Chief Executive Report

Meeting:

Public Board

Date:

10.05.2023

Report Title:

Chief Executive Report

Agenda Item:

PUB23/4/06

Author:

Tom Abell, Chief Executive 

Lead Director:

Tom Abell, Chief Executive 

X

SR1b: If we do not ensure our leaders are developed and equipped, there is a risk that we will not be able to change our culture, and value, support, develop and grow our people

X 

SR2: If we do not deliver operational and clinical standards then there is a risk of poor patient outcomes and experience

X 

SR3: If we do not ensure we have the ability to plan, influence and deliver across our systems to secure change, we will not be able to meet the needs of our public and communities

X 

SR4: If we do not resolve long standing organisational inefficiencies we will be unable to deliver an effective, sustainable, value for money service to our public

X 

SR5: If we do not clearly define our strategic plans we will not have the agility to deliver the suite of improvements needed

X 

SR6: If we do not deliver sustainable regulatory compliance and develop positive relationships, we will have limited ability to deliver our strategy

Equality Impact Assessment

No negative impact identified

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Recommendation:

Board members are asked to note the report.

Purpose

The purpose of the report is to provide an update from the Chief Executive to the Board of Directors on the activities of the Trust since its’ last meeting.

Executive Summary

Response Times and Operational Performance Improvement Plan (OPIP)

As board members will note from the Integrated Performance Report we have seen a continued reduction in response times to patients, although we currently remain above the NHS planning target of a 30 minute mean C2 response which at the time of writing was around 35 minutes for April.

This reduction has been enabled through good levels of resourcing so far this financial year with an average of 87,500 patient facing staff hours being delivered each week (against our agreed target of 84,240) allowing us to improve ambulance cover to an average of around 335 ambulances each day, alongside around 140 ambulances each night.

Handover delays at hospital have reduced from an average of around 4,000 lost ambulance hours per week to around 2,700 hours in April, however this remains above the 1,500 hours target we have identified to allow us to consistently deliver the 30 minute standard.

Therefore, we have more to do, both to drive our internal efficiency and productivity and to continue working with the wider health and care system to further improve response times to patients as set out within our Operational Improvement Plan (OPIP) which was recently approved by the Board and has now moved to delivery phase.

Focusing on our internal actions, the current status of action delivery is set out below:

Overall performance against OPIP metrics are improving over the last reporting area, although the need for significant improve remains.  The key escalations and areas of focus for our internal actions are as follows:

• Deterioration of Handover to Clear times, with actions being undertaken by HALOs to standardise and monitor our processes around Handover to Clear, alongside recommendations being commissioned from our Tactical Operations Centre.

• Sickness remains broadly unchanged, with focus on delivery of sickness absence activities.

• C2 on scene time has seen improvement in Cambridgeshire and Peterborough alongside Norfolk and Waveney, although 5 areas remain above Q1 target, we are trialling a training module in Suffolk and North East Essex aimed at supporting and empowering staff on scene to reduce on scene time.
• Out of Services times have improved, although remain above Q1 target. The new Out of Service process has now been implemented, with work ongoing to refine the detail of this new process.

In terms of our work with the wider system, we continue to make good progress to increase the use of alternative pathways though the utilisation of ‘Access to the Stack’ with 2,380 calls being referred to alternative services (around a 40% increase), with acceptance rates increasing to over 50% (from around 40%).  We aim through the actions we are taking to double the number of referrals referred, alongside increasing the acceptance rate to 60% or higher.

We are also working closely with each of our 6 Integrated Care Systems to set up Community Hubs by the end of summer to drive the use of alternative pathways and activities such as Call Before You Convey, with a pilot now being established in Suffolk and North East Essex, alongside our first Deputy Director of Urgent and Emergency Care (a joint appointment between EEAST and an ICB) having started in Hertfordshire and West Essex.

Focus remains on establishing clear, ICS and hospital site level plans to support handover reduction, we have now had sight of proposed trajectories to reduce handover delays to around 1,500 hours per week and are working with ICSs and NHS England on the assurance processes to support this and to revise our forecast response times based on these which will be shared with the Board once available.

Trust Recruitment Plan

Alongside the OPIP, a further key risk faced by the Trust is the delivery of the Trusts’ ambitious recruitment plan, aiming to recruit 775 new A&E clinicians within the Trust over the course of this year.  The current progress against plan is set out in the table below with 40% of the target at an offer, course booked or in post stage as at 19^th April 2023.

Alongside A&E recruitment we continue to focus on strengthening our control functions with good progress being made to increase the number of Clinical Advisors (45 at offer or better stage against a target of 96 for this financial year) working within our triage teams to enable better use of alternative pathways and ensuring patients get the most appropriate response to meet their needs.

Industrial Action

Board members will be aware that the intended industrial action in March by both UNISON and GMB was deferred as a result of negotiations on pay between the unions and Government.

At the time of writing a decision on the new pay offer is expected imminently and a verbal update will be provided to the board on the latest position on this.

