ࡱ>  QbjbjcTcT 4>>H+||###8[W#+111+++++++-~0t+"+11+811++:%,%18|r#I% ++0+S%R0W0%0%+++0| : NORTHERN IRELAND AMBULANCE SERVICE  Present: Mr P Archer ChairmanMr L McIvorChief ExecutiveMr F HughesNon-Executive DirectorProf M HanrattyNon-Executive DirectorMr N McKinleyNon-Executive DirectorMr S MullanNon-Executive DirectorMr B McNeillDirector of OperationsMs R OHaraDirector of Human ResourcesDr D McManusMedical DirectorMrs S McCueDirector of Finance In Attendance: Mrs M CrawfordExecutive AdministratorMs K BaxterSenior Secretary 1.0ApologiesMr S Shields, Non-Executive Director 2.0Welcome and Format of the MeetingMr Archer opened the meeting by welcoming members of the public and Trust Board and explained the arrangements for receiving questions from the public attending. 3.0Minutes of the Previous Meeting of the Trust Board held on 2 July 2009Members accepted the minutes as a true and accurate record of proceedings on the proposal of Mr Hughes seconded by Mr McKinley. 4.0Matters Arising4.1NIAS Governance ArrangementsA Workshop has been arranged for the 1 October 2009 at the Beeches Management Centre. The recommendations of the KPMG report will be incorporated into the new governance arrangements. As an interim measure changes to the Committee Members have been drawn up, however there may be further changes which will make best use of the skill mix of Non Executive Directors. It was also advised that Mr Hughes has recently been appointed Chair of the Risk Management Committee. Action: One change to be made to the list of Committee members. Mrs McCue, Director of Finance should be listed as attending the Audit Committee. It was also suggested that the Secretary for each Committee should also be listed. 4.2Efficiency Savings and Comprehensive Spending Review Investment ConsultationThe Minister has now approved NIAS proposals for efficiency savings and the Trust is now moving forward to implementation. Mr McIvor stated that he recognises the scale of the challenges ahead and the work required by staff. Mr Archer reiterated Mr McIvors comments stating that the implementation of efficiency savings will be a huge task for the Senior Executive Team and their staff. He wished them well in their endeavours to implement the efficiency savings. 5.0Chairmans Business5.1Chairmans Update Mr Archer gave a brief outline of his diary commitments since the last Board meeting. Met with: Chair/CE plus some Board Members of the Northern Ireland Fire & Rescue Chair of the Northern Health & Social Care Trust Chair/CE of the Patient & Client Care Council Mr Archer has carried out appraisals for the Non Executive Directors and his own appraisal has been completed by Mr Donaghy, Deputy Secretary. He also continues his weekly meetings with Mr McIvor. 6.0Chief Executives Business6.1Chief Executives Update Mr McIvor briefed members on current issues: Met with: Mervyn Storey, MLA in regard to protocols for road traffic accidents. Mr Storey also had a tour of Control where he was advised of the robust arrangements that are in place for road traffic accidents. Along with Mr McNeill met with Declan OLone, MLA regarding the impact of efficiency savings. Omagh District Council regarding the provision of service in the area and the impact of efficiency savings. Mr McIvor was pleased to advise them that the response times of Cat A calls exceed that of the Western Board area and overall performance for Northern Ireland. Prof Hanratty asked if their perception of NIAS performance was in line with the information presented. Mr McIvor advised that it was not clear however he explained the difficulty in achieving the target set for Cat A calls and advised that a lot of incidents took crews from the area for long periods of time. Mr Mullan commented on the adverse attention of local press toward RRV (Rapid Response Vehicle) in the North West area and enquired if this was expressed at the meeting. Mr McIvor advised that he had outlined the role and contribution of Paramedic rapid response in relation to life threatening and non-life threatening calls. He also commented on the issue of long distance transfers and the consequent loss of emergency ambulance cover requiring redistribution of ambulance resources. The added value of Paramedic rapid response units in this context was also explained in the context of current high levels of emergency response performance. Mr Hughes added that there were a lot of poor roads in the rural areas of the North West. Mr McIvor agreed stating that these areas do present challenges for the Service. 6.2Swine Flu See Performance Report for the Medical Directorate. 7.0Performance Reporting as at 31 August 2009OPERATIONS Mr McNeill updated members highlighting the following: OP01 The summer period presented a lot of pressures on the service. Mr McNeill commended the efforts of Managers and the Resource Centre on enabling NIAS to achieve the targets set. He further added that at present the service is enjoying the full complement of resource pre-efficiency savings. Mr Mullan noted the drop in the monthly figures for category A in the Northern area. This was attributable to inter hospital transfers and road traffic accidents which can sometimes require 3 vehicles. Prof Hanratty asked how the recent announcements in respect of Whiteabbey and Magherafelt will impact on the service. Work is ongoing with the Acute Reform Steering Group in this regard and a proposal for the funding of additional vehicles in Whiteabbey and Mid Ulster has been made. Prof Hanratty also asked if 999 calls would be diverted to Antrim or Magherafelt and was advised that bypass protocols are in place for Whiteabbey and revised protocols are in place for Magherafelt. OP02 The target set has not yet been achieved and the aim is to respond to 95% of emergency calls within 18/21 minutes. Current cumulative performance is 93.4%. The