ࡱ>      zbjbjcTcT 4|>>Yq+ 777KKK8lKHGGGGGGGILlG7c"GG87GGRk9K<Ps5K=d_:GG0H}: M^ M<K< M7K<` GGH M : NORTHERN IRELAND AMBULANCE SERVICE  Present: Mr P Archer ChairmanMr L McIvorChief ExecutiveProf M HanrattyNon-Executive DirectorMr N McKinleyNon-Executive DirectorMr S MullanNon-Executive DirectorMr S ShieldsNon- Executive Director Mr B McNeillDirector of OperationsMs R OHaraDirector of Human ResourcesDr D McManusMedical DirectorMrs S McCueDirector of Finance In Attendance: Mrs M CrawfordExecutive AdministratorMiss K BaxterSenior Secretary 1.0ApologiesMr Frank Hughes, 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. Mr Archer stated that notification had been received from Mr Dixon from the Patient & Client Council (PCC) that he would not be attending todays meeting. 3.0Minutes of the Previous Meeting of the Trust Board held on 26 November 2009Members accepted the minutes as a true and accurate record of proceedings on the proposal of Professor Hanratty, seconded by Mr McKinley, subject to the following amendments: Item 9.1, Page 9 - end of second paragraph where it says He stated that the Non-Executive Directors can only review arrangements and cannot be responsible for them. Mr Mullan asked that the end of the sentence be amended to read He stated that the Non-Executive Directors can only review arrangements and make recommendations as they have no executive authority. Item 9.1, Page 10, third paragraph, first line. Mr Mullan asked that an insertion be put in at the end of the sentence where it says He added that he would be writing to the DHSSPS in this regard should now read He added that he would be writing to DHSSPS in this regard as Chair of the Audit Committee.4.0Matters Arising4.1NIAS Governance ArrangementsMr Archer referred to the document presented which captures what the Board had agreed at the Governance Workshops in relation to the review of governance arrangements for NIAS. He highlighted the main recommendation which is that NIAS four Committees should become three. Membership of the Committees would be made up of Non-Executive Directors, however Executive Directors and Trust Officers can be in attendance. He also stated that the new process and time-frame for agreeing minutes will be actioned as soon as possible. He further explained that minutes will be agreed electronically by members to enable presentation to the Board in a more timely fashion. The Board were all in agreement to this new process. Mr McIvor stated that the lead Executive Directors and the forthcoming Chairs of Audit and Governance Committees will meet to amend and/or develop the Terms of Reference which will be presented to the Board. Standing Orders will be amended to reflect the decision of the Board and presented to the Board for ratification. Board members were in agreement to proceed on this basis. Action: Meetings to be arranged for the revision of the Terms of Reference. Standing Orders to be amended and presented to the Board. 4.2Efficiency Savings and Comprehensive Spending Review InvestmentMr McIvor advised the Board that following Ministerial approval NIAS has undertaken the necessary steps to implement efficiency savings. Phase I was implemented in October 2009 and we are currently in Phase II which was implemented at the beginning of December 2009. Mr McIvor reminded the Board that Phase III was due for implementation on 1 April 2010. Further information would be provided by Mr McNeill and Mrs McCue in the Operational and Financial Reports. 4.3Review of Retention and Disposal Schedule Mrs McCue updated the Board and it was agreed that a letter be sent to the DHSSPS outlining and emphasising what the Trust Board have considered in regard to the legislative requirements of retaining documents. It was agreed that this letter be appended to the Retention and Disposal Schedule to ensure clarity in relation to the retention of records, particularly in respect of future consideration of the Schedule. Action: Mrs McCue, Director of Finance.4.42010 Trust Board Schedule of Meetings Members of the Board agreed the proposed dates for Trust Board meetings. 4.5Infection, Prevention and Control PolicyDr McManus updated the Board advising that the Policy has been submitted as agreed at the last meeting of the Board following consideration by Clinical Governance committee of the RQIA response. The Board enquired in respect of healthcare acquired infections attributed to NIAS. Dr McManus responded that to date there had been no evidence of healthcare infections attributed to NIAS. It was noted however that it was important that NIAS maintain vigilance in this area.4.6HR Performance Reporting Ms OHara updated members advising that following the last Board meeting she had met with Mr McIvor and reviewed the HR Performance Report. Following this meeting she met with HR Senior Managers in relation to developing a method to capture core HR information. She welcomed the opportunity to provide this information which will demonstrate the work of the HR Directorate. She planned that the work would be finalised by year-end to support revised HR performance reporting for 2010-2011. She further advised that she intended to present the end-of-year Report to the Board in July 2010. Mr Archer and the Non-Executive Directors welcomed this development and Mr McIvor commented that the feedback from the Report provided NIAS with an opportunity to learn. 