ࡱ>  cbjbj 4FZ+||###8[#F"f!!!!!!!$#N&~!"!"MMM8!M!MMM[)#I^M!"0F"M&&M&MdM!!MF"&| : NORTHERN IRELAND AMBULANCE SERVICE  Present: Mr P Archer ChairmanMrs S McCueDirector of Finance / Acting Chief ExecutiveMr F HughesNon-Executive DirectorProfessor M HanrattyNon-Executive DirectorMr S MullanNon-Executive DirectorMr N McKinleyNon-Executive DirectorDr D McManusMedical DirectorMr B McNeillDirector of OperationsMs R OHaraDirector of Human Resources In Attendance: Mrs M CrawfordExecutive AdministratorMrs J McSwigganPersonal Assistant 1.0ApologiesMr L McIvor, Chief Executive.2.0Welcome and Format of the MeetingThe Chairman opened the meeting by welcoming members of the public and Trust Board and explained the arrangements for receiving questions from the public attending. The Chairman introduced the new Non-Executive Director, Mr Norman McKinley, who replaces Professor Ron Perrott, and noted that this will be the last meeting attended by Mrs Margie Greer, whose tenure finishes on 18 May 2009. 3.0Minutes of the Previous Meeting of the Trust Board held on 19 March 2009The Trust Board members unanimously accepted the Minutes as a true and accurate record of proceedings. The Minutes were adopted on the proposal of Mr Mullan, seconded by Prof Hanratty.4.0Matters Arising4.1Terms of Reference for Sub-Committees of the TrustThe Chairman reported that this work is underway, and it is important that NIAS draws this process, embracing wide governance issues, to a conclusion.4.2Efficiency Savings and Comprehensive Spending Review Investment ConsultationMrs McCue reported that it had been planned to present plans for consideration under Agenda Item 7, however a number of prior steps remain to be completed. The consultation exercise has been completed and NIAS is in the process of producing a report to identify key findings. A more detailed piece of work is underway to assess implications and items arising from the consultation. 4.3Contract of EmploymentMs OHara advised members that legal advice was sought in relation to the query raised regarding personal injury claims and advised that staff are obliged to pay back any monies paid by the Trust. Staff should ensure that loss of earnings is covered under their claim. It was also confirmed that the issue is addressed in the National Terms and Conditions and a paragraph on personal injury appears within the contract. Mr Mullan was satisfied that this covered issues which he had raised at the previous Board meeting.4.4Disciplinary PolicyMs OHara responded to the query raised at the previous meeting regarding aggregation of minor disciplinaries advising that the policy was regionally negotiated and agreed with Trade Unions and therefore cannot be changed, however the matter can be considered again when it comes up for review. Legal advice received was against including aggregation on minor disciplinaries within the policy advising that each case is a matter for the panel. Aggregation is accepted, but does not require to be explicitly outlined within the Disciplinary Policy. Ms OHara further stated that the Trust should proceed with caution and advised that this will be an issue for Disciplinary training and added that the Regional Joint Negotiating Forum will be informed of the concerns raised by the Board. Mr Mullan stated that advice he received from Counsel disagrees with this, however accepts that the Trust should follow legal opinion received, as long as consistency is applied. He noted that once an offence is spent, it cannot be considered. Professor Hanratty highlighted the importance of consistency and advice given to panels. Ms OHara responded that the NIAS Employee Relations Manager along with a member of the Human Resources Department advise panels on protocols.5.0Chairmans Business5.1Appointment of new Non-Executive DirectorsThe Chairman informed the Board that Mr Norman McKinley replaced Professor Ron Perrott on 8 April 2009. Mrs Margie Greer will be replaced by Mr Seamus Shields on 18 May 2009.5.2Chairmans UpdateThe Chairman informed the Board that he has had several meetings with Chairs of other Trusts, and has attended meetings in relation to the Senior Executive Review process. He has attended the launch of the four new bodies created on 1 April 2009 Health and Social Care Board, Public Health Agency, Business Services Organisation and Patient and Client Council. He has also met with the Chairman and Chief Executive of the new Business Services Organisation. He continues to meet with other NIAS Non-Executive Directors and meets with the Chief Executive on a weekly basis.6.0Chief Executives Business6.1Chief Executives UpdateMrs McCue updated members on the Health Professions Council (HPC) Accreditation. The HPC are now satisfied that the remaining conditions have been met and are recommending the Paramedic In Training Programme for re-approval. It was noted that NIAS is the only national service to be approved for the two-year programme. In response to a question from Mr Mullan, Ms OHara provided the background to IHCD and HPC accreditation and clarified that this regulatory body approval is new to NIAS, bringing added responsibility and accountability to NIAS staff, and raising academic and practice standards. She emphasised the amount and significance of the work involved in redesigning the full programme to meet HPC requirements and wished to commend Ms Linda Gregg, for her personal commitment and tenacity. Mr Mullan also asked for confirmation that there were no major deficiencies found in the training programme and was advised that this was the case. There will be another HPC review visit with IHCD accreditation following in a few weeks; however this is usually a positive experience. The Chairman congratulated NIAS on this achievement on behalf of the Board. Ms OHara noted the Boards appreciation to all staff involved Mr McKinley asked if positive news stories would automatically appear on the NIAS website. Ms OHara advised that no action will be taken in this regard until written approval is received from HPC. Mr Mullan endorsed Mr McKinleys views with regards a proactive approach to positive news stores. Members were advised that positive news stories are often circulated to the press; however they may not always use the stories given. 