CONFIRMED MINUTES OF THE OPEN MEETING OF THE WELSH AMBULANCE SERVICES NHS TRUST BOARD, HELD ON THURSDAY 28JANUARY 2016, AT VANTAGE POINT HOUSE CWMBRAN
BOARD MEMBERS PRESENT:Mick Giannasi
Tracy Myhill
Emrys Davies
Professor Kevin Davies
Hannah Evans
Pam Hall
Wendy Herbert
Dr Brendan Lloyd
James Mycroft
Patsy Roseblade
David Scott
Claire Vaughan
Martin Woodford / Chairman of the Board
Chief Executive
Non Executive Director
Non Executive Director
Director of Planning and Performance (Interim)
Non Executive Director
Assistant Director of Quality and Nursing
Medical Director
Non Executive Director
Director of Finance and ICT
Non Executive Director
Director of Workforce and Organisational Development (OD)
Non Executive Director and Vice Chair
TRUST BOARD REPRESENTATIVES:
Keith Cox
Leanne Hawker
Nigel Heal
Estelle Hitchon
Nathan Holman
Melfyn Hughes
Lee-Anne Leyshon
Steve Owen
Jonathan Sweet / Board Secretary
Partners in Health Care Lead (part)
Staff Side Representative
Director of Partnerships and Engagement
Staff Side Representative
Welsh Language Officer
Communications Manager
Corporate Governance Officer
Staff Officer (part)
APOLOGIES
Bleddyn Roberts / Staff Side Representative
OBSERVERS
Helen Bushell
Geoff Davies
Margaret Foster
Neil Frow
Richard Lee
David Mackerras
Chad Phillips / WAST Board Mentee (part)
Community Healthcare Representative (part)
Chair, NHS Wales Shared Services Partnership (part)
CEO, NHS Wales Shared Services Partnership (part)
Director of Operations designate (part)
WAST Board Mentee
Community First Responder (part)
01/16 / CHAIRMAN WELCOME AND UPDATE
The Chairman welcomed all to the meeting including Geoff Davies CHC Representative, Chad Phillips, Community First Responder and the two Board Mentees, Helen Bushell and David Mackerraswith a reminder that the meeting was being audio recordedand the facility to simultaneously translate from Welsh into English was available.
The Board were advisedthat Nigel Heal was retiring following 46 years of service with the NHS. The Chairman thanked Nigel on behalf of the Board for all his hard work, commitment and valued contribution not only during his time as a staff side representative on the Board but with the NHS as a whole.
The Chairman drew the Board’s attention to the following points:
1)Strategic transformation- this had been moving at pace, progress and performance despite the ongoing challengeshad been sustained with significant milestones being achieved on the way including clinical modernisation. In addition the NonEmergency Patient Transport Service proposal had been approved, the senior team had been strengthened incrementally and further progress had been made with the 111 service and the Commissioning framework.
2)Integrated Medium Term Plan- thefirst draft for submission to Welsh Government was being presented at the meeting today.
3)Jasmine Lapsley inquest- The Board acknowledged that the Welsh Ambulance Service’s action during and after this heart-breaking event added to the distress of the family and the Board’s sincere apologies were to be formally recorded. It was also to be acknowledged that the Trust had learned many lessons from this and these would be implemented going forward.
RESOLVED: That the update be noted.
02/16 / NHS WALES SHARED SERVICES PARTNERSHIP PRESENTATION
Members were provided with a presentation by the Chair and CEO of NHS Wales Shared Services Partnership which demonstrated the varied services provided by the partnership.
The Board’s attention was drawn to the future priorities of the partnership which included investment in technology. The Chair of the partnership added that the investment in the recruitment of more Data Analysts was key for prudent healthcare going forward.
Members discussed and raised several points which considered the implications involved in terms of procurement, recruitment timelines and standardisation of equipment.
The Chief Executive thanked the team for the informative presentation and commented that it would be helpful if future presentations could contain information which related specifically to the Trust.
RESOLVED: That the presentation be received.
03/16 / CHIEF EXECUTIVE REPORT
The Board received the verbal report of the Chief Executive. The following points were highlighted:
1)Jasmine Lapsley Inquest- The Chief Executive echoed the comments of the Chairman adding that the Trust had been made aware from the inquest of improvements in many areas it should take forward and these were and had been implemented. The Board were advised that following this tragedy the detailed underlying work being conductedwould be presented at the Board once completed. A note of thanks was to be recorded for those staff involved during the inquest whose professionalism was exemplary.
