV advised that there could possibly be an opportunity to develop this going forward, subject to cost etc. HE added that other opportunities and options could emerge going forward 2. Does the cost include all ICT implications? CT advised that in terms of the costs, from a capital perspective all the ICT implications were covered. It was assumed that this would not cover any increase in staff or revenue costs 3. In terms of the break clause would the decision in two years’ time be different to that being made now? CT informed the Committee that recent correspondence he had seen, had shown that the decision on the break clause could be five years. In any case, the merits of the case still stood up, irrespective of timing around the break clause.
The Committee noted the full support of the Executive Team and recognised that giving approval would affect other items earmarked for potential funding in 2018/19. In terms of the break clause, irrespective if it was two or five years there would be no guarantee that any of the options within the business case would still be available in the future.
CV added that the Organisation Change Policy and the transition process was being adhered to with due diligence and governance.
RESOLVED: That
(1) an allocation of £916.5k from the Trust’s remaining 2018-19 discretionary capital allocation, to refurbish Matrix One was approved;
(2) Approval to give notice to terminate the lease of Conwy House, through the break clause was given;
(3) an estimated small part year revenue cost impact of £17k for the current 2018/19 financial year was noted; and
(4) the commitment for future years revenue costs for this relocation, rising to c£125k in 2019/20 and £210k recurring and the need for this to be included as cost pressures in these years was noted.
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49/18 CARDIFF MAKE READY DEPOT (MRD) – BUSINESS CASE
The Director of Planning and Performance HE, reminded the Committee that the delivery of the Estates SOP had been established as the main estate priority in the Trust’s Integrated Medium Term Plan (IMTP), and that the replacement of the existing Blackweir Ambulance Station and Fleet Workshop was critical going forward.
A Blackweir Replacement Project was established to respond to the Estates SOP and to address the risks associated with current arrangements and to enable delivery of the future service model. The capital cost of the project would be £7.8m and this would need to be funded by Welsh Government.
The outputs of the Project thus far was that the replacement of Blackweir would be developed in two phases, resulting in two separate Business Cases namely:
1. the replacement of Blackweir Ambulance Station with an operational facility to incorporate EMS and NEPTS, together with a Make Ready Depot (Cardiff MRD); and
2. the development of an Ambulance Resource Centre (ARC) merging the Fleet Workshop facilities currently at Blackweir and Blackwood (Cardiff ARC).
Members were informed of the long standing issues with the existing Blackweir site, namely:
1. Poor condition of the facility resulting increased health and safety risks as detailed within the OBC; 2. Unable to expand and develop the facility to delivery future operating model, namely ‘Make Ready’. 3. Limited opportunity to maximise productivity and improve stock control; 4. Significant backlog maintenance liability; 5. Unable to accommodate NEPTS; 6. Unable to provide training and meeting facilities for staff working in Cardiff, and 7. Limited opportunities to develop partnerships and integrated working.
In terms of the costs involved, the Committee were given further details by the Interim Director of Finance and ICT, including the resulting potential future revenue costs and how these would need to be funded or offset by savings and efficiencies elsewhere. These included the additional running costs of a modernised facility and the staffing cost associated with developing an MRD for Cardiff.
The Director of Operations expressed that from an operational perspective, the opportunities and efficiencies would be of great benefit going forward. This was also reiterated by MH from a NEPTS perspective.
Going forward, the Chair suggested it would be beneficial that future business cases contain details which quantify the benefits of the business case offset against the revenue costs, where this is quantifying and such costs are deemed to be cash releasing.
RESOLVED: That:
(1) the progress made was noted;
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(2) the Cardiff MRD OBC was endorsed;
(3) the progression of the Cardiff OBC to the Trust Board for approval was supported subject to considering the inclusion of indicative benefits within the table at paragraph 26;
(4) the early submission of the OBC to WG for scrutiny prior to access capital funding for the site acquisition and subsequent redevelopment of the preferred option was approved; and
(5) the commitment for future year’s revenue costs for this development and also for the implementation of the make ready function within Cardiff was noted.
50/18 TRANSFORMATION OF EDUCATION AND TRAINING – UPDATE
The Director of Workforce and OD (CV), provided the Committee with an update on the draft strategy to consider the training and education needs of the workforce. The aim was to create a high quality, modern, flexible and adaptable model of education that encompasses the entire workforce, with the ability to meet the challenges ahead with ambition and confidence.
There were several opportunities going forward in which the Trust could enhance its ability to deliver education and training services for staff which the Committee was briefed on by CV.
Members recognised the opportunities and benefits going forward noting the possibility of exploring other options should they emerge.
CV clarified, following a query in terms of what exactly the Committee were being asked to do, that the timelines illustrated within the annex were purely indicative milestones of some of the steps being taken and were external timelines.
RESOLVED: That
(1) the content of the paper was considered, discussed and noted; and
(2) the transformation of education and training in the Trust was supported.
51/18 TRANSFORMATIONAL OPERATIONAL UPDATE - VERBAL
Advanced Paramedic Practitioner (APP) Paramedic Business Case
The Director of Operations (RL), briefed the Committee on the background in terms of how APP’s had been developed and gave an overview in terms of how effective they have been. The pilot scheme in North Wales had been the most effective with a 70% deflection of patients away from the Emergency Department. Members were advised that the business case had consisted of extrapolated information from the North Wales model and integrated into an all Wales model.
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Falls Framework Business Case
Members were given an overview by RL commenting that St John Ambulance had been engaged in assisting the Trust with non injured fallers which had been very successful. The business case detailed the resourcing requirement by way of engaging St John Ambulance to provide a falls assistant in four locations along the M4 corridor during the winter period this year and was aligned to the falls strategy. RL gave an overview of how falls assistants were being employed across the remainder of Wales; there was still further work required in North Wales to provide a sustainable level of volunteers.
Hear and Treat
RL advised the Committee that the Hear and Treat model being used by English ambulance services now followed the Trust’s Ambulance Quality Indicators and this now made it possible for the Trust to benchmark its indicators against them.
Band 6
The Director of Workforce and OD (CV), reminded the Committee that the funding had been secured to enable the payment of paramedics at Band Six level to be implemented. There were approximately 59 paramedics who had moved across to the Band Five Emergency Medical Technician three roles; this was significantly less than had been anticipated.
Education managers at Band Six level had been appointed to each of the Health Board areas and these personnel were responsible for providing support to the other paramedics in their particular area in terms of their further training etc...
The impact of what the Band Six paramedic will deliver is as yet unknown but a benefits realisation framework had been established to develop this; however, this work has been suspended until such time the amber review work was completed.
CT gave an overview from a financial perspective and the implications involved going forward.
RESLOVED: That the update was noted
52/18 POST PRODUCTION LOST HOURS UPDATE
In providing the update, RL advised that there had been significant improvements in the reporting of lost unit hours (LUH) with the new C3 Computer Aided Dispatch (CAD) system. The new CAD was more sophisticated in how it handles resources and can record most LUH incidents automatically.
The most significant reason for lost hours during a shift was crews returning to station for a meal break. The new C3 CAD allows for more detailed information to be gleaned and analysed and therefore provide the ability to address the issues. Going forward, in light of the new information being made available, the relevant action plan would be updated.
Following the update Members raised the points below:
1. Did the information being reported include the hours lost above the Handover to Clear time? RL explained that this was recorded by a different method, the
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hospital arrivals screen; the CAD does not measure this, however it would be reported as supplemental data to the CAD. 2. Achieving the best timing of meal breaks, how would that reduce lost hours going forward? RL explained that when a crew had overshot its meal break window, and was overdue their break, they would return to station and be unavailable. If less crews overshot the meal break window, then less crews would be returning to station unavailable. RL stressed that returning to base was not a good use of time and measures were in place to address the issue, consider better alternatives and achieve an improved compliance.
RESOLVED: That the update was noted and the focus now was to address the actions to achieve better compliance.
53/18 UPDATE ON THE IMPLEMENTATION OF THE ASSET MANAGEMENT SYSTEM
The Interim Director of Finance and ICT (CT), in providing the update informed the Committee that as a result of previous audit recommendations in how the Trust managed its fixed assets, it purchased the Real Asset Management (RAM) asset management system. The system was on target to be fully up and running by September 2018.
RESOLVED: That the update on the implementation of the RAM system was noted.
54/18 POLICIES
The following policies were submitted to the Committee for formal approval and adoption by the Trust:
1. Vehicle Disposal Policy 2. Adverse Weather Conditions Policy and Procedure
Disposal of vehicles: Paragraph 6.4.1. Members considered it was inappropriate to donate outdated vehicles to organisations going forward. Following further discussion it was agreed that the paragraph be re-worded to state that the Trust does not donate outdated vehicles to good causes.
RESOLVED: That the above policies were approved subject to the re-wording of paragraph 6.4.1 as detailed above of the Vehicle Disposal Policy.
55/18 ESTABLISHING THE ESTATES PROGRAMME BOARD
The Director of Planning and Performance (HE), reminded the Committee that this Board had been established to drive forward the Welsh Government endorsed Estates Strategic Outline Programme.
In terms of progress being made HE drew attention to the following areas:
1. The relocation of HMS Stanley Project - the move to Unit 7 2. The redevelopment of Tredegar into a Make Ready Depot 3. The relocation of Barry station to a joint Fire and Ambulance station and the creation of a Make Ready Depot 4. Progress with Llanidloes and Whitland fire stations with Mid and West Fire Services 5. A number of feasibility studies in the Hywel Dda area
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HE commented that the programme would benefit by having a Non Executive Director as one of its members.
RESOLVED: That the establishment of the Estates Programme Board was noted.
56/18 RISKS RELEVANT TO FRC
The Board Secretary (KC), referred to the report and advised that the full risk register was part of the overall report and the risks associated with the FRC were identified within the covering report. Each separate risk applicable to the FRC was discussed in further detail by the Committee with a brief update given by the relevant Director.
At the next FRC meeting, it was agreed that, taking into account that some of the risks may have been re-scored, they would be weaved into other relevant areas within the agenda for discussion.
RESOLVED: That
(1) the key corporate risks relevant to FRC were received and reviewed; and
(2) the development work currently in progress was noted.
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1 ITEM 1.3b FRC Action Log Open and completed.xlsx
FINANCE AND RESOURCES COMMITTEE ACTION LOG
No: DATE MINUTE ACTION DATE DUE ASSIGNED TO UPDATE RAISED REFERENCE
14 27-Jul-17 21/17 A Long Term Financial Strategy Day 25/10/2018 Executive Director of REVIEW OF to take place to enable Committee Finance & Deputy Chief COMMITTEE development and align FRC Date Executive Officer, Chair EFFECTIVENESS with Board meetings and Corporate Governance Officer
36 10-May-18 UPDATE ON 2017/18 A query arose in terms of the 25/10/2018 Interim Director of CAPITAL variance in spend with regard to Finance PROGRAMME AND digipens. CT explained that table INITIAL 2018/19 three within the report illustrated how DISCRETIONARY the Trust spent the slippage and CAPITAL PLAN agreed to provide further clarification following the meeting
37 10-May-18 32/18 WORKFORCE The Chair and the Director of 25/10/2018 Director of Workforce PERFORMANCE Workforce and OD undertake further and OD REPORT QUARTER analysis in order to establish the 4 2017/18 underlying problems associated with timely PADRs completion was agreed
39 5-Jul-18 Workforce The Director of Workforce and OD 25/10/2018 Director of Workforce Performance undertake further analysis in order to and OD Sickness analysis establish the underlying problems associated with sickness and provide figures was agreed 40 5-Jul-18 Workforce Conduct analysis into Non Pay 25/10/2018 Director of Workforce Performance pressures and OD
41 5-Jul-18 Risks Consider how risks are reported to 25/10/2018 Board Secretary and FRC, separate Agenda Item? Interim Director of Finance and ICT
42 5-Jul-18 Winter Issues A Member from Public Health Wales 25/10/2018 Interim Director of be invited to attend an FRC meeting Finance and ICT to discuss winter issues and challenges
43 5-Jul-18 IPR Minor amendment on page 87 of 25/10/2018 Director of Planning and IPR, remove the word 'trial' at top of Performance/Head of page Planning and Performance
44 5-Jul-18 54/18 Vehicle Disposal ParagraphPolicy 6.4.1 be amended to read 25/10/2018 Director of Operations 'the Trust does not donate outdated vehicles to good causes such as St John Ambulance, Red Cross or oversees organisations'
COMPLETED ACTIONS
DATE MINUTE ACTION STATUS/ ASSIGNED TO RAISED REFERENCE DUE DATE 1 26-Feb-16 01/16 Procedural Vehicle replacement BJC - Report 24-Nov-16 Director of Finance and Matters to be presented at next meeting. ICT COMPLETED 2 28-Jul-16 28/16 The Director of Operations was to 24-Nov-16 Director of Operations circulate to FRC Members an Monthly IPR and AQI update on the Handover to Clear situation following the conclusion of the process mapping exercise. On Agenda
COMPLETED
3 13 Ambulance and Fire Lessons Learnt update. Gateway 27-Jul-17 Director of Finance and September Services Resource five review – Update paper ICT 2016 and WrexhamCentre (AFSRC) 24 November COMPLETED 2016 and 4 2427 April Action Log update A verbal update on the Demand 26-Oct-17 Director of Operations November2017 and Capacity Internal Efficiency 2016 and Actions was provided at the April 27 April meeting. A written report on the 2017 three month trial being On Agenda – undertaken to further analyse the Item 1.4a internal efficiencies would be provided at the next meeting COMPLETED
5 24-Nov-16 Action Log update Update on actions regarding on- 27-Apr-17 Director of Workforce call issues and review of LDP’s and OD following the ICT outage.
COMPLETED
6 24-Nov-16 Action Log update Estates Strategic Outline 23-Feb-17 Director of Finance and Programme be presented to FRC ICT
COMPLETED 7 24 51/16 A detailed report on the post 27-Jul-17 Director of Operations November production lost hours was to be 2016 and Post Production Lost provided at the next meeting 27 July Hours and 12/17 2017 COMPLETED
8 24-Nov-16 54/16 UCS - A detailed analysis into the 23-Feb-17 Director of Workforce sickness absence levels would be and OD Workforce provided at the next meeting COMPLETED
9 24-Nov-16 56/16 Fleet Management Plan to be 23-Feb-17 Director of Operations presented at next meeting Fleet Management
COMPLETED
10 23 Feb-17 Chairman and Director of Finance 27-Jul-17 Director of Finance February to consider grouping items for 2017 and Committee Forward inclusion into a more consistent 27 April Plan and 12/17 manner and provide update at 2017 next meeting. COMPLETED
11 23 Aug-17 A verbal update was provided and 27-Jul-17 Director of Operations February It was agreed that a more 2017 and WAST Fleet comprehensive proposal/plan 27 April Management Plan would be presented at the next 2017 and 12/17 meeting. COMPLETED
12 27-Apr-17 14/17 Handover to Clear performance in 27-Jul-17 Director of Operations the Abertawe Bro Morgannwg AQIs University Health Board area was disappointing and did not appear to be improving. RL agreed to COMPLETED consider the issue further and 13 27-Jul-17 20/17 Aprovide revised further forward clarification plan for the at the Revised Corporate Governance remainingnext FRC meeting meetings following in the cycle an of Forward Plan Officer investigation. Forward Plan 2017/18 and if possible early e mailed on 2018/2019 be forwarded to the 28 August Chair and the Executive Director COMPLETED2017 for of Finance & Deputy Chief comment Executive Officer by the end of (Copied to August 2017. Board Secretary) – On Agenda 14 27-Jul-17 21/17 Following the survey a number of Executive Director of recommendations/actions were Finance & Deputy Chief Review Of Committee highlighted: Executive Officer, Chair Effectiveness and Corporate · A Long Term Financial First 2 bullet Governance Officer Strategy Day to take place to points in enable Committee development Open section
· Align FRC Date with Board meetings Autumn 2017
· Add ‘Risks from the Corporate Risk Register to FRC’ as a regular item on the Agenda
· Feedback from SWAST COMPLETED meeting
Already earmarked within the annual plan - · Consider adding MeetingCOMPLETED with Consent Items as part of the SWAST taking Agenda place in December, · Review of Committee Alreadyfeedback will to be conducted annually earmarkedbe provided withinfollowing the that annualmeeting plan - COMPLETED
· Structure the Agenda To be to be more cohesive conducted at first meeting in new cycle (26 April 2018 now 10 May 2018) 14 27-Jul-17 Executive Director of Finance & Deputy Chief Executive Officer, Chair and Corporate Governance Officer
COMPLETED
15 27-Jul-17 22/17 A comprehensive plan on 26-Oct-17 Assistant Director of reducing variation to be presented Operations IPR, Plan to reduce at the next meeting COMPLETED variation 16 27-Jul-17 23/17 Does the Trust know how much, 26-Oct-17 Executive Director of as a direct result of Handover Finance & Deputy Chief Finance Report delays, has been attributed to the Executive Officer deficit? PR explained that the overtime cost due to over-runs COMPLETED was known and a correlation could be conducted to see how much was attached to Handover delays.
17 27-Jul-17 25/17 The workforce team were 10-May-18 Assistant Director of requested to provide a more Workforce and OD Workforce and condensed report. This would Performance take a little while to work through, due to several technical COMPLETED challenges and should be . available by April 2018.
The Committee 18 27-Jul-17 27/17 A discussion on the Demand and COMPLETEDnoted that Board Secretary Capacity review be added to the the first Demand and Capacity Board Development day report of the programme in October new year 19 27-Jul-17 28/17 A report on the benefits 25-Jan-18would be in a Executive Director of realisation and details of revised Finance & Deputy Chief format Estates – Gateway recommendation four within the Executive Officer Five review review would be presented at the next meeting. COMPLETED On Agenda 20 27-Jul-17 29/17 A further update was to be 26-Oct-17 Executive Director of provided at the next meeting Finance & Deputy Chief CAD Implementation Executive Officer
On Agenda – Item 2.6
COMPLETED
21 27-Jul-17 30/17 Post production An update on the next steps and 26-Oct-17 Assistant Director of lost hours actions being undertaken to Operations reduce lost hours would be provided at the next meeting On Agenda – Item 5.1
COMPLETED
22 27-Jul-17 32/17 It was agreed that a working 26-Oct-17 Chairman and the group would be established to Executive Director of Developing Plans For focus on plans for financial Finance & Deputy Chief Long Term Plans For sustainability; the details of which Executive Officer Financial would be circulated by the COMPLETED Sustainability Chairman and PR going forward. 23 10-May-17 Asset management – the Audit 25-Jan-18 Executive Director of Committee discussed the Finance & Deputy Chief RAISED processes in terms of asset Executive Officer AT AUDIT management in further detail COMMITT paying particular attention to the Deferred to 10 EE issues which had now become May 2018 embedded as a management process going forward. It was agreed that PR would arrange for On Agenda – this to be brought to the attention see item 1.3ci of the Finance and Resources Committee for their consideration 23 Asset management – the Audit Executive Director of Committee discussed the Finance & Deputy Chief processes in terms of asset Executive Officer management in further detail paying particular attention to the issues which had now become embedded as a management process going forward. It was agreed that PR would arrange for this to be brought to the attention of the Finance and Resources Committee for their consideration COMPLETED
24 RAISED A ‘deep dive’ of sickness absence 26-Oct-17 All AT CWG and amber performance be ON 3 undertaken by FRC. Any quality October issues arising to be referred to 2017 QuESt for investigation. COMPLETED
25 26-Oct-17 40/17 The Demand and Capacity review 1-Nov-17 Director of Operations work programme and timescales Demand and Capacity would be distributed to Members after the meeting COMPLETED
26 26-Oct-17 45/16 A full update on progress 25-Jan-18 Assistant Director of regarding sickness was to be Workforce and OD Workforce and OD presented at the next meeting. COMPLETED
27 26-Oct-17 50/17 A further update was to be 25-Jan-18 Head of Health provided at the next meeting Informatics Enterprise Business Intelligence Solution Qlik Sense ITEM DEFERRED TO 10 May 2018 COMPLTED
Members recognised 28 26-Oct-17 51/17 A further update was to be 25-Jan-18the item was Executive Director of provided at the next meeting listed in the Finance & Deputy Chief QUALITY AND Forward Plan Executive Officer DELIVERY ASSURANCE COMPLETED FRAMEWORK FOR 29 26-Oct-17 53/17NON EMERGENCY It was agreed that prior to the 4-Dec-17 Executive Director of PATIENT Trust Board meeting in December, Finance & Deputy Chief RevisedTRANSPORT Fleet SOP FRC Members be provided with an Executive Officer SERVICES update. 29 26-Oct-17 It was agreed that prior to the Executive Director of Trust Board meeting in December, Finance & Deputy Chief FRC Members be provided with an Executive Officer update. COMPLETED
30 25-Jan-18 Feb-18 A forward plan of the policies 10-May-18 Corporate Governance expected to come to the FRC was Manager Committee Forward required Plan COMPLETED
35 10-May-18 30/18 The savings profile and the 05/07/2018 Deputy Director of associated risks would be included in COMPLETED Finance SAVINGS DELIVERY the next report. UPDATE 38 10-May-18 003/18 - Cefn Project Update at next meeting 05/07/2018 Director of Planning and Coed/Conwy House COMPLETED Performance Relocation Project DATE MINUTE ACTION STATUS/ DUE DATE ASSIGNED TO 1 26-Feb-16RAISED 01/16REFERENCE Procedural Matters Vehicle replacement BJC - Report to 24-Nov-16 Director of Finance and ICT be presented at next meeting. COMPLETED
2 28-Jul-16 28/16 The Director of Operations was to 24-Nov-16 Director of Operations circulate to FRC Members an update Monthly IPR and AQI on the Handover to Clear situation following the conclusion of the On Agenda process mapping exercise. COMPLETED 3 13 September Ambulance and Fire Lessons Learnt update. Gateway 27-Jul-17 Director of Finance and ICT 2016 and 24 Services Resource Centre five review – Update paper November 2016 (AFSRC) and 27 April 2017
Wrexham COMPLETED 4 24 November Action Log update A verbal update on the Demand and 26-Oct-17 Director of Operations 2016 and 27 Capacity Internal Efficiency Actions April 2017 was provided at the April meeting. A written report on the three month On Agenda – Item 1.4a trial being undertaken to further analyse the internal efficiencies would be provided at the next meeting COMPLETED
5 24-Nov-16 Action Log update Update on actions regarding on-call 27-Apr-17 Director of Workforce and OD issues and review of LDP’s following the ICT outage. COMPLETED 6 24-Nov-16 Action Log update Estates Strategic Outline 23-Feb-17 Director of Finance and ICT Programme be presented to FRC
COMPLETED 7 24 November 51/16 A detailed report on the post 27-Jul-17 Director of Operations 2016 and 27 production lost hours was to be July 2017 provided at the next meeting Post Production Lost Hours and 12/17 COMPLETED 8 24-Nov-16 54/16 UCS - A detailed analysis into the 23-Feb-17 Director of Workforce and OD sickness absence levels would be Workforce provided at the next meeting COMPLETED 9 24-Nov-16 56/16 Fleet Management Plan to be 23-Feb-17 Director of Operations presented at next meeting Fleet Management COMPLETED 10 23 February Feb-17 Chairman and Director of Finance to 27-Jul-17 Director of Finance 2017 and 27 consider grouping items for April 2017 inclusion into a more consistent Committee Forward Plan manner and provide update at next and 12/17 meeting. COMPLETED 11 23 February Aug-17 A verbal update was provided and It 27-Jul-17 Director of Operations 2017 and 27 was agreed that a more April 2017 comprehensive proposal/plan would WAST Fleet Management be presented at the next meeting. Plan and 12/17 COMPLETED 12 27-Apr-17 14/17 Handover to Clear performance in 27-Jul-17 Director of Operations the Abertawe Bro Morgannwg University Health Board area was disappointing and did not appear to be improving. RL agreed to consider the issue further and provide further clarification at the next FRC meeting following an investigation. 12 27-Apr-17 Handover to Clear performance in Director of Operations the Abertawe Bro Morgannwg University Health Board area was disappointing and did not appear to be improving. RL agreed to consider the issue further and AQIs provide further clarification at the next FRC meeting following an COMPLETED investigation.
13 27-Jul-17 20/17 A revised forward plan for the Revised Forward Plan e Corporate Governance Officer remaining meetings in the cycle of mailed on 28 August 2017 2017/18 and if possible early for comment (Copied to 2018/2019 be forwarded to the Chair Board Secretary) – On and the Executive Director of Agenda Forward Plan Finance & Deputy Chief Executive Officer by the end of August 2017. COMPLETED
14 27-Jul-17 21/17 Following the survey a number of Executive Director of Finance recommendations/actions were & Deputy Chief Executive highlighted: Officer, Chair and Corporate Governance Officer Review Of Committee Effectiveness
· A Long Term Financial Strategy First 2 bullet points in Day to take place to enable Open section Committee development
· Align FRC Date with Board meetings
Autumn 2017 · Add ‘Risks from the Corporate Risk Register to FRC’ as a regular item on the Agenda
· Feedback from SWAST COMPLETED meeting 14 27-Jul-17 Executive Director of Finance & Deputy Chief Executive Officer, Chair and Corporate Governance Officer
Already earmarked within the annual plan - COMPLETED
· Consider adding Consent Meeting with SWAST taking Items as part of the Agenda place in December, feedback will be provided following that meeting
· Review of Committee to Already earmarked within be conducted annually the annual plan - COMPLETED
· Structure the Agenda to To be conducted at first be more cohesive meeting in new cycle (26 April 2018 now 10 May 2018)
COMPLETED
15 27-Jul-17 22/17 A comprehensive plan on reducing 26-Oct-17 Assistant Director of variation to be presented at the next Operations IPR, Plan to reduce meeting COMPLETED variation 16 27-Jul-17 23/17 Does the Trust know how much, as 26-Oct-17 Executive Director of Finance a direct result of Handover delays, & Deputy Chief Executive has been attributed to the deficit? Officer Finance Report PR explained that the overtime cost due to over-runs was known and a COMPLETED correlation could be conducted to see how much was attached to Handover delays.
17 27-Jul-17 25/17 The workforce team were requested 10-May-18 Assistant Director of to provide a more condensed report. Workforce and OD Workforce and This would take a little while to work Performance through, due to several technical challenges and should be available by April 2018. COMPLETED.
The Committee noted that the first report of the new year would be in a revised format
18 27-Jul-17 27/17 A discussion on the Demand and COMPLETED Board Secretary Capacity review be added to the Demand and Capacity Board Development day programme in October
19 27-Jul-17 28/17 A report on the benefits realisation 25-Jan-18 Executive Director of Finance and details of recommendation four & Deputy Chief Executive within the review would be Officer presented at the next meeting. Estates – Gateway Five review COMPLETED On Agenda 20 27-Jul-17 29/17 A further update was to be provided 26-Oct-17 Executive Director of Finance at the next meeting & Deputy Chief Executive CAD Implementation Officer 20 27-Jul-17 A further update was to be provided Executive Director of Finance at the next meeting & Deputy Chief Executive Officer On Agenda – Item 2.6
COMPLETED
21 27-Jul-17 30/17 Post production lost An update on the next steps and 26-Oct-17 Assistant Director of hours actions being undertaken to reduce Operations lost hours would be provided at the next meeting On Agenda – Item 5.1
COMPLETED 22 27-Jul-17 32/17 It was agreed that a working group 26-Oct-17 Chairman and the Executive would be established to focus on Director of Finance & Deputy plans for financial sustainability; the Chief Executive Officer Developing Plans For details of which would be circulated Long Term Plans For by the Chairman and PR going Financial Sustainability forward.
COMPLETED
23 10-May-17 Asset management – the Audit 25-Jan-18 Executive Director of Finance Committee discussed the processes & Deputy Chief Executive in terms of asset management in Officer further detail paying particular attention to the issues which had RAISED AT now become embedded as a AUDIT management process going COMMITTEE forward. It was agreed that PR would arrange for this to be brought Deferred to 10 May 2018 to the attention of the Finance and Resources Committee for their consideration On Agenda – see item 1.3ci 23 Asset management – the Audit Executive Director of Finance Committee discussed the processes & Deputy Chief Executive in terms of asset management in Officer further detail paying particular attention to the issues which had now become embedded as a management process going forward. It was agreed that PR would arrange for this to be brought to the attention of the Finance and Resources Committee for their consideration
COMPLETED
24 RAISED AT A ‘deep dive’ of sickness absence 26-Oct-17 All CWG ON 3 and amber performance be October 2017 undertaken by FRC. Any quality issues arising to be referred to QuESt for investigation. COMPLETED 25 26-Oct-17 40/17 The Demand and Capacity review 1-Nov-17 Director of Operations work programme and timescales Demand and Capacity would be distributed to Members after the meeting COMPLETED 26 26-Oct-17 45/16 A full update on progress regarding 25-Jan-18 Assistant Director of sickness was to be presented at the Workforce and OD Workforce and OD next meeting. COMPLETED 27 26-Oct-17 50/17 A further update was to be provided 25-Jan-18 Head of Health Informatics at the next meeting Enterprise Business Intelligence Solution Qlik Sense ITEM DEFERRED TO 10 May 2018
COMPLTED Members recognised the item was listed in the Forward Plan
28 26-Oct-17 51/17 A further update was to be provided 25-Jan-18 Executive Director of Finance at the next meeting & Deputy Chief Executive Officer 28 26-Oct-17 A further update was to be provided Executive Director of Finance at the next meeting & Deputy Chief Executive QUALITY AND Officer DELIVERY ASSURANCE FRAMEWORK FOR NON EMERGENCY PATIENT TRANSPORT SERVICES
COMPLETED
29 26-Oct-17 53/17 It was agreed that prior to the Trust 4-Dec-17 Executive Director of Finance Board meeting in December, FRC & Deputy Chief Executive Revised Fleet SOP Members be provided with an Officer update. COMPLETED 30 25-Jan-18 Feb-18 A forward plan of the policies 10-May-18 Corporate Governance expected to come to the FRC was Manager Committee Forward Plan required COMPLETED
35 10-May-18 30/18 The savings profile and the associated 05/07/2018 Deputy Director of Finance risks would be included in the next COMPLETED SAVINGS DELIVERY report. UPDATE
38 10-May-18 003/18 - Cefn Project Update at next meeting 05/07/2018 Director of Planning and Coed/Conwy House COMPLETED Performance Relocation Project 2.1 Finance Performance - Month 5, 2018/19 and Savings Delivery (Interim Director of Finance and ICT) 1 ITEM 2.1 Finance Report M5 18-19 FINAL.doc
AGENDA ITEM No 2.1 OPEN or CLOSED OPEN
No of ANNEXES 5 ATTACHED
FINANCIAL PERFORMANCE AS AT MONTH 5 2018/19
MEETING Finance and Resources Committee DATE 20TH September 2018 EXECUTIVE Interim Director of Finance & ICT AUTHORS Gwen Kohler / Edward Roberts / Chris Turley Chris Turley Tel 01633 626201 CONTACT DETAILS [email protected]
CORPORATE OBJECTIVE IMTP priorities CORPORATE RISK (Ref if CRR42, CRR45 & CRR46 appropriate) QUALITY THEME HEALTH & CARE STANDARD 2.1, 2.4, 3.1
To provide the Committee with an update on REPORT PURPOSE the financial performance and savings delivery of the Trust for the first five Months of 2018/19 CLOSED MATTER REASON N/A
REPORT APPROVAL ROUTE
WHERE WHEN WHY 12th September EMT Verbal update on M05 financial position 2018 20th September FRC To note the M05 financial position 2018 To note the M05 financial position, 27th September Trust Board associated key risks and issues. 2018
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WELSH AMBULANCE SERVICES NHS TRUST
FINANCE AND RESOURCES COMMITTEE
FINANCIAL PERFORMANCE AS AT MONTH 5 2018/19
SITUATION
1. This report provides the Committee with a detailed update on the financial performance of the Trust against budget as at August 2018 (Month 5) of the 2018/19 financial year.
BACKGROUND
1. The reported year to date financial position of the Trust as at Month 5 2018/19 (August 2018) is a small overspend against budget of £0.049m. This is a very slight improvement in the year to date position this month of £0.001m. Whilst still reasonably early in the financial year this position will need to be addressed and corrective actions, plans to recover and deliver additional savings are all being progressed via the Executive Finance Group and Executive Management Team, to bring the financial position back on track before the financial year end. The current deficit is therefore forecasted to be fully recovered over the remaining months of the financial year, with the year end position forecasting breakeven. This will be subject to the successful management of some emerging risks.
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2. Areas adversely impacting on the Trust’s financial position as at Month 5 are in relation to fuel due to an upward trend in forecourt prices, causing a pressure against the baseline budget set for 2018/19. Use of Taxi services to support the Non Emergency Patient Transport Services and an increase in servicing and consumable costs for Medical Equipment are also a factor. The Trust has also being adversely affected by the increase in business rates and the loss of business rates relief. Previously reported pressures in the NEPTS service, including the delivery of service enhancements as part of the previously approved business case, continue.
ASSESSMENT
2. The Month 5 Statutory Targets Performance and year end forecast dashboard are shown at Annex 1.
3. Year to date (YTD) and full year income assumptions reflect those agreed within the approved IMTP and are used to support cost pressures identified in the Trust’s budget setting. The key funding assumptions for 2018/19 being that the 2017/18 funding is fully recurrent, and is currently subject to the nationally agreed 2% funding uplift for pay and other pressures (at a pay award level of 1%), which is applied to all areas of the Trust’s funding, for all its services. On top of this there are some specifically agreed additional funding items for 2018/19, including funding for the continuing implementation of Band 6 Paramedics and in relation to ESMCP. Again, all of this is fully consistent with that contained and agreed within the Trust’s refreshed IMTP, and with the exception of the funding for the ESMCP Control Room Solution (CRS)
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Business Case all income is now all being received by the Trust in 2018/19. The balance required for the ESMCP CRS is now also being urgently chased up.
3. Non EASC income assumptions are in line with agreed services provide by WAST. As above, the WHSSC / EASC values are consistent with that agreed and supported within the IMTP, and any additional funding adjustments agreed since.
4. The current position assumes a cost impact of the 2018/19 pay deal at a 1% pay award, in line with the funding agreed through the IMTP. Following the pay deal proposed by the Cabinet Secretary, it is assumed that the balance of costs for the final pay deal will be fully funded by WG and therefore any costs of re-instating unsocial hour payments whilst on sick leave will also be included in this deal, but currently the full details of the pay deal are yet to be published. Cumulative to Month 5 enhanced sick costs are is £0.354m, with corresponding matched income assumed from Welsh Government. Until finally confirmed and received, this continues to be flagged as a risk.
5. Reported Income as at Month 5 is a favourable variance of £0.409m. Assumptions and main variances are as follows:
• As above, £0.354m of assumed income (corresponding cost in pay position) in respect of the payments now re-instated for unsocial hours sick periods;
• Full cost impact of Band 6 funding against actual expenditure incurred is a surplus of £0.225m. This is reflected as reduced income in the Month 5 position and is due to c110 staff now paid at Band 5 rates for the grades of EMT 3 and Newly Qualified Paramedics (NQPs). Work continues with the commissioner to determine the financial value of this funding to be “handed back” to EASC to be invested at their discretion, as per the 2018/19 Health Board Allocation Letter;
• Small over recovery on a number of locally delivered schemes to Health Boards e.g Falls support, APP projects;
6. Expenditure by Directorate and Health Board Area is shown at Annex 2. Overall the total pay variance for the year to date period is an under-spend of £0.623m. Assumptions and main variances are as follows, including some offsetting the income variance above:
• As noted above, the cumulative pay position includes an accrued value of 1% for the 2018/19 pay award, until the full details of the pay deal are known;
• Month 05 (August 18) includes £0.354m of estimated costs in respect of the re- instatement of sickness payments during unsocial hour periods. The value of £0.354m has been offset with assumed income from WG as this is above the funded level identified in the IMTP financial plan;
• Full cost impact of Band 6 funding against actual expenditure incurred is a surplus of £0.225m. This is reflected as reduced income in the Month 5 position and is due to c110 staff now paid at Band 5 rates for the grades of EMT 3 and NQPs;
• Pay savings continue in corporate functions due to vacancies and some directorates have brought forward achievement of vacancy management savings.
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7. Cumulative non-pay position at Month 5 is an adverse variance of £0.623m. Assumptions and main variances with this are as follows:
• Taxi and other vehicle hire position overspent by £202k. NEPTS share is £191k (of which £30k is offset by rechargeable income) with the main overspending area being the South East. EMS CCC use of taxis is overspent by £11k;
• Fuel overspent by £149k (increase of £27k in Month 5) due to increased forecourt prices. Budget has now been devolved out to directorate / Operational areas;
• Voluntary sector providers (St John) are overspent by £152k. NEPTS overspent by £37k and EMS Ops by £115k of which the majority supports UCS vacancies (reported in the pay position) and continuation of ‘falls support’ introduced in Quarter 4 2017/18;
• Travel & Subsistence budget is currently under spent by £47k with the majority of this due to reduction in meal breaks now controlled by CCC where expenditure has reduced by £40k per month compared to 2017/18;
• Clinical Services and supplies are cumulatively overspent by £122k with the majority due to Medical and Surgical Equipment and the servicing and parts costs associated with Corpuls defibs;
• Pressures on Rates costs from loss of small business relief, general inflation uplifts and costs for new premises for 2018/19 has resulted in cost pressure of £150k;
• £400k of savings (£200k Admin Review and £200k additional income target) is yet to be allocated to directorate positions. £68k of the £200k additional income target has been met by a fortuitous non recurrent gain from a VAT recovery exercise. Month 3 cumulative financial position includes £113k of the unallocated and therefore unachieved admin review target.
Savings
8. Our financial plan for 2018/19 indicates that £4.2m (Circa 3%) of savings and cost containment measures will be required to achieve financial balance.
9. As at 31st August the Trust has achieved total savings of £1.995m against a target of £2.017m, an under achievement against the target of £0.022m. The year to date target represents 48% of the total annual target.
10. The graph below presents the cumulative savings profile and the year to date savings delivery by month.
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11. Key points drawn from this are:-
• Whilst 99% of our savings plans have been achieved as at Month 5 there are specific schemes over achieving which are offsetting others that are under achieving;
• There is yet to be an achievement against the savings attributed to NEPTS;
• Travel & Subsistence savings have over-achieved to date by £68k due to a significant reduction in the provision of allowable and disturbed meal break payments;
• Through management of non-operational vacancies, plan has been exceeded to date by £134k;
• Estates and utilities have realised savings of £27k due to reduction in electricity and gas. Full delivery is currently off track due to significant increases in rates;
• As a result of rising forecourt prices savings against fuel have slowed dramatically. We will continue to maximise the benefits of discounted fuel through the use of All-Star fuel cards at specified garages with additional monitoring information to be provided at a local level
12. A full detailed update, including the re-introduction of the highlight reports for each key savings theme, will be provided to FRC for the 25th October meeting.
Corrective action
13. Work continues to be progressed through the Executive Finance Group (EFG) and Executive Management Team (EMT) to discuss and deliver the actions to ensure the continuing delivery of financial balance by the Trust in 2018/19. Areas of work that are progressing includes: Page 6
• Further understanding of the root cause of the NEPTS overspend which has resulted in a slowdown of the overspend each month;
• Continue to identify the benefits of the introduction of the Fleetwave system, maximise the impact of the previous fleet review and explore areas of additional opportunities and what, if any of these can be further accelerated in year;
• The finalisation of the output of the review into lease and pool cars and then implement these recommendations at pace. Further explore other areas to reduce spending on travel and subsistence;
• Continued engagement with Budget Holders to ensure they remain within their delegated budgets for 2018/19. Cost pressures and directorate developments are assessed against their baseline budgets locally prior to any forward request for additional funding;
• Ensuring all additional income opportunities are pursued;
• Further work on areas of savings not yet achieving will continue.
Balance sheet and capital expenditure to date
14. The Trust’s balance sheet at Month 5 and forecast yearend balance sheet are shown at Annex 4.
15. The Trust’s detailed capital expenditure by project is shown at Annex 5. At Month 5 the Trust’s current approved Capital Expenditure Limit (CEL) is at a level of £17.485m, which includes £10.293m. Orders are currently now being raised and projects are moving forwarded with costs likely to start being incurred over the next few months, further helped by the earlier confirmation this year of fleet funding.
16. At Month 5 the Trust has expended £1.101m or 6.3% of the CEL, however schemes are progressing well, with a number of new schemes being presented to this meeting fro approval (via a separate paper providing a detailed update on the discretionary capital programme), to utilise the majority of current unallocated budget of c£0.575m.
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17. Public Sector Payment (PSPP) compliance for Month 5 was 96.2% against the 95% WG target set for non-NHS invoices by number, and 98.2% by value.
Risks
18. Within the monthly reported financial position returns to WG the Trust continues to highlight some key risks of delivery which will need to be mitigated and managed to ensure successful delivery of financial balance by the year end. These include:-
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➢ Non delivery of Saving Plans/CIP’s is included as a low risk, and will be assessed in detail during the year. As at month 5 this has been consistently included as an annual risk of £0.650m; this will continue to being monitored monthly and no doubt reduce in the coming months;
➢ Linked to the pay deal, due to the end of the three year pay agreement the costs of enhancements on sickness pay were accounted for and matched with funding through WG for the last quarter of the 2017/18 financial year. As mentioned above costs have been re-instated and as at Month 5 are estimated at £0.354m (estimated full month costs are c£0.070m) with the assumption that this will also be matched with income from WG. The non receipt of this funding is therefore classified as a medium financial risk to WAST. Estimated figure is c£1.000m pa based on current sickness levels;
➢ Following a recent ruling which provided for holiday pay entitlements to apply not just to compulsory overtime (such as over runs) but also to incidental and voluntary overtime, including an element for all other pay related allowances, this was added as a risk from Month 4. The value of this could be significant at c£1m per annum with potential arrears payments due. This would impact on all NHS organisations, and is being raised through CEOs to WG;
➢ Given the pressures the Trust felt last winter, the Trust has included a figure of £0.500m to cover any unfunded winter pressures; this has been deemed as a medium risk.;
➢ Personal Injury Benefit (PIBs) funding has been included as a risk, albeit the Trust will discuss with WG as it has in previous financial years to ensure funding would be made available in line with the PIBs costs which materialise during the financial year.
➢ Two additional risks were added in regards to funding for additional depreciation and impairment funding £1.879m and £3.486m respectively, this is recorded as low risk as it is assumed that WG will fund this as in previous financial years, and discussions are taking place to get this agreed.
RECOMMENDED That the Committee:
(1) Note the current year to date revenue and capital financial position and performance of the Trust, key drivers and risks within this, corrective action being progressed and the resulting year end forecast.
