South East Coast Ambulance Service NHS Foundation Trust Trust Board Meeting to be held in ...

117 Pages·2012·4.21 MB·English

South East Coast Ambulance Service NHS Foundation Trust
Trust Board Meeting to be held in public.
27 October 2016
10:00
Tangmere Make Ready Centre
City Fields Way, Tangmere, PO20 2FT
Agenda
Item Time Item Encl. Purpose Lead
No.
117/16 10.00 Chairman’s introduction - - PD
118/16 10.01 Apologies for absence–KS; FO - - PD
119/16 10.02 Declarations of interest - - PD
120/16 10.03 Minutes ofthe previous meeting:27September 2016 Y Decision PD
121/16 10.05 Matters arising(Actionlog) Y Discussion PD
Organisational culture
122/16 10.10 Patient story - Set the tone JC
123/16 10.15 Chief Executive’sreport Y Information GD
Trust strategy
124/16 10.25 STPs, STPengagement and the Trust’s role in them. Y Discussion JA
125/16 10.35 Emergency Preparedness, Resilience and Response Y Information AN
Assurance Report
Allocating resources to achieve plans
126/16 10.45 Winter Capacity Plan Review Y Information IF
127/16 10.50 Call Handling Y Assurance IF
128/16 11.00 Defibrillators–clinical review Y Information AN
RM
129/16 11.10 Extension to East Kent 111 service Y Discussion JA
130/16 11.20 Improving clinical governance - Discussion EW
Ten minute Break
Monitoring performance
131/16 11.40 Integrated performance report Y Discussion SS DH
AN SG
132/16 12.00 Mortality and morbidityreviews and learning Y Discussion RM
133/16 12.10 SeriousIncidents Y Discussion EW
Holding to account
134/16 12.20 Finance & Investment Committee Y Information GC
Escalation report from meeting: 20 October 16
135/16 12.25 Audit Committee Y Information TW
Escalation report from meeting: 4 October 16
136/16 12.30 Quality and Patient Safety Committee Y Information LB
Escalationreport from meeting: 11 October 2016
137/16 12.35 Any other business - Discussion PD
138/16 - Review of meeting effectiveness - Discussion ALL
-
Close of meeting
Date of next Board meeting:24 November 2016
After the close of themeeting, questions will be invited from members of the public.
South East Coast Ambulance Service NHS Foundation Trust
Trust Board Meeting,Tuesday 27 September,2016, 9.15am
Brighton Racecourse, BN2 9XZ.
Minutes of the meeting, which was heldin public.
_________________________________________________________________________________
Present:
SirPeter Dixon (PD) Chairman
TimHowe (TH) Non-Executive Director
LucyBloem (LB) Non-Executive Director
Alan Rymer (AR) Non-Executive Director
Terry Parkin (TP) Non-Executive Director
Katrina Herren (KH) Non-Executive Director(from item 16.065)
Graham Colbert (GC) Non-Executive Director
Trevor Willington (TW) Non-Executive Director
Geraint Davies (GD) Acting Chief Executive
David Hammond (DH) Director of Finance
Rory McCrea (RM) MedicalDirector
Andy Newton (AN) Director of Clinical Operations
Jon Amos (JA) Acting Director of Commissioning
Ian Ferguson (IF) Interim Director of Operations
Steve Graham (SG) Interim Director of Human Resources
Emma Wadey (EW) ActingDirector of Quality and Patient Safety
In attendance:
Janine Compton (JC) Head of Communications
Andy Chittenden (AC) Interim Trust Secretary
094/16 Chairman’sintroductions.
The Chair welcomed a new director, Emma Wadey to the meeting. She joins the Trust on a secondment as
Director of Quality and Patient Safety.
The Trust would participate in a CQC quality summit the following day, bringing to a conclusion, with the
publication of a report, the Trust’s CQC inspection, which occurred in May 16. The report and press releases
regarding it remain embargoed until tomorrow.
The Trust’s appointed headhunters continue the search for candidates who will be considered for
appointment as CEO.
