Last updated: 24 January 2024 15:32.

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Executive Summary

An executive summary will be included in later versions of this report.

What Is Statistical Process Control?

Statistical process control (SPC) is an analytical technique that automatically identifies changes in data over time. SPC analysis uses statistical principles first developed in engineering to more robustly distinguish improvement from random variation. It helps us to understand meaningful variation in data, focusing our attention on areas most appropriate for action.

The use of SPC to support decision making is a key component of the Model for Improvement widely used across the NHS. NHSE have developed documentation describing best practices around the use of SPCs. The SPC charts below have been produced using the NHSR Plot The Dots package.

In this report, we have used this method as a tool for rapidly assessing a wide variety of service measures. The SPC charts below use a standard notation to identify types of variation and assurance. An assurance indicator is only shown if a target has been specified. Assurance and Causes are summarised in the section Assurance & Cause Identification.


NHSE have produced the following guide to interpreting the variation and assurance symbols.


Assurance & Cause Identification

The table below categorises each measure in the IPR depending on the assurance relative to a specified target (Consistent Fail, Consistent Pass, Inconsistent, and No Target) and whether the SPC method has identified meaningful variation (Common Cause, Special Cause Concern, Special Cause Improvement). In later sections this table is reproduced with only the variables in specific areas.

Variation Consistent Pass Inconsistent Consistent Fail No Target
Special Cause Improvement Ambulance Cases Validated (%) Local, Trust Turnover, Ambulance Operations Turnover, Ambulance Operations Stat and Man Training (%) Call Answering Mean, Calls Abandoned (%), Average Speed To Answer, Trust Stat and Man Training (%), IUC Stat and Man Training (%) Time Lost at Hospital 15 Minutes (Hours), Clinical Ringbacks on all Priorities Within Target (%) Local, EOC Turnover, IUC Turnover, Trust Appraisal Compliance (%), Ambulance Operations Appraisal Compliance (%), 999 Emergency Operations Appraisal Compliance (%), IUC Appraisal Compliance (%) Category 4 Mean, Calls Answered, Cases With ED Outcome (%) Local, Cases Closed With No Onward Referral Via DOS (%) Local, Trust Staff In Post, Ambulance Operations Staff In Post, 999 Emergency Operations Staff In Post, Trust BME Staff (%), Ambulance Operations BME Staff (%), 999 Emergency Operations BME Staff (%), IUC BME Staff (%), 30 Day Survival, Complaints, Complaints Within Target (%), Excellence Reports
Common Cause ED Cases Validated (%) Local, Hand Hygiene Compliance (%), Premises Cleaning Audit (%) Category 1 Mean, Category 3 Mean, Speed To Answer 95th Centile, Trust Sickness Absence, Ambulance Operations Sickness Absence, STEMI, Vehicle Deep Clean (%) Category 2 Mean, IUC Sickness Absence, 999 Emergency Operations Stat and Man Training (%) EOC Contacts, Calls Answered, Face to Face Incidents, Hear and Treat (%), ED Conveyance (%), Calls Offered, Cases With Ambulance Outcome (%) Local, IUC Staff In Post, ROSC, ROSC Utstein, Survival, 30 Day Survival Utstein, Survival Utstein, Stroke, PSII Incidents Declared, PSR Incidents Declared, Patient Safety (Death), New Inquests Notified, Calls from Frequent Callers, RIDDOR Reports, MSK RIDDOR, Body Fluid Exposure, Sharps Incidents, Physical Assaults on Staff per 1000 AandE F2F Incidents
Special Cause Concern 999 Emergency Operations Sickness Absence See and Treat (%), Hours Released To Ambulance Operations By Cohorting, Patient Safety (No-Low Harm), Patient Safety (Moderate-Severe Harm), Child Safeguarding, Adult Safeguarding, Adult Welfare, Controlled Drugs Incident Reports, Physical Assaults

Latest Data & Analysis

The following sections show the latest data for measures in Performance, People and Quality. Commentary for the SPC charts has been provided by each area. Most data is at a monthly interval covering the last two years. There are exceptions where reporting is quarterly or improvement is being assessed over a shorter timeframe.

