QUALITY
Henry Ford
is looking.”
Contents
Summary and introduction...
4
Part 1: statements of quality and accountability...
7
Part 2: our priorities for 2014/15...
12
Review of services and statement of assurance...
25
Part 3: our priorities for 2013/14...
43
Stakeholder feedback...
88
Glossary...
95
Summary
W
elcome to the East of England Ambulance Service NHS Trust Quality Account for 2013/14.This document has been approved by the Trust and is an accurate account of the level of quality of service provided to patients. In developing this Quality Account the Chief Executive has set out a summary of the Trust’s achievements for 2013/14, and goals for 2014/15.
The Trust has drawn on information from a range of data sources and, in setting the priorities for 2014/15 it has engaged with staff and service users to identify the key clinical areas which require its focus to further improve the quality to meet patient and public expectation. It has also acknowledged the core/ mandatory priorities for improvement published by the Department of Health (DH).
Improving quality is an overarching priority of the Trust and this report lays out plans for developing future services to improve patient care and patient outcomes by delivering the right resources at the right time so that the service is publicly accountable for driving clinical quality higher.
Contributions to this document
Ipswich and East Suffolk CCG, the lead commissioner, the Trust User Group,
Healthwatch groups and the regions health overview and scrutiny committees (HOSCs) have been asked to comment on this document.
There is a glossary for reference on pages *****. Where can you get hold of this document?
This Quality Account will be made available on the NHS Choices website: http://www.nhs.uk/aboutNHSChoices/professionals/
healthandcareprofessionals/quality-accounts/Pages/about-quality-accounts.aspx
This will be made available by 30th June 2014 and hard copies are available on request by contacting:
East of England Ambulance Service NHS Trust Headquarters Whiting Way,
Off Back Lane, Melbourn, Cambridgeshire SG8 6EN
Tel no. 0845 601 3733
Backgound and profile
F
ormed in July 2006, the East of England Ambulance Service NHS Trust (EEAST), operates in Bedfordshire, Cambridgeshire, Hertfordshire, Essex, Norfolk and Suffolk and covers a population of 5.8m. The operational service is co-ordinated from the emergency operations centres (EOCs) located in Bedford, Chelmsford and Norwich, and there are more stations and offices. The Trust headquarters has recently moved to Melbourn, Cambridgeshire.Over the last 10 years all-cause mortality rates in the East of England have fallen. Early death rates from heart disease and stroke have fallen and are better than the national average.
With the exception of London, the East of England has the highest incidence of newly-diagnosed diabetes over the surrounding ambulance services. The number of early deaths from heart disease and stroke is less than the national average but is higher than in some of the surrounding areas.
Falls in the older population are associated with high morbidity and mortality; hip fractures are a significant contributing factor to this and the east of England, although not significantly different from the national average, does have more of these than its counterparts.
The number of significant road injuries and deaths is considerably higher than the national average, and the region has a substantial major road network that is mixed between high volume carriageways and rural roads.
Although binge drinking and alcohol related incidents regularly make the news, the east of England has a significantly larger than average number of hospital admissions for alcohol related self-harm.
The Trust provides a wide range of services to a variety of people, and can be categorised into the following areas:
• emergency 999 ambulance and rapid response provision • a scheduled transport service
(STS)
• primary and call handling for urgent care
• NHS 111 service in Norfolk • other commercial services.
The Trust provides the NHS111 service for Norfolk, serving a population of about 750,000. The service began in December 2012 and after some initial teething problems where demand outstripped resource, the service is now achieving its call performance targets every month. It is now one of the highest performing in the country and on a region-wide basis, it has one of the lowest 999 transfer rates and one of the highest conveyance rates.
This demonstrates that the referrals made by Norfolk 111 are suitable and appropriate. Working closely with the out-of-hours doctors service for the area and with all three services (999, 111 and OOH) all situated in one room at Hellesdon means that EEAST has a truly integrated model, one which ensures the most appropriate care, in the right place at the right time for the patients of Norfolk.
Quality Account amendment
regulations 2011
These Regulations require the Trust by law to publish a set of Quality Accounts by 30th June, 2014. This will be the fifth set of Quality Accounts published by the Trust. The Quality Account is presented in three parts and includes a quality statement from the Board, the priorities for quality improvement for the year 2014/15 and a review of the quality improvements made in the past year 2013/14 with regards to the three domains of quality:
1 – Patient safety
2 – Clinical effectiveness 3 – Patient experience
The Quality Account 2013/14 is set out into:
a) Part 1, containing a statement summarising the provider’s view of the quality of NHS services provided (or sub-contracted) by the Trust during the reporting period, and a written statement, at the end of Part 1, signed by the Chief Executive that to the best of his knowledge the information in the document is accurate (refer to Regulation 6); b) Part 2, containing a description of the areas for improvement in the quality of NHS services provided (or subcontracted) by the Trust during the reporting period which is prescribed for the purposes of section 8 (1) or (3) of the 2009 Act by paragraph (2) and the information required by Regulation 7;
c) Part 3, containing information about the review of the Trust’s quality performance of NHS services provided (or sub-contracted) by it during the reporting period.
Statement on quality from the Board
W
elcome to the East of England Ambulance Trust NHS Trust’s Quality Account for 2013/14. This is my first Quality Account as Chief Executive of the Trust after coming into post in January.The start of the new financial year gives us all an opportunity to move forward in a positive manner. It allows us to improve the high quality service that we already provide to our patients ensuring that it is a service in which they can have confidence, and in which our staff can take pride. The previous 12 months have been a challenging time, and I would like to thank former CEO Andrew Morgan for his work during this period. I and the Trust Board believe that the challenges of the previous year can be overcome and together with our staff, we can make the East of England a top performing ambulance Trust.
The purpose of the Quality Account is to ensure that the Trust is focused on quality improvement as a primary function of the organisation. It enables us to be held accountable by the public and our commissioners for the quality of the care that we provide.
The Quality Account reflects on the progress made during the previous year and identifies our priorities for the coming year. This year, we are focusing on seven key priorities for the Trust ensuring that our patients are seen promptly, treated effectively and are satisfied with the service that they receive from our staff.
In our last Quality Account, we identified 22 priorities and I am happy to say that we have seen improvement across a wide range of priorities, which will be identified in this report. In particular we have made some significant clinical improvements which have had a positive impact on both patients and staff including the introduction of wound closure skills to paramedics, the introduction of the clinical record viewer to support our Hear and Treat clinicians, and recognition of our dementia pathways as best practice. We have made strides in our drive to recruit more paramedics and put more ambulances on the road, with 27 additional emergency ambulances delivered and in use; shortlisted more than 1,000 student paramedic applications and have successfully trained the first cohort of 15
emergency care assistants on their six week conversion course to emergency medical technician.