5.0Chairmans Business5.1Visit to Banbridge Station Mr Archer commented that the visit to Banbridge Station was very enlightening and he welcomed the opportunity for the Board to visit regional Stations. He was generally impressed with the Station which was neat and tidy with good facilities; however it was noted that the Station was somewhat cramped for storage. He was able to talk to the A&E crew which rarely happened during station visits as they were often engaged in patient response activity. Prof Hanratty commented that it was a very pleasant and hospitable visit. Mr McIvor advised that the cramped conditions experienced by the Board during their visit could be attributed in part to the presence of eleven additional personnel above the norm (Board members and Area officers). 5.2Chairmans UpdateMr Archer gave a brief outline of his diary commitments since the last Board meeting: Pre-Meeting on 4 November 2009 with George Dickson, facilitator of the Governance Workshops, in preparation for the next Workshop scheduled for 18 November 2009. Christmas Reception Mr John Compton of HSC Board. Corporate Strategy Workshop 22 January 2010. Meeting chaired by Dr Ian Clements to include the Chairs of the Trusts, Commissioning Groups and the Chair of Public Health Agency. Mr Archer continues his weekly meetings with Mr McIvor.6.0Chief Executives Business6.1Chief Executives UpdateMr McIvor gave a brief outline of his activities since the last Board Meeting and remarked that it has been a busy period in relation to maintaining service response in light of the weather and other pressures. The key highlights are as follows:- Met with the new Clinical Support Officers (CSOs) in December 2009. Has become a member of the Northern Ireland Confederation Representatives Group which will enable Mr McIvor to reinvigorate and challenge them to become a more effective voice for the health care system. Mr McIvor has attended two meetings so far. January 2010 - met with the family of a complainant where the patient had died. The background and nature of the complaint centred around alleged acts/omissions by NIAS. The meeting was well received by the family and it provided Mr McIvor with a good opportunity to hear directly from members of the public about the Service. It also gave him an opportunity to offer condolences, apologise and give reassurance to the family that the issues raised have been addressed and are being rectified. Attended two Strategy Workshops, one in November 2009, the other in January 2010. Attended Governance Workshop in December 2009. In January 2010, met with Pat Ramsey, MLA regarding issues in the West. This was a challenging and robust meeting. In January 2010, attended Ambulance Chief Executives Group (ACEG) meeting in London. These meetings provide an excellent opportunity for NIAS and their UK counterparts to exchange views and experiences. It also provides an opportunity for the Ambulance Services to share and benchmark with each other. Along with Dr McManus met with West of Ireland Air Ambulance. At this meeting, NIAS outlined their own position as well as the position of both the HSC Board and Department. It was also emphasised that NIAS main priority is to provide the best possible care to the patient. Nonetheless, if an air ambulance can be established in the future, NIAS will welcome this as an additional and complementary resource to the service. Mr Shields commented about NIAS performance during the big freeze and advised that he had recently read an article where it was reported that an emergency vehicle got stuck in the snow when responding to a 999 call and had to be rescued by a farmer. Another ambulance arrived at the scene and it also got stuck. Mr Shields enquired if NIAS would be better equipped in future to cope in cold conditions. Mr McIvor responded by agreeing that the recent cold spell certainly imposed various difficulties for NIAS, although ambulance crews showed initiative in challenging circumstances, for example, where conditions were difficult, they reached patients by foot. It was commended how staff went the extra mile to ensure continuity in delivery of care to patients. Mr McNeill reported that he was delighted that no ambulances were damaged or lost in the bad weather and advised that the market is limited which allows NIAS to build on and improve a vehicle. He further advised that at present NIAS have no plans to change vehicles to account for 2/3 weeks of inclement weather per year. Mr Shields responded that the limitation of vehicles in such circumstances was embarrassing to the crew and that investment in 4x4s would be much better. Mr McIvor advised that such risks are considered and managed and procedures are put in place to mitigate those risks within the context of providing the service throughout the year. Mr McNeill advised that the procurement market has been tested and we are procuring the most effective vehicle available for our use. It was also highlighted that most services follow the same pattern for procurement of vehicles. 