Performance EOC & AMB


Variation Consistent Pass Inconsistent Consistent Fail No Target
Special Cause Improvement Call Answering Mean Time Lost at Hospital 15 Minutes (Hours) Category 4 Mean
Common Cause Category 1 Mean, Category 3 Mean Category 2 Mean EOC Contacts, Calls Answered, Face to Face Incidents, Hear and Treat (%), ED Conveyance (%)
Special Cause Concern See and Treat (%), Hours Released To Ambulance Operations By Cohorting

EOC Activity & Performance

EOC Contacts

EOC contacts has risen from 163,849 for November to 182,719 for December, moving out of special cause improvement. Figures are expected to increase at this time of year due to seasonal winter pressures, increase in demand and pressure service wide, alongside increase in demand for other emergency services. The figure this year remains lower than the same point last year.

Calls Answered

Calls answered has risen from 128,800 for November to 144,100 for December. This increase may be owing to festive period, reduced care / urgent care facilities open over this period, the half term period, and colder temperatures which may exacerbate respiratory/seasonal illnesses.

Call Answering Mean

Call Answering Mean has risen from 15 seconds in November to 23 seconds in December, exceeding the national target of 10 seconds. We have continued to maintain special cause improvement. Increase in Calls Answered and EOC Contacts will directly affect our call answering mean. Other influences include increased sickness over the winter period, increased short notice cancellation of overtime and short notice annual absence, leading to reduced staffing. SMT, Leadership Teams and Winter Cell have ensured focus around these areas have been maintained and first day sickness contacts have been targeted. Overtime Incentives have been increased and overtime slots have been increased to ensure optimum call handling staffing can be achieved.

Ambulance Activity & Performance

Face to Face Incidents

We have continued to maintain our common cause variation despite a 10.7% increase in face to face incidents compared to the previous month. It should be noted that there is one extra day in December (contributing circa 3% volume increase) and, notably, the festive period with Christmas parties and New Years Eve. Typically we would expect to see an increase in activity and acuity at this time of year however it is of note that there was an overall increase in face to face incidents in December 2023 compared to December 2022. The increase in social activity appears to have returned to the volume and pattern seen in 2019 where activity starts earlier (late November) and curtails in the week immediately before Christmas. Continuation of Category 2 validation is ongoing to ensure the most appropriate care pathways support patients although this consistent demand continues to place pressure on our ability to respond in a timely manner.

Category 1 Mean

The national target for Category 1 mean average is 7 minutes. The SPC shows common cause variation with an increase in the response time of 5% compared to the previous month. This is in line with the increase of C1 patients seen in December 2023. LAS continues to deliver the second best C1 performance nationally with common case variation between 7 and 8 minutes. Acuity follows a seasonal trend pattern where it rises through the winter months.

Category 2 Mean

The Category 2 mean national target is 18 minutes which we have not met between June 2021 and December 2023. The SPC shows common cause variation with a sharp increase in both incidents and response time in December. There is a 26% increase in response time compared to the previous month. Actions ongoing include reduction in hospital handover time & incentivised overtime targeted at key times. Significant focus has been applied to the C2 recovery however surges in demand in early December contributed to a response time for the month of 52minutes. The national average for December was 45 minutes. The 45 minute handover process is now implemented within all ICS areas. Targeted overtime is used to support the delivery of operational hours. Fleet availability remains a key limitation in delivering our recovery plan. There is a robust fleet replacement and growth plan that will continue to deliver improvement through Q1 of 2024.

Category 3 Mean

The Category 3 mean national target is 60 minutes. There has been a special cause improvement from early 2023 and was sustained into November 2023. However, we are now showing common cause variation for December 2023. A sharp increase in response time of 21% compared to the previous month can also be seen despite only a 1% increase of C3 incidents. Whilst the target is not consistently hit the LAS continues to deliver the best performance nationally against this metric. Both UCR cars and NETS resources attend clinically suitable Category 3 patients.

Category 4 Mean

Category 4 continues to show special cause improvement with a decrease seen between September to October. There was an increase last month which has continued in December. Both UCR cars and NETS resources attend clinically suitable Category 4 patients.

Patient Outcomes

Hear and Treat (%)

Hear and Treat % has increased from 16.2% in November to 16.6% in December, moving closer to special cause improvement. This increase in patients who have been managed via Hear and Treat will be directly linked to the implementation and roll out of the Clinical Future Dispatch Model. FDM has been operational for a proportion of the December period, providing daily focus dynamiclly to areas which are found to be facing the most demand.

