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

UNCONFIRMED MINUTES OF THE OPEN MEETING OF THE WELSH AMBULANCE SERVICES NHS TRUST BOARD, HELD ON THURSDAY 23 MARCH 2017atTHE BUTETOWN COMMUNITY CENTRE, 40 LOUDON SQUARE, CARDIFF CF10 5UZ

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
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 and Vice Chair
TRUST BOARD REPRESENTATIVES:
Julie Boalch
Richard Davies
Wendy Davies
Nathan Holman
Leanne Hawker
Lee-Anne Leyshon
Steve Owen
Liam Randall
OBSERVERS
Iney Alexander
Jayne Bennett
Helen Birtwhistle
Richard Bowen
Geoff Davies
Jessica Evans
Julie Evans
Samantha Evans
Hollie Gore
Stuart Humphries
Stephanie James
Benjamin Jenkins
Gemma John
Alison Johnstone
Isobel Jones
Gemma Macmuriss
Melissa Marston
Hywell Martin
Nick Morgan
Sarah Morrison
Dennis Moss
Carl Powell
Aled Salt
Nick Spiller
Roma Taylor
Kelly Benyon Thomas
Natalie Wilson / Corporate Governance Manager
Assistant Director of Capital and Estates
Staff Side Representative
Staff Side Representative
Partners in Healthcare Lead
Head of Communications
Corporate Governance Officer
Communications Officer
Member of Public
WAST
Non Executive Director designate
111 Project Director
Community Health Council
WAST
WAST
WAST
Member of Public
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
WAST
RCN
Diverse Cymru
WAST
WAST
APOLOGIES
Keith Cox
Bleddyn Roberts / Board Secretary
Staff Side Representative
01/17 / CHAIRMAN INTRODUCTION AND UPDATE
The Chairman of the Board welcomed everyone to the meeting and in particular Helen Birtwhistle who was due to be appointed as a Non Executive Director of the Trust from 1 April 2017. He emphasised that the meeting was not a public one but a meeting being held in public adding that it was not usually an opportunity to ask questions; however the stakeholder session taking place following the Board meeting would be the ideal forum to raise any issues about the ambulance service. Furthermore the Chairman informed the meeting that it was being audio recorded.
A minute’s silence was observed at this time to pay respect and sympathy to those affected by the senseless eventsin London yesterday. Tribute was also paid to those Emergency staff who were involved at the scene.
The Trust acknowledged the significant contribution of Non Executive Director David Scott who was due to leave at the end of the month. The Chairman and Vice Chairman highlighted areas where his involvement and influence had added great value to the Board going forward and wished him well for the future.
David Scott thanked the Board Members for their kind words and wished the Trust continued success going forward.
02/17 / CHIEF EXECUTIVE REPORT
The Chief Executive in presenting her report drew attention to the following areas:

Clinical Response Model (CRM) - It had recently been announced by Welsh Government that the CRM would be permanently adopted in Wales. Further work was now required to strengthen the model going forward with a focus on the Amber category calls. The work undertaken by the Medical Directorate and the Operations Teamin reaching this point was acknowledged by the Board.

Band 6 Paramedic job profile- a partnership forum had been established and substantial progress was being made in driving this forward.

Complaints and Concerns- the significant positive turnaround in the management of concerns was a credit to all those involved.

Enhanced Hear and Treat Service – This was a temporary enhancement to the current service of providing clinicians in call centres which had further reduced the number of ambulances attending to patients.

Winter period – Notwithstanding this challenging time, it was obvious the winter plan had been executed well and improvement could be seen from previous years.

Abertillery Station - The new Emergency Services Station had recently been opened comprising of the three emergency services in one location.

Staff Survey workshop - The results had shown overall improvement during the last three years; further detailswould be presented at a future Board meeting.

Recruitment Day in Butetown- This had been a success and showed signs of optimism going forward.

Clinical Contact Centre (CCC), Engagement - Feedback from this had been robust and this resonated with the type of culture the Board was advocating going forward.

03/17 / DIRECTOR OF OPERATIONS UPDATE
The Director of Operations Richard Lee,provided the Boardwith an overall assessment on the current operational status of the Trust. He highlighted several areas of note as follows:

Red performance- this was becoming more sustainable with less variability across the health board areas.

Breakdown of emergency calls- an overview was provided.

Demand and Capacity review –this had been an extremely useful exercise; it had illustrated there would be a 22% increase of 999 calls by 2022. This issue would require detailed planning to meet the extra demand.