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Annex 1- Statutory Targets Performance Dashboard
YTD Forecast
Breakeven-achievement of Missed R On Target G financial balance
CRL- Capital spend equal or less than the Capital Resource On Target G On Target G limit
EFL- Remain within External On Target G On Target G Financing Limit
PSPP- 95% of Non NHS Invoices by Number are paid On Target G On Target G within 30 days
Note * Amber would be shown if overall financial deficit was within 1% of turnover
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Annex 2 - Breakdown by Directorate and Health Board Area
INCOME PAY NON-PAY TOTAL
Variance Variance Variance Variance Month 5 2018/19 £'000 £'000 £'000 £'000 Service Delivery 130 55 27 212 Resilience - 29 - 12 9 - 32 Resources 1 - 126 16 - 108 Clinical Contact Centre - 1 - 87 - 5 - 93 999 Clinical Contact Centres - - - 86 - 86 Head of NHSD/111 - 29 - 131 20 - 141 Abertawe Bro Morganwg HB - 15 - 132 39 - 108 Aneurin Bevan HB - 64 12 42 - 10 Betsi Cadwaladr HB - 11 - 261 143 - 129 Cardiff and Vale HB - 2 - 33 101 65 Cwm Taf HB - 0 8 9 17 Hywel Dda HB - 23 - 79 13 - 89 Powys HB - 2 90 35 123 First Responders - 10 15 10 15 Air Ambulance - - - - Subtotal Service Delivery - 55 - 681 372 - 364 Chief Executive - 0 - 6 2 - 4 Board Secretary - 8 - 5 3 Director of Partnerships & Engagement - 11 3 - 4 - 12 Strategic Development - 0 - 10 - 2 - 12 Clinical 0 47 10 57 Workforce & OD - 21 - 84 48 - 57 Quality, Safety & Patient Experience 1 - 40 12 - 26 Trust Income 21 - - 21 Reserves - 265 180 164 79 Deputy Director of NEPTS - 65 41 277 252 Finance Department 1 - 19 - 6 - 24 Head of ICT - 5 5 - 32 - 31 Estates - 9 19 237 247 Head of Health Informatics - 0 - 14 1 - 13 Capital & Estates - 0 - 74 6 - 68 HCS - - 0 0 Net (Surplus) / Deficit - 409 - 623 1,081 49
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Annex 3 - Income and Expenditure Analysis
Annual Plan Actual Variance Plan Month 5 2018/19 YTD YTD YTD 2018-19 £'000 £'000 £'000 £'000 INCOME Total Income - 78,089 - 78,498 - 409 - 189,984 EXPENDITURE Administrative, Clerical & Board Members - Pay 8,768 8,355 (413) 20,289 Medical & Dental - Pay 13 41 28 91 Nursing & Midwifery Registered - Pay 3,264 3,116 (148) 9,048 Prof Scientific & Technical - Pay 301 Additional Clinical Services - Pay 19,132 20,332 1,200 50,252 Allied Health Professionals - Pay 21,976 20,761 (1,215) 52,543 Healthcare Scientists - Pay - Estates & Ancilliary - Pay 756 681 (75) 1,618 Students - Pay - Pay - Sub Total 53,909 53,286 - 623 134,142
Clinical Services & Supplies - Non Pay 1,168 1,290 122 2,817 General Services & Supplies - Non Pay 327 350 23 784 Establishment & Transport Expenses - Non Pay 7,012 7,318 306 16,824 Premises and Fixed Plant - Non Pay 12,933 13,056 123 26,147 External Contract staffing & consultancy - Non Pay 107 114 7 181 Other Services - Non Pay 2,633 3,133 500 9,089 Non Pay - sub total 24,180 25,261 1,081 55,842
Total Expenditure 78,089 78,547 458 189,984 Net (Surplus) / Deficit - 49 49 -
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Annex 4 - Balance Sheet
Closing Balance Forecast Closing End of Balance End of Aug 18 Mar 19 Non-Current Assets £'000 £'000 Property, plant and equipment 70,076 76,243 Intangible assets 3,838 4,270 Trade and other receivables 566 500 Other financial assets - Non-Current Assets sub total 74,480 81,013 Current Assets Inventories 1,228 1,200 Trade and other receivables 13,719 13,475 Other financial assets - - Cash and cash equivalents 11,603 326 Non-current assets classified as held for sale - Current Assets sub total 26,550 15,001
TOTAL ASSETS 101,030 96,014
Current Liabilities Trade and other payables 14,986 12,154 Borrowings 910 1,500 Other financial liabilities - - Provisions 8,471 8,471 Current Liabilities sub total 24,367 22,125
NET ASSETS LESS CURRENT LIABILITIES 76,663 73,889
Non-Current Liabilities Trade and other payables - - Borrowings 942 927 Other financial liabilities - - Provisions 6,228 6,228 Non-Current Liabilities sub total 7,170 7,155
TOTAL ASSETS EMPLOYED 69,493 66,734
FINANCED BY: Taxpayers' Equity PDC 66,162 63,354 Retained earnings (6,360) (6,311) Revaluation reserve 9,691 9,691 Other reserve - - Total Taxpayers' Equity 69,493 66,734
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Annex 5 - Capital Programme Capital Programme - 2018/2019
2018-2019 2018-2019 Date Capital Project Planned Expenditure To 2018-2019 Expected Discretionary Bid no Approved Expenditure Date Final Cost £'000 £'000 £'000
ICT AWCP Control Room Solution 1,367 - 1,367
ICT AWCP TOTAL 1,367 - 1,367
18/19 Fleet BJC EMS Chassis 18-19 1,319 242 1,319 EMS Conversion 18-19 1,894 - 1,894 EMS Comms 18-19 45 7 45 EMS Equipment 18-19 1,019 111 1,019 RRV Chassis 18-19 853 - 853 RRV Conversion 18-19 576 - 576 RRV Comms 18-19 86 9 86 RRV Equipment 18-19 820 111 820 PCS Large Renault Master (stretcher) Chassis 18-19 40 - 40 PCS Large Renault Master (stretcher) Conversion 18-19 64 - 64 PCS Large Renault Master (stretcher) COMMS 18-19 3 4 3 PCS Large Renault Master (stretcher) EQUIP 18-19 34 - 34 PCS Large Renault Master (Double Wheel Chair) Chassis 18-19 623 - 623 PCS Large Renault Master (Double Wheelchair) Conversion 18-19 980 - 980 PCS Large Renault Master (Double Wheelchair) COMMS 18-19 47 0 47 PCS Large Renault Master (Double Wheelchair) EQUIP 18-19 98 - 98 Specialist (NREV) Chassis 18-19 158 - 158 Specialist (NREV) Conversion 18-19 105 - 105 Specialist (NREV) COMMS 18-19 35 - 35 Specialist (NREV) EQUIP 18-19 14 - 14 Specialist (Neonatal) Chassis 18-19 106 - 106 Specialist (Neonatal) Conversion 18-19 70 - 70 Specialist (Neonatal) COMMS 18-19 23 - 23 Specialist (Neonatal) EQUIP 18-19 82 3 82 Project Costs 18-19 102 23 102 Specialist (Driver Training) Chassis 18-19 106 - 106 Specialist (Driver Training ) Conversion 18-19 152 - 152 Specialist (Driver Training) COMMS 18-19 4 - 4 Specialist (Driver Training) EQUIP 18-19 10 - 10 Specialist (Paramedic) Chassis 18-19 106 - 106 Specialist (Paramedic) Conversion 18-19 152 - 152 Specialist (Paramedic) COMMS 18-19 4 - 4 Specialist (Paramedic) EQUIP 18-19 82 3 82 Contingency 485 - 485
18/19 Fleet BJC TOTAL 10,293 515 10,293
Funded From Discretionary Capital 2018-2019 Fleet 2017/18 BJC EMS Chassis 17-18 Slippage 08/09/2017 - - - EMS Conversion 17-18 Slippage - - - EMS Comms 17-18 Slippage 4 3 4 EMS Equipment 17-18 Slippage - 0 - PCS Large Renault Master (stretcher) Chassis 17-18 Slippage - - 0 - PCS Large Renault Master (stretcher) Conversion 17-18 Slippage - 0 - PCS Large Renault Master (stretcher) COMMS 17-18 Slippage 25 22 25 PCS Large Renault Master (stretcher) EQUIP 17-18 Slippage - - 0 - PCS Large Renault Master (Double Wheel Chair) Chassis 17-18 Slippage - - - PCS Large Renault Master (Double Wheelchair) Conversion 17-18 Slippage 227 - 0 227 PCS Large Renault Master (Double Wheelchair) COMMS 17-18 Slippage 1 5 1 PCS Large Renault Master (Double Wheelchair) EQUIP 17-18 Slippage - - - HART Primary Responders - Chassis 17-18 Slippage - - - HART Primary Responders - Conversions 17-18 Slippage - - - HART Primary Responders - Comms 17-18 Slippage 12 6 12 HART Primary Responders - Equipment 17-18 Slippage - 2 - Joint Response Unit Slippage - - - Vito Conversions Slippage - - - NEPTS Vehicle Bag Slippage - - - Fleet Tyre Pressure Bag Slippage - - - Fleet Handheld Tablets Slippage - - 0 - Project Costs 17-18 Slippage 5 6 5 Fleet 2017/18 BJC TOTAL 274 43 274
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Fleet 2016/17 BJC EMS Slippage 27/04/2017 WG - 6 - PCS Slippage WG - - - RRV/EP Slippage WG - 2 - Specialist Slippage WG - - - Project Costs Slippage WG - - - Sat Nav Slippage 27/04/2017 WG - - - Patient Movement Support Vehicles (3) - - - NEPTS Renal cars 16-17 Slippage WG - - - Fleet 2016/17 BJC TOTAL - 9 -
Fleet Other - 8810 Fleet Safety Costs - repairs to vehicles 27/04/2017 NS 150 66 150 MercedesAsset De-recognition Vito x 3 - £75k - engine of this replacement expenditure for is 515's in capital accruals to be reversed 27/04/2017 NS 150 41 150 PROCUREMENTin M3 OF EQUIPMENT TO CONFIGURE THE WREXHAM 27/04/2017 NS - - - WORKSHOP INTO A VOSA MOT TESTING STATION 1718-R1-BID014 04/07/2017 NS - - - Major Incident Response Equipment – Immobilisation and Moving and Handling 1718-R1-BID003 04/07/2017 NS - - - Installation of VDO SAT NAV Replacement 1718-R1-BID039 14/09/2017 NS 76 3 76 Retro Fitting of Corpuls Defibrilators RRV Fleet 1718-R1-BID042 14/09/2017 NS - - 0 - - - - NEPTS Chargers 27/02/2018 NS - - - BJC 17-18 Fleet Other 8810 - TOTAL 376 110 376
ICT Projects - 8830 General replacement and new hardware 1033 27/04/2017 NS 175 42 175 NEPTS Communication Hubs 1718-R1-BID024 27/04/2017 NS - - - Qklisense 22/01/2018 NS - - - Digipens 17-18 NS 22 22 22 Real Asset Management System NS - - - Airwave and Terrafix Device for Falls Response Service and Joint Response Unit 1718-R1-BID049 27/02/2018 NS 17 8 17 Improve communication for North West Aneurin Bevan 27/02/2018 NS - 0 - Corpuls File Transfer Protocol (FTP) Upload Server 27/02/2018 NS - - - Emergency Medical Services Computer Aided Dispatch System CAD WG 3 31 3 NEPTS Call Taking Integration Infrastructure 1819-R1-BID003 16/05/2018 - - - EMS CCC Secondary Triage System 1819-R1-BID014 16/05/2018 - - - Upgrade of WAST 999 Cisco Phone System 1819-R1-BID015 22/05/2018 151 - 151 - - - ICT Projects - 8830 TOTAL 368 103 368
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Estates Projects - 8840 2016-17 Projects Roofing Colwyn Bay 16/17 - 17/18 1017 27/04/2017 NS - 2 - Holyhead Roof 1019 NS - - - Rhyl Heating 16/17 1023 27/04/2017 NS - Holyhead/llandudno/Portmadog Kitchens 16/17 1021 27/04/2017 NS - - - Drainage Works 2016/17 1020 27/04/2017 NS - - - Aberystwyth Building Works 16/17 1011 NS - Tredegar Refurbishment 16/17 1029 27/04/2017 NS - 16 - Asbestos remedials - £21k in capital accruals to reverse in M3 a1052 NS - - - VPH Technology Upgrade a1053 NS - - - CCC training rooms for CAD training a1069 NS - - - CCC infrastructure 1001a NS - Cynon Taf - Hawthorne ESTATES 7 27/04/2017 NS - - - Carmarthen Old Control - ESTATES 6 27/04/2017 NS - - - Abergavenny ESTATES 10 27/04/2017 NS - - - North Drains - BC £51k approved. Pre tender cost check £80k ESTATES 15 NS - - - Remedial work & electrical Testing ESTATES 8 NS - - - Bangor Workshop Oil Tank Refurb 16-17 -
2017-18 Projects Relocation of Llandrindod Wells Ambulance Station to Llandrindod Wells Fire Station 1718-R1-BID025 27/04/2017 NS 50 - 50
LlanidloesRelocation extensionof Newquay and Ambulance relocation Stationto Fire Stationto Minaeron, due to Aberaeron structural and asbestos 1718-R1-BID026 27/04/2017 NS - - - issues at existing station 1718-R1-BID022 27/04/2017 NS 150 - 150 Whitland Extension and Relocation to Fire Station 1718-R1-BID023 27/04/2017 NS 84 - 84 Bryncethin - Drainage repairs, Tarmac resurfacing and additional parking spaces 1718-R1-BID030 27/04/2017 NS - - - Improvements and refurbishments at Blaenau Ffestiniog Ambulance Station 1718-R1-BID015 27/04/2017 NS - - 0 - VPH CCC Technology refresh 1718-R1-BID028 20/07/2017 NS 477 172 477 Relocation of Barry Ambulance Station to Barry Fire Station & MRD 1718-R1-BID027 14/09/2017 NS 1 - 0 1 Unit 7 - HQ St Asaph Relocation 17-18 1718-R1-BID060 15/12/2017 NS 1,654 78 1,654 CCC Furniture 17-18 1718-R1-BID017 NS 38 0 38 Tumble Replacement Garage Doors 1718-R1-BID061 27/02/2018 NS - - - Thanet & Snowdon House Control Centres – Replacement Furniture 1718-R1-BID063 27/02/2018 NS - - - Bryn Tirion Control Centre – Replacement Furniture 1718-R1-BID064 27/02/2018 NS - - - Unit 7 – Security Works NS - - - Bassaleg - NEPTS PARKING AND CHARGER NS - 3 - Monmouth - Tarmac Resurfacing NS - - - Aberdare - Replacement Garage Door NS - - -
General Estates Fund 17-18 Utilised on Projects Below: 27/04/2017 NS Replacement access system – Vantage Point House 1718-R1-BID031 27/04/2017 GF - - - Replacement Boiler, distribution and controls – Colwyn Bay Ambulance Station 1718-R1-BID032 27/04/2017 GF 2 1 2 PhaseHOLLYHEAD 2 Replacement – LED lighting Furniture & Welfare and Associated improvements Works at Llanfairfechan Control 1718-R1-BID035 27/04/2017 GF - - - Centre, North Wales 1718-R1-BID041 29/08/2017 GF - - - VPH Training 29/08/2017 NS - - - Pembroke Roof 16/17 1016 27/04/2017 NS - 5 - - - - 2018-19 Projects - Bryn Tirion - Replacement Lighting and Mechanical Ventilation to Control Room and associated works 1819-R1-BID004 10/05/2018 109 2 109 BangorColwyn &Bay Caernarfon Amb Station Amb - StationsReplacement - Replacement Boiler, Distribution Kitchens andand Controlsassociated 1819-R1-BID010 10/05/2018 45 2 45 works 1819-R1-BID011 10/05/2018 66 - 66 Snowdon House - Replacement mechancial servicers 1819-R1-BID012 10/05/2018 42 3 42 Thanet & Snowdon House CC – Replacement Furniture (additional) 1819-R1-BID013 10/05/2018 8 8 8 Cowbridge 1718-R1-BID021 65 - 65 Cefn Coed Relocation FRC 05/07/18 917 - 917 General Estates Fund 18-19 Utilised on Projects Below: 175 - 175
Estates Projects- 8840 TOTAL 3,882 291 3,883 Equipment - 8820 ReplacementEfficiency through of Hazardous technology Area Response Team (HART) Breathing Apparatus a1067 NS - - - Equipment 1718-R1-BID012 27/04/2017 - Estates & Network Work to Accommodate Omnicell Medicines Cabinets 1718-R1-BID019 27/04/2017 - Cycle Response 16-17 - - - Equipment - 8820 TOTAL - - -
Project Support Costs - salary paid from capital 27/04/2017 NS 350 30 350
Discretionary Capital 2018/2019 TOTAL 5,250 586 5,250 Non-Discretionary Capital Total 11,660 515 11,660 Discretionary & Non-Discretionary TOTAL 16,910 1,101 16,910
Unallocated Discretionary Capital (incl NBV proceeds) 575 - 575 Unapproved/Overspend Schemes - - -
TOTAL CAPITAL PROGRAMME 17,485 1,101 17,485
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2.2 Update on 2018/19 Capital Programme (Interim Director of Finance and ICT) 1 ITEM 2.2 FRC 20 09 18 Discretionary Capital Programme 2018-19 - final.docx
AGENDA ITEM No 2.2 OPEN or CLOSED OPEN No of ANNEXES 1 ATTACHED
Update on Discretionary Capital Programme 2018/19
MEETING Finance and Resources Committee DATE 20 September 2018 Chris Turley, Director of Finance and ICT EXECUTIVE (Interim) Chris Turley, Director of Finance and ICT (interim) AUTHORS Richard Davies, Assistance Director Capital & Estates Edward Roberts, Project Accountant CONTACT DETAILS [email protected]
CORPORATE OBJECTIVE IMTP Delivery CORPORATE RISK (Ref if
appropriate) QUALITY THEME HEALTH & CARE 2.1, 2.4, 3.1 STANDARD
To provide the Finance and Resources Committee with the recommendations for the REPORT PURPOSE allocation of the remaining 2018/19 discretionary capital funding (Round 2). CLOSED MATTER REASON
REPORT APPROVAL ROUTE
WHERE WHEN WHY Executive Management 13.09.2018 For noting Team Finance & Resources For noting and 20.09.2018 Committee approving For noting (as part of Trust Board 27.09.2018 financial performance update)
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WELSH AMBULANCE SERVICES NHS TRUST
UPDATE ON DISCRETIONARY CAPITAL PROGRAMME 2018/19
SITUATION
1. This paper is to provide the Finance & Resources Committee (FRC) with an update on the Trust’s discretionary capital programme for 2018/19, including additional schemes recommended to utilise the majority of the remaining discretionary capital funding. Through some of the detail provided in Appendix 1, it will also update the Committee in relation to the latest position with regard to the move off the Lansdowne site.
BACKGROUND
2. FRC will be aware that, following previously agreed discretionary capital commitments, there remained residual funding of c£0.5m to be allocated through the rest of the financial year, with the intention being to run a second round of prioritisation of potential schemes to be undertaken through Internal Capital Planning Group. This has now been undertaken.
3. The above c£0.5m is after taking account of the following:-
a. The commitments and agreements made at FRC on 10th May 2018, which included that brought forward from 2017/18 and an initial agreed range of schemes for this financial year. At this point the remaining funding (out of the Trust’s 2018/19 total discretionary capital allocation of £5.8m) was just over £1.4m;
b. The additional commitments that were agreed at FRC on 5th July. This was predominantly in relation to the move to Matrix One is Swansea, at a cost of just over £0.9m, resulting in the above c£0.5m remaining.
4. The Internal Capital Planning Group (ICPG) met on 3rd September where newly received business cases were reviewed, ahead of scoring and prioritisation. Members of the ICPG went on to assess and score the twelve financially verified business cases individually. An average score was determined and sensitivity checks took place. On 10th September a prioritisation meeting took place where it was agreed that six of these bids be recommended for approval.
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ASSESSMENT
5. The process to prioritise and score the received bids was consistent with that deployed earlier in the financial year for the first round of prioritisation.
6. The prioritisation process used the following criteria and scoring:
Criteria 1: Improve Quality and Safety Criteria 2: Statutory Compliance Requirements Criteria 3: Revenue affordable and Value for money Criteria 4: Alignment to Directorate Local Delivery Plan (LDP) Criteria 5: Mission critical to the delivery of Welsh Government targets (Operational and Non Operational), Trust Strategic Actions or Performance Ambitions”
Scoring Matrix: (5) = Definitely meets the requirement (4) = Likely to meet the requirement (2) = Might meet the requirement (1) = Unlikely to meet the requirement (0) = Not applicable
7. The table below outlines those capital bids that scored highly (an average score of 15 and above) and were supported by the ICPG to be progressed from the remaining discretionary funding:-
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Schemes £m £m
Remaining discretionary funding (per 10th May paper) 1.417
Additional Schemes approved / noted at FRC 5 th July:- Additional CCC Furniture -0.013 Cefn Coed Relocation -0.917
Previously approved schemes now not progressing:- EMS CCC Secondary Triage System 0.072 NEPTS Call Taking Integration Infrastructure 0.016
Schemes recommended for approval by ICPG - Sept 2018:- Relocation of staff off Lansdowne -0.084 EMS CCC - CAD Phase 2 and 3 Implementation* 1819-R2-BID023 -0.174 Upgrade of Cybertech call recording system 1819-R2-BID024 -0.089 Replacement of VPH Core LAN switches 1819-R2-BID025 -0.032 Implementation of the GoodSAM MIS Module into the EMS CAD System 1819-R2-BID026 -0.033 Data Warehouse Modernisation Programme 1819-R2-BID032 -0.031
Sub total schemes recommended for approval by ICPG -0.443
Balance of discretionary capital funding remaining - 2018/19 0.132 *The above scheme also requires approval for expenditure of c£144k in 2019/20
8. The following is to be noted by FRC in relation to the above table:-
a. Two of the schemes previously approved are not now progressing. In relation to the EMS CCC Secondary triage system, this is due to changes in the accessibility of this for call takers. For the NEPTS call taking infrastructure one, this is due to a change in approach to the transfer of current non NEPTS work into WAST. The previously allocated values for these two have therefore been included in the funding available for prioritisation through this round.
b. The total financial commitment being proposed for one of these latest prioritised schemes (Ref R2 – BID023) exceeds the delegated approval limit of officers who attend ICPG. FRC will be explicitly asked to approve this one, therefore, noting that this also has a carried forward commitment to 2018/19. It has been validated that the costs included here can be capitalised.
c. Detailed below is a summary of each capital bid (full business cases detailed in Appendix 1):-
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Relocation of staff off Lansdowne The Assistant Director of Capital and Estates has requested that the Estates upper slice is increased by £70k (plus VAT) to allow for expenditure on the de- commissioning and decanting of Lansdowne. FRC members will be aware of the need for the Trust to move off the Lansdowne site over the coming months, with further pressure now being put on the Trust to do so. The SBAR attached in appendix 1 therefore provides Committee members with a further update in relation to this. It does not however at this stage include a breakdown of costing's but does indicate some of the work the Estates Team is aware of that will be required - for example, Cardiff East will require minor works to reconfigure office space, minor repairs and more than one site will require additional charging points for vehicles.
EMS CCC – CAD Phase 2 and 3 Implementation This capital bid is to now progress much of the benefits first described in the CAD replacement business case but which were accepted would be part of a Phase 2 (and 3) of the project. It is for £145k (plus VAT) which encompasses additional expenditure for interfaces and improved functionality, as well as project management support, to enhance the assets previously procured.
It should be noted that this bid comes with a pre-commitment requirement of £120k (plus VAT) for 2019/20 as this project will span into the next financial year.
The programme of work will incorporate:
• Phase two of the CAD implementation project – this will ensure additional functionality is configured to improve working processes within CCC, impacting on service delivery and major incident management; • Phase three will utilise the improved working processes to inform and support a structural review of roles within CCCs across Wales to provide increased capacity and improved productivity.
Additional functionality in this bid includes:
• GRS to C3 Interface • Advanced Duplicate Call Management • Improved business continuity measures for resource deployment (SPN Locality Selection)
Upgrade of Cybertech
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The Cybertech call recording system provides all of the Trust recording requirements for 999,111, PCS, resource, service desk etc. It covers all Cisco phones and the Integrated Control Communication Systems (ICCS). The current version is nearing the end of support therefore requires this upgrade. This update will also meet the requirement for the DS2000 ICCS replacement; Frequentis LifeX as part of the Control Room Solution upgrade project. Without the upgrade the Trust will not be able to implement Control Room System (CRS).
Replacement of VPH Core LAN Switches The key objective of this capital bid is to provide a reliable and future proofed core data network at Vantage Point House (VPH) by replacing the core LAN switches. Currently at VPH the core of the data network is made up of two Cisco Nexus 7000 switches, these were installed at the beginning of 2012. Many of the components of the switches are now nearing end of life and end of support from Cisco. The cost to upgrade the Nexus 7000 switches with new hardware would be in excess of £80k.
However, Cisco has developed its portfolio of switches over recent years and they now offer a more suitable core switch to meet our requirements at a much lower capital cost with the additional benefit of significantly lower annual support costs. These are also much smaller, generate far less heat and therefore reduce the demand for air conditioning and use far less electricity and in turn reduce our environmental impact.
Implementation of the GoodSAM MIS Module into the EMS CAD System The capital bid was to request funding to pilot the implementation of the GoodSAM MIS Module into WASTs CAD system as part of the Out of Hospital Cardiac Arrest (OHCA) plan.
Implementation of the GoodSAM module into the WASTs CAD system would enable WAST to assess whether the app would increase responder rates to an OHCA event when used in addition to the existing CAD processes.
It must be noted that this will not be progressed until all of the potential governance, liability and licencing issues that are associated with this have been fully satisfied, via the Executive Management Team.
Data Warehouse Modernisation Programme In order to improve the provision of data through the Trust’s Data Warehouse platform and to realise the objective of having a Uniformed Data Layer, a number of improvements are required to the Data Warehouse Infrastructure. This bid covers the creation of a pre-production environment for improved change and release management as well as the procurement of additional
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licences to enable the Trust to incorporate more data sources into the Data Warehouse.
This would allow the Informatics Team to prepare data from more sources expanding the amount of intelligence available through Health Informatics Systems. In addition to the requirements for additional licenses, a recent Health Check of our Warehouse by our system supplier has recommended the creation of a Pre-Production Environment. This would vastly improve current test and release practices, providing better governance surrounding the release of new and updated datasets.
d. Following the progress of all of the above, there is a remaining amount of £132k discretionary capital funding this financial year. This will be held as a small contingency for now, with the potential to review a small number of additional bids between now and the end of the financial year, to ensure the funding is fully utilised and maximum value from this investment is achieved.
RECOMMENDED: That the Finance and Resources Committee;
• Approve those schemes prioritised within this paper for spend out of the Trust’s remaining 2018/19 discretionary capital funding, in particular the one scheme in excess of £100k (CAD phase 2 and 3), also approving the carried forward commitment for this scheme.
• To also note the small residual uncommitted level of discretionary capital for future commitment between now and the end of the financial year.
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APPENDIX 1
Title Business Case Relocation of staff and NEPTS at Lansdowne FRC - Lansdowne update.docx EMS CCC – CAD Phase 2 and 3 Implementation 1819-R2-BID023 CAD Implementation Phase 2 and 3 v2.docx Upgrade of Cybertech
1819-R2-BID024 Cybertech Call Recording system upgrade inc VAT.docx Replacement of VPH Core LAN Switches
1819-R2-BID025 VPH Core Switch Upgrade inc VAT.docx Implementation of the GoodSAM MIS Module into the EMS CAD System 1819-R2-BID026v3 GoodSAM Module Implementation(amended).docx Data Warehouse Modernisation Programme 1819-R2-BID032 Data Warehouse U.docx
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2.3 Monthly Integrated Quality and Performance Report (Director of Partnerships and Engagement and Interim Director of Planning and Pefrormance) 1 ITEM 2.3 SBAR MIQPR June 18 Final FRC.DOCX
AGENDA ITEM No 2.3 OPEN or CLOSED OPEN No of ANNEXES ATTACHED 2
MONTHLY INTEGRATED QUALITY and PERFORMANCE REPORT– June 2018
MEETING Finance and Resources Committee DATE 20th September 2018 Estelle Hitchon – Director of Partnerships & EXECUTIVE Engagement and (Interim) Director of Planning and Performance Jessica Hooper – Commissioning and AUTHOR Performance Officer CONTACT DETAILS [email protected]
CORPORATE OBJECTIVE IMTP priority objective (ALL) CORPORATE RISK (Ref if ALL Risks appropriate) QUALITY THEME ALL HEALTH & CARE ALL STANDARD
Consider the Trust’s performance and REPORT PURPOSE improvement actions. CLOSED MATTER REASON Not applicable.
REPORT APPROVAL ROUTE WHERE WHEN WHY EMT 15/08/18 Consideration and approval.
QUEST 04/09/18 Note and Discuss.
FRC 20/09/18 Note and Discuss.
Page 1
SITUATION
1. The purpose of this report is to provide an overview of the Trust’s performance against key quality and performance indicators for June 2018, and includes performance data over the previous quarters.
BACKGROUND
2. The Emergency Ambulance Service (EMS) Ambulance Quality Indicators (AQIs) and the Welsh Government Delivery and Outcomes Framework (which in turn informs the Welsh Government Balanced scorecard) form the basis of the Trust’s performance indicators. The detailed information pack incorporates these indicators and is attached at Annex 1. Annex 2 contains the first iteration of the new Non-Emergency Patient Transport Service (NEPTS) AQIs, which is a significant addition to the Trust’s performance management arrangements.
3. The AQIs are published quarterly by the Emergency Ambulance Services Committee (EASC) on their website; http://www.wales.nhs.uk/easc/ambulance- quality-indicators. The latest quarter (April 2018 – June 2018) was published on 25th July 2018. Monthly information is published by Welsh Government on Red and Amber performance. http://gov.wales/statistics-and-research/ambulance- services/?lang=en. We are expecting the EMS AQIs to be published monthly in future, on a realistic timeframe agreed with the Trust.
4. The next iteration of the EMS AQIs is due to be published on 31 October 2018 for the period July 2018 – September 2018.
5. The EMS AQIs are being reviewed with a more user friendly set of EMS AQIs originally due to be published in April 2018 (now reprogrammed to September 2018), as determined by the Chief Ambulance Services Commissioner (CASC), and as per a requirement from the Cabinet Secretary.
6. As previously outlined, this report will provide monthly performance data (in Annex 1) and analysis (in SBAR), with further in depth, quality-focused analysis provided through a Quarterly Quality Assurance Report.
7. The purpose of this SBAR is to draw out the key themes and trends from the detailed information packs and highlight the improvement actions that have been put in place.
8. A recommended change (from Internal Audit) to this report has been the inclusion of an exceptions section or synopsis.
9. The dashboard has been updated to reflect the 18/19 Performance Ambitions for the list of dashboard indicators. Further work will be undertaken to review and update the dashboard in September 2018.
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Synopsis
Overall demand (verified incidents) decreased by 1% in June 2018, compared to May 2018, and was 1.1% more than the same period last year.
999 call demand decreased by 1% in June 2018, compared to May 2018, and was 12% higher in June 2018 compared to June 2017.
Red performance has been sustained above the 65% target at an all Wales level (75.6%). We achieved the target across all LHBs, except Hywel Dda in June.
Handover delay lost hours in quarter one 2018/19, compared to quarter one 2017/18, increased by 32%. If this trend were to continue, then we could be entering the winter with increased pressure on the system than previous years.
The increase in incident demand and the pressure on the unscheduled care system in general, is reflected in the Amber 95th percentile, which increased to 2 hours and 32 minutes in June 2018, compared to 1 hours and 02 minutes in June 2017. Whilst this is clearly a significant increase, the Amber median for June 2018 was 23 minutes and 25 seconds and the 65th percentile was 36 minutes and 03 seconds.
Patient safety incidents have decreased, with one Serious Adverse Incident (SAI) reported to Welsh Government in June.
Despite the increased system pressure, in June 2018, the Trust conveyed 20,075 of patients to Major EDs, compared to 20,263 in the same period last year and 9.2% less patients in quarter 1 2018/19, compared to the same quarter last year. The Clinical Desk and NHSDW (Hear & Treat) achieved 7.4% performance in June, below the Trust’s performance ambition of 8% of calls ending as a result of telephone assessment. Whilst the hear & treat rate was below our performance ambition, the level of hear & treat activity has increased this quarter (8,359 ambulances stopped), compared to the same quarter last year (7,306 ambulances stopped).
Emergency ambulance Unit Hours Production (UHP) remained at 91% in June 2018, with a marginal decrease in actual hours put out: Emergency Ambulance actual hours (69,489 in May to 66,930 in June) delivered, Rapid Response Vehicle (RRV) hours (20,156 in May to 18,522 in June), and UCS hours in June 2018 (11,974) compared to May 2018 (12,124) (note there is one day less in June compared to May, which accounts for some of the reduction).
The clinical indicators are positive this quarter, with six improving, one static at 100% and one seeing a small fall in performance, but achieving 89.5%.
Cumulative sickness absence was 7.33% (June 2018) against the internal target of 5.09%.
The Trust’s financial metrics included a deficit in May (£60,000) and delivery of 94.6% of savings to target.
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The 32% year on year (quarter one comparison) increase in handover lost hours and the year on year significant increase in the Amber tail, up one hour and 28 minutes (June 2018 compared to June 2017) suggests we may enter the forthcoming winter at higher levels of escalation and system pressures than in previous years.
In the short term, the Trust will continue to pro-actively manage performance through its robust resilience and escalation arrangements.
In the medium term i.e. in advance of next winter, the Trust is working to reduce the relief gap, identified in the Demand & Capacity Review, for example, through converting an element of overtime to full time equivalents (FTEs) and over recruiting through the Big Bang event. The Trust will complete rota reviews in Aneurin Bevan and Cwm Taf (which were not completed due to the relief gaps in 2014) and in the Clinical Contact Centre (CCC). The Trust will then go on to re- review the other five LHB rosters, again using information from the Demand & Capacity Review, although this is not planned to come on line in advance of this winter. The Trust has also identified the need to improve arrangements for collaborating with the LHBs across the 5 Steps in a systematic and routine manner; consequently, there are series of Executive to Executive meetings between the Trust and each LHB. The Trust will also continue to roll out the 111 service. The Trust is also in advanced dialogue with NHS Wales and the Chief Ambulance Services Commissioner (CASC) on three transformational initiatives for this winter: falls assistants, further enhanced hear & treat and the Advanced Paramedic Practitioner (APP) rotational model. The Trust’s winter planning arrangements are also well advanced with a report expected to September Board.
The Emergency Ambulance Services Committee (EASC) has been commissioned by the Cabinet Secretary to undertake an Amber Review by the end of the summer. Recommendations for improvement that can be implemented in time for next winter will also be acted on.
In the medium to longer term i.e. through 2018/19 and into 2019/20, the Trust will further develop its approach to demand prediction, modelling and capacity management, in particular, by using Optima Predict. The Optima embedded analyst is now on site and is currently tuning Optima Predict as planned. It is anticipated that the tuning will take up to two months, after which Optima Predict will be available to use and give the Trust an in-house modelling capability.
Even with these developments, next winter is likely to remain challenging.
The longer term action is the development of the Trust’s Long Term Strategy.
For the first time, this report provides a new 5 step NEPTS AQIs, which is a significant milestone in the Trust’s performance management journey.
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ASSESSMENT
10. MONTHLY INTEGRATED QUALITY AND PERFORMANCE DASHBOARD
Emergency Medical Services and Urgent Care Services
SECTION 1: Dashboard
IMTP PA
Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 RAG TREND Cross
Theme Theme 18/19
Quality Quality
Indicator Reference Emergency Medical Services and Urgent Care Services 3 Strategic Aim: Delivery of Excellent Patient Care Step 1: Help Me choose AQI4i NHSDW Number of NHS Direct Wales website unique visits 367,614 356,542 363,332 ↑ IPR Number of Calls to NHS Direct 24,249 22,651 20,643 ↓ 1 Strategic Aim: Value, Innovation and Efficiency Percentage of Frequent Callers Incidents against
Staying Healthy Staying ↑ AQI5 overall number of Incidents 5.2% 5.5% 5.7% 3 Strategic Aim: Delivery of Excellent Patient Care Step 2: Answer My Call AQI7 Number of 999 calls answered 41,349 46,198 45,694 ↓ IPR % of 999 calls answered within 6 seconds 93.8% 92.70% 91.40% ↓ 1 Strategic Aim: Value, Innovation and Efficiency Number of calls ended following WAST telephone ↑ AQI9 i assessment (Hear and Treat) 2,663 2,820 2,876 % of call ended following telephone assessment ↑ AQI9ii (Hear and Treat) 8% 7.4% 7.2% 7.4% % unplanned re-contact with the ambulance service ↑ AQI10i within 24hours of discharge of care (by clinical telephone advice) 3.5% 4.6% 13.5% % unplanned re-contact with the ambulance service within 2 ↓ AQI10ii 4 hours of discharge of care (following treatment at the scene) 0.7% 0.9% 0.8% 3 Strategic Aim: Delivery of Excellent Patient Care Step 3: Come to See Me Percentage of RED category incidents with first response ↓ AQI11 P06 arriving on scene within 8 minutes 65% 65% 75.1% 76.1% 75.6% AQI12 Median Response for AMBER category incidents 00:20:54 00:21:51 00:23:25 ↑ AQI13 Median Response for GREEN category incidents 00:43:35 00:47:19 00:49:15 ↑ Step 4: Give Me Treatment Percentage of patients suffering a cardiac arrest with a return of ↓ AQI16i spontaneous circulation 13.8% 18.7% 12.8% Percentage of stroke patients who are documented as receiving ↑
Timely Care Timely AQI16ii appropriate stroke care bundle 95% 98.1% 96.2% 96.6% Percentage of older people who have fallen and have suspected ↓ AQI16iii fracture of hip/femur who are documented as receiving analgesia 95% 90.3% 90.0% 88.0% Percentage of Acute Coronary Syndrome patients who are ↑ AQI16iv documented as receiving appropriate STEMI care bundle 95% 66.0% 73.0% 74.3% Percentage of suspected sepsis patients who have had a ↑ AQI16 v documented NEWS score 95% 100.0% 98.0% 100.0% Percentage of patients with a suspected febrile convulsion aged 5 years and under who are documented as receiving the appropriate ↔ AQI16 vi care bundle 95% 100.0% 100.0% 100.0% Percentage of hypoglycaemic patients who are documented as ↑ AQI16 vii receiving the appropriate care bundle 95% 84.4% 87.5% 90.5% Step 5: Take Me to Hospital Percentage of patients conveyed to hospital following a face to face ↓ AQI19 i assessment 68% 68.4% 68.2% 67.7% Percentage of notification to handover within 15 minutes of arrival ↑ AQI20 I P19 at hospital 51.7% 57.0% 58.6% Number of lost hours following notification to handover over 15 ↓ AQI21 minutes 6,134 4,137 3,777 Percentage of handover to clear within 15 minutes of transfer of ↔ AQI22i P21 patient care to hospital staff 90% 75.5% 73.4% 73.4%
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Non-Emergency Patient Transport and Additional Indicators by Quality
Non-Emergency Patient Transport 3 Strategic Aim: Delivery of Excellent Patient Care
62,743 67,822 65,977 ↓ IPR Number of patient journeys Performance 12.40% 12.20% 13.20% ↑
Timely Care Timely Ambition Percentage of NEPTS Journeys aborted 10% Performance 27.00% 28.00% 25.70% ↓ Ambition Number of bookings made by fax/post/hand 15% Additional Indicators by Quality Theme CR6 Five step service model. These will be included in future reports 6 Strategic Aim: Quality at the Heart IPR Patient Safety Incidents, near misses and hazards 140 140 148 ↑ Safe Care Care Safe IPR Number of Serious adverse incidents reported to Welsh Government 1 1 1 ↔ CR3, CR4 Equity, Clinical Care 3 Strategic Aim: Delivery of Excellent Patient Care
Care AQI11 Red performance within 8 minutes 95th percentile 00:10:00 00:14:56 00:14:17 00:14:51 ↑ Effective Effective AQI12 Amber performance 95th percentile 00:35:00 02:22:11 02:27:19 02:32:05 ↑ CR2, CR3. Patient Experience and Satisfaction, Equity 3 Strategic Aim: Delivery of Excellent Patient Care IPR Number of complaints 132 121 115 ↓ Percentage of responses completed within 30 days - due in reporting
↑ Dignified Care Care Dignified Individual and and Individual IPR month 75% 79% 30% 29% 56% CR1, CR5 Governance, Leadership & Accountability, Staffing 4 & 5 Strategic Aim: Fantastic People & Vibrant Leadership IPR Staff turnover % FTE 0.40% 0.36% 0.66% ↑ L03 IPR % of sickness absence 7.12% 6.56% 6.61% ↑ IPR PADR 72.4% 74.5% 74.7% ↑ 3 Strategic Aim: Delivery of Excellent Patient Care IPR Unit Hours Production (UHP) Emergency Medical Services 93.0% 91.0% 91.00% ↔ 1 Strategic Aim: Value, Innovation and Efficiency
V01 IPR Actual Expenditure YTD as % of budget expenditure YTD Breakeven 100.2% 100.2% 100.1% ↓ Staff and Resources Resources Staff and V02 IPR Annual Trust surplus/deficit YTD £000 -23 -43 -60 ↑ IPR Actual Savings YTD as % of planned savings YTD 86.6% 87.5% 94.60% ↑ IPR % of non - NHS creditor invoices paid within 30 days of receipt of invoice 99.2% 94.1% 98.30% ↑ RAG TREND R Indicator not met ↑ Increase >10% away from target A Within 10% Margin of Indicator ↓ Decrease >10% away from target G Meeting Indicator ↑ Increase exceeding target ↓ Decrease exceeding target ↔ No target/ target not impacted ↑ Increase within 10% of target ↓ Decrease within 10% of target
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11. Key Areas of Note
▪ Overall demand (verified incidents) decreased by 417, (1%) during June 2018 compared to May 2018.
▪ In comparison to June 2017 overall demand has increased by 414 incidents (1%).
▪ Graph 1 looks specifically at incidents that resulted in an emergency response and the impact this has on Red performance.
Graph 1
▪ Red performance continues to exceed the 65% response target with a response rate of 75.6% achieved in June 2018.
▪ The Trust achieved 65% in all Local Health Board areas, except Hywel Dda which was 62.8% in June.
▪ Graph 2 below displays the Amber 95th response time for against lost hours as a result of notification to handover delays (as a marker of system pressures)
Graph 2
Amber 95th vs Lost Hours to Notification of Handover Delays 15000.00 7:12:00 AM 10000.00 4:48:00 AM 5000.00 2:24:00 AM 0.00 12:00:00 AM
ABM Lost Hours AB Lost Hours BCU Lost Hours C&V Lost Hours Cwm Taf Lost Hours Hywel Dda Lost Hours Powys AMBER 95th
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▪ Hours lost as a result of delays during notification to handover decreased in June to 3,777 from 4,137 hours in May. This is a 16% increase on June 2017 where 3,235 hours were lost. Graph 2 suggests a correlation between system pressures (handover delays) and Amber responsiveness.
▪ Amber 95th percentile performance remains an area of challenge. Amber is a large category, accounting for circa. 84% of our incident response volume. Amber 95th percentiles has increased by circa. 1 hour 03 minutes compared to the same period last year.
▪ EASC has commissioned an Amber Review, which is to be completed by the summer.
12. Overall Demand Analysis (June 2018)
▪ In June 2018, there were 39,042 verified incidents (overall demand), compared to 39,459 in May 2018.
Graph 3
Total Verified Incidents 50,000
40,000
30,000
20,000
10,000
- June July Aug Sep Oct Nov Dec Jan Feb Mar Apr May June
Jan 2016 - Jan 2017
▪ In June 2018, 20,643 calls were made to NHS Direct Wales; a decrease on the previous month where 22,651 calls were made.
Graph 4
Total NHSDW Calls 40,000 30,000 20,000 10,000 -
Apr 2016 - Mar 2017 Apr 2017 - Mar 2018
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Improvement Actions:
o The Demand and Capacity Review is now complete.
o The Trust will continue to use the findings from the Review, for example, the demand predictions and the identified efficiencies. Two project teams have been set up: 1) Optima, to progress the development of an in-house forecasting and modelling approach (now being tuned) and 2) Rota Review Group, with an initial focus on Aneurin Bevan and Cwm Taf rosters.
13. Emergency Medical Service and Urgent Care Services Step 1: Help Me Choose. (June 2018)
▪ There were 363,332 visits to the NHS Direct Wales website in June, an increase compared to the previous month. Graph 6 demonstrates a steady rise in the number of visits since May 2017, with a 27% increase in visits this quarter, compared to the same quarter last year, which is attributable to marketing of the site via social media, choose well and My A&E Live. Further improvement is expected through this winter with plans for an additional two symptom checkers and a clear focus on our winter planning on Step 1-Help Me Choose.
Graph 5
Number of NHS Direct Wales unique website visits 450,000 400,000 350,000 300,000 250,000 200,000 150,000 100,000 50,000 -
▪ Dental problems remain the most significant reason for calling NHS Direct Wales, with 3,263 calls made in June 2018.
▪ Frequent callers accounted for 5.7% of all incidents in June 2018.
Improvement Actions:
o The 111 Strategic plan outlines the next phase of roll out for 2018/19 with Pembrokeshire and Ceredigion and Powys in line for Quarter 1 / 2 roll out, subject to “Service Readiness”. The Plan also includes the development of Clinical Support Hubs in the South East and North regions.
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o A Service Improvement Plan is in place for NHS Direct Wales/111 that outlines the key activities required to improve efficiencies, staff experience and flow into the GPOOH service. This is monitored within the CCC Team and into the Joint Implementation Governance Group.
14. Emergency Medical Service and Urgent Care Services Step 2: Answer My Call (June 2018)
▪ A total of 45,694 (999) calls were answered in June 2018, compared to 40,683 in June 2017 (12% increase). There was a 1% decrease compared to last month’s 46,198 calls answered.
▪ In June, 37,541 (91.4%) 999 calls were answered within six seconds, compared to 80.4% in June 2017. This improvement was sustained across the quarter.
▪ A total of 2,876 (7.4%) of calls were ended following telephone assessment (Hear and Treat) in June 2018 i.e. an ambulance was not sent. Of the 2,876 calls, a total of 1,114 were ended following an assessment by NHS Direct Wales and 1,762 by the Clinical Desk.
Graph 6
% and number of calls ended following WAST telephone assessment (Hear and Treat) 10.0% 6,000 4,000 5.0% 2,000 0.0% -
Number of calls ended following WAST telephone assessment (Hear and Treat) Percentage of calls ended following WAST telephone assessment
▪ The unplanned re-contact rate within 24 hours of discharge of care by clinical telephone advice increased from 4.6% in May to 13.5% in June.
Improvement Actions:
o The increase in unplanned re-contact rates within 24 hours following discharge of care by clinical telephone advice has been attributed to one frequent caller in BCU.
o The expansion of the Clinical Desk has significantly contributed towards the improved Hear & Treat rates. Having clinicians in Police Control continues to provide mutual benefits for WAST and the police service. Page 10
o CCC rotas are also being reviewed in an effort to better match demand. Implementation is now expected beginning of September 2018.
o As part of the review of AQIs and the ambition to have a user friendly version, there is a proposal to change the call answering indicator from percentage answered within six seconds to end to end times to better understand the actual responsiveness of the call answering function. This is currently in the testing and quality assurance stage, with initial reporting starting in approximately two weeks’ time.
15. Emergency Medical Service and Urgent Care Services Step 3: Come To See Me.
▪ There were 2,016 Red incidents in June, compared to 1,927 in the previous month.
▪ 75.6% of red calls in June were responded to within 8 minutes against a target of 65%.
Graph 7
% of Responses to RED Incidents within 8 mins 90.0% 80.0% 70.0% 60.0% 50.0%
% 40.0%
79.2%
78.6%
78.0%
76.8%
76.1%
75.9%
75.6% 75.1%
30.0% 73.3%
70.0%
69.7%
69.6% 69.0% 20.0% 10.0% 0.0%
Red % in 8 mins Indicator
▪ There were 22,234 Amber calls resulting in an emergency response in June compared to 22,588 in May.
▪ The Amber median response time in June was 23 minutes and 25 seconds, a marginal increase from 21 minutes and 51 seconds in May. Graph 9 demonstrates how Amber spikes during periods of higher demand.
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Graph 8
AMBER MEDIAN
12:34:41 AM 12:34:41 AM 12:32:32
12:29:40 AM 12:29:40
12:29:23 AM 12:29:23
12:23:25 AM 12:23:25
12:21:51 AM 12:21:51
12:21:28 AM 12:21:28
12:20:54 AM 12:20:54
12:16:59 AM 12:16:59
12:16:55 AM 12:16:55
12:15:04 AM 12:15:04
12:15:02 AM 12:15:02
12:14:24 AM 12:14:24 HOURS:MINUTES:SECS
AMBER Median
Improvement Actions:
o There is a continued focus on response times both within the Trust and with the Welsh Government and EASC.
o There is work ongoing to review the improvement actions already in place to maximise resource capability, particularly in times of wider system pressures. This focuses on matching capacity to demand. Key factors include:
❖ Roster Reviews: the Trust has established a Demand & Capacity Rota Project Team, with the aim of completing Aneurin Bevan and Cwm Taf Q2 of 2018, before going on to re-review the other five areas.
❖ Resourcing: benchmarking work and the Demand and Capacity Review have identified that we have an insufficient relief rate. During 2018/19 the Trust will focus on internal efficiencies to help reduce this relief gap. The proposed work on “missed opportunities” (a strategic action in the IMTP), is on hold pending the outcome of the Amber Review.
❖ Multiple dispatch: a focus on reducing multiple vehicle arrivals to calls that do not require multiple resources, to maximise ambulance availability. In quarter one, the Trust switched over the reporting of multiple dispatch to multiple arrival, as agreed with the CASC. In quarter one 83% of incidents had one arrival on scene (this measures excludes incidents where more than one arrival is appropriate) and 15% had two arrivals.
❖ Non-productive time: the Trust is currently working to reduce the number of hours lost where ambulances are not productive during their shift. These include the interval once an ambulance hands over their patient at hospital to the crew being available, lost hours surrounding travelling to meal Page 12
breaks and those associated with admin activities such as vehicle stocking and cleaning.
16. Emergency Medical Service and Urgent Care Services Step 4: Give Me Treatment (June 2018 – updated Quarterly)
▪ As a result of the small numbers involved for each clinical indicator, the quarterly performance is detailed below, rather than the monthly performance. Graphs displaying the full month on month data are included for each clinical indicator below to compare trends:
▪ 12.8% of patients suffering a cardiac arrest had a return of spontaneous circulation (ROSC) in June 2018.
Graph 10 ROSC Clinical Indicator 20.0%
15.0% 18.7%
10.0% 15.7%
14.9%
14.3%
13.8%
13.6%
13.4%
12.8%
11.8%
11.6% 11.6%
5.0% 9.6%
0.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May- Jun-18 18 % of patients with attempted resuscitation following cardiac arrest, documented as having a return of spontaneous circulation (ROSC) at hospital door
▪ 96.6% of stroke patients are documented as receiving an appropriate stroke care bundle in June 2018.
Graph 11
120.0% Stroke Clinical Indicator 100.0%
80.0%
98.1% 98.1%
97.5%
96.9%
96.7%
96.6% 96.6%
96.2% 96.2% 96.2% 95.5% 60.0% 95.3% 40.0% 20.0% 0.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Stroke patients documented as receiving appropriate stroke bundle of care
▪ 88% of older people who have fallen and have a suspected fracture of hip/femur were documented as receiving analgesia between January and June 2018.
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Graph 12
100.0% Fracture Hip/Femur Clinical Indicator
94.3%
92.9%
92.0%
91.6%
91.5% 91.5%
91.1%
90.3%
90.1%
90.0%
87.9% 88.0% 80.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Fracture hip/femur who are documented as receiving analgesia
▪ 74.3% of acute coronary syndrome patients were documented as receiving the appropriate STEMI (ST-elevation myocardial infarction) care bundle in June 2018.
Graph 13
100.00% STEMI Clinical Indicator
77.50%
75.90%
75.40%
74.30%
73.00%
71.60% 71.60%
69.70%
66.00%
65.30%
62.50% 58.80% 0.00% AcuteJul-17 coronaryAug-17 syndromeSep-17 Oct-17patientsNov-17 who areDec-17 documentedJan-18 Feb-18 as receivingMar-18 appropriateApr-18 May-18 STEMIJun-18 care…
▪ 100% of suspected sepsis patients had a documented NEWS (A screening tool that promotes early recognition of suspected sepsis) score in March 2018.
Graph 14
Clinical Indicator - NEWS Score 102.0% 100.0% 98.0%
96.0%
100.0% 100.0% 100.0% 100.0% 100.0% 98.3%
94.0% 98.0%
97.1% 97.0% 92.0% 96.8%
90.0% 94.3% 93.3% 88.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May- Jun-18 18 % of suspected sepsis patients who have had a documented NEWS score
▪ 100.0% of patients with a suspected febrile convulsion aged 5 years and under were documented a receiving the appropriate care bundle in June 2018.
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Graph 15
120.0% Clinical Indicator - Febrile Convulsion 5 years and under
100.0%
80.0%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 60.0%
40.0%
20.0%
0.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
% of patients with a suspected febrile convulsion aged 5 years and under who are documented as receiving the appropriate care bundle
▪ 90.5% of hypoglycaemic patients were documented as receiving the appropriate care bundle in March 2018.
