Performance Against Key Targets

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					                    YORKSHIRE AMBULANCE SERVICE NHS TRUST

                                       Board Meeting

                                    21st November 2007


Report from:            John Darley, Operations Director

Subject:                Performance Against Key Targets

Report Status:          Open


1         Summary

1.1       This report presents progress against key performance indicators (KPIs) for the
          Yorkshire Ambulance Service (YAS) NHS Trust, during the period 1st April 2007
          to 31st October 2007 inclusive.

1.2       Performance information is presented in the following summary tables for each
          CBU area and the Trust overall:

          A.   Response times for Category A calls – 8 minutes (75%).
          B.   Transport times for Category A calls – 19 minutes (95%).
          C.   Response times for Category B calls – 19 minutes (95%).
          D.   Response times for GP Urgent calls – arrival with patient (95%).
          E.   Response activation times for all 999 calls.
          F.   Category A and Category B activity levels (including PCT specific)
          G.   Category A and Category B response times (PCT specific).

1.3       Also included as part of this report is graphical representation of the Yorkshire
          Ambulance Service NHS Trust performance against it’s agreed target trajectory
          for recovery against the A8 standard (submitted to and agreed by the Yorkshire
          & Humber StHA and DoH) for Category A response (appendix 6). Appendix 7
          details the Yorkshire Ambulance Service NHS Trust (shadow) performance
          reporting against our agreed Call Connect trajectory between September 2006
          and delivery in April 2007.

          PCT specific information is also included in this report on activity levels and
          response times against the KPIs as specified in the 2007/08 SLA (Appendices
          8 & 9). Appendix 10 summarises the national position for A8, B19 and Call
          Connect as a “snapshot” for the week ending 28th October 2007 and for the
          YTD.

2         Key issues

2.1       This report highlights:

         Year to date Category A 8 minute response time target (31st October 2007)
          stands at 74.9%.

         Year to date Category A 19 minute transport target (31st October 2007) stands
          at 96.3%.
       Year to date Category B 19 minute response time target (31st October 2007)
        stands at 92.7%


       Indicator A         Response times for Category A calls (8 mins)

Trust / CBU                National     Local Target     Actual Performance
                            Target
                             Oct            Oct            Oct         YTD
YAS NHS Trust               75.0%          75.0%          73.7%       74.9%
South Yorkshire                            78.0%          77.8%       77.9%
North Yorkshire                            69.0%          64.2%       68.3%
Bradford / Calderdale                      75.0%          72.8%       73.6%
Leeds / Wakefield                          75.5%          76.1%       74.9%
Hull & ER                                  80.0%          71.7%       77.7%

Comment

Performance during October 2007 was very challenging and resulted in a
performance figure of 73.7% for Category A response within 8 minutes.

This is below the national standard by 1.3% for the month of October. The
main contributory factor in the Trust failing to meet the 75% standard for the
months of September and October was the change to the CAD in the York
Communications Centre which has severely hit performance in both North
Yorkshire CBU and Hull and East Riding CBU. PCT performance across
those two areas has also felt a similar negative impact on their performance
levels.

The overall negative impact on the YAS A8 performance figure has been
between 2.0% and 2.5% as a consequence in each of the last two months.

The Trust has and will continue to operate all possible contingency measures
to mitigate the performance fall and recover the 75% YTD position as soon as
is possible.

Some of the tactical and strategic measures to mitigate the performance fall
are as follows:

Strategic Measures

       Negotiation is currently ongoing with Strategic Health Authority for
        additional financial support (between now and 31st March 2008) to
        underwrite increased performance in all areas of YAS (Central and
        South particularly) to recover the YTD A8 figure back to 75%.

Tactical – York Communication Centre

       Additional training support provided to York Communications Centre
        staff in MIS C3
       Expert external support in MIS C3 provide to York Communication
        Centre Staff.

