ࡱ> _ 'Kbjbj 4bbSB+ @@@TTT8xTI222|I~I~I~I~I~I~I$KNlI@"I22Illl"82@2|Il|IllR6(92P}S:("7hII0I7NJ"N<9N@9lIIlIN  : NORTHERN IRELAND AMBULANCE SERVICE  Present: Mr P Archer ChairmanMr L McIvorChief ExecutiveMr Frank HughesNon-Executive DirectorMr N McKinleyNon-Executive DirectorMr S MullanNon-Executive DirectorMr S ShieldsNon- Executive Director Prof M HanrattyNon- Executive DirectorMr B McNeillDirector of OperationsMs R OHaraDirector of Human ResourcesDr D McManusMedical DirectorMrs S McCueDirector of Finance In Attendance: Mr R DixonPatient Client CouncilMrs M CrawfordExecutive AdministratorMiss K BaxterSenior Secretary Welcome and Format of the Meeting The Chairman opened the meeting by welcoming members of the public and Trust Board and explained the arrangements for receiving questions from the public. 1.0Apologies None.2.0Declaration of Potential Conflict of InterestNone declared. 3.0Minutes of the Previous Meeting of the Trust Board held on 25 March 2010Members accepted the minutes as a true and accurate record of proceedings on the proposal of Mr McKinley, seconded by Mr Shields. 4.0Matters Arising4.1NIAS Governance ArrangementsMembers were advised that Risk Management and Clinical Governance Committees will be merged for the next meeting due to take place in May 2010. This is an interim arrangement until the Terms of Reference for the new Assurance Committee are agreed. Both Chairs of these Committees advised they were content with this arrangement and Prof Hanratty is to Chair the meeting. A meeting to discuss the Terms of Reference is arranged for 30 April 2010. Once agreed the revised Terms of Reference will be presented to the Audit Committee and then Trust Board for approval. Some concerns in relation to the management of risks were raised and members were reminded that the Board has a collective responsibility for all areas of risk. The Board will look to members and Officers with specific expertise in the areas of finance and clinical risk to provide assurance to the Board. It was noted that this matter was discussed in some detail at the Governance Workshops attended by the Board and the revised arrangements reflect the direction provided by the Board. It was also suggested that the Director of Human Resources should be in attendance at the new Assurance Committee. It was agreed that this was a matter for the Chair of the Assurance Committee. 4.2Efficiency Savings and Comprehensive Spending Review InvestmentThe Trust continues to progress efficiency savings with the 3rd phase in place from 1 April 2010 with the removal of planned A&E and the introduction of additional RRV hours. The impact of this will continue to be monitored. There is also concern that congestion within the hospital system is also impacting on the service. NIAS is continuing to progress with current plans notwithstanding the emerging additional financial pressures. At this point the Chair opened the discussion to the floor and a member of the public commented that NIAS has managed the efficiency savings very well and improved performance. 4.3Minutes The Board noted the speed with which they had received the draft minutes for comment and considered that this was good progress. The Chair advised that it is also proposed that a draft agenda be sent out with the draft minutes as a further development of the process. 5.0Chairmans Business5.1Chairmans Update The Chairman gave a brief outline of his diary commitments since the last Board meeting: Met with the Minister at Bangor Ambulance Station for a photo opportunity with the new vehicles. Met with the Chair of Risk Management Committee for debrief following the meeting in February 2010. DHSSPS Diversity & Equality Event. CIPFA Chairs Forum due to meet six times a year. Continues weekly meetings with the Chief Executive. 6.0Chief Executives Business6.1Chief Executives UpdateThe Chief Executive gave a brief outline of his activities since the last Board meeting Met with the Minister at Bangor Ambulance station. The Chief Executive used this opportunity to engage with the Minister to discuss concerns and pressures for the year ahead. Met with an Air Ambulance Group and the DHSSPS. NIAS position was restated. The DHSSPS are to take this matter forward. Holding regular meetings with the Regional Board together with NIASs Director of Finance and Director of Human Resources. Met with the Strategic Investment Group to discuss capital planning and continued investment for fleet. Chief Executive and Medical Director met with the Northern Ireland Fire and Rescue Service (NIFRS) in relation to issues around patient extrication. A road safety strategy is currently being developed and NIAS wished to state clearly that the Ambulance Service have lead responsibility for management of patients at such incidents. 