Graph 16
Clinical Indicator - Hypoglycaemic Patients 92.0% 90.0%
88.0% 90.5%
86.0% 90.1%
89.1%
88.5%
87.8% 87.8% 84.0% 87.5%
82.0% 85.9%
84.4%
84.0% 83.6%
80.0% 83.3% 78.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
% of hypoglycaemic patients who are documented as receiving the appropriate care bundle
▪ 4,759 incidents were not conveyed to hospital in June 2018 of which 2,692 were treated at scene and 2,067 were referred to an alternative provider.
▪ Of the 2,692 treated at scene (See and Treat) only 21 (0.8%) re-contacted the service within 24 hours.
Improvement Actions:
o Cardiac Arrest Plan launched by Cabinet Secretary focussing on improving survival rates, ROSC pathway (phase 1) agreed between WAST and Wales Cardiac Network.
o Access for Clinical Team Leaders to clinical indicator compliance against optimal patient care has now gone live and automated reports are now available at a Trust, Head of Service, locality and team level. There has Page 15
been a general increase in the use of the CTL Teams Management System.
o As previously reported, performance against the clinical indicators has been analysed and a targeted plan of improvement is underway focused initially on; fractured neck of femur, stroke, hypoglycaemia and STEMI. Given that many of the Clinical Indicators are reliant on the recording of Condition Codes to generate the reports, an emphasis is made on improving compliance to Condition Codes.
o The evaluation of the Clinical Indicators Improvement Plan results will feed into the work of the Medical Directorate’s restructure, with Regional Clinical Leads and Clinical Leads playing a key role in developing clinical practice. The training plan and benefits realisation plan for Band 6 Paramedics is also relevant.
o New Medical Directorate Structure has significantly increased capacity to support Operations with clinical developments and practice.
17. Emergency Medical Service and Urgent Care Services Step 5: Take Me to Hospital (June 2018)
Graph 17
% of patients conveyed to hospital following a face to 70.0% face assessment
69.0%
69.2% 69.1%
68.0% 69.1%
68.9%
68.4% 68.4%
68.2% 68.2%
67.0% 68.1%
67.9%
67.7% 67.6%
66.0% 67.0%
65.0% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
▪ The number of verified incidents was 1% more in June 2018, compared to June 2017 and 18,555 patients were conveyed to major A&Es in June 2018, compared to 20,035 in the same period last year.
▪ In June, the conveyance rate ranges across the Health Board areas from 64.4% in Betsi Cadwaladr and Powys to 76.5% in Cwm Taf.
▪ 58.7% were handed over to the hospital within 15 minutes in June. Graph 18 demonstrates how this compares to previous months.
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Graph 18
▪ 3,777 hours were lost because of hospital handover delays in June 2018 compared to 4,137 hours in May 2017, as demonstrated in Graph 18, an increase of 16%.
▪ The highest number of lost hours was experienced in Betsi Cadwaladr (1,662 hours) and 847 hours were lost within Abertawe Bro Morgannwg.
Improvement Actions:
Short Term Actions
In the short term, the Trust has continued to pro-actively manage performance through its robust resilience and escalation arrangements.
Medium Term
In the medium term i.e. in advance of next winter, the Trust has a significant amount of actions coming on stream, for what is likely to be a challenging winter (see synopsis).
In the medium to longer term i.e. through 2018/19 and into 2019/20, the Trust will further develop its approach to demand prediction, modelling and capacity management.
The use of Optima Predict will have implications for workforce planning and training. These are also receiving an increased focus within the Workforce & OD Directorate which has increased its capacity within the Directorate (through internal changes within existing resource) to support workforce planning, particularly for the Operations Directorate.
The Band 6 Paramedic project will increase the skills of our paramedic workforce, in particular, for the top 10 condition codes, which should increase the Trust’s see & treat rates. Specific collaborate work with the National
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Collaborative Commissioning Unit is going on at the moment, around benefits realisation for the Band 6.
Executive Management Team has also identified a need to improve systematic and routine arrangements for collaborating with each LHB on the 5 Step Ambulance Care Pathway.
Longer Term
The longer term action is the development of the Trust’s Long Term Strategy. Whilst the Trust has a clear programme of actions designed to mitigate the impact of increased incident demand, lost hours to handover delays and the relief gap, the levels of observed increases in verified demand and handover lost hours are too great for the Trust to be able to contain the impact and performance will start to deteriorate. A more fundamental conversation will be required about the level of unscheduled care demand entering the 5 Step Ambulance Care Pathway (in particular Steps 2 to 5) and the level of resourcing required to sustain performance.
18. Non-Emergency Patient Transport (NEPTS) (June 2018)
▪ WAST has recently worked with the CASC and LHBs to finalise the future NEPTS service measures, based upon the NEPTS five step service model. These will be included on a quarterly basis, with a view to reporting on a monthly basis.
▪ The control chart below shows the monthly percentage of journeys aborted since June 2017. The Performance Ambition for 2018/19 is a reduction to 10%.
▪ 13.2% of journeys were aborted in June 2018.
Graph 21
Percentage of Journeys Aborted 18.0% 16.0% 14.0% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Percentage of Journeys Aborted ** Average UCL LCL
▪ The control chart below shows a reduction in number of bookings made by fax, post and hand since March 2018. The Performance Ambition for 2018/19 is reduction to 15%. Page 18
▪ 25.7% of bookings made in June 2018 were made by fax, post or hand.
Graph 22
Number of Bookings made by fax/post/hand 40.0% 35.0% 30.0% 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Number of bookings made by fax/post/hand Average UCL LCL
Improvement Actions:
o The NEPTS Commissioning Framework went live in shadow form on 01 November 2017. It is anticipated that the Framework will go live fully in late summer 2018.
o Significant work on developing a NEPTS data repository for the NEPTS Five Steps has now concluded, and these has been available since June 2018. This has led to an improvement in the performance information available through the NEPTS management team, EMT and Board. It should be noted that these will continue to be refined as the Framework becomes live, and is embedded within the organisation.
o The NEPTS team is undertaking a piece of improvement work across the service, using the Lean and Systems Methodology. An action plan from this improvement work has been produced and is currently being delivered.
o The Cardiff & Vale transfer of NEPTS activity took place from 01 June 2018. The Velindre Trust transfer of NEPTS activity took place from 01 August. The data in relation to these two organisations will be incorporated into the data suite available in future.
19. Safe Care (June 2018)
▪ In June there were 148 patient safety incidents, near misses and hazards reported. 41 were recorded as causing harm. Graph 21 demonstrates how this compares to previous months.
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Graph 21
Patient Safety Incidents, Near Misses and Hazards 300 256 250 208 191 200 175 173 156 141 143 152 140 140 148 150 129 100 55 60 40 40 41 25 25 34 28 31 29 50 12 20 0 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
No. of Patient Safety Incidents, near misses and hazards Incidents recorded as causing harm
▪ One Serious Adverse Incident was reported to Welsh Government (WG) in June.
▪ The Trust’s duty to co-operate under section 25 Children Act 2004 has resulted in the Safeguarding Team’s engagement with 10 Child Practice Reviews in June.
▪ In accordance with Social Services and Wellbeing (Wales) Act 2014, the Trust co-operated with seven Adult Practice Reviews in June.
▪ The Trust has been involved with five child deaths during June. The Safeguarding Team was able to secure paramedic attendance at one PRUDiC meeting held. All WAST staff were supported through the PRUDiC process. There were no adverse outcomes requiring internal investigations by WAST.
▪ The Safeguarding Team has continued engagement with 13 professional issues under the allegations of abuse policy. These allegations have been investigated by local authority, police or WAST as required.
▪ One domestic abuse and sexual violence concern was facilitated by WAST staff in June 2018.
Improvement Actions:
o Social Services and Wellbeing (Wales) Act - Continued engagement with Regional Safeguarding Boards across Wales. - Both Senior Professionals now support this attendance - Safeguarding Team engagement with the work programmes from the operational groups within the Boards.
o Violence Against Women Domestic Abuse and Sexual Violence Act
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- Implications of the new Act and associated National Training Framework remains a high priority for WAST Safeguarding agenda 2018/19. - WAST VAWDASV Trainers have commenced Agored Cymru study and coursework associated with the train the trainer program.
o System for collating data/ processing referrals
- The Safeguarding Team continues to highlight the need to review and restructure the Safeguarding referral process i.e. the use of fax. Further work is on-going for a full process review. - Management is governed by Safeguarding Strategic Group. - The Referral Process Task and Finish Group established will report to EMT every two weeks. A proposed solution plan with potential options is being examined. - Safeguarding Team has reinstated reporting on WAST compliance for referrals processed to local authorities within two working days. This continues to be monitored and reported via the IPR and QAR process.
20. Individual and Dignified Care (June 2018)
▪ There were 115 complaints received in June 2018, a decrease from the previous month where 121 complaints were received. Graph 22 demonstrates how this further compares to previous months.
Graph 22
▪ 56% of complaint responses that were due within the reporting month were completed within 30 days. Graph 23 demonstrates how this compares to previous months. Performance is still below our performance ambition, but is recovering from the backlog of last winter and trending in the right direction.
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Graph 23
Concerns - Response within 30 days 100% 93% 81% 78% 76% 77% 76% 80% 73% 56% 57% 56% 60%
35% 40% 30% 29%
20%
0% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Concerns - Response within 30 days
Improvement Actions:
o The Quality Steering Group continues to develop and track the themes and trends from all quality data in order to develop quality improvement priorities.
o The Quality, Safety & Patient Experience Directorate and Planning & Performance Directorate are working on identifying a long list of metrics across the Core Requirements for the EMS and NEPTS Commissioning Frameworks. This work was reported to the June Planning Delivery & Evaluation Group (a sub-committee of EASC) and received positive feedback.
o With the CAD now implemented, more ICT and Health Informatics capacity will be available to progress Qliksense, new performance reporting software for the Trust that will enable greater triangulation of quality and performance data. A Project Initiation Document (PID) is currently under development, with options for the roll out of Qliksense. A development workshop for the QSPE Directorate is being held on 10 August 2018.
21. Staff and Resources (June 2018)
▪ Unit hour production (UHP) for emergency ambulances remained at 91% in June with fewer actual Emergency Ambulance hours than May, and fewer RRV hours.
Graph 24 below shows Planned vs Actual UHP against Lost Hours and Verified demand. Actual EA hours delivered in June 2018 were 66,930 compared to 67,612 in June 2017. RRV actual hours delivered were 18,522 and 19,707 in June 2018 and June 2017 respectively. 11,974 actual UCS hours were delivered in June 2018 compared to 11,501 in June 2017.
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Graph 24
Planned vs Actual UHP against Lost Hours and Verified Demand 100,000 50000 80,000 40000 60,000 30000 40,000 20000 20,000 10000 - 0
EA Expected Unit Hours EA Actual Unit Hours UCS Expected Unit Hours UCS Actual Unit Hours RRV Expected Unit Hours RRV Actual Unit Hours Total Lost Hours Verified Demand
▪ The monthly sickness rate was reported as 6.61% during June, a reduction of 0.11% from May’s figure, but slightly lower than June 2017’s 6.82%. (Graph 25).
Graph 25
10.00% 9.00% 8.00% 7.00% 6.00% 2016/17 5.00% 2017/18
4.00% 2018/19 3.00% 2.00% Trust Target 2018/19 (5.90%) 1.00%
0.00%
Jul
Jan
Jun
Oct
Apr
Feb Sep
Dec
Aug
Nov Mar May ▪ For June, 5.19% of sickness absence was long term (calculated as a percentage of full time equivalents), and 1.42% was short term sickness.
▪ The top reason for absence during June was once again anxiety/stress/depression/other psychiatric illnesses at 24.4% which was also the top reason for absence for the same period last year. Percentage of staff suffering from a mental health condition increased, however, from last year’s figure of 19.2%.
▪ Return to Work completion within ESR for those staff who returned during the month of June is reported as 76.02% which is lower than the May figure of 78.62% and year on year is 72.41%. Discussions on improving return to work figures continue to take place on a monthly basis.
Page 23
▪ There was one new Dignity at Work complaint opened in June.
▪ Three new Disciplinary cases opened in June, with 12 cases currently live.
▪ There were no new grievances submitted during June. The total number of live grievances in June was nine.
▪ Graph 26a shows overall Trust compliance with Statutory & Mandatory training as at 30 June 2018; Graph 26b shows Corporate Statutory & Mandatory compliance and Graph 26c shows Operational staff compliance (EMS, UCS, NEPTS, CCC, NHSDW / 111).
Graph 26a Trust - Statutory & Mandatory Training Compliance 100% 87.71%88.16%88.77%86.98% 90% 85.57%86.54% 84.92%84.01% 79.60%78.87% 78.99%81.08% 80% 74.95% 70% 65% 66% 60% 50% 40% 30% 20% 10% 0%
Graph 26b
Corporate Staff: Statutory & Mandatory Training Compliance 100.00% 90.68%89.62%89.82%89.35% 86.33%86.87% 87.48% 88.54%88.24%86.94% 90.00% 83.22% 85.67% 85.69% 80.00% 70.00% 60.44% 60.00% 55.56% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00%
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NB: due to the rolling nature of the statutory and mandatory training programme (including individual refresher periods for each subject), compliance can increase or decrease throughout the year; this is in contrast to CPD compliance rates which will increase on a cumulative basis from financial year start to financial year end. Graph 26c
Operational Staff: Statutory & Mandatory Training Compliance 100.00% 87.90%88.70% 87.84% 90.00% 84.72%85.90%85.71% 86.98% 86.75% 80.34%82.48% 80.00% 70.99%71.02%71.77%72.25%72.98% 70.00%
60.00%
50.00%
40.00%
30.00%
20.00%
10.00%
0.00%
▪ Image 1 displays 74.67% of eligible employees within WAST have had a PADR review in the rolling year to June against a target of 85%.
Image 1
▪ Actual expenditure year to date as a percentage of budget expenditure has remained at 100.1% for June as displayed in Graph 27.
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Graph 27
Actual Expenditure YTD as % of budget expenditure YTD 100.5% 100.2% 100.2% 100.2% 100.1% 100.1% 100.1% 100.1% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
99.5%
99.0%
98.5%
98.0% Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18
Improvement Actions:
• A new Workforce Planning toolkit is due to be introduced by the Workforce Planning Lead, with the aim of introducing the toolkit into the next planning cycle across the Trust. • Job Evaluation, New and Changed Job Protocol to be implemented following review by Employment Policy Sub Group in August. • Implementation of a Sickness Absence Improvement Plan to achieve 1% reduction in sickness, in response to implementation of Welsh NHS Pay Deal. Conversations to be held with Trade Union Partners to support achievement, or lose pay enhancements whilst on sickness in the future. • Development of a pathway to support the mental wellbeing of all WAST staff from prevention, to early intervention and longer term.
RECOMMENDATION
24. FRC is asked to note and discuss the June Monthly Integrated Quality and Performance Report.
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1 ITEM 2.3a Annex 1 - MIQPR June 18 WD2.pdf
Annex 1 Monthly Integrated Quality and Performance Report
Jun-18 Contents Page 1 Overall Dashboard 3 2 Overall Demand Analysis 4 3 Emergency Medical Services and Urgent Care Services 5 3.1 Step 1: Help Me Choose 6 3.2 Step 2: Answer My Call 7 3.3 Step 3: Come to See Me 8 3.4 Step 4: Give Me Treatment 9 3.5 Step 5: Take Me To Hospital 10 4 Non Emergency Patient Transport Service 11 4.1 Step 1 - Help me to choose - 4.2 Step 2- Book my transport - 4.3 Step 3- Take me to my appointment 4.4 Step 4- Take me home 12 5 Additional Indicators by Quality Theme 13 See 3.1 Staying Healthy - 5.1 Safe Care 15 5.2 Effective Care (Under Development) 16 See 3.2-3.5 Timely Care - 5.3 Individual and Dignified Care 17 5.4 Our Staff and Resources 18 Appendices A Clinical Contact Centre Performance 20 B Frequent Caller 21 C Red 8,9,10 Minute Performance, Amber and Green Performance by LHB 22 D Missed Reds by LHBs 23 E Handover Analysis by LHBs 24 F Longest Waits, 95th and 50th Percentiles Responses 25 G Conveyance Rates and Referrals to Alternative Care Pathways 26 EASC Ambulance Quality Indicator Definition Table 27 Ambulance Quality Indicator Glossary 28 Response Model 29 Additional Indicators by Quality Theme Non-Emergency Patient Transport Care and MedicalServices Urgent Services Emergency SECTION 1: Dashboard Quality Safe Care Timely Care Timely Care Staying Healthy Theme CR6 Ambition Performance Ambition Performance IPR AQI22i P21 AQI21 AQI20 I P19 i AQI19 5:Step Taketo Me Hospital viiAQI16 viAQI16 v AQI16 AQI16iv AQI16iii AQI16ii AQI16i 4: Treatment Step Me Give AQI13 AQI12 AQI11 P06 3:Step Me Cometo See AQI10ii AQI10i AQI9ii i AQI9 IPR AQI7 Call My 2:Step Answer AQI5 IPR AQI4i NHSDW 1:Step Help choose Me
Cross Reference 3 3 1 3 1 3 Five step service model. These will These model. stepservice Five beincluded in future reports Number of bookings made by fax/post/hand Percentage of Journeys NEPTS aborted Number of patient journeys Strategic Delivery Aim: of Excellent Patient Care patient care to hospital staff Percentage of handover to clear within 15 minutes of transfer of minutes Number of lost hours following notification to handover over 15 at hospital Percentage of notification to handover within 15 minutes of arrival assessment Percentage of patients conveyed to hospital following a face to face receiving the appropriate care bundle Percentage of hypoglycaemic patients who are documented as care bundle 5 years and under who are documented as receiving the appropriate Percentage of patients with a suspected febrile convulsion aged documented score NEWS Percentage of suspected sepsis patients who have had a documented as receiving appropriate care STEMI bundle Percentage of Acute Coronary Syndrome patients who are fracture of hip/femur who are documented as receiving analgesia Percentage of older people who have fallen and have suspected appropriate stroke care bundle Percentage of stroke patients who are documented as receiving spontaneous circulation Percentage of patients suffering a cardiac arrest with a return of Median Response for GREEN category incidents Median Response for AMBER category incidents arriving on scene within 8 minutes Percentage of RED category incidents with first response Strategic Delivery Aim: of Excellent Patient Care 4 hours of discharge of care (following treatment at the scene) % unplanned re-contact with the ambulance service within 2 within 24hours of discharge of care (by clinical telephone advice) % unplanned re-contact with the ambulance service (Hear and Treat) % of call ended following telephone assessment assessment (Hear and Treat) Number of calls ended following telephone WAST Strategic Value, Aim: Innovation and Efficiency % of 999calls answered within 6 seconds Number of 999calls answered Strategic Delivery Aim: of Excellent Patient Care overall number of Incidents Percentage of Frequent Callers Incidents against Strategic Value, Aim: Innovation and Efficiency Number of Calls to NHSDirect Number of NHSDirect Wales website unique visits Strategic Delivery Aim: of Excellent Patient Care Description
65% Indicator IMTP PA PA IMTP 18/19 15% 10% 90% 68% 95% 95% 95% 95% 95% 95% 65% 8%
367,614 00:43:35 00:20:54 Apr-18 41,349 24,249 62,743
27.00% 12.40% 100.0% 100.0%
6,134 2,663 75.5% 51.7% 68.4% 84.4% 66.0% 90.3% 98.1% 13.8% 75.1% 93.8% 0.7% 3.5% 7.4% 5.2%
May-18 356,542 00:47:19 00:21:51 67,822 22,651
92.70% 28.00% 12.20% 100.0% 46,198 73.4% 57.0% 68.2% 87.5% 98.0% 73.0% 90.0% 96.2% 18.7% 76.1% 4,137 2,820 0.9% 4.6% 7.2% 5.5%
363,332 00:49:15 00:23:25 Jun-18
65,977 20,643 25.70% 13.20% 100.0% 100.0% 91.40% 45,694 73.4% 58.6% 67.7% 90.5% 74.3% 88.0% 96.6% 12.8% 75.6% 13.5% 3,777 2,876 0.8% 7.4% 5.7% Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 RAG RAG TREND ↔ ↔ ↓ ↑ ↓ ↓ ↑ ↓ ↑ ↑ ↑ ↓ ↑ ↓ ↑ ↑ ↓ ↓ ↑ ↑ ↑ ↓ ↓ ↑ ↓ ↑ TREND ↔ ↓ ↑ ↓ ↑ ↓ ↑ Decrease within 10% of target Increase within 10% of target No target/ target not impacted Decrease exceeding target Increase exceeding target Decrease >10% away from target Increase >10% away from target 6 Strategic Aim: Quality at the Heart IPR Patient Safety Incidents, near misses and hazards 140 140 148 ↑ Safe Care Care Safe IPR Number of Serious adverse incidents reported to Welsh Government 1 1 1 ↔ CR3, CR4 Equity, Clinical Care 3 Strategic Aim: Delivery of Excellent Patient Care
Care AQI11 Red performance within 8 minutes 95th percentile 00:10:00 00:14:56 00:14:17 00:14:51 ↑ Effective Effective AQI12 Amber performance 95th percentile 00:35:00 02:22:11 02:27:19 02:32:05 ↑ CR2, CR3. Patient Experience and Satisfaction, Equity 3 Strategic Aim: Delivery of Excellent Patient Care IPR Number of complaints 132 121 115 ↓ Percentage of responses completed within 30 days - due in reporting ↑
Dignified Care Care Dignified Individual and and Individual IPR month 75% 79% 30% 29% 56% CR1, CR5 Governance, Leadership & Accountability, Staffing 4 & 5 Strategic Aim: Fantastic People & Vibrant Leadership IPR Staff turnover % FTE 0.40% 0.36% 0.66% ↑ L03 IPR % of sickness absence 7.12% 6.56% 6.61% ↑ IPR PADR 72.4% 74.5% 74.7% ↑ 3 Strategic Aim: Delivery of Excellent Patient Care IPR Unit Hours Production (UHP) Emergency Medical Services 93.0% 91.0% 91.00% ↔ 1 Strategic Aim: Value, Innovation and Efficiency V01 IPR Actual Expenditure YTD as % of budget expenditure YTD Breakeven 100.2% 100.2% 100.1% ↓
Staff and Resources Resources and Staff V02 IPR Annual Trust surplus/deficit YTD £000 -23 -43 -60 ↑ IPR Actual Savings YTD as % of planned savings YTD 86.6% 87.5% 94.60% ↑ IPR % of non - NHS creditor invoices paid within 30 days of receipt of invoice 99.2% 94.1% 98.30% ↑ RAG TREND R Indicator not met ↑ Increase >10% away from target A Within 10% Margin of Indicator ↓ Decrease >10% away from target G Meeting Indicator ↑ Increase exceeding target ↓ Decrease exceeding target ↔ No target/ target not impacted ↑ Increase within 10% of target ↓ Decrease within 10% of target SECTION 2: Overall Demand Analysis 2018 All Wales Cross Ref. Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Total Total Verified Incidents 36,153 39,459 39,042 IPR Apr 2018 - Mar 2019 114,654 Total Verified Incidents 37,655 39,845 38,628 Apr 2017 - Mar 2018 116,128 Variance - 1,502 - 386 414 - 1,474 Variance as a percentage -4.0% -1.0% 1.1% -1.3% Calls to NHS Direct Wales 24,249 22,651 20,643 IPR Apr 2018 - Mar 2019 67,543 Calls to NHS Direct Wales 25,026 23,437 20,787 Apr 2017 - Mar 2018 69,250 Variance - 777 - 786 - 144 - 1,707 Variance as a percentage -3.1% -3.4% -0.7% -2.5% Non-Emergency Patient Transport Journeys 62,743 67,822 65,977 IPR Apr 2018 - Mar 2019 196,542 Non-Emergency Patient Transport Journeys 58,581 67,631 68,196 Apr 2017 - Mar 2018 194,408 Variance 4,162 191 - 2,219 2,134 Variance as a percentage 7.1% 0.3% -3.3% 1.1% SECTION 3: Emergency Medical Services and Urgent Care Services; June 2017 June 2018 - Linked to publication of AQIs Section 3.1: Step 1 Help Me Choose Cross Apr-18 May-18 Jun-18 Ref. AQI Description All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
AQI1 Number of Welsh Ambulance Services NHS Trust (WAST) community engagement events 12 0 3 1 0 5 1 2 22 1 9 0 3 7 2 0 23 4 10 0 1 6 2 0
AQI2 Number of local health board engagement events attended by WAST
AQI3 Number of attendances at key stakeholder events 23 4 4 2 4 4 2 3 20 3 3 2 3 3 2 4 16 3 3 1 3 3 1 2
AQI4 i Number of NHS Direct Wales unique website visits 367,614 ------356,542 ------363,332 ------
AQI4 ii NHS Direct Wales number of calls by reason (top 10) Dental Problems 3724 1208 35 1227 29 17 904 304 3552 1183 39 1188 25 16 820 281 3263 1221 37 1018 22 16 734 215 Abdominal Pain 1059 326 194 157 119 86 156 21 1081 336 162 189 142 82 151 19 1043 328 159 177 121 86 153 19 Rash 752 306 113 84 74 59 101 15 760 309 111 82 85 67 100 6 624 248 92 75 54 51 98 6 Ingestion Toxic 367 105 50 69 52 33 49 9 364 105 63 49 59 27 43 18 367 105 59 59 55 29 52 8 Chest Pain 463 154 86 68 64 32 52 7 454 158 67 66 66 30 59 8 442 166 74 53 55 28 63 3 Fever 396 104 69 70 40 32 69 12 562 189 104 86 60 43 74 6 521 163 92 67 59 40 92 8 Back Pain 398 133 54 70 49 31 52 9 400 128 47 70 44 44 59 8 370 133 45 63 41 31 46 11 Sore Throat 506 292 34 41 33 22 78 6 484 262 29 41 32 24 88 8 418 221 29 26 32 18 84 8 Vomiting 288 74 46 50 30 28 50 10 295 109 43 51 29 28 32 3 343 96 55 65 41 24 53 9 Other Symptoms 522 133 93 78 72 58 76 12 609 158 94 111 80 57 92 17 555 159 89 79 76 62 75 15
AQI5 Number of Frequent Callers 208 36 39 62 32 10 23 6 262 48 41 91 33 17 28 4 249 37 43 87 30 14 33 5 Number of Incidents generated by Frequent Callers 1,886 300 276 686 313 88 186 37 2,163 380 341 739 310 123 227 43 2,216 327 340 826 294 114 268 47 Total Number of Incidents 35,999 5,833 6,440 9,354 5,091 3,287 4,345 1,649 39,258 6,381 6,951 10,142 5,807 3,542 4,769 1,666 38,864 6,311 6,678 10,268 5,660 3,590 4,713 1,644 Percentage of Frequent Callers Incidents against overall number of Incidents 5.2% 5.1% 4.3% 7.3% 6.1% 2.7% 4.3% 2.2% 5.5% 6.0% 4.9% 7.3% 5.3% 3.5% 4.8% 2.6% 5.7% 5.2% 5.1% 8.0% 5.2% 3.2% 5.7% 2.9% Section 3.2: Step 2 Answer My Call Cross Apr-18 May-18 Jun-18 Ref. AQI Description All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
AQI6 Number of Healthcare Professional (HCP) Calls answered 6,276 ------6,648 ------6,775 ------Central & West - HCP Urgent (0845 NGN) 1,490 ------1,650 ------1,624 ------North - HCP Urgent (0845 NGN) 1,381 ------1,416 ------1,575 ------South East - HCP Urgent (0845 NGN) 3,405 ------3,582 ------3,576 ------
AQI7 Number of 999 calls answered 41,349 ------46,198 ------45,694 ------Number of 999 calls answered on Primary Line 36,372 ------40,426 ------39,956 ------Number of 999 calls answered on Secondary Line 157 ------189 ------233 ------Number of 999 calls answered on Alternative Line 11 ------25 ------96 ------Number of 999 calls answered on (Emergency Services 0845) line 4,809 ------5,558 ------5,409 ------IPR Number of 999 calls answered within 6 seconds 36,107 ------39,538 ------37,541 ------Percentage of 999 calls answered within 6 seconds 87.3% ------85.6% ------82.2% ------
AQI8 Number of 999 calls taken through the Medical Priority Dispatch System (MPDS) 35,999 5,833 6,440 9,354 5,091 3,287 4,345 1,649 39,258 6,381 6,951 10,142 5,807 3,542 4,769 1,666 38,864 6,311 6,678 10,268 5,660 3,590 4,713 1,644 Protocol 17: FALLS 4,360 711 668 1,244 557 408 559 213 4,987 769 823 1,494 596 426 652 227 4,941 761 780 1,460 614 436 653 237 Protocol 35: HEALTH CARE PROFESSIONAL 3,599 450 695 960 473 298 505 218 3,733 559 656 973 455 357 526 207 3,706 537 629 974 446 375 552 193 Protocol 10: CHEST PAIN 4,020 733 691 967 493 383 543 210 3,995 713 712 925 554 390 475 226 3,791 657 652 995 484 327 487 189 Protocol 06: BREATHING PROBLEMS 3,796 634 722 994 495 356 434 161 3,686 647 663 926 545 363 405 137 3,518 637 611 908 474 340 400 148 Protocol 26: SICK PERSON - SPECIFIC DIAGNOSIS 2,906 406 540 751 399 316 378 116 3,283 459 620 878 468 294 451 113 3,168 450 538 883 467 329 394 107 Protocol 31: UNCONSCIOUS/FAINTING(NEAR) 2,243 344 384 580 372 197 268 98 2,479 374 461 611 444 202 301 86 2,642 436 449 677 469 243 279 89 Protocol 28: STROKE - CVA 1,273 200 225 348 150 105 167 78 1,326 203 245 348 195 108 182 45 1,313 201 235 332 174 112 182 77 Protocol 12: CONVULSIONS/FITTING 1,217 207 220 322 181 122 123 42 1,289 192 202 374 223 105 155 38 1,275 225 204 318 216 122 145 45 Protocol 21: HAEMORRHAGE/LACERATIONS 1,326 210 264 319 184 135 166 48 1,369 212 248 349 193 142 170 55 1,288 202 249 346 180 126 144 41 Protocol UGA2: UPGRADE TO AMBER 2 1,114 182 195 303 135 77 151 71 1,365 236 232 376 154 94 190 83 1,331 209 209 389 144 95 209 76
Percentage of Incidents Coded as Unknown
AQI9 i Number of calls ended following WAST telephone assessment (Hear and Treat) 2,663 477 517 663 478 216 223 89 2,820 425 552 695 573 223 293 59 2,876 463 513 750 544 241 261 104 Number of NHSDW telephone assessments that were resolved with an ambulance not required outcome 1,152 170 214 321 155 118 122 52 1,249 158 238 340 192 120 170 31 1,114 157 197 324 163 104 118 51 Number of Clinical Desk telephone assessments that were resolved with an ambulance not required outcome 1,511 307 303 342 323 98 101 37 1,571 267 314 355 381 103 123 28 1,762 306 316 426 381 137 143 53 Percentage of calls ended following WAST telephone assessment 7.4% 8.2% 8.0% 7.1% 9.4% 6.6% 5.1% 5.4% 7.2% 6.7% 7.9% 6.9% 9.9% 6.3% 6.1% 3.5% 7.4% 7.3% 7.7% 7.3% 9.6% 6.7% 5.5% 6.3%
AQI9 ii Number of calls transferred to NHS Direct Wales 2,236 327 401 644 279 229 250 106 2,575 355 455 742 377 234 335 77 2,396 325 413 722 317 220 292 107 Number of 999 calls taken through the Medical Priority Dispatch System (MPDS) 35,999 5,833 6,440 9,354 5,091 3,287 4,345 1,649 39,258 6,381 6,951 10,142 5,807 3,542 4,769 1,666 38,864 6,311 6,678 10,268 5,660 3,590 4,713 1,644 Percentage of calls transferred to NHS Direct Wales 6.2% 5.6% 6.2% 6.9% 5.5% 7.0% 5.8% 6.4% 6.6% 5.6% 6.5% 7.3% 6.5% 6.6% 7.0% 4.6% 6.2% 5.1% 6.2% 7.0% 5.6% 6.1% 6.2% 6.5%
P10 % Response rate to GREEN 3 calls planned clinical telephone assessment within 10 minutes
AQI9 iii Number of calls returned from NHS Direct Wales with an outcome ambulance required 823 122 128 249 94 85 98 47 985 142 157 320 129 79 123 35 950 112 153 302 120 92 132 39 Total Number of Calls Triaged by a Nurse Advisor 1,975 292 342 570 249 203 220 99 2,234 300 395 660 321 199 293 66 2,064 269 350 626 283 196 250 90 Percentage of calls returned from NHS Direct Wales 41.7% 41.8% 37.4% 43.7% 37.8% 41.9% 44.5% 47.5% 44.1% 47.3% 39.7% 48.5% 40.2% 39.7% 42.0% 53.0% 46.0% 41.6% 43.7% 48.2% 42.4% 46.9% 52.8% 43.3%
AQI9 iv Number of calls ended through transfer to alternative care advice services 1152 170 214 321 155 118 122 52 1249 158 238 340 192 120 170 31 1114 157 197 324 163 104 118 51 Total Number of Calls Triaged by a Nurse Advisor 1975 292 342 570 249 203 220 99 2234 300 395 660 321 199 293 66 2064 269 350 626 283 196 250 90 Percentage of calls ended through transfer to alternative care advice services 58.3% 58.2% 62.6% 56.3% 62.2% 58.1% 55.5% 52.5% 55.9% 52.7% 60.3% 51.5% 59.8% 60.3% 58.0% 47.0% 54.0% 58.4% 56.3% 51.8% 57.6% 53.1% 47.2% 56.7%
P17 Patients referred to alternative provider
AQI10 i Re-Contact rates - Telephone Number of incidents received within 24 hours following WAST telephone assessment (Hear and Treat) 93 14 15 40 14 2 6 2 130 21 20 45 15 7 17 5 388 26 32 276 20 4 26 4 Number of calls ended following WAST telephone assessment (Hear and Treat) 2,663 477 517 663 478 216 223 89 2,820 425 552 695 573 223 293 59 2,876 463 513 750 544 241 261 104 Re-Contact Percentage within 24hrs of Telephone Triage (Hear and Treat) 3.5% 2.9% 2.9% 6.0% 2.9% 0.9% 2.7% 2.2% 4.6% 4.9% 3.6% 6.5% 2.6% 3.1% 5.8% 8.5% 13.5% 5.6% 6.2% 36.8% 3.7% 1.7% 10.0% 3.8%
AQI10 ii Re-Contact rates - Attendance at Scene Number of incidents within 24 hours following an Attendance at Scene that were not transported to hospital (See and Treat) 18 2 4 8 - 1 2 1 26 3 4 16 - - 3 - 21 1 5 14 - - 1 - Number of verified incidents that following an Attendance at Scene that were not transported to hospital (See and Treat) 2,596 462 480 831 257 112 297 157 2,780 464 533 881 297 142 329 134 2,692 425 535 914 263 144 284 127 Re-Contact Percentage within 24hrs which resulted in treatment and discharge on scene 0.7% 0.4% 0.8% 1.0% 0.0% 0.9% 0.7% 0.6% 0.9% 0.6% 0.8% 1.8% 0.0% 0.0% 0.9% 0.0% 0.8% 0.2% 0.9% 1.5% 0.0% 0.0% 0.4% 0.0% Section 3.3: Step 3 Come To See Me Cross Apr-18 May-18 Jun-18 Ref. AQI Description All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
AQI11 Number of RED category incidents resulting in an emergency response 1778 368 333 370 313 129 198 67 1927 356 354 389 347 183 212 86 2016 373 306 447 385 186 239 80 Number of RED category incidents with first response arriving on scene within 8 minutes 1335 288 243 281 260 90 133 40 1466 275 270 293 291 138 140 59 1524 291 226 328 330 144 150 55 P14 Percentage of RED category incidents with first response arriving on scene within 8 minutes, 65% of the time 75.1% 78.3% 73.0% 75.9% 83.1% 69.8% 67.2% 59.7% 76.1% 77.2% 76.3% 75.3% 83.9% 75.4% 66.0% 68.6% 75.6% 78.0% 73.9% 73.4% 85.7% 77.4% 62.8% 68.8% RED Category - Median Response 00:04:52 00:04:33 00:05:26 00:04:36 00:04:43 00:05:53 00:04:50 00:04:19 00:04:45 00:04:30 00:05:24 00:04:26 00:04:40 00:05:25 00:04:33 00:03:45 00:04:48 00:04:49 00:05:03 00:04:42 00:04:35 00:04:54 00:05:22 00:05:03 RED Category - 65th Percentile 00:06:30 00:05:56 00:06:51 00:06:17 00:06:05 00:07:14 00:07:09 00:09:06 00:06:22 00:06:06 00:06:48 00:06:01 00:05:47 00:06:32 00:07:34 00:07:16 00:06:25 00:06:12 00:06:28 00:06:32 00:05:53 00:06:19 00:08:19 00:07:38 RED Category - 95th Percentile 00:14:56 00:12:56 00:13:39 00:17:21 00:11:37 00:13:41 00:18:44 00:18:52 00:14:17 00:12:42 00:12:49 00:16:33 00:11:36 00:12:16 00:17:57 00:16:02 00:14:51 00:12:03 00:14:43 00:17:04 00:10:47 00:12:24 00:17:29 00:20:08 IPR RED Category - Longest Wait
AQI12 Number of AMBER category incidents resulting in an emergency response 21,114 3,352 3,707 5,531 2,724 2,039 2,732 1,029 22,588 3,659 3,906 5,927 3,046 2,096 2,905 1,049 22,234 3,595 3,852 5,835 2,982 2,064 2,854 1,052 Number of AMBER category incidents with first response arriving on scene within Target P27a % of AMBER category incidents with first response arriving on scene within 20 Minutes AMBER Category - Median Response 00:20:54 00:22:14 00:24:06 00:20:29 00:25:06 00:19:25 00:17:20 00:19:08 00:21:51 00:23:55 00:26:04 00:20:16 00:26:52 00:18:58 00:18:34 00:18:13 00:23:25 00:24:09 00:24:52 00:23:55 00:26:16 00:22:51 00:20:53 00:19:02 AMBER Category - 65th Percentile 00:32:05 00:35:20 00:37:02 00:30:45 00:42:17 00:27:54 00:24:01 00:27:24 00:32:57 00:37:17 00:43:04 00:29:30 00:44:25 00:26:47 00:26:58 00:26:28 00:36:03 00:38:18 00:38:49 00:34:55 00:42:14 00:35:23 00:30:15 00:28:29 AMBER Category - 95th Percentile 02:22:11 02:50:41 03:02:22 02:00:48 03:12:08 01:44:52 01:26:07 01:34:45 02:27:19 02:43:08 03:16:35 02:00:48 04:04:44 01:42:24 01:36:18 01:19:11 02:32:05 02:45:17 03:04:18 02:23:15 03:06:37 02:19:40 01:59:04 01:29:37 IPR AMBER Category - Longest Wait
AQI13/ P27bNumber of GREEN category incidents resulting in a response 2,134 332 327 580 267 215 293 120 2,400 332 406 728 254 230 328 122 2,113 318 398 577 219 205 293 103 Number of GREEN category incidents with first response arriving on scene within Target % of GREEN category incidents with first response arriving on scene within agreed timeframe GREEN Category - Median Response 00:43:35 00:42:32 00:51:33 00:40:15 00:50:02 00:34:55 00:40:09 00:39:21 00:47:19 00:49:44 01:01:54 00:40:12 01:05:48 00:39:26 00:45:15 00:36:34 00:49:15 00:46:18 00:53:15 00:53:17 00:47:51 00:46:51 00:45:38 00:43:10 GREEN Category - 65th Percentile 01:05:50 01:12:46 01:20:36 01:01:21 01:09:56 00:52:26 01:02:11 00:57:57 01:14:49 01:27:23 01:37:07 00:59:52 01:54:51 00:57:19 01:08:20 01:08:26 01:20:01 01:21:41 01:22:02 01:21:16 01:18:00 01:23:32 01:13:50 01:13:21 GREEN Category - 95th Percentile 04:52:09 06:37:26 07:21:57 03:59:11 08:33:17 03:14:43 03:08:24 03:14:09 06:09:10 07:36:04 08:26:42 04:14:04 12:56:32 03:09:20 03:41:46 03:54:18 06:01:29 06:31:39 08:05:05 04:26:59 08:41:51 05:56:36 04:42:43 03:39:21 IPR GREEN Category - Longest Wait
P26 % of requesting transporting vehicles arriving within 19 minutes of request for back up
P28 % of Card 35 patients (pre-planned admission requests from HCPs) where response was within the pre-arranged time
AQI14 Number of responded Incidents where at least 1 resource arrived at scene (excluding incidents where multiple dispatches are appropriate) 20,386 3,147 3,632 5,285 2,730 2,004 2,642 946 22,052 3,489 3,859 5,823 2,847 2,154 2,879 1,001 21,412 3,418 3,678 5,575 2,827 2,165 2,810 939 Percentage of Incidents where 1 Vehicle Arrived at Scene 83% 82% 80% 87% 79% 80% 91% 86% 83% 83% 80% 86% 79% 79% 90% 88% 84% 83% 80% 87% 81% 80% 92% 87% Percentage of Incidents where 2 Vehicles Arrived at Scene 15% 17% 19% 12% 20% 18% 9% 13% 15% 16% 18% 14% 19% 19% 9% 11% 14% 16% 18% 12% 17% 18% 7% 12% Percentage of Incidents where 3 Vehicles Arrived at Scene 1% 1% 2% 1% 1% 2% 0% 1% 1% 1% 2% 1% 2% 2% 0% 1% 1% 1% 1% 1% 2% 1% 0% 1% Percentage of Incidents where 4 or More Vehicles Arrived at Scene 0% 1% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 0% 1%
AQI15 Number of Community First Responders (CFRs) attendances at scene 1,354 171 240 437 183 56 171 96 1,449 173 226 440 257 63 207 83 1,026 119 167 319 210 35 118 58 RED 212 37 41 46 31 9 29 19 279 39 54 55 49 17 44 21 198 23 33 47 42 7 36 10 AMBER 1,093 134 199 353 145 46 139 77 1,116 133 172 336 207 46 162 60 787 91 132 247 164 25 81 47 GREEN 49 - - 38 7 1 3 - 54 1 - 49 1 - 1 2 41 5 2 25 4 3 1 1 Number of Community First Responders (CFRs) attendances at scene where first response arriving on scene 1,118 141 213 359 146 44 140 75 1,239 150 188 387 224 56 170 64 859 100 144 279 170 29 94 43 Percentage of Community First Responder (CFR) attendances at scene where they were the first response arriving at scene 82.6% 82.5% 88.8% 82.2% 79.8% 78.6% 81.9% 78.1% 85.5% 86.7% 83.2% 88.0% 87.2% 88.9% 82.1% 77.1% 83.7% 84.0% 86.2% 87.5% 81.0% 82.9% 79.7% 74.1% Section 3.4: Step 4 Give Me Treatment Cross Apr-18 May-18 Jun-18 Ref. AQI Description All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
AQI16 i Percentage of patients with attempted resuscitation following cardiac arrest, documented as having a return of spontaneous circulation (ROSC) at hospital door 13.8% All Wales Indicator Only 18.7% All Wales Indicator Only 12.8% All Wales Indicator Only Number of patients with attempted resuscitation following cardiac arrest, documented as having a return of spontaneous circulation (ROSC) at hospital door 32 ------42 ------32 ------Total Number of patients with attempted resuscitation following cardiac arrest 232 ------225 ------250 ------
