SAS Quality Scorecard August 2011

SAS Quality Scorecard August 2011 Access & Referral Unscheduled AR1: Cat A Performance AR2: Cat A Cardiac Arrest Performance AR3: Cat B Performance AR4: Islands Emergency Performance AR5: 1Hr Urgents In Performance Scheduled AR8: PTS Punctuality for Appointment AR9: PTS Punctuality for Pickup After Appointment AR10: PTS Journeys Cancelled by SAS Air Ambulance AR11: Time from Take Off to Land on Scene < 60mins Clinical Excellence CE1: ROSC CE2: Hyper Acute Stroke To Hospital < 60 mins CE3: SEWS Scores >= 4 Taken to Hospital Engaging with Partners EP3: PTS Aborts and Cancels EP6: Emergency Incidents Treated at Scene Organisational Development OD3: Sickness Absence OD4: Meet Financial Targets ( 000) OD5: Meet Cash Efficiency Targets ( 000) Heat Target Measure YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 On Target Of Concern SAS H3 75% 73.8% 75.1% 73.7% 73.1% 73.0% 74.4% 73.9% 73.6% >=75% 72-75% <=72% SAS H2 80% 78.6% 79.7% 80.8% 79.8% 73.5% 79.1% 80.1% 76.3% >=80% 76-80% <=76% SAS H4 95% 93.2% 93.1% 93.7% 92.6% 92.7% 94.0% 93.1% 93.3% >=95% 91-95% <=91% SAS H5 55% 56.2% 55.0% 57.0% 55.7% 54.6% 58.5% 55.9% 56.6% >=55% 52-55% <=52% SAS A1 91% 85.1% 86.0% 86.1% 84.1% 83.9% 85.5% 85.4% 84.7% >=91% 88-91% <=88% Action Required SAS A2 72% 71.1% This 71.7% indicator 70.5% is reported quarterly >=72% 70-72% <=70% SAS A3 90% 80.6% This 80.5% indicator 80.7% is reported quarterly >=90% 87-90% <=87% SAS A4 <0.5% 0.4% 0.3% 0.4% 0.6% 0.3% 0.4% 0.5% 0.3% <0.5% 0.5-0.8% >=0.8% Heat Target April June 95% 95.5% 96.9% 94.7% 96.0% 94.8% 93.6% 95.9% 94.5% >=95% 91-95% <=91% Measure YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 On Target Of Concern SAS H1 12-20% 17.3% 21.7% 15.9% 15.5% 15.0% 15.2% 17.7% 15.7% >=12% 10-12% <=10% SAS T5 80% 80.7% 78.2% 86.7% 83.6% 75.2% 78.9% 83.3% 77.3% >=80% 76-80% <=76% SAS T4 95-98% 96.2% 97.0% 97.1% 95.0% 96.0% 95.4% 96.3% 95.7% >=95% 91-95% <=91% Heat Target Measure YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 On Target Of Concern 18wks <18% 15.6% 16.5% 15.8% 15.5% 14.6% 15.1% 15.9% 14.9% <=18% 18-20% >=20% SAS T3 12% 12.5% 12.4% 12.3% 12.7% 12.6% 12.4% 12.5% 12.5% >=12% 11-12% <11% Heat Target Measure YTD Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Q1 Q2 Q3 Q4 On Target Of Concern SAS E1 <5% 5.0% 4.9% 4.5% 5.4% 5.4% 5.0% 4.9% 5.2% <=5% 5-5.5% >=5.5% Action Required Action Required Action Required NHSS E5-971 n/a - 585 25-190 - 221-560 - 411 >= 0-100k- 0 <=- 100k NHSS E6 6,525 4,745 n/a 4,078 127 22 518 4,205 540 >=3% 2.5-3% <=2.5%

Summary Clinical performance remains strong in July and August, with the year to date position above target. Despite higher levels of sickness absence, response times improved in August and PTS cancellation rates remained within tolerance limits. The higher than expected sickness absence, together with late notification and non recurring cost pressures has resulted in a worsening financial balance of a 970k overspend.