See and Treat (%)

There are no targets for See & Treat. August to November there has been a decrease in patients seen face to face and not requiring conveyance to hospital. There has been a sharp increase in patients seen in December compared to the previous months. There is a clear link between Hear and Treat volumes as well as operational demand levels that impacts upon the ability to see and treat. The level of Clinical Safety plan will also impact as lower acuity patients will already be directed to other pathways outside of either hear & treat or see & treat leading to a higher acuity group of patients who are responded to.  Indicators for acuity (percentage of incidents graded as C1& C2, percentage of blue calls and NEWS 2 score) all show an increase in acuity driven by the weather. This follows a seasonal pattern.

ED Conveyance (%)

Emergency Department conveyance percentage has no target. Special cause concern was shown for most of the year although a decrease of 1.5% in December and are now showing as a common cause variation. There is a clear link between Hear and Treat volumes as well as operational demand levels that impacts upon the ability to see and treat. The level of Clinical Safety plan will also impact as lower acuity patients will already be directed to other pathways outside of either hear & treat or see & treat leading to a higher acuity group of patients who are responded to. Whilst robust data that identifies the acuity level of patients is not available all the proxy indicators (ARP category, NEWS2 scoring & percentage of blue call activity) are increasing which is suggestive that patients we attend are more sick. This clearly restricts the ability to safely manage the patient in another setting rather than ED.

Time Lost at Hospital 15 Minutes (Hours)

Time lost at hospital over 15 minutes continues to show common cause improvement however there has been an increasing trend from September in line with seasonal trends. Arrangements to rapidly offload patients are now in place across London. The implementation of the 45 minute handover process in all of the 5 ICS areas has been instrumental in achieving this success. Work continues to manage the handover process with partners and a case stuy of work focussed on a site in North East London as an examplar of partnership working which has been shared nationally.

Performance IUEC


Variation Consistent Pass Inconsistent Consistent Fail No Target
Special Cause Improvement Ambulance Cases Validated (%) Local Calls Abandoned (%), Average Speed To Answer Clinical Ringbacks on all Priorities Within Target (%) Local Calls Answered, Cases With ED Outcome (%) Local, Cases Closed With No Onward Referral Via DOS (%) Local
Common Cause ED Cases Validated (%) Local Speed To Answer 95th Centile Calls Offered, Cases With Ambulance Outcome (%) Local
Special Cause Concern

Call Handling Activity

Calls Offered

Uplift in demand due to winter illnesses peaking during late December where there were periods of exceptional demand

Forecast Calls Offered

We continue to provide consistenly high levels of call answering against the forecast and demand has increased especially in peak periods (December 22 and 23). This does not account however for the impact of surges on performance, but only counts total call volumes. To understand the impact of surges we would require a graph that breaks down to 15 minute intervals or less.

Calls Answered

As stated above high incoming volume answered due to adjusted staffing levels and previous improvements in call handling times, giving more capacity to answer the high demand levels

Calls Abandoned (%)

Staffing levels and reduced call handling times have contributed to this improvement, although noting abandoned calls rose when the high demand occurred late December. Continual work on absence levels and attrition rates is contributing to this improvement. This is another metric where LAS is performing better than the national average.

Call Handling Performance

Average Speed To Answer

Still performing well, although monitoring, increase due to high demand late December. Of note is that LAS remains well ahead of the national average for ASA, and has done for some time.

Speed To Answer 95th Centile

Monitoring although this rise is due to the exceptional demand and surges in late December, we did still see the benefit from the work being done to reduce absence and monitor rota adherence.

Clinical Assessment (Local)

ED Cases Validated (%) Local

Good performance being reported in this metric against the ADC definitions. The slight downturn in December due to management of exception peak periods

Cases With ED Outcome (%) Local

Improvement continues - focussing on correct use of the DOS and adequate probing helps to reduce ED outcomes. Clinician performance triangulation has also picked up outliers with high ED outcomes and further support has been given

Ambulance Cases Validated (%) Local

After changes made to structure of CAS this metric is has stabalised and is now improving as IUC validation rotas are reformed and filled

Cases With Ambulance Outcome (%) Local

Reducing but more work to do. Note: the nature of this year's winter illness is believed to have generated more ambulances due to the breathing triggers therefore the improvement may be masked due to this. CLose monitoring, clinician triangulation work and probling workshops for HAs will help to bring this down further. LAS perform well in this metric compared to many other providers