2)Health and Social Care Committee - The Chief Executive updated the Board on the response following the Trust’s attendance and was pleased to announce that the Committee reported a marked improvement in most areas that had been subject to scrutiny. It was to be noted that the attendance of Trust Staff Side representatives and their input had been very positive.
3)Operational Pressures - The challenges being faced by operational staff, in providing the best possible care and treatment to patients and their continuing hard work was to be commended. The Chief Executive commented that the Trust’s approach in dealing with the media in such a professional manner had been recognised by Welsh Government for which the team should be praised for.
4)Executive Team -The Board acknowledged that this was the last meeting for the Assistant Director of Quality and Nursing in that role and thanked her for the work. The Board were informed that Claire Bevan, Director of Quality, Patient Experience and Safety and Richard Lee, Director of Operations (Interim) were due to take up post next week.
RESOLVED: That the update be noted.
04/16 / PROCEDURAL MATTERS
Minutes
The Minutes of the Open and Closed sessions held on 27 November 2015 were confirmed as a correct record subject to re-wording the resolutions in the Closed session of Minute 33/15 to correctly reflect the decision made.
Action Log
Members discussed the individual actions contained within the Action Logwhich was updated as required.
Action Number 1 – Minute 49/15 – this was to remain on the Action Log as not completed.
RESOLVED: That
(1)the standing declaration of Mr Emrys Davies as a retired member of UNITE be noted;
(2)the Minutes of the Open and Closed session of the Trust Board held on 27 November 2015 be confirmed as a correct record subject to the minor correction as described;
(3)the adjustments to the action log as referred to be implemented and in future the action log contain written updates.
05/16 / CYCLE OF BOARD AND COMMITTEE MEETINGS (INCLUDING 2016/17 CALENDAR)
The Board Secretary presented the report which included the proposed calendar of meetings for 2016/17. He advised the Board that a great deal of work had been undertaken which had taken into account the various requirements expressed by the Non Executive Directors.
In terms of the Finance and Resources Committee concern was expressed that the four month gap during July and October could be problematic and it was agreed that the Board Secretary would consider this issue going forward.
The Chief Executive reassured the Board that given the reduced number of meetings, stringent processes had beenimplemented to ensure the timeliness of papers.
The Chairman asked the Board, at this stage, to consider the possibility of holding the Annual meeting scheduled forSeptember in the eveningand it was agreed that this possibility be discussed later during the year.
RESOLVED: That
(1)the quarterly Board and Committee meeting cycle for 2016/17 be approved; and
(2)the Board and Committee meetings calendar for 2016/17 subject to further discussion surrounding the FRC dates be approved.
06/16 / PATIENT STORY
Members were introduced to Chad Phillips, a 19 year old Community First Responder (CFR)based in Pontypridd who provided Members withan enlightening overview from his perspective in terms of what was involved in being a CFR. He explained the reasons which had led to him joining the CFR community and added that he encouraged other young people to join. Chad was keen to emphasise the contribution made by CFR’s not only clinically but also the extended support theygive to family members during times of distress.
Board Members raised several questions and comments which included the training involved and how CFR’s were allocated to specific jobs.In terms of allocation, Chad referred to Terrafix, a device that tracked the CFR’s location which was being trialledin his area.The Board expressed their appreciationand gratitude to Chad and indeed all CFR’s as they played a vital role in the health community.
Following the presentation, Jonathan Sweet updated the Board on the CFR development programme and detailed how CFR’s would become more integral to the development of the Trust going forward.
RESOLVED: That the update be noted.
07/16 / 100 DAY IMPROVEMENT PLAN FOR PUTTING THINGS RIGHT (PTR) - FINAL REPORT
The Assistant Director of Quality and Nursing outlined the report to the Board highlighting that overall, compliance figures, especially with ‘on the spot’ concerns,had greatly improved. The 100 day improvement plan had been based around the following four key themes which had been identified from the PTR review conducted in July:
- leadership
- process
- staffing
- culture
The Assistant Director of Quality and Nursing was generally satisfied that progress was being made adding that phase two of the plan would consist of addressing the challenges including education and training and the management of concerns within the organisation with an emphasis on attempting to revolutionise the culture into being more open and transparent.
Members discussed the concerns situation in greater detail and it was agreed that the Board would continue to be apprised with regular reports until such time compliance in responding to concerns had improved noticeably.
The Board commented on the Trust’s Datix system which in part was used as a tool to monitor concerns and it was agreed that this system must be fit for purpose and sustainable going forward with an emphasis on the training of staff involved.