Highlight/Exception Report SAS AR1 (HEAT SAS H3) % of Cat A within 8 minutes 100.0% Scotland Total - Cat A % Met 8 Minutes Performance against this indicator increased in the past month, narrowly missing the 75% target with a performance of 74.4%. 90.0% 80.0% 70.0% 60.0% In August 2011 2 of the 5 divisions exceeded the target of 75% for the month. North and West Central Divisions both achieved over 75% in August with 76.3% and 77.2% respectively. East Central and South East, whilst below target improved on the July position and South West fell below target for the month of August. 50.0% Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 % Met 8 Mins 73.4% 74.3% 70.6% 58.6% 68.4% 71.1% 73.4% 75.1% 73.7% 73.1% 73.0% 74.4% Target 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% 75.0% Cat A % performance by Division 78.0% 76.0% 74.0% 72.0% 70.0% In August Scotland as a whole struggled to maintain performance over weekends and on Mondays, the 3 days in which emergency and urgent demand is at its highest. Throughout August Sundays had the lowest performance with 70.8% and Tuesdays had the highest with an average of 77.6%. Scotland as a whole is currently sitting 1.2% behind the 75% target for the year to date with North and West Central being the 2 divisions which are meeting the target at 76.1% and 75.1% respectively. Now that the Optima Software has been procured, shift reviews are progressing in divisions to refine the matching of resourcing to demand patterns. 68.0% 66.0% East Central North South East South West West Central Scotland MTD 73.6% 76.3% 70.3% 74.3% 77.2% 74.4% YTD 73.4% 76.1% 70.8% 74.6% 75.1% 73.8% Target 75% 75% 75% 75% 75% 75%

SAS AR2 (HEAT SAS H2) % of cardiac arrest incidents responded to within 8 minutes %Category A Calls 100.0% Cardiac Arrests Responded To Within 8 Minutes - Scotland 100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Sep- 10 Oct- 10 Nov- 10 Dec- 10 All Cat A % Met 73.4% 74.3% 70.6% 58.6% 68.4% 71.1% 73.4% 75.1% 73.7% 73.1% 73.0% 74.4% Cardiac Arrest Cat A % Met 81.0% 78.9% 75.2% 61.7% 70.4% 79.7% 80.1% 79.7% 80.8% 79.8% 73.5% 79.1% Target 75% 75% 75% 75% 75% 75% 75% 75% 80% 80% 80% 80% Jan- 11 Feb- 11 Mar- 11 Apr- 11 May- 11 Jun- 11 Jul- 11 Aug- 11 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 H2 Cardiac arrest patients responded to within 8 mins Performance against this indicator marginally fell short of the 80% target in August at 79.1%. The performance in August was an improvement on July s number which was 73.5%. In Scotland as a whole there was a 1.3% fall in the number of cardiac arrest incidents in August when compared to August 2010. South East and West Central were the 2 divisions which achieved the target with 82.5% and 82.1% respectively. East Central, North and South West divisions all fell below target in August. Two of these divisions had a rise in the number of cardiac arrest incidents, East Central by 20.8% and North by 6.0%. Year to date Scotland is slightly behind target by 1.4% with only West Central exceeding the target for the year with 83.9%. The position for 2010/11 was 77.4%. 90.0% 80.0% Cat A%met within8mins 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% East Central North South East South West West Central Scotland MTD 76.3% 79.2% 82.5% 76.3% 82.1% 79.1% YTD 76.5% 76.6% 77.7% 75.8% 83.9% 78.6% Target 80% 80% 80% 80% 80% 80%

SAS AR3 (HEAT SAS H4) % of Cat B incidents responded to within 14,19,21 minutes 100.0% Scotland Total - Cat B % Met 14,19 and 21 Minutes Performance against this indicator rose in August to the highest level this year at 94.0%. Overall emergency demand is 3.8% higher than the same 5 months last year. 90.0% 80.0% East Central and South West achieved the target in August with 95.5% and 95.1% respectively. 70.0% 60.0% 50.0% Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 % Met 14,19 or 21 Mins 94.4% 93.6% 91.5% 84.7% 91.2% 91.5% 93.2% 93.1% 93.7% 92.6% 92.7% 94.0% Target 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% 95.0% Although an improvement on previous month s performance, West Central division accounted for the bulk of the shortfall in performance due to the 14 minute response time target in Glasgow which is the only area where the 14 minute target applies, due to historical reasons (the rest of the country has Category B targets of 19 or 21 minutes). The development of indicators more closely aligned to clinically safe and effective care continues. Cat B % Performance by Division 96.0% 95.0% 94.0% 93.0% 92.0% 91.0% 90.0% 89.0% 88.0% 87.0% East Central North South East South West West Central Scotland MTD 95.5% 93.8% 93.8% 95.1% 92.8% 94.0% YTD 94.8% 93.9% 94.8% 94.3% 90.4% 93.2% Target 95% 95% 95% 95% 95% 95%