6.2Swine Flu The Chairman asked Mrs McCue to update members on the swine flu situation. Mrs McCue advised that an Incident Control Team has been meeting on a daily basis, and NIAS is in close contact with the Public Health Agency, the Department, Minister and other Trusts. Daily teleconferences with other Emergency Planning Officers and UK Ambulance Services are also taking place. NIAS has had a pandemic flu plan in place for some time and is currently reviewing the plan on a day to day basis to ensure a state of readiness.7.0Consultation Proposals Efficiency Savings and Comprehensive Review InvestmentCovered under Item 4.2.8.0Performance Reporting as at 31 March 2009OPERATIONS Mr McNeill updated members on the end of year position, highlighting the following: OP01 there has been a steady improvement throughout the year. PFA target achieved in March 2009, primarily because NIAS has enjoyed the benefits of CSR investment without any material change in frontline service, but also thanks to all staff throughout NIAS who have worked so hard to bring in this result. It has been a team effort, with contributions from all aspects of the Service. Mr Mullan congratulated NIAS for the exceptional performance. He asked if Category A performance is sustainable at that level. Mr McNeill advised that sustainability will be a concerted effort but is optimistic that it will be achieved. OP02 This focuses on the fracture target, which has turned the Trusts attention towards PCS. A comprehensive review of that service has led to the design of an e-driven system which should be piloted at the Ulster Hospital within the next month. A leaflet on PCS was circulated to members. This will be circulated mostly through GP surgeries and hospital wards. Professor Hanratty suggested that this would be useful information for the general public. Mr McNeill added that the review of PCS is ongoing. Once completed, a summary report will be produced. OP03 The PFA target has improved, probably due to the use of RRVs. Work still needs to be done in this area. OP04 Primarily due to the focus on the Ministers PFA target, and also due to the increase in activity, particularly over the winter months, the Trust has not met this performance objective. Intermediate Care Vehicles have been transferred into the Emergency Control Centre, keeping pressure off the A&E fleet this has worked well and will be explored further. OP05 NIAS is delighted to report the purchase of 66 vehicles: 28 A&E, 26 of which are replacement and 2 new for the Omagh area; 25 PCS replacement vehicles; 13 Skoda Octavia RRVs, some of which are replacements. The Trust also purchased 24 new chassis cabs, not yet converted to A&E vehicles. This should be completed by January 2010. Approval for the business case is required to further improve on the Trusts position. OP06 All construction work has been completed at the Ballynahinch site, just waiting for BT to test, should be operational within next week or so. This is a key deployment point for NIAS, and should ease congestion in the Downpatrick station. A review of all estate is being conducted as part of the OBC requirements including existing facilities and deployment points, and potentially new deployment points. FINANCE Mrs McCue updated members highlighting the following: FN01 A key target for the Trust is to achieve break even. The accounts are subject to audit, however the current small deficit of 51,000 is within the framework of break even. FN02 The Trust has not actioned most of the savings which are part of the consultation exercise underway at the moment. Mrs McCue advised members of the additional pressures that this will bring on the ability to break even. FN03 This relates to the requirement to identify to the Department any funds we have from disposal of surplus assets. This focuses on a review across all Trusts redundant estate. As NIAS mostly rents buildings from other Agencies/Trusts disposal of owned property is not an issue. Mrs McCue highlighted a provisional figure for disposal which relates to vehicles, as a result of purchasing a new fleet. In response to a query from the Chairman, Mr McNeill advised that vehicles are of limited value on disposal. FN04 Prompt payment of invoices, NIAS has achieved the target of 95% by value, but not quite by volume. FN05 It has been a very active year, with a significant spend on previous years. The Trust has been fortunate to secure a significant amount of money primarily with regards to fleet. A great deal of effort has gone into getting vehicles specified, ordered and in place. With regards the spend profile, a tender exercise has been carried out for replacement defibrillators, with some secured and some in place. A significant training programme will follow. Mr Hughes congratulated the Executive team on their persistence in the purchase of the new vehicles and defibrillators. FN06 FOI Requests. NIAS is working hard to adhere to the strict guidelines on turnaround time, which is a legislative requirement. MEDICAL DIRECTORATE Dr McManus updated members highlighting the following: MD01 Roll-out of paramedic administered thrombolysis; all RRV Paramedics