However, there are areas in which we failed to make the improvements that we would have wished to see, most notably in meeting performance targets which we are set and for this reason, we are focusing on improving our performance against these targets for the
coming year. We are implementing significant changes that will allow us to improve the speed of our response to our patients.
I would like to take this opportunity to thank our staff for their dedication and professionalism throughout this year and without whom our achievements would not have been possible. Please be assured of my continued full support, as we work together to transform this organisation.
Statement of accountability
A
s Accountable Officer and Chief Executive of the Trust, I have responsibilityfor maintaining the performance and standards achieved within the Trust’s services, and to support an environment of continuous quality improvement. This is the fifth Quality Account produced by the East of England Ambulance Service NHS Trust, in line with the requirements of the Health Act 2009. The Quality Account contains details mandated by the regulations and also identifies the measures that the Trust, in association with our NHS and public partners, has decided will best demonstrate the work that has been done to improve the standards and quality of clinical care. The results of these measures show that much work has been undertaken this year to improve the quality of care to
patients; however, there are areas in which the Trust needs to improve to ensure all patients have a positive experience in using the ambulance service.
As Accountable Officer, it is also my responsibility to ensure both the quality and accuracy of the data within this Quality Account and to confirm that it presents a balanced picture of the Trust’s performance. I can provide this assurance based on the Trust’s internal processes for ensuring the quality of data and the opinion of our Internal Auditors, who completed and delivered an annual audit programme including an audit on the Quality Account and the processes used to develop it. Therefore to the best of my knowledge the information contained within this Quality Account for the East of England Ambulance Service NHS Trust is a true and accurate record.
Dr Anthony Marsh QAM SBStJ DSci (Hon) MBA MSc FASI
Statement on Quality from the acting Head
of Quality Governance
Aristotle
“Quality is not an act, it is a habit”
W
elcome to the review of the quality of service for 2013/14. The Quality Account is designed to give a clear picture of our quality performance for the year in the 22 priority areas we set under the five domains:
• Saving lives
• Keeping our patients safe
• Giving a positive experience of our care
• Improving quality of life for long term conditions • Starting recovery from the moment of injury
It has been a transitional year for the Trust with challenges of increased demand and significant change at Board level. I believe that this quality account represents an honest view of our performance in the areas and continues to highlight the fantastic work frontline clinicians have been continuing to do to improve care for our patients.
The urgent and emergency care review undertaken by Professor Sir Bruce Keogh is welcome as it highlights that ambulance services, and paramedics in particular, will have an increasingly important role to play within the community in dealing with patients in a way that better suits their needs and expectations.
We are pleased that in some areas there have been improvements in the care we deliver, including recognition of sepsis patients and feedback to our staff. We have also seen high results in our net promoter score which shows that the public support the service we deliver to them. However in some areas, including getting to patients quickly and stroke care, we have not seen the improvement we set out to achieve.
In order to continue to maintain these quality improvements, whilst contributing to the Government’s significant efficiency savings as well as meeting increased patient demand, it will require the same commitment next year as we continue to transform our service delivery to focus on better patient outcomes.
During the year we have engaged with a range of stakeholders in setting the quality agenda for the coming year. This has led to the development of seven priorities:
We believe focusing on these areas will allow us to deliver high quality, equitable patient care across the population we serve. We also need a renewed focus on patient safety and feedback to staff as set out in the priorities for the year.
The Trust Performance Improvement Action Plan is pivotal to achieving improvements in these areas, and we will need to work together as a team to accomplish them.
Aristotle was once quoted as saying, “quality is not an act, it is a habit.” The challenge for the service moving forward is to culturally change so that everyone is focused on high quality patient care, all the time. This is a challenge that the Trust Board intend to take seriously, focusing every decision in the light of impact on patient care, and is a challenge for every member of staff in our day to day work.
Statement on Quality from the acting Head
of Quality Governance
1. Timely response
2. Heart attack care
3. Stroke care
4. Friends and family
Stakeholder engagement
D
uring the reporting year and more recently during the Quality Account consultation the Trust has received valuable comments and contributions from its workforce and key stakeholders including the Healthwatch groups, Trust User Group, health overview and scrutiny committees (HOSCs), and commissioners to determine improvement priorities for next year’s Quality Account.Significant work was done during the year to improve stakeholder engagement, including: • feedback sheets in last year’s Quality Accounts
• a public opinion poll and one for staff
• a dedicated email address for staff to provide feedback on the proposed improvement priorities and to suggest new ideas
• the publication of articles in staff bulletins and in the monthly staff newsletter • a review of complaints, incidents and patient feedback
• regular meetings with health overview scrutiny committees • engagement with local Healthwatch boards
• a review of patient survey information
• a review of feedback from stakeholder groups including Trust User Group
• During the year the progress on the Quality Account priorities were considered at the Trust Clinical Quality and Safety Group.
• All feedback returned by stakeholders during the consultation period will be considered as part of the Quality Account.
The draft quality account was sent to the commissioners, Healthwatch and Health Overview Scrutiny Committees in May. Formal responses can be found at the end of this account.
The Trust has seen significant changes within the last year and acknowledges that the ambitious 22 quality priorities set have been challenging to meet. To reflect the work needed doing in the Trust needs to do in the coming year to stablise and meet the needs of patients, the focus will be on a reduced number of core priorities which match the mandatory indicators for ambulance trusts set by the Department of Health (DH).
In 2012 the DH and Monitor introduced changes to the Quality Account reporting requirements for the 2013/14 reporting, following consideration by the National Quality Board (NQB) about strengthening quality accounts by introducing mandatory reporting against a small, core set of quality indicators. The core set of quality indicators are based on recommendations by the NQB and are aligned closely with the NHS.
Outcomes Framework and are all based on data that the Trust is already collecting and which is reported to the DH. The Trust will be required to report:
• performance against the mandatory core set of quality indicators; • a comparison of performance against the national average;
• a supporting commentary, to explain any variation from the national average and any steps to be taken or planned to improve the quality of service/care. The list of core indicators is for a variety of healthcare providers. The following list has been selected as being applicable to the ambulance service and reporting against these is mandatory.
In addition to these mandatory requirements, the Trust has also identified the Friends and Family Test, management of the septic patient, and frequent callers as priorities for 2014/15.
This account reflects the mandatory indicators.