SAS AR5 (HEAT SAS A1) % of 1 hour urgents responded to within 1 hour 100.0% 95.0% 90.0% % of 1 Hour Urgents responded to within 1 Hour Performance against this indicator improved slightly in August when compared with July to 85.5%. The demand for 1 hour urgent journeys decreased by 8.1% in August when compared to August 2010. 85.0% 80.0% In August 2011 the North was the only division which reached the target of 91% with a performance of 93.8%. 75.0% 70.0% 65.0% 60.0% Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 YTD Performance 93.5% 92.7% 92.7% 91.4% 87.1% 91.7% 88.3% 82.8% 86.0% 86.1% 84.1% 83.9% 85.5% 85.1% Target 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% 91% % of 1 Hour Urgents Responded to within 1 Hour by Division 100.0% A significant focus has been placed on improving responses to doctors urgents requests, particularly those with a response within 1 hour, as these are often very ill patients. Over the last few months, standards, definitions and reporting arrangements have been refined, together with real time exception arrangements for breaches. As a result the number and waiting times of outliers has significantly reduced. 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% East Central North South East South West West Central Scotland MTD 89.0% 93.8% 81.2% 83.5% 82.5% 85.5% YTD 89.0% 95.5% 83.9% 82.3% 80.4% 85.1% Target 91% 91% 91% 91% 91% 91%

SAS AR8 (HEAT SAS A2) P1 patients PTS punctuality for appointment 100.0% 90.0% 80.0% Scotland Total - PTS Appointment Punctuality Performance against this indicator showed a fall in the second quarter of 2011/12 when compared against the previous quarter (2011/12 Q1). The performance in Q2 2011/12 was 1.5% below target at 70.5% and was also lower than the same time last year when it was 72.6%. 70.0% 60.0% 50.0% 2010/11 Q2 2010/11 Q3 2010/11 Q4 2011/12 Q1 2011/12 Q2 % Punctuality 72.6% 72.6% 70.1% 71.7% 70.5% Target 72.0% 72.0% 72.0% 72.0% 72.0% PTS A2 Appointment Punctuality 100% 80% Three of the 5 divisions exceeded the 72% target, these were North, South East and South West with East Central and West Central falling short at 69.0% and 64.8% respectively. East Central currently has nine whole time equivalent ACA vacancies, which with widespread use of part time working equates to more than nine posts. In addition, use of the Volunteer Ambulance Car Service is being curtailed. This will impact on quality standards until Scheduled Care Review implementation takes effect and reduces excess demand. 60% 40% 20% It is worth noting that these figures are based on a 1 week sample of PTS activity which means a small sample of information is used to calculate an average for the quarter. By the end of this financial year it is planned to introduce PTS mobile data into the Data Warehouse. This will make the measuring of this indicator more robust and timely. 0% East Central North South East South West West Central Scotland Q1 2011/12 69.8% 80.6% 75.1% 78.2% 63.9% 71.7% Q2 2011/12 69.0% 78.8% 73.2% 74.0% 64.8% 70.5% 2011/12 YTD 69.4% 79.6% 74.2% 76.1% 64.4% 71.1%

SAS AR9 (HEAT SAS A3) P1 patients PTS punctuality for pickup after appointment 100.0% 90.0% 80.0% Scotland Total - PTS Pick up Punctuality Although showing a slight improvement compared to the previous quarter, performance against this indicator continues to fall short of the target of 90% at 80.7%. Despite the small rise in performance against last quarter it fell when compared to the same time last year (81.8%). 70.0% 60.0% All 5 divisions fell short of the 90% target in Q2 2011/12. East Central and West Central had the lowest performance with West Central again recording a performance below 80%. 50.0% 2010/11 Q2 2010/11 Q3 2010/11 Q4 2011/12 Q1 2011/12 Q2 % Punctuality 81.8% 79.9% 80.3% 80.5% 80.7% Target 90.0% 90.0% 90.0% 90.0% 90.0% PTS A3 Pick-up Punctuality 100% 80% Again, it is worth noting that these figures are based on a 1 week sample of PTS activity which means a small sample of information is used to calculate an average for the quarter. By the end of this financial year it is planned to introduce PTS mobile data into the Data Warehouse. This will make the measuring of this indicator more robust and timely. 60% 40% 20% 0% East Central North South East South West West Central Scotland Q1 2011/12 76.3% 88.4% 89.7% 84.3% 74.2% 80.5% Q2 2011/12 81.1% 86.7% 85.6% 85.3% 71.2% 80.7% 2011/12 YTD 78.8% 87.5% 87.9% 84.8% 72.8% 80.6%

