Chief Executive Officer Report
Meeting: Public Board
Date: 08.11.2023
Report Title: Chief Executive Report
Agenda Item: 1.6
Author: Tom Abell, Chief Executive
Lead Director: Tom Abell, Chief Executive
Link to strategic risk(s):
- SR1a: If we do not ensure our people are safe and their wellbeing prioritised, there is a risk that we will be unable to attract, retain and keep all our people safe and well
- 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
- SR2: If we do not deliver operational and clinical standards then there is a risk of poor patient outcomes and experience
- 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
- SR5: If we do not clearly define our strategic plans we will not have the agility to deliver the suite of improvements needed
- 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
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 on the activities of the Trust since its last meeting.
Executive summary
Operational Improvement Plan (OPIP)
As board members will note from the Integrated Performance Report, performance in all categories has slightly increased in the last month due to an increase in call volume. We remain above the NHS planning target of a 30-minute mean C2 response which at the time of writing was around 45 minutes for September.
Patient facing staff hours have increased for September compared to August. Abstraction rates remain within target and sickness remains below the target set within the Operational Improvement Plan at 9.6%, there is clearly a risk of increased sickness during the winter relating to flu and COVID and will remain an area of close focus for the Trust.
The number of hours lost to handover have continued to increase across our region with particular challenges remaining in Norfolk and Waveney with 16% of our conveyed patients being delayed for over an hour before handover. This continues to be an area of ongoing discussion with partners in Norfolk and Waveney and we held an improvement week during October with partners spending time with our services to identify opportunities for improvement and how we may improve resilience of the urgent and emergency care pathway during Winter.
We continue to progress with our work to refer patients to alternative services when they have called 999 but do not need an ambulance response, known as “Access to the Stack”. We are now working on an automation process for clinically validated code sets being passed over which should be in place in November, and continue to work on the establishment of the Unscheduled Care Co-ordination Hubs in each of our 6 systems – a key priority being to establish call before you convey lines in each system in the coming months.
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 55% booked on a course or started in a role. Of the remaining 45%: 32% Are currently Completing Pre-Employment Checks and we are advertising to attract the final 23%. To improve performance against the target the recruitment team are working on recruitment incentives, different advertising campaigns to appeal to a wider market and international recruitment of nurses.
Time to Lead
The consultation for the Time to Lead transformation is progressing.
The recruitment process for head of sector roles has now been completed, with the next step being for the other senior leadership roles at a sector level.
We will also shortly be launching our leadership development offer for these leaders which is the critical element to help support sustainable culture change and performance improvement alongside the structural changes we are making.
Clinical Entrepreneurship Programme
We are one of 10 Trusts across England who is a member of the NHS England Clinical Entrepreneur InSites programme which aims to develop organisational capability amongst health and care organisations in the adoption of innovation, and to test and trail entrepreneur-developed innovations in the NHS.
This work is being led by our Quality Improvement team and we will be formally launching this within the organisation in November. As part of this programme, we have a lead appointed who will be leading pilots and engagement with colleagues across the Trust and it’s an exciting opportunity for us to pilot new technology and explore different ways we can deliver both the highest quality care to our communities alongside improve the way that our organisation works.
COVID-19 and Flu
The annual flu vaccination programme started on the 23 October and will run until December. Clinics will be held across the Trust to provide every member of the team protection against flu through the winter months.
The COVID vaccine will also be available for all staff and volunteers from the 30 October. Staff are being encouraged to get both vaccines on the same visit as this has been evidenced as safe.
Sustainability
An update on sustainability is provided in Appendix A to this paper.
Regulatory Update
The key update since my last report is to note the progress made in respect of our education provision with our action plan with NHS England having now been closed and the Trust moving back to normal monitoring from the enhanced monitoring which has been undertaken for the last three years. A big thank you to our education team for all of their work to make this possible.
Executive Team
Now that Melisssa Dowdeswell has been announced as the chief of clinical operations the Trust is recruiting to a chief paramedic/allied health professional and executive for quality. This new role will ensure that Paramedicine is represented at Board level and importantly offer a senior clinician role model to drive forward paramedic and emergency practice for our people. The role is currently being advertised with interviews planned prior to Christmas. Simon Chase is acting into the role during the recruitment process.
Engagement
In recent weeks the Trust has suffered the loss of two long serving colleagues. My thoughts are with their colleagues and families during these difficult times. We are all extremely grateful for their service to our patients and our organisation – they will be greatly missed. I have continued to visit ambulance stations, acutes and blue light colleagues and met with a external stakeholders since my last report:
- I visited Stansted, Stevenage, Chelmsford, Ipswich, Colchester, Huntington, Peterborough, Bury St Edmunds, Longwater and King’s Lynn stations.
- Have presented Chief Executive commendations to members of the community in Ipswich and Huntingdon to award people for their bravery and support to our patients.
- Q&A session with colleagues in EOC to respond to concerns about changes relating to Time to Lead and staffing numbers.