7.0Performance Reporting as at 31 December 2009 OPERATIONS Mr McNeill updated members as follows:- OP1 - Mr McNeill reported that there was a drop in figures from November (73.4%) to December 2009 (72.2%). This was mainly due to the adverse weather conditions. Reasons for the fall also include: The Trust experienced a higher volume of 999 calls (11,370), an increase of 11% from November. Mr McNeill advised that out of these 999 calls, half were Category A calls which involve extra time and work. Adverse weather conditions affected the performance but it was noted NIAS coped well in these circumstances. It was also noted that the worst affected area was the North and West of the province. The response dropped on average from 63/62 to 53%. Mr McNeill highlighted that the poor weather conditions caused significant difficulties to crew. There was a notable increase in fractures with longer hospital turnaround times and excessive trolley waits. The average turnaround time of 15 minutes was increased to 30 minutes at the majority of hospitals, with 60/90 minutes at others. Although this was primarily out of NIAS control, action was taken to initiate diverts to other hospitals thereby alleviating some of the pressure. Year 2 Efficiency Savings were put in place in December 2009. Despite this Mr McNeill was pleased to report that NIAS achieved our PFA Target with faster response to more Category A calls in comparison with the same period last year. He also commended St John Ambulance for their contribution as part of NIAS contingency plan, who was engaged by NAIS to provide additional cover during evenings and weekends. Professor Hanratty commented that the Board should formally recognise the efforts of staff during the Christmas/New Year period where crews went the extra mile to ensure continuity in delivery of care, and acknowledged the extra efforts that crews made during this period. Mr McIvor and Mr McNeill have already issued a communiqu to staff in this regard, however Mr McIvor suggested that Mr Archer could send a communiqu to staff commending them for their efforts during this period. Mr Archer agreed to this point of action. Mr McKinley enquired if there was anything obvious which NIAS can do to be more effective in adverse weather conditions. Mr McNeill responded by saying that it is normal to have a spike of demand for December. NIAS managed well as a result of the preparation undertaken and the management of pressures as they arose, although Northern Ireland did not experience the same severity of weather as some areas in the United Kingdom. NIAS have arranged to meet with colleagues at the DHSSPS of in order to share learning and concerns and better prepare the system for the future. OP2 & OP3 - It was noted that there was a drop in the response levels for the same reasons highlighted above. It took longer for crews to reach calls and longer handovers at hospitals. OP4 - There has been a sizeable injection of cash for fleet and it was noted that 3.4 million has been spent. We are currently in the process of finishing work from last year. The bulk of our work involves the conversion of 24 ambulances which should be completed by March 2010. NIAS are currently waiting for 4 vehicles to be delivered and have procured 14 PCS vehicles for build next year. 4 vehicles have been purchased for replacing the Toyota RRVs. 10 RRVs have been purchased, some for replacement, some for new. Mr McNeill commented that there is a lot of ongoing work in this area. Professor Hanratty enquired how NIAS is meeting targets for the replacement of old ambulances. Mr McNeill responded by saying that there is a clear rise in the figures presented, rising from approximately 26% in April to 40% in December 2009, of NIAS fleet being less than 5 years old. Prof Hanratty enquired if there has been any movement on making better use of NIAS resources. Discussion ensued in relation to the procedure for booking ambulances and Mr McNeill advised that following a presentation at the Directors Forum it was agreed that Patient Care Services (PCS) required a review. The question of GP fundholding was raised however it was advised that GP Fundholding no longer applies and there is currently no GP budget for ambulances. Mr McIvor agreed that there were problems encountered when booking ambulances and highlighted the lack of uncertainty and reassurance that could be given to the patient in relation to a booking. There also appears to be some confusion by the clerk/agency nurse at the time of making the booking, as they are not fully conversant with rules and procedures and are not aware of the stipulations. Mr McNeill remarked that there is a lot of work to be done in this area. He also stated that last year PCS transported 218,000 non-emergency patients. OP5 - Mr McNeill reported that NIAS have secured funding to carry out feasibility studies in 2010 to look at potential sites for new stations. Public service properties will be looked at and if sites show potential, design and specifications can be drawn up. NIAS are also planning a deployment point in Coalisland which is hoped to be in place by year end. Action: Mr Archer to issue a communiqu to staff to commend them for their efforts during adverse weather conditions. FINANCE Mrs McCue updated members highlighting the following: FN01 - There is pressure on the public sector and on health authorities, funds are limited and are likely to become more limited in the near future. All Trusts are required to break-even by year end. Mrs McCue advised that NIAS are currently facing a deficit of 78,000 due to spend in planning for the pandemic flu. It is hoped that this cost can be recouped from the Department. Mrs McCue was pleased to report that NIAS anticipate break-even by year end. FN02 - Over the three year period NIAS are to deliver savings of 4.4 million by 2011. This figure may be revised upwards. It was reported that NIAS are achieving savings for the current financial year and are expected to achieve the requisite figure of 4.4 million next year. In achieving these savings the Trust has looked at overall expenditure and it was noted that salaries are the largest area of spend. NIAS