Clinical Ringbacks on all Priorities Within Target (%) Local

Ringing cases back within target time is impacted by other priorities such as *5s. It is also impacted when cases are downgraded or upgraded from the original outcome. Work is ongoing to ensure that LAS is continuing to prioritise patient safety and that we capture the data in the same way as other providers. Commissioners are reviewing call back time KPIs to ensure the targets are appropriate. Rotas have the best fill ever acheived in the UCAS particularly during the busiest hours at weekends and during the evenings, (but are still not completely full) and productivity has improved due to the triangulation work. Surges in demand impact performance significantly so work is ongoing to model rotas to address surges in demand with appropriately skilled clinicians via heat-mapping and more granular demand analysis

Cases Closed With No Onward Referral Via DOS (%) Local

Significant improvements have been made in this metric due to probing workshops for HAs and support for clinicians to close cases correctly. Outliers who were not achieving outcomes aligned to expectations were given further support to ensure that self-care is maximised where possible. December performance is likely to be related to the increased viral patients with breathing problems which would need a face to face appointment. Monitoring closely to ensure the previous success in achieving this KPI resumes.

People


Variation Consistent Pass Inconsistent Consistent Fail No Target
Special Cause Improvement Trust Turnover, Ambulance Operations Turnover, Ambulance Operations Stat and Man Training (%) Trust Stat and Man Training (%), IUC Stat and Man Training (%) EOC Turnover, IUC Turnover, Trust Appraisal Compliance (%), Ambulance Operations Appraisal Compliance (%), 999 Emergency Operations Appraisal Compliance (%), IUC Appraisal Compliance (%) Trust Staff In Post, Ambulance Operations Staff In Post, 999 Emergency Operations Staff In Post, Trust BME Staff (%), Ambulance Operations BME Staff (%), 999 Emergency Operations BME Staff (%), IUC BME Staff (%)
Common Cause Trust Sickness Absence, Ambulance Operations Sickness Absence IUC Sickness Absence, 999 Emergency Operations Stat and Man Training (%) IUC Staff In Post
Special Cause Concern 999 Emergency Operations Sickness Absence

Staff In Post

Trust Staff In Post

Recruitment to the Trust Workforce plan continues at a positive rate. The current pipeline is at circa 550 candidates at conditional offer stage (400 of these are for frontline roles, and 150 call handlers). In Q3 we have continued to see a very positive performance by the recruitment team with strong pipelines and fill rates. We achieved a 93% fill rate with 333 joiners against 359 planned. Corporate/Specialist recruitment – there continues to be significant recruitment activity to support the frontline including recruitment into Advanced Paramedic Practitioners, CRU, TRU, HART, HEMS, PCN Programme, Mental Health and Community Resuscitation roles. We currently have over 80 candidates at conditional offer stage. .

Ambulance Operations Staff In Post

Paramedic recruitment - Year to date we have filled 314 of the 324 training places which is ten behind plan. The international pipeline remains strong with over 170 candidates offered. The next International Trip to Australia is planned for February, where interviews will take place over Melbourne, Brisbane and Sydney. We have over 220 applications to date, with vacancies for Australian candidates still open. This campaign will boost our pipeline for our 2024/2025 workforce plan.

AAP Recruitment - Year to date we have filled 183 of the 207 training places which is 24 behind plan. The pipeline is positive with over 75 candidates offered. The team have attended a number of recruitment events to continually improve the pipeline numbers.

999 Emergency Operations Staff In Post

Positive fill rate of 100% achieved in EOC call handling. The pipeline is strong with 80 candidates at offer stage and this will continue to grow with Super Saturday and assessment events on-going.

IUC Staff In Post

111 call handlers – we achieved a 98% fill rate in Q3 and the pipelines have improved with over 60 candidates at offer stage. The recruitment team have attended community events where they actively promote 111 and 999 roles to boost the pipelines and work continues with outreach events in the South, to boost the pipeline for Croydon. 

Turnover

Trust Turnover

Turnover has remained at 10% during Q3 and the number of frontline leavers has remained positively below plan (-53fte). The stability rate which measures the ‘stay’ rate for staff over a 12 month period averages 85% for the year. There are a number of key retention initiatives in progress covering flexible retirement, stay conversations and personalised holistic health plans (piloting in 999 and 111 call handling) and a review of the internal exit interview process to improve intelligence on reasons for leaving.   