CCC initiatives – an outline of the initiatives was provided which included the use of the Triage system SIEVE which was a new script for call handlers at the point of answering the call.

Joint Response Unit (JRU) – this comprised of a police officer and a paramedic in a vehicle predominantly attending to low acuity calls. A great deal of incidents were being dealt with at scene which negated the need for ambulance attendance. It was of note that several members of the Trust had been given awards for their contributions in the JRU.

Falls initiatives - details of these initiatives were provided which were proving to be a success across Wales in addressing the issue of elderly fallers.

04/17 / PROCEDURAL MATTERS
Apologies were recorded from Keith Cox and Bleddyn Roberts and the standing declaration of Mr Emrys Davies as a retired member of Unite was noted.
Minutes – Closed 15 December 2016
MW referred to Minute 31/16 recommendation four and it was suggested and agreed that the recommendation be amended to read as follows: ‘the Board acknowledged that the Trust had inadvertently breached Standing Orders and no further action in relation to the specific breach was required’.
Minutes – Open 15 December 2016
Minute 56/16 – Re-wording of this Minute in terms of the inference regarding discretionary capital would be provided by Patsy Roseblade.
Action Log
The Board considered the action log and the actions therein were annotated as completed.
Trust Seal
Patsy Roseblade provided the Board with further details into why the seal had been used which related to seal number 0174, and was the agreement with Wrexham County Borough Council in connection with the Ambulance and Fire Services Resources Centre (AFSRC) in Wrexham.
Chair of Committees
The Board noted that with effect from 1 April 2017 the undermentioned Non Executive Directors were designated as the Chair of Committee as shown below:
Pam Hall Audit Committee
Kevin DaviesCharitable Funds Committee
Urgent Business Approved by the Chairman and Chief Executive
The Board noted the items of business approved by the Chairman and Chief Executive, in consultation with other Non Executive Directors since the last meeting under the urgency procedures contained in Standing Order No: 2.1 as listed below:
1/2017 – Clinical Negligence Claim Settlement
2/2017 – Automated External Defibrillators for Ambulance Car Service Business Case
3/2017 – Qlik Sense Business Case
RESOLVED: That
(1)the standing declaration of Mr Emrys Davies as a retired member of UNITE was noted;
(2)subject to the minor corrections to the Minutes as described above, the Minutes of 15 December 2016 and 26 January 2017 were confirmed as a correct record;
(3)the use of the Trust seal number 0174 as described above was noted;
(4)the Chairs of Committee as shown above wasnoted; and
(5)the urgent business as approved by the Chairman and Chief Executive in consultation with other Non Executive Directors since the last meeting as detailed above was noted.
05/17 / 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 or matters which were commercially sensitive. He gave a brief overview of the discussions that had taken place with regard to the following items:

an update on managing serious adverse incidents and high profile cases
a current estates issue which once resolved would be discussed in Open session

RESOLVED: That the update was noted.
06/17 / CLINICAL CONTACT CENTRE FOR MID AND WEST WALES: OUTCOME OF STAFF AND STAKEHOLDER ENGAGEMENT
The Chairman presented background information to the report and explained the processes involved in the consideration of the various solutions that had emerged; and through engagement and consultation with staff and external stakeholders, the report illustrated the results of the testing of some of those proposed assumptions for the Board to consider further.
Richard Lee explained that the Trust had agreed a strategy in 2016 to deliver clinical contact services from three centres across Wales; one in North Wales and two in South Wales, with a focus on delivery of the “integrated health” model.
He provided detailed information in terms of the engagement process which had included engaging with staff and numerous external stakeholders noting it had been very positive going forward.
Following the engagement with staff, several clear themes had emerged from the feedback provided:

The distance from Llangunnor to Bridgend was a major concern for staff
Implications to the workforce – concern was expressed whether the current working arrangements would remain following a move
Synergy and benefits of co-terminosity, especially with the Police
Many new sites and ideas had been identified by staff
Challenges were acknowledged with Thanet House in terms of whether its layout was suitable to house a call centre