PD explained that the Trust Board meeting held in public would be followed by two other meetings open to
the public; the Council ofGovernors’ meeting and later in the day, the Annual Members’ Meeting.
095/16 Apologiesfor absence.
Kath Start Director of Nursing & Urgent Care.
Francesca Okosi Director of Workforce and Transformation
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096/16 Declarations of conflicts of interest.
The Trust maintains a register of directors’ interests. IF had previously declared to the Board that he is an
employee of Lightfoot, a company which provides goods and services to the Trust and from which he has
been seconded short term to assist the Trust in improving operational performance. No further declarations
were made in relationto agenda items.
097/16 Minutes of the meeting held in public on27 July16.
The minutes were approved as a true and accurate record after several minor typographical amendments
were made.
In agreeing the minute regarding defibrillators at 16.067, the Board was not yet assured if the Trust’s
arrangements regarding public access defibrillators had caused harm, or not. Whilst several papers had
been provided to the directors on this topic, including one in September 16, the Board remained concerned
thata clear analysis had not been completed and it could not yet form a view on the matter.
Action:
A paper for the October Board setting out if patient harm had occurred as a result of the Trust’s defibrillator
arrangements–AN, RM.
098/16 Mattersarising (action log).
The progress made with outstanding actions was noted. Completed actions had been removed from the log.
099/16 Patient story.
A video was played to the meeting in which a patient who had benefitted from the Trust’s responses
recounted his experience and what it meant to him. Having been involved in a motorcycle accident, he
described the caring, professional, compassionateapproach of SECAmb’s paramedics.
100/16 ActingChief Executive’s report.
GDbriefed the Board on developments during the past few days since his report had been written.
Although the report from the CQC resulting from its May 16 inspection of the Trust was embargoed until the
following day, the Trust had been able to plan communications to staff and stakeholders, as well as drop in
sessions for staff, for the days immediately afterwards, to ensure that all staff and stakeholders were
appropriately briefed.
GDthanked all those involved in planningfor and participating in theSurvivorsevent the previous Sunday at
which patients who have experienced life-saving treatment from SECAmb staff are able to be reunited to
celebrate. A video recounting some of the stories would be shown at the Annual Members’ Meeting.
GD also paid tribute to 40 SECAmb staff who responded in 2015 to the Shoreham air disaster, for which a
private service will be held on 6 October.
The Trust continues to engage with stakeholders to seek a regional policy that is in patients’best interests in
regard to hospital handover. This is a complex agreement to achieve but essential to the high quality care
that patients need.
101/16 Recovery plan
The paper provided to the Board set out revised, strengthened governance arrangements for the unified
recovery plan.
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Management assurances were sought and provided that:
 All programme management office (‘PMO’) appointments bar 1 had now been made;
 Internal Audit were to shortly review the PMO arrangements and this will be reviewed by the Audit
Committee and available to all directors;
 The controls established by the PMO were reflected in the Board’s assurance framework;
 The programme risks which had been identified are to be managed through the Trust’s risk register;
 The Trust’s initiative register is subject to a change management process, which promotes projects
with a mandate whilst holding those back which have not been through appropriate scrutiny and
challenge;
 The focus achieved by the PMO remains that of the 8 corporate objectivesfor 16-17;
 A weekly challenge session including GD and the Improvement Director was now in place and will
achieve a new level of accountability for project leads;
 This willallow monthly progress against a clear plan to be reported;
 The Executive will continue to be open and honest about the progress being made and will escalate
to the Board areas where progress is slow or unachievable with existing resources;
 Future reporting to the Board will be in a format that provides assurance that progress against
specific improvement tactics is being achieved, rather than a copy of the action tracker;
 An example if such reporting was the presentation on 999 performance to be made by the Interim
Director of Operations during the performance item (16.103) later in themeeting;
 The costs associated with recovery are being identified and allocated in order to plan to resource
relevant areas of the Trust’s front line services and governance structure and to report against them
accurately;
The report was noted.
