Confirmed Minutes of the Open Meeting of the Welsh Ambulance Services Nhs Trust Board

CONFIRMED MINUTES OF THE OPEN MEETING OF THE WELSH AMBULANCE SERVICES NHS TRUST BOARD, HELD ON THURSDAY 15 DECEMBER2016 atTHE LYSAUGHT INSTITUTE, 445 CORPORATION ROAD, NEWPORT NP19 0HE

BOARD MEMBERS PRESENT:
Mick Giannasi
Tracy Myhill
Claire Bevan
Emrys Davies
Professor Kevin Davies
Hannah Evans
Pam Hall
Estelle Hitchon
Paul Hollard
Richard Lee
Dr Brendan Lloyd
James Mycroft
Patsy Roseblade
David Scott
Claire Vaughan
Martin Woodford / Chairman of the Board
Chief Executive
Director of Quality, Safety and Patient Experience
Non Executive Director
Non Executive Director
Director of Planning and Performance (Part)
Non Executive Director
Director of Partnerships and Engagement
Non Executive Director
Director of Operations
Medical Director
Non Executive Director
Director of Finance and ICT
Non Executive Director
Director of Workforce and Organisational Development (OD)
Non Executive Director
TRUST BOARD REPRESENTATIVES:
Hugh Bennett
Keith Cox
Nathan Holman
Lee-Anne Leyshon
Steve Owen
Liam Randall
Bleddyn Roberts
OBSERVERS
Richard Bowen
Dorothy Edwards
Andy Swinburn
Nick Morgan
Helen Bushell
Carl Powell
Sarah Jones
Grant Lewis
Jacqui Jones
Mike Lewis
Jeff Cuthbert
Chris Hughes
Adrian Harris
Helen Higgs / Head of Planning and Performance
Board Secretary
Staff Side Representative
Head of Communications
Corporate Governance Officer
Communications Officer
Staff Side Representative
AMB University Health Board
AMB University Health Board
East Midlands Ambulance Service
WAST Staff Side Representative
WAST Mentee
WAST
HIW
Ferno UK
WAST
Gwent Police and Crime Commissioner
Community Health Council
Head of Internal Audit
APOLOGIES
Hannah Evans (note, final item only)
51/16 / CHAIRMAN INTROUDUCTION AND UPDATE
The Chairman of the Board welcomed everyone to the meeting.
He commented that the meeting was being audio recorded and that simultaneousWelsh translation was available should it be necessary. Apologies for absence were received from the Director of Planning and Performance Hannah Evans.
The Chairman reflected on the past year and provided a potted history of the key factors that had seen a vast improvement in several areas; these areas had underpinned the improvement in performance the Trust had seen particularly since April 2016. In addition, since the new clinical model was introduced, month on month improvement on performance had been seen.
There had been significant developments during the year which included; roll out of the 111 service and the opening of a state of the art ambulance and fire services resource centre in Wrexham.
There was still much work to do to create an ambulance services the people of Wales could be proud of, however it was of particular note that the Trust was in a much better place than it was 12 months ago. This had primarily been achieved through the hard work and dedication of the staff which the Board acknowledged.
RESOLVED: That the update was noted.
52/16 / CHIEF EXECUTIVE REPORT
The Board received the verbal report of the Chief Executive The following areas were focused upon:

1. NHS Wales staff survey – the results had been received which would be analysed further going forward in tandem with staff side representatives. A high percentage of those surveyed indicated they were happy working for the ambulance service. On the whole the survey illustrated there had been an overall improvement with staff satisfaction from the previous survey
2. Band 6 Paramedic role profile - England have agreed to fund this. The Trust will now be formally considering their position with this going forward
3. Christmas arrangements – all EMS staff on duty up to 2pm on Christmas day would receive a Christmas dinner and staffing levels during this period had improved
4. Winter pressures – demand already has and would increase during the coming months. Resilience was more robust from this time last year which will assist in dealing with the added pressures. There was also a great deal of focus being applied to consider alternative pathways of care during this busy period. The Board should note that the Additional Capacity Vehicles referred to in the winter plan would no longer be provided due in part to health board staffing levels. Furthermore, the support of Hospital Ambulance Liaison Officers to ease the pressures in hospitalswas no longer available. Notwithstanding these issues the Trust was still continuing to find other ways to relieve operational pressure during the winter months
5. BBC news – recent positive stories about the Welsh Ambulance Service had been very encouraging
6. Concerns and Complaints – There had been major improvements in the handling and replying to concerns received by the Trust; however there was still room for further improvement