Ambulance Operations Turnover

We have low turnover rates across the Ambulance Sectors ranging from 6% to 10%, NETS (8%) and Resilience and Specialist Assets (6%). 

EOC Turnover

The well-being team are piloting 'stay conversations' in the 999 and 111 call handling teams. Stay conversations scheduled at regular points throughout the employment journey can help to gather feedback about what is working well and any areas that could be improved. The aim of these conversations is to better understand why employees stay and what might cause them to leave, providing information needed to help retain staff. They can be one-to-one conversations between an employee and their line manager, a manager from another directorate/department, or by a member of the HR/retention team.

IUC Turnover

Turnover is beginning to show a downward trend for the last 6 month period. Turnover rates have improved from a high of 40% to 29% in December. The well-being team are piloting 'stay conversations' in the 999 and 111 call handling teams. Stay conversations scheduled at regular points throughout the employment journey can help to gather feedback about what is working well and any areas that could be improved. The aim of these conversations is to better understand why employees stay and what might cause them to leave, providing information needed to help retain staff. They can be one-to-one conversations between an employee and their line manager, a manager from another directorate/department, or by a member of the HR/retention team.

Sickness Absence

Trust Sickness Absence

Absence during December climbed to 7.5% and this is being picked up in FFRs. The Wellbeing Hub continues to provide support to all colleagues and volunteers five days a week 0900-1700 with a full range of mental health support services for all colleagues, including an extended psychotherapy offer for colleagues who have complex or historic PTSD. The internal ‘Flu vaccination programme continued across the Trust with colleagues offered the vaccine at huddles, training days and contact centres. Although there was no internal Covid-19 vaccination programme, colleagues were encouraged to access the vaccine via the National Booking System, and the Trust was fortunate enough to host several clinics on our sites where external partners co-delivered the Covid-19 and flu vaccines. In order to reflect the additional pressures that arise over the winter months, the Wellbeing team heavily promoted access to a range of financial and mental health support services, including 24/7 help for those in crisis. There was also an increase in the number of wellbeing support vehicle and wellbeing cafe shifts with enormously positive feedback from staff, particularly for the wellbeing support provided on Christmas Day and New Year’s Eve. The Wellbeing Team were also able to utilise funds to ensure that all colleagues working over the Christmas period had some festive food on their station or site. Preparations are underway for a larger focus on physical wellbeing in 2024, with initiatives including functional movement programmes, individual health plans and how we can promote “Dry January”. To support this, nine members of the Wellbeing Team have now been trained in health coaching and will be able to support colleagues to achieve healthier lifestyles. There has also been a significant transition to the use of a new platform hosted by our physiotherapy provider which can help colleagues self-manage injuries where it is safe to do so and physiotherapy is not appropriate.

Ambulance Operations Sickness Absence

Sickness levels are slightly above target with the top reason still stress, S10 Anxiety /stress/depression/other psychiatric illnesses, MSK and unknown. We are seeing increasing reports of cough/cold/flu that is expected at this time of year and are continuing to promote vaccination take up in all sectors. Line managers are being reminded of the support and resources available from the Health and wellbeing, HR teams and the Enabled network. Line managers are continuing with general absence discussions (GAD) this informal supportive conversation is held when someone is just under the trigger to try to prevent things from escalating. We continue to send reminders to staff to update their personal details and request line managers to not use ‘unknown/not specified’ as a reason for sickness where possible. Long term and short term sickness is lower than the same time last year, with STS seeing a slight increase and LTS seeing an improvement from last month.

999 Emergency Operations Sickness Absence

The sickness absence rate is high and the team are taking actions to reduce absences. As part of this process the team have introduced additional activities to improve management focus and activity in this area. Initiatives include; Daily reporting on management activity relating to employees with significant irregular attendance, weekly watch reporting, covering the full range of abstractions including sickness absence; twice weekly attendance review meetings with Watches to review attendance management activity in conjunction with the P&C team and a monthly SLT assurrance meeting. 

IUC Sickness Absence

The sickness absence trend is a concern, the team have introduced a weekly meeting and reporting schedule which is chaired by a Deputy Director focussing on management activity and attendance management priorities. Additionally the team have completed an audit of management activity in relation to the application of the Supporting Attendance Policy.  

