NORTHERN IRELAND AMBULANCE SERVICE

Present:

Mr P Archer / Chairman
Mr L McIvor / Chief Executive
Mr Frank Hughes / Non-Executive Director
Mr N McKinley / Non-Executive Director
Mr S Mullan / Non-Executive Director
Mr S Shields / Non- Executive Director
Mr B McNeill / Director of Operations
Ms R O’Hara / Director of Human Resources
Dr D McManus / Medical Director
Mrs S McCue / Director of Finance

In Attendance:

Mr R Dixon / Patient Client Council
Mrs M Crawford / Executive Administrator
Miss K Baxter / Senior Secretary
1.0 / Apologies
Prof M Hanratty, Non-Executive Director.
2.0 / Welcome and Format of the Meeting
The Chairman opened the meeting by welcoming members of the public and Trust Board and explained the arrangements for receiving questions from the public attending.
3.0 / Minutes of the Previous Meeting of the Trust Board held on 4 February 2010
Members accepted the minutes as a true and accurate record of proceedings on the proposal of Mr McKinley,seconded by Mr Mullan.
4.0 / Matters Arising
4.1 / NIAS Governance Arrangements
Members were advised that the review process has identified apre-existing requirement that amendments to Standing Orders be considered by Audit Committee, and the new arrangements will not therefore be in place for April 2010 as originally envisaged. Preliminary work has been completed and amendments are required to theTerms of Reference for Committees which will be considered at a meeting scheduled for 30April 2010. The Chairman and Chief Executive will discuss interim arrangements with the Chairs of each Committee.
4.2 / Efficiency Savings and Comprehensive Spending Review Investment
Members were advised that the Trust is progressing efficiency savings. Investments are also in place, however some difficulties are being experienced in maintaining response cover. Plans are in place for additional RRV hoursfor 2010-2011 subject to normal constraints on staff availability. Year 3 will be the most challenging yearin terms of cash release for the Trust.
4.3 / Review of Retention and Disposal Schedule
Director of Finance confirmed that a letter has been sent to the DHSSPS outlining and emphasising the Trust Board’s position to the legislative requirements of retaining documents.
4.4 / Air Ambulance
Members requested an update about the outcome of recent meetings in regard to the provision of air ambulance support. They were advised that NIAS has met with 2 potential providers along with the DHSSPS/Board. NIAS restated the position previously outlined. The DHSSPS are arranging meetings with various providers in order to brief the Minister as appropriate It was further advised that NIAS has renewed its arrangements with the Maritime & Coastguard Agency for helicopter support and also remain in discussions with PSNI regarding further support.
4.5 / Performance Report - OP4
The Chairman referred to the minute on the Performance Report - Item OP4second paragraph in regard to the work of PCS. He acknowledged that the work of the PCS was a sizeable part of NIAS operations and requested that the Director of Operations provide a briefing paper for afuture meeting of theBoard.
Action: Director of Operations to provide briefing paperon PCS.
4.6 / Audit Committee Terms of Reference
The Chair of Audit Committee referred to Item 3 of the minutes of 4 February 2010 (paragraph 3) and advised that instead of writing to the DHSSPS in this regard he had raised the issue of the appropriateness of the wording “ensure” in standard Audit Committee Terms of Reference with the members of the team taking forward the “Review of the Arms Length Bodies”. These members had agreed to take the matter forward.
5.0 / Chairman’s Business
5.1 / Visit to LimavadyStation
An urgent meeting of the Remuneration Committee was convened this morning and Members of the Committee were unable to attend the Station visit.
In the Chairman’s absence Mr Mullan on behalf of the Board wished to extend thanks to the staff for their warm welcome this morning and commented that the visit was very informative. The staff appear to be content with no complaints however it was noted that space is a premium. The Station covers a large geographical area from Magilligan to the Glenshane Pass with backup provided for Altnagelvin and Coleraine.
5.2 / Chairman’s Update
The Chairman gave a brief outline of his diary commitments since the last Board meeting:
  • Met with Mr John Allen and Ms Alison Caldwell in relation to a Departmental Review of Arms Length Bodies.
  • Continues his weekly meetings with the Chief Executive.
  • Met with Chair of Clinical Governance. The Chairman intends to meet with each Chair as soon as possible after each Committee.