AQI16 ii Percentage of suspected stroke patients who are documented as receiving appropriate stroke care bundle 98.1% All Wales Indicator Only 96.2% All Wales Indicator Only 96.6% All Wales Indicator Only Number of suspected stroke patients who are documented as receiving appropriate stroke care bundle 309 ------330 ------315 ------Total Number of suspected stroke patients 315 ------343 ------326
AQI16 iii Percentage of older patients with suspected hip fracture who are documented as receiving appropriate care bundle [including analgesia] 78.7% All Wales Indicator Only 75.1% All Wales Indicator Only 75.5% All Wales Indicator Only Number of older patients with suspected hip fracture who are documented as receiving appropriate care bundle 163 ------181 ------163 ------Total Number of older patients with suspected hip fracture 207 ------241 ------216 ------Percentage of older patients with suspected hip fracture who are documented as receiving analgesia 90.3% All Wales Indicator Only 90.0% All Wales Indicator Only 88.0% All Wales Indicator Only Number of older patients with suspected hip fracture who are documented as receiving analgesia 187 ------217 ------190 ------Total Number of older patients with suspected hip fracture 207 ------241 ------216 ------
AQI16 iv Percentage of ST segment elevation myocardial infarction (STEMI) patients who are documented as receiving appropriate STEMI care bundle 66.0% All Wales Indicator Only 73.0% All Wales Indicator Only 74.3% All Wales Indicator Only Number ST segment elevation myocardial infarction (STEMI) patients who are documented as receiving appropriate STEMI care bundle 64 ------54 ------55 ------Total Number of ST segment elevation myocardial infarction (STEMI) patients 97 ------74 ------74 ------
AQI16 v Percentage of suspected sepsis patients who have had a documented NEWS score 100.0% All Wales Indicator Only 98.0% All Wales Indicator Only 100.0% All Wales Indicator Only Number of suspected sepsis patients who have had a documented NEWS score 42 ------50 ------47 ------Total Number of suspected sepsis patients 42 ------51 ------47 ------
AQI16 vi Percentage of patients with a suspected febrile convulsion aged 5 years and under who are documented as receiving the appropriate care bundle 100.0% All Wales Indicator Only 100.0% All Wales Indicator Only 100.0% All Wales Indicator Only Number of patients with a suspected febrile convulsion aged 5 years and under who are documented as receiving the appropriate care bundle 25 ------29 ------23 ------Total Number of patients with a suspected febrile convulsion aged 5 years and under 25 ------29 ------23 ------
AQI16 vii Percentage of hypoglycaemic patients who are documented as receiving the appropriate care bundle 84.4% All Wales Indicator Only 87.5% All Wales Indicator Only 90.5% All Wales Indicator Only Number of hypoglycaemic patients who are documented as receiving the appropriate care bundle 244 ------272 ------209 ------Total Number of hypoglycaemic patients 289 ------311 ------231 ------
AQI17 Number of Incidents that resulted in non conveyance to hospital 4,546 825 870 1,252 580 205 535 279 4,734 827 921 1,309 621 257 552 247 4,759 800 881 1,420 590 256 562 250 Treated At Scene 2,596 462 480 831 257 112 297 157 2,780 464 533 881 297 142 329 134 2,692 425 535 914 263 144 284 127 Referred To Alternate Provider 1,950 363 390 421 323 93 238 122 1,954 363 388 428 324 115 223 113 2,067 375 346 506 327 112 278 123
AQI18 AMBER1 Total Number of AMBER1 Incidents with a Response Number of AMBER1 Incidents where Ideal Resource First on Scene Percentage of AMBER1 Incidents where Ideal Resource First on Scene Number of AMBER1 Incidents where Ideal Resource Arrived Subsequently Percentage of AMBER1 Incidents where Ideal Resource Arrived Subsequently
AMBER2 Total Number of AMBER2 Incidents with a Response Number of AMBER2 Incidents where Ideal Resource First on Scene Percentage of AMBER2 Incidents where Ideal Resource First on Scene Number of AMBER2 Incidents where Ideal Resource Arrived Subsequently Percentage of AMBER2 Incidents where Ideal Resource Arrived Subsequently
GREEN2 Total Number of GREEN2 Incidents with a Response Number of GREEN2 Incidents where Ideal Resource First on Scene Percentage of GREEN2 Incidents where Ideal Resource First on Scene Number of GREEN2 Incidents where Ideal Resource Arrived Subsequently Percentage of GREEN2 Incidents where Ideal Resource Arrived Subsequently
GREEN3 (Non HCP Incidents) Total Number of GREEN3 Incidents with a Response Number of GREEN3 Incidents where Ideal Resource First on Scene Percentage of GREEN3 Incidents where Ideal Resource First on Scene Number of GREEN3 Incidents where Ideal Resource Arrived Subsequently Percentage of GREEN3 Incidents where Ideal Resource Arrived Subsequently
GREEN3 (HCP Incidents) Total Number of GREEN3 Incidents with a Response Number of GREEN3 Incidents where Ideal Resource First on Scene Percentage of GREEN3 Incidents where Ideal Resource First on Scene Number of GREEN3 Incidents where Ideal Resource Arrived Subsequently Percentage of GREEN3 Incidents where Ideal Resource Arrived Subsequently
Apr-18 May-18 Jun-18 All Wales Central & West North South East All Wales Central & West North South East All Wales Central & West North South East AQI18 Number of Incidents where RRV Ideal as per clinical response model 9,579 2841 2906 3832 9,817 2602 3376 3839 9,492 2733 3339 3420 Number of Incidents where RRV sent as ideal response 2,420 654 489 1277 2,534 584 675 1275 2,389 608 690 1091 Percentage of Incidents where RRV sent as ideal response 25.3% 23.0% 16.8% 33.3% 25.8% 22.4% 20.0% 33.2% 25.2% 22.2% 20.7% 31.9% Number of Incidents where EA Ideal as per clinical response model 3,030 887 956 1187 3,316 869 1170 1277 3,132 870 1148 1114 Number of Incidents where EA sent as ideal response 2,198 673 751 774 2,383 671 873 839 2,237 642 844 751 Percentage of Incidents where EA sent as ideal response 72.5% 75.9% 78.6% 65.2% 71.9% 77.2% 74.6% 65.7% 71.4% 73.8% 73.5% 67.4% Number of HCP (card 35) calls where UCS ideal as per clinical response model 2,673 819 748 1106 2,733 838 738 1157 2,606 775 749 1082 Number of HCP (card 35) calls where UCS sent as ideal response 1,709 532 514 663 1,732 539 501 692 1,661 491 524 646 Percentage of HCP calls where UCS sent as ideal response 63.9% 65.0% 68.7% 59.9% 63.4% 64.3% 67.9% 59.8% 63.7% 63.4% 70.0% 59.7% Section 3.5: Step 5 Take Me To Hospital Cross Apr-18 May-18 Jun-18 Ref. AQI Description All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
AQI19 i Number of 999 Patients conveyed to Hospital 15,304 2,304 2,601 3,857 1,967 1,760 2,135 680 16,126 2,468 2,761 4,100 2,149 1,743 2,203 702 15,622 2,514 2,714 3,835 2,074 1,692 2,112 681 Total Number of Incidents where an Ambulance Resource Attended Scene 22,362 3,574 3,904 5,803 2,923 2,209 2,889 1,060 23,638 3,759 4,121 6,173 3,228 2,277 3,007 1,073 23,090 3,733 4,040 5,956 3,169 2,213 2,921 1,058 Percentage of patients conveyed to hospital following a face to face assessment 68.4% 64.5% 66.6% 66.5% 67.3% 79.7% 73.9% 64.2% 68.2% 65.7% 67.0% 66.4% 66.6% 76.5% 73.3% 65.4% 67.7% 67.3% 67.2% 64.4% 65.4% 76.5% 72.3% 64.4%
P18 % Conveyance rate to A&E department
P16 % incidents treated at scene with no transport required
AQI19 ii Number of patients conveyed to hospital by type 19,636 2,908 3,398 5,005 2,534 2,134 2,724 933 20,980 3,218 3,593 5,369 2,767 2,187 2,874 972 20,263 3,174 3,468 5,069 2,679 2,145 2,802 926 Tier 1 Major A&E Units 17,992 2,590 3,232 4,853 2,094 2,118 2,264 841 19,193 2,853 3,397 5,216 2,282 2,167 2,393 885 18,555 2,854 3,300 4,921 2,190 2,128 2,327 835 Tier 2 (Minor A&E Units) - Minor Injuries Unit or Local Accident Centre 498 292 142 34 - 5 17 8 550 331 158 33 1 7 13 7 478 290 133 27 - 4 13 11 Tier 3 (Major Acute) - Medical Admissions Unit 835 2 - - 401 - 432 - 894 1 1 - 434 1 457 - 893 4 - - 439 1 449 - Other (all other units such as Maternity or Mental Health Units) 311 24 24 118 39 11 11 84 343 33 37 120 50 12 11 80 337 26 35 121 50 12 13 80
AQI20i/ P19Number and Percentage of notification to handover within 15 minutes of arrival at hospital 51.7% 45.5% 50.3% 36.5% 45.0% 92.3% 61.5% 51.0% 57.0% 48.6% 54.1% 46.9% 55.4% 93.0% 63.6% 54.5% 58.6% 51.7% 59.6% 43.3% 61.0% 92.3% 66.4% 57.7% Number of Notification to Handover within 15 minutes 9,804 1,341 1,532 1,789 1,070 1,955 1,677 440 11,521 1,578 1,746 2,460 1,416 1,987 1,844 490 11,398 1,649 1,849 2,153 1,520 1,873 1,868 486 Total Number of Handovers 18,974 2,946 3,045 4,895 2,379 2,119 2,728 862 20,213 3,246 3,227 5,249 2,556 2,136 2,900 899 19,449 3,192 3,101 4,976 2,492 2,030 2,815 843
AQI20 ii Number and Percentage of notification to handover within 15 minutes of arrival at hospital by hospital type. TIER 1 (Major A&E Units) - Percentage of Notification to handover within 15 minutes 51.5% 46.5% 50.3% 36.5% 45.9% 92.3% 58.0% 51.4% 56.9% 49.5% 54.1% 46.9% 57.2% 93.2% 59.9% 54.6% 58.7% 52.9% 59.6% 43.3% 65.0% 92.3% 63.1% 57.7% TIER 1 (Major A&E Units) - Notification to handover within 15 minutes 9194 1243 1532 1789 922 1954 1315 439 10819 1456 1745 2460 1239 1987 1445 487 10740 1544 1849 2153 1361 1871 1482 480 TIER 1 (Major A&E Units) - Total Number of Handovers 17859 2671 3044 4895 2009 2118 2268 854 19020 2941 3226 5249 2167 2133 2412 892 18294 2916 3101 4976 2095 2027 2347 832
TIER 2 (Minor A&E Units) - Percentage of Notification to handover within 15 minutes 36.1% 35.5% 0.0% - - 100.0% 56.3% 12.5% 40.3% 39.8% - - 0.0% 0.0% 63.6% 42.9% 38.9% 37.5% - - - 100.0% 46.2% 54.5% TIER 2 (Minor A&E Units) - Notification to handover within 15 minutes 108 97 0 0 0 1 9 1 131 121 0 0 0 0 7 3 116 102 0 0 0 2 6 6 TIER 2 (Minor A&E Units) - Total Number of Handovers 299 273 1 0 0 1 16 8 325 304 0 0 1 2 11 7 298 272 0 0 0 2 13 11
TIER 3 (Major Acute) - Percentage of Notification to handover within 15 minutes 61.5% 50.0% - - 40.0% - 79.5% - 65.8% 100.0% 100.0% - 45.6% 0.0% 82.2% - 63.2% 75.0% - - 40.1% 0.0% 83.5% - TIER 3 (Major Acute) - Notification to handover within 15 minutes 502 1 0 0 148 0 353 0 571 1 1 0 177 0 392 0 542 3 0 0 159 0 380 0 TIER 3 (Major Acute) - Total Number of Handovers 816 2 0 0 370 0 444 0 868 1 1 0 388 1 477 0 857 4 0 0 397 1 455 0
Other - Percentage of Notification to handover within 15 minutes ------Other - Notification to handover within 15 minutes ------Other - Total Number of Handovers ------
AQI21 Number of lost hours following notification to handover over 15 minutes 6134 1433 944 2257 877 18 424 181 4137 1149 639 1304 479 17 424 126 3777 847 478 1662 309 14 375 92 Tier 1 Major A&E Units 5914 1343 944 2257 773 18 404 176 3954 1058 639 1304 407 16 407 123 3637 793 478 1662 241 14 358 90 Tier 2 (Minor A&E Units) - Minor Injuries Unit or Local Accident Centre 97 90 - - - - 2 5 94 91 - - - 1 - 2 58 54 - - - - 2 2 Tier 3 (Major Acute) - Medical Admissions Unit 123 - - - 104 - 18 - 89 - - - 72 1 17 - 82 - - - 68 - 14 - Other (all other units such as Maternity or Mental Health Units) ------
AQI22 i/ P21Number and Percentage of handover to clear within 15 minutes of transfer of patient care to hospital staff 75.5% 72.8% 61.9% 83.8% 72.0% 82.7% 73.2% 84.1% 73.4% 72.3% 63.1% 79.8% 64.3% 81.2% 72.6% 85.9% 73.4% 70.8% 63.6% 80.3% 64.4% 82.3% 72.0% 88.6% Number of Handover to Clear within 15 minutes 14,320 2,144 1,884 4,104 1,714 1,753 1,996 725 14,830 2,348 2,035 4,191 1,644 1,735 2,105 772 14,280 2,261 1,973 3,998 1,604 1,671 2,026 747 Total Number of Handovers 18,974 2,946 3,045 4,895 2,379 2,119 2,728 862 20,213 3,246 3,227 5,249 2,556 2,136 2,900 899 19,449 3,192 3,101 4,976 2,492 2,030 2,815 843
AQI22 ii Number and Percentage of handover to clear within 15 minutes of transfer of patient care to hospital staff by hospital type TIER 1 (Major A&E Units) - Percentage of Handover to Clear within 15 minutes 75.3% 71.6% 61.9% 83.8% 69.1% 82.7% 74.5% 84.2% 73.1% 70.9% 63.1% 79.8% 60.7% 81.2% 73.9% 86.0% 73.0% 69.8% 63.6% 80.3% 60.5% 82.3% 71.4% 88.6% TIER 1 (Major A&E Units) - Number of Handover to Clear within 15 minutes 13447 1912 1883 4104 1388 1752 1689 719 13906 2085 2034 4191 1315 1732 1782 767 13353 2035 1973 3998 1267 1668 1675 737 TIER 1 (Major A&E Units) - Total Number of Handovers 17859 2671 3044 4895 2009 2118 2268 854 19020 2941 3226 5249 2167 2133 2412 892 18294 2916 3101 4976 2095 2027 2347 832
TIER 2 (Minor A&E Units) - Percentage of Handover to Clear within 15 minutes 84.3% 84.2% 100.0% - - 100.0% 87.5% 75.0% 85.8% 86.2% - - 100.0% 100.0% 81.8% 71.4% 82.9% 82.0% - - - 100.0% 92.3% 90.9% TIER 2 (Minor A&E Units) - Number of Handover to Clear within 15 minutes 252 230 1 - - 1 14 6 279 262 - - 1 2 9 5 247 223 - - - 2 12 10 TIER 2 (Minor A&E Units) - Total Number of Handovers 299 273 1 - - 1 16 8 325 304 - - 1 2 11 7 298 272 - - - 2 13 11
TIER 3 (Major Acute) - Percentage of Handover to Clear within 15 minutes 76.1% 100.0% - - 88.1% - 66.0% - 74.3% 100.0% 100.0% - 84.5% 100.0% 65.8% - 79.3% 75.0% - - 84.9% 100.0% 74.5% - TIER 3 (Major Acute) - Number of Handover to Clear within 15 minutes 621 2 - - 326 - 293 - 645 1 1 - 328 1 314 - 680 3 - - 337 1 339 - TIER 3 (Major Acute) - Total Number of Handovers 816 2 - - 370 - 444 - 868 1 1 - 388 1 477 - 857 4 - - 397 1 455 -
Other - Percentage of Handover to Clear within 15 minutes ------Other - Number of Handover to Clear within 15 minutes ------Other - Total Number of Handovers ------
AQI23 Conveyance to hospital outside of Local Health Board area 1,464 41 429 191 139 95 129 440 1,563 58 447 203 169 88 127 471 1,482 52 405 202 155 70 135 463 Number of patients conveyed to hospital 19,636 2,908 3,398 5,005 2,534 2,134 2,724 933 20,980 3,218 3,593 5,369 2,767 2,187 2,874 972 20,263 3,174 3,468 5,069 2,679 2,145 2,802 926 Percentage of Overall Conveyance to hospital outside of Local Health Board area 7.5% 1.4% 12.6% 3.8% 5.5% 4.5% 4.7% 47.2% 7.4% 1.8% 12.4% 3.8% 6.1% 4.0% 4.4% 48.5% 7.3% 1.6% 11.7% 4.0% 5.8% 3.3% 4.8% 50.0%
AQI24 Number of lost hours following handover to clear over 15 minutes 862 140 299 128 149 36 96 15 941 146 275 160 178 58 107 18 816 133 226 146 157 32 112 12 Tier 1 Major A&E Units 834 135 299 128 142 36 79 15 909 142 275 160 172 58 85 17 781 125 226 146 146 32 95 12 Tier 2 (Minor A&E Units) - Minor Injuries Unit or Local Accident Centre 5 5 ------5 4 ------8 8 ------Tier 3 (Major Acute) - Medical Admissions Unit 24 - - - 7 - 16 - 27 - - - 6 - 22 - 28 - - - 11 - 16 - Other (all other units such as Maternity or Mental Health Units) ------Section 4: Non -Emergency Patient Transport
*R1 and A1 schedules have been provided as an additional annex, pending the review of the IPR SECTION 5: Additional Quality Indicators by Quality Theme (June 2018) Section 5.1: Step 5 Safe Care (Core Requirement 6: Safety) Cross Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Ref. AQI Description All Wales All Wales All Wales All Wales All Wales All Wales All Wales All Wales All Wales All Wales All Wales All Wales
Number of adverse incidents 338 329 333
IPR Patient Safety Incidents, near misses and hazards 140 140 148 Incidents recorded as causing harm 31 29 41 Minor 19 18 31 Moderate 4 4 5 Major 3 2 1 Catastrophic 5* 5* 4*
IPR Number of Serious adverse incidents reported to WG 1 1 1
IPR Safeguarding team engagement in Child Practice Reviews 9 10 10
New Safeguarding team engagement in Adult Practice Reviews 7 6 7
IPR Engagement in PRUDiC multi disciplinary meetings 1 7 5
New Safeguarding Update Training; Total Staff Trained To date 2119 2439 2107 Emergency Medical Services 1301 1337 1331 EMS Compliance Rate % 89.01% 96.74% 96.66% Urgent Care Services 167 478 157 UCS Compliance Rate % 87.89% 86.05% 86.26% Non Emergency Patient Transport 402 478 474 NEPTS Compliance Rate % 79.92% 95.22% 95.18% Clinical Contact Centres 249 146 145 CCC Compliance Rate % 82.45% 92.41% 92.95% Section 5.2: Effective Care (Core Requirements 2:Equity and 4: Clinical Care) Cross Apr-17 May-17 Jun-17 Ref. AQI Description All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
AQI11 Red performance within 8 minutes 95th percentile 00:14:56 00:12:56 00:13:39 00:17:21 00:11:37 00:13:41 00:18:44 00:18:52 00:14:17 00:12:42 00:12:49 00:16:33 00:11:36 00:12:16 00:17:57 00:16:02 00:14:51 00:12:03 00:14:43 00:17:04 00:10:47 00:12:24 00:17:29 00:20:08
AQI12 Amber performance 95th percentile 02:22:11 02:50:41 03:02:22 02:00:48 03:12:08 01:44:52 01:26:07 01:34:45 02:27:19 02:43:08 03:16:35 02:00:48 04:04:44 01:42:24 01:36:18 01:19:11 02:32:05 02:45:17 03:04:18 02:23:15 03:06:37 02:19:40 01:59:04 01:29:37
AQI13 Green performance 95th percentile 04:52:09 06:37:26 07:21:57 03:59:11 08:33:17 03:14:43 03:08:24 03:14:09 06:09:10 07:36:04 08:26:42 04:14:04 12:56:32 03:09:20 03:41:46 03:54:18 06:01:29 06:31:39 08:05:05 04:26:59 08:41:51 05:56:36 04:42:43 03:39:21 Section 5.3: Individual and Dignified Care (Core Requirements 2: Patient Experience & Satisfaction and 3: Equity) Cross Ref. AQI Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
IPR Number of Complaints 132 121 115
IPR Complaints Responses Percentage acknowledged within 2 days 98% 100% 97% Percentage of responses completed within 30 days - due in reporting month 30% 29% 56% Section 5.4: Staff and Resources (Core Requirement 6: Staffing) Cross Ref. AQI Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
IPR Full Time Equivalent (FTE) 3,110.58 3,093.07 3,081.67 Total Staffing: (Headcount) 3,316 3,318 3,308
IPR Staff turnover: Full Time Equivalent (FTE) 0.40% 0.36% 0.66% Turnover Rate (Headcount) 0.42% 0.36% 0.70%
IPR Starters: Full Time Equivalent (FTE) 26.27 21.27 8.15 Headcount: 29 22 10 Additional Clinical Services 16 8 4 Administrative and Clerical 1 7 3 Allied Health Professional 1 - 1 Estates and Ancillary 8 2 - Medical and Dental - - - Nursing and Midwifery Registered 3 5 2 Unspecified - - -
IPR Leavers: Full Time Equivalent (FTE) 12.37 11.12 20.43 Headcount: 14 12 23 Additional Clinical Services 7 3 7 Administrative and Clerical 2 3 6 Allied Health Professional 2 4 5 Estates and Ancillary 2 1 2 Medical and Dental - - - Nursing and Midwidery Registered - 1 3
IPR Leavers - Reasons: Headcount - 2 - Dismissal - Capability - - - Flexi Retirement - - - Initial Pension Ended - - - Retirement - ill health - - - Retirement age - - - Death in service - 2 -
Leavers - Destination on Leaving: Headcount 14 10 NHS Organisation 4 3 No employment 2 1 Other private sector - - Other public sector 2 1 Voluntary resignation - child dependents - - Voluntary resignation -health - - Education Sector - - Voluntary resignation -promotion - - Voluntary resignation -relocation - - Education/ Training - - Voluntary resignation -work life balance - - Self Employed - - General Practice - - Unknown 6 5 Social Services - - Armed forces - -
IPR Maternity Headcount 31 33 36
IPR Unit Hours Production (UHP) Emergency Ambulance (EA) Percentage 93% 91% 91% EA Expected Unit Hours 73,621 76,903 73,646 EA Actual Unit Hours 68,199 69,489 66,930 Urgent Care Service (UCS) Percentage 148% 96% 146% UCS Expected Unit Hours 8,186 12,666 8,224 UCS Actual Unit Hours 12,086 12,124 11,974 Rapid Response Vehicle (RRV) Percentage 102% 97% 93% RRV Expected Unit Hours 19,866 20,709 19,882 RRV Actual Unit Hours 20,309 20,156 18,522 Clinical Contact Center (CCC) Percentage 101% 103% CCC Expected Unit Hours 27,973 28,128 CCC Actual Unit Hours 28,198 28,970
IPR Monthly sickness rate 7.12% 6.56% 6.61% Cumulative sickness rate 7.12% 7.28% 7.33%
Short term sickness as a percentage of full time equivalents 1.76% 1.60% 1.42%
Long term sickness as a percentage of full time equivalents 5.35% 4.96% 5.19%
IPR Reasons for Sickness Absence (Top five listed each month):
Anxiety/stress/depression/other psychiatric illnesses 22.90% 22.90% 28.60% Back problems 10.30% 10.40% 8.50% Other musculoskeletal problems 16.30% 16.10% 16.60% Injury fracture 9.30% 9.60% 9.80% Gastrointestinal problems 7.60% 7.70% 6.70%
IPR Return to Work Compliance (rolling 12 month) 78.08% 78.62% 83.98%
IPR % of staff compliant with Statutory and Mandatory Training 86.98% 84.92% 85.98%
IPR PADR 72.43% 74.52% 74.67%
IPR Grievances L09 Number of new cases 31 1 3 Number of ongoing cases (including new cases) 77 9 11 Number closed within the month 4 - 2 IPR Dignity at work Number of new cases - - 1 Number of ongoing cases (including new cases) 1 1 2 Number closed within the month - - -
IPR Disciplinary Number of new cases 4 - 1 Number of ongoing cases (including new cases) 8 7 10 Number closed within the month 2 1 1
IPR Suspensions Number of new cases - - - Number of ongoing suspensions (including new cases) 1 1 - 4 to 6 months - - - 6 months or more 1 1 1 Closed - - -
IPR Alternate duties New 2 - 1 Ongoing (including new cases) 2 2 3 Closed 1 - -
V01/IPR Actual Expenditure YTD as % of budget expenditure YTD 100.2% 100.2% 100.1%
V02/IPR Annual Trust surplus/deficit YTD £000 -23 -43 -60
IPR Actual Savings YTD as % of planned savings YTD 86.60% 87.50% 94.60%
% of non - NHS creditor invoices paid within 30 days of receipt IPR 99.2% 94.1% 98.3% of invoice Appendix A: Clinical Contact Centre (CCC) Performance Cross Ref. AQI Description Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19
Calls Answered at Originating CCC
IPR Calls Answered (Primary and Secondary) Central & West 7895 7945 8108 North 8313 9489 9342 South East 15168 16390 14940
IPR % Call Abandonment Rate (Primary Line Only) Central & West 0.29% 0.34% 0.89% North 0.40% 0.29% 0.67% South East 0.38% 0.45% 0.94%
IPR % Call Answered in 6 Seconds (Primary Line Only) Central & West 96.1% 95.0% 93.4% North 95.2% 94.5% 91.9% South East 93.8% 92.7% 91.4%
Calls Answered by other CCC
IPR Calls Answered (Primary and Secondary) Central & West 2635 2887 3587 North 4209 6165 6348 South East 3129 3322 3369
IPR % Call Abandonment Rate (Primary Line Only) Central & West 0.0% 0.1% 0.0% North 0.1% 0.1% 0.1% South East 0.0% 0.1% 0.0%
IPR % Call Answered in 6 Seconds (Primary Line Only) Central & West 73.1% 70.3% 68.7% North 76.9% 76.7% 71.0% South East 68.2% 64.3% 59.2% Appendix B: Frequent Callers Appendix C: Red (8, 9 and 10 minute Response)
Health Board % Jan Feb Mar Apr May Jun
8 69.7% 69.0% 69.6% 75.1% 76.1% 75.6%
All Wales 9 75.4% 74.2% 74.9% 79.9% 81.3% 80.8% 10 80.0% 78.7% 79.9% 84.1% 85.5% 85.4%
8 66.1% 68.9% 66.6% 78.3% 77.2% 78.0%
Abertawe Bro Morgannwg 9 71.8% 75.0% 73.8% 82.6% 82.6% 85.3% 10 77.6% 79.1% 79.3% 87.2% 87.1% 89.8%
8 71.1% 61.4% 67.2% 73.0% 76.3% 73.9%
Aneurin Bevan 9 77.2% 68.5% 72.6% 78.4% 81.6% 78.1% 10 82.6% 75.8% 78.2% 83.5% 86.4% 84.0%
8 70.0% 71.3% 73.8% 75.9% 75.3% 73.4%
Betsi Cadwaladr 9 75.4% 75.6% 76.9% 80.8% 79.9% 77.9% 10 77.6% 78.6% 81.3% 82.7% 83.5% 81.9%
8 78.2% 75.8% 78.9% 83.1% 83.9% 85.7%
Cardiff and Vale 9 83.7% 80.2% 85.3% 87.5% 88.8% 88.6% 10 89.3% 85.8% 89.7% 91.1% 92.5% 93.5%
8 67.3% 71.2% 68.9% 69.8% 75.4% 77.4%
Cwm Taf 9 75.0% 77.4% 73.7% 76.7% 83.1% 83.9% 10 80.9% 80.8% 78.4% 85.3% 88.5% 88.2%
8 65.2% 65.5% 58.9% 67.2% 66.0% 62.8%
Hywel Dda 9 70.1% 69.8% 64.2% 71.2% 70.3% 69.5% 10 73.5% 72.5% 69.4% 75.3% 74.5% 74.5%
8 68.3% 71.7% 70.3% 59.7% 68.6% 68.8%
Powys 9 69.8% 73.3% 73.0% 62.7% 73.3% 75.0% 10 71.4% 75.0% 77.0% 68.7% 75.6% 77.5%
Appendix D: Missed Red Calls by Health Board Area
Appendix E: Handover Analysis by Health Board Areas (Updtaed Quarterly)
Handover Over Target Time Lost Hours Hospital LHB KPI Jan Feb Mar Apr May Jun Row Labels April 2018 May 2018 June 2018 Grand Total 15 min Handover %* 45.2% 43.7% 45.4% 51.7% 57.0% 58.6% *Undetermined LHB* 121.42 75.35 53.76 935.62 All Wales Lost Hours 9971.8 9167.1 8835.0 6135.0 4137.8 3777.7 Bronglais Gen Hosp Aberystwyth 0.00 15 min Handover %* 25.6% 26.6% 30.6% 36.3% 47.4% 43.3% Countess Of Chester Hospital 3.08 3.23 1.37 24.15 Betsi Cadwaladr Lost Hours 3937.2 3293.6 2977.3 2184.7 1231.8 1606.6 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.76 15 min Handover %* 61.6% 59.4% 58.0% 61.3% 63.9% 66.1% Glangwili Hospital Carmarthen 0.02 0.00 0.00 1.79 Hywel Dda Lost Hours Hereford County Hospital 0.18 0.28 641.1 647.7 691.6 464.4 437.5 391.8 15 min Handover %* 31.7% 35.1% 31.2% 45.3% 48.3% 51.4% Llandough Hospital 0.06 Abertawe Bro Morgannwg Maelor General Hosp Wrecsam 0.22 0.87 2.38 19.00 Lost Hours 2774.5 2327.4 2704.5 1515.3 1209.7 886.1 15 min Handover %* 43.2% 35.8% 44.7% 44.7% 56.9% 61.7% Morriston Hospital Swansea 107.49 61.48 47.87 799.84 Cardiff And Vale Nevill Hall Hosp Abergavenny 0.23 0.23 0.20 1.41 Lost Hours 983.2 1305.0 803.1 876.3 454.5 306.4 15 min Handover %* 87.3% 85.3% 87.6% 93.9% 94.0% 93.3% Prince Charles Hosp Merthyr 0.00 0.00 0.11 Cwm Taf Prince Philip Hosp Llanelli 0.00 1.80 Lost Hours 56.9 60.7 51.9 11.9 17.4 11.7 15 min Handover %* 38.8% 34.2% 36.7% 45.4% 49.7% 56.2% Princess Of Wales Bridgend 0.11 2.57 0.00 7.38 Aneurin Bevan Royal Gwent Hospital Newport 3.70 0.22 0.00 11.26 Lost Hours 1327.2 1366.0 1452.5 965.4 651.8 481.7 15 min Handover %* 34.6% 35.3% 37.0% 45.7% 42.2% 47.3% Singleton Hospital Swansea 6.03 6.57 1.91 57.39 Out of Area University Hospital Of Wales 0.54 0.00 0.03 8.87 Lost Hours 251.8 166.7 154.0 117.0 135.1 93.3 Withybush Hosp Haverfordwest 1.51 Ysbyty Gwynedd Hosp Bangor 0.00 Abertawe Bro Morgannwg 1301.51 1073.07 791.55 14381.81 Bronglais Gen Hosp Aberystwyth 0.49 0.00 0.49 Glangwili Hospital Carmarthen 0.21 1.50 0.23 11.15 Hereford County Hospital 0.00 Llandough Hospital 0.19 3.22 Morriston Hospital Swansea 931.94 662.98 501.36 9504.64 Nevill Hall Hosp Abergavenny 0.00 0.00 0.00 0.42 Prince Charles Hosp Merthyr 0.00 0.00 0.00 0.10 Prince Philip Hosp Llanelli 0.47 0.00 0.24 5.04 Princess Of Wales Bridgend 282.45 320.11 235.47 3959.32 Royal Glamorgan Hosp Pontyclun 0.01 2.56 0.00 3.35 Royal Gwent Hospital Newport 0.00 0.00 0.00 1.09 Royal Shrewsbury Hospital 1.51 Singleton Hospital Swansea 80.98 85.11 51.91 872.41 University Hospital Of Wales 4.96 0.81 2.14 19.07 Withybush Hosp Haverfordwest 0.00 0.00 0.00 0.00 Ysbyty Gwynedd Hosp Bangor 0.00 0.00 Aneurin Bevan 919.36 641.32 468.10 8617.24 Glangwili Hospital Carmarthen 0.15 Hereford County Hospital 0.32 0.26 1.44 Llandough Hospital 0.96 1.61 0.00 11.46 Morriston Hospital Swansea 2.61 0.34 0.39 7.24 Nevill Hall Hosp Abergavenny 141.71 117.53 74.71 1644.01 Prince Charles Hosp Merthyr 2.33 2.76 0.66 48.62 Prince Philip Hosp Llanelli 0.00 Handover Over Target Time Lost Hours Princess Of Wales Bridgend 0.00 0.95 Row Labels April 2018 May 2018 June 2018 Grand Total Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.04 1.73 *Undetermined LHB* 121.42 75.35 53.76 935.62 Royal Gwent Hospital Newport 743.98 495.41 381.56 6608.56 Abertawe Bro Morgannwg 113.63 70.62 49.77 864.61 Royal Shrewsbury Hospital 0.00 Aneurin Bevan 3.93 0.45 0.20 12.67 Singleton Hospital Swansea 0.10 1.85 Betsi Cadwaladr 0.22 0.87 2.38 19.76 University Hospital Of Wales 27.35 23.41 10.74 291.22 Cardiff And Vale 0.54 0.00 0.03 8.94 Betsi Cadwaladr 2255.93 1298.45 1657.84 23384.53 Cwm Taf 0.00 0.00 0.11 Bronglais Gen Hosp Aberystwyth 35.26 13.25 16.60 230.35 Hywel Dda 0.02 0.00 0.00 5.10 Countess Of Chester Hospital 42.13 56.71 40.87 584.44 Out of Area Hospital 3.08 3.42 1.37 24.43 Glan Clwyd Hosp Bodelwyddan 541.60 566.32 549.41 7263.40 Abertawe Bro Morgannwg 1301.51 1073.07 791.55 14381.81 Glangwili Hospital Carmarthen 0.00 Abertawe Bro Morgannwg 1295.36 1068.20 788.74 14336.37 Maelor General Hosp Wrecsam 1008.48 461.19 843.93 9556.73 Aneurin Bevan 0.00 0.00 0.00 1.51 Morriston Hospital Swansea 0.00 0.00 0.00 Betsi Cadwaladr 0.00 0.00 Nevill Hall Hosp Abergavenny 0.00 Cardiff And Vale 4.96 0.81 2.34 22.29 Royal Shrewsbury Hospital 0.42 0.03 0.00 3.74 Cwm Taf 0.01 2.56 0.00 3.45 Singleton Hospital Swansea 0.00 Hywel Dda 1.18 1.50 0.47 16.68 University Hospital Of Wales 0.00 Out of Area Hospital 1.51 Ysbyty Gwynedd Hosp Bangor 628.05 200.95 207.04 5745.88 Aneurin Bevan 919.36 641.32 468.10 8617.24 Cardiff And Vale 855.11 453.41 309.35 6811.34 Abertawe Bro Morgannwg 2.71 0.34 0.39 10.05 Bronglais Gen Hosp Aberystwyth 0.00 Aneurin Bevan 885.69 612.94 456.27 8252.57 Glan Clwyd Hosp Bodelwyddan 0.00 Cardiff And Vale 28.31 25.02 10.74 302.68 Glangwili Hospital Carmarthen 0.00 0.00 0.00 2.31 Cwm Taf 2.33 2.76 0.70 50.36 Hereford County Hospital 0.00 Hywel Dda 0.15 Llandough Hospital 96.60 62.65 65.51 686.24 Out of Area Hospital 0.32 0.26 1.44 Maelor General Hosp Wrecsam 0.53 4.42 Betsi Cadwaladr 2255.93 1298.45 1657.84 23384.53 Morriston Hospital Swansea 0.21 0.13 0.12 4.29 Abertawe Bro Morgannwg 0.00 0.00 0.00 Nevill Hall Hosp Abergavenny 0.68 1.21 0.42 25.95 Aneurin Bevan 0.00 Prince Charles Hosp Merthyr 0.08 0.00 0.00 2.77 Betsi Cadwaladr 2178.13 1228.46 1600.38 22566.00 Prince Philip Hosp Llanelli 0.00 0.22 Cardiff And Vale 0.00 Princess Of Wales Bridgend 28.24 41.59 17.22 411.85 Hywel Dda 35.26 13.25 16.60 230.35 Royal Glamorgan Hosp Pontyclun 0.25 0.49 0.59 8.04 Out of Area Hospital 42.55 56.74 40.87 588.18 Royal Gwent Hospital Newport 17.77 3.63 5.38 140.75 Cardiff And Vale 855.11 453.41 309.35 6811.34 Royal Shrewsbury Hospital 0.10 Abertawe Bro Morgannwg 28.45 41.84 17.35 416.26 Singleton Hospital Swansea 0.13 0.13 University Hospital Of Wales 711.27 343.05 220.11 5523.78 Aneurin Bevan 18.45 4.84 5.80 166.70 Withybush Hosp Haverfordwest 0.50 Betsi Cadwaladr 0.53 4.42 Cwm Taf 58.03 40.02 24.08 699.34 Cardiff And Vale 807.87 405.70 285.61 6210.01 Glangwili Hospital Carmarthen 0.00 0.02 0.57 Cwm Taf 0.34 0.49 0.59 10.82 Hereford County Hospital 0.00 0.00 Hywel Dda 0.00 0.00 0.00 3.03 Llandough Hospital 6.17 8.27 2.11 46.37 Out of Area Hospital 0.10 Morriston Hospital Swansea 0.71 1.79 1.49 6.03 Cwm Taf 58.03 40.02 24.08 699.34 Nevill Hall Hosp Abergavenny 1.10 0.71 0.61 21.88 Abertawe Bro Morgannwg 2.19 3.36 2.91 44.68 Prince Charles Hosp Merthyr 2.32 2.59 2.64 91.17 Aneurin Bevan 14.79 4.22 4.93 101.21 Princess Of Wales Bridgend 1.47 1.04 1.41 35.71 Cardiff And Vale 31.81 21.00 5.99 290.26 Royal Glamorgan Hosp Pontyclun 6.92 8.83 7.61 171.44 Cwm Taf 9.24 11.42 10.25 262.61 Royal Gwent Hospital Newport 13.69 3.51 4.33 79.34 Hywel Dda 0.00 0.02 0.57 Singleton Hospital Swansea 0.00 0.54 0.00 2.95 Out of Area Hospital 0.00 0.00 University Hospital Of Wales 25.64 12.73 3.88 243.89 Hywel Dda 431.02 426.36 379.66 4669.43 Hywel Dda 431.02 426.36 379.66 4669.43 Abertawe Bro Morgannwg 25.07 10.23 18.05 653.96 Bronglais Gen Hosp Aberystwyth 66.40 33.34 46.83 511.54 Aneurin Bevan 0.00 0.00 0.00 1.18 Countess Of Chester Hospital 0.00 0.00 Betsi Cadwaladr 0.00 0.00 0.60 4.67 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.00 3.94 Cardiff And Vale 2.80 0.97 1.60 17.34 Glangwili Hospital Carmarthen 179.78 214.99 152.45 1981.43 Cwm Taf 0.00 0.00 0.18 0.52 Hereford County Hospital 0.00 0.12 Hywel Dda 402.97 415.16 359.23 3991.48 Llandough Hospital 0.11 0.16 0.00 0.61 Out of Area Hospital 0.17 0.00 0.29 Maelor General Hosp Wrecsam 0.00 0.00 0.00 0.13 Out Of Area 3.90 Morriston Hospital Swansea 22.67 9.80 15.72 605.53 Aneurin Bevan 3.90 Nevill Hall Hosp Abergavenny 0.00 0.00 0.00 1.18 Out of Area Hospital 0.00 Prince Charles Hosp Merthyr 0.00 0.00 0.00 0.00 Powys 192.65 129.79 93.35 2082.59 Prince Philip Hosp Llanelli 17.94 16.35 14.03 322.24 Abertawe Bro Morgannwg 47.87 15.05 8.84 585.30 Princess Of Wales Bridgend 0.08 0.33 0.00 6.59 Aneurin Bevan 42.58 29.36 14.52 423.05 Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.18 0.52 Betsi Cadwaladr 6.34 1.96 3.28 38.03 Royal Gwent Hospital Newport 0.00 0.00 0.00 0.00 Cardiff And Vale 0.00 0.96 0.13 7.30 Royal Shrewsbury Hospital 0.17 0.17 Cwm Taf 0.02 0.13 0.02 3.06 Singleton Hospital Swansea 2.32 0.11 2.34 41.83 Hywel Dda 24.98 7.62 15.47 215.61 University Hospital Of Wales 2.70 0.80 1.60 16.73 Out of Area Hospital 70.86 74.71 51.10 810.24 Withybush Hosp Haverfordwest 138.85 150.48 145.91 1176.27 Grand Total 6135.03 4137.78 3777.70 61585.79 Ysbyty Gwynedd Hosp Bangor 0.00 0.00 0.60 0.60 Out Of Area 3.90 Hereford County Hospital 0.00 Nevill Hall Hosp Abergavenny 2.95 Royal Gwent Hospital Newport 0.95 Powys 192.65 129.79 93.35 2082.59 Bronglais Gen Hosp Aberystwyth 24.37 5.29 15.47 196.76 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.00 0.65 Glangwili Hospital Carmarthen 0.33 2.17 0.00 17.44 Hereford County Hospital 19.72 15.03 13.16 176.42 Maelor General Hosp Wrecsam 6.34 1.96 3.28 32.87 Morriston Hospital Swansea 40.45 12.56 6.60 526.74 Nevill Hall Hosp Abergavenny 40.09 29.34 14.52 417.75 Prince Charles Hosp Merthyr 0.02 0.13 0.02 3.06 Prince Philip Hosp Llanelli 0.28 0.15 0.00 1.41 Princess Of Wales Bridgend 0.52 5.76 Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.00 0.00 Royal Gwent Hospital Newport 2.49 0.02 0.00 5.30 Royal Shrewsbury Hospital 51.13 59.68 37.94 633.81 Singleton Hospital Swansea 7.42 1.97 2.23 52.80 University Hospital Of Wales 0.00 0.96 0.13 7.30 Withybush Hosp Haverfordwest 0.00 Ysbyty Gwynedd Hosp Bangor 4.51 Grand Total 6135.03 4137.78 3777.70 61585.79 Handover Over Target Time Lost Hours Row Labels April 2018 May 2018 June 2018 Grand Total *Undetermined LHB* 121.42 75.35 53.76 935.62 Bronglais Gen Hosp Aberystwyth 0.00 Countess Of Chester Hospital 3.08 3.23 1.37 24.15 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.76 Glangwili Hospital Carmarthen 0.02 0.00 0.00 1.79 Hereford County Hospital 0.18 0.28 Llandough Hospital 0.06 Maelor General Hosp Wrecsam 0.22 0.87 2.38 19.00 Morriston Hospital Swansea 107.49 61.48 47.87 799.84 Nevill Hall Hosp Abergavenny 0.23 0.23 0.20 1.41 Prince Charles Hosp Merthyr 0.00 0.00 0.11 Prince Philip Hosp Llanelli 0.00 1.80 Princess Of Wales Bridgend 0.11 2.57 0.00 7.38 Royal Gwent Hospital Newport 3.70 0.22 0.00 11.26 Singleton Hospital Swansea 6.03 6.57 1.91 57.39 University Hospital Of Wales 0.54 0.00 0.03 8.87 Withybush Hosp Haverfordwest 1.51 Ysbyty Gwynedd Hosp Bangor 0.00 Abertawe Bro Morgannwg 1301.51 1073.07 791.55 14381.81 Bronglais Gen Hosp Aberystwyth 0.49 0.00 0.49 Glangwili Hospital Carmarthen 0.21 1.50 0.23 11.15 Hereford County Hospital 0.00 Llandough Hospital 0.19 3.22 Morriston Hospital Swansea 931.94 662.98 501.36 9504.64 Nevill Hall Hosp Abergavenny 0.00 0.00 0.00 0.42 Prince Charles Hosp Merthyr 0.00 0.00 0.00 0.10 Prince Philip Hosp Llanelli 0.47 0.00 0.24 5.04 Princess Of Wales Bridgend 282.45 320.11 235.47 3959.32 Royal Glamorgan Hosp Pontyclun 0.01 2.56 0.00 3.35 Royal Gwent Hospital Newport 0.00 0.00 0.00 1.09 Royal Shrewsbury Hospital 1.51 Singleton Hospital Swansea 80.98 85.11 51.91 872.41 University Hospital Of Wales 4.96 0.81 2.14 19.07 Withybush Hosp Haverfordwest 0.00 0.00 0.00 0.00 Ysbyty Gwynedd Hosp Bangor 0.00 0.00 Aneurin Bevan 919.36 641.32 468.10 8617.24 Glangwili Hospital Carmarthen 0.15 Hereford County Hospital 0.32 0.26 1.44 Llandough Hospital 0.96 1.61 0.00 11.46 Morriston Hospital Swansea 2.61 0.34 0.39 7.24 Nevill Hall Hosp Abergavenny 141.71 117.53 74.71 1644.01 Prince Charles Hosp Merthyr 2.33 2.76 0.66 48.62 Prince Philip Hosp Llanelli 0.00 Handover Over Target Time Lost Hours Princess Of Wales Bridgend 0.00 0.95 Row Labels April 2018 May 2018 June 2018 Grand Total Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.04 1.73 *Undetermined LHB* 121.42 75.35 53.76 935.62 Royal Gwent Hospital Newport 743.98 495.41 381.56 6608.56 Abertawe Bro Morgannwg 113.63 70.62 49.77 864.61 Royal Shrewsbury Hospital 0.00 Aneurin Bevan 3.93 0.45 0.20 12.67 Singleton Hospital Swansea 0.10 1.85 Betsi Cadwaladr 0.22 0.87 2.38 19.76 University Hospital Of Wales 27.35 23.41 10.74 291.22 Cardiff And Vale 0.54 0.00 0.03 8.94 Betsi Cadwaladr 2255.93 1298.45 1657.84 23384.53 Cwm Taf 0.00 0.00 0.11 Bronglais Gen Hosp Aberystwyth 35.26 13.25 16.60 230.35 Hywel Dda 0.02 0.00 0.00 5.10 Countess Of Chester Hospital 42.13 56.71 40.87 584.44 Out of Area Hospital 3.08 3.42 1.37 24.43 Glan Clwyd Hosp Bodelwyddan 541.60 566.32 549.41 7263.40 Abertawe Bro Morgannwg 1301.51 1073.07 791.55 14381.81 Glangwili Hospital Carmarthen 0.00 Abertawe Bro Morgannwg 1295.36 1068.20 788.74 14336.37 Maelor General Hosp Wrecsam 1008.48 461.19 843.93 9556.73 Aneurin Bevan 0.00 0.00 0.00 1.51 Morriston Hospital Swansea 0.00 0.00 0.00 Betsi Cadwaladr 0.00 0.00 Nevill Hall Hosp Abergavenny 0.00 Cardiff And Vale 4.96 0.81 2.34 22.29 Royal Shrewsbury Hospital 0.42 0.03 0.00 3.74 Cwm Taf 0.01 2.56 0.00 3.45 Singleton Hospital Swansea 0.00 Hywel Dda 1.18 1.50 0.47 16.68 University Hospital Of Wales 0.00 Out of Area Hospital 1.51 Ysbyty Gwynedd Hosp Bangor 628.05 200.95 207.04 5745.88 Aneurin Bevan 919.36 641.32 468.10 8617.24 Cardiff And Vale 855.11 453.41 309.35 6811.34 Abertawe Bro Morgannwg 2.71 0.34 0.39 10.05 Bronglais Gen Hosp Aberystwyth 0.00 Aneurin Bevan 885.69 612.94 456.27 8252.57 Glan Clwyd Hosp Bodelwyddan 0.00 Cardiff And Vale 28.31 25.02 10.74 302.68 Glangwili Hospital Carmarthen 0.00 0.00 0.00 2.31 Cwm Taf 2.33 2.76 0.70 50.36 Hereford County Hospital 0.00 Hywel Dda 0.15 Llandough Hospital 96.60 62.65 65.51 686.24 Out of Area Hospital 0.32 0.26 1.44 Maelor General Hosp Wrecsam 0.53 4.42 Betsi Cadwaladr 2255.93 1298.45 1657.84 23384.53 Morriston Hospital Swansea 0.21 0.13 0.12 4.29 Abertawe Bro Morgannwg 0.00 0.00 0.00 Nevill Hall Hosp Abergavenny 0.68 1.21 0.42 25.95 Aneurin Bevan 0.00 Prince Charles Hosp Merthyr 0.08 0.00 0.00 2.77 Betsi Cadwaladr 2178.13 1228.46 1600.38 22566.00 Prince Philip Hosp Llanelli 0.00 0.22 Cardiff And Vale 0.00 Princess Of Wales Bridgend 28.24 41.59 17.22 411.85 Hywel Dda 35.26 13.25 16.60 230.35 Royal Glamorgan Hosp Pontyclun 0.25 0.49 0.59 8.04 Out of Area Hospital 42.55 56.74 40.87 588.18 Royal Gwent Hospital Newport 17.77 3.63 5.38 140.75 Cardiff And Vale 855.11 453.41 309.35 6811.34 Royal Shrewsbury Hospital 0.10 Abertawe Bro Morgannwg 28.45 41.84 17.35 416.26 Singleton Hospital Swansea 0.13 0.13 University Hospital Of Wales 711.27 343.05 220.11 5523.78 Aneurin Bevan 18.45 4.84 5.80 166.70 Withybush Hosp Haverfordwest 0.50 Betsi Cadwaladr 0.53 4.42 Cwm Taf 58.03 40.02 24.08 699.34 Cardiff And Vale 807.87 405.70 285.61 6210.01 Glangwili Hospital Carmarthen 0.00 0.02 0.57 Cwm Taf 0.34 0.49 0.59 10.82 Hereford County Hospital 0.00 0.00 Hywel Dda 0.00 0.00 0.00 3.03 Llandough Hospital 6.17 8.27 2.11 46.37 Out of Area Hospital 0.10 Morriston Hospital Swansea 0.71 1.79 1.49 6.03 Cwm Taf 58.03 40.02 24.08 699.34 Nevill Hall Hosp Abergavenny 1.10 0.71 0.61 21.88 Abertawe Bro Morgannwg 2.19 3.36 2.91 44.68 Prince Charles Hosp Merthyr 2.32 2.59 2.64 91.17 Aneurin Bevan 14.79 4.22 4.93 101.21 Princess Of Wales Bridgend 1.47 1.04 1.41 35.71 Cardiff And Vale 31.81 21.00 5.99 290.26 Royal Glamorgan Hosp Pontyclun 6.92 8.83 7.61 171.44 Cwm Taf 9.24 11.42 10.25 262.61 Royal Gwent Hospital Newport 13.69 3.51 4.33 79.34 Hywel Dda 0.00 0.02 0.57 Singleton Hospital Swansea 0.00 0.54 0.00 2.95 Out of Area Hospital 0.00 0.00 University Hospital Of Wales 25.64 12.73 3.88 243.89 Hywel Dda 431.02 426.36 379.66 4669.43 Hywel Dda 431.02 426.36 379.66 4669.43 Abertawe Bro Morgannwg 25.07 10.23 18.05 653.96 Bronglais Gen Hosp Aberystwyth 66.40 33.34 46.83 511.54 Aneurin Bevan 0.00 0.00 0.00 1.18 Countess Of Chester Hospital 0.00 0.00 Betsi Cadwaladr 0.00 0.00 0.60 4.67 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.00 3.94 Cardiff And Vale 2.80 0.97 1.60 17.34 Glangwili Hospital Carmarthen 179.78 214.99 152.45 1981.43 Cwm Taf 0.00 0.00 0.18 0.52 Hereford County Hospital 0.00 0.12 Hywel Dda 402.97 415.16 359.23 3991.48 Llandough Hospital 0.11 0.16 0.00 0.61 Out of Area Hospital 0.17 0.00 0.29 Maelor General Hosp Wrecsam 0.00 0.00 0.00 0.13 Out Of Area 3.90 Morriston Hospital Swansea 22.67 9.80 15.72 605.53 Aneurin Bevan 3.90 Nevill Hall Hosp Abergavenny 0.00 0.00 0.00 1.18 Out of Area Hospital 0.00 Prince Charles Hosp Merthyr 0.00 0.00 0.00 0.00 Powys 192.65 129.79 93.35 2082.59 Prince Philip Hosp Llanelli 17.94 16.35 14.03 322.24 