Setting Quality Account priorities for 2014/15
Mandatory indicator Related NHS Outcomes Framework Domain Category ‘A’ ambulance
response times Domain 1: people from dying Preventing prematurely
Patients with a pre-hospital diagnosis of suspected ST elevation myocardial infarction who received an appropriate care bundle
Domain 1: Preventing people from dying prematurely
Domain 3: Helping people to recover from episodes of ill health or following injury Suspected stroke patients
assessed face to face who received the appropriate care bundle
Domain 1: Preventing people from dying prematurely
Domain 3: Helping people to recover from episodes of ill health or following injury Percentage of staff who
would recommend the provider to friends or family needing care
Domain 4: Ensuring people have a positive experience of care
TIMELY
RESPONSE
PATIENT SAFETY
HEART
ATTACK
CARE
CLINICAL
EFFECTIVENESS
SEPSIS
CARE
PATIENT SAFETY
CARDIAC
CARE
ARREST
CLINICAL
EFFECTIVENESS
CARE
STROKE
CLINICAL
EFFECTIVENESS
FAMILY
FRIENDS
AND
PATIENT
EXPERIENCE
CALLERS
FREQUENT
PATIENT SAFETY
QUALITY
PRIORITIES
2014/15
TIMELY
RESPONSE
PATIENT SAFETY
Rationale: Ambulances services are required
to meet response time standards for 999 calls coded as life threatening. Faster response times improve health outcomes and experience for patients with immediately life-threatening conditions. The Trust failed to meet this target in both 2012/13 and 2013/14 but is committed to meeting this target in 2014/15. Feedback and complaints suggest that patients who are non life-threatened have had increased waiting times for an ambulance too.Improvement:
The Trust is aiming for a specific improvement in the longest waiting time for these indicators, hence the introduction of ‘maximum response times’. This means that fewer patients will have long waits for an ambulance response than in the previous year. This will improve the time taken to get patients with life-threatening conditions to hospital. Benefits for non-life-threatening patients include less time spent on the floor if they have fallen and therefore reducing the potential for otherwise avoidable pressure ulcers occurring.Overall 2013/14 proved to be a challenging year for the Trust. In the last quarter, the new Chief Executive Dr Anthony Marsh, has implemented a
Performance Improvement Action Plan (PIAP) focusing on six key priorities as follows:
1. Recruit 400 student paramedics in 2014/5
2. Up-skill Emergency Care Assistants (ECAs) to Emergency Medical Technicians (EMT) and EMTs to paramedics
3. Maximise clinical staff on frontline vehicles 4. Reduce response cars and increase ambulances
5. Accelerate fleet and equipment replacement programme 6. Reinvest corporate spend in frontline delivery
The PIAP has been approved by the Trust Board and also shared with commissioners and will continue to be implemented in 2014/15.
One of these key objectives implemented in January was the reduction in rapid response vehicles and an increase in the number of ambulances. Whilst performance has not been achieved against the national standards, this action has resulted in a reduced waiting time for ambulances and therefore is a key element of patient safety. In 2014/15 the focus will be in a sustained reduction in ambulance waiting times alongside a continual improvement against the national standards from the last quarter 2013/14 baseline. This is reflected in the revised indicators for 2014/15 as described on the following page.
Baseline:
2013/14 end of year performance for Red 1 is 73.6% and for Red 2 is 69.4% (based on March 2014 provisional data)*to February 2014
Based on provisional data for 2013/14, of the nine performance (time based) indicators for green and urgent calls, the Trust has met eight of the required standards. All of the Green indicators have been met and these include emergency responses within 20 or 30 minutes and also telephone based assessment for those calls not requiring an ambulance response.
Goal:
To improve the response times to patients for the most life-threatening call categories as follows.The Trust is committed to improving performance against national targets and has also committed to meeting local quality indicators for non-life-threatening calls. As part of its commitment to improving performance against national standards, the Trust has agreed a series of maximum response standards for 2014/15. These will be monitored against from April with a target applied from October. In effect, these replace the percentile measures for 2013/14.
Indicator National Standard Trust Performance National Average*
Category A (Red 1) 8 minutes 73.6% 75.1% Category A (Red 2) 8 minutes 69.4% 75.0% Category A19 (Red 1 and 2) 19 minutes 92.9% 96.0%
The following table shows the local contracted quality requirements for these measures in 2014/15.
Response code Definition Standard % to be achieved Maximum response time
Red 1 Calls which may be immediately life threatening and should receive an
emergency response within 8 minutes 8 mins 75% 30 minutes
Red 2 Calls which may be life threatening but less time-critical and should receive
an emergency response within 8 minutes 8 mins 75% 40 minutes
Category A19 (Red 1 and Red
2) Calls which may be immediately life threatening and should receive an ambulance vehicle response at the scene within 19 minutes 19 mins 95% 60 minutes (ambulance only) Green 1 Serious calls but not life- threatening which require an emergency response
to arrive within 20 minutes. 20 mins 75% 60 mins
Green 2 Serious calls but not life- threatening which require an emergency response
to arrive within 30 minutes. 30 mins 75% 90 mins
Green 3 Telephone advice Low acuity calls which require further telephone assessment by our clinicians
within 20 minutes. 20 mins 75% N/A
Green 3 Face-to-Face Low acuity calls which require a non-blue light emergency (normal road
speed) response within 50 minutes. 50 mins 75% 120 mins
Green 4 Telephone advice Lowest acuity calls which require further telephone assessment by our
clinicians within 60 minutes. 60 mins 75% N/A
Green 4 Face-to-Face Our lowest acuity calls which require a non-blue light (normal road speed)
emergency response within 90 minutes. 90 mins 75% 120 mins
GP Urgents Transportation to hospital request made by a Healthcare professional
1 hour 75% N/A
2 hours 75% N/A
SEPSIS
CARE
PATIENT SAFETY
Rationale: Sepsis claims the lives
of more than 37,000 people in the UK, which is more than lung cancer and more than breast and bowel cancer combined. The estimated cost to the NHS for sepsis is around £2 billion annually for treatment. During 2013/14 The Trust worked in partnership with other health care providers to improve outcomes for septic patients. It is shown in recent research that early recognition of the signs and symptoms of sepsis will save lives, possibly as many as 12,500 per year in the UK.
Neutropenic sepsis is a significant cause of death for cancer patients receiving chemotherapy and causes delays and changes to planned treatments. In England and Wales, relative to the increasing number of cancer diagnoses, the proportion of deaths due to neutropenic sepsis continued to rise for all age groups between 2001 and 2010. Recent NICE guidance recognises neutropenic sepsis is a medical emergency that requires immediate hospital investigation and treatment and recommends improving the clinical care pathways of cancer patients undergoing chemotherapy, immediate access to antibiotics and appropriate healthcare staff training.