BME Staff

Trust BME Staff (%)

Levels have remained at circa 22%. The EDI team have requested for the development of an EDI dashboard which will be used to identify themes and trends across the LAS and to make this information more readily accessible to managers and staff. The Workforce Intelligence Team are leading on this work and they have proposed that the existing ESR Workforce Dashboard is used. This is a platform which all managers can currently access and it includes staff in post profiles, joiners, leavers, vacancies, appraisal, stat and mand training and managers can drill into the data using the Trust organisation hierarchy. It takes a daily feed from ESR and the dataset has been created and shared with BI colleagues. The work has started with a view to completing the pages by the end of Q4. It is expected that the new EDI pages will be available for managers in Q4.Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.

Ambulance Operations BME Staff (%)

Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.

999 Emergency Operations BME Staff (%)

BME representation in EOC remains positive. Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.

IUC BME Staff (%)

IUC have the highest BME representation of any service/team at the Trust. Work is underway to include EDI data in the FFR packs which will enable teams to see their data and then also be held accountable for delivering any required improvements.

Appraisal

Trust Appraisal Compliance (%)

Appraisal levele Trust wide are at circa 65%. We launched Phase 2: Initial roll out stage of the e-Appraisal system - for 345 people - on 26 September 2023. This includes all colleagues from Homerton and New Malden. The system has been met with positive response, which aligns to the feedback received from Phase 1: Trial stage, launched in August 2023, for 320 colleagues from the People and Culture Directorate, EDI Team, and all those that were part of the stakeholder engagement panels (including their manager and their direct line reports). The OD and Talent Team has run several drop-in sessions for colleagues, along with delivering one-to-one sessions to support colleagues over the two phases that have launched. A formal evaluation has been planned for December 2023. The OD and Talent team has also recorded a training video, which is currently being edited to support colleagues further.   

Ambulance Operations Appraisal Compliance (%)

Appraisal rates are increasing week by week within Ambulance and there has been a real focus on this across all groups. Assurances have been provided by LGM's to ADO's that if an appraisal has not been completed there is a date booked within a 4 week period rosters allowing. Appraisals are at 77% which is an improvement from last month and on the same period last year which was 63%.

999 Emergency Operations Appraisal Compliance (%)

Appraisal rates have continued to reduce and the team will need to work on appraisal delivery over the coming months.

IUC Appraisal Compliance (%)

Appraisal rates for the Directorate have remained fairly static and off target for a number of months. The team will need to prioritise appraisal delivery in order to improve compliance.

Statutory & Mandatory Training

Trust Stat and Man Training (%)

Stat and mand rates positively above target at 89%.

Ambulance Operations Stat and Man Training (%)

Statutory and Mandatory training for December 23 is 92.94% so has dropped slightly from 93.14% last month but still higher than the same period last year.

999 Emergency Operations Stat and Man Training (%)

Stat Man training is a focus area for the management team.

IUC Stat and Man Training (%)

The Stat Man training remains in a positive position for this Directorate.

Quality


Variation Consistent Pass Inconsistent Consistent Fail No Target
Special Cause Improvement 30 Day Survival, Complaints, Complaints Within Target (%), Excellence Reports
Common Cause Hand Hygiene Compliance (%), Premises Cleaning Audit (%) STEMI, Vehicle Deep Clean (%) ROSC, ROSC Utstein, Survival, 30 Day Survival Utstein, Survival Utstein, Stroke, PSII Incidents Declared, PSR Incidents Declared, Patient Safety (Death), New Inquests Notified, Calls from Frequent Callers, RIDDOR Reports, MSK RIDDOR, Body Fluid Exposure, Sharps Incidents, Physical Assaults on Staff per 1000 AandE F2F Incidents
Special Cause Concern Patient Safety (No-Low Harm), Patient Safety (Moderate-Severe Harm), Child Safeguarding, Adult Safeguarding, Adult Welfare, Controlled Drugs Incident Reports, Physical Assaults

ROSC

ROSC

The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest that had Return of Spontaneous Circulation (ROSC) on arrival at hospital.

Common cause variation is currently present in the process.


ROSC Utstein

"The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT) that had Return of Spontaneous Circulation (ROSC) on arrival at hospital.

Common cause variation is currently present in the process. "

Survival

30 Day Survival

The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest who were alive 30 days post arrest.

Special Cause Imrovement is currently present in the process.

