Welsh Ambulance Services Nhs Trust

WELSH AMBULANCE SERVICES NHS TRUST

MINUTES OF THE OPEN SESSION OF THE MEETING OF THE QUALITY DELIVERY COMMITTEE HELD ON 24 JULY 2014 AT VANTAGE POINT HOUSE, CWMBRAN

PRESENT :

Emrys Davies Non Executive Director and Chairman Pam Hall Non Executive Director John Morgan Non Executive Director James Mycroft Non Executive Director Martin Woodford Non Executive Director

DIRECTORS:

Mike Collins Director of Service Delivery Mike Coupe Director of Strategy, Planning and Performance Judith Hardisty Director of Workforce and Organisational Development (OD) Sara Jones Director of Quality and Nursing Patsy Roseblade Director of Finance and ICT Jonathan Whelan Interim Director of Medical and Clinical Services

IN ATTENDANCE:

Kath Charters Staff Side Representative (UNISON) Wynne Evans Community Health Council (CHC) Representative Mick Giannasi Chairman of the Board Nigel Heal Staff Side Representative (RCN) Dawn Sharp Corporate Secretary

66/14 PROCEDURAL MATTERS

The Chairman opened the meeting and welcomed all in attendance and added that the agenda had been restructured in order to accommodate Executive Directors having to attend a commissioners meeting at 1:00pm.

Wynne Evans, CHC representative asked the Committee if the CHC protocol could be signed as soon as possible. The Chairman of the Board suggested that the document be signed by himself and the Chief Executive and then be formally reported to the Board.

RESOLVED: That

(1) the standing declaration of Mr Emrys Davies be noted;

(2) the minutes of the Committee held on 26 June 2014 be confirmed as a correct record; and

(3) the CHC protocol be signed by the Chairman of the Board and the Chief Executive and reported to the September Board. 67/14 A8 PERFORMANCE REPORT 1 The Director of Strategy, Planning and Performance referred Members to the report which set out the arrangements for monitoring and managing delivery of the A8 performance improvement target and confirmed that the target of 60% was to be achieved by the end of July 2014.

Pam Hall, Non Executive Director asked whether there could be a consistency of the colours used within the tables on page 1 of the report. Questions were raised in relation to whether there were any clinical issues in using the St John resource. The Director of Service Delivery explained that he was not aware of any because St John should only be used in the context of Community First Responder codes.

The Chairman of the Board asked whether average Cat A cycle times which seemed to be significantly more in the South East area was due to the difficulty in finding a resource. It was confirmed by the Director of Service Delivery that it was effectively due to the resource availability for allocation.

Concern was expressed by Kath Charters, Staff side representative that the term ‘War Cabinet’ was an unfortunate phrase to use when describing the regular Wednesday meetings held by Executive Directors due to the inferences it evoked, and it was agreed that an alternative title be found that afforded the gravitas it deserved without offending anyone.

Members held a detailed discussion which considered the contents of the report and it was agreed that the ongoing outstanding work undertaken by Health Informatics to produce the report be acknowledged by the Committee.

The Chairman of the Board suggested that this was now a key opportunity to communicate to all staff that their efforts were being recognised. He further added that this was an excellent report and contained the appropriate level of data which the Committee had been seeking.

RESOLVED: That

(1) the report be received;

(2) a communication be issued to all staff commending them on their efforts in supporting the performance improvement plan;

(3) the outstanding work undertaken by the Health Informatics Team be acknowledged; and

(4) a suitable title other than ‘War Cabinet’ be found to describe the regular Wednesday meetings attended by Executive Directors.

68/14 PLANNING AND PERFORMANCE MANAGEMENT SYSTEM

The Director of Strategy, Planning and Performance provided Members with an overview of the proposals which were to further develop the planning and performance management arrangements within the Trust.

The Director highlighted that the process of recruiting to the planning and performance team was progressing in that job descriptions and specifications were being drawn up

Martin Woodford, Non Executive Director asked in terms of the Integrated Business Plan 2 (IBP) whether due attention was being paid with regard to finance within the five domains as referred to in the report. The Director of Strategy, Planning and Performance confirmed that finance was weaved in to the five areas as opposed to it being treated as a separate exercise. It was emphasised by the Director that the need to deliver financial targets was not adequately referred to in the paper however he made it clear that the business planning cycle had to include, amongst other issues income and expenditure.

The Director further advised Members that the aim of the team was to provide clarity and the support of decentralisation on one hand. He added that it was also to provide a consistency of framework for the LHBs, Trust Board and Executive Team to understand the steps going forward.

Pam Hall, Non Executive Director raised a technical point in relation to the prospect of having seven mini IBPs and asked how differently activity would be allocated within each Local Health Board. The Director of Strategy, Planning and Performance advised that the seven Heads of Service would, with support, be able to localise the national contract which would align to the concept of decentralisation.

Kath Charters, Staff side representative raised the subject of border issues and reminded Members that problems around this had occurred in the past. She asked that from the very start, it was explicit within the mini IBP’s that the nearest resource was still being deployed to calls. The Chairman of the Board reassured Members that the issue of cross border functionality was at the forefront of the Local Health Boards Agendas.

RESOLVED:

That the report be received and the direction of travel as outlined in the paper be supported.