Baseline:
There are about 70-90 cases across the region per month where our clinicians have recognised sepsis and the patient’s condition has warranted hospital admission, equating to a recognition rate of approximately 75%.Goal:
The Trust intends to increase the number of sepsis cases the clinicians recognise and record to 85%.Improvement:
Continue to increase the awareness and delivery of the sepsis care bundle and neutropenic sepsis, thus giving patients the very highest standards of pre-hospital care.Rationale: A frequent caller is someone who calls 999 regularly, with contact with the ambulance service ranging from
daily calls to multiple calls within a month. A frequent caller should not necessarily be considered a nuisance caller; many suffer from long term conditions which may necessitate more regular contact with the service. These calls only represent a small number of the Trusts overall call volume but can make it more challenging to respond to those patients who have serious, life-threatening emergencies. An alternative way to manage these patients who will invariably have complex health and social care needs is required ,which will necessitate us working closely with other health care partners.Baseline:
Currently AQI measures the number of frequent callers as a percentage of all calls received. Each ambulance service has its own definition of a frequent caller and can manage them locally as they see fit. This leads to hugevariations between ambulance trusts and the data cannot be compared fairly. The frequent caller AQI guidance is currently under review and it is expected that improved and comparable frequent caller national reporting parameters will be introduced. The baseline will be defined during the year when these new reporting processes are in place.
Goal:
To increase the number of patients with a locally-agreed frequent callers procedure in place by working with the patient’s other health and social care providers.Improvement:
If patients are identified, the patient’s GP details will be obtained and call volume details recorded via an established format and made available to the patient’s GP. If the patient is not registered with a GP, the local commissioning group or other relevant agency will be approached. The Trust should provide quarterly analysis relating to management plans in place for patients identified as frequent callers.CALLERS
FREQUENT
HEART
ATTACK
CARE
CLINICAL
EFFECTIVENESS
Rationale:
Most deaths in the UK from heart disease are caused by a heart attack, and someone dies every seven minutes from this cause. Around 103,000 heart attacks occur each year, with some people having more than one. Approximately 50,000 of those heart attacks are suffered by men and around 32,000 by women. This is why the care in the pre-hospital arena is vital. Most heart attacks are caused by coronary heart disease which is when the coronary arteries narrow due to a gradual build up of atheroma (fatty material) within their walls and a piece breaks off leading to a blood clot. A heart attack is life threatening and by providing patients with a pre-hospital assessment for a STEMI and administering an appropriate care bundle, a significant improvement on patient outcomes will result, thereby supporting the NHS to reduce the number of patients dying prematurely and to help people to recover from episodes of ill health or injury. In particular, working together for patients as the patient care pathway crosses organisational boundaries and requires robust systems in place to ensure patient handovers are safe.Baseline:
The Trust already measures the ACQIs for the percentage of patients suffering a STEMI who are directly transferred to a centre capable of delivering PPCI and angioplasty within 150 minutes of call, and the percentage of patients suffering a STEMI who receive an appropriate care bundle. The baseline figure for STEMI 150 in March was 88.5% and the care bundle was 85.4% .Goal:
The Trust intends to achieve 95% PPCI within 150 minutes and 87% STEMI care bundle compliance.Improvement:
To reduce the on-scene times for those patients who are having confirmed STEMI and to continue to give high standards of care to those patients experiencing cardiac chest pain.Objective
Baseline
Target for improvement
The percentage of patients suffering a STEMI who are directly transferred to PPCI and angioplasty within 150 minutes of call
88.5% 95%
The proportion of patients with STEMI who received an appropriate care bundle
Rationale:
Around 30,000 people each year in the UK have cardiac arrests in the pre-hospital environment – less than 10 per cent of these people will survive to be discharged from hospital, according to the Resuscitation Council UK. Evidence shows that around two thirds of cardiac arrests that occur outside of hospital happen in the home, and that nearly half that occur in public are witnessed by bystanders. With each minute that passes in cardiac arrest before defibrillation, chances of survival are reduced by about 10%. Immediate CPR in a shockable pre-hospital cardiac arrest can give three times the chance of survival than no intervention. The British Heart Foundation has a campaign to train members of the public in emergency life support and to deal with cardiac arrests, to get it as part of the National Curriculum in England, and for Government to include skills training as part of the National Citizen Service.Goal:
To improve outcomes from cardiac arrest and work towards an increase in return of spontaneous circulation (ROSC) and Survival To Discharge figures.Improvement:
The Trust will aim to see improvements in both the ROSC (overall and Utstein) and the Survival to Discharge (overall and Utstein) figures on a consistent basis.Baseline:
Last year’s figures for ROSC and ‘survival to discharge’ are shown below. The baseline figures for 2014/15 taken from March 2014 year to date figures.CARDIAC
CARE
ARREST
CLINICAL
EFFECTIVENESS
Clinical outcome
Baseline
Target for improvement
ROSC (overall) 21.4% 21.5%
ROSC (Utstein) 43.6% 45%
Survival to discharge (overall) 6.6% 7%
CARE
STROKE
CLINICAL
EFFECTIVENESS
Rationale:
Stroke is the third biggest cause of death in the UK and the largest single cause of severe disability. Each year more than 110,000 people in England will have a stroke. FFace-Arm-Speech-Time (FAST) is a simple test to help people recognise the signs of stroke and understand the importance of emergency treatment. The faster a stroke patient receives treatment (care bundle), the better their chances are of surviving and reducing long-term disability.Goal:
The Trust aims to achieve continuous improvement in Stroke 60, and aims to see continually high care bundle compliance.Improvement:
To reduce on scene times for patients who are having a stroke and continue to give high quality care.Baseline:
The Trust already measures the percentage of FAST positive stroke patients (assessed face-to-face) potentially eligible for stroke thrombolysis who arrive at a hyper-acute stroke centre within 60 minutes. The baseline figure for YTD (March 2014) is 96% for the care bundle and 52.7% for Stroke 60.Objective
Baseline
Target for improvement
The percentage of stroke patients (assessed face-to-face) who received an appropriate care bundle
96% 97%
The percentage of Face Arms Speech Time (FAST) test positive stroke patients (assessed face-to-face) potentially eligible for stroke thrombolysis who arrive at a hyper-acute stroke centre within 60-minutes of call
FAMILY
FRIENDS
AND
PATIENT
EXPERIENCE
Rationale:
The NHS believes that patients and staff should be asked whether they would want a friend or relative to be treated by or at a service in their hour of need. The Prime Minister says the results will be made public so “everyone will have a really clear idea of where to get the best care”, which will drive continuous improvement. The Trust supports this model and has been capturing this data for the last year, and found that, whilst not a sophisticated measure of quality, it captures what patients think and encourages the Trust to focus on what matters to patients. This is a relatively simple measure that can easily be applied.Baseline (friends and family test):
During the previous year friends and family (net promoter) scores ranged as follows (YTD Jan 2014):• Emergency Services: +79 • Primary care services: +51 • Patient transport services: +68
Goal:
Once the national average is known, the Trust will aim to maintain the friends and family score at the national level for those patients who agree or strongly agree that they would recommend the East of EnglandAmbulance Service to a friend or relative across all service lines which will capture the experience of the patients served by the Trust.