30 Day Survival Utstein

"The percentage of patients who had resuscitation (Advanced or Basic Life Support) commenced / continued by ambulance service following an out-of-hospital cardiac arrest of presumed cardiac origin, where the arrest was bystander witnessed and the initial rhythm was Ventricular Fibrillation (VF) or Ventricular Tachycardia (VT) who were alive 30 days post arrest.

Common cause variation is currently present in the process. "

STEMI & Stroke

STEMI

The percentage of patients with a pre-hospital diagnosis of suspected ST elevation myocardial infarction (confirmed on ECG) who were provided with a STEMI care bundle.

Common cause variation is currently present in the process. We are consistently performing under the LAS target for this measure (80%).

Stroke

The percentage of patients with suspected stroke who were provided with a stroke diagnostic bundle.

Common cause variation is currently present in the process.

Patient Safety Incident Response Framework

PSII Incidents Declared

The numbers of comissioned PSIIs have remained within common cause variation.

PSR Incidents Declared

The numbers of comissioned PSRs have remained within common cause variation.

Patient Safety Incident Management

Patient Safety (No-Low Harm)

The number of patient safety incidents reported as no and low harm has continued to increase in recent months which is a sign of a positive reporting culture. A more detailed review of the data has identified key categories as medical equipment and clinical concern regarding an external provider. This category was introduced in Sep 2023 as a way to accurately capture concerns about other provider but that are not incidents for the LAS. Medical equipment incidents have accounted for the largest increase noting that 100 more incidents were reported in December 2023 compared to July 2023 with an upward trend being evident. equipment includes , LP15 for ECG, defibrillation and ETCO2 monitoring both via nasal cannula and for confirmation of advanced airway, BVMs either missing or failing during use, lack of diagnostic pouches, missing elements to sealed airway pouches including catheter mounts, missing oxygena and nebuliser masks and missing or faulty oxygen saturation probes. A risk has been raised in relation to ETCO2 monitoring and issues with the LP15.

Patient Safety (Moderate-Severe Harm)

special cause variation is evident in the moderate and severe harm date noting an increase in the number of patient safety incidents reported with these levels of harm. This association can be linked with a general increase in the reporting of patient saferty incidents. Reviewing these cases has identified increase and more robust governance from other reporting channels such as legal services where cases are being idenfied as requring further reivew.

Patient Safety (Death)

The number of patient safety incidents reporting a harm rating of death as remained in common cause variation. It should be noted that, once reviewed, severity scores are likely to change and re categorised appropriately.

Inquests & Prevention

New Inquests Notified

The number of notified inquests dipped in this period. This is normal for the time of year. Numbers are expected to rise again in the new year figures.

Complaints

Complaints

Incoming complaints continue to be under the median. Highest theme is 'conduct and behaviour' and work regarding this theme is in progress including a review of the crew ‘statement’ and reflection process, identifying the key factors and behaviours involved and providing assurance that learning has taken place.

Complaints Within Target (%)

In December, 62% of complaints were closed within the 35 working day Trust target which is the highest reported since monitoring began using SPC charts. The team continue to work towards the Trust target of 75% of complaints closed within timeframe.

Safeguarding

Child Safeguarding

Child Safeguarding concerns remain historically high - this has been a sustained and now stable increase in volume throughout the year and is similar to that reported by external partners. In previous months this increase has been attributable to significantly increased share of concerns associate with mental health, suicidality, self harm - this is not so evident in very recent months. The spread of concerns is in line with long-term trends.

Adult Safeguarding

Both adult safeguarding and welfare show significant increases in December. This is probably attributable to an increase in calls associated with winter / REAP 4, which are significantly more likely to be older patients who in turn are more likely to generate safegaurding and welfare concerns. We will expect to see this decrease in future months.

Adult Welfare

Both adult safeguarding and welfare show significant increases in December. This is probably attributable to an increase in calls associated with winter / REAP 4, which are significantly more likely to be older patients who in turn are more likely to generate safegaurding and welfare concerns. We will expect to see this decrease in future months.

Frequent Callers

Calls from Frequent Callers

Calls from Frequent Callers are currently around the average over the reference period and do not exhibit any significant variation. Numbers of active callers is also fairly static, although both measures show a long-term downward trend (about 15% reduction over two years).