The Board were given an overview in terms of phase two of the plan which was based around sustainability adding that an organisational and developmental workforce plan was in place to address the ongoing challenges with regard to the overall administration of responses.
The Medical Director referred to the training of staff in providing responses to concerns and it was recognised that a more clinical perspective could be undertaken in this regard in some cases.
The Assistant Director of Quality and Nursing was reasonably confident that in the future, reports would be embedded within the IPR as opposed to separate regular narrative reports.
RESOLVED: That
(1)this report as a completed 100 day Improvement Plan be received;
(2)the progress and improvements that had been made be acknowledged;
(3)phase two of the facilitated sessions with the PTR Team and the Heads of Operations, which would enable the development and progression of a sustainable workforce model going forward, which was part of the WODI Plan be supported;
(4)it be acknowledged that the Executive Management Teamand the additional resources to address the backlog continue to be supported; and
(5)an updated plan be presented to the Board with the detailed process having been monitored through the Quality, Patient Experience and Safety Committee be noted.
08/16 / CLINICAL MODERNISATION PROGRAMME
The Medical Director outlined the contents of the report for the Board’s attention. He highlighted that there had been a sea-change in the perception of the Welsh Ambulance Service that had been brought about by the implementation of the new Clinical Model.
He referred to the release of the new Ambulance Quality Indicators (AQI) which had attracted positive feedback from the Deputy Health Minister. The AQI were used as markers to monitor performance and the quality of the clinical care provided by the Trust.
The Director commented upon the feedback from staff following a recent survey which highlighted some areas that staff were concerned with, in particular meal breaks and stand downs.
The following issues were raised by the Board:
1)Frequent Callers – Was the Trust under the assumption that with some calls the Health Boards or primary care were taking responsibility for them? The Medical Director confirmed that areas had been identified where there were gaps in taking responsibility for the calls. Clinical Support Officers had been liaising with their appropriate counterparts to establish multi-disciplinary teams in the Health Boards to identify the callers and set up a mechanism to avoid these callers dialling 999. The Director of Finance and ICT advised that frequent caller data was being shared, in particular with North Wales Police which had identified that a lot of the callers were indeed the same.
2)Computer Aided Despatch (CAD)- Concern was expressed whether the project was underway as the CAD was absolutely critical to the programme going forward and what was the situation with the project management resource? The Director of Finance and ICT explained that due to a staff absence, critical to the progression of the project, the project board was unable to go ahead, however this had now been rearranged. She assured the Board that finances had been ring fenced by Welsh Government within next year’s capital programme.
3)Digital Pens – The report acknowledged there was an issue with the missing recognition of data, Members queried whether this had been resolved and whether caution was being exercisedin extending the system further until it had fully settled down. The Medical Director explained that the issue had been addressed and, following discussion with the manufacturer who provided assurance it had been rectified,it would be managed and monitored very closely going forward. The Director of Finance and ICT added that this issue had highlighted the new system was significantly better than before in that the old system would have taken much longer to identify the fact that there had initially been an issue.
4)Survey results–In terms of staff surveys regarding the appropriate categorisation and patient safety there appeared to be a high level of dissatisfaction amongst crews. The Medical Director stated thatunder the new clinical model there had been numerous challenges, especially hospital handover delays. These delays had led to a tremendous impact on the ability for crews to respond appropriately.
5)Equity of Response - The Medical Director commented that the clinical model would address the needs of the most urgent patient first and designate the most appropriate response.
6)Staff surgery - How did the Trust capture all the useful themes and trends emanating from these surgeries? The Medical Director confirmed that continuing work in terms of leadership and training support to facilitate data capture was being developed following the surgeries.
7)There should be more emphasis on the retraining of staff with the new clinical model and concerns had been expressed from staff with the non-attendance of crews on the lower acuity calls. The Medical Director advised the Board that staff surgeries and the increase in the use of social media to keep staff informed was being developed incrementally.
8)What was the position in terms of expanding the clinical desk to create more staff resource? - This was being considered by the Medical Director ensuring the right model was in place.
9)GP calls, there was a perception of poor understanding in terms of the scope of Unscheduled Care Service work allocated by GP’s. The Medical Director advised the Board that a piece of work was being undertaken to address this issue.
10)Percentage of calls being resolved by‘hear and treat’was low. The Medical Director commented that the Trust would expect to see improvement in this area and this was being mitigated by the phasing in of extra staff.
11)In terms of the AQI reporting it was agreed that these were to be presented formally at the next Trust Board Meeting and going forward be presented on a regular basis.
12)The Trust should continue to work and focus on the development of staff surgeries and the learning gleaned from them going forward.