SAS OD3 (HEAT SAS E1) Sickness Absence 10.0% 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% HEAT Target E1 - Reducing Sickness Absence Scotland Total Sickness Absence Aug-10 Sep-10 Oct-10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11 Jul-11 Aug-11 YTD Performance 4.6% 4.8% 4.9% 5.6% 6.3% 6.1% 5.8% 5.1% 4.9% 4.5% 5.4% 5.4% 5.0% 5.0% Target 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 12.0% 10.0% 8.0% 6.0% 4.0% 2.0% 0.0% East Central EMDC - East HEAT Target E1 - Reducing Sickness Absence EMDC - North EMDC - West NHQ North East North & West South East MTD 5.9% 6.0% 6.7% 11.3% 2.9% 4.6% 3.7% 4.6% 3.2% 6.4% 5.0% YTD 5.9% 3.8% 3.6% 8.4% 3.2% 5.1% 4.3% 4.9% 2.8% 7.1% 5.0% Target Lower 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% 5% South West West Central Scotland Performance against this target narrowly missed the <5% target in August with a figure of 5%. The performance in August improved compared to June and July 2011 where the performance in both months was 5.4%. In August East Central, West Central and all the EMDCs were outwith the target of 5% with the West EMDC recording the highest rate at 11.3%. This is a rise from the previous 2 months where the rate was 6.3% in June and 10.5% in July. The remaining 2 EMDCs and West Central both recorded sickness absence of over 6%. The high rates seen in August are unusual for these 2 EMDCs as both have been below 5% in every other month this year and remain below 5% for the year to date. Scotland as a whole is slightly above the <5% target for the year to date at 5%. Four divisions, East Central, West EMDC, North East and West Central are also above the <5% target. Again the West EMDC has recorded the highest year to date rate at 8.4%.

HEAT TARGET E5: MEET FINANCIAL TARGETS (OD4 and OD5) REPORT TO SCOTTISH AMBULANCE SERVICE BOARD BY PAMELA McLAUCHLAN, DIRECTOR OF FINANCE AND LOGISTICS FINANCIAL PERFORMANCE TO 31 AUGUST 2011 Introduction This paper sets out the financial position at 31 August 2011 for the Scottish Ambulance Service in terms of the three financial targets. The paper also covers related targets such as the Cash Releasing Efficiencies. Summary The summary outturn figures are shown in Table 1 below. Table 1 Summary performance against financial targets Limit Under/(over)spend 000 Core Revenue Resource (971) Capital Resource 0 Cash balance 382 Core Revenue Resource Analysis The 31 August 2011 position reflects a very significant overspend position for the first five months of the year of 971k against the core Revenue Resource limit. This position has been impacted by: the additional public holiday in April which has a total cost of 600k; additional resourcing for the Royal wedding in July of 50k; the additional cost pressures from diesel pricing of 195k year to date; and the additional payments to volunteer drivers per the government CEL of 205k. All of these cost pressures materialised after the Board had

established its current year budget. Whilst 650k will be non-recurring, this will have to be recovered within the current financial year. Income is under-recovered by 7k, in the main through reduced income from repairs and servicing within the Fleet department. Total Pay is overspent by 973k, having worsened by 431k from June Basic pay is slightly overspent by 4k However, overtime is significantly overspent by 954k. 650k of this is due to the additional public holiday and additional cover in Edinburgh in July. The graphs showing divisional overspend by month are shown below. From these, it can be seen that West Central and North Divisions had higher overtime expenditure in July and August than in the previous 17 months. The North has a high number of vacancies - 18WTE - which accounts for some of the overtime used. West Central had high levels of sickness in June and July of 7.1% and 7.4%, impacting the overtime used. However, the dependence on overtime is not sustainable in the short or medium term. All of the Divisions have prepared financial recovery plans which are being updated to incorporate the Workforce Planning Learn and Improve findings. The key areas of action thus are focused on annual leave planning and management; relief management, authorisation and management of overtime. A summary of actions is included in Appendix 1. 11