102/16 Ambulance Response Programme(‘ARP’)
IF briefed the Board on the nationwide ARP, which has been piloted in some ambulance Trusts and which
the remainder are now being invited to join. The programme introduces some subtle differences to call
handling, despatch and reporting of performance. SECAmb will be going live with two revisions to the
protocols which it uses on 18 October; known as ‘nature of call’ (‘NoC’) and ‘despatch on disposition’
(‘DoD’), subject to Board approval.
IF explained to the Board that the relevant training of staff was planned and being implemented and that the
planning process included relevant clinical and IM&T leadership. The Trust is working to a template ‘go live’
plan provided by NHS England. Assessments of clinical risk have been made, including a review of process
changes by the Medical Director.
Management assurances were sought and provided that:
 The Trust had already engaged with early adopting ambulance Trusts (there are 6) to gain an insight
about the go live process and the patient safety aspects and potential benefits of the programme;
 As a result of the programme the Trust may need to plan to amend the ratio and numbers of
different types of vehicles in the fleet;
 Under the auspices of the programme, responses tourgent calls would be faster than currently and
responses to non-life threatening calls are allocated additional time for a response;
 The Trust’s arrangements for assessing clinical risk had been involved in planning to accept the
invitation to go live;
 Learning from alerts; incidents, claims, safeguarding referrals; complaints and other sources of
intelligence about clinical quality were being evaluated independently with a view to strengthening
them;
 The Executive would keep under constant review the intelligence arising from the system when it
goes live, to detect any sign of a dip in performance or a reduction in safety;
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 The programme would be subject to review under the PMO arrangements;
Resolution
The Board resolved by verbal assent to approve the Trust’s participation in the national ARP effective 18
October 16.
(One director, KH, asked that the minutes record that she reserved her position on the matter, pending
learning more about the Trust’s capability to learn and change as a result of quality governance
arrangements).
103/16 Integrated Performance Report
GD summarized the performance of the Trust noting that the 111 service had performed well against peer
Trusts nationally and also ahead of its planned recovery trajectory. The Board welcomed this short term
improvement.
In other respects, across workforce, quality, performance and finance metrics, there remained a general
underlying under-performance that was responding slowly to recovery tactics, whilst further specialist
management andleadership capacity was embedded within the Trust.
Appraisals had been explored by the Board’s assurance committee (known as Workforce & Wellbeing
Committee, ‘WWC’) in the previous week and the committee intended to escalate to the Board its own
concerns that the system of internal controls supporting appraisals, mandatory training and staff retention
were inappropriately designed andoperating ineffectively.
The inclusion of whistleblowing and bullying/harassment statistics in the dashboard was welcomed.
Workforce
Management assurances were sought and provided that:
 Addressing below planned levels of mandatory training and appraisal was highlighted as a concern
by the CQC and isincluded in the recovery plan;
 A sample of completed appraisal documents have been audited and found not to exhibit best
practice principles; and as a result, appraisal processes were to be redesigned;
 An online system for governing appraisals was being piloted;
 Abstracting staff to ensure mandatory training and appraisals were completed could impact on
operational performance if not properly built into a workplan, which would be addressed;
 The Director of Quality and Patient Safety has been registered with the office of the National
Guardian as the Trust’s Freedom to Speak Up Guardian, the effect of which will be to ensure that the
Trust is linked in to any themes arising from whistleblowing instances concerning the Trust;
 Further action was being taken to improve data quality supporting HR metrics;
 A programmeof action to address a lack of staff in key operational areas such as EOCs was in place
and expected to improve staffing levels by March 17, but the Board should note that full
establishment would not deliver the 75% operational target as the Trust was not commissioned for
that level of activity by commissioners.
Actions
1. A paper for the November Board on planning for winter pressures (in particular human resource
planning). SG; IF.
2. Staff retention would be added as a risk to the risk register. (Immediate, SG).
Operational performance
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Four CCGs have tendered the east Kent 111 service. The Trust has been asked to extend its provision of
service pending the outcome of the tender exercise.
A presentation was made on the changes being made to the system of internal controls supporting 999
operations. The intention of management is that by putting in place a more appropriate system of controls
which operate effectively, performance will improve.
IF described to the Board the redesign of the system of controls (referred to as the integrated performance
model) relating to resourcing; demand management; response times (i.e. call answering); performance
management; performance information and staff engagement.