Although we have not seen direct industrial action within EEAST, we have continued to work closely with partners across the NHS to help manage patient safety during the strikes undertaken by junior doctors and continue to maintain our Incident Management arrangements to support service delivery throughout this period of industrial action.

COVID and Flu

The IPC team are working with the national team to incorporate Covid into our business-as-usual activity and therefore we have removed the requirement for staff to have 2 negative tests after day 5 to enable them to return to work on day 6 if staff feel well enough.

At the time of writing this report the Trust have 106 positive covid cases, down from 120 at the last report. Sickness through Cough, Cold & Flu has reduced to 35 (0.53%).

Sustainability

Progress continues to be made to deliver our sustainability commitments, with progress being made across a number of areas:

• Fleet emissions for 2022/23 (as of January 2023) are down 12.7%, with a high likelihood we will exceed our 5% annual reduction target.

• Utilities emissions for 2022/23 (as of January 2023) are down 19.3%.

• Nitrous oxide emissions from Entonox are down 8% from the 2019/20 baseline.

Annex A provides fuller details of the further actions that are being taken to further progress our sustainability work, but I would like to draw attention to the following activities:

• We have procured 27 power units for EV charging, and are mobilising a charge point management system with the ability to use RFID cards and a mobile app allowing staff to charge and pay for their personal vehicles.

• Electronic payslips were launched on 1^st April, which will reduce both paper consumption, alongside distribution requirements.

• Funding has been secured for the trail for three fully electric ambulances, with expected delivery during 2023.

Regulatory Update

Care Quality Commission

• The Trust continues to make progress against the CQC action plan and two CQC conditions have been lifted in relation to DBS and Safer recruitment. I am very grateful to the teams involved for all their hard work and extremely pleased to report that the Trust is making progress.

• The SOF4 support continues, and we have been joined by Peter Cutler as our new Improvement Director and Charlotte Moore as Senior Programme Support who is assisting in the delivery of the OPIP.

European Human Rights Commission (EHRC)

• The Trust received contact from EHRC on Wednesday 12^th April following the media reports on the BME Survey.

• We have returned all requested information to the EHRC and await their response at the time of writing.

National Guardian’s Office report into speaking up within the ambulance sector

On 23^rd February 2023 the National Guardian’s Office (NGO) published ‘Listening to Workers’ which identified that the culture in ambulance services did not support workers to speak up and that this was having an impact on worker wellbeing and ultimately patient safety (the full report is available here).

This is something we are clearly aware of as an organisation and are determined to tackle through our work to strengthen and improve our culture as an organisation, and I am pleased that in respect of the actions identified by the NGO we as an organisation are already taking action against the vast majority of these.

I have included our response on the actions identified within the report for Ambulance Trusts at Annex B, with progress against these being reported through the Quarterly Freedom to Speak Up report we receive at the Board.

Trust Chair

The recruitment of the new Trust Chair has been successfully completed, following a robust assessment process including stakeholder panels and formal interviews.

NHSE have approved the appointment of Mrunal as the new Trust Chair, who will start with us on 1^st June 2023.

I would like to take this opportunity to thank Nicola for the guidance and support she has provided to the Trust & I during her tenure.

Engagement

I have continued to visit Ambulance Stations, hospitals and blue light colleagues and met with a number of external stakeholders in recent months.

I had the opportunity to visit Basildon Hospital to celebrate their 50^th Anniversary where we planted a time capsule to be opened in years to come.

I have also visited the Hellesdon site, where we have our Norwich Emergency Operations Centre & CallEEAST and visited all staff with the treat trolley, giving them time to have a break and chat to me about their career, aspirations and any concerns or feedback they had.

We have welcomed a number of parliamentary colleagues to our stations since my last report which has included:

• I attended the East of England All Parliamentary Group in Westminster to update MPs and Lords on the work of the Trust and our improvement activities.

• On behalf of the Association of Ambulance Chief Executives I attended a round table led by Richard Meddings (Chair of NHS England) on Urgent and Emergency Care.

• I presented at the Essex Health Overview and Scrutiny Committee to provide an update on our service, our improvement activities and to take questions from councillors.

• We ran a session for Healthwatch Chief Executives across our region, and have agreed a number of areas of joint work to better understand perceptions and experiences of our service, alongside the creation of a quarterly forum to improve our dialogue and joint working with Healthwatch.

• Sir Mike Penning MP visited Hemel Hempstead Station.

• Charles Bishop, High Sherriff of Essex visited Chelmsford Ambulance Station & Chelmsford EOC and met with a number of staff and witnessed the outstanding work of both our EOC & A&E colleagues.

Armed Forces

On 13^th April we received confirmation that following our one-year review of being appointed a Veteran Aware Trust, the Veterans Covenant Healthcare Alliance has approved our renewal. I signed the covenant on Thursday 20^th April on behalf of the Trust and was pleased to be joined by Terry Hicks, Head of Operations for Cambridgeshire and Peterborough.

This award demonstrates the Trust’s commitment to the Armed Forces Covenant and exemplifies the outstanding advocacy by the Trust, but in particular the work of Terry Hicks and Paul Gates.