Abertawe Bro Morgannwg 47.87 15.05 8.84 585.30 Princess Of Wales Bridgend 0.08 0.33 0.00 6.59 Aneurin Bevan 42.58 29.36 14.52 423.05 Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.18 0.52 Betsi Cadwaladr 6.34 1.96 3.28 38.03 Royal Gwent Hospital Newport 0.00 0.00 0.00 0.00 Cardiff And Vale 0.00 0.96 0.13 7.30 Royal Shrewsbury Hospital 0.17 0.17 Cwm Taf 0.02 0.13 0.02 3.06 Singleton Hospital Swansea 2.32 0.11 2.34 41.83 Hywel Dda 24.98 7.62 15.47 215.61 University Hospital Of Wales 2.70 0.80 1.60 16.73 Out of Area Hospital 70.86 74.71 51.10 810.24 Withybush Hosp Haverfordwest 138.85 150.48 145.91 1176.27 Grand Total 6135.03 4137.78 3777.70 61585.79 Ysbyty Gwynedd Hosp Bangor 0.00 0.00 0.60 0.60 Out Of Area 3.90 Hereford County Hospital 0.00 Nevill Hall Hosp Abergavenny 2.95 Royal Gwent Hospital Newport 0.95 Powys 192.65 129.79 93.35 2082.59 Bronglais Gen Hosp Aberystwyth 24.37 5.29 15.47 196.76 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.00 0.65 Glangwili Hospital Carmarthen 0.33 2.17 0.00 17.44 Hereford County Hospital 19.72 15.03 13.16 176.42 Maelor General Hosp Wrecsam 6.34 1.96 3.28 32.87 Morriston Hospital Swansea 40.45 12.56 6.60 526.74 Nevill Hall Hosp Abergavenny 40.09 29.34 14.52 417.75 Prince Charles Hosp Merthyr 0.02 0.13 0.02 3.06 Prince Philip Hosp Llanelli 0.28 0.15 0.00 1.41 Princess Of Wales Bridgend 0.52 5.76 Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.00 0.00 Royal Gwent Hospital Newport 2.49 0.02 0.00 5.30 Royal Shrewsbury Hospital 51.13 59.68 37.94 633.81 Singleton Hospital Swansea 7.42 1.97 2.23 52.80 University Hospital Of Wales 0.00 0.96 0.13 7.30 Withybush Hosp Haverfordwest 0.00 Ysbyty Gwynedd Hosp Bangor 4.51 Grand Total 6135.03 4137.78 3777.70 61585.79 Handover Over Target Time Lost Hours Row Labels April 2018 May 2018 June 2018 Grand Total *Undetermined LHB* 121.42 75.35 53.76 935.62 Bronglais Gen Hosp Aberystwyth 0.00 Countess Of Chester Hospital 3.08 3.23 1.37 24.15 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.76 Glangwili Hospital Carmarthen 0.02 0.00 0.00 1.79 Hereford County Hospital 0.18 0.28 Llandough Hospital 0.06 Maelor General Hosp Wrecsam 0.22 0.87 2.38 19.00 Morriston Hospital Swansea 107.49 61.48 47.87 799.84 Nevill Hall Hosp Abergavenny 0.23 0.23 0.20 1.41 Prince Charles Hosp Merthyr 0.00 0.00 0.11 Prince Philip Hosp Llanelli 0.00 1.80 Princess Of Wales Bridgend 0.11 2.57 0.00 7.38 Royal Gwent Hospital Newport 3.70 0.22 0.00 11.26 Singleton Hospital Swansea 6.03 6.57 1.91 57.39 University Hospital Of Wales 0.54 0.00 0.03 8.87 Withybush Hosp Haverfordwest 1.51 Ysbyty Gwynedd Hosp Bangor 0.00 Abertawe Bro Morgannwg 1301.51 1073.07 791.55 14381.81 Bronglais Gen Hosp Aberystwyth 0.49 0.00 0.49 Glangwili Hospital Carmarthen 0.21 1.50 0.23 11.15 Hereford County Hospital 0.00 Llandough Hospital 0.19 3.22 Morriston Hospital Swansea 931.94 662.98 501.36 9504.64 Nevill Hall Hosp Abergavenny 0.00 0.00 0.00 0.42 Prince Charles Hosp Merthyr 0.00 0.00 0.00 0.10 Prince Philip Hosp Llanelli 0.47 0.00 0.24 5.04 Princess Of Wales Bridgend 282.45 320.11 235.47 3959.32 Royal Glamorgan Hosp Pontyclun 0.01 2.56 0.00 3.35 Royal Gwent Hospital Newport 0.00 0.00 0.00 1.09 Royal Shrewsbury Hospital 1.51 Singleton Hospital Swansea 80.98 85.11 51.91 872.41 University Hospital Of Wales 4.96 0.81 2.14 19.07 Withybush Hosp Haverfordwest 0.00 0.00 0.00 0.00 Ysbyty Gwynedd Hosp Bangor 0.00 0.00 Aneurin Bevan 919.36 641.32 468.10 8617.24 Glangwili Hospital Carmarthen 0.15 Hereford County Hospital 0.32 0.26 1.44 Llandough Hospital 0.96 1.61 0.00 11.46 Morriston Hospital Swansea 2.61 0.34 0.39 7.24 Nevill Hall Hosp Abergavenny 141.71 117.53 74.71 1644.01 Prince Charles Hosp Merthyr 2.33 2.76 0.66 48.62 Prince Philip Hosp Llanelli 0.00 Handover Over Target Time Lost Hours Princess Of Wales Bridgend 0.00 0.95 Row Labels April 2018 May 2018 June 2018 Grand Total Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.04 1.73 *Undetermined LHB* 121.42 75.35 53.76 935.62 Royal Gwent Hospital Newport 743.98 495.41 381.56 6608.56 Abertawe Bro Morgannwg 113.63 70.62 49.77 864.61 Royal Shrewsbury Hospital 0.00 Aneurin Bevan 3.93 0.45 0.20 12.67 Singleton Hospital Swansea 0.10 1.85 Betsi Cadwaladr 0.22 0.87 2.38 19.76 University Hospital Of Wales 27.35 23.41 10.74 291.22 Cardiff And Vale 0.54 0.00 0.03 8.94 Betsi Cadwaladr 2255.93 1298.45 1657.84 23384.53 Cwm Taf 0.00 0.00 0.11 Bronglais Gen Hosp Aberystwyth 35.26 13.25 16.60 230.35 Hywel Dda 0.02 0.00 0.00 5.10 Countess Of Chester Hospital 42.13 56.71 40.87 584.44 Out of Area Hospital 3.08 3.42 1.37 24.43 Glan Clwyd Hosp Bodelwyddan 541.60 566.32 549.41 7263.40 Abertawe Bro Morgannwg 1301.51 1073.07 791.55 14381.81 Glangwili Hospital Carmarthen 0.00 Abertawe Bro Morgannwg 1295.36 1068.20 788.74 14336.37 Maelor General Hosp Wrecsam 1008.48 461.19 843.93 9556.73 Aneurin Bevan 0.00 0.00 0.00 1.51 Morriston Hospital Swansea 0.00 0.00 0.00 Betsi Cadwaladr 0.00 0.00 Nevill Hall Hosp Abergavenny 0.00 Cardiff And Vale 4.96 0.81 2.34 22.29 Royal Shrewsbury Hospital 0.42 0.03 0.00 3.74 Cwm Taf 0.01 2.56 0.00 3.45 Singleton Hospital Swansea 0.00 Hywel Dda 1.18 1.50 0.47 16.68 University Hospital Of Wales 0.00 Out of Area Hospital 1.51 Ysbyty Gwynedd Hosp Bangor 628.05 200.95 207.04 5745.88 Aneurin Bevan 919.36 641.32 468.10 8617.24 Cardiff And Vale 855.11 453.41 309.35 6811.34 Abertawe Bro Morgannwg 2.71 0.34 0.39 10.05 Bronglais Gen Hosp Aberystwyth 0.00 Aneurin Bevan 885.69 612.94 456.27 8252.57 Glan Clwyd Hosp Bodelwyddan 0.00 Cardiff And Vale 28.31 25.02 10.74 302.68 Glangwili Hospital Carmarthen 0.00 0.00 0.00 2.31 Cwm Taf 2.33 2.76 0.70 50.36 Hereford County Hospital 0.00 Hywel Dda 0.15 Llandough Hospital 96.60 62.65 65.51 686.24 Out of Area Hospital 0.32 0.26 1.44 Maelor General Hosp Wrecsam 0.53 4.42 Betsi Cadwaladr 2255.93 1298.45 1657.84 23384.53 Morriston Hospital Swansea 0.21 0.13 0.12 4.29 Abertawe Bro Morgannwg 0.00 0.00 0.00 Nevill Hall Hosp Abergavenny 0.68 1.21 0.42 25.95 Aneurin Bevan 0.00 Prince Charles Hosp Merthyr 0.08 0.00 0.00 2.77 Betsi Cadwaladr 2178.13 1228.46 1600.38 22566.00 Prince Philip Hosp Llanelli 0.00 0.22 Cardiff And Vale 0.00 Princess Of Wales Bridgend 28.24 41.59 17.22 411.85 Hywel Dda 35.26 13.25 16.60 230.35 Royal Glamorgan Hosp Pontyclun 0.25 0.49 0.59 8.04 Out of Area Hospital 42.55 56.74 40.87 588.18 Royal Gwent Hospital Newport 17.77 3.63 5.38 140.75 Cardiff And Vale 855.11 453.41 309.35 6811.34 Royal Shrewsbury Hospital 0.10 Abertawe Bro Morgannwg 28.45 41.84 17.35 416.26 Singleton Hospital Swansea 0.13 0.13 University Hospital Of Wales 711.27 343.05 220.11 5523.78 Aneurin Bevan 18.45 4.84 5.80 166.70 Withybush Hosp Haverfordwest 0.50 Betsi Cadwaladr 0.53 4.42 Cwm Taf 58.03 40.02 24.08 699.34 Cardiff And Vale 807.87 405.70 285.61 6210.01 Glangwili Hospital Carmarthen 0.00 0.02 0.57 Cwm Taf 0.34 0.49 0.59 10.82 Hereford County Hospital 0.00 0.00 Hywel Dda 0.00 0.00 0.00 3.03 Llandough Hospital 6.17 8.27 2.11 46.37 Out of Area Hospital 0.10 Morriston Hospital Swansea 0.71 1.79 1.49 6.03 Cwm Taf 58.03 40.02 24.08 699.34 Nevill Hall Hosp Abergavenny 1.10 0.71 0.61 21.88 Abertawe Bro Morgannwg 2.19 3.36 2.91 44.68 Prince Charles Hosp Merthyr 2.32 2.59 2.64 91.17 Aneurin Bevan 14.79 4.22 4.93 101.21 Princess Of Wales Bridgend 1.47 1.04 1.41 35.71 Cardiff And Vale 31.81 21.00 5.99 290.26 Royal Glamorgan Hosp Pontyclun 6.92 8.83 7.61 171.44 Cwm Taf 9.24 11.42 10.25 262.61 Royal Gwent Hospital Newport 13.69 3.51 4.33 79.34 Hywel Dda 0.00 0.02 0.57 Singleton Hospital Swansea 0.00 0.54 0.00 2.95 Out of Area Hospital 0.00 0.00 University Hospital Of Wales 25.64 12.73 3.88 243.89 Hywel Dda 431.02 426.36 379.66 4669.43 Hywel Dda 431.02 426.36 379.66 4669.43 Abertawe Bro Morgannwg 25.07 10.23 18.05 653.96 Bronglais Gen Hosp Aberystwyth 66.40 33.34 46.83 511.54 Aneurin Bevan 0.00 0.00 0.00 1.18 Countess Of Chester Hospital 0.00 0.00 Betsi Cadwaladr 0.00 0.00 0.60 4.67 Glan Clwyd Hosp Bodelwyddan 0.00 0.00 0.00 3.94 Cardiff And Vale 2.80 0.97 1.60 17.34 Glangwili Hospital Carmarthen 179.78 214.99 152.45 1981.43 Cwm Taf 0.00 0.00 0.18 0.52 Hereford County Hospital 0.00 0.12 Hywel Dda 402.97 415.16 359.23 3991.48 Llandough Hospital 0.11 0.16 0.00 0.61 Out of Area Hospital 0.17 0.00 0.29 Maelor General Hosp Wrecsam 0.00 0.00 0.00 0.13 Out Of Area 3.90 Morriston Hospital Swansea 22.67 9.80 15.72 605.53 Aneurin Bevan 3.90 Nevill Hall Hosp Abergavenny 0.00 0.00 0.00 1.18 Out of Area Hospital 0.00 Prince Charles Hosp Merthyr 0.00 0.00 0.00 0.00 Powys 192.65 129.79 93.35 2082.59 Prince Philip Hosp Llanelli 17.94 16.35 14.03 322.24 Abertawe Bro Morgannwg 47.87 15.05 8.84 585.30 Princess Of Wales Bridgend 0.08 0.33 0.00 6.59 Aneurin Bevan 42.58 29.36 14.52 423.05 Royal Glamorgan Hosp Pontyclun 0.00 0.00 0.18 0.52 Betsi Cadwaladr 6.34 1.96 3.28 38.03 Royal Gwent Hospital Newport 0.00 0.00 0.00 0.00 Cardiff And Vale 0.00 0.96 0.13 7.30 Royal Shrewsbury Hospital 0.17 0.17 Cwm Taf 0.02 0.13 0.02 3.06 Singleton Hospital Swansea 2.32 0.11 2.34 41.83 Hywel Dda 24.98 7.62 15.47 215.61 University Hospital Of Wales 2.70 0.80 1.60 16.73 Out of Area Hospital 70.86 74.71 51.10 810.24 Withybush Hosp Haverfordwest 138.85 150.48 145.91 1176.27 Grand Total 6135.03 4137.78 3777.70 61585.79 Ysbyty Gwynedd Hosp Bangor 0.00 0.00 0.60 0.60 OutOut Of Of Area Area 3.90 HerefordHereford County County Hospital Hospital 0.00 NevillNevill Hall Hall Hosp Hosp Abergavenny Abergavenny 2.95 RoyalRoyal Gwent Gwent Hospital Hospital Newport Newport 0.95 PowysPowys 192.65192.65 129.79129.79 93.3593.35 2082.59 BronglaisBronglais Gen Gen Hosp Hosp Aberystwyth Aberystwyth 24.3724.37 5.295.29 15.4715.47 196.76 GlanGlan Clwyd Clwyd Hosp Hosp Bodelwyddan Bodelwyddan 0.000.00 0.000.00 0.000.00 0.65 GlangwiliGlangwili Hospital Hospital Carmarthen Carmarthen 0.330.33 2.172.17 0.000.00 17.44 HerefordHereford County County Hospital Hospital 19.7219.72 15.0315.03 13.1613.16 176.42 MaelorMaelor General General Hosp Hosp Wrecsam Wrecsam 6.346.34 1.961.96 3.283.28 32.87 MorristonMorriston Hospital Hospital Swansea Swansea 40.4540.45 12.5612.56 6.606.60 526.74 NevillNevill Hall Hall Hosp Hosp Abergavenny Abergavenny 40.0940.09 29.3429.34 14.5214.52 417.75 PrincePrince Charles Charles Hosp Hosp Merthyr Merthyr 0.020.02 0.130.13 0.020.02 3.06 PrincePrince Philip Philip Hosp Hosp Llanelli Llanelli 0.280.28 0.150.15 0.000.00 1.41 PrincessPrincess Of Of Wales Wales Bridgend Bridgend 0.520.52 5.76 RoyalRoyal Glamorgan Glamorgan Hosp Hosp Pontyclun Pontyclun 0.000.00 0.000.00 0.000.00 0.00 RoyalRoyal Gwent Gwent Hospital Hospital Newport Newport 2.492.49 0.020.02 0.000.00 5.30 RoyalRoyal Shrewsbury Shrewsbury Hospital Hospital 51.1351.13 59.6859.68 37.9437.94 633.81 SingletonSingleton Hospital Hospital Swansea Swansea 7.427.42 1.971.97 2.232.23 52.80 UniversityUniversity Hospital Hospital Of Of Wales Wales 0.000.00 0.960.96 0.130.13 7.30 WithybushWithybush Hosp Hosp Haverfordwest Haverfordwest 0.00 YsbytyYsbyty Gwynedd Gwynedd Hosp Hosp Bangor Bangor 4.51 GrandGrand Total Total 6135.036135.03 4137.784137.78 3777.703777.70 61585.79 Appendix F: Patient Safety; Longest Waits, 95th and 50th Percentile Responses Apr-18
May-18
Jun-18 Appendix G: Conveyance Rates and referrals to Alternative Care Pathways EASC Ambulance Quality Indicator Definition Table No. AQI Ref. AQI Description AQI Detailed Description
Number of Welsh Ambulance Services NHS Trust community How often are the Welsh Ambulance Services NHS Trust engaging with the communities it serves and 1 AQI1 engagement events spreading health messages about self-care, choice and appropriate use of ambulance/health services
How many events relating to public education / engagement in using the Ambulance Service did the Welsh Number of Local Health Board engagement events attended Ambulance Services NHS Trust attend. This work is vital if over time the number of inappropriate 999 calls 2 AQI2 by the Welsh Ambulance Services NHS Trust is to be reduced. This AQI is under development.
How often is the Welsh Ambulance Services NHS Trust meeting with stakeholders to discuss, agree and 3 AQI3 Number of attendances at key stakeholder events design services to meet clinical and service user expectation needs?
How often is the NHS Direct Wales website being used? This allows us to examine links between website 4 AQI4i Number of NHS Direct Wales unique website visits use and 999 and 0845 call volumes. It also allows for the identification of high demand periods. What are people calling NHS Direct Wales about? How does this demand compare to website visits? What 5 AQI4ii NHS Direct Wales number of calls by reason (top 10) are the gaps in service that NHS Direct Wales are identifying? How many frequent callers are there and how often are they calling? What is the number of calls from 6 AQI5 Number and Percentage of frequent callers frequent callers in the overall call volume? How many Healthcare professional calls for assistance does the Welsh Ambulance Services NHS Trust 8 AQI6 Number of Healthcare Professional Calls Answered receive? 9 AQI7 Number of 999 Calls Answered How many 999 calls do the Welsh Ambulance Services NHS Trust receive? Number of 999 calls taken through the Medical Priority How many 999 calls are assessed using the MPDS system? MPDS is the system that WAST call takers use 10 AQI8 Dispatch System (MPDS) to assess the severity of 999 calls. Number of calls ended following WAST telephone assessment Number of NHSDW & Clinical Desk telephone assessments that were resolved with an ambulance not 11 AQI9i (Hear & Treat) required as the outcome (Hear & Treat) 12 AQI9ii Number and Percentage of calls transferred to NHS Direct Wales How many 999 calls are, after assessment, being transferred to NHS Direct Wales?
13 AQI9iii Number of calls returned from NHS Direct Wales How often does NHS Direct Wales then return a call to the Welsh Ambulance Services NHS Trust?
Number of calls ended through transfer to alternative care How often does NHS Direct Wales and the Welsh Ambulance Services NHS Trust pass a call to another part 14 AQI9iv advice of the NHS rather than sending an ambulance?
Number and Percentage of incidents received within 24 hours Unplanned re-contact with the ambulance service within 24 hours of discharge of care (by clinical 15 AQI10i following WAST telephone assessment (Hear and Treat) telephone advice). Number and Percentage of incidents within 24 hours following an attendance at scene that were not transported to hospital (See and Unplanned re-contact with the ambulance service within 24 hours of discharge of care (following 16 AQI10ii Treat) treatment at the scene). Number of RED coded calls including median, 65th and 95th How many 999 calls received are coded as a RED verified incident resulting in an emergency response 17 AQI11 percentile within 8 minutes. Number of AMBER coded calls including median, 65th and 95th How many 999 calls received are coded as an AMBER verified incident resulting in an emergency 18 AQI12 percentile response? Number of GREEN coded calls including median, 65th and 95th How many 999 calls received are coded as a GREEN verified incident resulting in a 19 AQI13 percentile response? Number of responded Incidents that received at least 1 How effective is the Welsh Ambulance Services NHS Trust at sending the right resource first 20 AQI14 resource allocation time to an incident. Number of Community First Responders attendances at scene, 21 AQI15 including by call category and percentage How often is a Community First Responder sent to a 999 call? Outcome from out-of-hospital cardiac arrest with attempted resuscitation, measured by Number and percentage of patients with attempted resuscitation documented return of spontaneous circulation (ROSC) at time of arrival of the patient to hospital. following cardiac arrest, documented as having a return of Recording of ROSC at hospital is the international Utstein standard and indicates the outcome of the pre- 22 AQI16i spontaneous circulation (ROSC) at hospital door hospital response and intervention. Patients with suspected stroke (including unresolved transient ischaemic attack) who are Number and percentage of suspected stroke patients who are documented as receiving the appropriate care bundle. The stroke care bundle comprises measurement of 23 AQI16ii documented as receiving appropriate stroke care bundle blood pressure, consciousness level, blood glucose and FAST test. Fractured hips (known as neck of femur injuries): fractured hips cause significant pain which can be exacerbated by movement. Pain control for patients with a fractured neck of femur in the immediate post-trauma period is paramount to promoting recovery and patient experience. This reduces suffering and the detrimental effects uncontrolled pain may have. The care bundle measures the Number and percentage of older patients with suspected hip fracture recording of initial and subsequent verbal pain scores and administration of appropriate pain medicines who are documented as receiving analgesia and appropriate care before arrival at hospital, also included is the total number of patients with a suspected fractured hip who 24 AQI16iii bundle received analgesia. Number and percentage of ST segment elevation myocardial infarction Patients with STEMI diagnosis (ST-elevation myocardial infarction) who are documented as (STEMI) patients who are documented as receiving appropriate STEMI receiving the appropriate care bundle. The STEMI care bundle comprises of four elements including pain 25 AQI16iv care bundle assessment and administration of three medicines including analgesia.
Number and percentage of suspected sepsis patients who have had a Patients with a suspected diagnosis of sepsis or septic shock who have a documented NEWS 26 AQI16v documented NEWS score. score. This promotes early recognition of suspected sepsis and enhances handover in hospital.
Number and percentage of patients with a suspected febrile convulsion Patients aged 5 years and under with suspected febrile convulsion who are documented as aged 5 years and under who are documented as receiving the receiving the appropriate care bundle. The febrile convulsion care bundle comprises measurement of 27 AQI16vi appropriate care bundle. heart rate, respiratory rate, oxygen saturation, temperature and blood glucose. Patients with low blood sugar (hypoglycaemia) who are documented as receiving the Number and percentage of hypoglycaemic patients who are appropriate care bundle, which comprises blood glucose measurement before treatment, treatment and 28 AQI16vii documented as receiving the appropriate care bundle. blood glucose measurement after treatment. Number of incidents that resulted in a non conveyance to How effective are the Welsh Ambulance Services NHS Trust in closing incidents at 29 AQI17 hospital scene?
Number and percentage of incidents where a resource was the ideal / How often are Welsh Ambulance Services NHS Trust sending the ideal resource to scene? How often are 30 AQI18 suitable response as per the pilot clinical response model Welsh Ambulance Services NHS Trust sending a suitable resource to scene? Percentage of patients conveyed to hospital following a face to face 31 AQI19i assessment. What percentage of patients from 999 calls are conveyed to hospital. Where do Welsh Ambulance Services NHS Trust convey patients? What are opportunities 32 AQI19ii Number of patients conveyed to hospital by type to convey elsewhere? Number and percentage of notification to handover within 15 33 AQI20i minutes of arrival at hospital This AQI measures handover performance at hospital. Number and percentage of notification to handover within 15 This AQI looks at handover performance by site. This allows good practice to be identified 34 AQI20ii minutes of arrival at hospital by hospital type. and spread. Number of lost hours following notification to handover over 15 This AQI measures the amount of lost hours following notification to handover over 15 35 AQI21 minutes minutes. Number and percentage of handover to clear within 15 minutes of This AQI measures the number of times where a WAST crew are available again within 15 36 AQI22i transfer of patient care to hospital staff minutes of handing over their patient. Number and percentage of handover to clear within 15 minutes of This AQI measures the amount of lost hours following handover to clear over 15 37 AQI22ii transfer of patient care to hospital staff by hospital type minutes. This AQI records the number of occasions where a patient is taken to a destination in a 38 AQI23 Conveyance to other LHB locations different Health Board area than the location of the call. Number of lost hours following handover to clear over 15 This AQI shows the amount of time lost where ambulance crews are not available within 15 39 AQI24 minutes minutes of handing over their patient. Ambulance Quality Indicator Glossary No. Term Definition A percentile (or a centile) is a measure used in statistics indicating the value below which a given percentage of observations in a 1 65th Percentile group of observations fall. For example, the 65th percentile is the value below which 65 percent of the observations may be found. A percentile (or a centile) is a measure used in statistics indicating the value below which a given percentage of observations in a 2 95th Percentile group of observations fall. For example, the 95th percentile is the value below which 95 percent of the observations may be found. Emergency telephone service operated by telephony providers such as BT, allowing anyone to contact the emergency services, this 3 999 also applies to 112 (European) & 911 (US).
Calls received and categorised as serious but not life threatening. These calls will include most medical and trauma cases such as chest pain and fractures. Amber calls will receive an emergency response. A response profile has been created to ensure that the most suitable clinical resource is dispatched to each amber call. This will include management via “hear & treat” services over the telephone. Patient 4 AMBER experience and clinical indicator data will be used to evaluate the effectiveness of the ambulance response to amber calls. 5 Call A telephone call received by the Welsh Ambulance Services NHS Trust via 999 or from a Health Care Professional. Community First Responder trained by the Welsh Ambulance Services NHS Trust to respond to appropriately graded 6 CFR calls. 7 Clear Time a Welsh Ambulance Services NHS Trust crew are clear (free for other work) from either the scene or hospital. 8 Conveyance A 999 incident which has received an emergency response at scene and resulted in the patient being conveyed to hospital. Emergency Ambulance Service Committee: Ambulance commissioning in Wales is a collaborative process underpinned by a national collaborative commissioning quality and delivery framework. All seven Health Boards have signed up to the framework. Emergency 9 EASC Ambulance Services in Wales are provided by a single national organisation – Welsh Ambulance Services NHS Trust (WAST). A 999 call which excludes the following: Calls made in error, duplicate calls, information calls, test calls and calls to other ambulance 10 Incident controls. 11 Response A 999 Incident which as received an emergency response at scene. Hip fractures, also called proximal femoral fractures, are cracks or breaks in the top of the thigh bone (femur) close to the 12 Fractured Femur hip joint. Frequent callers are defined where the Welsh Ambulance Services NHS Trust have received 5 or more calls from the same address in 13 Frequent Caller the same month. Calls received and categorised as green are neither serious or life threatening. Conditions such as ear ache or minor injuries are coded 14 GREEN as green calls. Green calls are ideally suited to management via secondary telephone triage. 15 Handover Handover of care from Welsh Ambulance Services NHS Trust to LHB Hospital Staff. Suitably qualified health professional defined as: Doctor, General Practitioner, Emergency Care Practitioner, Nurse, District Nurse, 16 Health Care Professional Midwife, Paramedic, Dentist, Approved Social Worker. Hear and treat are callers who were deemed to have non-life-threatening conditions and received triage and advice over 17 Hear & Treat the phone. 18 Ideal Response The type of clinician / resource to send, in preference for the specific category (or codes). Local Health Board: An LHB is an administrative unit within the National Health Service in Wales. The 7 LHB's in Wales are Abertawe Bro Morgannwg University Health Board, Aneurin Bevan University Health Board, Betsi Cadwaladr University Health Board, Cardiff & Vale University 19 LHB Health Board, Cwm Taf University Health Board, Hywel Dda University Health Board, Powys Teaching Health Board. Hospitals which provide a wide range of acute in-patient and out-patient specialist services together with the necessary support 20 Major A&E Unit systems, which allow emergency admissions and which usually has an Accident and Emergency department. 21 Major Acute Hospitals which provide acute services limited to a one or two specialist units. Median is the number separating the higher half of a data sample. The median of a finite list of numbers can be found by arranging all 22 Median the observations from lowest value to highest value and picking the middle one (e.g., the median of {3, 3, 5, 9, 11} is 5). Hospitals which provide a range of acute in-patient and out-patient services specialist services (including some surgical acute specialties) but not the 23 Minor A&E Unit wide range available in major acute hospitals. Medical Priority Dispatch System: MPDS is a unified system used to dispatch appropriate aid to medical emergencies including systematised caller 24 MPDS interrogation and pre-arrival instructions. NHS Direct Wales is a health advice and information service available 24 hours a day, every day and is part of the Welsh Ambulance Services NHS 25 NHSDW Trust. 26 Non-Conveyance Patients which are not transported to hospital following assessment by clinician. 27 Non-conveyances (by reason) Number of patients not taken to hospital split by the reason why i.e. Treated at Scene. 28 Notification Time that the Welsh Ambulance Services NHS Trust notified LHB hospital staff of their arrival at hospital. Percentage of patients transported to hospital following initial assessment at scene by a Welsh Ambulance Services 29 Overall % Conveyance NHS Trust clinician. Professional Questioning & Answering Software: ProQA is an expert system designed to help provide the very best in service and speed. Correct dispatch levels are usually determined in less than one minute. ProQA additionally provides Dispatch Life Support (DLS) protocols which meet or exceed the international standards for emergency medical dispatching. ProQA is built on a foundation of empirical literature and medical experience 30 PROQA relevant to medical dispatching. 31 RED Calls deemed to be Immediately Life-Threatening. Return of spontaneous circulation refers to signs of restored circulation (more than occasional gasp, occasional fleeting pulse or arterial waveform) 32 ROSC evidenced by breathing, a palpable pulse or a measurable blood pressure. 33 STEMI STEMI - ST segment elevation myocardial infarction - occurs when a coronary artery is totally occluded by a blood clot. A Care Bundle is a group of between three and five specific interventions or processes of care that have a greater effect on patient outcomes if done 34 Stroke Care Bundle together in a time-limited way, rather than separately. 35 Suitable Response The type of clinician / resource to send, if the IDEAL response is not available for the specific category (or codes). Welsh Ambulance Services NHS Trust: Spread over an area of 20,640 kilometres and serving a population of 2.9 million, our diverse area 36 WAST encompasses tranquil rural retreats, busy seaside resorts and large urban conurbations. 37 ABM Abertawe Bro Morgannwg University Health Board 38 AB Aneurin Bevan University Health Board 39 BCU Betsi Cadwaladr University Health Board 40 C&V Cardiff and Vale University Health Board 41 CT Cwm Taf University Health Board 42 HD Hywel Dda University Health Board 43 P Powys Teaching Health Board Clinical Response Model
Call Type Severity Example Quality Indicator 8 Minute Response Time within 65% National RED Immediately life-threatening Respiratory / cardiac arrest Target
Compliance with care bundles for cardiac AMBER1 All other life-threatening emergencies Cardiac chest pains / stroke stroke and fractured neck of femur patients.
Compliance with care bundles for cardiac AMBER2 Serious, but non immediately life-threatening Diabetic problems stroke and fractured neck of femur patients.
Compliance with care bundles for cardiac GREEN2 Neither serious, nor life-threatening Fainting - recovered and alert stroke and fractured neck of femur patients. Clinical Telephone Triage within 10 minutes GREEN3 Suitable for Clinical Telephone Assessment Poisoning (spider bite) and report on patient outcomes (e.g. self- care, referral to other health provider) 1 ITEM 2.3b Annex2NEPTSPerformanceAQIs.xlsx
Welsh Ambulance Services NHS Trust National Collaborative Commissioning: Quality and Delivery Framework NEPTS Activity & Performance Report: April - June 2018
AQI Definition Table STEP 1: Help Me Choose STEP 2: Answer My Request STEP 3: Coordinate My Journey STEP 4: Pick Me Up STEP 5: Take Me To My Destination Glossary Revisions The information contained in this document is not restricted and is classified for general release Produced by the Welsh Ambulance Services NHS Trust Health Informatics Department commissioned by the Emergency Ambulance Services Committee in accordance with the National Collaborative Commissioning: Quality and Delivery Framework
Version: 2.0 Document Reference: 7716 EASC NEPTS Activity Report - Definition Table No. AQI Ref. AQI Description AQI Detailed Description Date STEP 1: Help Me Choose Number of engagement events that have been attended by WAST & The number engagement events attended by WAST, educating the public on how to access NEPTS or alternative 1 S1/A1 LHB transport providers 2 S1/A2 Number of non-eligible patients signposted to alternative providers The number of non-eligible patients who have been signposted to alternative transport providers The number of non-eligible patients who re-contact and attempt to become eligible for NEPTS. This data is Number of non-eligible patients who re-contact and attempt to become 3 S1/A3 reliant on the patient being honest in their response when asking the question “Have you previously tried to eligible book ambulance transport for this appointment and been refused?” STEP 2: Answer My Request The total number of calls answered by each of the 5 NEPTS booking centres. This data indicates the total number Number of Calls received and answered by each of the NEPTS booking 4 S2/A1 of calls recieved by a NEPTS booking centre and does not soley indicate the number of requests made for centres transport. 5 S2/A2 Number of calls answered by Time Band The timeleness of all calls being answered by each NEPTS booking centre 6 S2/A3 Number of calls abandoned before being answered The number of calls abandoned by the caller before being answer by a NEPTS booking centre 7 S2/A4 Number of calls handled in Welsh The number of callers who select to have their call handled in Welsh The number of patients who are conveyed by NEPTS but also recieve the mobility benefit element of Personal 8 S2/A5 Number of patients who access NEPTS but also receive mobility benefit Independence Payment (PIP) or Disability Living Allownace (DLA) disability benefit at the lower or higher rate of benefit entitlement. STEP 3: Coordinate My Journey 9 S3/A1a Number of bookings made by telephone The number of patients who book NEPTS by telephone for each NEPTS booking centre The number of NEPTS bookings made online. Online bookings can only made by Health Care Professionals (HCP). 10 S3/A1b Number of bookings made Online There is no facilty for patients to book NEPTS online The number of NEPTS bookings made by fax/paper. Fax and paper bookings can only be made by HCP's. 11 S3/A1c Number of bookings made by fax/paper Fax/paper bookings are made by HCP's via Ambulance Liasion Offices (ALO) located at District General Hospital (DGH) Sites 12 S3/A2 Number of bookings from non- eligible patients The number of patient bookings that are accepted on a social needs basis The number of patient bookings that are automatically accpted on a medical needs basis or automatically 13 S3/A3 Number of bookings from automatically eligible patients accepted if booked by a Health Care Professional (HCP) Number of discharges/transfers booked prior to day of travel by 14 S3/A4 The number of discharges or transfers booked prior to day of travel mobility 15 S3/A5 Number of discharges/transfers booked on the day of travel by mobility The number of "on the day" booked discharges or transfers by mobility
16 S3/A6 Number of patients conveyed by Emergency Ambulances (AS3 Journeys) The number of patients conveyed by WAST EMS resources 17 S3/A7 Number of journeys passed to alternative providers The number of patients conveyed by non-WAST resources 18 S3/A8 Number of bookings received after 12pm the day before travel The number of bookings received after 12pm the day before travel STEP 4: Pick Me Up The number of aborted journeys. There will be variation between historically abort data and current data with 19 S4/A1 Number of journeys aborted the introduction of a new standarised booking acceptance time. The number of times a hospital kiosk has been used by a patient to indicate they are ready for collection from 20 S4/A2 Number of ready notifications received from hospital kiosks hospital. 21 S4/A3 Number of core patients arriving prior to their booked arrival time The number of core patients arriving before their booked arrival time, by time slots 22 S4/A4 Number of core patients arriving after their booked arrival time The number of core patients arriving after their booked arrival time, by time slots Number of enhanced renal patients arriving prior to their booked arrival 23 S4/A5a The number of enhanced patients (renal patients)arriving before their booked arrival time, by time slots time Number of enhanced oncology patients arriving prior to their booked 24 S4/A5b The number of enhanced patients (oncology patients)arriving before their booked arrival time, by time slots arrival time Number of enhanced renal patients arriving after their booked arrival 25 S4/A6 The number of enhanced patients (renal patients) arriving after their booked arrival time, by time slots time Number of enhanced oncology patients arriving after their booked 26 S4/A6 The number of enhanced patients (oncology patients) arriving after their booked arrival time, by time slots arrival time The number of patients conveyed to each healthcare destination. The volume of data required for this quality indicator is extensive and not inkeeping with the format of the report. Further discussion is required to 27 S4/A7 Number of patients transported by healthcare setting destination understand the purpose of this quality indicator and identify where the quality indicator data should be reported. 28 S4/A8 Number of discharges (end of life journeys) conveyed The number of journeys conveying end of life patients STEP 5: Take Me To My Destination 29 S5/A1a Number of core patient journeys by mobility (Discharge & Transfer) The number of core patient journeys (Discharge & Transfer) by patient mobility 30 S5/A1b Number of core patient journeys by mobility (Other) The number of core patient journeys (Other) by patient mobility 31 S5/A2a Number of enhanced renal patient journeys by mobility The number of enhanced service patient journeys by patient mobility 32 S5/A2b Number of enhanced oncology patient journeys by mobility The number of enhanced service patient journeys by patient mobility 33 S5/A3 Number of patient journeys requiring additional or specialist assistance The number of patient journeys requiring the assistance of a NEPTS Patient Support Vehicle Number of core service patients collected after their booked ready time 34 S5/A4a The number of core service patients (Discharge & Transfer) collected after their booked ready time, by time slots (Discharge & Transfer) Number of core service patients collected after their booked ready time 35 S5/A4b The number of core service patients (Other) collected after their booked ready time, by time slots (Other) Number of enhanced renal service patients collected after their booked 36 S5/A5a Number of enhanced service patients (Renal) collected after their booked ready time, by time slots. ready time Number of enhanced oncology service patients collected after their 37 S5/A5b Number of enhanced service patients (Oncology) collected after their booked ready time, by time slots. booked ready time Number of enhanced patients having reduced treatments as a result of The number of enhanced service patients (Renal) having reduced treatments as a result of late arrival due to 38 S5/A6 late arrival due to transport related issues transport related issues. Information provided by Renal Hub 39 S5/A7 Number of patient journeys with an escort The number of patient journeys undertaken, where the patient requires the assistance of their own escort
Version: 2.0 Document Reference: 7716 Step 1 Help Me Choose LHB Review: April 2018 - June 2018
Step 1: Help Me Choose
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description Total All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
A1 Number of engagement events that have been attended by WAST & LHB 12 - 3 1 - 5 1 2 22 1 9 - 3 7 2 - 23 4 10 - 1 6 2 - 57
A2 Number of non-eligible patients signposted to alternative providers -
A3 Number of non-eligible patients who re-contact and attempt to become eligible -
Version: 2.0 Document Reference: 7716 Step 2 Answer My Request LHB Review: April 2018 - June 2018
Step 2: Answer My Request
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description All Wales CW & N SE Ty Elai Powys All Wales CW & N SE Ty Elai Powys All Wales CW & N SE Ty Elai Powys Total
A1 Percentage of Calls received and answered by each of the NEPTS booking centres 85.1% 81.0% 94.5% 85.3% 83.0% 90.0% 84.1% 80.6% 91.1% 84.8%
A2 Percentage of Calls Answered by Time Band
Within 15 Seconds 45.0% 34.5% 65.7% 42.3% 35.0% 55.8% 41.3% 35.9% 51.1% 42.8%
16 - 30 Seconds 8.3% 8.3% 8.2% 8.8% 8.5% 9.2% 8.6% 7.9% 9.8% 8.5%
31 - 45 Seconds 4.7% 5.0% 4.0% 5.1% 5.2% 5.0% 5.0% 4.4% 6.0% 4.9%
46 - 60 Seconds 3.6% 3.8% 3.2% 3.5% 3.8% 3.0% 4.2% 3.9% 4.7% 3.8%
61 - 120 Seconds 11.0% 12.7% 7.5% 11.9% 13.2% 9.6% 11.7% 12.5% 10.2% 11.6%
Over 120 Seconds 27.5% 35.6% 11.4% 28.4% 34.3% 17.4% 29.3% 35.3% 18.3% 28.4%
A3 Percentage of Calls abandoned before being answered 14.9% 19.0% 5.5% 14.7% 17.0% 10.0% 15.9% 19.4% 8.9% 15.2%
A4 Percentage of Calls handled in Welsh 1.4% 2.0% 0.1% 1.3% 1.9% 0.1% 1.1% 1.7% 0.1% 1.2%
A5 Number of patients who access NEPTS but also receive mobility benefit - - - -
Version: 2.0 Document Reference: 7716 Step 3 Coordinate My Journey LHB Review: April 2018 - June 2018
Step 3: Coordinate My Journey
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description Total All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
A1 Number & Percentage of bookings 42,762 6,397 8,776 11,339 4,971 4,107 5,142 2,030 42,624 6,255 8,962 11,282 4,863 3,965 5,357 1,940 42,060 6,267 8,750 11,000 4,875 4,079 5,029 2,06-0 127,446