Improvement: To see a rise in the friends and family
test for those patients who are surveyed which will give a simple indication of how our patients view the Trust and the service it provides.Baseline (staff):
During the previous year the Trust had a score of 40 when staff responded to the statement “if a friend or relative needed treatment, I would be happy with the standard of care provided by the organisation”. This is lower than the average median score (50) for other ambulance services.Goal:
To increase the number of positive responses received to Q12d in the annual staff survey to meet the average median for ambulance trusts recorded in 2013.Improvement: To see a rise in the score for Q12d of
the annual staff survey which will provide an indication of how staff view the Trust and the care it provides.Review of service 2013/14 and
statement of assurances
Monitoring priorities
2014/15
A
number of indicators will be developed to measure both process and outcome for each of the priorities. Performance will be reported through the clinical quality governance channels and provided to managers to share with their teams. This will allow for performance benchmarking and taking any actions to improve areas of underperformance. Outcome indicators monitor specific criteria achieved; for example a percentage improvement in patients who are transported to a PPCI centre within 150 minutes of call.The following objectives and indicators will be measured for the list of improvement priorities for 2013/14 and performance against these will be published throughout the year and will be made available to key stakeholders.
Objective Numerator Denominator Baseline improvementTarget for The percentage of patients suffering a
STEMI who are directly transferred to a centre capable of delivering PPCI and angioplasty within 150 minutes of call
The number of patients conveyed to a heart attack centre within 150 minutes
Number of eligible cardiac patients 88.5% 95%
The proportion of patients with STEMI who received an appropriate care bundle
The percentage of patients suffering a STEMI who receive an appropriate care bundle
Patients with a pre-hospital diagnosis of suspected ST elevation MI confirmed on ECG
85.4% 87%
The percentage of Stroke patients (assessed face-to-face) who receive an appropriate care bundle.
Patients with suspected stroke assessed face-to-face who received an appropriate care bundle FAST, BP,BM
The number of suspected stroke patients who receive appropriate care bundle
96.0% 97%
The percentage of Face Arms Speech Test (FAST) positive Stroke patients (assessed face-to-face) potentially eligible for Stroke thrombolysis who arrive at a hyper-acute Stroke centre within 60 minutes of call
Patients with new onset stroke like symptoms of known time <4.5hours conveyed to a hyper acute stroke centre within 60 minutes
Number of eligible stroke patients arriving at a hyper acute stroke centre within 60 minutes of 999 call
52.7% 56%
Sepsis early intervention The number of patients whose symptoms are correctly identified as sepsis.
Number of sepsis patients as per the
clinical impression 75% 85%
Cardiac care
ROSC at time of arrival at hospital overall
Of the patients included in the
denominator, the number of patients who had return of spontaneous circulation on arrival at hospital. Time of arrival refers to the point at which clinical responsibility for the patient is handed over from ambulance service to the receiving hospital
All patients who had resuscitation (advanced or basic life support) commenced/continued by ambulance service following an out-of-hospital cardiac arrest
ROSC at time of arrival at hospital (Utstein comparator group)
Of the patients included in the
denominator, the number of patients who had return of spontaneous circulation on arrival at hospital. Time of arrival refers to the point at which clinical responsibility of the patient is handed over from the ambulance service to the receiving hospital
All 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 - or emergency medical service witnessed and the initial rhythm was VF or VT
43.6% 45%
Survival to discharge-Overall survival rate
Of the patients included in the denominator, the number of patients discharged from hospital alive
All patients who had resuscitation (advanced or basic life support) commenced/continued by ambulance service following an out-of–hospital cardiac arrest
6.6% 7%
Survival to discharge -Utstein Comparator Group survival rate.
Of the patients included in the denominator, the number of patients discharged from hospital alive
All patients who had resuscitation (advanced or basic life support) commenced/continued by ambulance service following an out-of-hospital cardiac arrest
20.7% 25%
Frequent callers No of patients deemed as ‘frequent callers’ with an agreed management plan
No of patients deemed as ‘frequent callers’
TBC Achieve
national average 75%of Category A calls resulting in an
emergency response arrival within 8 minutes
The proportion of Category A calls requiring an emergency response that were responded to within 8 minutes
Number of calls 70.3% 75%
95%of Category A calls resulting in an ambulance arrival at scene within 19 minutes
The proportion of Category A calls requiring an emergency response that were responded to within 19 minutes
Number of calls 93.1% 95%
Friends and Family Test The proportion of patients who would be extremely likely to recommend EEAST, minus the proportion of patients who would not recommend EEAST.
The number of patients confirming they would recommend the Trust to friends and family
+66 Achieve national average
National targets
The national targets for all UK ambulance services changed in 2011/12. Eleven new ambulance clinical quality indicators were introduced to focus on clinical quality and patient outcomes.
Ambulance Clinical Quality Indicators
The Ambulance Clinical Quality Indicators (ACQIs) have provided the Trust and its stakeholders with a broad overview of the clinical quality achieved during 2013/14, and allow for comparison with other ambulance service providers. Data is submitted monthly to the Department of Health (DH). The Trust Board receives the information within two months of the incident date; however the Department of Health (DH) publication date is some months after this. Published results can be found here:
http://www.england.nhs.uk/statistics/statistical-work-areas/ambulance-quality-indicators/ambulance-quality-indicators-data-2013-14/
With the exception of the eight-minute response time standard and the 19-minute transportation standard for Category A (immediately life-threatening) calls, no thresholds have been set by the DH to denote ‘poor’ clinical performance for the ACQIs. However, the Trust has set its own targets to encourage performance improvement.
Emergency 999 calls are separated into Red 1 and Red 2 to support and improve the service provided to patients with life-threatening conditions or injuries. • Category A (Red 1) - presenting conditions which may be immediately
life-threatening and should receive an emergency response within eight minutes in 75% of cases.
• Category A (Red 2) - presenting conditions which may be life-threatening (but less time critical than Red 1) and should receive an emergency response
within eight minutes in 75% of cases.
• Category A (both Red 1 and Red 2) - presenting conditions which may be immediately life-threatening and should receive an ambulance response at the scene within 19 minutes in 95% of cases.
For both of these eight minute standards, an emergency response includes resources such as an ambulance, rapid response car, a community first responder equipped with a defibrillator or a healthcare professional.
The clock stops when the first emergency response arrives at the scene of the incident for the eight minute standards and when the first ambulance response vehicle arrives at the scene for the 19-minute standard.
In 2013/14, the Trust dealt with 912,474 emergency calls during the year, sent a resource to scene for 716,576 calls and conveyed 456,179 patients to hospital. The table below summarises the Trust’s performance against the national response time standards:
Indicator
National
standard
Trust
performance
National
average*
Category A (Red 1) Eight minutes 73.6% 75.1%
Category A (Red 2) Eight minutes 69.4% 75%
Category A19 (Red
In 2013/14, the Trust underperformed against both the national standards and national average of English ambulance services. The Trust has experienced considerable challenges over the past year in having sufficient levels of ambulance resource and qualified paramedics.
