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NORTHERN IRELAND AMBULANCE SERVICE
Present:
Mr P Archer ChairmanMr L McIvorChief ExecutiveDr D McManusMedical DirectorMr F HughesNon Executive DirectorMrs M GreerNon Executive DirectorProfessor M Hanratty CBENon Executive DirectorMr P NicholsonAssistant Director of Finance
In attendance:
Mr F RaffertyComplaints/Administration ManagerMrs M CrawfordPersonal Assistant
1.0ApologiesMr S Mullan, Non Executive Director
Mr B McNeill, Director of Operations
Ms R OHara, Director of Human Resources
Mrs S McCue, Director of Finance
2.0Welcome and Format of the MeetingMr Archer opened the meeting by welcoming members of the public and Trust Board members and explained the arrangements for receiving questions from the public attending.
3.0Minutes of Previous Meeting of the Trust Board held on 27 November 2008
The Trust Board members unanimously accepted the minutes as a true and accurate record of proceedings. The minutes were adopted on the proposal of Mrs Greer, seconded by Mr Hughes.
4.0Matters Arising
4.1Terms of Reference for Sub Committees of the Trust
Mr Archer advised members that this matter is still to be resolved and referred to the KPMG report which was generally favourable with some points needing addressed. One vacancy currently exists on the Board with another vacancy due shortly when Mrs Greer completes her tenure in May 2009. Interviews have recently taken place, however the decision lies with the Minister to make the appointments. When the positions are filled roles can then be identified within the various sub committees. A workshop is to be arranged to discuss this and other issues.
4.2Efficiency Savings and Comprehensive Spending Review Investment Equality Impact Assessment
The Trust is currently awaiting the responses from the public consultation which is due to end on the 13 February 2009. It was also noted that the Trust received requests to meet with District Councils, Health Councils and Carers Groups to discuss the proposals. The Board to be kept informed of progress.
5.0Chairmans Business5.1Visit to Kilkeel Ambulance Station
Board members were very impressed with the station at Kilkeel and noted the large geographical area to be covered. Professor Hanratty commented on the welcome and openness of staff which was a very positive experience for the Board.
5.2Chairmans Update
Mr Archer gave a brief outline of his diary commitments since the last board meeting.
Currently visiting all the Divisions and has had the opportunity to speak with staff to identify any problems/issues they may have which is proving very useful.
Meeting with Chairs from the various Trusts and Boards and hopes that these links will prove useful in the future.
Meeting with the Non Executive Directors.
Met with past Chairman, Mr Smyth.
Interviewing for 2 new Non Executive Directors.
Attended the Risk and Clinical Governance Committee meetings and hopes to attend the next meeting of the Audit Committee.
Attended 3 days mandatory training for members of Board.
Undertaking weekly meetings with the Chief Executive.
Members noted.
6.0Chief Executives Business
6.1
6.2
6.3
Fund Raising
Mr McIvor advised members that staff in conjunction with the other emergency services raised 264,000 this year for the Northern Ireland Cancer Fund for Children. With the money raised the charity was able to establish a new service called Young Shoulders. He wished to commend staff for their efforts and noted that staff wished to continue to raise funds for the charity.
Members noted.
Christmas and New Year
This was a difficult and busy time for staff with the return of 999 diverts and trolley waits. The Chief Executive and Medical Director met with DHSSPS/Trusts to map out the rules of engagement with patient care remaining paramount. NIAS staff were pivotal in identifying patients to be transferred with Officers attending A&E departments to assist. The outbreak of flu had a major impact on services.
Members noted.
Performance
Mr McIvor and Mr McNeill met with Permanent Secretary regarding NIAS performance in Cat A. Performance improvement measures are in place and continue to be developed.
Members noted.
7.0Performance Reporting as at 31 December 2008 OPERATIONS
Mr McIvor updated members in Mr McNeills absence.
OP01 It was reported that performance is still down in Category A 8 minute response with 62.4% reported for December 2008. This situation prompted the meeting with the Permanent Secretary and a major internal review prior to Christmas. A range of performance improvement plans are now in place.
It was noted that there was a significant percentage improvement on last year generally but down on the target set by the DHSSPS.
OP02 There is a need to enhance information and redefine requirements with DHSSPS and Northern Board. It is hoped that there will be additional investment from the NHSSB for fracture patients.
OP03/OP04 At the recent performance management meeting it was agreed that a review would be undertaken in relation to the information analysis as there may be an issue with how this is measured.
OP05 Procurement is underway to replace fleet and delivery is anticipated by 28 March 2008. The Fleet Manager is to review and establish a new fleet plan. It is envisaged that 20 A&E vehicles will be replaced every year. It was noted that the business case for fleet is linked to the Comprehensive Spending Review.
OP06 There has been one additional deployment point in Newry and Mourne.
FINANCE
Mr Nicholson updated members on the financial position of the Trust highlighting the following:
FN01 The financial position at November 2008 indicates a deficit of 289k. This deficit is due to delays in cash releasing efficiency savings. He commented that the financial position has improved and work is ongoing to achieve breakeven by the end of the financial year.
FN02 A full public consultation of the proposed efficiency savings is currently underway and is due to close on the 13 February 2009. Professor Hanratty sought clarification on who the Commissioners are and was advised that they are made up of the four Boards. Mr McIvor advised that it is the Health Boards responsibility to identify the health needs for each area and assign resources. He stated that NHSSB performance has been an issue as they have not been in a position to invest in enhancing response times following acute service changes in their area, as has been the case in other Board areas. Professor Hanratty stated as a Board member she was concerned in relation to the hard work that is carried out by the team and wished to give her support along with the other Board members. Mr McIvor suggested that perhaps the Board would wish to take up this matter with the Northern Board. It was noted however, that the current 4 Boards will be replaced by a Regional Board from 1 April 2009.