69/14 STB UPDATE

The Director of Strategy, Planning and Performance referred Members to the contents of the report and highlighted the areas which looked at the methods in which the Trust was able to balance its demand and capacity. He tabled a report (as requested by the Board on 17 July) which provided the ‘overarching narrative’ bringing together the PIP, ADP and STP and set out a number of proposals which had been reviewed and agreed by the Executive Team on 23 July. It was approved to extend the work on the clinical response model into a broader review and redefinition of the overall clinical model which would incorporate the more radical application of lean design principles. The Director highlighted the impact on Service Delivery if NHSDW was replaced by the 111 service and run independently of WAST.

The Director updated Members in terms of the timelines and added that certain areas would need to be brought forward which included the clinical model and the overall leadership project.

James Mycroft, Non Executive Director asked why the Clinical Contact Centre project was scheduled to take so long. The Director of Finance and ICT explained that the Trust was being delayed in its data collection exercise as staff were focussing primarily on performance delivery. The Director added that this was a realistic timeframe for the amount of work that was required. The Director of Workforce and OD advised that the Trust was required to adhere to the organisational change policy which required certain levels of engagements which was an iterative process going forward. There were, if the numbers of staff was going to be reduced, certain legal requirements which had to be taken into account when timelines were being identified. 3 John Morgan, Non Executive Director asked for an updated report to be provided at the next meeting in terms of the current situation with regard to NHS DW and 111. He also raised concerns with regard to clinical leadership moving to a single leadership development project and that this move could result in Clinical Team Leaders being seen as managers rather than senior clinical practitioners. The Director of Workforce and OD reminded Members that Clinical Team Leaders were local managers who were clinicians with varying levels of clinical expertise who had been appointed as the clinical leaders of teams. The Director further added that the clinical leadership project was about the development of a structure and not the principles of clinical leadership. The Director of Strategy, Planning and Performance added that ongoing work by the Deputy Director of Medical and Clinical Services and the Director of Workforce and OD was being conducted into clinical leadership to define what was meant by the term.

The Chairman of the Board sought clarification of the associated risks in terms of the potential disaggregation of NHSDW. The Director of Strategy, Planning and Performance confirmed that it was a risk and that the matter had not been determined could be inferred from the report.

The Director of Strategy, Planning and Performance updated Members in terms of the progress with regard to the ongoing recruitment of staff to his team and it was confirmed that a draft ‘team list’ would be provided at the next STB meeting.

The Chairman of the Committee asked that further feedback in terms of due dates be provided at the next meeting and that the active pursuance of staff recruitment to the directorate be supported by the Committee.

RESOLVED: That

(1) the update be noted;

(2) the Strategic Transformation Board at its next meeting be presented with a detailed update with regard to 111; and

(3) the active pursuance of staff recruitment to support the Planning team be supported.

70/14 CLINICAL AUDIT AND EFFECTIVENESS PROGRAMME UPDATE

The Interim Director of Medical and Clinical Services referred Members to the contents of the paper which provided a rolling update and considered the ongoing audit work programme.

Non Executive Directors sought clarification in relation to the triggers that led to the selection of clinical audit and effectiveness topics. The Interim Director of Medical and Clinical Services confirmed that future reports would include details of how the triggers were mapped out.

Members discussed the issues surrounding the learning processes that emanated from Serious Adverse Incidents (SAI’s) and Adverse Incidents (AI’s) and how they related to the clinical audit programme.

The Director of Quality and Nursing advised Members that within the Trust a team looked into the NICE guidance which ensured that any guidance was put into practice and that an audit trail existed. 4 RESOLVED: That

(1) the Clinical Audit & Effectiveness Programme (v1 2014/15) be approved; and

(2) future reports be prepared outlining the process for selecting clinical audit topics.

71/14 CONCERNS UPDATE The Interim Director of Medical and Clinical Services advised Members that there had been a significant rise in the number of open concerns in July 2014. He added that one of the reasons for this increase had been the pressure placed on operational performance which had a consequential effect in terms of delaying the progress of investigations. Martin Woodford, Non Executive Director asked that with regard to the Evans review, the Committee should consider the report in more depth at a future Quality Delivery Committee meeting. The Chairman referred Members to the work conducted within ABM Health Board and the closure of a number concerns to a satisfactory conclusion within a short space of time which the Trust should examine the merits of as a learning opportunity. He added that the Evans review had detailed a number of recommendations which the Committee would review in more detail at the next meeting. RESOLVED: That (1) the contents of the report be noted; and (2) the Evans report be reviewed in more depth at the next QDC meeting. 72/14 FINANCE REPORT

In view of the time constraints and the fact that the Month 3 position had been discussed by the Full Board on 17 July this item was received and noted without further discussion.

RESOLVED:

That the financial position as reported for Month 3 and the associated key risks and issues noted.

73/14 ANY OTHER ITEMS `

RESOLVED:

That the following items be deferred until the next meeting:

(1) Infection Prevention and Control Update; and

(2) Quality and Assurance Framework

RESOLUTION TO MEET IN CLOSED SESSION

Representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted in accordance with the requirements of Section 1(2) of the Public 5 Bodies (Admissions to Meetings) Act 1960.

Reports relating to the items of business in these minutes can be found on the Trust’s website, www.ambulance.wales.nhs.uk