In terms of feedback received from external stakeholders, the Dyfed Police and Crime Commissioner expressed a view on what was available at Llangunnor commenting that more space could be made available if required. Additionally, the engagement with Carmarthenshire County Council gave rise to several potential areas for ambulance bases.
The engagement had shown that as well the three options referred to in the report, other options had emerged which included (Thanet House staff) the possibility of working from home or from an ambulance satellite station.
The situation was now to scope out better defined options as described below:
1The relocation of the services currently operated from Thanet House to the Llangunnor site which would involve a remodelling of the site to develop the capacity to establish a CCC with NHS Direct and ambulance control (VPH Model)
2Consider the siting of ambulance desks within the Police Control Centre (PCC) in Bridgend and subject to funding, establishing a Clinical Triage Team in the PCC.
Going forward, Richard Lee advised that by 29 June 2017 Trust Board meeting, definite proposals would be presented for consideration.
The Board considered the report in further detail and raised the following issues and comments:
1It was expressed that more engagement with Thanet House staff to include arranged site visits at Llangunnor was required
2It was noted that this engagement and consultation had been the start of the process and thanks were expressed to those staff and external stakeholders involved going forward
3The process must continue to be open and transparent
4Full engagement with the Police and Fire services should continue.
5There has been no evidence to suggest that recruiting in the Llangunnor area, in particular nursing staff, had been an issue.
6The Emergency Medical Retrieval and Transfer Service (EMRTS) desk would be located in Llangunnor and not Bridgend for practical reasons.
7That the implications for the 111 service in terms of working from home were being taken into account going forward including IT security.
The Chief Executive informed the Board that the Executive Management Team had held detailed and challenging discussions recognising the risks to recruiting and retention and the resilience in being able to provide the necessary cover. The Chief Executive reiterated the comments by the Chairman in relation to the requirement for the Board to be provided with the necessary data regarding recruiting. Taking into account the issues raised, the Board looked forward to receiving the final proposition at the Board meeting on 29 June 2017.
The Chairman concluded that the engagement process had been a valuable exercise and had revealed both new opportunities and a clearer picture of the issues discussed which now required further review and analysis.
RESOLVED: That
(1)the update and the following were noted:
(2)Given the opportunities that the facilities at Bridgend offer and the fact that the offer at Llangunnor had been improved together with the views expressed by staff, a third way had emerged from this engagement. This third way was outlined as follows:
(3)WAST should commit to relocating some services to the Tri-Service Centre at Bridgend. Subject to funding, this should include a clinical desk and subject to further engagement and consultation with the relevant staff, the relocation of the relevant control desks to ensure co-terminosity with the South Wales Police force area.
(4)NHS Direct services currently provided at Thanet House and ambulance control functions for the Hywel Dda and Powys areas should be provided at Llangunnor to ensure co-terminosity with the Dyfed Powys Police force area. Engagement with ABMU will be required about the relocation of the EMRTS desk to Llangunnor.
(5)The other opportunities which have emerged from the engagement process relating to the wider operational estate strategy, including those with Carmarthenshire County Council, should be explored further to optimise the potential benefits these may bring for WAST, the Council and the people and economy of Carmarthenshire.
07/17 / 111 PATHFINDER – PROGRESS AND NEXT STEPS
Richard Bowen, Programme Director for 111 provided an overview of progress and drew the Board’s attention to the following areas:

It had been 24 weeks since the launch of the programme
There were still significant peaks in demand which were being addressed
Patient feedback had been positive
No major clinical incidents had been reported
Evaluation of the programme was being undertaken, the results of which should be available by June 2017

In terms of the wider governance issues Richard Bowengave details of the next steps going forward and advised that the next phased roll out would be Carmarthen; which was due to launched in early April 2017 and run for at least four weeks. Should the Carmarthen roll out be successfuland with the appropriate tripartite agreement in place, Members were advised that the service would be launched within Hywel Dda in May and following that if the outcomes were positive, rolled out in Aneurin Bevan in September 2017. He emphasised the fundamental issue of having the appropriate tripartite agreement in place going forward. In terms of procurement of equipment and the financial implications involved, he gave an overview of the corporate challenges ahead.
The Board considered the update in more detail and discussed in depth several topics which included collaboration agreements and whether the programme would be subject to a commissioning process; the latter Richard Bowen agreed to provide increased clarity on at the next Trust Board meeting.
Patsy Roseblade gave details of how the procurement process would be subjected to the relevant scrutiny andmonitored through the Finance and Resources Committee (FRC). Furthermore, she advised the Board, should 111 not progress and the Trust continued with NHS DW, the Trust could proceed using its own processes going forward. Hannah Evans further commented on the potential impact and informed the Board that further analysis would be undertaken in that regard.
RESOLVED: That
(1)the successful launch of the 111 Pathfinder in the ABMU Health Board area
and that the Collaboration Agreement between ABMU Health Board and WAST was under revision to incorporate the planned roll out of the pathfinder into Carmarthenshire was noted; and