The Trust is addressing this through six key priorities: 1. Recruit 400 student paramedics in 2014/5
2. Up-skill ECAs to EMTs and EMTs to paramedics 3. Maximise clinical staff on frontline vehicles
4. Reduction in the use of response cars and increase in the use of double manned emergency ambulances 5. Accelerate fleet and equipment replacement programme
The Patient Services Department is responsible for coordinating all complaints, patient advice liaison service (PALS) issues and compliments, as well as legal claims against the Trust, inquests involving staff and requests for information, e.g. under the Data Protection Act 1998 and Freedom of Information Act 2000. The feedback, both positive and negative, is processed by the department and complainants, enquirers and staff are kept informed throughout the process and informed of the outcome.
In 2013, the Trust updated the information on our website to explain clearly how members of the public can make a complaint or leave other feedback, including compliments, about the services they had received. We included a section on ‘Information we will need from you’ and explained about how we need to seek consent when someone is raising an issue on behalf of someone else. We also added pages for requesting information: there are separate pages for police, solicitors and one for members of the public.
Complaints
The Trust received 798 complaints in 2013/14 compared to 1,177 in 2012/13, which is a decrease of 32%. The table opposite shows the number of complaints received by directorate over the past three years. Complaints about scheduled transport increased, whereas complaints about emergency care and primary care decreased. Complaint types where significant numbers of complaints are received have decreased, but there was a marked increase in complaints about transport and driving.
PALS/concerns
In 2013/14 the Trust received 1,231 concerns compared to 1,161 in 2012-13, an increase of 6%. The most frequent types of concerns raised are broadly similar to the complaints. However, the number of concerns raised about emergency transport and scheduled transport are similar to each other, in contrast to the higher proportion of complaints received about emergency care compared with scheduled transport.
The Trust received 380 PALS enquiries, including comments on the Trust’s activities and enquiries about lost property, making a total of 1,611 issues received. 2011-12 2012-13 Percentage change: 2011-12 to 2012-13 2013-14 Percentage change: 2012-13 to 2013-14 Emergency Care 529 980 85.3% + 611 37.7 -Scheduled Transport 76 102 34.2% + 126 26.5 + Primary Care 82 94 14.6% + 60 36 -Clinical Quality 0 1 100% + 1 0
Type 2011-12 2012-13 Percentage change
2011-12 to 2012-13 2013-14 Percentage change: 2012-13 to 2013-14 Attitude 164 176 7.3% ↑ 162 7.8
-Clinical care 187 229 22.5% ↑ 163 28.8 -Communication
and call handling 44 78 77.3% ↑ 56 28.2
-Delay 213 622 192% ↑ 315 49.5
-Equipment 2 11 450% ↑ 5 54.5
-Medication 4 0 100% ↓ 1
Patient property 1 4 300% ↑ 7 75 +
Privacy/Dignity 8 3 63.0% ↓ 3 0
Transport & driving 57 44 22.8% ↓ 72 63.6 +
Patient safety incidents
During Quarter 1 there were four incidents causing serious harm or death. There have been no further incidents causing serious death or harm for the remainder of the year.
Learning into action
We are committed to using the feedback through complaints and PALS to help improve the service provided in the future. The themes and trends identified through complaints and PALS are linked with learning from other sources such as clinical audits, staff reported incidents, claims made by staff and patients, and health and safety issues.
• The most common subject of complaints and concerns is delay in an ambulance attending a patient. The immediate priority of the Trust’s CEO Dr Anthony Marsh is to reduce long waits for ambulances. A major recruitment drive, with the aim of increasing the number of paramedics, began in January 2014. Dr Marsh has six key priorities for the organisation which include recruiting 400 more staff and providing more ambulances across the whole service. As such, it is envisaged that patients will receive a timelier and more appropriate response to their 999 calls.
• Staff attitude – a ‘Customer Care’ process has been developed by the Patient Services Department and the Human Resources Department for staff who are involved in a complaint about their attitude.
• The Trust has received claims from staff regarding injuries from the use of responder bags. The Trust is conducting a review of the bags on operational vehicles and an operations bulletin was circulated canvassing staff views. A review group has been working on ideas and recommendations for new bag systems.
Learning identified from individual complaints, PALS and concerns: • As a result of issues around abdominal assessment after a complaint
investigation, the Trust has included an abdominal assessment and symptoms module on the mandatory professional development programme.
• Training was delivered to ensure all staff are aware they are able to have guide dogs in an ambulance with patients and related written guidelines are being developed. Ambulances specially adapted to convey guide dogs are being introduced.
• A complaint investigation indicated that the Trust’s instruction for call handlers to use a certain set of questions when receiving a call from a health care professional is not clear enough and can be misunderstood by staff. A review of the instruction will take place though the
Emergency Operations Governance Committee and clear guidance will be issued.
• A new system for placing ‘markers’ on addresses has been introduced. Information can be linked on the Trust’s computer systems to a
certain address, providing a warning to crews attending such as extra instructions for accessing the property or a patient’s medical condition. These markers are now reviewed systematically on an annual basis.
Parliamentary and Health Service Ombudsman (PHSO)
Although most complaints are resolved through the Trust’s complaints process, complainants are able to refer their complaint to theParliamentary and Health Services Ombudsman (PHSO) if they consider that the Trust can take no further action to resolve their problem. In 2013/14, the Trust received 21 PHSO referrals, compared to 13 in 2012/13, an increase of 65%. This is can be explained by a change in PHSO procedures in 2013, which has resulted in an increase across the NHS in the amount of cases referred by the PHSO for formal investigation. Of the
21 PHSO referrals, none were fully upheld and only three were partially upheld.
Appropriate action was taken by the Trust in response to
recommendations made by the Ombudsman for upheld complaints. For example, the guidance for EOC staff around the escalation of calls to duty managers has been revised and re-issued.
Compliments
This year the Trust received 1,388 compliments, an average of 115 a month with February 2014 recorded as the highest number of compliments received at 178. The Trust also received 221 donations, totalling more than £105,000. Most donations were for community first responders (groups who volunteer for the Trust).
Compliments are reported on a monthly basis to the Trust Board and names are published internally via Need to Know (staff-facing news website). Management teams are informed of all compliments so they can be passed onto the member of staff mentioned. Personal letters are also sent by the CEO to members of staff.
Looking forward
The Trust actively encourages feedback from anyone who uses the service. The Trust’s Equality and Diversity Lead completed an Equality Analysis in 2013/14 which identified that people with learning disabilities were under-represented amongst those providing feedback to the Trust. This led to an ‘easy read’ poster being produced about how to provide feedback to the Trust and this is being sent to community centres, libraries and religious centres across the region.