6.0 / Chief Executive’s Business
6.1 / Chief Executive’s Update
The Chief Executive gave a brief outline of his activities since the last Board Meeting and advisedthat he has been engaging with the DHSSPS/Permanent Secretary/Board on financial and performance issues.
  • Met with the Chief Executives of the other 5 Trusts.
  • Has attended and contributed to the PSNI “Common Practice” group.
  • Met with DHSSPS/Board/Air Ambulance Providers
  • RQIA Conference
  • Visit to Boston with The Medical Director for Patient Safety Conference.

7.0 / Performance Reporting as at 31 December 2009
OPERATIONS
Director of Operations updated members as follows:-
OP1 - Director of Operationsadvised that there are 4 elements to OP1 as follows:
  1. Achieved 70% of Cat A calls by the end of February 2010.
  2. Achieved 62.5% of Cat A calls by LCG except for the North which achieved 62.3%.
  3. Achieving 71% overall at present and do not believe that 72.5% can be achieved for the month of March at this stage.
  4. 65% required by year end for each LCG. Optimistic that the Trust can achieve, however this is not guaranteed.
Director of Operationsadvised that delays in the implementation of efficiency savings was a factor in the Trust not achieving all targets. There were also the usual winter pressures, with this year being particularly severe. One of the most significant factorshowever is congestion in acute services with delays in A&E and ambulance diverts. Members considered that the overall performance in light of constraints and external pressures is commendable.
OP2– Achieving 95% in the Belfast area however more work is required in the other areas.
OP3 –Currently achieving 93%. NIAS continues to experience pressures in this area due to an increase in emergency activity, longer journey times as a consequence of hospital diverts and capacity pressures within the system.
OP4–On target for delivery of vehicles. A&E/RRV/PCS vehicles are due this month.
OP5–On track to achieve. Plans to progress full business case for Station in Ballymena.
Director of Operations was asked about the EnniskillenStation and if any consultations had taken place. Members were advised that NIAS is engaged in consultations and a new facility has been offered, although NIAS would prefer to remain in the current location. No decision has yet been made.
Members requested an update in relation to Bariatric vehicles which transport heavy/obese patients. They were advised that the Trust plan to have 1 vehicle available in each Division which will help to preserve the dignity of the patient.
It was noted that waiting times at hospitals are a complex issue and if resolved would also improve the patient’s experience. NIAS are engaged with the Commissioner in this regard which is also a focus for the Chief Executive’s Performance meetings.
Mr Dixon considered that there is a role for patient involvement in unscheduled care and access. He advised that some work was carried out some time ago on accessing patient care with an emphasis on patient need and urgent care. This report is currently with the DHSSPS.
FINANCE
Director of Finance updated members highlighting the following:
FN01 -At the end of January 2010 there was a deficit of £74k, although the Trust hopes to breakeven by year end. Thisdeficit is largely due to the effects of unfunded cost pressures relating to Pandemic Flu planning. The Trust has recently received confirmation of funding for the Pandemic Flu planning which should eliminate this deficit. The Trust is examining assumptions on an ongoing basis and the Director of Finance was pleased to report that NIAS anticipate break-even by year end. Mr Mullan paid tribute to the team on this achievement.
FN02–Currently implementing stage 2 of the efficiency savings which is £2.719m. Plans are in place to deliver within budget.
FN03 -Disposals in this target mainly relate to out of standard vehicles and £50k capital proceeds from the sale of these vehicles is anticipated.
FN04–The Trust has achieved a cumulative performance of 94.3%of invoices by volume paid within 30 days. Whilst efforts continue the Director of Finance advised that she estimates that the target of 95% will not be fully achieved by year end.
FN05–Capital expenditure at the start of the year was £5m however this was reduced to £2.5m with further additional allocations of £471k bringing the total capital allocationfor 2009/10 to £2.971m.
FN06 – On track to achieve.
FN07 – On track to achieve.
FN08 - On track to achieve.
FN09 – This is a new target forthe reporting arrangements of Service Level Agreements with key performance indicators in respect of purchase and supply.
MEDICAL
Medical Director updated members highlighting the following:
MD01 –Good progress has been made and it is anticipated that the Ministerial target will be met. Staff have completed training and necessary drugs issued to all emergency vehicles. All emergency vehicles can now transmit 12-lead ECGs to hospitals and all relevant hospitals are now able to receive the transmitted ECGs.