a Number of bookings made by telephone 40.3% 40.0% 29.3% 61.6% 31.6% 24.7% 38.7% 27.0% 41.0% 39.9% 30.4% 61.8% 32.0% 28.8% 39.2% 24.9% 41.4% 42.0% 31.5% 62.4% 30.4% 29.0% 39.4% 23.8% 40.9%
b Number of bookings made Online 32.7% 7.6% 65.7% 4.3% 57.6% 63.8% 10.1% 60.8% 31.0% 8.2% 62.9% 3.6% 55.0% 57.2% 9.4% 61.9% 32.9% 10.1% 63.3% 4.4% 60.2% 59.2% 10.4% 64.0% 32.2%
c Number of bookings made by fax/post/hand 27.0% 52.5% 5.0% 34.1% 10.9% 11.4% 51.2% 12.2% 28.0% 51.9% 6.8% 34.6% 13.0% 14.0% 51.4% 13.1% 25.7% 47.8% 5.1% 33.2% 9.4% 11.7% 50.2% 12.2% 26.9%
A2 Number of bookings from non-eligible patients - - - -
A3 Number of bookings from automatically eligible patients - - - -
a Oncology & Renal - - - -
b HCP Requests - - - -
A4 Number & Percentage of Discharge & Transfers booked prior to day of travel by mobility 1,031 186 231 366 6 122 64 56 1,171 207 268 384 12 168 75 57 1,077 197 230 371 18 146 62 5-3 3,279
Walking Case (T1 - ACS Suitable) 8.6% 10.8% 2.2% 7.9% 33.3% 0.8% 35.9% 16.1% 7.7% 8.2% 1.5% 6.8% 33.3% 2.4% 37.3% 12.3% 6.8% 7.6% 0.4% 6.7% 33.3% 1.4% 32.3% 7.5% 7.7%
Walking Case (C1) 5.7% 5.4% 3.0% 8.2% 0.0% 2.5% 10.9% 3.6% 6.9% 12.6% 3.7% 7.8% 0.0% 3.0% 9.3% 5.3% 7.2% 11.7% 1.3% 5.9% 5.6% 4.8% 24.2% 13.2% 6.6%
Chair Case (C2) 55.2% 58.6% 67.1% 48.1% 50.0% 68.9% 26.6% 44.6% 56.4% 52.2% 69.0% 55.2% 33.3% 63.7% 22.7% 47.4% 53.1% 51.8% 63.9% 50.9% 33.3% 63.7% 22.6% 39.6% 54.9%
In Own Wheelchair (C3) 3.9% 3.8% 3.5% 2.5% 16.7% 3.3% 6.3% 12.5% 4.7% 7.2% 3.4% 3.9% 0.0% 1.8% 1.3% 21.1% 3.5% 4.1% 1.7% 3.0% 0.0% 3.4% 0.0% 18.9% 4.1%
In Own Wheelchair (C4) (Steps) 2.3% 3.2% 1.7% 3.0% 0.0% 1.6% 1.6% 0.0% 2.2% 2.4% 0.7% 3.1% 0.0% 3.6% 1.3% 0.0% 2.0% 2.0% 0.9% 2.7% 0.0% 0.7% 1.6% 7.5% 2.2%
Electric Wheelchair (C5) 0.5% 1.1% 0.0% 0.8% 0.0% 0.0% 0.0% 0.0% 0.3% 0.5% 0.0% 0.3% 0.0% 0.0% 1.3% 0.0% 0.3% 0.0% 0.4% 0.0% 5.6% 0.0% 0.0% 1.9% 0.3%
Stretcher patient (C6) 23.8% 17.2% 22.5% 29.5% 0.0% 23.0% 18.8% 23.2% 21.9% 16.9% 21.6% 22.9% 33.3% 25.6% 26.7% 14.0% 27.0% 22.8% 31.3% 30.7% 22.2% 26.0% 19.4% 11.3% 24.2%
A5 Number & Percentage of Discharge & Transfers booked on the day by mobility 2,790 296 889 1,084 64 286 162 9 2,928 289 961 1,152 48 305 165 8 2,867 271 918 1,158 43 313 161 -3 8,585
Walking Case (T1 - ACS Suitable) 11.8% 7.8% 3.8% 18.4% 23.4% 3.1% 29.0% 22.2% 10.5% 8.7% 4.1% 15.2% 8.3% 3.9% 30.9% 12.5% 11.8% 13.3% 2.9% 16.9% 23.3% 3.2% 37.3% 0.0% 11.4%
Walking Case (C1) 8.7% 13.5% 3.7% 11.5% 9.4% 3.1% 17.9% 11.1% 8.4% 14.9% 1.8% 11.1% 16.7% 3.9% 22.4% 12.5% 9.4% 18.1% 4.0% 12.1% 7.0% 1.3% 23.0% 0.0% 8.8%
Chair Case (C2) 51.9% 48.6% 65.5% 44.4% 45.3% 57.7% 25.9% 55.6% 52.9% 48.1% 66.1% 45.4% 45.8% 60.3% 24.8% 50.0% 50.6% 39.9% 64.9% 43.2% 41.9% 60.1% 23.6% 66.7% 51.8%
In Own Wheelchair (C3) 2.5% 6.4% 2.5% 1.9% 1.6% 0.7% 3.7% 0.0% 2.4% 2.8% 2.2% 2.9% 2.1% 1.6% 1.2% 12.5% 2.1% 5.9% 1.2% 1.6% 2.3% 2.2% 2.5% 33.3% 2.3%
In Own Wheelchair (C4) (Steps) 0.4% 0.0% 0.1% 0.4% 0.0% 1.0% 2.5% 0.0% 0.9% 1.7% 0.0% 1.3% 0.0% 1.6% 1.2% 0.0% 0.9% 1.5% 0.2% 1.5% 0.0% 0.0% 1.2% 0.0% 0.7%
Electric Wheelchair (C5) 0.4% 0.7% 0.1% 0.4% 0.0% 1.0% 0.0% 0.0% 0.4% 0.0% 0.3% 0.5% 0.0% 0.3% 0.6% 0.0% 0.2% 0.4% 0.2% 0.3% 2.3% 0.0% 0.0% 0.0% 0.3%
Stretcher patient (C6) 24.3% 23.0% 24.3% 23.1% 20.3% 33.2% 21.0% 11.1% 24.5% 23.9% 25.6% 23.6% 27.1% 28.2% 18.8% 12.5% 25.0% 21.0% 26.5% 24.4% 23.3% 33.2% 12.4% 0.0% 24.6%
A6 Number of Journeys Conveyed by Emergency Ambulances (AS3 Journeys) - - - -
Percentage of Journeys passed to alternative providers A7 2.6% 5.6% 2.4% 0.0% 1.7% 4.3% 5.3% 0.1% 2.5% 5.5% 2.4% 0.0% 1.8% 5.1% 4.6% 0.0% 3.2% 6.4% 2.5% 0.0% 2.1% 5.5% 4.8% 0.0% 2.7% (Red Cross, Social Services & St Johns)
A8 Percentage of bookings received after 12noon the day before travel 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0%
Version: 2.0 Document Reference: 7716 Step 4 Pick Me Up LHB Review: April 2018 - June 2018
Step 4: Pick Me Up
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description Total All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
A1 Percentage of Journeys Aborted ** 12.4% 14.4% 12.0% 12.6% 14.7% 12.1% 10.1% 8.3% 12.2% 13.6% 11.4% 11.6% 16.1% 12.7% 9.6% 10.4% 13.2% 12.6% 11.6% 18.5% 14.9% 12.5% 10.2% 9.4% 12.6%
A2 Number of ready notifications received from hospital kiosks - - - -
A3 Number & Percentage of core patients arriving prior to their booked arrival time 7,410 1,230 1,546 1,588 691 974 893 488 7,049 1,217 1,390 1,495 741 994 812 400 6,995 1,194 1,476 1,441 650 924 811 499 21,454
Less than 15 Mins Prior to Booking Time 31.0% 20.1% 27.5% 37.3% 41.4% 27.5% 25.1% 51.6% 29.3% 22.9% 25.8% 34.2% 36.3% 26.2% 23.3% 50.3% 32.3% 23.4% 29.5% 38.3% 45.2% 28.1% 25.2% 47.3% 30.9%
16 - 30 Mins Prior to Booking Time 25.8% 24.1% 24.6% 29.2% 29.5% 25.9% 20.0% 28.5% 25.6% 21.9% 23.4% 31.8% 27.3% 25.2% 22.9% 25.5% 24.1% 20.9% 23.6% 28.4% 22.3% 27.4% 19.6% 24.4% 25.2%
31 - 45 Mins Prior to Booking Time 17.0% 15.9% 18.3% 17.7% 13.9% 20.7% 16.3% 11.1% 18.4% 20.4% 20.0% 17.5% 15.1% 20.3% 16.9% 14.3% 17.1% 18.3% 17.4% 18.0% 12.2% 18.4% 17.1% 14.8% 17.5%
46 - 60 Mins Prior to Booking Time 11.0% 14.3% 14.1% 8.1% 7.7% 11.3% 12.9% 3.7% 11.7% 12.7% 12.4% 10.2% 10.3% 12.5% 15.0% 5.8% 11.2% 13.1% 11.7% 8.8% 11.2% 12.7% 12.9% 6.0% 11.3%
Over 60 Mins Prior to Booking Time 15.2% 25.5% 15.5% 7.7% 7.5% 14.6% 25.6% 5.1% 15.0% 22.1% 18.4% 6.3% 11.1% 15.9% 21.9% 4.3% 15.3% 24.4% 17.8% 6.5% 9.1% 13.4% 25.2% 7.4% 15.1%
A4 Number & Percentage of core patients arriving after their booked arrival time 4,887 932 694 1,026 1,089 437 447 262 4,177 806 621 878 865 351 399 257 4,711 869 709 962 1,022 474 435 240 13,775
Less than 15 Mins After Booked Arrival Time 34.5% 28.1% 36.3% 40.3% 29.7% 38.0% 34.5% 44.3% 38.8% 31.1% 45.6% 42.7% 33.8% 45.0% 33.6% 49.4% 34.5% 29.3% 35.4% 37.5% 29.8% 40.5% 34.0% 46.3% 35.8%
16 - 30 Mins After Booked Arrival Time 27.2% 24.0% 27.1% 27.9% 30.2% 32.3% 20.6% 25.6% 25.7% 25.2% 23.5% 24.7% 29.5% 23.4% 23.8% 28.8% 25.7% 21.2% 25.4% 28.5% 24.4% 30.0% 23.2% 33.8% 26.2%
31 - 45 Mins After Booked Arrival Time 16.1% 18.8% 16.4% 14.8% 16.7% 12.1% 15.2% 15.6% 15.9% 16.9% 13.0% 15.4% 19.0% 15.1% 14.5% 14.0% 16.8% 17.3% 16.9% 13.5% 21.8% 13.9% 17.0% 11.3% 16.2%
45 - 60 Mins After Booked Arrival Time 9.8% 9.9% 10.1% 8.2% 11.6% 9.2% 11.0% 7.6% 9.0% 11.4% 8.4% 9.1% 9.0% 8.5% 7.8% 4.3% 10.5% 12.5% 10.0% 9.0% 12.6% 8.0% 11.3% 4.2% 9.8%
Over 60 Mins After Booked Arrival Time 12.4% 19.2% 10.1% 8.9% 11.8% 8.5% 18.8% 6.9% 10.7% 15.4% 9.5% 8.1% 8.8% 8.0% 20.3% 3.5% 12.6% 19.7% 12.3% 11.4% 11.4% 7.6% 14.5% 4.6% 12.0%
A5 Number & Percentage of enhanced patients arriving prior to their booked arrival time
a Enhanced Renal Patients 4,762 570 1,105 790 844 685 697 71 5,138 614 1,195 810 854 819 747 99 4,977 509 1,205 761 871 797 750 84 14,877
Less than 15 Mins Prior to Booking Time 36.4% 49.6% 31.0% 34.6% 43.5% 29.2% 33.7% 45.1% 36.3% 54.1% 32.3% 34.9% 39.8% 25.5% 37.8% 35.4% 37.5% 47.9% 31.4% 34.7% 45.4% 34.4% 36.5% 44.0% 36.7%
16 - 30 Mins Prior to Booking Time 35.7% 32.3% 37.4% 41.3% 27.5% 39.6% 33.9% 50.7% 37.2% 27.7% 37.5% 37.5% 32.2% 46.6% 37.2% 53.5% 34.8% 30.6% 36.1% 36.5% 26.8% 39.9% 36.1% 46.4% 35.9%
31 - 45 Mins Prior to Booking Time 20.2% 14.4% 22.2% 13.9% 19.9% 23.2% 28.1% 2.8% 19.2% 14.3% 21.0% 17.5% 20.7% 20.8% 20.1% 9.1% 20.2% 16.7% 23.4% 18.7% 20.1% 18.6% 21.9% 9.5% 19.8%
46 - 60 Mins Prior to Booking Time 6.3% 3.0% 7.0% 8.7% 7.5% 6.6% 4.3% 1.4% 6.0% 3.1% 8.0% 8.0% 5.9% 5.6% 4.3% 2.0% 6.1% 3.3% 7.1% 8.5% 6.4% 6.5% 4.0% 0.0% 6.2%
Over 60 Mins Prior to Booking Time 1.4% 0.7% 2.5% 1.5% 1.7% 1.5% 0.0% 0.0% 1.2% 0.8% 1.2% 2.0% 1.4% 1.5% 0.7% 0.0% 1.4% 1.4% 2.1% 1.6% 1.4% 0.6% 1.5% 0.0% 1.4%
b Enhanced Oncology Patients 809 110 193 193 112 85 96 20 871 117 210 174 193 73 89 15 903 138 185 197 152 102 105 24 2,583
Less than15 Mins Prior to Booking Time 61.7% 68.2% 54.4% 50.8% 74.1% 58.8% 75.0% 80.0% 60.3% 66.7% 54.3% 54.6% 72.0% 49.3% 62.9% 46.7% 63.1% 77.5% 53.0% 60.4% 65.1% 60.8% 63.8% 75.0% 61.7%
16 - 30 Mins Prior to Booking Time 20.8% 11.8% 27.5% 24.9% 21.4% 16.5% 14.6% 10.0% 25.6% 17.9% 28.1% 34.5% 19.2% 24.7% 27.0% 26.7% 18.9% 8.0% 23.8% 23.4% 25.7% 7.8% 16.2% 25.0% 21.8%
31 - 45 Mins Prior to Booking Time 6.9% 5.5% 6.7% 13.0% 1.8% 3.5% 6.3% 5.0% 7.0% 7.7% 9.5% 8.0% 4.7% 4.1% 3.4% 20.0% 7.4% 5.1% 14.6% 7.1% 3.9% 9.8% 2.9% 0.0% 7.1%
46 - 60 Mins Prior to Booking Time 2.8% 4.5% 1.6% 4.7% 0.0% 2.4% 4.2% 0.0% 1.4% 0.9% 2.9% 0.6% 1.0% 1.4% 1.1% 0.0% 2.8% 3.6% 3.2% 2.0% 2.0% 3.9% 2.9% 0.0% 2.3%
Over 60 Mins Prior to Booking Time 7.8% 10.0% 9.8% 6.7% 2.7% 18.8% 0.0% 5.0% 5.7% 6.8% 5.2% 2.3% 3.1% 20.5% 5.6% 6.7% 7.8% 5.8% 5.4% 7.1% 3.3% 17.6% 14.3% 0.0% 7.1%
A6 Number & Percentage of enhanced patients arriving after their booked arrival time
a Enhanced Renal Patients 1,091 178 259 186 97 46 290 35 1,176 140 298 170 93 92 342 41 1,148 193 344 168 58 101 254 30 3,415
Less than 15 Mins After Booked Arrival Time 29.1% 29.8% 23.9% 33.3% 38.1% 6.5% 28.6% 51.4% 29.8% 25.7% 29.9% 24.1% 44.1% 18.5% 29.5% 61.0% 29.4% 31.1% 28.8% 29.2% 36.2% 24.8% 28.0% 43.3% 29.5%
16 - 30 Mins After Booked Arrival Time 28.3% 27.0% 28.6% 31.7% 26.8% 30.4% 28.3% 17.1% 23.0% 27.9% 17.8% 32.4% 23.7% 21.7% 21.9% 17.1% 25.3% 28.5% 22.1% 33.3% 27.6% 21.8% 24.0% 16.7% 25.5%
31 - 45 Mins After Booked Arrival Time 17.5% 17.4% 20.1% 16.7% 15.5% 23.9% 15.2% 20.0% 19.0% 17.1% 19.5% 24.1% 16.1% 21.7% 18.1% 7.3% 15.9% 14.0% 18.3% 16.1% 10.3% 19.8% 14.2% 13.3% 17.5%
45 - 60 Mins After Booked Arrival Time 12.2% 12.4% 12.0% 10.2% 12.4% 10.9% 14.1% 8.6% 13.6% 12.1% 17.1% 11.8% 8.6% 9.8% 14.9% 9.8% 12.1% 10.4% 13.7% 10.7% 15.5% 15.8% 10.2% 10.0% 12.7%
Over 60 Mins After Booked Arrival Time 12.8% 13.5% 15.4% 8.1% 7.2% 28.3% 13.8% 2.9% 14.6% 17.1% 15.8% 7.6% 7.5% 28.3% 15.5% 4.9% 17.2% 16.1% 17.2% 10.7% 10.3% 17.8% 23.6% 16.7% 14.9%
Version: 2.0 Document Reference: 7716 Step 4 Pick Me Up LHB Review: April 2018 - June 2018
Step 4: Pick Me Up
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description Total All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
b Enhanced Oncology Patients 460 112 67 46 75 13 115 32 543 108 92 56 85 25 148 29 615 148 131 68 68 34 152 14 1,618
Less than 15 Mins After Booked Arrival Time 38.5% 37.5% 41.8% 58.7% 32.0% 30.8% 37.4% 28.1% 37.2% 38.0% 39.1% 35.7% 32.9% 44.0% 36.5% 41.4% 38.2% 39.2% 39.7% 41.2% 25.0% 47.1% 38.2% 42.9% 37.9%
16 - 30 Mins After Booked Arrival Time 23.3% 22.3% 29.9% 15.2% 25.3% 30.8% 24.3% 12.5% 25.0% 26.9% 28.3% 30.4% 18.8% 28.0% 16.9% 55.2% 24.9% 24.3% 22.1% 26.5% 32.4% 5.9% 28.9% 14.3% 24.5%
31 - 45 Mins After Booked Arrival Time 14.3% 13.4% 13.4% 8.7% 21.3% 7.7% 11.3% 25.0% 16.4% 13.9% 14.1% 14.3% 21.2% 16.0% 20.9% 0.0% 13.5% 8.1% 15.3% 19.1% 17.6% 26.5% 10.5% 7.1% 14.7%
45 - 60 Mins After Booked Arrival Time 11.5% 10.7% 7.5% 6.5% 8.0% 23.1% 13.0% 28.1% 10.5% 8.3% 8.7% 14.3% 15.3% 0.0% 12.8% 0.0% 9.6% 12.8% 8.4% 2.9% 13.2% 5.9% 9.2% 14.3% 10.4%
Over 60 Mins After Booked Arrival Time 12.4% 16.1% 7.5% 10.9% 13.3% 7.7% 13.9% 6.3% 10.9% 13.0% 9.8% 5.4% 11.8% 12.0% 12.8% 3.4% 13.8% 15.5% 14.5% 10.3% 11.8% 14.7% 13.2% 21.4% 12.4%
A7 Number of patients transported by healthcare setting destination - - - -
A8 Percentage of discharges (end of life journeys) conveyed 24 2 10 10 1 1 - - 23 6 7 4 3 1 1 1 - 47
Version: 2.0 Document Reference: 7716 Step 5 Take Me To My Destination LHB Review: April 2018 - June 2018
Step 5: Take Me To My Destination
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description Total All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
A1 Number & Percentage of Core Patient Journeys by Mobility
a Core Patient Journeys - Discharge & Transfer 3,763 480 1,119 1,432 38 405 224 65 4,043 496 1,219 1,511 42 471 239 65 3,217 446 1,096 868 69 412 186 140 11,023
Walking Case (T1 - ACS Suitable) 10.4% 8.8% 3.4% 15.4% 7.9% 2.2% 30.8% 16.9% 9.3% 8.5% 3.4% 12.6% 4.8% 3.2% 32.6% 12.3% 9.1% 10.1% 2.7% 13.8% 11.6% 1.5% 41.4% 4.3%3 9.6%
Walking Case (C1) 7.9% 10.4% 3.6% 10.5% 15.8% 3.0% 16.1% 4.6% 8.0% 13.9% 2.2% 10.3% 14.3% 3.6% 18.4% 6.2% 8.4% 15.2% 3.5% 10.6% 7.2% 2.4% 22.0% 10.7%94 8.1%
Chair Case (C2) 53.3% 52.5% 65.9% 45.8% 60.5% 61.2% 25.9% 46.2% 54.4% 49.8% 67.1% 48.5% 54.8% 61.6% 24.3% 47.7% 54.0% 46.0% 64.1% 48.6% 43.5% 64.1% 22.6% 52.1%3 53.9%
In Own Wheelchair (C3) 2.9% 5.4% 2.7% 2.1% 0.0% 1.5% 4.5% 10.8% 3.1% 4.6% 2.5% 3.2% 2.4% 1.7% 1.3% 20.0% 2.6% 5.4% 1.5% 2.2% 0.0% 2.4% 2.2% 7.9%4 2.9%
In Own Wheelchair (C4) (Steps) 1.0% 1.3% 0.4% 1.0% 0.0% 1.2% 2.2% 0.0% 1.3% 2.0% 0.2% 1.7% 0.0% 2.3% 1.3% 0.0% 1.3% 1.8% 0.4% 2.4% 0.0% 0.2% 1.6% 2.9%2 1.2%
Electric Wheelchair (C5) 0.4% 0.8% 0.1% 0.5% 0.0% 0.7% 0.0% 0.0% 0.3% 0.2% 0.2% 0.5% 0.0% 0.2% 0.8% 0.0% 0.2% 0.2% 0.3% 0.2% 1.4% 0.0% 0.0% 0.7%5 0.3%
Stretcher patient (C6) 24.1% 20.8% 23.9% 24.6% 15.8% 30.1% 20.5% 21.5% 23.5% 21.0% 24.4% 23.2% 23.8% 27.4% 21.3% 13.8% 24.4% 21.3% 27.6% 22.1% 36.2% 29.4% 10.2% 21.48%68 24.0%
b Core Patient Journeys - Other (Outpatient, Day Case, etc) 28,945 4,539 5,065 7,646 3,826 2,991 3,029 1,849 31,373 4,788 5,645 8,377 3,948 3,222 3,300 2,093 27,692 5,154 5,480 4,529 3,994 3,112 3,392 2,031 88,010
Walking Case (T1 - ACS Suitable) 46.9% 31.9% 47.3% 60.0% 32.1% 32.0% 62.3% 57.5% 47.0% 30.4% 45.3% 60.9% 32.7% 32.5% 63.5% 57.7% 46.2% 36.4% 45.2% 58.9% 33.5% 32.9% 65.7% 58.4%3 46.7%
Walking Case (C1) 12.7% 26.1% 13.3% 7.3% 7.7% 13.3% 10.4% 14.1% 12.6% 26.4% 15.8% 6.1% 6.5% 13.7% 7.5% 16.1% 12.8% 22.1% 14.6% 4.6% 8.8% 15.0% 7.6% 15.7%94 12.7%
Chair Case (C2) 20.8% 21.2% 17.7% 13.5% 40.5% 33.2% 11.8% 11.7% 20.3% 21.2% 17.4% 14.1% 37.9% 32.1% 12.0% 12.6% 20.4% 21.7% 16.7% 15.0% 35.3% 30.2% 12.2% 8.5%3 20.5%
In Own Wheelchair (C3) 11.5% 13.4% 14.1% 11.3% 9.7% 12.7% 6.9% 9.1% 11.3% 13.8% 13.5% 10.6% 11.1% 12.0% 8.1% 7.5% 12.0% 12.0% 15.0% 12.2% 11.3% 12.3% 7.8% 11.4%4 11.6%
In Own Wheelchair (C4) (Steps) 4.1% 3.7% 2.9% 4.3% 6.1% 4.4% 3.7% 3.5% 4.4% 4.2% 3.2% 4.4% 7.6% 4.5% 3.0% 3.2% 4.2% 3.3% 3.5% 5.6% 6.7% 4.2% 2.5% 3.2%2 4.2%
Electric Wheelchair (C5) 1.5% 1.2% 1.8% 1.3% 1.7% 1.2% 1.6% 1.6% 1.6% 1.2% 1.6% 1.6% 2.4% 1.4% 2.1% 1.1% 1.5% 0.8% 1.7% 1.5% 2.4% 0.8% 1.7% 1.1%5 1.5%
Stretcher patient (C6) 2.6% 2.4% 2.9% 2.3% 2.2% 3.1% 3.3% 2.4% 2.8% 2.7% 3.1% 2.4% 1.8% 3.8% 3.8% 1.9% 2.9% 3.6% 3.3% 2.2% 1.9% 4.5% 2.4% 1.78%68 2.8%
A2 Number & Percentage of Enhanced Patient Journeys by Mobility
a Enhanced Renal Patients 16,687 1,715 3,534 3,806 2,438 2,085 2,368 741 17,899 1,851 3,769 4,008 2,627 2,199 2,617 828 15,833 1,739 3,693 2,357 2,635 2,062 2,602 745 50,419
Walking Case (T1 - ACS Suitable) 55.6% 53.5% 42.7% 72.5% 45.8% 46.4% 58.9% 82.9% 56.1% 55.8% 42.2% 72.5% 46.5% 48.0% 60.6% 78.9% 54.7% 53.7% 45.1% 67.8% 48.2% 48.0% 60.6% 83.9% 55.5%
Walking Case (C1) 17.7% 15.3% 23.2% 8.5% 27.4% 23.9% 14.1% 6.7% 17.9% 14.3% 23.6% 8.8% 26.8% 24.6% 13.9% 10.0% 18.3% 18.6% 20.0% 12.1% 24.3% 22.2% 15.6% 6.2% 18.0%
Chair Case (C2) 12.4% 13.8% 15.7% 6.4% 11.9% 16.5% 16.1% 3.1% 11.3% 12.9% 15.0% 4.7% 11.8% 14.6% 15.0% 0.0% 12.0% 11.4% 17.5% 4.2% 12.6% 14.7% 12.3% 0.4% 11.9%
In Own Wheelchair (C3) 7.9% 7.7% 9.7% 8.3% 7.3% 9.2% 4.6% 5.9% 8.3% 7.8% 11.5% 9.3% 7.6% 8.7% 4.1% 4.8% 8.7% 8.1% 9.2% 12.6% 8.5% 10.4% 4.8% 5.8% 8.3%
In Own Wheelchair (C4) (Steps) 4.0% 4.3% 5.7% 2.7% 5.7% 1.9% 4.3% 1.3% 4.0% 4.3% 4.7% 3.3% 5.2% 2.6% 4.2% 2.7% 3.8% 2.5% 5.1% 3.4% 4.4% 2.5% 4.7% 0.0% 3.9%
Electric Wheelchair (C5) 0.6% 0.0% 1.4% 0.0% 2.1% 0.0% 0.0% 0.0% 0.7% 0.0% 1.3% 0.0% 2.0% 0.0% 0.2% 1.4% 0.8% 0.0% 1.3% 0.0% 2.0% 0.0% 0.0% 3.5% 0.7%
Stretcher patient (C6) 1.8% 5.5% 1.6% 1.5% 0.0% 2.1% 2.0% 0.0% 1.8% 5.0% 1.7% 1.3% 0.0% 1.4% 2.1% 2.2% 1.7% 5.6% 1.9% 0.0% 0.0% 2.1% 2.0% 0.3% 1.7%
b Enhanced Oncology Patients 4,384 647 968 961 453 165 948 242 4,970 517 1,278 1,071 484 282 1,062 276 4,823 754 1,380 710 412 340 899 328 14,177
Walking Case (T1 - ACS Suitable) 86.3% 81.6% 91.6% 87.0% 68.0% 73.9% 92.3% 93.8% 87.2% 85.5% 88.8% 89.5% 67.4% 72.7% 94.5% 95.7% 86.5% 90.3% 87.1% 86.3% 64.6% 80.9% 92.1% 93.9% 86.7%
Walking Case (C1) 3.4% 6.5% 2.3% 0.9% 8.2% 6.1% 2.5% 2.1% 3.4% 7.4% 3.2% 1.5% 7.9% 9.9% 0.3% 2.5% 3.4% 4.5% 3.0% 2.1% 8.3% 5.6% 1.0% 3.7% 3.4%
Chair Case (C2) 3.0% 2.0% 2.7% 1.9% 7.3% 9.1% 2.8% 0.0% 3.4% 2.7% 4.2% 2.4% 5.4% 7.1% 2.5% 0.0% 4.2% 2.3% 6.4% 3.9% 4.9% 6.5% 2.8% 0.3% 3.5%
In Own Wheelchair (C3) 2.9% 3.1% 1.8% 2.9% 8.4% 4.8% 0.6% 3.3% 2.1% 1.7% 1.3% 0.6% 11.8% 1.8% 0.8% 1.8% 3.4% 1.1% 2.1% 3.2% 16.5% 2.1% 2.7% 0.9% 2.8%
In Own Wheelchair (C4) (Steps) 1.8% 4.9% 0.4% 2.7% 1.8% 0.0% 1.1% 0.0% 1.0% 0.0% 0.9% 3.1% 0.4% 0.0% 0.4% 0.0% 0.6% 1.1% 0.1% 0.6% 0.0% 1.8% 0.6% 1.2% 1.1%
Electric Wheelchair (C5) 1.1% 0.0% 0.2% 3.7% 2.0% 0.0% 0.0% 0.0% 0.8% 2.3% 0.0% 1.2% 3.1% 0.0% 0.2% 0.0% 0.5% 0.0% 0.0% 0.3% 3.9% 0.6% 0.2% 0.0% 0.8%
Stretcher patient (C6) 1.6% 1.9% 1.0% 0.8% 4.4% 6.1% 0.6% 0.8% 2.0% 0.4% 1.6% 1.7% 4.1% 8.5% 1.3% 0.0% 1.5% 0.8% 1.2% 3.5% 1.9% 2.6% 0.7% 0.0% 1.7%
A3 Number of patient journeys requiring additional or specialist assistance ------
Version: 2.0 Document Reference: 7716 Step 5 Take Me To My Destination LHB Review: April 2018 - June 2018
Step 5: Take Me To My Destination
Apr-18 May-18 Jun-18 All Wales AQI Ref AQI Description Total All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P All Wales ABM AB BCU C&V CT HD P
A4 Number & Percentage of core service patients collected after their booked ready time
a Core Patient Journeys - Discharge & Transfer 2,551 441 817 682 58 300 138 115 2,697 411 859 753 65 362 121 126 2,837 427 926 756 60 400 134 134 8,085
Less than 15 Mins After Booked Ready Time 10.6% 21.5% 8.9% 4.0% 3.4% 9.3% 18.1% 17.4% 8.6% 15.6% 5.7% 4.1% 3.1% 11.6% 13.2% 22.2% 18.4% 25.3% 16.5% 10.3% 18.3% 22.3% 24.6% 38.1% 12.7%
16 - 30 Mins After Booked Ready Time 21.2% 20.4% 25.5% 18.0% 10.3% 20.7% 23.2% 16.5% 18.0% 17.5% 18.0% 15.9% 13.8% 20.7% 28.1% 15.9% 14.1% 16.2% 13.9% 12.6% 10.0% 11.8% 22.4% 17.2% 17.6%
31 - 45 Mins After Booked Ready Time 19.4% 14.5% 24.8% 17.0% 15.5% 16.7% 17.4% 26.1% 17.8% 16.1% 21.9% 14.6% 16.9% 17.4% 21.5% 12.7% 14.3% 13.6% 16.5% 13.1% 10.0% 13.3% 13.4% 14.2% 17.1%
45 - 60 Mins After Booked Ready Time 12.2% 7.3% 13.3% 15.0% 13.8% 11.0% 8.0% 14.8% 13.4% 10.5% 15.8% 12.7% 12.3% 12.7% 9.1% 17.5% 11.0% 7.5% 13.0% 12.0% 10.0% 8.8% 11.2% 9.0% 12.2%
Over 60 Mins After Booked Ready Time 36.6% 36.3% 27.4% 46.0% 56.9% 42.3% 33.3% 25.2% 42.2% 40.4% 38.5% 52.6% 53.8% 37.6% 28.1% 31.7% 42.2% 37.5% 40.1% 52.0% 51.7% 44.0% 28.4% 21.6% 40.4%
b Core Patient Journeys - Other (Outpatient, Day Case, etc) 9,979 1,932 1,768 1,443 1,606 1,285 1,264 681 10,395 2,032 2,004 1,535 1,669 1,353 1,109 693 9,821 1,901 1,846 1,466 1,574 1,330 1,003 701 30,195
Less than 15 Mins After Booked Ready Time 39.4% 37.2% 28.2% 34.2% 41.7% 37.2% 47.5% 69.9% 37.2% 36.9% 28.2% 30.5% 38.7% 39.2% 41.5% 65.1% 37.1% 35.9% 25.8% 27.5% 39.9% 40.3% 42.3% 70.2% 37.9%
16 - 30 Mins After Booked Ready Time 18.4% 20.8% 18.1% 16.1% 21.4% 19.4% 15.8% 13.8% 18.3% 19.2% 18.5% 18.6% 19.1% 18.7% 17.3% 13.1% 17.8% 18.7% 18.1% 17.5% 20.8% 17.2% 16.7% 11.7% 18.2%
31 - 45 Mins After Booked Ready Time 13.3% 13.8% 16.2% 15.7% 11.2% 14.7% 11.3% 5.9% 13.7% 15.8% 15.5% 12.4% 12.6% 14.5% 12.6% 8.2% 12.8% 14.4% 15.1% 13.4% 12.5% 12.2% 10.7% 6.1% 13.3%
45 - 60 Mins After Booked Ready Time 9.5% 10.5% 11.0% 11.1% 8.2% 9.8% 8.1% 4.4% 9.9% 10.7% 10.7% 11.4% 9.7% 9.7% 8.8% 4.9% 10.0% 10.0% 12.6% 12.2% 7.8% 9.7% 10.3% 4.1% 9.8%
Over 60 Mins After Booked Ready Time 19.3% 17.8% 26.5% 22.9% 17.5% 18.9% 17.2% 6.0% 20.8% 17.3% 27.1% 27.2% 19.9% 17.9% 19.7% 8.7% 22.3% 20.9% 28.4% 29.5% 19.1% 20.6% 20.1% 7.8% 20.8%
A5 Number & Percentage of enhanced service patients collected after their booked ready time
a Enhanced Renal Patients 5,094 661 1,257 648 860 672 926 70 5,402 679 1,401 667 908 741 920 86 5,148 609 1,298 652 822 779 898 90 15,644
Less than 15 Mins After Booked Ready Time 46.4% 51.9% 37.6% 42.6% 35.3% 48.1% 64.0% 71.4% 45.1% 46.7% 38.3% 40.9% 32.7% 49.4% 64.6% 62.8% 42.9% 42.4% 37.1% 37.4% 30.7% 44.7% 63.3% 60.0% 44.8%
16 - 30 Mins After Booked Ready Time 27.3% 23.4% 29.1% 31.0% 32.1% 27.2% 21.3% 20.0% 26.7% 26.4% 28.4% 29.2% 27.4% 27.1% 22.3% 20.9% 28.0% 30.2% 28.1% 31.9% 28.6% 29.3% 21.8% 25.6% 27.3%
31 - 45 Mins After Booked Ready Time 15.4% 14.7% 17.8% 14.8% 20.0% 13.4% 11.0% 4.3% 15.4% 14.4% 17.2% 15.3% 21.8% 13.6% 9.6% 5.8% 15.7% 14.6% 17.0% 16.6% 22.4% 15.0% 9.0% 7.8% 15.5%
45 - 60 Mins After Booked Ready Time 6.9% 6.4% 8.1% 8.5% 9.1% 7.1% 2.9% 2.9% 7.3% 8.4% 8.1% 7.6% 11.6% 5.0% 2.6% 4.7% 7.4% 8.4% 8.1% 6.9% 10.5% 7.4% 3.8% 1.1% 7.2%
Over 60 Mins After Booked Ready Time 4.0% 3.6% 7.3% 3.1% 3.5% 4.2% 0.8% 1.4% 5.4% 4.1% 7.9% 6.9% 6.5% 4.9% 1.0% 5.8% 6.1% 4.4% 9.6% 7.2% 7.9% 3.6% 2.1% 5.6% 5.2%
b Enhanced Oncology Patients 1,565 284 335 174 181 71 432 88 1,626 233 438 160 185 107 441 62 1,635 326 453 179 148 128 366 35 4,826
Less than 15 Mins After Booked Ready Time 34.7% 31.3% 28.4% 33.9% 11.0% 26.8% 49.1% 55.7% 35.0% 37.3% 26.0% 38.8% 13.0% 30.8% 49.0% 53.2% 33.3% 35.9% 21.9% 30.2% 21.6% 27.3% 50.3% 65.7% 34.3%
16 - 30 Mins After Booked Ready Time 19.0% 23.2% 17.3% 17.8% 22.1% 21.1% 15.3% 23.9% 17.0% 19.7% 14.6% 15.0% 23.2% 18.7% 15.2% 21.0% 18.2% 17.2% 16.8% 16.8% 22.3% 29.7% 17.2% 2.9% 18.0%
31 - 45 Mins After Booked Ready Time 14.7% 14.1% 15.5% 13.2% 22.7% 15.5% 12.7% 9.1% 15.9% 18.0% 18.5% 11.3% 23.2% 17.8% 11.1% 9.7% 16.1% 15.6% 19.6% 11.7% 22.3% 19.5% 10.7% 14.3% 15.6%
45 - 60 Mins After Booked Ready Time 11.4% 11.6% 14.6% 5.7% 17.7% 18.3% 8.8% 3.4% 11.7% 8.6% 15.8% 7.5% 14.6% 15.0% 10.0% 4.8% 11.7% 11.3% 15.0% 12.3% 16.9% 7.0% 7.7% 5.7% 11.6%
Over 60 Mins After Booked Ready Time 20.3% 19.7% 24.2% 29.3% 26.5% 18.3% 14.1% 8.0% 20.4% 16.3% 25.1% 27.5% 25.9% 17.8% 14.7% 11.3% 20.8% 19.9% 26.7% 29.1% 16.9% 16.4% 14.2% 11.4% 20.5%
Number of Renal patients having reduced treatments as a result of late arrival due to transport related A6 - - - - issues a Treatmentts Reduced - - - -
b Treatmentts Reduced as a result of Ambulance Service - - - -
A7 Percentage of patient journeys with an escort 18.0% 21.0% 20.9% 17.2% 14.9% 17.7% 15.8% 17.0% 17.8% 19.0% 21.7% 16.6% 15.5% 18.6% 14.9% 16.8% 20.8% 19.2% 23.2% 28.3% 17.6% 19.6% 14.4% 19.6% 18.8%
Version: 2.0 Document Reference: 7716 3.1 A Strategic Outline Case for Electronic Patient Clinical Records (Medical Director) 1 ITEM 3.1 SBAR EPCR SOC for Finance & Resources Committee V1.docx
AGENDA ITEM No 3.1 OPEN or CLOSED OPEN No of ANNEXES ATTACHED 1
A Strategic Outline Case for Electronic Patient Clinical Records
MEETING Finance and Resources Committee DATE 20 September 2018 Dr. Brendan Lloyd EXECUTIVE Executive Director of Medical & Clinical Services Assistant Director of Research, AUTHOR(S) Audit & Service Improvement / Business Support Manager [email protected] / CONTACT DETAILS [email protected]
CORPORATE OBJECTIVE 2,8 IMTP SA 13 CORPORATE RISK (Ref if
appropriate) QUALITY THEME 2,3,7 HEALTH & CARE STANDARD 3.1,3.2,3.4,4.2,5.1,7.1
For endorsement of SOC to be submitted to REPORT PURPOSE Trust Board for endorsement. CLOSED MATTER REASON
REPORT APPROVAL ROUTE WHERE WHEN WHY Executive Endorsement for submission 12 September 2018 Management Team to Finance & Resource Com. Finance & Resources Endorsement for submission 20 September 2018 Committee to Trust Board. Endorsement for submission Trust Board 27 September 2018 to Government. Welsh Government October 2018 Endorsement to OBC stage.
EPCR Strategic Outline Case Page 1 of 4
SITUATION
1 The Strategic Outline Case (SOC) (Annex 1), is written to gain endorsement from Welsh Government to enable the Trust to develop an Outline Business Case (OBC) for Government funding to procure an electronic Patient Clinical Records (ePCR) solution, to replace the Trust’s interim digital pen system.
2 The Trust’s digital pen contract is due to expire on 31 March 2021. Procurement rules do not allow extension of this contract beyond the end date.
3 On 3 August 2018, representatives of the Trust met with Welsh Government to discuss the Trust’s approach to obtaining external capital funding for the project. The Welsh Government advised that the Trust should produce a SOC and subject to endorsement by the Cabinet Secretary, the Trust could proceed to develop an OBC and Full Business Case (FBC) for submission to secure Government capital support.
4 A timescale was agreed with Welsh Government to submit the SOC for endorsement to the Trust Board on 27 September 2018, with subsequent submission to Welsh Government in October 2018.
BACKGROUND
5 The Trust’s digital pen system was implemented in September 2015 to enable the collection of clinical PCR data in a digital format, to enable the Trust to report on clinical Ambulance Quality Indicators (AQIs). This clinical information was required to support the pilot of the Trust’s new Clinical Response Model, implemented in October 2015.
6 The initial contract for the digital pen system in 2015, was for three years and with the support of Welsh Government capital funding, was extended for a further three years until 31 March 2021.
7 The Trust is experiencing a number of significant issues associated with the support of the digital pen system currently in place. These are detailed in the strategic case section of the SOC document.
8 In April 2018, the Trust established an ePCR Task & Finish Group to develop a business case for an ePCR solution to replace the digital pen system at the end of the contracted period. A draft SOC was developed by July 2018.
9 In August 2018, a sub-group of the Task & Finish Group undertook visits to other ambulance services within the UK to collect valuable learning from the projects undertaken to implement various ePCR solutions. This learning has been built into the Trust’s ePCR SOC.
10 The Trust will now establish a formal Project Board for the ePCR Project to oversee the development of the business cases and specification of the preferred option for an ePCR solution (to be agreed at OBC stage).
EPCR Strategic Outline Case Page 2 of 4
ASSESSMENT
11 The Trust must make arrangements to obtain funding and procure a solution to record clinical information digitally beyond 31 March 2021 to meet our obligations to report on clinical AQIs to our commissioners.
12 The Welsh Government has advised that the content of the SOC needs to be focussed on the strategic case – the case for change. Whilst the SOC needs to consider the remaining elements of the five cases, these will be brought out in detail in the next stages of the OBC and FBC.
13 At this stage, the Trust has identified a wide range of possible scope and options for an ePCR solution. The Trust will require specialist support to undertake the detailed work of identifying and testing the options to arrive at a shortlist of options and a preferred option at OBC stage.
14 In order for the Trust to engage with specialist support, this SOC is required to be endorsed by the Trust Board and Welsh Government.
RECOMMENDED: That the Executive Management Team:
(1) Receives this paper and endorses the SOC (Annex 1) to be submitted to the Trust’s Finance and Resource Committee.
EPCR Strategic Outline Case Page 3 of 4
EQUALITY IMPACT ASSESSMENT
An Equality Impact Assessment is not required for this report.
REPORT CHECKLIST
Issues to be covered Paragraph Number (s) or “Not Applicable” Equality Impact Assessment Not Applicable – will be at OBC stage Environmental/Sustainability Not Applicable – will be at OBC stage Estate Not Applicable – will be at OBC stage Health Improvement Not Applicable – will be at OBC stage Health and Safety Not Applicable – will be at OBC stage Financial Implications Not Applicable – will be at OBC stage Legal Implications Not Applicable – will be at OBC stage Patient Safety/Safeguarding Not Applicable – will be at OBC stage Risks Not Applicable – will be at OBC stage Reputational Not Applicable – will be at OBC stage Staff Side Consultation Not Applicable – will be at OBC stage
EPCR Strategic Outline Case Page 4 of 4
1 ITEM 3.1a Annex 1 - EPCR SOC V1.0.pdf
Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records (ePCR) Strategic Outline Case
Executive Lead: Dr Brendan Lloyd Asst Dir Lead: Rachael Powell Author: Stephanie Harris September 2018 Version 1.0 Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case Contents Document Control ...... 4 1. Executive Summary...... 6 1.1 Introduction ...... 6 1.2 The Strategic Case ...... 6 1.3 The Economic Case ...... 7 1.4 The Commercial Case ...... 8 1.5 The Financial Case ...... 9 1.6 The Management Case ...... 9 1.7 Recommendation ...... 10 2. The Strategic Case ...... 12 2.1 Introduction ...... 12 2.2 Organisational Overview (Part A: The strategic context) ...... 14 2.3 National Strategic Context ...... 15 2.4 The Trust’s business strategy ...... 17 2.5 Investment objectives (Part B: The case for change) ...... 21 2.6 Existing arrangements ...... 24 2.7 Business needs ...... 28 2.8 Potential business scope and key service requirements ...... 30 2.9 Main benefits criteria ...... 30 2.10 Main risks ...... 31 2.11 Constraints ...... 32 2.12 Dependencies ...... 32 3. The Economic Case ...... 34 3.1 Introduction ...... 34 3.2 Critical success factors (CSFs) ...... 34 3.3 The long-listed options ...... 35 3.4 Scoping options ...... 36 3.5 Service solution options ...... 37 3.6 Service delivery options ...... 39 3.7 Implementation options ...... 39 3.8 Funding options ...... 40 3.9 The long list: inclusions and exclusions ...... 40 3.10 The Risk ...... 40 3.11 The options appraisal ...... 40 4. The Commercial Case ...... 43
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
4.1 Introduction ...... 43 4.2 Required services...... 43 4.3 Potential for risk transfer ...... 43 4.4 Proposed charging mechanisms ...... 44 4.5 Proposed contract lengths ...... 44 4.6 Proposed key contractual clauses ...... 44 4.7 Personnel implications (including TUPE) ...... 44 4.8 Procurement strategy ...... 45 4.9 Financial accountancy treatment ...... 46 5. The Financial Case ...... 48 5.1 Introduction ...... 48 5.2 Impact on the organisation’s income & expenditure account ...... 48 5.3 Impact on the balance sheet...... 48 5.4 Overall affordability ...... 48 6. The Management Case ...... 50 6.1 Introduction ...... 50 6.2 Programme management arrangements ...... 50 6.3 Project management arrangements ...... 50 6.4 Use of special advisors ...... 52 6.5 Gateway review arrangements ...... 53
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case Document Control
Document Version Control Version Date Author Summary of Changes Number 0.1 01.06.18 S Harris Initial draft document template created 0.2 01.08.18 S Harris Document developed into SOC. 0.3 03.08.18 S Harris Development following meeting with WG re format. 0.4 26.08.18 S Harris Updated all sections following review with Head of ICT. Added Executive Summary. 0.5 28.08.18 S Harris Updated following visits ready for ePCR workshop. 0.6 03.09.18 S Harris Updated following ePCR workshop 31.08.18 0.7 05.09.18 S Harris Financial case figures & update to economic case 1.0 12.09.18 S Harris Re-versioned from draft on endorsement
Approval This document requires the following endorsements:
Meeting Title/Group Date Version Endorsed? WAST ePCR Business Case Task & Finish Group 31.08.18 0.5 Yes, with comments WAST Executive Management Team Meeting 12.09.18 0.7 Yes WAST Finance and Resource Committee 20.09.18 1.0 WAST Trust Board Meeting 27.09.18 Welsh Government Oct 2018
Distribution Name/Group Date Version B Lloyd, R Powell, J Winspear, A Williams, C Turley 02.08.18 0.2 B Lloyd, R Powell, J Winspear, A Williams, C Turley 07.08.18 0.3 T Bracey 09.08.18 0.3 ePCR Task & Finish Group, C Turley 26.08.18 0.4 ePCR Task & Finish Group, C Turley 28.08.18 0.5 ePCR Task & Finish Group, C Turley 03.09.18 0.6 ePCR Task & Finish Group, submitted to Executive Management Team 05.09.18 0.7 Finance and Resources Committee members 20.09.18 1.0
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Executive Summary
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case 1. Executive Summary
1.1 Introduction
1.1.1 This Strategic Outline Case (SOC) is written in support of funding for the Welsh Ambulance Services NHS Trust (the Trust) procurement of an electronic Patient Clinical Records (ePCR) solution to replace the Trust’s current interim Digital Pen system contract which is due to expire on 31 March 2021.
1.1.2 The scope of an ePCR solution can vary significantly from a standalone simple electronic form to capture a Patient Clinical Record electronically to a fully integrated solution in which an ePCR is one piece of information in a wider system of related information regarding an incident of patient care.
1.1.3 This SOC aims to explore the strategic case for change, our business drivers, investment objectives and an overview of the options available for the Trust to explore further.
1.2 The Strategic Case
The strategic context
1.2.1 The Trust was established in 1998, our services cover over 20,640 km and we serve a population of over three million people. Our diverse area encompasses a diversity of challenging urban, costal and rural landscape.
1.2.2 We provide a range of services operating from over 90 ambulance stations, three control centres, three regional offices and five vehicle workshops. We also have our own National Training College.
1.2.3 The Trust’s business strategy in relation to ePCR is in our Integrated Medium Term Plan for 2018/19 – 2020/21, that has been approved by Welsh Government.
1.2.4 The Trust currently uses digital pen technology to complete PCRs for the patients that all of our Emergency Medical Services (EMS) staff attend. This technology has delivered considerable benefits compared to the historical paper based process, however this was implemented as an interim solution. Looking to the future, and in line with the emerging ideas from developing our Long Term Strategic Framework, we want to develop a more innovative and effective electronic solution to capture and record clinical data and information that will enable us to further demonstrate and improve the quality of care we provide to our patients.
1.2.5 The Trust’s EMS are commissioned by the seven Local Health Boards on behalf of the people of Wales though the Emergency Ambulance Services Committee (EASC). EASC has developed a set of Ambulance Quality Indicators (AQIs) to monitor and improve ambulance services performance across the 5 Step Ambulance Care Pathway. The AQIs are published every quarter. The clinical indicator data for the AQI submission is currently reliant upon digital patient clinical record data.
The case for change
1.2.6 The Trust currently has a significant risk to business continuity: the Trust’s current digital pen contract is due to expire on 31 March 2021. There is no provision for a further extension of this contract under procurement rules.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
1.2.7 The Trust is experiencing a number of significant issues associated with supporting the digital pen system that is currently in place. These are detailed in the main text of our strategic case.
1.2.8 The following key investment objectives have been identified through the Trust’s ePCR Business Case Task & Finish Group:
1. To implement a patient clinical records solution to ensure business continuity following 31 March 2021. 2. To improve the quality, timeliness, audit and analysis of clinical data; 3. To improve clinical outcomes and experience for patients and staff; 4. To bring the Trust to the forefront of pre-hospital clinical care to make a larger contribution to the wider economy.
1.3 The Economic Case
The long list
1.3.1 The Trust’s long list of options for this investment was generated from information from the NHS frameworks available and exploration of solutions adopted by other UK ambulance services. This generated options within the following key categories of choice: Scoping options – choices in terms of coverage (the what) Service solution options – choices in terms of solution (the how) Service delivery options – choices in terms of delivery (the who) Implementation options – choices in terms of the delivery timescale Funding options – choices in terms of financing and funding
1.3.2 The long list has identified a wide range of possible options. Subject to endorsement of this SOC, the Trust will continue to appraise each of the long list options against the investment objectives and critical success factors.
The preferred way forward
1.3.3 At this SOC stage, the Trust has not appraised the ‘possible’ and ‘preferred’ options available. The Trust met with Welsh Government on 12 August 2018 and agreed that in terms of the SOC content, this needs to be focused on the strategic case – the case for change. Whilst the SOC considers the remaining elements of the five cases, these are brought out in more detail in the Outline Business Case (OBC) and Full Business Case (FBC).
1.3.4 The SOC has considered investment objectives and the Trust has begun to make an assessment of what is core, desirable and optional functionality.
1.3.5 Subject to endorsement of the SOC, it is the intention of the Trust to enlist specialist support in business case development to undertake workshops with key Trust experts in the Trust’s ePCR Business Case Task & Finish Group, to undertake the detailed work of identifying and testing the shortlisted options at OBC stage.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
1.3.6 Below is an economic table produced in accordance with the appraisal methodology as set out in the Treasury Green Book: A Guide to Investment Appraisal in the Public Sector and the Welsh Government Better Business Cases Guidance.
Undiscounted (£) Net Present Cost (Value) (£) Option Capital £9,943.89 9,341.97 Revenue/ current £2,830.66 2,602.93 Risk retained Optimism bias Total costs £12,774.55 £11,944.90 Less cash releasing benefits Costs net cash savings Non-cash releasing benefits Total £12,774.55 £11,944.90
1.4 The Commercial Case
Procurement strategy
1.4.1 The Trust’s procurement function is provided by North Wales Shared Service Partnership (NWSSP) Procurement Services. The Trust has engaged with a procurement expert in the production of this SOC and will continue to do so through the OBC, FBC and procurement process.
1.4.2 The value for the supply and maintenance of an ePCR solution for the Trust is above the EU regulation threshold. The Trust has the options to undertake a full EU procurement exercise or utilise existing NHS procurement frameworks available.
1.4.3 The route which the Trust takes will depend upon the identification of a preferred option and whether the products and services in the preferred option can be procured from existing frameworks or not.
Required services
1.4.4 The Trust requires a system to be used on mobile devices to allow ambulance staff to record patient data electronically, fully replacing the current digital pen system. The mobile device will use a mobile communications bearer to send/receive data and interact with other systems.
1.4.5 The Trust’s required services include the following areas. At this early SOC stage, this should not be taken as a definitive list: ePCR software and licences ePCR hardware ePCR interfaces Server software and licences Server hardware Server interfaces Integration services
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Vehicle fitting services System viewers Reporting system Training System Upgrades System support – first and second line System security and governance Project management Project assurance
Potential for risk transfer and potential payment mechanisms
1.4.6 The potential for risk transfer and payment mechanisms is dependent upon the preferred solution. Subject to the endorsement of this SOC, the Trust will secure expert support to appraise the options available to us in the current market place to reach a preferred solution. Consideration of risk transfer and payment mechanisms will be undertaken during this process.