are trained in its use. Dr McManus was pleased to announce delivery of 160 new 12-lead cardiac monitors and defibrillators to facilitate the roll-out to all front line ambulances in service. These have been delivered and are in the process of being configured to the Trusts specific requirements, and a programme to Train the Trainers has commenced. As part of that programme of roll-out to all ambulances and RRVs, all Paramedics will be trained in the administration of thrombolysis. This has been a tremendous effort, and Dr McManus congratulated and thanked everyone involved. The roll-out is a two-phased programme over 2008/09 and 2009/10. The first phase was completed in that thrombolysis is available on each RRV and all Paramedics working on those vehicles are trained. With the new technology and the training of other Paramedics, this will also be available on all frontline emergency vehicles over the next few months. The programme is to the end of March 2010, however it may be completed before this time. In response to a question on the shelf life of the drug, Dr McManus clarified that as part of the NIAS review of pharmacy arrangements, there is a single supplier which also supplies other hospitals centrally, so NIAS can become part of the regional stock rotation, thereby increasing cost-effectiveness. MD02 HCAI, there is an ongoing programme of review of infection and prevention and control procedures. A number of actions have now been completed. NIAS participated in a review of policies and procedures by the Hygiene and Cleanliness Division of the Department of Health and following their report an action plan was developed. MD03 The RQIA report was received in August/September 2008 and all recommendations have been actioned. Some will require ongoing work, and some have no specific end point. All specific actions have been addressed. MD04 NIAS has been successful in improving operational responsiveness, and Dr McManus thanked and congratulated those involved for the excellent work in meeting the 70% target for an 8 minute response to Category A calls. This is of benefit to patient care. However NIAS has been very keen to develop a number of clinical performance indicators to assure and monitor the quality of the clinical care on arrival. These were based on recommendations made by the Healthcare Commission and which all UK Ambulance Services had been adopting. They allow NIAS to benchmark against all UK Ambulance Services. Initial audits indicated that some refinement to PRFs and the audit process itself was required and this has been made. The Trust is now beginning to look at electronic reporting. Professor Hanratty queried the narrative relating to the target. Dr McManus clarified that the target of development of clinical supervision is achieved, and that the target will now move on to the area of implementation of clinical supervision. MD05 Following the pharmacy review, NIAS has moved to a single central supplier. Due to circumstances beyond the Trusts control, the introduction of controlled drugs was delayed. The manufacturing issue was resolved, but due to an issue with the presentation of the drug which entailed a potential risk, Dr McManus delayed the introduction of the controlled drug until all other arrangements are in place which is expected to be June 2009. Professor Hanratty asked about controlled drugs and governance issues. Dr McManus outlined the robust procedures relating to access to controlled drugs. The Home Office has advised that the Trusts procedures meet and exceed legislation requirements. Group authority and licence to supply and possess have been issued. Each dose administered will be monitored so that it can be accounted for. The use of controlled drugs will be audited by region, division, station and individual Paramedic. Using clinical audit, it will also be possible to marry the administration of a drug to an individual patient, as recorded on the PRF. MD06 This is a work in progress, to be implemented by September 2009. An action plan has been drawn up, and the working group attended a workshop this week organised by the Department. MD07 NIAS has been exploring and engaging with other agencies in regard to alternatives and more appropriate pathways for patients. A pilot has been undertaken in relation to referral of some Category C calls. The numbers were limited but the evaluation was very positive. A triage pilot using doctors has commenced, and should run for six months; initial data is very encouraging, and a full evaluation of the pilot is expected in June/July 2009. Whether the pilot continues depends on the outcome of the evaluation and funding, until now, CSR monies have funded this. Dr McManus presented the Emergency Planning Report to members, which is self-explanatory. He wished to thank and congratulate the team for their hard work. Dr McManus agreed to include the Emergency Planning Report as part of his report to Trust Board. , mindful of the need for confidentiality of certain aspects of their work. HUMAN RESOURCES Ms OHara updated members highlighting the following: HR01 NIAS has recorded its lowest absence rate for nine years, exceeding the Ministerial target. Ms OHara noted that long term sickness has been a major issue for the Trust, in particular musculoskeletal and stress-related sickness. Eight employees retired on health grounds in the past year. Mr McNeill congratulated Ms OHara on this achievement adding that this would have been a contributing factor in the Trust achieving the targets set. The Chairman and Board members agreed with this view. HR02 NIAS continues to be under-resourced compared to other Trusts. HR03 No staff turnover reported for March 2009. HR04 At the