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      Migration of Wakefield Communication Centre managers and staff to
       support York Communications Centre staff.
      Move to 4 Bay dispatch (from 2) in York Communications Centre to
       increase speed and efficiency of assignment with each dispatcher
       controlling fewer resources.
      Increase the number of Call Takers in York Communications Centre to
       increase the speed and efficiency with which 999 calls are answered –
       ultimate target for Call Connect is to achieve 95% within 5 seconds.
      Focussing dedicated managerial support to York Communications
       Centre.
      Providing operations support (Locality Manager or CTL) into the
       Communications Centre to deal with “road crew issues”.

The first tranche of Call Connect staff (31) were received in Operations from
training school at the end of October which has significantly improved the rota
position particularly in the Central area by a daily average of 5%. The first
tranche (50) of Student Paramedic staff are also expected out of training
school in early December and will be distributed Trust wide further improving
our A&E rota coverage.

Wherever the Trust can bring forward the delivery of specific operational Call
Connect initiatives (e.g. early implementation of RRV rotas (e.g. Bradford
team in early December)) this is being done - all being supported by 24hr
stand by capacity at 7 sites across Yorkshire (with a further 11 expected by
31st March 2008) – operational capability just awaiting YEB connections.

All managers who are clinically trained to respond are being made available to
do so and all non-clinically trained managers are concentrating their efforts on
hospital turnaround and activation targets.

The major operational changes (Rotas, Stand By and Meal Breaks) brought in
on 5th March 2007 all remain under constant and formal review by the staff
side/management groups that developed them to ensure they continue to
deliver the service benefits required.

In agreement with staff side YAS implemented a new A&E meal break policy
during October 2007 which now means the Trust is fully compliant with both
AfC and the WTD across all areas of A&E operations.

The next phase of the service improvement plan for call connect remains
“work in progress” concentrating on the delivery of Call Connect which is to be
implemented by 1st April 2008. All work streams remain on target to deliver
their required outputs by 31st March 2008. Full delivery against the 75% Call
Connect performance target in April 2008 still remains “high risk” for the Trust.

Appendix 1 details the 2007/08 monthly performance against the 8 minute
standard during October and for the year to date.

Appendix 9 details the PCT specific performance against their 2007/08 SLA
for Category A8 response during October and for the year to date.

Appendix 10 details the national position with regard to the current A8
standard, B19 standard and the shadow monitoring position for A8 Call
Connect – “snapshot” as at week ending 28/10/07 and for the YTD overall.
                                                                                    3
     Indicator B         Transport times for Category A calls within 19
                                              min

Trust / CBU             National     Local Target    Actual Performance
                         Target
                          Oct            Oct           Oct         YTD
YAS NHS Trust            95.0%          95.0%         96.0%       96.3%
South Yorkshire                         99.0%         99.1%       99.2%
North Yorkshire                         90.0%         89.4%       89.9%
Bradford / Calderdale                   96.5%         96.0%       96.6%
Leeds / Wakefield                       98.5%         97.4%       97.1%
Hull & ER                               98.0%         93.9%       94.8%

Comment

During October 2007 YAS NHS Trust recorded 96.0% transport response to
Category A calls within 19 minutes against the standard of 95.0%.

This equates to a year to date performance figure of 96.3% for transport
response to all Category A calls within 19 minutes.

South Yorkshire, Bradford/Calderdale and Leeds/Wakefield CBUs all
delivered performance in excess of 95% during October 2007 while North
Yorkshire and Hull & East Riding CBUs recorded performance below their
target figures.

Appendix 2 details the 2007/08 monthly performance against the 19 minute
standard during October and also for the YTD.

Appendix 9 details the PCT specific performance against their 2007/08 SLA
for Category A19 response during October and for the year to date.


     Indicator C         Response times for Category B Calls within 19
                                             min

     Trust / CBU         National     Local Target   Actual Performance
                          Target
                           Oct            Oct          Oct         YTD
YAS NHS Trust             95.0%          95.0%        92.1%       92.7%
South Yorkshire                          97.0%        95.8%       96.3%
North Yorkshire                          91.0%        88.0%       89.0%
Bradford / Calderdale                    90.0%        89.7%       90.3%
Leeds / Wakefield                        92.0%        92.1%       92.0%
Hull & ER                                95.0%        93.1%       94.2%


Comment

The YAS NHS Trust delivered a performance figure of 92.1% response to
Category B calls within 19 minutes during October 2007 against a target of
95.0%.