7.0Performance Reporting as at 31 March 2010 OPERATIONS Director of Operations updated members as follows commenting that this will be a very challenging year for the Trust: OP1 There has been an increase of 6.7% in A&E activity during 2009-10 which is an additional 7,800 calls. The cumulative target achieved is 71.5% with the strongest area being Belfast which achieved 85.6%. However the increased target for March 2010 has not been fully achieved .The target by LCG area is 65% which was achieved with the exception of the Southern Division which achieved 63%. This was due to congestion in Craigavon Hospital which was beyond NIAS control. The RRVs direct contribution to the response performance achieved was in the order of 18%. This has been a challenging year for NIAS with efficiencies in place however the Trust still achieved 71.6% Category A response within 8 minutes for Northern Ireland. Members commended the efforts of staff for their achievement given the challenges presented and the extreme weather conditions this year. The Chair endorsed this comment stating that what NIAS has achieved is worthy of note. OP2 Achieving 95.2% in the Belfast area with more work required in the other areas. OP3 This target has not been achieved with issues to be addressed. The Director of Operations and Medical Director are to review this area to determine how calls can be managed more effectively. OP4 Delivery of the vehicles received are as detailed in the report; further specialist work is required before being fully commissioned into service. OP5 Feasibility studies are underway for a number of locations. A full business case for the replacement of Ballymena is a priority with a plan for submission early this year. The issue of GP referrals was raised and members enquired if patients always require hospitalisation or if there was an alternative. The Board was advised that this is a decision for the patients GP. If a request is received for a patient to be transported to hospital the Trust endeavour to facilitate this within 1 hour of receiving the call. It was noted that the withdrawal of A&E vehicles will be an added pressure in this area. FINANCE Director of Finance updated members highlighting the following: FN01 Board advised that it is the Trusts statutory duty to breakeven and the Trust is currently reporting a position of breakeven with a surplus of 11k. This is based on assumptions subject to audit. Members wished to commend staff for their hard work in achieving the breakeven position. The Chair added that this is very commendable stating that the Finance report does not reflect the amount of work carried out by the Finance team and others. Budget Holders throughout the Trust are also to be commended. FN02 Year 2 efficiency savings have been removed from the budget and the Trust has fulfilled its responsibility to breakeven subject to audit. FN03 - Disposals in this target relate to out of standard vehicles and 30k capital proceeds from the sale of vehicles have been identified. FN04 The Trust has achieved a cumulative performance of 93.3% of invoices by volume being paid within 30 days. Some delays in the payment of invoices have been experienced in this area. FN05 Total capital allocation for 2009/10 was finalised at 2.971m. The Trust has managed within its capital expenditure. FN06 On track to achieve. FN07 On track to achieve. FN08 - On track to achieve. FN09 This is a new target for the reporting arrangements of Service Level Agreements with key performance indicators in respect of purchase and supply. At present the Trust are within the target set. MEDICAL Medical Director updated members highlighting the following: MD01 This target has been achieved with paramedic thrombolysis being available throughout the region. In response to a question, the members were advised that all the drugs necessary to treat a heart attack, including thrombolysis, are contained within a single pack and all RRVs and A&E ambulances are issued with a pack. It was also noted that the drugs used for thrombolysis are expensive and members were informed that following the move to a single regional pharmacy, the drugs are cycled through the Ambulance Service and the wider healthcare system by pharmacy to minimise wastage as the drugs approach their expiry date. MD02 The Committee were advised that no incidents of healthcare acquired infections have been reported as arising within the Trust during the past year. An audit of compliance of infection prevention and control procedures and practices by NIAS operational staff has been carried out by the Clinical Support Officers and the results are currently being collated. The final analysis will be presented to the next meeting of the Clinical Governance Committee. The recommendation of previous HCAI audits and inspections have been actioned but the provision of expert infection prevention and control advice for the Trust remains outstanding and members were informed that this had been highlighted to the Regulation Quality Improvement Authority (RQIA) during their recent visit. Progress in this regard will continue to be reported to the Clinical Governance or Assurance Committee. It was confirmed that hand sanitizers were available in all stations and vehicles for staff in addition to personal issue dispensers for individual use and members were advised of the arrangements in place which meet this requirement. MD03 Members were advised of the ongoing work in relation to Personal and Public Involvement and Patient Experience within the Trust. The engagement with the other five HSC Trusts in relation to the regional development of joint monitoring and reporting arrangements was noted. Members were also informed of a recent visit to the London Ambulance Service Patient Forum by Medical Director and Equality Manager as part of the benchmarking against best practice with other UK Ambulance Services. It was noted that during this visit contact was also made with the South East Coast Ambulance Service Patient Representatives. MD04 Members were informed that NIAS continues to participate in a number of