RESOLVED: That the update was noted.
53/16 / DIRECTOR OF OPERATIONS UPDATE
Prior to the report, the Chairman congratulated Richard Lee on being awarded the Queen’s Ambulance Service medal.
The Director of Operations gave an update of the Trust’s operational status. He commented that the Trust was still managing the number of calls as at December last year bearing in mind that the number of resources had remained extant. In terms of highlights within the report the Director of Operationsexpanded on the following;

• Recruitment – progress was continuing
• Hear and Treat services
• Fallers – this process required improvement
• CFR schemes
• Joint Response Unit
• Demand and Capacity review had now been completed

The Board discussed the report in further detail and raised several comments which were addressed by the Director of Operations
54/16 / PROCEDURAL MATTERS
The Chairman addressed the meeting and explained the administrative process in terms of the level of scrutiny which had been applied to the reports prior to them being presented at the Board
The minutes of the open and closed sessions of the Trust Board held on 23 September 2016 were confirmed as a correct record subject to adding Martin Woodford to list of attendees.
The Chairman drew the Board’s attention to the Action Log which was self-explanatory.
The Director of Finance and ICT Patsy Roseblade, referred to and briefly explained the use of the Trust seal as presented.
RESOLVED: That
(1)the standing declaration of Mr Emrys Davies as a retired member of UNITE was noted;
(2)the minutes of the meeting of the open and closed sessions of the Board held on 23 September 2016 and the closed session held on 24 November 2016 were confirmed true records subject to the amendment as described;
(3)the updates to the action log was discussed and noted; and
(4)the use of the following seal numbers; 0170, Renewal of Lease, Barry Ambulance Station (effective date: 3 October 2016), 0171, Renewal of Lease of Port Talbot Ambulance Station (effective date: 6 October 20163), 0172, Renewal of Lease of Caernarfon Ambulance Station (effective date: 28 October 2016) and 0173, Modifications to Lease relating to 15 Aberaman park, Aberdare (effective date: 29 Nov 2016) were noted
55/16 / FEEDBACK FROM CLOSED SESSION
The Chairman explained the reasons why some matters required to be dealt with in the closed session of Trust Board meetings, for example there may have been reference to personal information. He gave a brief overview of the discussions that had taken place with regard to thefollowing items:

• Managing serious adverse incidents
• Re- banding of paramedics to pay band 6
• Allegation of a breach in standing orders
• Clinical Contact Centre configuration

RESOLVED:Thatthe feedback be noted.
56/16 / FINANCE REPORT – MONTH 07 2016/17 AND UPDATE RE DISCRETIONARY CAPITAL
The Director of Finance and ICT Patsy Roseblade reported the position as at month seven was an overspend of £0.122m, however it was her expectation the Trust would break-even by the end of the financial year.
In terms of the Trust’s capital, Patsy Roseblade referred to in particular the purchase of 70 defibrillators which had been recommended for approval by the relevant committees going forward. Furthermore the other items listed in the report also required Board approval due to the fact they were above committee delegated financial limits. The Board were further informed that there still remained £1m of discretionary capital still to be spent and that the Computer Aided Despatch project had been fully supported by Welsh Government who had also provided a contingency of £500k.
Members were given a further overview of the finances and the details covered during meetings of the Finance and Resources Committee (FRC) by Martin Woodford, Chairman of FRC. Of particular note were the clinical issues concerning the defibrillators in which it had been noted that the approval of the latter had been subject to addressing the issues raised.
Following more discussion Members raised several comments which included:

• The Medical Director clarified the potential clinical risk with the defibrillators which had been referred to at the previous FRC and informed the Board it had been a software issue which had since been resolved
• In terms of any associated costs with the defibrillators for example training, the Director of Finance and ICT confirmed that this cost would be borne from the capital
• Concern was expressed that the Computer Aided Despatch training infrastructure requirements had not been recognised as part of the business case development going forward. The Director of Finance and ICT explained it was an oversight which had subsequently been addressed and going forward agreed to develop a check list system to avoid this kind of episode in the future
• In response to a query regarding financial forecasts, Patsy Roseblade gave an overview commenting that they were monitored on a monthly basis

RESOLVED: That
(1)the financial position as reported for month 7and the associated key risks and issues were noted; and
(2)the additional planned discretionary capital expenditure as ratified by the Finance and Resources Committee was approved.
57/16 / 111 PATHFINDER UPDATE
The Director of Operations Richard Lee, gave an overview of the 111 programme highlighting areas for the Board’s attention which included:

• the abandonment rate ( calls where the caller, after listening to the recorded message, calls off within 60 seconds) had reduced
• the number of patients being triaged to hospital by 111 had decreased
• there was a reduction of members of the public going to A and E
• the overall quality and patient experience in terms of dealing with patients on the phone had improved

At this point the Director of 111 Richard Bowen, updated the Board on the programme from his perspective. Having now reached week 10 into the programme he reported that there were encouraging signs, feedback had been positive and the weekends were proving to be a challenge. He added there was now a stable foundation going forward and once greater confidence was established following further testing and evaluation within the Abertawe Bro Morgannwg University Health Board area, consideration would be given to rolling out the programme to other areas.
In terms of pathways and the ongoing work going forward, Dorothy Edwards the Assistant Programme Director of 111 gave an update adding there had been a particular focus on the fallers pathway.
The Board acknowledged the update and the Chief Executive was keen to see the project being rolled out across Wales as soon as feasible.
RESOLVED: That
(1)the continued progress of the 111 programme was noted; and
(2)the next steps were noted.
58/16 / INTEGRATED MEDIUM TERM PLAN (IMTP)– 2016/17 QUARTER 2 DELIVERY REPORT
The Head ofPlanning and Performance Hugh Bennett, presented the report as read and drew the Board’s attention to highlighted areas within the report which included:

• clinical modernisation
• actions from the Integrated Medium Term Plan (IMTP)

The Board discussed the report further and raised a number of remarks in terms of seeking clarity and general observations.
The Medical Director explained work on key clinical indicators was ongoing and the Trust was now moving towards measuring clinical based outcomes.
The Chairman commented that the IMTP was demonstrating good progress going forward. He suggested that it may be worthwhile for a briefing in terms of the work being undertaken on the developing clinical and operational infrastructure be held if possible prior to the Board meeting on 26 January 2017 and those interested should advise the Medical Director.
RESOLVED: That
(1)the approach taken to build a picture of performance against IMTPcommitments was noted; and
(2)the progress in quarter 2 was noted.
59/16 / MONTHLY INTEGRATED QUALITY AND PERFORMANCE REPORT
The report was presented by the Head of Planning and Performance Hugh Bennett.
The Board’s attention was drawn to several areas within the report and the ongoing work being undertaken

• Demand figures, likely to increase going forward
• 111 project
• Answering times at Clinical Contact Centres
• Lost Hours with handover delays
• Ambulance Quality Indicators
• Community First Responder data

The Chairman commented that the reports now contained information which had been added following previous feedback given by Board members.
Having reflected upon the report the following questions arose:

• Healthcare professional calls, was there any trend analysis for the reason of calls data available. The Director of Operations explained how the data was being monitored and analysed; he added ongoing work was being conducted with each health board to examine the purpose and outcome of the calls to healthcare professional
• Reference was made to the possible upgrade of paramedics to Band 6 pay and one of the expectations of the Board, should this be supported, was that a reduction in variance in those areas where the current practice was the cause of the variance. The Director of Workforce and OD Claire Vaughan, commented that the Trust, in its preparation for formal negotiations recognised there would be value for money expectations to be considered going forward
• The clinical indicator ‘Pain relief to elderly people following a fall’ seemed to be performing poorly. The Medical Director explained that detailed work with key clinical indicator where deficiencies in performance had been recognised. There could be several reasons why this particular indicator was only performing at 68% and further detailed analysis would provide the necessary information

Members acknowledged the progress and development of the clinical indicators going forward and recognised the work of the teams involved.
RESOLVED: That the report was discussed and noted.
60/16 / RESTART A HEART DAY PROJECT
The Medical Director Brendan Lloyd, provided an overview of the project commenting it had been an excellent example of collaborative working going forward.
The Board acknowledged the work undertaken by staff who had volunteered their services to assist at schools across Wales in promoting the project. It was noted that following the Board meeting a presentation on the project would be shown during the stakeholder engagement session.
RESOLVED: That
(1)the content of the paper was noted; and
(2)the restart a heart as an annual event was supported.
61/16 / ENGAGING OUR STAKEHOLDERS: A DRAFT ENGAGEMENT AND COMMUNICATIONS FRMEWORK FOR THE WELSH AMBULANCE SERVICE
The Director of Partnerships and Engagement Estelle Hitchon, gave an overview of the first iteration of the report. She provided details of how and why the Trust engaged with its stakeholders and how it could be developed and improved going forward.
The Board considered the report in further detail and provided the following feedback:

• consider ways to influence public behaviour in terms of the use of the service
• working with the wider communities to facilitate more diverse recruitment
• look at methods in accessing ways to reach out more and target vulnerable groups
• there should be a focus on other languages in particular, Welsh
• was the Trust fully equipped to undertake this proposed engagement
• there needs to be clarity in terms of articulating ownership of the different aspects within the engagement process and also defining the geographical implications

RESOLVED: That
(1)the direction of travel as set out in the Draft Engagement and Communications Framework was supported; and
(2)the development of a Draft Engagement Delivery Plan, based on identification of outcome goals, delivery and resourcing mechanisms, to be supported for Board approval by March 2017 for delivery from April 2017 onwards was supported.
62/16 / CONSENT ITEMS
The following Committee Minutes which had been approved by the relevant Committee were included in the supporting papers for adoption and noting by the Board:
Audit Committee / 8 September 2016
Finance and Resources Committee (FRC) / 28 July and 13 September 2016
Quality, Patient Experience and Safety / 21 July 2016
In terms of FRC business, Martin Woodford Non Executive Director and Chairman of FRCprovided the Board with an update of Committee business in which he drew attention to the following areas:

1. Monitoring of financial and operational performance had improved
2. A detailed analysis on handover issues had taken place
3. Business cases requiring Board approval had been scrutinised with due diligence
4. Post project reviews had been undertaken
5. Progress against the IMTP had been carried out
6. Business Continuity
7. Fleet management
8. In terms of focus going forward: discussions should be more targeted (particularly on performance areas, FRC and Board cycle alignment could be reviewed and there should be more planning with what is on the Agendas

The Chairman of the Board informed members that going forward there would be a review on the three committees which would include their governance procedures.
Additional Consent Items were approved/noted as follows:

• Improving Governance and Accountability: Joint working and decision-making across NHS Wales. The Chairman provided further detailson this reportcommenting that himself and the Chief Executive had been appointed constituent members with this new forum and asked the Board for approval to act on its behalf content going forward
• Charitable Funds Accounts and Annual report 2015/16. The Board approved the accounts
• Policies and Procedures: Data protection policy and procedure for NHS Staff to raise concerns
• NHS Wales Health Collaborative Major Trauma Network

RESOLVED: That
(1)the minutes of the meetings and the recommendations within those minutes were adopted, noted as items of business on the agenda for this meeting and were approved, in particular the items of business as detailed by the Chairman of the Finances and Resources Committee; and
(2)the additional consent items as listed above were noted/approved as required.

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