Information is being captured about the lessons learned and action taken as a result of complaints and PALS concerns on a database in order to identify themes in particular service areas.
The Trust sent out a survey in April to ask people about their experience of the complaints process in 2013/14. The results will be published on the website, www.eastamb.nhs.uk.
T
he Trust operates a well-established system of obtaining patient feedback, with activity mostly operated from a team acting independently from departments delivering patient services. The system includes the Trust’s Ethics Group and the Patient User Group, and the involvement of such volunteers has proved to be of great value especially with design of patent surveys and reporting to external patient groups. The design of all surveys is done with great care to ensure all respondents involved will be able to take part. For example, a dedicated project took place during 2013/14 to obtain the views of young patients. The Trust has an annual programme of patient surveys which includes continuous feedback from users of the three main service departments (emergency services, out of hours primary care, including Bedford out-of-hours call handling, and the patient transport service). A number of ad-hoc projects are conducted throughout the year and these will be focusing on specific topic areas, e.g. a new service or an area of care that is being developed, or where there may be a value in re-auditing.Senior Trust groups ensure appropriate governance, review of results and manage any actions. Results are written into formal management reports which are fed back to responsible service managers and published on the Trust’s website. Monthly figures are presented as part of the Trust’s ‘dashboard’, used by the Trust Board to oversee organisational performance.
Following on from the national ambulance ‘Hear and Treat’ pilot work
completed during 2012, the national ambulance patient survey carried out by the Care Quality Commission (CQC) went ahead during 2013/14, although results are not yet available. There have been just two national ambulance surveys completed in the past, one in 2003/04 for patients using the 999 service, and one during 2008/09 which surveyed patients whose 999 call was categorised as low priority (category C). The King’s Fund commented on the results of the survey, saying: “2011 saw the largest drop in satisfaction ever recorded by the British social attitudes survey, down 58%. The latest results for 2012 show an increase of three percentage points that is not statistically significant. While satisfaction levels have not recovered to the high 70% recorded in 2010, they remain high by historical standards.” This will require the Trust to ensure the patient remains its main focus and priority and that this is reflected in its continuation of patient engagement and learning.
The Trust’s current system for monitoring patient experience includes surveys and discovery interviews for those patients using emergency, out-of-hours and patient transport services. The Trust has also surveyed young patients on pain management and surveys of obstetric, trauma and falls, and bariatric patients were surveyed in 2013/14.
The survey system consisted of rolling monthly surveys which provided the figures for the Trust’s clinical performance dashboard. Formal six-monthly reports were also sent to lead managers so that clinicians can continue to monitor patient satisfaction and look for specific areas of potential improvement at a local level.
As part of each questionnaire, the Trust collects data on the patient’s overall satisfaction levels and this result is used as a benchmark across the Trust. During 2013/14, the Trust also collected data using the friends and family test, based on the Department of Health’s well-publicised ‘friends and family’ initiative; this figure is a response to the question ‘would you recommend the service to a friend or relative?’ and it is used as a general performance marker and benchmark. This score was also reported as part of the Trust’s corporate dashboard. The chart below shows the patient experience ‘overall satisfaction’ and ‘friends and family test’ figures between April 2013 and January 2014.
N.B. Please note that patient experience data is always retrospective so at the time of writing data is only available up until January 2014. The FFT calculation also slightly differs to the previous calculations of the Net
Promoter Score and is now more in line with the Department of Health Publication Guidance. The Trust also always collects data on patient demographics. The sample of size of patients from an ethnic or other minority is quite small, so the Trust pulls together the whole year results in an annual report. The overall satisfaction of the patient is checked against patient demographics to ensure that separate patient group levels of satisfaction are recorded.
Every survey encourages comments from patients which are written up as part of the reporting. The number of positive comments always far outweighs the negative, but it is often the negative comments which are the most useful from the perspective of learning and finding areas of improvement.
Trust patient experience: Apr to Dec 2013
Overall satisfaction Recommend to family or friends Quantity of patients Performance
Recommend – would not
recommend/indifferent
Performance
Emergency services 1,175/1,213 96.9% 81.8 – 3.3 +79
Norfolk 111 and OOH 903/1,056 85.5% 63.8 – 12.5 +51
Bedford OOH call
handling 142/151 94% 62.2 – 8.1 +54
Patient Transport Service (results from June 2013 onwards)
Future patient and carer survey strategy
The Trust is committed to developing its patient engagement activity and seeking new methods of collecting information about the experience patients have while using the service. The Trust will continue to use the patient user group and report on satisfaction levels as a key performance indicator.
The general level of satisfaction is good across the whole of the Trust. Acceptable patient
satisfaction is currently measured as a patient’s response of ‘very satisfied’ or ‘satisfied’. Whether a patient would choose to recommend the service to a friend or relative is also measured and more emphasis will be put on monitoring and reporting friends and family data, which is included within the Trust’s CQUIN for 2014/15.
All three of the Trust’s service areas will be active in collecting the patient experience, as follows: Emergency services
• Postal survey to random samples of 999 and GP urgent patients will continue, with monthly management reports and annual Trust reporting
• Specific surveys of patients receiving new services or treatments where appropriate e.g. obstetric patients, young patients with pain, trauma and falls patients. During 2013/14 areas such as for mental health and Hear and Treat patients are planned to be done
• Face to face interviews to continue with an annual report. Primary care services
• Postal survey to a random 2% sample of patients who used the Norfolk 111 service will continue, with monthly management reports and annual Trust reporting
• Postal survey to a random 2% sample of patients using the Norfolk out of hours services will continue, with monthly management reports and annual Trust reporting
• Postal survey sent to a random 2% sample of patients who had used the Bedford out of hours call handling service, with monthly management reports
Patient transport service
• Postal survey of patients to continue with project reports and annual Trust report
• Quarterly ‘patient transport clinical assessment and advice service’ surveys to continue, with quarterly management reports
• Specific surveys of patients in relation to a certain aspect of the patient transport service (e.g. bariatric patients). During 2013/14, a project on the experiences of dementia patients who have used the patient transport service is planned to be undertaken.
During 2013/14 the Trust took part in two national clinical audits and zero national confidential enquiry in which it was eligible to participate. National clinical audit: myocardial ischemia national audit project (MiNAP)
Data input is completed by the acute hospital trusts across the east of England region, and EEAST is required to submit data elements to each acute hospital trust. A total of 4981 cases were registered with MiNAP between 1st April 2013 and 31st March 2014. The audit is handled centrally by the Trust and includes all areas of service delivery.
National Ambulance Non-Conveyance Audit (NANA)
This audit is undertaken by the National Ambulance Service clinical Quality Group (NASCQG) to examine re-contact rates to non-conveyed patients during a 24-hour period, including the nature of subsequent calls and their outcome.