continue to plan on the basis of further investment as outlined in the 2008-2011 CSR allocations, the majority of which will be used for RRVs. The Trusts ability to achieve break-even is reliant on having access to those funds. Mr McKinley enquired about what would happen if the money is withdrawn and Mr McIvor responded by saying that Trust Board would be engaged in financial contingency planning for the revised financial position as had been undertaken this year, however it was very likely that there would be an impact on the service provided to patients. FN03 - As NIAS own little estate, with the majority of premises being rented from other Trusts, this Target does not have as big an impact on NIAS as it does for other Trusts. Disposals in this target mainly relate to vehicles. FN04 - The Trust is currently achieving 94.8% which has risen slightly. Mrs McCue was pleased to report that although this target is challenging to achieve, NIAS are on target. Mr McKinley enquired if it would be possible to exceed 94.8% in this area and Mrs McCue responded that this would be extremely difficult with our current financial and HR systems. FN05 - Mrs McCue advised that capital spend has been reduced by 1.5m with a further 1m of capital funding being removed from the 2009/10 funding allocation. This puts considerable pressure on the Trust and work is ongoing to ensure the priorities of the Trust are accommodated within the Budget. It was noted NIAS have spent 432K to date. FN06 On track to achieve. FN07 On track to achieve. FN08 - On track to achieve. MEDICAL DIRECTORATE Dr McManus updated members highlighting the following: MD01 Roll out of Thrombolysis continues and the issue concerning drugs has been resolved with all vehicles now equipped with drug packs. The problems in relation to mobile phones have been rectified and work is well advanced with new mobile phones currently being rolled out to vehicles. It is anticipated that work in this area will be completed in a few weeks before the end of March 2010 deadline. Dr McManus advised that the matter is being reviewed on a fortnightly basis. MD02 No incidents of healthcare acquired infections have been reported. Regular training in infection control is being given to current staff and is also included at induction for new staff. NIAS are monitoring the situation closely and it was noted that there is a lot of work involved particularly in vehicle cleaning. The Risk Manager and Medical Director continue to meet on a weekly basis to review the matter and report to the Risk Management Committee. Clinical Support Officers (CSOs) are undertaking an audit which enables NIAS to monitor activity and focus on difficult areas through training and development. NIAS takes this matter very seriously and continues to participate in meetings and development in this area. It was noted that hygiene inspections have already been carried out at the other five Trusts by RQIA staff and Departmental staff, however NIAS has not been included in this audit. NIAS have written to the DHSSPS with suggested dates for an inspection but as yet have not received a reply. Discussion then ensued as to whether it would be feasible for NIAS to appoint their own member of staff to lead in this area. It was noted that this was a possible option, and Dr McManus stated that it would be preferable if the person appointed was responsible solely for infection control. NIAS are to request support in this area from the DHSSPS. It was noted that although this is a regional issue and support should be given at a regional level, NIAS do not appear to be a priority for the DHSSPS in comparison to the other HSC Trusts. Dr McManus advised that the Healthcare Acquired Infection and Cleanliness Team, which had supported the Trust do not exist anymore which makes it difficult to obtain further support, however the Risk Manager has been engaging with the Health & Social Care Board in an effort to progress the matter. Mr McIvor suggested that we close down actions in the Report by the end of this financial year to enable us to consider other issues to be addressed next year. MD03 It was pointed out that the narrative in this section of his report was incorrect. Dr McManus advised that NIAS submitted the consultation scheme to the DHSSPS at the beginning of January 2010 and are currently waiting their response. It was noted that the Patient/Client Experience Standards were adopted at the Annual General Meeting in September 2009 which included induction training for staff. Dr McManus reported that he had a successful and constructive meeting with Richard Dixon from the Patient & Client Council. Dr McManus updated members with the results from the regional Patient Survey. It was noted that 44.7% of patients were identified as using an ambulance as a method of travel to hospital and a very positive report was received which related specifically to ambulance staff. Dr McManus is keen to put a positive message out to NIAS staff to appraise them of the outcome and results of the Survey. It was agreed that this should be issued along with the Staff Satisfaction Survey. MD04 NIAS continues to work with other Trusts and agencies regarding pre- hospital care. There has been a lot of work carried out in relation to the Respiratory Service Framework. Dr McManus advised that he was hopeful this would be finalised by the end of February 2010. Dr McManus advised the Board of an incident he was made aware of by a Consultant in Belfast as an example of the advances in patient assessment and care