Monthly Performance Report March 2019 This report refers to February 2019 (M11) data unless otherwise stated All data is based on LONDON Clinical Commissioning Groups only, unless otherwise stated. Incident re-categorisation has been applied retrospectively; impacting previously reported response times and demand per category.

Ambulance Response Programme – Definition & Overview EXECUTIVE SUMMARY Ambulance Response Programme – Definition & Overview Category Percentage of calls per Category National Standard How long does the ambulance service have to make a decision? What stops the clock? Category 1 8% 7 minutes mean response time 15 minutes 90th centile response time The earliest of: The problem being identified An ambulance response being dispatched 30 seconds from the call being connected The first emergency vehicle that arrives on scene stops the clock (there is an additional Category 1 transport standard to ensure that these patients also receive early ambulance transportation). Category 2 48% 18 minutes mean response time 40 minutes 90th centile response time An ambulance response being dispatched 240 seconds from the call being connected If a patient is transported by an emergency vehicle, only the arrival of the transporting vehicle stops the clock. If the patient does not need transport, the first emergency vehicle arriving at the scene of the incident stops the clock. Category 3 34% 60 minutes mean response time 120 minutes 90th centile response time Category 4 10% 180 minutes 90th centile response time Category 4T: If a patient is transported by an emergency vehicle, only the arrival of the transporting vehicle stops the clock. The new standards are intended to: Prioritise the sickest patients quickly to ensure they receive the fastest response. Ensure national response targets to apply to every patient for the first time – so ending ‘hidden waits’ for patients in lower categories. Ensure more equitable response for patients across the call categories. Improve care for stroke and heart attack patients through sending the right resource first time. Due to the nature and impact of these changes, the previous performance measures are not comparable. However, NHS England have published National Standard for a number of the key measures which are included here.

EXECUTIVE SUMMARY Performance Summary Demand Performance A total of 90,884 incidents were provided with a face to face response, 3.7% above plan for M11. Category 1 incidents reached a total of 11,499. This remains significantly above plan for M11 at 51.5%. This is the highest above plan, compared to M1 through M10. 54,833 incidents were categorised as Category 2 and provided with a face-to-face response. M11 saw four of the nine key measures perform within the national standards. All the response measures increased in February 2019. Despite this increase, C1 Mean and C1 90th Centile continued to perform within the 7 and 15 minute National Standards respectively. The C2 90th Centile and C3 Mean remain within the National Standard for the Year To Date position. * Incident data is correct as of 12th March and is subject to change due to data validation.

Response Times by Category Performance Overview Response Times by Category Category 1 The NEW Category 1 (C1) measure is expected to comprise of approximately 8% of all incidents and covers a wider range of conditions than the former Red 1 category. These are to be responded to within an average time of seven minutes. Fig 1.1 shows the time taken to respond to patients triaged as Category 1 (C1) The grey line shows the LAS 90th centile response time. The dotted grey line shows the National Standard of 15 minutes 90th centile response time. The blue line shows the LAS monthly average (mean) response time The dotted blue line shows the National Standard of 7 minutes average (mean) response time. Fig 1.1 Category 2 The NEW Category 2 (C2) measure is expected to comprise of approximately 48% of all incidents. These are to be responded to within an average time of 18 minutes. Fig 1.2 shows the response time for patients triaged as Category 2 (C2) The grey line shows the LAS 90th centile response time. The dotted grey line shows the National Standard of 40 minutes 90th centile response time. The blue line shows the LAS monthly average (mean) response time The dotted blue line shows the National Standard of 18 minutes average (mean) response time. Fig 1.2

Response Times by Category Performance Overview Response Times by Category Category 3 The NEW Category 3 (C3) measure is expected to comprise of approximately 34% of all incidents. Fig 1.3 shows the time taken to respond to patients triaged as Category 3 (C3) The grey line shows the LAS 90th centile response time. The dotted grey line shows the National Standard of 120 minutes (2 hours) 90th centile response time. The blue line shows the LAS monthly average (mean) response time. The dotted blue line shows the National Standard of 60 minutes (1 hour) average (mean) response time. Fig 1.3 Category 4 The NEW Category 4 (C4) measure is expected to comprise of approximately 10% of all incidents. Fig 1.4 shows the response time for patients triaged as Category 4 (C4) The grey line shows the LAS 90th centile response time. The dotted grey line shows the National Standard of 180 minutes (3 hours) 90th centile response time. The blue line shows the LAS monthly average (mean) response time. There is no National Standard the mean response time. Fig 1.4