MD02 – No incidents of healthcare acquired infections have been reported within the Trust this year. Work is ongoing in this area with regular meetings of the Infection Prevention & Control Group taking place. The revised policy and procedures reviewed by RQIA and approved by Trust Board are now included in Post Proficiency (PP) training to all operational staff as well as in initial training for new staff. Clinical Support Officers have just completed an audit of infection prevention and control practices within the Trust and results will be available shortly which will be presented to the Clinical Governance Committee and Trust Board in due course.
MD03 – NIAS continues to develop its strategy and arrangements in conjunction with the other Trusts. Response from DHSSPS still awaited regarding consultation scheme in order to progress further development of our strategy. Recent meeting between NIAS and representative of the Patient Client Council regarding the further development of joint working was very positive and productive. Benchmarking continues with other UK Ambulance Services regarding, for example, the LAS Patients Forum and PPI Strategy etc.
MD04 – NIAS continues to explore the development of alternative care pathways through engagement with other Trusts, agencies and care providers. NIAS has contributed to the implementation of recommendations of a number of regional strategies, networks and care pathways, for example, cardiac, respiratory, cancer, palliative and end of life care. The evaluation of the Cat C pilot involving doctors in Control is almost complete and is positive.
MD05 – The Medical Director gave a presentation on Clinical Performance Indicators regarding the standard of clinical care being provided for a number of clinical conditions. The Board wished the minutes to reflect that the presentation was well delivered and received by those present.
MD06 – A number of delays to achievement due to circumstances beyond the control of NIAS were highlighted, however it is anticipated that full regional roll-out will be completed by the end of April 2010 when the introduction of controlled drugs can then commence.
MD07 – The Board were referred to the Emergency Planning Report appended to the papers. NIAS are to participate in a review of regional swine flu planning and lessons learnt. The contingencies developed and implemented ensure that NIAS is prepared for any further surges of swine flu that may arise.
HUMAN RESOURCES
Director of Human Resources updated members highlighting the following:
HR01- NIAS are unlikely to achieve this target. Managers are responding well. The Trust has invested in additional physiotherapy sessions and staff are usually seen within 5 days. Benchmarking is ongoing with other Ambulance Services, HSC Trusts and Occupational Groups. Absence figures are presented to DHSSPS on a quarterly basis. Consultations are taking place with Trade Unions regarding a stress management policy. Detailed information on staff absence was provided. Meetings continue with Human Resource Directorate staff and Managers to look at each case individually. It was considered that in the event of the Trust not meeting this target, NIAS have clearly demonstrated strong management of absenteeism. It was further advised that the Joint Negotiating Forum have agreed over-riding principles in relation to Managing Attendance that will be built on locally. Members suggested that previous years figures be included to aid comparative assessment of performance.
Action: Director of Human Resources.
HR02 – On track to achieve.
HR03 –No longer applicable.
HR04 – On target to achieve. Joint Working group has agreed action plan. Trade Unions to nominate Staff Side representative.
HR05 –After acknowledgment 21% of complaints have been responded to within the 20 day deadline.This has been due to competing priorities for Managers. The Trust is exploring ways in which we can achieve this target. 34% of staff have received awareness level training in complaints.
The complaints procedure is to be revised which will supplement the existing procedure in line with the new arrangements. The Trust will be engaging with Mr Dixon in this regard. Mr Dixon commended the Trust for their openness in this area.
8.0 / Policies /Procedures (for approval)
No policies for approval.
9.0 / For Noting
9.1 / Minutes of Clinical Governance Committee held on 3 September 2009
Noted.
The Director of Human Resources requested that her name be removed from the list of apologies as she is not a member of the Clinical Governance Committee.
9.2 / Minutes of Risk Management Committee held 3 September 2009
Noted.
9.3 / Minutes of the Audit Committee held on 3 December 2009
The Chair of Audit Committee drew member’s attention to the query raised under Item 7 of the minute in relation to absenteeism. Members were directed to the detailed report on absenteeism presented by Director of Human Resources in her performance report to this meeting and confirmed that they were content that the issue raised in Audit had been covered satisfactorily through this report.
Noted.
10.0 / Application of Trust Seal
The Trust Seal has not been used since the last Trust Board meeting.
11.0 / Forum for Questions
No questions received from the floor.
12.0 / Any Other Business
No other business.
Date, Time and Venue of Next Meeting
The next meeting of the Trust Board will be held on Thursday, 29April 2010 at Trust Headquarters.

The Chairman thanked those present for attending and called proceedings to a close.

Signed: ______

Date: ______

Chairman

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