made by NIAS. A patient had taken an acute stroke and due to the actions of the ambulance crew involved in responding to the call in a professional, timely and efficient manner, and also by alerting the A&E Department at the receiving hospital a scan and thrombolysis was administered quickly. It was noted that the patient made a full recovery and was discharged from hospital 24 hours later. MD05 The appointment of the Clinical Support Officers (CSOs) has been well received and in particular welcomed by operational staff. NIAS are currently undertaking audits of clinical performance for spinal injuries and monitoring is ongoing for heart attacks and in relation to the administration of oxygen to patients suffering from chronic lung disease. Dr McManus reported that a process has now commenced in relation to changing of dressings. Work in this area continues to be reported through the Clinical Governance Committee. MD06 There have been some constraints in rolling out of pharmacy provision for some Divisions. This is due to circumstances out of NIAS control and partly attributable to the swine flu pandemic in creating extra pressure for the regional pharmacy in supplying antivirals and vaccines. Divisional work programmes have commenced and NIAS anticipate completion by end of March 2010. Dr McManus is confident that the process of rolling out will accelerate as it starts to happen. Pending progress in this area the issue of Controlled Drugs has been deferred. MD07 The Board were referred to the Emergency Planning Report appended to the papers. NIAS are continuing to monitor activity in relation to swine flu which has scaled down dramatically almost to zero. It was agreed that contingency arrangements could be stood down. Dr McManus remarked that the swine flu pandemic was an interesting experience and learning process for NIAS. Action: Dr McManus to liaise with the Communications Officer and arrange to issue a staff communiqu in relation to the results of NIAS Patient Survey together with results from the Staff Satisfaction Survey. HUMAN RESOURCES Ms OHara updated members highlighting the following: HR01 NIAS are working towards achieving the target for absenteeism by managing attendance. NIAS have commenced benchmarking with other ambulance services in relation to absenteeism. Additional investment will be made into Occupational Health for physiotherapy for treating muscular and skeletal injuries and an employee should receive physiotherapy within 5 days. Detailed information on staff absence was provided. Meetings continue with Human Resource Directorate staff and Senior Managers to look at each case individually. It was reported that over 50% of staff took up the swine flu vaccination which is a higher uptake compared to the other Trusts. Mr McKinley enquired about the national target and Ms OHara advised that NIAS are benchmarking at present so that this could be established. Professor Hanratty noted that the biggest percentage of injuries relate to muscular/skeletal and enquired what preventative measures are in place. Mr McNeill advised that there are training modules for strengthening muscles and for lifting of patients. Stretchers are also looked at in an effort to assist staff and prevent injuries. It was also noted that not all injuries sustained by staff are work related. It was also noted that in 09/10, absenteeism is the lowest it has been for 9 years. Work continues in this area and it was reported that we are just short of achieving our target. HR02 On track to achieve. Paramedic-in-Training Programme has been deferred until the next financial year. HR03 On target to achieve. HR04 On target to achieve. Project Manager has been recruited. Joint Working Group (JWG) has agreed action plans and timescales and NIAS has developed their action plan. It was noted that the NIAS management side lead is leaving to take up another position within NIAS. There is also an issue concerning the Union Staff Side lead. NIAS are endeavouring to resolve these issues. More detail will be presented to the next Trust Board meeting in March 2010. HR05 A change in the Complaints report is noted which will present complaints, which have been resolved during the period between Trust Board meetings. It was noted that a total of 85 compliments have been received since April 2009 and that the Compliments Report is a sample of compliments recently received. Mr Archer suggested that we take the same approach for Compliments and the Board agreed to this course of action. 8.0Policies /Procedures (for approval) Nothing to report.9.0For Noting9.1 Minutes of Clinical Governance Committee held on 3 September 2009 Noted.9.2 Minutes of Risk Management Committee held 3 September 2009 Noted. Page 3, first sentence of first paragraph to be amended from Ms Gregg advised that for paramedic and EMT posts, full job evaluations have been carried out..... to Ms Gregg advised that for paramedic and EMT posts, full job evaluations have to be carried out. 9.3 Minutes of the Audit Committee held on 3 December 2009 Noted.10.0Application of Trust SealThe Trust Seal has not been used since the last Trust Board meeting. 11.0Forum for QuestionsNo questions received from the floor.12.0Any Other BusinessNo other business.Date, Time and Venue of Next MeetingThe next meeting of the Trust Board will be held in the Western Division on Thursday, 25 March 2010 (venue to be confirmed). Mr Archer thanked those present for attending and called proceedings to a close. 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