Overtime Spend by Division 250,000 200,000 150,000 100,000 50,000 0 April 2010 May 2010 June 2010 July 2010 August 2010 September 2010 October 2010 November 2010 December 2010 January 2011 February 2011 March 2011 April 2011 May 2011 June 2011 July 2011 August 2011 Month North Division East Central Division West Central Division South East Division South West Division In relation to non-pay, the overall position is an underspend of 8k. Ambulance Car service is overspent by 77k. This is due to government guidance to increase the amount paid to volunteers by 5p a mile up to the first 10,000 miles. This will create a cost pressure of 205k in a full year. Consumables are overspent by 65k due to additional items purchased to ensure compliance with infection control standards. Fleet maintenance is also of concern with a 60k overspend. However, this can be explained as being due to the older vehicles still being maintained. This is expected to reduce considerably from October as the new vehicles are now operational in parts of Scotland, with five per week coming on stream.. 12

The key areas of significant underspend are: Air Ambulance is currently underspent by 64k due to a rebate on last year s contract of 75k Cleaning consumables are underspent by 20k Printing and Stationery are underspent by 20k Hire of vehicles is underspent by 20k Radio repairs are also underspent by 32k. This relates to the old radio system and may be funding that is not required this year. The high level organisational position is shown in Table 2. This indicates that the A&E service is 1.1 million overspent. This compares with 960k at the same time last year. 13

14

Table 3 shows the high level outturn for each Division. From this, it should be noted that all Divisions are overspent, mainly due to their usage of overtime - and there have been supplies movements in, due to diesel and ambulance car. 15

BALANCE SHEET Table 4 shows the Balance Sheet, with a cash balance of 382k, which is the level of cash that should be held as the year progresses. 16

CAPITAL Table 5 shows the capital position, with Cumbernauld and Helensburgh stations completed during June. Kirkcaldy completed in August. The final accounts for these three projects will go through in September. The Shock boxes (AEDs) have been delivered and the roll out programme is almost complete. Evaluation of the vehicle safes is progressing during the autumn. 17

FINANCE TARGETS - CONCLUSION The financial position is of significant concern given the revenue overspend of 971k. Each of the Divisions has a financial recovery plan and areas of non- pay have been examined to put on hold non-essential expenditure until the organisation is in a more financially balanced position. EFFICIENCY TARGET The Scottish Government has set a 3% efficiency target on the Territorial Boards and direct patient care Special Health Boards. This represents a figure of 5.8 million for the Scottish Ambulance Service. However, the requirement to internally fund the additional public holiday means that a further 600k was required for 2011/12. Also other cost pressures have increased the target to 7.07 million. To the end of August 4.7 million has been achieved - or 67% of the annual requirement. Table 1 summarises the cash-releasing savings position at the end of August TARGET DIVISION/DEPT/BUDGET March 2012 '000 REALISED TO DATE August VARIANCE at August 2011 2011 '000 '000 Clinical Productivity 2,662 2,109 553 Workforce 1,500 852 648 0 0 0 616 616 0 1,247 1,128 119 Estates and Facilities 627 40 587 Unidentified Savings 361 0 361 TOTAL 7,077 4,745 2,332 SAS Target 7,077 SGHD Target 5,850 Drugs and Prescribing Procurement Support Services 18 1,227

APPENDIX 1 Areas of Action in Divisional Recovery Plans Whilst there are some specific actions unique to certain Operational Divisions the key areas of action are around the following: Overtime authorisation is at Head of Service level with weekly prospective reviews of resourcing availability and retrospective analysis of cover provided in each area Advancement of shift reviews in line with the demand and resourcing modelling tool Robust application of annual leave policies Implementation of the Workforce Learn and Improve recommendations Consolidation of meetings involving staff side representation Robust monitoring of sickness absence procedures Review of non-frontline posts from the administration Learn and Improve and other work streams Examination of non-pay areas such as: consumables; uniforms; fuel; and equipment replacement to ensure best practice in replacement is being followed Robust monitoring of vehicle accident trends and appropriate action 19