last Board meeting it was reported that the Trust had recruited a Complaints Officer for one year. Training in the investigation of complaints is also underway. HR05 NIAS is working on the Training Plan for the next two years. All aims identified have been achieved. Prof Hanratty asked if the training plan included manual handling given absenteeism due to musculoskeletal problems. Ms OHara advised that the Trust has a Health and Well Being Strategy included within the training plan which includes manual handling with priority being given to this area. This will form part of the Continuous Personal Development (CPD) for staff. Mrs McCue added that there is a variety of training incorporated as part of CPD which may not be listed individually. Mr McKinley asked to what extent Supervisors are actively conducting return to work interviews etc. Ms OHara responded that due to the nature of the service, with employees working shifts, there may at times be a delay in carrying these out. HR06 Complaints Report noted. 9.0Policies / Procedures (for approval) Policy documents 9.1 to 9.5 are based on the relevant legislation, and have been adapted from generic policies to suit NIAS. 9.1Freedom of Information Action 2000 PolicyNo comments noted.9.2Data Protection 1998 PolicyMrs McCue highlighted pages 9 to 13 (sections 6.2 to 6.6) in relation to responsibilities. This legislation affects all Trust staff. The Chairman raised the issue of emails being discoverable under Freedom of Information. Mrs McCue responded that in the case of disciplinary or legal issues, emails are made available. A clear procedure is currently being drafted in response to the legislation.9.3Records Management PolicyThe wording of section 2.1 was discussed and no changes made. Mr Mullan asked that sent should be amended to read sense in section 3.3.1. The Chairman asked how long records must be kept. Mrs McCue responded that NIAS receive guidance from the Department in conjunction with PRONI, which depends on the type of record. Work is being carried out on the archiving system and procedures are being drafted in response to the legislation.9.4The Safeguarding, Movement and Transportation of Patient/Client/ Staff/Trust Records, Files and other Media between Facilities Mr Mullan requested that one word be added to section 5.2 of the document as follows: Keep the information out of sight, for example, in the locked boot of vehicles; Acceptance of Agenda Items 9.1 to 9.4 was proposed by Mr Hughes and seconded by Professor Hanratty. 9.5Information Communication and Technology (ICT) StrategyMrs McCue updated members on this document, which has been written in an easy to read format. In recognition of attention to information governance in terms of data protection etc., the Trust has split the ICT function into a Technology Group and an Information Governance Group. This document takes technology and some information governance issues into account. Mrs McCue highlighted how the Trust has performed against the previous strategy and against other Trusts. Mr Mullan asked about electronic PRF developments. Mrs McCue responded that trials have been carried out, and the digital pen system is currently under review. NIAS is now represented on the Regional ICT Programme Board, which looks at ICT for the Health Service as a whole, so there will be opportunities to look at PRFs in a more strategic way, as part of an overall patient record. Mr Mullan asked if these trials should be noted in the document, however at the time this document was prepared, evaluations had not been completed. Mrs McCue highlighted the six key themes, making best use of technologies to provide information in timely fashion. Preparation of the strategy involved a workshop for Senior Managers. Mrs McCue highlighted the implementation plan and added that it needs to be determined how the Trust can be sure that the document is appropriately implemented. Mr Mullan noted the absence of a fully integrated accounting system. Mrs McCue responded that there has been some progress in this area, and NIAS representatives have attended overall Health Service meetings which have been looking at procuring a system. This will probably take place within the next two years. In response to a question from the Chairman with regards common unique patient identifier, Mrs McCue clarified that there is a directive that this identification number should be used, where possible, across all Trusts. However the feasibility of this for NIAS is being explored. Discussion on NIAS programme management capability followed as this is an extremely time intensive programme. Acceptance of this strategy was proposed by Mrs Greer and seconded by Professor Hanratty. 10.0Audit Committee10.1Minutes of the Audit Committee Meeting held 10 March 2009The Chairman of the Audit Committee will sign these Minutes today. Mr Mullan had no points that he wished to highlight. Corporate Governance arrangements had been discussed, and no major issues had been raised.11.0Application of Trust SealTrust Seal has not been used since the last Trust Board. 12.0Forum for QuestionsNo questions received from the floor.13.0Any Other BusinessNo other business.14.0Date, Time and Venue of Next MeetingThe next meeting of the Trust Board will be held in the Northern Division on Thursday, 2 July 2009. Mr Archer thanked those present for attending and called proceedings to a close. Signed: _______________________ (Chairman) Date: ____________      PAGE \* MERGEFORMAT 2 Minutes of a Meeting of Trust Board held on Thursday, 7 May 2009 at 1.30pm NIAS HQ, Site 30, Knockbracken Healthcare Park, Saintfield Road, BELFAST BT8 8SG #$&(2BCKLMXY ! 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