Health & Safety

RIDDOR Reports

18 RIDDOR incidents were reported to HSE during December’23.

8 incidents were MSK related, 8 incidents were Slip, Trips and Falls & 2 incidents were related to Staff Safety.

17 out of the 18 RIDDORs were reported within the 15 days timeframe during December'23.

The Trust wide RIDDOR reporting time frame (<15 days) compliance in December'23 was 94%.

Manual Handling Incidents account for the highest number of RIDDORs reported across the Trust during 2023/24 (up to end of December'23).

MSK RIDDOR

Total of 8 MSK related RIDDOR incidents reported during December'23.

6 reported RIDDOR incidents occurred in Patients Home (n=6), 1 incident occurred in Ambulance (In/Ext) (n=1) and 1 incident occurred in Hospital (n=1).

3 reported RIDDOR incidents involved Carry chair (n=3), 2 incidents involved Mangar Elk (n=2), 1 incident involved LP 15 (n=1), 1 incident involved Trolley Bed (n=1) and 1 incident involved no equipment (n=1).

7 reported RIDDOR incidents resulted in Back injury (n=7) and1 incident resulted in Arm injury (n=1).

6 reported RIDDOR incidents were occurred during Lifting & Carrying (n=6), 1 incident was occurred during performing CPR (n=1) and 1 incident occurred due to Lifting Equipment(n=1).

Controlled Drugs Incident Reports

As per previous commentary, changes from reporting solely schedule 2 CD incidents to reporting all CD incidents has lead to a spike in numbers. On this basis the ranges for normal variation will need to change once sufficient data points have been entered. With regard to this month specifically there has been a reduction in total CD incidents. We continue to see reports relating to midazolam and the medicines management group is monitoring trends.

Hand Hygiene Compliance (%)

Three group stations did not submit/complete hand hygiene audits for December. Complianc remains over 90%, however submission data will not meet Quality objective.

Premises Cleaning Audit (%)

Three stations did not complete monthly audit. Cleaning compliance is above accepted limits.

Vehicle Deep Clean (%)

Vehicle deep clean compliance remains over 90%.

Body Fluid Exposure

6 cases reported for December. Continuing theme is intentional and unintentional patients spitting at crew members faces.

Sharps Incidents

5 Sharps incidents noted for December. This is within expected limits

Assaults

Physical Assaults

Total of 69 Physical assaults reported during December'23. There was a slight increase in the number of physical assaults on staff related incidents in December'23 and the trend is up-ward. The most common underlying causes remain: intoxication (drugs/alcohol), Mental Health related issues, patients recovering from fits/seizures or reacting to medication.

The greatest number of reported physical assaults (58%) occur due to the clinical condition of the patient during 2023/24; Police attended 52% of physical assault incidents during 2023/24.

LAS Violence Reduction Unit (VRU) and EOC to meet with AACE Violence Reduction Hub to discuss and explore potential projects to support call takers facing abuse on calls .

12 successful prosecution for assault have been recorded during 2023/24 (up to end December'23).

Physical Assaults on Staff per 1000 AandE F2F Incidents

Total of 69 Physical assaults reported during November'23. There was a slight increase in the number of physical assaults on staff related incidents in December'23 and the trend is down-ward. The most common underlying causes remain: intoxication (drugs/alcohol), Mental Health related issues, patients recovering from fits/seizures or reacting to medication.

LAS staff are facing about one physical assault incident per 1000 face to face attendances.

BWV cameras has now been successfully rolled out across all sites.

Total of 806 new users have been trained the ESR e-learning module.

Excellence

Excellence Reports

There has been a positive increase in the number of excellence reports received by the service indicationg a good reporting culture.

Finance


Income & Expenditure


In month - £1.6m deficit; £0.1m favourable to plan.

Capital Expenditure


Year to date spend - £18m; £1.0.7m behind forecast.

CIP Savings


In month - £2.4m, on plan.

Cash


Closing cash balance - £42.6m; £5.4m above plan.

Risks and Mitigations

Risk Description Mitigation
  1. Income
Block contracts with 4 ICB’s in dispute Value agreed for 23/24 and discussions ongoing re level of non-recurrent funding in contract going forward
  1. CIP Delivery
Under-delivery against £25.0m CIP target Developing recovery plan for Ambulance Services, 999 operations and 111 service
  1. Operational Pressures
Performance below trajectory submitted to NHSE Identifying operational efficiencies