The Trust participated in this audit by providing the relevant data in a pro-forma format to calculate non-conveyance and re-contact rates on two 24-hour periods (24th October 2011 and 24th October 2012).
Reviewing reports of national clinical audits
The Trust reviewed two national clinical audit reports during the 2013/14 period: Myocardial Ischemia National Audit Project: How the NHS cares for patients with heart attack (annual public report April 2012 – March 2013) and National Ambulance Non-Conveyance Audit (NANA) Report (October 2013).
National clinical audit: myocardial ischemia national audit project (MiNAP)
1,642 EEAST patients with ST-elevation myocardial infraction (STEMI) received primary Percutaneous Coronary Intervention (pPCI) treatment in 2012/13, the fourth highest number of all ambulance services. 83.2% of eligible patients received this hospital treatment within the standard of 150 minutes, which exceeds the national ambulance service standard of 82.8%. This is a drop of 0.8% on last year’s reported figures and a comparison can be found in the table below, taken from the 12th MiNAP report April 2012 – March 2013.
The Trust continues to monitor the treatment of heart attack patients and is working on a number of actions that are aimed at improving the timeliness of treatment.
R
esearch helps the NHS to improve the current and future health of the people it serves. It is essential in successfully promoting health and plays a major part in continuing to improve the services and supporting safe and effective care. It identifies new ways of preventing, diagnosing and treating conditions.To date, 20 patients receiving NHS services provided or sub-contracted by the East of England Ambulance Service NHS Trust (the Trust) in 2013/14 were recruited during that period to participate in research approved by a research ethics committee (REC). During the same time period, 16 Trust staff were recruited to research approved by a REC.
Accruals to research during 2013/14 arose partly from Trust participation in four projects on the National Institute for Health Research (NIHR) Portfolio in different medical specialties. These were:
• ATLANTIC – A 30-day study to evaluate efficacy and safety of pre-hospital versus in-hospital initiation of ticagrelor therapy in STEMI patients planned for percutaneous coronary intervention (cardiovascular specialty)
• a study of major system reconfiguration in stroke services (stroke specialty)
• identification of emergency and urgent care system characteristics affecting preventable emergency admission rates (generic relevance specialty), and
• evaluation of the implementation and health-related impacts of the national cold weather plan for England (generic relevance specialty)
The Trust also participated in two Collaborations for Leadership in Applied Health Research and Care (CLAHRC) projects: one a staff-related study focusing on hospital admission close to the end of life; the other looking at use of the emergency ambulance service by people with dementia. In addition, Research Support Services (RSS) supported a number of smaller-scale student level projects being undertaken by internal and external members of staff.
Trust involvement with clinical research shows its commitment to
improving the quality of care and to making a contribution to wider health improvement. Research findings are regularly used to inform clinical service developments where such evidence is available.
In terms of capacity building activity, RSS organised an awareness raising event at the Trust HQ in response to the NIHR ‘OK to Ask’ campaign. In addition, relevant literature and emerging research evidence are made available to all staff on a regular basis by dissemination on the intranet RSS folder. More than 100 paramedics have received an Introduction to Good Clinical Practice training, two managers are being supported to undertake on-line research skills modules, and one manager has won a CLAHRC Fellowship.
Looking forward to 2014/15 the Trust awaits the outcome of several submitted research bids for external funding, which if successful will entail the Trust sponsoring research for the first time.
C
ommissioning for Quality and Innovation (CQUIN) enablescommissioners, which are the NHS bodies charged with provision and funding of services, to reward innovation and excellence. A proportion of the Trust’s income during 2013/14 was conditional on achieving quality improvement and innovation goals for the provision of emergency and urgent ambulance NHS services, as agreed by the commissioning Clinical Commissioning Groups (CCGs).
The programme consisted of 13 initiatives and is forecast to achieve 92% of income which is exceptional and which has influenced changes in clinical practice to improve patient experience and clinical effectiveness. The theme for the CQUIN programme this year was “Safest care, closest to home”. All the initiatives delivered aimed to support patients either to remain in their own home, or to be able to access appropriate alternative care pathways which would allow them to receive the most appropriate care with out the need for an unnecessary hospital admission.
As a result of the CQUIN programme, the Trust and 19 CCGs indentified 34 new or reinvigorated alternative care pathways and more than 3,837 patients were referred into alternative services, specialist services such as for dementia or falls, or kept out of hospital through initiatives such as the wound closure projects.
The CQUIN programme provided bespoke training for mental health learning needs, including the development of an e-learning package; to improve the cardiac care to patients through the provision of master classes and the development of an ECG recognition guide, and a bespoke training course was developed with the University of East Anglia to provide
additional training for 30 paramedics to support improved decision making skills.
To access more detailed information about the agreed CQUIN goals for 2013/14 and for the following 12-month period go to:
www.institute.nhs.uk/world_class_commissioning/pct_portal/cquin.html In 2014/15 the Trust will be aligning the Friends and Family mandatory CQUIN with the Quality Account as the sole A&E CQUIN for the coming year.
Data quality
Data quality continues to be a significant focus for the Trust. The Trust has a Data Quality Compliance and Strategy Group which was formed to gain confidence and assurance that systems, policies, and procedures are in place and operating to the best possible level of data quality and compliance.
The Trust has introduced a CAD Data Quality Policy which supports the activities of the Data Audit Team. The team have done various audits across the Trust and have a programme of regular checks to verify information that is reported nationally. This includes checking a sample of incidents that have ‘on-scene times’ entered by dispatch staff manually and the use of the ‘FIRST’ call sign to check it has been used in compliance with the national standards.
The activities of the Data Audit Team are subject to independent external audit and continue to support the Trust’s Data Quality Action Plan.
NHS Number and General Medical Practice code validity
The Trust did not submit records during 2014/15 to the Secondary Uses Service for inclusion in the Hospital Episode Statistics.
Information governance toolkit attainment levels
The toolkit is an online assessment produced by the Department of Health (DH) and administered nationally by the Health and Social Care Information Centre (HSCIC). It draws together legal requirements and central NHS guidance for information security best practice, and presents them as a set of specific information governance requirements.
The toolkit requires NHS organisations to carry out an annual self-assessment against each of these requirements. The purpose of the assessment is to enable organisations to ascertain whether information is handled correctly and protected from unauthorised access, loss, damage and destruction. The ultimate aim is to demonstrate that the organisation can be trusted to maintain the confidentiality and security of personal information.
The overall score for the Trust’s 2013/14 Information Governance Toolkit return will be 75%, giving a ’satisfactory’ compliance rating. This provides assurance to the Executive Leadership Team, the Trust Board and the public that there are sufficient controls in place to ensure that the Trust’s information is kept confidential and secure.
The Information Governance Toolkit is available on the HSCIC website: https://nww.igt.hscic.gov.uk/