- Visited Bury St Edmunds new hub for a ground breaking ceremony with the project team. It was great to see a number of staff attend and see the progress which has been made to date and will be welcoming Jo Churchill MP to the site to show the work being undertaken.
- Shadowed Leading Operations Manager Nick Ball in Longwater for a shift. It was great to see the variety of work the LOMs negotiate alongside excellent and complex patient care.
- Spent a day with Patient Transport colleagues at the Paddocks in Cambridge. I was incredibly impressed with their care and dedication for our patients. Great to be part of such a hard working team for the day – thank you
- Observed our colleagues undertaking major incident training alongside colleagues from Essex Police, Hertfordshire Fire and Rescue and Norfolk Fire and Rescue.
- Joined first responder colleagues in Debenham, Suffolk for a training seminar on managing cardiac arrests and working with crews which had a fantastic turn out despite the terrible flooding we have seen in Suffolk and with representation from first responder groups across our region.
Celebrations
- Our joint work in Mid and South Essex on mental health urgent care pathways have been announced as finalists for an HSJ award.
- Pilot launch of the new Welfare Wagons at the NNUH
- EEAST staff awarded a MUM award at a Gala event in London recognising their outstanding patient care
- Met with Justin Honey Jones to celebrate EEAST being one of the first NHS Trusts to be awarded Bronze Status by the British Dyslexia Association.
Appendix A - EEAST Sustainability Report November 2023
The detail below outlines the progress made with the Sustainability Programme since our last report to the Trust Board.
Recommendations for decision:
- Operations staff needed for EV strategy working group and EV ambulance trials.
- Leadership message needed for Green Plan re-launch and progress communications.
Trust Carbon Footprint
Sustainability manager is collating and analysing data to establish our carbon footprint for direct emissions (NHS Carbon Footprint).
Fleet emissions
- Fuel consumption has increased slightly (increase in vehicles between June and August), this has been partially offset by procurement of more fuel-efficient vehicles and vehicle disposal. Vehicle numbers are now similar to those in April.
- 2023/24 M06: fleet emissions from Trust-procured fuel increased by 0.9% compared with the same period in 2022/23 – we are still on track to exceed our 5% annual reduction target (projected 24% reduction on 2019/20 baseline, target is 20%).
- Missing fleet data: PTS fleet, business use only managers cars.
- Missing business travel data: private ambulance service, managers’ lease vehicle mileage, taxis, public transport (booked via expenses). Sustainability Manager still collating past annual data for grey fleet (staff personal vehicles).
Gas and electricity emissions
- Electricity consumption has decreased by 5%, whereas gas consumption has increased by 81% during this period. There are currently some open queries on gas invoices which are likely to explain this significant increase, the automatic meter reading project will enable more accurate billing.
- 2023/24 M05: utilities emissions have increased by 31% compared with the same period in 2022/23.
Nitrous oxide emissions from Entonox
- 2023/24 M06: nitrous oxide emissions have decreased by 12% compared with the same period in 2022/23 – on track to reduce emissions by 10% this year (projected 26% reduction over 2019/20 baseline).
- QCIP working group now established for 2023/24. Clinical advice to be developed to reduce Entonox waste (estimate 25%).
- Sustainability Manager to link with other trusts on supplier engagement with BOC to eliminate industry practice of venting to atmosphere any gas in returned cylinders.
Utilities data
Half-hourly electricity and gas automatic meter reading project is 75% complete, expected to go live in Q4. Will increase bill accuracy and enable targeted energy efficiency projects.
Electric vehicle (EV) strategy
- EV infrastructure: Sustainability Manager mobilising EV charge point management system and 27 dual 40kW chargers. Installation in two phases: Phase 1 (Longwater, Luton, Peterborough, Stevenage and Waveney) includes priority sites for ZEEV Pathfinder RRVs, electrical surveys are underway for Phase 2 sites.
- FleetEVs: o Rapid Response Vehicles - ordered 15 Skoda Enyaq (58 diesel Skoda Kodiac). o Mental Health Response Vehicles - ordered 6 Mercedes eVito Tourer (2024/25 funding is pending for further 6 vehicles). o NHSE trial of 9 EV double-staffed ambulances (DSAs) likely to start in 2024/25, due to conversion availability.
- NHS England Net Zero Travel and Transport Strategy consultation underway.
Reporting/Assurance
(Sustainability manager engaging with subject leads):
- Estates Returns Information Collection (ERIC): 2022/23 validation completed.
- Premises Assurance Model (PAM): 2023 completed.
- NHS Standard Contract (SC18): 2022/23 annual report submitted to Commissioner.
- Greener NHS Quarterly Return: 2023/24 Q2 reporting underway.
- Green Plan Self-Assessment: 2022/23 completed 5/10 sections. 2023/24 to start.
- Trust Annual Report: Sustainability Manager is gathering data for carbon footprint trajectory (NHS Standard Contract requirement) to be added to website.
- Internal Audit (by TIAA): Fleet Sustainability Audit, report and action plan completed. Estates Planned Preventative Maintenance and Sustainability Audit started.