main reason for not achieving the target set is the focus on achieving the Cat A target in OP01. OP03 No change since the last report. Work is ongoing with GPs to agree reasonable timeframes. It is considered that some of the calls could be handled by Patient Care Services. OP04 Rolling out of new vehicles is still ongoing with 20 out of 28 vehicles now in place. Mr McNeill wished to commend Mr Heasley, Fleet Manager and his team for their hard work in rolling out the vehicles. Training for frontline staff has also been completed. The Trust is still awaiting approval for non emergency vehicles. An order has also been placed to convert 24 chassis into full A&E vehicles. Mr Hughes asked if the fitting out had been done in house. Mr McNeill advised that this work is completed in the UK and not by NIAS. Mr Hughes further added that response times are good and hoped they can be maintained. Whilst Mr Mullan noted the response times reported, he expressed concern in the Trusts ability to breakeven if the use of overtime continues to be used in this manner. OP05 Outline Business Case for estate has been submitted to the DHSSPS. Mr Archer asked how the new deployments points were working. Mr McNeill advised that they have been working well, particularly Ballynahinch which has eased congestion at Downpatrick station. FINANCE Mrs McCue updated members highlighting the following: FN01 The trust at present is forecasting a deficit of 1.5m at year end. Ministerial approval for efficiency savings has just been received and the Trust has not yet been able to embed the efficiencies. Contingency plans have been developed and are with the DHSSPS for approval. Mr Mullan stated that any delay in the enactment of efficiency savings will impact on the service further and wished to offer the Boards support to the Senior Team. FN02 Approval has just been received and the Trust needs to embed efficiencies as soon as possible. FN03 The Trust holds little estate with the majority of premises being rented. FN04 The Trust is currently achieving 94.5% at present. This area continues to be a focus for the Finance Department. FN05 All Trusts were required to review proposed capital schemes with a view to indentifying potential slippage. Due to the uncertainties in respect of estate in terms of approval, site identification, planning and lead times, 1.5m has been surrendered. Therefore the amount available in 2009/10 for Estate and Equipment is 568k. FN06 This target is set by the Trust and is on track to achieve. FN07 This target is set by the Trust and is on track to achieve. FN08 - This target is set by the Trust and is on track to achieve. MEDICAL DIRECTORATE Dr McManus updated members highlighting the following: MD01 Roll out of Thrombolysis is on track with RRV training completed. A new cell phone has been trialled to facilitate ECG transmission. MD02 There has been no reported cases of healthcare acquired infections. Work on the recommendations arising from the Healthcare Associated Infection (HCAI) report continues. These include the introduction of personal and vehicle issue hand cleaning materials. A vehicle cleaning reporting system has been introduced and regular reports and updates are being provided at the Clinical Governance Committee. The Trust continues to pursue through the Commissioners expert advice infection control for NIAS. MD03 See Item 8. MD04 NIAS continues to develop pathways for the provision of pre-hospital thrombolysis and PCI for patients. Arrangements are now in place through ambulance control and the provision of oxygen alert cards to patients in a number of areas to identify patients with COPD and specific oxygen requirements. A campaign is underway advising people of getting urgent help for stroke. Patients with potential stroke are to be taken to hospital to facilitate specialist assessment. This may cause problems operationally as it will not necessarily be the nearest hospital but specific nominated hospitals which are facilitating this. Positive feedback has been received regarding rapid intervention. Final details of the nominated hospitals has not yet been finalised however the current status is: South East - 2 North - 1 West - 2 South 1 Mr Archer commented that this will impact on the service with further distances for patients to travel. MD05 Clinical areas continue to be benchmarked against other English ambulance services and reported at Clinical Governance Committee. MD06 Difficulties are still being experienced in the roll out of pharmacy arrangements. This has been due to capacity constraints within the regional pharmacy. MD07 The Emergency Planning report was presented and Mr Mullan asked about the fault with the paging system. Dr McManus advised that the system has been reviewed and the issue addressed. Dr McManus gave further detail on the incident at St Angelo Airport where a light aircraft came down. He added that interagency co-operation worked well with a PSNI Helicopter locating the craft. He wished to commend everyone involved in the incident. Swine Flu The incident team continue to meet on a weekly basis to review activity. A workshop attended by Mr McIvor and Mr Newton, Emergency Planning Officer took place on the 17 September 2009 for Health Trusts within Northern Ireland to identify conflicts and issues. NIAS is prepared and has plans in place to deal with Swine Flu. HUMAN RESOURCES Ms OHara updated members highlighting the following: HR01 Ms OHara advised that the August absence figure is not fully validated at this time. She further advised that the Trust is at risk of not achieving target due to swine flu and efficiency savings. This area is being managed as a priority. Different methods are used to engage with staff that are on sick leave. Mr McKinley asked if return to work interviews are carried out. Return to work interviews are carried out for