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The Trust’s 2007/08 year to date figure (31st October 2007) is 92.7% for
Category B response within 19 minutes.

Appendix 3 details the 2006/07 monthly performance for October against the
19 minute standard and also for the year to date.

Appendix 9 details the PCT specific performance against their 2007/08 SLA
for Category B19 response during October and for the year to date.


     Indicator D                Response times for GP Urgent calls
                           (within 15 mins of agreed arrival with patient)

Trust / CBU                National     Local Target    Actual Performance
                            Target
                             Oct            Oct           Oct          YTD
YAS NHS Trust                95%            95%          83.2%        87.9%
South Yorkshire                             95%          92.4%        94.6%
North Yorkshire                             95%          79.4%        85.6%
Bradford / Calderdale                       95%          79.9%        81.4%
Leeds / Wakefield                           95%          79.5%        81.5%
Hull & ER                                   95%          71.4%        83.6%

Comment

The Trust delivered a performance figure of 83.2% during October 2007,
against a target of 95.0% and 87.9% for the year to date (31st October 2007).

The poor response times to Urgent calls resulted from the same operational
issues currently being faced in trying to deal with the emergency demand and
are exaggerated as the Trust prioritises a response to it’s emergency details.

Appendix 4 details the 2007/08 monthly performance against the 15 minute
standard and also for the year to date.


Indicator E               Response Activation Times for all Emergency
                                             calls
                                         (3 minutes)

Trust / CBU               National     Local Target     Actual Performance
                           Target
                            Oct            Oct            Oct          YTD
YAS NHS Trust               95%            95%           92.3%        92.9%
South Yorkshire                            95%           96.8%        96.9%
North Yorkshire                            95%           90.3%        92.8%
Bradford / Calderdale                      95%           90.1%        90.2%
Leeds / Wakefield                          95%           92.6%        90.8%
Hull & ER                                  95%           87.8%        93.1%


Comment
                                                                                 5
The Trust delivered a performance figure of 92.3% during October 2007,
compared to a target figure of 95%. The YTD figure for the Trust stands at
92.9%.

This figure remains a considerable improvement on the 2006/07 outurn as the
Trust aims to deliver a consistent response in terms of activation times to
patients across all areas of the Yorkshire Ambulance Service particularly in
the Central area which has historically been the weakest performer.

Appendix 5 details the 2007/08 monthly performance for October against the
3 minute standard and also for the year to date (31st October 2007).


     Indicator F                            Activity Levels

Trust / CBU                  2007/08 Cat A                2007/08 Cat B

                            Oct         YTD            Oct            YTD
YAS NHS Trust              16,501      110,784        16,528         116,734
Comment

Overall activity levels for Category A and Category B during October 2007 and
for the year to date (Apr – Oct) are reflected in the table above.

Appendix 8 provides full detail of the PCT and Trust activity levels for
Category A, Category B, Category C and “Other” as well as the cumulative
position for October 2007 and the year to date (April – October inclusive).

The PCT activity levels in Appendix 8 compare activity levels against plan as
per the agreed 2007/08 SLA with the relevant variances calculated through for
each area.

During October the Trust responded to an aggregate 1.6% (766 incidents)
reduction in activity when compared to the commissioned levels through the
2007/08 SLA for month seven.

Category A activity for the Trust overall was up by 1.8% (298 incidents)
against plan during October while Category B activity levels reported 3.5%
(598 incidents) below commissioned levels.

The increase in “Other” Activity (Urgent, Planned and Routine details) of 5.0%
(413 incidents) was more than balanced by a reduction in Category C work of
11.5% (879 incidents) during the month.

For the year to date (April – October inclusive) the Trust has responded to a
total of 0.7% (2,173 incidents - all categories) more activity than has been
commissioned in the first seven months of the year. This includes an increase
of 5.0% (5,229) Category A incidents above plan which, combined with other
factors referenced in this report, has contributed significantly to the pressure
on the Trust’s performance against it’s headline 75% Category A response
target.


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3     Recommendations

3.1   The Board is asked to note and comment on the report.




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