Performance Overview Key Metric Variation

(MONTH 11) Performance Overview Benchmarking - National Picture Fig 4.2

Performance by CCG & STP Performance Overview Performance by CCG & STP These tables shows key performance measures profiled by STP. All STPs continued to perform within the 7 minute national standard for the C1 Mean. All STPs performed above the 18 minute standard for the C2 Mean. The C2 response measures decreased in M11 in the South West STP. Despite this decreased, these measures remained above the National Standards. The South West was the only STP to achieve the C4 90th Centile response time within the National Standard. Ambulance Turnaround The Patient Handover to Green measure demonstrates the percentage of handovers within 15 minutes This table opposite shows the Data Completeness for Ambulance Turnarounds for the previous 11 months and the Year To Date position. Ambulance Turnaround (M1) (M2) (M3) (M4) (M5) (M6) (M7) (M8) (M9) (M10) (M11) YTD 2018/19 Patient Handover to Green (within 15 mins) 55.49% 54.99% 54.16% 54.08% 54.41% 54.68% 54.53% 55.72% 57.45% 57.52% 56.93% 55.48% Data Completeness (arrival) 99.99% 100% 99.98% 99.94% Data Completeness (green) 99.97%

Performance Overview Performance by CCG & STP

Performance Overview Performance by CCG & STP

Call Answering Performance Performance Overview Call Answering Performance Fig 5.1 Fig 5.2 Figure 5.1 demonstrates three key measures for call answering under the Ambulance Response Programme (ARP). 127,959 calls were received into the EOC in February 2019 (M11). 1,451,719 calls have been received into the EOC for YTD. During M11 the median call answering was zero seconds. This means 50% or half of all calls received into the Emergency Operations Centre (EOC) were answered immediately. The 95th centile was 79 seconds. In other words 95 out of every 100 calls were answered in less than 79 seconds. The graph continues to show a positive downward trend. Figure 5.2 shows the percentage of calls answered within five seconds. 90,884 incidents received a face-to-face response in February 2019 (M11). 1,040,841 incidents received a face-to-face response for the YTD. The new ARP standards no longer use this performance measure and for that reason there is longer a requirement to report it. However, to illustrate the graph shows the daily call taking performance in the month. In M11 81% of all calls received into the EOC were answered within five seconds. The graph continues to show a positive upward trend. * Incident data is correct as of 12th March and is subject to change due to data validation.

Hospital Handover Summary Hospital Conveyance Lost Hours

Resource Levels Plan vs. Actual * Including MRU ^ ORH plan  Vehicle Hours   Responder Type Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Planned Resource Level ^ DCA 161,563 167,288 161,617 167,027 167,291 161,346 167,290 161,832 166,800 151,782 FRU * 53,904 55,804 53,898 55,724 55,824 53,771 55,830 54,005 55,621 50,346 Current Resource Level (GRS) 156,726 160,710 152,749 159,399 157,860 153,745 163,176 162,970 163,292 165,190 153,094 47,403 48,451 46,505 48,310 48,036 46,210 48,387 47,686 49,514 49,287 44,554 Current Resource Gap -4,837 -6,578 -8,867 -7,627 -9,430 -7,600 -4,115 1,138 -3,508 -2,098 1,311 FRU -6,501 -7,353 -7,393 -7,414 -7,788 -7,561 -7,443 -6,318 -6,107 -6,517 -5,791 Fig 6.1 Figure 6.1 shows a breakdown of resource levels, in patient facing vehicle hours, for the previous 11 months. The Planned Resource Level is the ORH plan for patient facing vehicle hours. This is profiled by responder type for the previous 10 months. The Current Resource Level (GRS) are the actual patient facing hours produced profiled by responder type. The Current Resource Gap is shown to demonstrate the gap in resourcing for these responder types each month. GRS data shows scheduled hours and as such it does not include pre or post shift overtime hours. * Including MRU ^ ORH plan