1.5 The Financial Case
Summary of financial appraisal
1.5.1 The anticipated payment stream for the project over its intended life span over the five years of the expected lifetime of the contract is as follows:
Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total £000 £000 £000 £000 £000 £000 £000 £000 Preferred way forward Capital 137.93 8,014.42 338.87 200.93 2,949.00 63.00 63.00 11,629.22 Revenue - 1,434.03 492.57 492.57 492.57 492.57 492.57 3,896.88 TOTAL 137.93 9,448.45 831.44 693.50 3,441.57 555.57 555.57 15,526.10 Funded by Existing - - 128.75 128.75 128.75 128.75 128.75 643.75 Additional 137.93 9,448.45 702.69 564.75 3,312.82 426.82 426.82 14,882.35 TOTAL 137.93 9,448.45 831.44 693.50 3,441.57 555.57 555.57 15,526.10
Overall affordability and balance sheet treatment
1.5.2 At this stage, the impact on the Trust’s balance sheet has not been calculated, this will be done as part of the OBC process.
1.6 The Management Case
Project management arrangements
1.6.1 The proposed implementation of an ePCR solution will be a significant investment and digital advancement that will require professional management by a dedicated, qualified and experienced team to ensure successful delivery and realisation of benefits.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
1.6.2 The scheme is an integral part of the Trust’s Integrated Medium Term Plan (IMTP), which comprises of a portfolio of strategic actions underpinned by local delivery plans.
1.6.3 The scope and complexity of this project will require a proven project management methodology to be utilised. The Trust will require the project manager to utilise the PRINCE2 methodology. This is in line with the Trust’s draft Programme & Project Management Framework, the development of which is being led by our Planning & Performance Directorate.
1.6.4 On endorsement of the SOC, the Trust will appoint a formal project board who will operate under the responsibility and governance arrangements outlined in PRINCE2.
Gateway review arrangements
1.6.5 Subject to the endorsement of this SOC, the Trust will commit to having gateway arrangements in place which will be documented in the OBC.
1.7 Recommendation
1.7.1 It is recommended that the Trust Board supports the endorsement of this SOC to be submitted to Welsh Government for endorsement.
1.7.2 On endorsement from the Trust Board, it is recommended that the Welsh Government endorse this SOC. This will enable the Trust to engage with specialist support, in business case development, to develop the SOC with more detail to create an OBC for consideration through the same channels.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Strategic Case
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case 2. The Strategic Case
2.1 Introduction
2.1.1 This Strategic Outline Case (SOC) is written in support of funding for the Welsh Ambulance Services NHS Trust (the Trust) procurement of an electronic Patient Clinical Records (ePCR) solution to replace the interim Digital Pen system contract which is due to expire on 31 March 2021.
2.1.2 The scope of an ePCR solution can vary significantly from a standalone simple electronic form to capture a Patient Clinical Record electronically to a fully integrated solution in which an ePCR is one piece of information in a wider system of related information regarding an incident.
2.1.3 This SOC aims to explore the strategic case for change, our business drivers, investment objectives and initial identification of the options available for the Trust to explore further.
Overview of the Business Case Development Process
2.1.4 The business planning process for the scoping (SOC), planning (OBC) and procurement (FBC) of a scheme is an iterative exercise. Therefore, it follows that whilst some sections of the cases using the Five Case Model may look remarkably similar, the level of detail required will vary significantly over the developmental phases of a business case.
2.1.5 The Welsh Government guidance is provided in Departmental Capital Investment Manuals, along with the Treasury Green Book: A Guide to Investment Appraisal in the Public Sector.
2.1.6 The business case development process for a scheme is a single document, developed over time, in four distinct phases. Detailed guidance on the completion of the Welsh Government template is set out in Public Sector Business Cases using the Five Case Model: a Toolkit, published by the HFMA and in HM Treasury a ‘Guide to Developing the Project Business Case’, published in 2018.
2.1.7 The distinct phases of business case development are:
Stage 0 – Business planning Phase 0 – determining the strategic context (Strategic Outline Plan – SOP) Step 1: ascertaining strategic fit Gate O: strategic fit
Stage 1 – Scoping Phase 1 – preparing the Strategic Outline Case (SOC) Step 2: making the case for change Step 3: exploring the preferred way forward Gate 1: business justification
Stage 2 – Planning Phase 2 – preparing the Outline Business Case (OBC) Step 4: determining potential VFM Step 5: preparing for the potential deal Step 6: ascertaining affordability and funding requirement Step 7: planning for successful delivery Gate 2: procurement strategy
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Stage 3 – Procurement Phase 3 – preparing the Full Business Case (FBC) Step 8: procuring the VFM solution Step 9: contracting for the deal Step 10: ensuring successful delivery Gate 3: investment decision
Stage 4 – Implementation Gate 4: ‘Go Live’
Stage 5 – Evaluation Gate 5: benefits realisation
Structure and Content of the Document
2.1.8 This document provides a Strategic Outline Case (SOC), in support of an investment in ePCR which has been identified as a requirement within the Trust’s Integrated Medium Term Plan.
2.1.9 The main purpose of this SOC is to establish the need for investment; to identify the main options for service delivery and to provide management with a recommended way forward for further analysis.
2.1.10 In practice, this entails building on the Trust’s strategy documents to make the case for change within the strategic case; beginning to identify the long list of options within the economic case; and recommending a preferred way forward, together with indicative costs, for much further analysis within an OBC
2.1.11 This SOC had been prepared in accordance with best practice guidance provided in HM Treasury’s Green Book.
2.1.12 The approved format is the Five Case Model, which comprises of the following key components:
the strategic case section, which sets out the strategic context and the case for change, together with the supporting investment objectives for the project; the economic case section, which demonstrates that the NHS Wales has selected the choice for investment which best meets the existing and future needs of the service and is likely to optimise value for money (VFM); the commercial case section, which outlines what the proposed deal might look like. the financial case section, which highlights likely funding and affordability issues and the potential balance sheet treatment of the project; the management case section, which demonstrates that the scheme is achievable and can be successfully delivered to cost, time and quality in accordance with accepted best practice.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.2 Organisational Overview (Part A: The strategic context)
2.2.1 The Trust was established in 1998, our services cover over 20,640 km and we serve a population of over three million people. Our diverse area encompasses a diversity of challenging urban, costal and rural landscape.
2.2.2 We answered 540,891 999 calls in 2017/18, which was significantly higher than the previous year’s figure of 486,085. That translated into 479,444 incidents. Our Non- Emergency Patient Transport Service (NEPTS) made 787,666 patient journeys during the year and NHS Direct Wales dealt with 301,640 calls, with 3,871,348 visits to its website.
2.2.3 The 111 service, which currently operates in Swansea, Bridgend, Neath Port Talbot and Carmarthenshire brings together the services of NHS Direct Wales and the GP out-of- hours service, dealt with 225,757 calls.
2.2.4 Our dedicated staff are our biggest asset, and our 17/18 Annual Report shows that we employ 3,059 people in a wide range of clinical and non-clinical roles.
2.2.5 We provide a range of services including: Emergency Medical Services 111 Services Doctor’s urgent admissions NHS Direct Wales Medical cover at large events Hospital transfers Non-Emergency Patient Transport Services Emergency Planning
2.2.6 We operate from over 90 ambulance stations, three control centres, three regional offices and five vehicle workshops. We also have our own National Training College to ensure our staff are appropriately trained and receive regular professional development.
2.2.7 In 2016/17 we worked with our staff and Board to develop our strategic aims which are: To deliver value, innovation and efficiency across the organisation; To build even stronger partnerships with staff, patients, the wider public and our stakeholders; To ensure service delivery excellence and further improve the services we provide to patients; Our staff are fantastic. We must ensure that they are continually able to be their best; To ensure all our leaders are vibrant, compassionate leaders that help create a compassionate caring culture.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.3 National Strategic Context
Informed Health and Care: A Digital Health and Social Care Strategy for Wales
2.3.1 This Welsh Government strategy document sets out the Government’s ambition to build on the progress they have already made and transform how the people of Wales, citizens and staff, embrace modern information technology and digital tools to deliver safer, more efficient and joined-up health and social care services to improve outcomes and experiences of patients and service users.
2.3.2 The strategy sets out that in the future, ‘all emergency ambulance staff will use a tablet device which will allow them to call up the patient’s summary health record at the scene. Key information such as diabetes, allergies, recent prescriptions, medical history and support from family and friends will help paramedics make key decisions on the best care for each patient, and whether they need to be admitted to hospital, remain at home or access services in their local community.’
Parliamentary Review
2.3.3 The Parliamentary Review of Health and Social Care in Wales final report was published on 16 January 2018. The report made 10 key recommendations around themes of a unified vision of seamless health and care services in Wales and a focus on maximising value through application of four aims of: Improving the health and wellbeing of the population; Improving the experience and quality of care for individuals and their families; Improving the wellbeing and engagement of the workforce; Increasing the value achieved from the resources that are invested in services.
Prosperity for All
2.3.4 In September 2017, the Welsh Government published its national strategy ‘Prosperity for All’. The strategy is designed to drive integration and collaboration across the Welsh public sector and put people at the heart of improved service delivery.
2.3.5 The strategy sets out a vision and actions covering each of the key themes – prosperous and secure, healthy and active, ambitious and learning and united and connected.
2.3.6 It also identifies five priority areas – early years, housing, social care, mental health and skills, which have the potential to make the greatest contribution to long term prosperity and well-being.
2.3.7 An ePCR solution will enable the Trust to share digital clinical records with other healthcare providers along the patient’s journey to improve their experience and outcomes.
A Healthier Wales
2.3.8 The Welsh Government’s Plan for health and social care in Wales outlines five main ways that are intended to change health and social care in Wales:
The health and social care system in Wales will work together so that people will not notice when they are provided with services from different organisations. Part of this will be to have a single digital record for each patient;
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Services will be shifted from hospitals into communities with more services to prevent illness with early detection; We will get better at measuring what really matters to people to work out which treatment and services work well and which need to be improved; We will make Wales a great place to work in health and invest in technology to support care; We will make our services work as a single system across the country.
Prudent Health Care
2.3.9 At the Welsh NHS confederation conference in January 2015, the Minister for Health and Social Services endorsed the prudent healthcare principles proposed by the independent Bevan Commission.
2.3.10 Below are the final four principles set out by The Bevan Commission: Achieve health and wellbeing with the public, patients and professionals as equal partners through co-production; Care for those with the greatest health need first, making the most effective use of all skills and resources; Do only what is needed, no more, no less; and do no harm. Reduce inappropriate variation using evidence based practices consistently and transparently.
Why electronic Patient Clinical Records is linked to these external strategies
2.3.11 In order to support the integration of organisations and services into a single system across Wales, the Trust will be required to share clinical information with partner organisations and support the creation of a single electronic patient record.
2.3.12 The Trust must be able to have access to our own accurate clinical data quickly to review the clinical care that we are providing. We can then identify best practice and learning to improve our performance against our clinical indicators which will ultimately improve the clinical outcomes for our patients.
2.3.13 Having access to accurate clinical data quickly will enable the Trust to make decisions regarding the clinical services that we provide in order to support the principles of Prudent Healthcare. This can be done through: Improving the continuity of care for patients; Linking data to provide greater information; Enabling patient outcome information to be available.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.4 The Trust’s business strategy
Integrated Medium Term Plan (IMTP)
2.4.1 The Trust’s business strategy in relation to ePCR is in our IMTP for 2018/19 – 2020/21, that has been approved by Welsh Government.
2.4.2 We are transitioning from a traditional model of time-based ambulance services to one which is at the forefront of clinical ambulance services worldwide.
2.4.3 We have already established ourselves as a global leader with our clinical model, which was introduced as a pilot in October 2015 and subsequently adopted permanently in early 2017, but we are now on the cusp of a much bigger cultural and system change which, we believe, has the potential to make a fundamental difference to the landscape of unscheduled and scheduled care services over the next 10 years.
2.4.4 Our IMTP marks the preliminary year of our next phase of development, with an absolute focus on the needs of the people we serve, both now and in the future.
2.4.5 During 2017/18 we made significant strides in positioning ourselves as a system leader across NHS Wales, influencing policy through our contributions to a number of Welsh Government consultations and Assembly committees, while actively delivering change and improvement at the frontline of care delivery through developments like those in community paramedic schemes, hear and treat and multi-agency working.
2.4.6 We have also begun to understand more fully the impact of our clinical response model, recognising that, working with our commissioners, we need to keep its operation under regular review, especially given the pressures placed upon the unscheduled care system by consistently growing demands for services.
2.4.7 While our performance in meeting our target for Red calls has been consistently good, we recognise that our performance in the Amber category needs to be reviewed to understand what we can do, working within our organisation and across the wider unscheduled care system, to improve the experience for patients, some of whom currently wait longer than we would like.
2.4.8 With changes in our operational and clinical leadership structures in 2017/18, we have taken steps to structure our organisation in a way that is fit for the future and allows us to further develop our twin ambitions of being a clinically-led and operationally effective service.
The ePCR Ambitions in our IMTP
2.4.9 The Trust currently uses digital pen technology to complete PCRs for the patients that all of our Emergency Medical Services staff attend. This technology has delivered considerable benefits compared to the historical paper based process, however this was implemented as an interim solution. Looking to the future, and in line with the emerging ideas from developing our Long Term Strategic Framework, we want to develop a more innovative and effective electronic solution to capture and record clinical data and information that will enable us to further demonstrate and improve the quality of care we provide to our patients.
2.4.10 The Trust’s strategy is to involve key stakeholders from across the organisation, including Operations, Health Informatics, Clinical Audit, Fleet and Information Communications Technology and will also engage closely with other health partners (including NHS Wales
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Information Service and Welsh Government) and wider organisations to support the development of an ePCR solution. This will ensure that we identify a ‘preferred’ solution that is fit for purpose, user friendly, delivers value for money and aligns with the strategic direction set out in the Welsh Government’s Digital Health & Social Care Strategy for Wales and associated work streams.
2.4.11 In our strategy, we have identified a number of opportunities and potential functionality of the ePCR solution, including:
Linking the ePCR to the vehicle dispatch system to pre-populate incident information; Ensuring there is a simple and intuitive completion methodology, to minimise time completing records, thus maximising time spent caring for patients; Providing clear prompts to the clinician to complete specific fields aligned to the patients presenting complaint; Ensuring compliance with clinical indicator metrics by having mandatory fields; Ensuring that the ePCR solution has capability to link other data (CAD records, vehicle telematics data, PCR, cardiac monitoring and other sources such as body-cam footage if introduced in the future) relating to an incident into one data file per incident.
2.4.12 Whilst we undertake this strategic action to develop a business case for investment in an ePCR solution, we continue to utilise and enhance the digital pen technology.
The Health Informatics Strategy within our IMTP
2.4.13 Whilst our Health Informatics’ priorities are dynamic and fluid, the Trust has committed to a number of areas that we will focus on during the next few years. One of these areas is to support the delivery of the Trust’s ePCR ambitions. This will enable us to:
Meet the requirements set out as part of the Trust’s long term digital innovation and transformation programme. Support the requirements of the Welsh Government’s strategic objective for improvement and innovation with better use of data and information to improve decision making, plan service changes and drive improvement in quality and performance. Harness the local requirements of the ‘Informed Health and Care: A Digital Health and Social Care Strategy for Wales’. Ensure local digital advances and innovation by supporting the information requirements of the ‘Once for Wales’ technical platform.
2.4.14 The ePCR solution will contribute to the expansion of our robust information framework with the appropriate governance, to allow stakeholders to get the clinical information they require, in a timely manner to make the most effective decisions.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
The Information Communication & Technology (ICT) Strategy within our IMTP
2.4.15 The Trust’s ICT Department will play a key role in supporting the development of the Trust’s long term digital innovation and transformation strategy, ensuring it aligns with national developments and programmes and wider Welsh Government and NHS Wales Strategy. In this spirit, our ICT work is framed within the four key themes of the Strategy: Information for You; Improvement and Innovation; Supporting Professionals; and Planned Future.
2.4.16 The Trust has committed our ICT function to work with corporate departments and programmes within the Trust to improve or replace operational information systems, while ensuring they meet the needs of the Trust and, as far as possible, comply with national standards. We will ensure that systems are optimised for mobile access, thereby providing access to information for operational staff wherever care is being delivered.
2.4.17 The 6 key priority areas for our ICT are:
Implementation of the new CAD (Phase 1); Continued preparation and mobilisation for the replacement of Airwave services through the national ESMCP and ARP programmes; Continued operation and support for the national 111 pathfinder along with the leading the national procurement of a replacement system; Review ePCR capability and its suitability to replace the Trust current digital pen system in the future. In the interim progress with digital pens further enhancement and capability review. The Trust is committed to the implementation of the SNOMED- CT to align with organisations across NHS Wales. The initial area for action will revolve around the project to implement a Trust wide digital ePCR solution. We will also look at other clinical information held within the Trust and whether SNOMED-CT can be implemented as a coding structure; Implement the pilot mobile device solution for staff ensuring efficient and effective communications and access to appropriate clinical information; Provide access for clinicians in the CCC to the master patient index (e MPI) and individual health records (IHR) as well as investigating options to provide Trust information into national repositories, such as Welsh Clinical Records Service (WCRS) and national systems such as Welsh Emergency Department System (WEDS) and Welsh Community Care Information System (WCCIS).
2.4.18 To date we have:
completed the successful implementation of the C3 Computer Aided Dispatch across the Trust; continued our preparatory works to replace the Airwave services, actively working with the Welsh Government, Airwave Replacement Programme and Joint Emergency Services Group to ensure the Trust is aligned to the national rollout plans, both operationally and technically; continued to support the 111 pathfinder and its extension into other health board areas. We have continued to play an active role in the procurement of the new 111 system and have seconded Trust staff into the programme to provide additional support;
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
commenced the roll-out of the mobile devices with tablets devices issued to an initial cohort of staff. We have also commenced the roll-out of Wi-Fi equipment to 30 EMS vehicles that can be used by staff to access Trust information systems when away from the bases; We have worked with NHS Wales Information Service (NWIS) to ensure that the governance and audit is in place and robust. We are waiting on the release of the next Welsh Clinical Portal version to progress access to the GP Summary Record and WCRS. We are in dialogue with NWIS and health boards to identify early opportunities to access the WCCIS for community care information from both the clinical desk and NHSDW/111.
Our Ambulance Quality Indicators
2.4.19 The Trust’s Emergency Medical Services are commissioned by the seven Local Health Boards on behalf of the people of Wales though the EASC. EASC has developed a set of Ambulance Quality Indicators (AQIs) to monitor and improve ambulance services performance across the 5 Step Ambulance Care Pathway. The AQIs are published every quarter. The clinical indicator data for the AQI submission is currently reliant upon digital patient clinical record data.
Figure 1: 5 Step Ambulance Care Pathway
2.4.20 The Quality Indicators within Step 4 of the Ambulance Care Pathway, ‘Give Me Treatment’, are designed to report on treatment given by ambulance clinicians before a patient reaches hospital. This is because this treatment is a major factor in the chances of a patient’s survival and recovery.
2.4.21 Ambulance clinicians use packages of care, assessment and treatment known as care bundles for certain conditions. Care bundles are a series of assessments, treatments and actions that are clinically recognised to improve a patient’s outcome and experience.
2.4.22 EASC currently collect performance against seven key clinical indicators for cardiac arrests, strokes, heart attacks (called STEMI), fractured hips (known as neck of femur injuries), febrile convulsion, sepsis and hypoglycaemia.
2.4.23 Clinical indicator information is currently gained from PCRs completed by staff using their digital pens. Further Ambulance Quality Indicators are under development. The implementation of an ePCR solution will support the timely collection and reporting of clinical Quality Indicator information.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.5 Investment objectives (Part B: The case for change)
2.5.1 The following key investment objectives have been identified with the Trust’s ePCR Business Case Task & Finish Group:
To implement a patient clinical records solution to ensure business continuity following 31 March 2021. To improve the quality, timeliness, audit and analysis of clinical data; To improve clinical outcomes and experience for patients and staff; To bring the Trust to the forefront of pre-hospital clinical care to make a larger contribution to the wider economy.
2.5.2 IO1: To implement a patient clinical records solution to ensure business continuity following 31 March 2021.
Key Current Challenges Proposed Solutions Procurement Rules: the Trust has extended its The Trust must undertake a procurement exercise original digital pen contract for 3 years from April to put alternative arrangements in place before 31 2018 to March 2021. Current procurement rules March 2021 to ensure business continuity. do not allow for further extension of this contract. Funding: The original digital pen contract and extension of the contract were funded from Welsh Government capital investment. The Trust does The Trust obtains funding for a longer term not have a long term funding arrangement for the sustainable solution. provision of capturing, and storing electronic patient clinical records.
2.5.3 IO2: To improve the quality, timeliness, audit and analysis of clinical data;
Key Current Challenges Proposed Solutions A new more effective digital solution with faster, Effectiveness relies on human intervention. The direct uploading of data without the need for a current digital pen system relies on the pen being manual docking process. docked to upload information to the server, Reduced time from record creation to being creating a risk of delays in data uploads and available for clinical audit. missing data from undocked pens. Increase accuracy of electronic records. There is a lag in availability of clinical data during A new digital solution will provide near real time the validation and cleansing process. access to data. Significantly less data validation required due to Poor efficiency due to significant data validation: specific electronic fields to improve data quality. The current solution has a high data validation Investment in data input would change to requirement. The Trust employs 8 data input investment in data analysis, clinical audit and clerks to undertake validation. clinical indicator reporting, to create information to improve clinical care provision. Cost is impacted by the need to purchase paper Expenditure on paper forms wold be for back up based Microdot pattern forms. only and not for the primary solution. Microdot pattern forms have a number of quality Improved electronic form completion with system issues associated with them including poor measures in place to reduce risk of poor data legibility of the free text in the forms that are collection. completed and uploaded. Lack of availability of digital pens: In July 18, the Trust had unfulfilled requests for No reliance on a digital pen. 140+ new digital pens to replace faulty pens, Reliable and sustainable hardware and software replace lost pens or for new staff. This was a solution. consequence of supplier issues with the new model of digital pen which prevented its release.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
200 new pens have been returned to supplier as they did not pass testing. Regular reliance on paper back-up PCRs: where Reduction in reliance on manual paper fall-back digital pens are not available, clinicians are procedures. utilising packs of back up paper PCRs as they have
no alternative. These are scanned into the system Reduction in number of clinical records kept as and as an image, limiting automated data digital images only by the Trust. collection. Caldecott compliance to storage of paper clinical Reduction in paper records created reduction of records creates a risk to the Trust. risk of non-compliance. Risk of system failure: there is a risk that the Procurement of a proven stable ePCR platform deterioration of the service that the Trust are from an experienced supplier with a good being provided with will result in the failure of the reputation for service delivery. digital pen system in areas with no digital pen Reduction in reported issues associated with the replacements available. system. New device with camera to put photograph directly Clinical staff do not have a Trust device to enable into an ePCR e.g. to show a wound before it has them to photograph at scene. been dressed at scene or to show the patients mechanism of injury at a road traffic collision. Improved service by utilising ePCR software in the Clinical Desk staff providing hear and treat service Clinical Contact Centres for hear and treat in the Clinical Contact Centres do not utilise a PCR. patients.
2.5.4 IO3: improve clinical outcomes and experience for patients and staff;
Key Current Challenges Proposed Solutions The ePCR solution could be integrated/available to It is very difficult for the Trust to report on clinical external systems to enable the Trust to join up outcomes as our digital pen system does not individual patient records and access outcome interface with hospital systems for data collection. data. Measurable data sharing and/or integration. The ePCR solution could be integrated/shared with key areas that would benefit from having access to Evidence of poor continuity of care and record the ePCR information prior to the patient’s arrival transfer from pre-hospital care to continuing care. at hospital. E.g. sharing live data with Coronary Care Centres. The ePCR solution could have functionality to The current system does not allow sharing of PCR share clinical records quickly and securely to data with specialist hospital clinicians from the support specialist advice being provided in the pre- scene which would aid more complex decision hospital environment. E.g. sharing live data with making. Cardiac Consultants at hospitals. The current system does not enable ambulance A new system could provide the opportunity to clinicians to have access to any previous patient send ambulance clinicians a copy of a patient’s summary records before their arrival at scene. summary record containing basic information such They are only provided with information gathered as allergens, or medical information to support the by the 999 call taker. clinician’s decision making at scene. Clinicians have limited access to electronic Clinical decision making software can be supportive clinical decision making tools or integrated into the ePCR software for support on electronic JRCALC guidelines at scene. scene. The existing digital pen system does not allow for Digital clinical data will be available near real time any live clinical data to be shared with other for sharing. relevant clinical partners. Unique identifiers from the Ambulance CAD are Auto-populated unique identifiers such as NHS not inputted into the hospital systems resulting in numbers in new system could enable data links to difficulties with measuring patient outcomes. measure outcomes. Ability to integrate ePCR into other systems. E.g. with an NHS number look up, the Trust could No integration into any other systems obtain a patient’s summary record or previous 999 attendances to support the decision making of the attending clinician.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Early identification of sub-standard care is a Provide near real time reporting of individual challenge. clinical practice. The system is limited in its ability to provide A new digital system will have a wider scope for information for development of paramedic reporting than providing collective data to report practice. on clinical AQIs. The current paper-based system has no clinical ePCR could include functionality for clinical supportive software, warnings or advance supportive software, triage software and directives. medication dose information. The current system is set up for reporting on collective clinical AQIs, it does not provide The proposed system should allow clinicians to clinicians with the opportunity run reports on their carry out clinical audit and support their own individual performance and therefore reduces personal clinical development. their ability to identify areas for future clinical development. The Trust is unable to provide appropriate The Trust will have the evidence of the information assurance with regards to clinical efficacy, leaving available and decision making process of the the Trust vulnerable to claims of clinical clinician at scene to support investigations into negligence. alleged clinical negligence. It is not possible to transmit clinical data to a ePCR could allow transmission of information to a patient’s GP or other healthcare professional for patients’ GP or other healthcare professional who advice or follow up. will be continuing their care. Clinical staff may be unaware of local pathways in ePCR software can include a directory of available the area that they are working in, leading to pathways based on the condition of the patient. admissions to emergency departments being This could avoid unnecessary admissions to undertaken unnecessarily. emergency departments.
2.5.5 IO4: To bring the Trust to the forefront of pre-hospital clinical care to make a larger contribution to the wider economy.
Key Current Challenges Proposed Solutions We cannot share digital clinical data with hospital emergency departments or specialist centres to New ePCR solution provides a platform to share support continuity of care and improved patient clinical data digitally in near real time. experience. New ePCR solution provides a platform to share We do not share digital PCRs with General clinical data digitally in near real time. Practitioners to support continuity of patient care ePCR software can be developed to look up and improved patient experience. patient’s GP from Welsh Demographics to send information to GPs. The Trust’s clinical information is not easily ePCR data is available near real time to provide accessible to support the wider health economy evidence for healthcare strategy in Wales healthcare strategy. ePCR data is available near real time to provide The Trust’s clinical information is not easily evidence for local authority strategy in Wales e.g. accessible to support social economic strategy set alcohol related incident locations in city centres by the local authorities. linked to licencing. Trust clinical staff are regularly called to attend Improved detail and quality of ePCR will lead to Coroners Court to provide evidence at inquest. reduction in requirement for staff to attend Coroners Court. Information sharing directly with the local Coroner Police attend the scene at a sudden death which could eliminated the need for police attendance to in certain circumstances can be extremely improve the family’s experience during a very distressing for the family. upsetting time. Raising a safeguarding issue for an adult or a child Safeguarding referrals can be developed and is a long manual process to complete a referral configured into ePCR software for much quicker and replicate information from the PCR form. digital referrals.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.6 Existing arrangements
Current Digital Pen System in Place
2.6.1 The Trust currently has a Digital Pen System in place. The technology empowers the traditional pen and paper process by turning traditional handwritten information into digital data with a digital pen and an image of the PCR.
2.6.2 As you write, the Digital Pen’s built-in camera automatically takes digital snapshots of the Microdot Patterned surface on the paper, enabling the pen’s image microprocessor to determine the exact position of the digital pen, and thereby accurately record what it writes or draws.
2.6.3 This information is combined with handwriting recognition capabilities to deliver editable digital text in the data validation software (the original PCR image cannot be changed).
2.6.4 The captured digital data is retained in the pen's memory and synchronized via USB once our staff are back at a computer with a digital pen docking cradle.
2.6.5 Data is routed to an application server for further processing. The application receiving the data extracts all information using an Application Programming Interface (API).
2.6.6 There are 4 components behind Anoto digital writing technology: the digital pen, the dot pattern, print and transfer of data.
Existing Contractual Arrangements in the Trust
2.6.7 In February 2013, the Trust completed a procurement exercise within the Government Procurement Services Framework available for PSN Services, Reference RM1498, Lot 6: Mobile Voice & Data, valid from 27th June 2012 to 26th June 2015. We awarded a contract to Vodafone Ltd for a proof of concept scheme in order for the Trust to evaluate the use of digital pens within our Emergency Medical Services (EMS) environment.
2.6.8 The aim of the proof of concept was to reduce the inefficiencies (cost and risk) associated with the Trust’s manual process for collecting, scanning and storing paper PCRs at the time, whilst improving clinical assurance and making a digital PCR available.
2.6.9 The proof of concept was successful and following submission of a business justification case, the Trust received capital monies from Welsh Government in the 2014/15 program, to roll out digital pens to all EMS staff.
2.6.10 In preparedness to support the Trust’s new Clinical Response Model piloted from October 2015, the Trust tendered using the same framework and in February 2015, awarded a three year contract for the provision of a digital pen system for all Wales to Vodafone Ltd for an Anoto Digital Pen System.
2.6.11 There was a subsequent period of software development, form development, user training and installation of new ICT equipment to support the use of the digital pens. The Trust went live with the digital pen system on 01 September 2015.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.6.12 The Trust’s digital pen system allows the capture of patient data using a digital pen and a printed unique form. The data captured is fed into a bespoke system where the data is validated, cleansed and analysed by the Trust’s Clinical Audit Department, prior to safe transfer to the Trust’s Data Warehouse. The system is utilised across the whole of the Trust’s EMS.
2.6.13 In December 2017, the Trust met with our suppliers to negotiate an extension to our contract which was due to end in March 2018. The contract extension would allow the Trust time to specify and procure a fully digital ePCR system.
2.6.14 The Trust explored an annual extension cost and a three year deal. The three year deal represents better value for money for the Trust. Capital funding was subsequently made available from Welsh Government to cover the majority of the three year contract costs. This enabled the Trust to sign a three-year extension deal with Vodafone Ltd, which will expire on 31 March 2021.
2.6.15 Existing Costs
Original Digipen contract Current Digipen contract Existing Costs (£) March 2015 April 2018 PCR Forms 1.2m @ 17.5p 1.5m @ 25.75p Capital (inc VAT) £1,082,332.20 £1,422,262.00 Duration of Contract 3 years 3 years
2.6.16 The Trust has extended our digital pen contract with our original supplier. Procurement rules do not allow any further extension of this contract beyond 31 March 2021. On 31 March 2021, the Trust’s digital pen service with Vodafone Ltd must be terminated.
Existing Arrangements in other Ambulance Services
2.6.17 Ambulance Services throughout the UK have been changing the way that operational staff record patient information utilising electronic forms and mobile computing devices. Many services have adopted or, are in the process of adopting, electronic patient records systems to support the provision of clinical care.
2.6.18 In April 2018, the Trust established a working group named the ePCR Business Case Task & Finish (T&F) Group. The group was established to develop a business case for the provision of an ePCR solution for the Trust to replace the digital pen system.
2.6.19 As part of the T&F Group’s remit, the group committed to reviewing good practice and learning adopted in ePCR solutions procured and utilised by other healthcare organisations.
2.6.20 The aim of this exploration was to identify and understand how other organisations have designed and adapted ePCR solutions to work in an ambulance service environment. The adoption of ePCR in ambulance services requires an element of business process re- engineering which was of particular interest to the group.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.6.21 The outcome of this exercise was to gather evidence from other ambulance services alongside other information sources, to support the development of a Trust User Requirement which will determine the specification requirement for the Trust’s ePCR solution. This approach has enabled the T&F Group to identify benefits, challenges and potential pitfalls of technical solutions, business process changes and lessons learned from the implementation and use of ePCRs in other UK NHS ambulance services.
2.6.22 A summary of the T&F Group ePCR arrangements findings from August 2018 is below:
Procurement Route Ambulance Service (AS) ePCR System in Place Available Now East Midlands AS Medusa Siren V4 Framework for ePCR East of England AS Medusa Framework for ePCR North East AS Safer Triage Systems Framework for ePCR West Midlands AS Safer Triage Systems Framework for ePCR Scottish AS Terrafix Framework for ePCR South Coast AS Ortivus MobiMed Smart Framework for ePCR South West AS Ortivus MobiMed Smart Framework for ePCR South East Coast AS Kainos Not on framework Yorkshire AS In house ePCR developed Not commercially available London AS Testing ipads with software Not on framework North West AS No ePCR on paper Not applicable
Swansea University Medical School - ERA Study
2.6.23 In 2016, Swansea University Medical School launched the Electronic Records in Ambulances (ERA) Research Study. The aim of this study was to examine the challenges, opportunities and workforce implications of Electronic Records in Ambulances.
2.6.24 The ERA Study was borne through an interest in how the introduction of ePCR can help emergency ambulance services with the shift to delivering more health care outside hospitals, where this is better for patients, by offering alternatives to transfer to the emergency department (ED).
2.6.25 The study conducted four in-depth case studies, one of which was with Welsh Ambulance Services NHS Trust. The results of the study is planned to be published in September 2018.
2.6.26 Preliminary summary findings shared at the Electronic Records in Ambulances (ERA) knowledge exchange workshop on Tuesday 3rd July 2018 in London include: Constant Change: organisations are transitioning from one system to another, one supplier to another. Software and hardware updates. To and fro – switching back to paper records; Digital Diversity: No standard hardware or software in use. Great variety in how (and whether) other tech and record systems were linked to the ePCR; Indirect Input: Some patient data can be fed straight into ePCR. But data entered by clinical staff is still sometimes written on a glove or notebook, or stored in the paramedic’s memory, before being entered into the ePCR;
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Data Dump: In most services, ePCR seem to act mainly as a store for data. As yet, there is limited evidence of their full potential being realised to transfer information, or support decision making or changes to patient care; The system is bigger than the service: to realise all the benefits of ePCR requires engagement with other parts of the local health economy – and dealing with variations between providers.
2.6.27 During visits to other ambulance services in August 2018, the Trust has found that since the ERA study in 2016, there have been significant developments in the provision of ePCR software and hardware in the market place.
2.6.28 The publication of the ERA study will provide the Trust with valuable learning from other ambulance services who have adopted early ePCR systems and worked with their software suppliers to develop the solutions that are available in the market place today.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.7 Business needs
2.7.1 Spending Objective 1: associated business needs
Spending Objective To implement a patient clinical records solution to ensure business continuity following 31 March 2021. Existing Arrangements Annoto Digital Pen contract in place until 31 March 2021. Procurement rules determine that this contract cannot be extended. Business needs (BN) BN1: The Trust requires an electronic solution for capturing and storing PCRs to ensure that we can continue to develop as a clinically led organisation.
BN2: Patient clinical data must be available quickly and accurately for access by staff and managers.
BN3: Patient clinical data must be available to report on our clinical Ambulance Quality Indicators to our commissioners (EASC) and to undertake clinical audits for assurance of the quality of clinical care provision and identification of learning.
BN4: Patient clinical data must be available for the investigation of concerns, clinical negligence claims and other investigations.
2.7.2 Spending objective 2: associated business needs
Spending Objective To improve the quality, timeliness, audit and analysis of clinical data. Existing Arrangements Data is collected by means of a digital pen system with a non-digital fall back mechanism in place of individually packaged paper PCRs. Business needs (BN) BN5: To eliminate the system failures that the Trust is facing with the digital pen system, associated with the new model of digital pen and the microdot patterned PCRs.
BN6: To reduce the requirement and cost of data validation and cleansing. The Trust currently employs eight data input clerks and two clinical data specialists to do this.
BN7: To eliminate the delay in availability of PCRs (currently due to the need to dock digital pens).
BN8: To improve the capability of the Trust to undertake clinical audit activities using timely information to verify and improve the quality of clinical care delivered.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.7.3 Spending objective 3: associated business needs
Spending Objective To improve clinical outcomes and experience for patients and staff. Existing Arrangements Digital patient records are utilised to report on clinical Ambulance Quality Indicators. Clinical Team Leaders have access to review PCRs and clinical indicator reports with their team online via the information portal. The Medical Directorate undertake mortality reviews using digital PCR data. Paper PCR is handed over with patient at hospital or to follow-on health care professional. Business needs (BN) BN9: To provide Trust clinicians with timely feedback/access to the clinical records they have created, to enable learning and improve delivery of care in line with the latest national clinical guidelines for pre-hospital care (JRCALC).
BN10: To expedite the sharing of electronic clinical information required for continuity of patient care e.g. handover at hospitals to improve experience and outcomes.
BN11: To utilise electronic clinical data, to provide the Trust’s new clinical leadership team with clinical evidence to improve the quality of care that our clinicians provide.
BN12: To have a mechanism for early identification of sub- standard care delivery.
2.7.4 Spending objective 4: associated business needs
Spending Objective To bring the Trust to the forefront of pre-hospital clinical care to make a larger contribution to the wider economy. Existing Arrangements Ambulance Quality Indicator information is reported to our Trust commissioners EASC on a quarterly basis to show compliance against clinical care bundles. The Clinical Audit & Effectiveness Team and other Trust clinicians undertake planned clinical audits as part of the annual clinical audit programme. Staff and managers obtain digital PCRs from clinical audit to conduct investigations into concerns and clinical negligence claims. Independent experts utilise digital PCRs from clinical audit to provide independent opinions on clinical care provided in clinical negligence and NHS Redress cases.
Business needs (BN) BN13: To contribute to the national public health agenda through the population based collation and timely analysis of demographic and clinical data from the whole of Wales.
BN14: To share clinical data with partner organisations to support the healthcare information requirements of the wider economy.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.8 Potential business scope and key service requirements
2.8.1 In relation to the above business needs, the table below describes the potential scope for investment, in terms of the required functionality and associated services.
1 2 3 4 5 Implement Implement Implement Do nothing Do minimum basic ePCR intermediate ePCR fully bespoke ePCR Revert to Re-procure a Replace the digital Replace the digital Replace the digital pen and digital pen pen system with pen system with pen system with paper PCRs system ePCR ePCR ePCR
Minimal integration Intermediate Maximum integration into the Trust’s CAD integration into the into the Trust’s CAD System only. Trust’s CAD System System, other key and other key technologies e.g. technologies in the cardiac monitoring vehicle e.g. cardiac device and external monitoring device. systems e.g. Welsh GP systems and hospital emergency department systems.
BN4 BN1 BN1 BN1 BN1 BN5 BN3 BN2 BN2 BN2 BN6 BN4 BN3 BN3 BN3 BN8 BN4 BN4 BN4 BN9 BN5 BN5 BN5 BN11 BN6 BN6 BN6 BN12 BN7 BN7 BN7 BN8 BN8 BN8 BN9 BN9 BN9 BN11 BN10 BN10 BN12 BN11 BN11 BN12 BN12 BN13 BN13 BN14 BN14 Table 1: Business Scope & Key Service Requirements
2.9 Main benefits criteria
2.9.1 Benefits in the appraisal of social value are classified as: Direct public sector benefits (to originating organisation) o Cash releasing benefits (CRB) o Monetisable non-cash releasing benefits (non-CRB) o Quantifiable but not readily monetisable benefits (QB) o Qualitative but not readily quantifiable benefits (Qual) Indirect public sector benefits (to other public sector organisations) o Cash releasing benefits (CRB) o Monetisable non-cash releasing benefits (non-CRB) o Quantifiable but not readily monetisable benefits (QB) o Qualitative but not readily quantifiable benefits (Qual) Wider benefits to UK society (e.g. households, individuals, businesses) o Monetisable, including cash benefits o Quantifiable but not readily monetisable benefits
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
o Qualitative but not readily quantifiable benefits
2.9.2 The table below details key benefits known at this stage and the measures that will be used to assess the progress against each benefit, this is linked to how benefits contribute to the overall investment objectives (IO1 – IO4).
2.9.3 On development of this SOC into an OBC, the Trust will explore and quantify the benefits associated with the ePCR solution.
Benefit Measure IO1 IO2 IO3 IO4
B01: Improved quality of clinical data Increased clinical audits in the Trust Reduced data validation Increased suite of clinical measures B02: Improved patient outcomes Evidence of improved clinical supervision New information available to staff B03: Improved experience for patients and patients and staff Staff and patient feedback B04: Improved clinical Increased clinical information flow communications to staff to staff via ePCR B05: Increased use of pathways or Reduction in conveyance to ED care at home for patients Referral to pathways B06: Improved access to patient Near real time access to ePCRs records and clinical information Demonstrated in business case and B07: Reduction in data validation costs measured post project Reduction in utilisation of paper B08: Improved security of patient data records B09: Improved opportunity for clinical Evidence of data sharing along the data sharing with other organisations patient’s care pathway B10: Reduction in requirement for staff Reduction in requests from Coroner to attend Coroners Court Table 2: Investment Objectives and Benefits Criteria
2.10 Main risks
2.10.1 The risks that follow provide a starting point for consideration in relation to service risks. Business risks will be identified separately by the Trust on a case by case basis. In this section, we have identified the key risks at the SOC stage of the business case.
2.10.2 Risk to business continuity: the Trust’s current digital pen contract is due to expire on 31 March 2021. There is no provision for a further extension of this contract under procurement rules.
2.10.3 Risk of no funding: the Trust has not identified a funding source for provision of digital patient clinical records beyond 31 March 2021.
2.10.4 Risk of lack of personnel resourcing: the Trust has not secured internal or external resources to support the implementation of a new ePCR solution.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
2.11 Constraints
The project is subject to the following known constraints:
2.11.1 The Trust’s Current Digital Pen Contract with Vodafone Ltd ends on 31st March 2021. The new solution must be implemented before this date to ensure business continuity.
2.11.2 The procurement of a new ePCR solution is constrained by the software and technology available in the marketplace in 2018/2019.
2.11.3 The West Midlands ePCR Procurement Framework is constrained to five suppliers. If the Trust’s preferred option falls outside the framework offering, then an OJEU procurement is required to be undertaken.
2.11.4 The Trust has commercial contracts in place for our EMS CAD system, Defibrillators and other devices that the ePCR solution must be able to integrate into.
2.12 Dependencies
2.12.1 The project is subject to the following known dependencies that will be carefully monitored and managed throughout the lifespan of the scheme.
2.12.2 The Trust must report on clinical Ambulance Quality Indicators on a quarterly basis. This data is collated by Health Informatics and Clinical Audit from digital PCR data that has been validated and cleansed.
2.12.3 The ePCR solution must consider the Trust’s staff devices schemes that are already in existence in the operational environment.
2.12.4 An ePCR system handover at hospital is reliant upon Health Board’s hospital emergency departments’ agreement to access electronic information (usually provided through a web based portal by the other UK ambulance service solutions in place).
2.12.5 The ePCR solution must also consider its future integration with the Emergency Services Network (ESN). ESN forms part of the Emergency Services Mobile Communications Programme (ESMCP), which will deliver a high speed mobile communications network that supports critical voice and data necessary to deliver the public safety requirements of the Emergency Services. ESMCP is seeking UK Government and developed administration approval for the Full Business Case and seeks to provide a more effective, robust and more affordable solution to that provided by Airwave or use of multiple commercial networks.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Economic Case
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case 3. The Economic Case
3.1 Introduction
3.1.1 In accordance with the Capital Investment Manual and requirements of HM Treasury’s Green Book (A Guide to Investment Appraisal in the Public Sector), this section of the SOC documents the wide range of options that have been considered in response to the potential scope identified within the strategic case.
3.2 Critical success factors (CSFs)
3.2.1 These are the attributes for successful delivery of the project, against which the initial assessment of the options for the delivery have been considered, alongside the spending objectives.
CF1 Strategic fit and operational need
3.2.2 The solution will improve the efficiency and effectiveness of current arrangements for data quality, timeliness, audit and analysis of patient clinical records;
3.2.3 The solution will enable patient clinical data to be available at the point of collection for the Trust’s Health Informatics Department and Clinical Audit Department to provide timely information required to our commissioners and to the rest of the Trust for multiple purposes i.e. clinical Ambulance Quality Indicator reporting, clinical audits, concerns/clinical negligence investigations etc.
3.2.4 The solution allows integration with the Trust’s digital communications projects and potential for integration into external systems for sharing of patient clinical information;
3.2.5 The solution enhances clinical operational performance rather than hinders it;
3.2.6 The solution will allow the Trust to proactively review and improve its standard of care to improve outcomes and experiences for patients and staff;
CF2 Potential value for money
3.2.7 The solution has the capability or potential capability to support on scene clinical practice with the additional provision of clinical decision making tools and JRCALC guidelines;
3.2.8 The scope and quality of the solution is deemed as good value, reducing the Trust’s current expenditure on data validation;
3.2.9 There are clear parameters for measuring system performance;
3.2.10 The solution cost is comparable to investment in digital record solutions made by other organisations across the United Kingdom, achieving economies of scale where possible;
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
CF3 Supplier capacity and capability
3.2.11 The solution must have evidence of reliability and have provision for new and replacement equipment should it be required as part of general management;
3.2.12 Ability for the solution to enable the Trust to provide timely clinical data for the collation of the Ambulance Quality Indicators for our commissioners EASC;
3.2.13 The service support from the supplier must be robust and effective, particularly in the event of system failures;
3.2.14 The accuracy of the data collected is high with a reduction in the current requirement for data validation and cleansing;
CF4 Potential affordability
3.2.15 The solution is within the appetite of the Welsh Government to attract capital support;
3.2.16 The solution has a revenue consequence that is predictable and sustainable for the Trust and its commissioners to afford with a low risk of potential hidden costs;
CF5 Potential achievability
3.2.17 The basic PCR part of the solution can be implemented before the constraint of the end of the digital pen contract on 31 March 2021;
3.2.18 There is an effective interface between the Trusts CAD and the solution for population of data;
3.2.19 The training for users of the solution is effective and the system is user friendly to enable the Trust to gain support for successful implementation from clinicians;
3.2.20 Transmission of data from the point of entry to other locations e.g. clinical audit or hospital emergency departments etc. is quick, seamless and effective;
3.2.21 The project management arrangements are robust with experienced project management committed for the full life-span of the project and subsequent handover of the product to a contract manager in business as usual;
3.3 The long-listed options
3.3.1 The long list of options for this investment was generated from information from the NHS frameworks available and exploration of solutions adopted by other UK ambulance services. This generated options within the following key categories of choice: Scoping options – choices in terms of coverage (the what) Service solution options – choices in terms of solution (the how) Service delivery options – choices in terms of delivery (the who) Implementation options – choices in terms of the delivery timescale Funding options – choices in terms of financing and funding
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
3.4 Scoping options
3.4.1 The choices for potential scope are driven by business needs and the strategic objectives at both national and local levels.
3.4.2 In accordance with the Treasury Green Book and Capital Investment Manual, the do nothing has been considered as a benchmark for potential value for money.
3.4.3 An infinite number of options and permutations are possible; however, within the broad scope outlined in the strategic case, the following options regarding the scope of integration have been identified:
Scope Options Option Main Advantages Main Disadvantages
SC01: Do nothing No digitisation, the business Significantly lower cost Revert to pen and paper PCRs needs are not met
Lower cost SC02: Do minimum Semi-digital only with no Standalone system Re-procure a digital pen system system integration Less complex to implement
SC03: Basic ePCR Basic ePCR solution to replace digital pen system with Less complex to implement Limited/less complex capability: as it is a standalone system system integration limits with one internal interface. data sharing. to integrate with Trust’s CAD system. SC04: Intermediate ePCR Intermediate ePCR solution to replace digital pen system with Integration into digital capability to: clinical devices provides Interfacing into clinical more direct automated data devices is more complex integrate into the Trust’s field completion for and requires software CAD System and other key handover at hospital or to development. technologies in the vehicle other healthcare e.g. cardiac monitoring professionals. device.