FN04 The DHSSPS have issued Best Practice Guide in relation to payment of invoices being paid within 10 days. It was noted that 50% of valid invoices are paid within the timeframe.
FN05 At the time of writing the report NIAS had received conditional approval; notification has since been received and this is now unconditional with the business case approved. The Board wish to commend all those involved for their hard work.
FN06 It was noted that 4 FOI requests have been received so far for January 2009 and are presenting a significant amount of work for staff involved. The website required updating by 1 January 2009 in line with guidance issued by the Information Commissioner. NIAS are responding to the majority of requests within the 20 days target.
MEDICAL DIRECTORATE
Doctor McManus updated members advising that the report was up to the end of December 2008; however there have been some developments since.
MD01 Work is ongoing with the roll out of Paramedic-delivered thrombolysis. The business case for replacement defibrillators has been approved and tender closed on 15 January 2009. The Trust will progress the tender and adjudication process in conjunction with the Regional Supplies Service. Thrombolysis packs for all RRV Paramedics have now been received and the Trust is planning for the delivery of thrombolysis by year end.
MD02 The Cleaner Hospital Campaign (CHC) report has been received and work is ongoing with the Infection Control Group to develop an action plan. This CHC has been used by the DHSSPS to review all Trusts and members were pleased that NIAS are being assessed on the same basis.
Mr Hughes requested an update on the supplies of morphine. He was advised that there is still an ongoing global shortage. It was noted that the Trust continues to provide an alternative to this drug. An update of the situation will be provided to the Clinical Governance Committee when they meet in February 2009.
MD03 Work is ongoing to progress this matter.
MD04 An audit of performance has commenced and the Trust is encouraged by the initial results.
MD05 Delays are being experienced due to manufacturing problems.
MD06 Work is ongoing in this area.
MD07 A positive report to the outcome of the Category C Dalriada Urgent Care pilot has been received. The GP Pilot in Control is up and running and the numbers of calls referred to GPs are increasing. This has been well received and complimented by callers.
Dr Ruddell has given a presentation regarding alternative care pathways to the Institute of Healthcare Management which was also well received. Discussion ensued regarding alternative care pathways.
HUMAN RESOURCES DIRECTORATE
Mr McIvor updated members in Ms Roisin OHaras absence highlighting the following.
HR01 It was commented that 6.79% is a creditable performance and it is hoped that the Trust can stay within 7.42% overall although a difficult period is coming up over the winter months.
HR04 - The new Complaints Manager has now been appointed and has taken up position.
HR05 Continues in line with Training Plan.
HR06 Reviews of all aspects of complaints is ongoing.
Professor Hanratty asked for an update on the introduction of Diploma for ambulance personnel. She was advised that work is in progress however, this has been slightly delayed due to the ongoing work with HPC.
Action: An update on 3rd Level Education is required for next Board meeting.
8.0Policies /Procedures
8.1Major Incident Procedure
This document has been reviewed as part of the controls assurance standards. It was noted that as part of the controls assurance the document should be presented to the Board annually. Some discussion ensued as to whether the plan had been tested though exercises. After assurances were given the document was adopted on the proposal of Mr Hughes, seconded by Mrs Greer. Dr McManus asked whether the Board would like updated on emergency planning in his performance report.
Action: Dr McManus to include emergency planning in his performance report.
9.0
Risk Management Committee Minutes held 4 September 2008
Mr McIvor advised members that he will be stepping down as Chair of this Committee; a Non Executive Director is to be nominated as a Chair. He noted that the KPMG report recommended this as good practice.
One error was noted in the title of the minutes, should read ... Risk Management Committee Meeting.
Members noted.
10.0Clinical Governance Committee Minutes held 4 September 2008
Mrs Greer commented that the Committee met on the 4 December 2008 and that a lot of the issues had moved on. It was noted that the KPMG report on governance arrangements was generally favourable.
Members noted.
11.0Audit Committee Minutes held 4 September 2008
Professor Hanratty also commented on the timing of the minutes to Trust Board and was pleased that the Terms of Reference are to be revisited. It was agreed that consideration would be given to unconfirmed minutes being presented to the Board.
11.0 Application of Trust Seal
The Trust seal has not been used for this period.
12.0Forum for Questions12.1A member of the public Mr Leslie Ferran tabled the following question:
If a 999 ambulance with a critical ill patient on board is diverted, how are the relatives, who are making their way to the original hospital to know where the patient is transported to?
Mr Ferran was advised that if diverts are in operation the crew will have been informed of the admitting hospital. It is very rare for an ambulance to be diverted on route, however if this was to happen the relatives would be informed via the telephone number made to make the 999 call.
13.0Any Other Business
13.1Mr McIvor advised members that an announcement was issued today from the Western Trust stating that they are no longer able to sustain emergency admissions at Tyrone County Hospital. Patients will be transported to Erne or Altnagelvin. Contingencies are in place and staff will be offered overtime to cover additional planned ambulance hours pending recruitment to substantive posts.
DatTiDate, Time and Venue of Next Meeting
The next meeting of the Trust Board will be in the Western Division on the 19 March 2009. Venue to be confirmed.
Professor Hanratty asked if there could be some flexibility in the date for the next meeting as she had a prior commitment. It was agreed that consideration would be given to changing the date of the next meeting.
Mr Archer thanked those present for attending and called proceedings to a close.
Signed: __________________ _____
(Chairman)
Date: ____________
PAGE \* MERGEFORMAT 8
Minutes of a Meeting of Trust Board held on Thursday, 22 January 2009 at 1.30pm
in the Kilmorey Arms Hotel, 41-43 Greencastle Street,
Kilkeel, Co Down, BT34 4BH
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