Other updates
- Sustainability team: two roles (Band 4 sustainability engagement coordinator and Band 5 environment and sustainability assistant) vacancy closed 24/10/23, shortlisting and interviews to commence shortly.
- Sustainability Working Group: governance structure review (SWG to report to new Performance and Sustainability Committee). Net Zero Board Lead received sustainability training and planning Board-wide training at development day.
- Training: Infrastructure and Estates Programme Lead and Head of Estates attended sustainability training via Centre for Sustainable Healthcare in September.
- People Services: Returning Trust Property Task and Finish Group – require contract changes for new starters, HR3 form reminders on managers checklist and a communications plan.
- Waste: waste training now live on Evolve.
Author - Katherine Middleton, Environment and Sustainability Manager Approver - Sean O’Sullivan, Head of Estates
23rd October 2023
Annex A - Sustainability Report
Trust Carbon Footprint
The Sustainability Manager is collating and analysing data to establish our carbon footprint for direct emissions (NHS Carbon Footprint).
Fleet emissions
- Fuel consumption has increased slightly due to the overall increase in vehicles, this has been partially offset by procurement of more fuel-efficient vehicles and vehicle disposal.
- 2023/24 M04: fleet emissions from Trust-procured fuel totalled 5,266 tCO2e, an increase of 4 tCO2e (0.1%) compared with the same period in 2022/23 - we are still on track to meet our 2023/24 carbon reduction target (16,655 tCO2e) with projected total 2023/24 emissions of 15,797 tCO2e (24% reduction on 2019/20 baseline).
- Missing fleet data: PTS fleet, business use only managers cars.
- Missing business travel data: private ambulance service, managers lease vehicle mileage, taxis, public transport (booked via expenses). Sustainability Manager still collating past annual data for grey fleet (staff personal vehicles) and rail.
Utilities emissions
- Utilities emissions during this period have increased, investigations underway.
- 2023/24 M03: Gas and electricity emissions total 549 tCO2e, an increase of 96 tCO2e (21%) compared with the same period in 2022/23.
Nitrous oxide emissions from Entonox
- 2023/24 M03: Entonox usage data from BOC equates to nitrous oxide emissions of 401 tCO2e, decrease of 52 tCO2e (11%) compared with the same period in 2022/23 - we are still on track to reduce emissions by 7% this year (projected 24% reduction over 2019/20 baseline of 2,097 tCO2e).
- QCIP working group now established for 2023/24. Clinical advice to be developed to reduce Entonox waste (estimate 25%).
- Sustainability Manager to link with other trusts on supplier engagement with BOC to eliminate industry practice of venting to atmosphere any gas in returned cylinders.
Utilities data
Half-hourly electricity and gas automatic meter reading (AMR) project continues - 48 out of 68 gas meters had meter exchanged and AMR installed with data available online. This will increase bill accuracy and enable us to target energy efficiency projects.
Electric vehicle (EV) strategy
- EV infrastructure: Sustainability Manager mobilising EV charge point management system and 27 dual 40kW chargers. Phase 1: electrical load measurement devices being used at 5 reporting hubs to determine number of EV chargers to install.
- Fleet EVs: o Rapid Response Vehicles - ordered 15 Skoda Enyaq (58 diesel Skoda Kodiac). o Mental Health Response Vehicles - ordered 6 Mercedes eVito Tourer (2024/25 funding is pending for further 6 vehicles). o NHSE trial of 3 EV DSAs likely to start in 2024/25, due to conversion availability.
- NHS England Net Zero Travel and Transport Strategy consultation underway.
Reporting/Assurance
(Sustainability Manager engaging with subject leads):
- Estates Returns Information Collection (ERIC): 2022/23 reporting submitted.
- Premises Assurance Model (PAM): 2023 data validation underway before September submission.
- Greener NHS Quarterly Return: 2023/24 Q1 submission completed.
- NHS Standard Contract (SC18): 2022/23 year-end reporting to Commissioner underway.
- Green Plan Self-Assessment: 2022/23 completed 5/10 sections. 2023/24 to start.
- Trust Annual Report: Sustainability Manager is gathering data for carbon footprint trajectory (NHS Standard Contract requirement) to be added to website.
- Audit: Fleet Sustainability Audit (TIAA), now reviewing final report and action plan.
Other updates
- Sustainability team: Sustainability Managers invest-to-save paper approved. Two roles (Band 4 Sustainability Engagement Coordinator and Band 5 Environment and Sustainability Assistant) currently with HR for banding evaluation.
- Sustainability Working Group: governance structure review (SWG to report to new Performance and Sustainability Committee). Net Zero Board Lead received sustainability training and planning Board-wide training at development day.
- Procurement: team are recruiting Contract Manager and Social Value Lead.
- People Services: Returning Trust Property Task and Finish Group are finalising an equipment list and IT are reviewing costs of non-returned IT assets.
- Wellbeing gardens and biodiversity: Charity team are gathering feedback, received positive feedback on the effect on wellbeing from the Longwater garden.
- Waste: new waste training package approved and due to be rolled out in October.
- Communications: EV transition communications plan devised and being implemented.