SC05: Bespoke ePCR Fully bespoke ePCR system to replace digital pen system with capability to: Significant clinical benefits Most complex and highest integrate into the Trust’s in terms of care, experience time and cost to integrate CAD System, other key and outcomes of clinicians into many systems across technologies e.g. cardiac having access to patient Wales. monitoring device and summary information at external systems e.g. Welsh scene. GP systems and hospital emergency department systems.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
3.5 Service solution options
3.5.1 The choices for potential solution are driven by new technologies, new services and new approaches and new ways of working, including business process re-engineering. In practice, these will range from services to how the estate of an organisation might be configured. Key considerations range from ‘what ways are there to do it?’ to ‘what processes could we use?’
3.5.2 In this section, we have considered the options for network, hardware and software. The majority of UK ambulance services have opted for devices docked in vehicles however, some ambulances services are procuring bespoke solutions which include individual issue tablets. The Trust will consider the details of our requirement for a device at the OBC stage, as affordability of software licences will have an impact on such a decision.
3.5.3 The Trust’s learning from visits to other ambulance services has identified that there is a significant difference in the scope of the software between solutions. This varies from software that replaces the traditional paper PCR with a basic electronic PCR form to much more developed systems that include clinical decision making tools, automated referral systems and automated sharing with other healthcare partners to enable improved continuity of care.
Service solution network options (N) Option Main Advantages Main Disadvantages GPRS coverage not as reliable N01: Single GPRS bearer GPRS is lower cost than as Airwave network coverage e.g. 1 SIM card in the ePCR Airwave GPRS is not as secure as device Airwave N02: Dual GPRS bearer GPRS is lower cost than GPRS coverage not as reliable e.g. 2 SIM cards from Airwave with 2 SIMs for as Airwave network coverage. different providers in the resilience in areas of poor GPRS is not as secure as device network coverage Airwave N03: Airwave then ESN as Airwave data too expensive Reliable network bearer currently Reliable and potentially cost No date for availability yet. N04: ESN network as bearer effective, secure network. Data costs are not yet known.
Service solution hardware options (HW) Option Main Advantages Main Disadvantages HW01: Purchase tablets and Supplier takes on risk and Higher cost than purchasing servers from ePCR supplier responsibility directly from manufacturer HW02: Purchase tablets and servers from another NHS The Trust have established The Trust is responsible for framework utilised by the suppliers hardware maintenance Trust HW03: Purchase tablets from The Trust have established The Trust do not have full another NHS framework and suppliers and data storage control of their data storage utilise external data storage responsibility is with supplier and must maintain tablets
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Service solution software options (SW)
Option Main Advantages Main Disadvantages High risk of losing system developer to another Bespoke solution to meet the organisation creating build SW01: build in house solution Trust’s needs and maintenance risks. Long timeframe for development and testing. SW02: procure off the shelf Proven solution Not bespoke to the Trust solution
SW03: develop off the shelf Proven solution made Longer timeframe for solution for the Trust bespoke for the Trust bespoke development.
SW04: outsource building of Bespoke system to meet the Expensive and time bespoke system for the Trust Trust’s needs. consuming to build.
Service solution software scope options (SS)
Option Main Advantages Main Disadvantages No integration into other SS01: basic electronic PCR Simple to design and replace systems, all data input form a paper PCR form manually
Pre-populated incident SS02: ePCR form with Limited integration into other information saves time in automated data from CAD systems form completion SS02 advantages plus: SS03: SS02 plus: Improved quality of clinical Increased software Automated information from data collected because it is development time and cost clinical monitoring systems on automated and not manually compared to SS02. the vehicle. entered. SS03 advantages plus: Ability for ambulance staff to complete electronic referrals SS04: SS03 plus: whilst on shift rather than The addition of electronic Increased software back at station. Trust forms e.g. Recognition development time and cost Improved referral rates and of Life Extinct Form and compared to SS03. improved information to Safeguarding Referral Form. external organisations e.g. Coroner, Police and Local Authority SS05: SS04 plus: SS04 advantages plus: The additional of clinical Provides clinical decision Increased software decision making tools and making support for staff on development time and cost clinical guidelines built into scene e.g. with pathway compared to SS04. the software. referral or medication dosage. SS06: SS05 plus: SS05 advantage plus: Increased software Facility to share every ePCR The software provides an development time and cost record with the relevant automatic mechanism to compared to SS05. healthcare provider share information e.g. some Dependent upon external automatically to improve the services share every databases of information e.g. patient’s experience and the attendance with a patient’s Welsh Demographics Service continuity of their care. GP for continuity of care. GP information.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
3.6 Service delivery options
3.6.1 The choices for service delivery are driven by the availability of service providers. In practice, these will range from within the organisation (in-house), to outsourcing, to use of the public sector as opposed to the private sector, or some combination of each category.
Service delivery options (SD) Option Main Advantages Main Disadvantages SD01: Current service model Multiple commercial with supplier support contracts to manage makes The Trust in control of i.e. the Trust ICT front the it more complex. service solution with support from a Higher reliance on in-house single supplier. resources to manage it. SD02: Multi supplier solution managed by the Trust Multiple commercial e.g. the Trust ICT continue to contracts to manage makes Shared risk and reduced front the solution with multiple it more complex. managed service costs suppliers support for differing Higher reliance on in-house parts of the ePCR support resources to manage it. contract
All risk held by supplier with SD03: Fully managed service less complexity in one Higher cost outsourced to supplier commercial contract.
3.7 Implementation options
3.7.1 The choices for implementation are driven by the ability of the supply side to produce the required products and services, VFM, affordability and service need. In practice, these will range from the phasing of the solution over time, to the modular, incremental introduction of services
Implementation options (IMP) Option Main Advantages Main Disadvantages Very high risk – higher resource cost as significantly large go live team required IMP01: National big bang Quickest implementation to support go live implementation Capital approval required much earlier as longer planning phase required. High risk – high resource IMP02: Phased regional Moderate implementation cost to go live as larger go Implementation live teams required More controlled implementation with full IMP03: Phased Health Board Longer go-live with smaller project management control area implementation go live team & lessons learned from each area to improve
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
3.8 Funding options
3.8.1 The choices for financing the scheme (public versus private) and funding (central versus local) will be driven by the availability of capital and revenue, potential VFM, and the effectiveness or relevance/ appropriateness of funding sources.
Funding Options (FD) Option Main Advantages Main Disadvantages
Easier to access FD01: 100% public funding Availability of capital Aligned to NHS strategy Not aligned to national More opportunities to FD02: Leasing arrangement strategy access capital Revenue required.
3.9 The long list: inclusions and exclusions
3.9.1 The long list has identified a wide range of possible options. Subject to endorsement of this SOC, the Trust will continue to appraise each of the long list options against the investment objectives and critical success factors.
3.10 The Risk
3.10.1 The Trust recognise that there will be a number of risks associated with each of the options and further work will be required to develop this section at this early stage, we have identified the following key risks within our strategic case:
3.10.2 Risk to business continuity: the Trust’s current digital pen contract is due to expire on 31 March 2021. There is no provision for a further extension of this contract under procurement rules.
3.10.3 Risk of no funding: the Trust has not identified a funding source for provision of digital patient clinical records beyond 31 March 2021.
3.10.4 Risk of lack of personnel resourcing: the Trust has not secured internal or external resources to support the implementation of a new ePCR solution.
3.11 The options appraisal
3.11.1 At this SOC stage, the Trust has not appraised the ‘possible’ and ‘preferred’ options available. The Trust met with Welsh Government on 12 August 2018 and agreed that in terms of the SOC content, this needs to be focused on the strategic case – the case for change. Whilst the SOC considers the remaining elements of the five cases, these are brought out in more detail in the OBC and FBC.
3.11.2 Below is an economic table produced in accordance with the appraisal methodology as set out in the Treasury Green Book: A Guide to Investment Appraisal in the Public Sector and the Welsh Government Better Business Cases Guidance.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Undiscounted (£) Net Present Cost (Value) (£) Option – Capital £9,943.89 9,341.97 Revenue/ current £2,830.66 2,602.93 Risk retained Optimism bias Total costs £12,774.55 £11,944.90 Less cash releasing benefits Costs net cash savings Non-cash releasing benefits Total £12,774.55 £11,944.90
3.11.3 The SOC has considered investment objectives and the Trust has begun to make an assessment of what is core, desirable and optional functionality.
3.11.4 Subject to endorsement of the SOC, it is the intention of the Trust to enlist specialist support to undertake workshops with key Trust experts in the Trust’s ePCR Business Case Task & Finish Group, to undertake the detailed work of identifying and testing the shortlisted options at OBC stage.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Commercial Case
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case 4. The Commercial Case
4.1 Introduction
4.1.1 This section of the SOC outlines the proposed deal in relation to the preferred way forward outlined in the economic case.
4.2 Required services
4.2.1 The Trust requires a system to be used on mobile devices to allow EMS staff to record patient data electronically, fully replacing the current digital pen system. The mobile device will use a mobile communications bearer to send/receive data and interact with other systems.
4.2.2 The Trust’s required services include the following areas. At this early SOC stage, this should not be taken as a definitive list:
ePCR software and licences ePCR hardware ePCR interfaces Server software and licences Server hardware Server interfaces Integration services Vehicle fitting services System viewers Reporting system Training System Upgrades System support – first and second line System security and governance Project management Project assurance
4.3 Potential for risk transfer
4.3.1 The potential for risk transfer is dependent upon the preferred solution. Subject to the endorsement of this SOC, the Trust will secure expert support to appraise the options available to us in the current market place to reach a preferred solution. Consideration of risk transfer will be undertaken during this process.
4.3.2 The Trust will undertake an assessment of how the associated risks might be apportioned between the Trust and its ePCR solution suppliers.
4.3.3 Risks will be passed to the ‘party best able to manage them’, subject to value for money.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
4.4 Proposed charging mechanisms
4.4.1 The proposed charging mechanisms is dependent upon the preferred solution. Subject to the endorsement of this SOC, the Trust will secure expert support to appraise the options available to us in the current market place to reach a preferred solution. Consideration of charging mechanisms will be undertaken during this process.
4.4.2 The Trust has experience of implementing charging mechanisms and this was done most recently in our procurement and implementation of a new Computer Aided Dispatch System for our Clinical Contact Centres.
4.5 Proposed contract lengths
4.5.1 The contract duration should be for the initial period of five years.
4.5.2 The Trust will reserve the right to extend the contract for a five year period. The option to extend will be contingent upon satisfactory performance by the contractor and are solely at the right and prerogative of the Trust.
4.6 Proposed key contractual clauses
4.6.1 The successful supplier will be required to meet performance criteria relating to system performance. This criteria will be embodied in the contract between the Trust and the service provider(s). Examples of elements to be included are: supplier service management, definition of core hours, permitted downtime, availability, service failure management, contractor response times and catastrophic event fix times.
4.7 Personnel implications (including TUPE)
4.7.1 It is anticipated that the TUPE – Transfer of Undertakings (Protection of Employment) Regulations 1981 – will not apply to this investment as outlined above.
4.7.2 Although TUPE is not relevant within this project, there will be an impact on clinical audit staff who are currently working with the digital pen system. In particular, this will impact upon the data validation roles within the team.
4.7.3 It is envisaged that, through negotiation, any changes in practice will be agreed. Any changes to employee terms and conditions will be managed utilising existing Trust and NHS Wales policy.
4.7.4 The preferred option identified in the OBC stage will determine the implications on staffing within the Trust for system management. For example, if the Trust has a preferred option of a managed service, then staffing implications will be minimal, however, if based on affordability, the Trust has a preferred option to manage the system in-house, then this may have a significant requirement for the Trust to employ new ICT staff to manage the ePCR solution. This may be in the form of staff to provide first line support for the solution.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
4.7.5 The preferred option will also identify the staffing impact on any other departments such as our Clinical Contact Centre for verifying NHS numbers or analytical staff for production of reports from the ePCR data deposited into the Trust’s data warehouse.
4.8 Procurement strategy
4.8.1 The Trust’s procurement function is provided by North Wales Shared Service Partnership (NWSSP) Procurement Services. The Trust has engaged with a procurement expert in the production of this SOC and will continue to do so through the OBC, FBC and procurement process.
4.8.2 The value for the supply and maintenance of an ePCR solution for the Trust is above the EU regulation threshold.
4.8.3 The Trust has the options to undertake a full EU procurement exercise or utilise existing NHS procurement frameworks available. The route which the Trust takes will depend upon the identification of a preferred option and whether the products and services in the preferred option can be procured from existing frameworks or not.
4.8.4 In early 2018, West Midlands Ambulance Service NHS Foundation Trust (WMAS) undertook a procurement exercise to create a framework agreement for the ‘Supply of Ambulance Electronic Patient Record System’. The authority undertook an open procurement process on behalf of itself and the other NHS ambulance Trusts in the United Kingdom to establish a framework of providers who are eligible to receive orders from the Trusts during the term of the framework.
4.8.5 The WMAS Framework of five suppliers, allows UK ambulance Trusts to direct award or to undertake a mini competition under procurement rules. The arrangement means that if a Trust deems the WMAS specification in the framework’s ‘Statement of Need’ is to their requirement then, a direct award can be made to any supplier on the framework. If a Trust has their own bespoke specification (that can be satisfied by the framework) then they can enter into a mini competition under tender rules to award a contract to the supplier who can best meet their needs.
4.8.6 As part of the OBC process, the Trust will consider the procurement option to utilise the ePCR software and support from the Electronic Patient Records Framework established by the West Midlands Ambulance Service OJEU process on behalf of all UK ambulance services.
4.8.7 The Trust will also consider options for the procurement of the ePCR hardware and associated services from the alternative supplier frameworks available and undertaking a full OJEU procurement.
4.8.8 The Trust recognises that there is also an opportunity to explore the supply of equipment and services from the frameworks that have been established for the purposes of the ESN and ESMCP programme solutions.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
4.9 Financial accountancy treatment
4.9.1 The assets developed through this business case and its delivery will be accounted for on the balance sheet of the Trust, funded extensively by capital and depreciated accordingly.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Financial Case
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case 5. The Financial Case
5.1 Introduction
5.1.1 The purpose of this section is to set out the indicative financial implications of the preferred option (as set out in the economic case section) and the proposed deal (as described in the commercial case section).
5.2 Impact on the organisation’s income & expenditure account
5.2.1 The anticipated payment stream for the project over its intended life span over the five years of the expected lifetime of the contract is as follows:
Year 0 Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Total £000 £000 £000 £000 £000 £000 £000 £000 Preferred way forward Capital 137.93 8,014.42 338.87 200.93 2,949.00 63.00 63.00 11,629.22 Revenue - 1,434.03 492.57 492.57 492.57 492.57 492.57 3,896.88 TOTAL 137.93 9,448.45 831.44 693.50 3,441.57 555.57 555.57 15,526.10 Funded by Existing - - 128.75 128.75 128.75 128.75 128.75 643.75 Additional 137.93 9,448.45 702.69 564.75 3,312.82 426.82 426.82 14,882.35 TOTAL 137.93 9,448.45 831.44 693.50 3,441.57 555.57 555.57 15,526.10
5.3 Impact on the balance sheet
5.3.1 At this stage, the impact on the Trust’s balance sheet has not been calculated, this will be done as part of the OBC process.
5.4 Overall affordability
Capital affordability
5.4.1 The proposed cost of the project is £15,526,100 over the five years of the expected lifetime of the contract.
Revenue affordability
5.4.2 The organisation’s commissioners have not been approached to signify their agreement to the potential revenue funding of £3,896,880 over the five years of the expected lifetime of the contract. This will be done on further development of the business case at OBC stage.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
Management Case
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case 6. The Management Case
6.1 Introduction
6.1.1 The proposed implementation of an ePCR solution will be a significant investment and digital advancement that will require professional management by a dedicated qualified and experienced team to ensure successful delivery and realisation of benefits.
6.1.2 The Trust has previous experience of delivering similar digital capital projects including the Airwave Project, Mobile Data Project and more recently our Computer Aided Dispatch Project.
6.2 Programme management arrangements
6.2.1 The scheme is an integral part of the Trust’s Integrated Medium Term Plan (IMTP), which comprises of a portfolio of strategic actions underpinned by local delivery plans.
6.2.2 The ePCR scheme is reported locally as Strategic Action 13. Progress on the scheme is reported through the Trust’s Medical & Clinical Services Directorate to the IMTP Delivery Assurance Group (iDAG) as part of the IMTP delivery assurance arrangements.
6.2.3 The ePCR scheme’s delivery assurance arrangements will therefore be incorporated into the Trust’s existing IMTP delivery assurance arrangements and not managed as a separate programme of work at this stage.
6.2.4 The Trust recognises that there are a number of significant digital projects beginning to emerge within the organisation and as the timescales for each development emerge, will consider the benefits and dis-benefits of establishing a digital programme of work within the OBC.
6.3 Project management arrangements
Outline project reporting structure
6.3.1 The Trust will appoint an Executive Director as the Project Executive for this project.
6.3.2 The Trust will appoint an appropriately qualified project manager with experience of implementing large scale digital projects into an operational environment.
6.3.3 The scope and complexity of this project will require a proven project management methodology to be utilised. The Trust will require the project manager to utilise the PRINCE2 methodology. This is in line with the Trust’s draft Programme & Project Management Framework, the development of which is being led by our Planning & Performance Directorate.
6.3.4 On endorsement of the SOC, the Trust will appoint a formal project board who will operate under the responsibility and governance arrangements outlined in PRINCE2.
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Welsh Ambulance Services NHS Trust Electronic Patient Clinical Records – Strategic Outline Case
6.3.5 Project board membership will consist of the roles of Project Sponsor, Senior User, Senior Supplier and Project Assurance as a minimum.
6.3.6 The project board will appoint a core project team, to be assigned to the project. They will agree work stream leads, established from current internal specialists, for the elements of the project such as training, implementation, standard operating procedures etc.
6.3.7 Stage plans will be developed alongside an implementation strategy, to support the production of an overall project plan to allow the Project Manager and Project Executive to maintain control within their level of accountability for the project’s implementation.
6.3.8 The project board will be accountable to the Trust Board’s Finance & Resources Committee.
Outline project roles and responsibilities
6.3.9 ePCR Project Executive: Although the Project Board is responsible for the project, the Executive (supported by the Senior User and Senior Supplier) is ultimately accountable for the project’s success and is the key decision maker. The Executive’s role is to ensure that the project is focussed throughout its life on achieving the forecasted benefits. The Executive has to ensure that the project gives value for money, balancing the demands of the business, user and supplier. The Executive is responsible for appointing the project management team and for the business case.
6.3.10 ePCR Senior User: The Senior User is responsible for specifying the needs of those who will use the project’s products, for user liaison with the project management team and for monitoring that the solution will meet those needs within the constraints of the Business Case in terms of quality, functionality and ease of use. The Senior User commits user resources and monitors products against requirements. They specify the benefits and are held to account by corporate management that the forecasted benefits that were the basis of the project approval are in fact realised.
6.3.11 ePCR Senior Supplier: The Senior Supplier represents the interests of those designing, developing facilitating procuring and implementing the project’s products. The role is accountable for the quality of products delivered by the supplier and is responsible for the technical integrity of the project. This role includes providing supplier resources to the project and ensuring that proposals for designing and developing the products are feasible and realistic.
6.3.12 ePCR Project Assurance: The Project Assurance is responsible for monitoring all aspects of the project’s performance and products independently of the Project Manager. Project Board members are responsible for the aspects of Project Assurance aligned to their areas of concern – business, user or supplier.
6.3.13 ePCR Project Manager: The Project Manager is the single focus for day-to-day management of a project. This person has the authority to run the project on behalf of the Project Board within the constraints laid down by the Project Board.
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6.3.14 ePCR Core Project Team: This group consists of managers who are assigned work packages from the Project Manager. The structure of the Core Project Team will not necessarily reflect line function or seniority but represents roles on the project. A project team manager may be more senior than the Project Manager, however in the context of the project, reports to and takes direction from the Project Manager.
6.3.15 ePCR Project Support: Project Support is the responsibility of the Project Manager. Some of the work may be delegated to a dedicated support role. This includes providing administration services or advice and guidance on the use of project management tools or configuration management.
Outline project plan
6.3.16 Phase 1 – Business Case Planning Dates will be refined in the OBC and matched to specific meeting dates in the schedule.
Activity Start End Prepare SOC July 2018 September 2018 Submit SOC to Executive Team September 2018 September 2018 Submit SOC to Trust Board September 2018 September 2018 Submit SOC to WG for endorsement October 2018 October 2018 Prepare OBC October 2018 February 2019 Submit OBC to Executive Team March 2019 March 2019 Submit OBC to Trust Board March 2019 March 2019 Submit OBC to WG for approval April 2019 May 2019 Prepare FBC June 2019 August 2019 Submit FBC to Executive Team September 2019 September 2019 Submit FBC to Trust Board October 2019 October 2019 Submit FBC to WG for approval November 2019 November 2019 Procurement November 2019 January 2020 Implementation/Go Live February 2020 January 2021
6.3.17 Phase 2 – Procurement Subject to approval of the business case, the procurement will be undertaken. Detailed timescales will be developed in the OBC that reflect a procurement route that will support the Trust’s preferred option in the economic case.
6.3.18 Phase 3 – Implementation Subject to award of contract, project initiation and planning will take place. Timescales will be developed as part of the plan in the OBC. There is a requirement for the new solution implementation to be planned for completion by January 2021 to ensure that the solution is embedded nationally before the digital pen contract end on 31 March 2021.
6.4 Use of special advisors
6.4.1 Specialist advisors will be used in a timely and cost-effective manner in accordance with the Treasury Guidance: Use of Specialist Advisers.
6.4.2 If this SOC is endorsed by Welsh Government, it is the Trust’s intention to utilise a Specialist Advisor in the development of the OBC and FBC.
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6.4.3 The Trust will also enlist the support of Specialist Advisors from North Wales Shared Services Partnership (NWSSP) to support the procurement and contractual arrangements with the supplier in this project.
6.4.4 Depending upon the nature and complexity of the contractual arrangements in the preferred option within the OBC, the Trust will consider enlisting a Specialist Advisor to provide Project Assurance.
6.5 Gateway review arrangements
6.5.1 Subject to the endorsement of this SOC, the Trust will commit to having gateway arrangements in place which will be documented in the OBC.
------END ------
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4.1 NHS Wales Capability Policy And Procedure (Director of Workforce and OD) 1 ITEM 4.1 Covering SBAR FRC NHS Wales Capablity Policy Procedure.docx
AGENDA ITEM No 4.1 OPEN or CLOSED Open No of ANNEXES ATTACHED 1
NHS WALES CAPABILITY POLICY AND PROCEDURE
MEETING Finance and Resource Committee DATE 20 September 2018 EXECUTIVE Director of Workforce and OD Sara Williams, Workforce Policy & Governance AUTHOR Lead Email: [email protected] CONTACT DETAILS Tel: 07813 818538 CORPORATE OBJECTIVE 7, 8 CORPORATE RISK (Ref if
appropriate) QUALITY THEME 7 HEALTH AND CARE 7.1 STANDARDS To note the report and formally adopt the REPORT PURPOSE revised NHS Wales Policy for WAST on behalf of the Trust Board CLOSED MATTER REASON N/A REPORT APPROVAL ROUTE WHERE WHEN WHY To note and support the formal adoption of the Welsh Ambulance Services 30 July 2018 revised NHS Wales Partnership Team (WASPT) Capability Policy by the Trust. To note and support the Employment Policy Sub 13 August 2018 formal adoption of the Group (EPSG) revised Policy. To approve and formally Finance and Resources 20 September adopt the revised NHS Committee (FRC) 2018 Wales Capability Policy and
SITUATION
1
1. The report advises of the revised Capability policy and procedure for NHS Wales, for formal adoption by the Welsh Ambulance Services NHS Trust.
2. The documents have been issued to all Health Boards and Trusts in Wales for adoption and implementation at the earliest opportunity.
BACKGROUND
3. As part of the reorganisation of the Trusts and Local Health Boards in 2009, it was agreed that new employment policies would be developed which would ensure a common set of terms and conditions of service for all employees in NHS Wales.
4. They are developed in partnership through the Welsh Partnership Forum. Trusts and Health Boards nominated senior Workforce and Organisational Development staff and managers to participate in the various task and finish groups and the Trade Unions’ nominated TU representatives. All organisations are given the opportunity to feed into this process and comment on the policies. The Welsh Partnership Forum is the body which formally adopts the policies for NHS Wales and they are then issued for adoption by the Trust Board and implemented at the earliest opportunity with review dates set.
5. The changes to the previous version of the Capability policy and procedure include a much more formal approach with three stages of hearings, as well as an additional reference to the NHS Wales Core Principles.
6. The revised documents were approved for implementation by Joint Chairs’ action on behalf of the Welsh Partnership Forum on 26 June 2018, with the amendments outlined in the attached letter dated 27 June 2018 from the NHS Employers.
ASSESSMENT
7. The revised Capability policy and procedure was noted by the Welsh Ambulance Services Partnership Team (WASPT) on 30 July 2018 and it is submitted to the Trust’s Finance and Resource Committee (FRC) for formal adoption on behalf of the Trust Board.
RECOMMENDED
That the FRC accepts the report and formally adopts the revised Capability policy and procedure for NHS Wales on behalf of the Trust Board.
EQUALITY IMPACT ASSESSMENT
2
8. An updated Equality Impact Assessment was issued with the policy and procedure.
REPORT CHECKLIST
Issues to be covered Paragraph Number (s) or “Not Applicable” Equality Impact Assessment 8 Environmental/Sustainability N/A Estate N/A Health Improvement N/A Health and Safety N/A Financial Implications Legal Implications Patient Safety/Safeguarding N/A Risks Reputational Trade Union Consultation 4,6,7
3
1 ITEM 4.1a Capability Policy Version FINAL (Jun 2018 v21) - WAST.docx
All Wales Capability Policy and Procedure
Version 16 Policy Number: 062 Version No: Version 21 Supersedes: (27/03/13)
Impact Date of Approval: June 2018 Review Date: June 2021 Assessments N/A Completed:
Welsh Partnership Classification of Type of Employment Policy Approved by: Forum (NHS) / Document: Document: WAST FRC
NHS Wales Policy, which all Trusts and Health Boards in Wales are required to adopt. The Brief Summary of policy provides a framework which managers can work with employees to maintain Document: satisfactory performance standards and to encourage improvement where necessary.
The policy is applicable to staff employed in the Welsh Ambulance Services NHS Trust, Scope: except Medical and Dental Staff– see Section 2
NHS Wales Disciplinary Policy To be read in NHS Wales Sickness Absence Policy conjunction with: Redeployment Policy
NHS Wales Partnership Forum Owning Committee WAST Finance and Resource Committee (FRC)
Policy Lead: Claire Vaughan Job Title: Director of Workforce and OD Trade Union Lead:
Executive Claire Vaughan Job Title: Director of Workforce and OD Director:
Capability Policy Version 21 (June 2018) 1
C O N T E N T S
1. Policy statement
2. About this policy
3. Principles
4. Rights of accompaniment
5. Identification of a capability issue
6. Initial assessment
7. Incapability to due to disability
8. Confidentiality
9. Redeployment/Downgrading
10. Timescales for achieving improvement
11. Notification requirements for formal capability hearings
12. Procedure at capability hearings
13. Stage 1 hearing: Improvement notice
14. Stage 2 hearing: Final written warning
15. Stage 3 hearing: Dismissal or redeployment
16. Appeals against action for poor performance
17. Training and/or Awareness Raising
18. Equality
19. General Data Protection Regulations 2018
20. Freedom of Information
21. Records Management
22. Review
23. Monitoring
24. Approval
Appendix 1 – Capability Hearings Flowchart
Capability Policy Version 21 (June 2018) 2
1. Policy Statement
The Core Principles of NHS Wales are:
• We put patients and users of our services first: We work with the public and patients/service users through co-production, doing only what is needed, no more, no less and trying to avoid harm. We are honest, open, empathetic and compassionate. We ensure quality and safety above all else by providing the best care at all times. • We seek to improve our care: We care for those with the greatest health need first, making the most effective use of all skills and resources and constantly seeking to fit the care and services we provide to users' needs. We integrate improvement into everyday working, by being open to change in all that we do, which also reduces harm and waste. • We focus on wellbeing and prevention: We strive to improve health and remove inequities by working together with the people of Wales so as to ensure their wellbeing now and in future years and generations. • We reflect on our experiences and learn: We invest in our learning and development. We make decisions that benefit patients and users of our services by appropriate use of the tools, systems and environments which enable us to work competently, safely and effectively. We actively innovate, adapt and reduce inappropriate variation whilst being mindful of the appropriate evidence base to guide us. • We work in partnership and as a team: We work with individuals including patients, colleagues, and other organisations; taking pride in all that we do, valuing and respecting each other, being honest and open and listening to the contribution of others. We aim to resolve disagreements effectively and promptly and we have a zero tolerance of bullying or victimization of any patient, service user or member of staff. • We value all who work for the NHS: We support all our colleagues in doing the jobs they have agreed to do. We will regularly ask about what they need to do their work better and seek to provide the facilities they need to excel in the care they give. We will listen to our colleagues and act on their feedback and concerns.
They have been developed to help and support staff working in NHS Wales.
NHS Wales is about people, working with people, to care for people. These Core Principles describe how we can work together to make sure that what we do and how we do it is underpinned by a strong common sense of purpose which we all share and understand.
The NHS is continually under pressure to deliver more services, with better outcomes and maintain and increase quality against the backdrop of significant financial challenge, high levels of public expectation and with a population which is getting older and with increased levels of chronic conditions.
These principles have been developed to help address some of the pressures felt by staff in responding to these demands. They will re-balance the way we work together so we are less reliant on process and are supported to do the right thing by being guided by these principles when applying policies and procedures to the workforce.
Capability Policy Version 21 (June 2018) 3
As people working within the health service, we will all use them to support us to carry out our work with continued dedicated commitment to those using our services, during times of constant change.
The Principles are part of an ongoing commitment to strengthen the national and local values and behaviour frameworks already established across Health Boards and Trusts.
They have been developed in partnership with representatives from employers and staff side.
The Principles will be used to create a simpler and consistent approach when it comes to managing workplace employment issues.
2. About this Policy
2.1 The primary aim of this policy is to provide a framework within which managers can work with employees to maintain satisfactory performance standards and to encourage improvement where necessary.
2.2 It is the Welsh Ambulance Services NHS Trust’s policy to ensure that concerns over performance are dealt with fairly and that steps are taken to establish the facts and to give employees the opportunity to respond at an initial informal discussion before any formal action is taken.
2.3 This policy is applicable to all employees, employed in the Welsh Ambulance Services NHS Trust, except Medical and Dental staff where specific arrangements apply in cases of professional conduct or competence. It does not apply to bank workers (see bank register principles - June 2017), agency workers or self-employed contractors.
Before considering any action in accordance with this policy, the relevant code of conduct and professional code of practice should be considered, and advice should be sought from the relevant professional lead.
2.4 Where an employee is either jointly employed or is not employed by the Trust but provides a service for the Trust, the capability issue will be addressed under the scope of the policy of the lead employer. The Welsh Ambulance Services NHS Trust will still have an active involvement in the management of the issue to ensure that the performance standards required by the Trust are met.
Managers should be aware that, depending on the outcome of discussions at either the informal or formal stages, it may be appropriate to defer handling the issue under the Capability Policy and refer instead to the alternative appropriate policies, e.g. Disciplinary Policy or Sickness Absence Policy.
3. Principles
3.1 All employees should be treated fairly and with dignity and respect.
3.2 An appropriate Workforce and OD (W&OD) representative will be available to support managers and employees in the application of this policy.
Capability Policy Version 21 (June 2018) 4
3.3 Line Managers are responsible for ensuring that all new employees undertake both the Welsh Ambulance Services NHS Trust induction and local induction on commencement of their new post. In addition, they will receive a job description and person specification and will be given a clear understanding of their duties and the standards expected. To support new or promoted employees, the line manager will also need to assess any immediate development needs which they may have and the timescales within which these need to be addressed. All employees will participate in a performance review at which a Personal Development Plan will be agreed on at least an annual basis, in line with the pay progression policy.
If an individual is in the formal stage of the capability policy at the beginning of sickness and/or maternity/adoption leave and there is evidence to show that they would be unlikely to have met their pay progression criteria, it may be possible to withhold their pay increment. However, advice must be sought from a relevant member of the W&OD team and such a decision must take account of any potential discrimination claims.
During the normal course of their duties, line managers should meet regularly with their employees and bring to their attention any issues relating to their performance. During an induction period, the expectation would be that the level of support required would be greater than once the employee has settled in.
4. Rights of accompaniment
All employees have the right to be accompanied by a Trade Union representative or a Welsh Ambulance Services NHS Trust workplace colleague, at all formal hearing stages of the procedure. However, as long as a suitable alternative representative is available, unavailability of a preferred representative or workplace colleague should not delay the hearing taking place.
Where reference is made in this policy to the employee’s “representative”, this will refer to the Trade Union representative or work place colleague.
5. Identification of a Capability Issue
In the first instance, performance issues should normally be dealt with informally between the employee and their line manager as part of day-to-day management. Where appropriate, a note of any such informal discussions should be shared with the employee and placed on the employee’s personal file.
Informal discussions may help:
a) Clarify the required standards;
b) identify areas of concern;
c) establish the likely causes of poor performance and identify any training needs; and/or
Capability Policy Version 21 (June 2018) 5
d) set targets for improvement and a time-scale for review.
This procedure should be used for more serious cases, or in any case where an earlier informal discussion has not resulted in a satisfactory improvement.
6. Initial Assessment
6.1 If initial discussions have not resulted in a satisfactory improvement and if the Trust has ongoing concerns or more serious concerns come to light about an employee’s performance, an Initial Assessment will be undertaken, which may be by the line manager, to decide if there are grounds for taking formal action under this policy. The procedure involved will depend on the circumstances but may involve reviewing the employee’s personal file including any appraisal records, gathering any relevant documents, monitoring the employee’s work and, if appropriate, interviewing the employee and/or other individuals confidentially regarding the employee’s work.
6.2 Managers need to consider in the light of relevant Welsh Ambulance Services NHS Trust policies and procedures any underlying issue such as:
• Health and/or domestic issues; • Bullying/harassment or feeling intimidated for any other reasons; • Inadequate resources to do the job; • Insufficient training or the need for further training; • Changes in the job environment.
7. Incapability Due to Disability
7.1 Consideration will be given to whether poor performance may be related to a disability and, if so, whether there are reasonable adjustments that could be made to the employee’s working arrangements, including changing duties or providing additional equipment or training. The Welsh Ambulance Services NHS Trust has a duty under the Equality Act 2010 to make reasonable adjustments as appropriate.
7.2 If an employee wishes to discuss this or inform the Trust of any medical condition the employee considers relevant, the employee should contact his/her line manager who may refer the employee to Occupational Health for assessment and support.
8. Confidentiality
8.1 The aim of the Welsh Ambulance Services NHS Trust is to deal with performance matters sensitively and with due respect for the privacy of any individuals involved. All employees must treat as confidential any information communicated to them in connection with a matter which is subject to this capability procedure.
8.2 The employee and anyone accompanying the employee (including witnesses), must not make electronic recordings of any meetings or hearings conducted under this procedure.
Capability Policy Version 21 (June 2018) 6
8.3 The employee will normally be told the names of any witnesses whose evidence is relevant to the employee’s capability hearing, unless there are exceptional circumstances in which the Trust believes that a witness's identity should remain confidential.
9. Redeployment/Downgrading
If it is mutually agreed at any stage in the process that redeployment/downgrading is in the best interests of both the employee and the organisation, every effort will be made to find a suitable appointment. In particular, the following must be considered:
Temporary redeployment: • The availability of opportunities; • It will be for the manager and employee to agree a suitable trial period for these arrangements; • Review arrangements whilst in the new post; • Protection of all earnings would apply.
Permanent redeployment: • The availability of opportunities; • Protection of earnings will not be applied.
10. Timescales for Achieving Improvement
The timescales for achieving improvement will be dependent on various factors such as the risks of the role not being carried out competently within the Welsh Ambulance Services NHS Trust the impact on the service, the complexities of the job itself, and the availability of the necessary training and support. However, managers are responsible for setting SMART (Specific, Measurable, Achievable, Relevant, Timely) targets for improvement. As a guideline the timescales to achieve the improvement should normally be a minimum of one month and no more than three months. During the period, there is an expectation that the manager and employee will have regular meetings to review performance. Periods of review may be paused if an employee is absent from work for an extended length of time in excess of 28 days, to cover the length of the absence where improvement cannot be monitored.
11. Notification requirements for formal capability hearings
If the Welsh Ambulance Services NHS Trust considers that there are grounds for taking formal action over alleged poor performance, the employee will be required to attend a capability hearing. The employee will be notified in writing of the concerns over their performance, the reasons for those concerns, and the likely outcome if it is decided after the hearing that the employee’s performance has been unsatisfactory. The Welsh Ambulance Services NHS Trust will also include the following where appropriate:
a) A summary of relevant information gathered as part of any investigation.
b) A copy of any relevant documents which will be used at the capability hearing.
Capability Policy Version 21 (June 2018) 7
c) A copy of any relevant witness statements, except where a witness's identity is to be kept confidential (which will only be in exceptional circumstances), in which case the employee will be given as much information as possible while maintaining confidentiality.
All documentation will be passed to the employee as soon as possible but no later than 21 calendar days prior to a capability hearing. Any additional information which the employee wishes to rely upon should be submitted as soon as possible but no later than 10 calendar days prior to the hearing. In exceptional circumstances, the employee may request to make a submission which has not been made available within the above timescale. The list of agreed witnesses will be provided no later than 14 calendar days before the hearing date.
12. Procedure at capability hearings
If the employee or their representative cannot attend the hearing they should inform the Trust immediately and the Trust will usually arrange an alternative time. The employee must make every effort to attend the hearing, and failure to attend without good reason may be treated as misconduct. If the employee fails to attend without good reason or is persistently unable to do so (for example, for health reasons), the Trust may have to take a decision based on the available evidence including any written representations made by the employee.
The hearing will normally be held by the employee’s line manager (save for at Stage 3 when it is likely that a more senior manager will hear the case) and it is likely that the manager will be supported by an appropriate professional advisor, and a member of the W&OD Department. The employee may bring an employee representative to the hearing (see paragraph 4). The employee representative may make representations, ask questions, and sum up the employee’s case, but will not be allowed to answer questions on behalf of the employee. The employee may confer privately with their employee representative at any time during the hearing.
The employee may ask relevant witnesses to appear at the hearing, provided sufficient notice is provided to arrange their attendance. The employee will be given the opportunity to respond to any information given by a witness and be permitted to cross examine witnesses in an appropriate manner.
The aims of a capability hearing will usually include:
a) Setting out the required standards that the Trust believes the employee may have failed to meet and going through any relevant evidence that gathered.
b) Allowing the employee to ask questions, present evidence, call witnesses, respond to evidence and make representations.
c) Establishing the likely causes of poor performance including any reasons why any measures taken so far have not led to the required improvement.
Capability Policy Version 21 (June 2018) 8
d) Identifying whether there are further measures, such as additional training or supervision, which may improve performance.
e) Where appropriate, discussing targets for improvement and a time-scale for review.
f) If dismissal is a possibility, establishing whether there is any likelihood of a significant improvement being made within a reasonable time and whether there is any practical alternative to dismissal, such as redeployment (see section 9).
A hearing will be adjourned if the Trust needs to gather any further information or give consideration to matters discussed at the hearing. The employee will be given a reasonable opportunity to consider any new information obtained before the hearing is reconvened.
The Welsh Ambulance Services NHS Trust will inform the employee in writing of its decision and the reasons for it, usually within seven calendar days of the hearing.
13. Stage 1 Hearing
Where performance issues have not been resolved at an informal level, or where there is a failure to reach and sustain the required standard, a Stage 1 hearing will be held.
Following a Stage 1 capability hearing, if it is decided that the employee’s performance is unsatisfactory, the Welsh Ambulance Services NHS Trust will give the employee an improvement notice, setting out:
a) The areas in which the employee has not met the required performance standards.
b) Targets for improvement.
c) Any measures, such as additional training or supervision, which will be taken with a view to improving performance.
d) A period for review (see section 10).
e) The consequences of failing to improve within the review period, or of further unsatisfactory performance.
The improvement note will normally remain active for six months from the end of the review period. After the active period the warning will remain permanently on the employee’s personal file but will be disregarded in deciding the outcome of any future capability proceedings.
The employee’s performance will be monitored during the review period and the Trust will write to inform the employee of the outcome:
Capability Policy Version 21 (June 2018) 9
f) if the line manager is satisfied with the employee’s performance, no further action will be taken at this stage but the improvement notice will remain active from the end of the review period;
g) if the line manager is not satisfied, the matter may be progressed to a Stage 2 capability hearing;
h) if the manager feels that there has been a substantial but insufficient improvement, the review period may be extended.
14. Stage 2 Hearing
If the employee’s performance does not improve within the review period set out in an improvement note, or if there is further evidence of poor performance while the improvement note is still active, the Welsh Ambulance Services NHS Trust may decide to hold a Stage 2 capability hearing. Written notification will be provided as set out in paragraph 11.
Following a Stage 2 capability hearing, if it is decided that the employee’s performance is unsatisfactory, the Trust will ordinarily give a final written warning, setting out:
a) the areas in which the required performance standards have not been met;
b) targets for improvement;
c) any measures, such as additional training or supervision, which will be taken with a view to improving performance;
d) a period for review; and
e) the consequences of failing to improve within the review period, or of further unsatisfactory performance.
A final written warning will normally remain active for 9 months from the end of the review period. After the active period, the warning will remain permanently on the employee’s personal file but will be disregarded in deciding the outcome of future capability proceedings.
The employee’s performance will be monitored during the review period and the Trust will write to inform the employee of the outcome:
f) if the line manager is satisfied with the employee’s performance, no further action will be taken;
g) if the line manager is not satisfied, the matter may be progressed to a Stage 3 capability hearing; or
h) if the manager feels that there has been a substantial but insufficient improvement, the review period may be extended.
15. Stage 3 Hearing
Following the Stage 2 Hearing and subsequent review period, and where an improvement to the degree required has not been achieved, termination of Capability Policy Version 21 (June 2018) 10
employment will be considered. This will take account of all previous action that has been taken in an attempt to improve the employee's performance.
The decision maker at this stage should not have been involved previously and should have the authority to dismiss.
The Welsh Ambulance Services NHS Trust may decide to hold a Stage 3 capability hearing if there is reason to believe:
a) the employee’s performance has not improved sufficiently within the review period set out in a final written warning;
b) the employee’s performance is unsatisfactory while a final written warning is still active.
Written notification of the hearing will be sent as set out in paragraph 11.
Following the hearing, if it is found that the employee’s performance is unsatisfactory, a range of options will be considered including:
a) extending an active final written warning and setting a further review period (in exceptional cases where it is believed that a substantial improvement is likely within the review period);
b) giving a further final written warning;
A final written warning will normally remain active for 9 months from the end of the review period. After the active period, the warning will remain permanently on the employee’s personal file but will be disregarded in deciding the outcome of future capability proceedings.
c) redeployment (subject to a trial period of a duration to be agreed but a minimum of 12 weeks) at the end of which the situation will be reviewed and if the redeployment has been successful for all parties, a permanent variation of contract will be put in place. If the redeployment has been unsuccessful in the view of any party, then a Stage 3 hearing will be reconvened, and the likely outcome will be dismissal.
d) dismissing the employee;
Dismissal will be with full notice or payment in lieu of notice.
16. Appeals against action for poor performance
Should the employee feel that a decision about poor performance under this procedure is wrong or unjust the employee should appeal in writing, stating the full grounds of appeal, to [APPROPRIATE POSITION] within 14 calendar days of receiving the written notification.
If appealing against dismissal, the date on which dismissal takes effect will not be delayed pending the outcome of the appeal. However, if the appeal is successful the employee will be reinstated with no loss of continuity or pay.
If an employee raises any new matters in the appeal, the Welsh Ambulance Services may need to carry out further investigation. If any new information Capability Policy Version 21 (June 2018) 11
comes to light it will be provided to the employee with a summary including, where appropriate, copies of additional relevant documents and witness statements. The employee will have a reasonable opportunity to consider this information before the hearing.
The administrative arrangements will be put in place within 14 calendar days and wherever possible the appeal heard within 28 calendar days of the notification of appeal being received. At least 7 calendar days before the Appeal Hearing the Appeal Officer must receive the nature of the appeal and all documentary evidence in support of it. Failure to comply may result in either the appeal being postponed or the appeal going ahead without this information.
There will be two levels of constitution of appeal hearings: -
For appeals against warnings short of dismissal, the appeal will normally be heard by a manager one level above the manager who imposed the penalty.
A (W&OD/HR) Advisor will be in attendance in order to give advice and to support the Appeal Officer in ensuring that all aspects of the appeal are fully explored.
In cases of appeals against dismissal, the appeal will normally be heard by a senior officer nominated (by the Director of Workforce and Organisational Development), in line with the organisation’s scheme of delegated authority.
The officers nominated to hear an appeal must not have been involved in the process at any earlier point.
The purpose of the appeal is to establish if the decision taken at the hearing was reasonable in light of the grounds raised by the employee. The appeal is not a re-hearing of the original evidence.
The appeal hearing must restrict itself to looking at the grounds of appeal made by the employee and ensuring that these grounds are adequately examined in order to reach a proper judgement on whether the appeal should be upheld.
The appeal hearing will consider specifically whether the action decided upon was fair and reasonable at the time that the action was taken. The appeal hearing may look at whether the procedure was applied correctly when deciding on the action.
The appeal will take account of any substantial new information cited in the grounds for appeal.
The decision reached by any level of appeal hearing is considered final. No further appeal mechanism will operate within the Welsh Ambulance Services NHS Trust.
Where possible, the appeal hearing will be conducted by a [more senior] manager who has not been previously involved in the case. [A member of the W&OD Department AND/OR the manager who conducted the capability
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hearing] will also usually be present. The employee may bring an employee representative to the appeal hearing.
An appeal hearing will be adjourned if there is a need to gather any further information or give consideration to matters discussed at the hearing. The employee will be given a reasonable opportunity to consider any new information obtained before the hearing is reconvened.
Following the appeal hearing the Welsh Ambulance Services NHS Trust will:
a) confirm the original decision; or
b) revoke the original decision; or
c) substitute with a different sanction.
The Trust will inform the employee in writing of its final decision as soon as possible, usually within one week of the appeal hearing. There will be no further right of appeal.
17. Training and/or awareness raising
All staff will be made aware of this policy upon commencement with the Welsh Ambulance Services NHS Trust. Copies can also be viewed on the Trust’s intranet or obtained via the W&OD department. Training will be provided as appropriate.
18. Equality
The Welsh Ambulance Services NHS Trust recognises the diversity of its workforce. Our aim is therefore to provide a safe environment where all employees are treated fairly and equally and with dignity and respect. The Trust recognises that the promotion of equality and human rights is central to its work both as a provider of healthcare and as an employer. This policy has been impact assessed to ensure that it promotes equality and human rights. The assessment was undertaken using the toolkit of the NHS Centre for Equality and Human Rights and completed in September 2017.
19. General Data Protection Regulations 2018
All documents generated under this policy that relate to identifiable individuals are to be treated as confidential documents, in accordance with the Welsh Ambulance Service NHS Trust’s Data Protection Policy.
20. Freedom of Information Act 2000
All the Trust’s records and documents, apart from certain limited exemptions, can be subject to disclosure under the Freedom of Information Act 2000. Records and documents exempt from disclosure would, under most circumstances, include those relating to identifiable individuals arising in a personnel or staff development context. Details of the application of the Freedom of Information Act within the Trust may be found in the Trust’s publications scheme.
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21. Records Management
All documents generated under this policy are official records of the Welsh Ambulance Services NHS Trust and will be managed and stored and utilised in accordance with the Welsh Ambulance Services NHS Trust’s Records Management Policy.
22. Review
This policy will be reviewed in 3 years’ time. Earlier review may be required in response to exceptional circumstances, organisational change or relevant changes in legislation or guidance.
23. Monitoring
Details of all capability procedure outcomes will be monitored and reported as deemed appropriate by the employing organisation.
24. Approval
Signed on behalf of the Staff Side:
Signed:
Name:
Title:
Date:
Signed on behalf of the Management Side:
Signed:
Name:
Title:
Date:
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Appendix 1 – Capability Hearings Flowchart
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