OPERATIONAL PERFORMANCE STANDARDS: DECEMBER 2008

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1 AGENDA ITEM No. 5 MEETING : TRUST BOARD DATE : 4 FEBRUARY 2009 REPORT OF : INTERIM DIRECTOR OF AMBULANCE SERVICES/DIRECTOR OF ICT Contact : David Jackland, Officer Tel: Ceryl.Jones@ambulance.wales.nhs.uk OPERATIONAL PERFORMANCE STANDARDS: DECEMBER 20 INTRODUCTION 1 The Board is invited to consider a detailed report (attached as an Appendix) describing the achievement against the operational response performance standards for the month of December 20, together with a year to date position by Region. The report sets out the following information:- Monthly and cumulative performance EMS Activity v Contract RECOMMENDED: That the content of the report and its appendices, be noted. CONTEXT 2 There were a number of contributory factors and challenges associated with the level of achievement against the Category eight minute performance standards during December 20. Increased levels of emergency activity were a major issue. Between 28 November and 31 December 20, emergency activity rose by an average of 82 incidents per day, dropping only slightly in January. The relationship between this activity rise and performance is indicated in the following charts (Figure 1);

2 Figure 1: Emergency activity and response time compliance, October-December 20 3 Partly as a consequence of this activity increase, hospital delays have been a major impediment to performance recovery. The following table indexes ambulance unit hours lost to last December s delays, taking December 2006 as Countess Glan Clwyd Prince Charles Bronglais Hereford C ty Wrexham Morriston Nevill Hall Neath Port Prince Phillip P cess of Wales Royal Gwent Royal Glam Royal Shrews Singleton UHW Withybush West Wales Y Gwynedd Total >50 minutes Hours 07 lost Dec >20 minutes Hours 07 lost Dec

3 4 In December, the levels of hospital delays experienced over 50 minutes and over 20 minutes, respectively, were 14% and 26% higher than those of our previous peak in February As the chart (above) shows, the delays affected all regions including, for the first time, North Wales. However, on both measures, four of the top five hospitals are in the Mid and West Wales region. In some of these hospitals, the numbers are small, but so is the level of local ambulance cover and distances to the next available ambulance are often great. South East Wales incurred the majority of the lost unit hours: 57% of all delays, 63% of extreme delays and 47% of the year-on-year growth. 6 Further, more detailed information concerning hospital handovers is included in the attached appendix. 7 The weather has a significant role in patient epidemiology and the achievement of performance. Recent fog, icy roads, heavy rain and flooding have all inhibited the ambulance resources from making speedy progress to the scene of life threatening incidents and present further challenges to the achievement of the eight minute performance standard. Breathing difficulties and falls continue to be the most significant conditions requiring an ambulance response. 8 Internal factors affecting performance such as increased short term sickness absence over the holiday period due to coughs and flu like viruses have added to the loss of shift cover. 9 Figure 2 (below) shows the impact lost ambulance cover, due to hospital delays and unfilled shifts, had on incident cycle times in each region. It should be noted that the time taken to verify an incident location is similar in each region, as are the mobilisation and drive to scene times. The main variation within the response time is the time it takes Ambulance Control to locate an available resource and allocate an emergency.

4 Figure 2: Incident cycle times by region, November 20 to early January The time taken to find a resource to which the emergency call can be allocated is significantly extended in the South East. The Mid & West region incurred the same effect to a lesser degree. An alternative way of looking at this phenomenon is via the percentage of emergencies receiving an eight minute response by double crewed ambulances. As Figure 3 shows, this was highest in North Wales, where the delays and staff shortages were lowest. 11 These charts also demonstrate the reliance that was placed on alternative responders in the South East, including managers, senior clinical staff and trainers, who were a constant and visible presence over the entire holiday period. EMERGENCY AND URGENT SERVICES 12 Year to date activity has increased by 15.7% against the 2002/2003 base line contract which includes a tolerance of +15%. Emergency activity continues to rise with the year to date Trust level, being 37% above the contract; this is, however, offset by an almost corresponding decrease in the urgent and routine activity. 13 The Trust s year to date position at December 20 for the A8 Category response performance standard is 59.3%.

5 RECOVERY PLANS 14 The Regional Directors are implementing recovery plans and working in partnership with staff and the local health and social care economies to improve performance.