short or long term sick leave and home visits are also carried out for staff that are on long term sick. HR02 On target to achieve. Ms OHara was delighted to advise that the Trust has received approval to provide a BTec Award. She added that NIAS is the first national Ambulance Service to receive approval. She wished to commend the work of Linda Gregg, Strategic Development and Training Manager, Michael Hughes and Sean Maguire, Training Officers. HR03 On target to achieve. Outline Business Case submitted to DHSSPS. HR04 On target to achieve. A Project Manager for the implementation of the Knowledge and Skills Framework (KSF) in Northern Ireland has been recruited. This is a departmental post. Mr Mullan asked if the delay in KSF was due to the recruitment of the Project Manager. He was advised that in relation to the introduction of KSF that the Trust is on line to achieve the targets set by the DHSSPS. HR05 The complaints report was presented in a new format. It was also advised that a new complaints procedure and policy is being drafted which will incorporate elements of the requirements under the new Patient and Public Involvement (PPI) As part of the new procedure it is envisaged that complaints will be reviewed by one of the existing Committees. Mr Archer suggested that the report to the Board be revised to include commentary on all complaints received, given the relatively small number received. This suggestion will be considered in the context of the revised Committee reporting arrangements. Mr Archer also suggested that a comparative on last years complaints be presented to the Board. Mr Mullan raised a question in relation to the section on Awaiting consent to proceed. He was advised that consent is required in some cases where personal data is to be released. DATIX is also being fully utilised to record all incidents and claims which will link all incidents involving a patient. Staff and Managers are to receive training on how to deal with a complaint. Mr McKinley asked if we could look at a 12 month period to ascertain how complaints have driven improvements. Ms OHara advised that a mechanism would be required to obtain this information. Prof Hanratty commented that the majority of complaints were in relation to staff attitude. She asked if staff recognise this as a problem and is communication a factor, or is it the patients perception. She was advised that on occasion the complaints are valid and staff are given the opportunity to state their case. Dr McManus added that staff are generally very good at reassuring patients in what can be a very stressful situation. They need to take control and the perception may be that they have an attitude problem in this challenging environment. Mr Mullan commented that overall the amount of complaints received is miniscule in comparison with the amount of calls that are dealt with by the service. 8.0Patient & Client Experience Standards This is a PFA target for the Trust and it is proposed that the Board would formally adopt the standards at this meeting, in line with the Priorities for Action target and letter to Trusts from the Minister for Health. The Trust has engaged with the Regional Working Group to establish a consistent approach to the measurement of these standards. It is proposed that the Board adopt the Patient and Client Experience Standards in relation to Respect, Attitude, Behaviour, Communication, Privacy and Dignity, and have put in place arrangements to monitor and report performance against these standards. Standards adopted on the proposal of Prof Hanratty, seconded by Mr McKinley. Dr McManus wished to commend the work of Mrs Michelle Lemon, Equality Manager in achieving the deadline of September 2009 for the completion of this work. 9.0Trusts Annual Section 75 Progress Report to Equality Commission Noted. Mrs Lemon, Equality Manager was commended for her work in this area. 10.0Policies / Procedures (for approval) 10.1 10.2 10.3 10.4 10.5 10.6Policy on the use of the Internet Information and Communications Technology (ICT) Security Policy Data Quality Policy Email Policy Policy on the use and Management of Passwords Records Management Retention and Disposal Schedule Mrs McCue advised that a focus for the Trust is on information governance and controls assurance. She wished to pay credit to Ms Alison Vitty, Corporate Manager for the development of the policies. These policies have been benchmarked against other Trusts. Prof Hanratty suggested that within the Records Management Retention and Disposal Schedule that a legend be included which will clearly show how long documents should be retained particularly where care has been delivered to patients. Mrs McCue advised that this is a standard format used by all Trusts. Mr McIvor suggested that a paragraph could be developed on the recommendation of the Board and communicated to staff implementing the policy. The polices listed above were collectively presented and approved on the proposal of Prof Hanratty, seconded Mr McKinley. 11.0For Noting 11.1Northern Ireland Ambulance Service Trust Delivery Plan Noted. 11.2Minutes of the Audit Management Committee held 18 May 2009 Noted. 11.3Minutes of the Risk Management Committee held 28 May 2009 Noted. 11.4Minutes of the Clinical Governance Committee held 8 June 2009 Noted. 12.0Application of Trust SealThe Trust Seal has been used on the following 3 occasions for the lease of premises: Derg Valley Hospital Newcastle Limavady 13.0Forum for QuestionsNo questions received from the floor. 14.0Any Other BusinessNo other business. Date, Time and Venue of Next MeetingThe next meeting of the Trust Board will be held in the Eastern Division, venue to be confirmed on Thursday, 26 November 2009. Mr Archer thanked those present for attending and called proceedings to a close. 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