regional service frameworks such as the cardiovascular, respiratory, palliative care, end of life care and cancer service frameworks. In particular the fast tracking of patients who have suffered a stroke to hospitals for potential thrombolysis was noted and the vital part that NIAS plays in this. NIAS continues to participate in the development of alternative care pathways with other agencies and healthcare providers and resistance to the acceptance of referrals from these providers was noted. It was hoped that a recent letter to the entire Health and Social Care system from the Health Minister encouraging work in this area would be beneficial in this regard. MD05 Clinical Performance Indicators have been developed with regular reports on the standard of clinical care being provided for a number of clinical conditions to the Clinical Governance Committee. The vital role of the Clinical Support Officers in ensuring a high standard of clinical care was highlighted and acknowledged. The Trust continues to explore the development of an electronic Patient Report Form, however it was accepted that current financial constraints may delay this development. MD06 The new pharmacy arrangements are now in place in four Divisions and the members were informed that the introduction of the new arrangements in the remaining Division has now commenced and will be fully completed in the next few weeks. The procedures and policy for the management of medicines have been scrutinised by RQIA during their recent visit and while their final report is awaited, they indicated that they were very satisfied with the arrangements in place. The controlled drugs have been ordered and their delivery is awaited. Once they are received, they will be introduced almost immediately thus completing the process. The Board wished to commend the Medical Director and his team for their efforts in this area. MD07 The Board were referred to the end of year Emergency Planning Report appended to the papers. They were also informed that the Emergency Planning Team received a letter of commendation from the Chief Constable for their work with PSNI recently. The Emergency Planning Officer and his team were commended for all their work during this year. HUMAN RESOURCES Director of Human Resources updated members highlighting the following: HR01 It was reported that sickness absence this year is the lowest recorded for the past 10 years, however the Trust has not met the PFA target. It was noted that there have been a lot of pressures this year with CSR efficiencies which involved changes to staff rotas, the severe winter and staff absent with swine and seasonal flu. The two main reasons for staff absence however are muscular skeletal injuries and stress. Occupational health is now seeing staff within 5 days of referral for muscular skeletal issues. It was further noted that NIAS has the lowest recorded sickness absence in administration and Senior Managers for the 6 HSC Trusts. Significant work is ongoing and monthly meetings with Managers are continuing. Further discussion ensued with the Director of Human Resources giving detailed information on staff absence. The Board considered that the delay in implementing Agenda for Change may also have had impact on sickness absence with uncertainty around pay bands for Paramedics and EMTs. The target for next year is 5.2% which will be very challenging for the Trust to achieve. It was noted that the Director of Human Resources would customarily provide a comprehensive breakdown on sickness absence in her end of year report in July 2010. She also intends to present a Mental Health & Wellbeing Policy for approval by the Board. Work will continue in this area which is a high priority for the Trust. HR02 Target achieved. The Training team were commended by the Board. HR03 No longer applicable. HR04 Work in progress. The Trust is working to action plan agreed by Joint Working group. Trade Unions are still to nominate Staff Side representative. HR05 Director of Human Resources noted an error within the report. The date for total complaints should read as 31/03/10. Delays have been experienced in responding to some of the complaints and this has been mainly due to competing priorities for Managers. Awareness Level Training for staff is ongoing with 400 staff trained to date. The review of the Trusts Complaints Procedure is in final draft and a copy has been sent for comment to the Patient & Client Council. The Human Resources team were commended by the Board. The Chief Executive proposed and outlined a new format for assurance reporting which will give a holistic view for the reporting of activity. This would include objectives and actions with risks to delivery identified. This will underpin performance management with supporting evidence. Some discussion ensued with the Board agreeing that a new format for performance reporting to be used at the July 2010 Board meeting. Action: Chief Executive. 8.0Application of Trust SealThe Trust Seal has not been used since the last Trust Board meeting.  9.0Forum for QuestionsNo questions received from the floor. 10.0Any Other BusinessNo other business. Date, Time and Venue of Next MeetingThe next meeting of the Trust Board will be held on Thursday, 1 July 2010 in the Northern Division. Venue to be confirmed. The Chairman thanked those present for attending and called proceedings to a close. 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