It was explained that based on an analysis of data, there is a strong correlation between the daily resources
used by the Trust’s 999 service and the daily performance achieved. If all current resources were used with
current processes, performance of around 50-55% against Red 2 would be achieved. This analysis proves the
case for a redesign of the system of controls used in operations.
It was explained that the risks to the programme of improvement have been identified and assessed and
mitigation plans developed. They include:
 Stakeholder engagement and support;
 A strengthening of management in operations;
 External assurance from SCAS and Lightfoot
The PMO is providing support to the programme. It is being reviewed fortnightly by the senior operations
leadership team. IF confirmed that he has spoken outside of formal meetings with a number of non-
executive directors to ensure they have an up-to-date understanding of the issues and is welcoming of
challenge.
It was underlined that even with the intended benefits of the redesign of internal controls described in the
presentation, the service commissioned by the CCG would not achieve the 75% target. The 999 service is
under-funded by commissioners and the Executive would continue to highlight to commissioners the
evidence that the contract sum agreed with the Trust would not purchase a service that delivered 75%.
Actions
1. A paper to the October Board on the east Kent 111 service extension (IF).
2. 999 improvement trajectories to be reported in theintegrated performance report (October, IF).
Quality
The Board accepted the quality dashboard as read.
Finance
The Trust continues to forecast a year end outturn of a deficit of £7.1M. A reforecast at the end of Q2 will
be undertaken and included in the October Board report. That reforecast will identify exceptional costs
associated with recovery (even if they are expected to be carried for a second year to build sustainability)
and other recurrent costswhich are a part of the Trust’s structural deficit.
A recurring overspend in the 111 service was reported, on account of high staff turnover and increased
training hours being delivered to new starters.
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On account of the Trust’s deteriorating financial position, a working capital facility will need to be in place in
early 2017 and negotiations with potential creditors have commenced. The Board will need to sign off any
agreement for a working capital facility.
The report was noted.
104/16 Learning from safeguarding, litigation, incidents and complaints.
The Board acknowledged the existing poor data quality associated with the report and poor practice which
exists within SECAmb. Management assurances were sought and provided that the system of internal
control is being redesigned to improve dataquality and practice.
EW briefed the Boardon the terms of reference ofan independent review requested by the Trust, provided
by NHSI, into the strength of governance systems supporting incident management, complaints and
safeguarding. Governance improvements will be facilitated by the implementation of a suite of modules on
the Datix platform, accompanied by training and recruitment of specialist clinical governance practitioners.
A report will be provided to the Board for the October meeting on this subject. It was explained that the
team supporting quality governance will beco-locatedtogether in Crawley as a consequence of the move in
2017.
Management assurances were sought and provided that:
 IM&T resources will be made available to support clinical governance developments;
 The Director of Quality & Patient Safety will be resourced sufficiently to succeed;
 The recent re-focusing of attention on security matters was linked to the success of awareness
raising campaign connected to the hiring of asuitably qualified and effective individual;
Actions
A paper to the October Board on improvements to clinical governance (EW).
A paper to the October Board on reducing the backlog of incidents yet to be investigated (EW).
Action
The Executive to collate a management response to each of the points escalated within the escalated
reports resulting from QPS and WWC committees, and to circulate them to the Board in the following week
(Exec Team).
105/16 Escalation report, Quality and Patient Safety Committee(‘QPS’), meeting on 1 Sept 16
Deferred.
106/16 Escalation report,Workforce and Wellbeing Committee(‘WWC’), meeting on20 Sept 16
Deferred.
107/16 Any other business
There was none.
107/16 Review of meeting effectiveness
Directors were positive aboutthe 999 presentation in particular.
There being no further business, the meeting closedat 11.15am
Signed as a true and accurate record by the Chair: __________________________
Date __________________________
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________________________________________________________________________________________
Questions from observers
After the meeting had closed, the Chairman invitedobservers to attend the Council of Governors’ meeting
which would be convened some 20 minutes later and the Annual Members’ Meeting, which would be
convened later the same day.
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South East Coast Ambulance Service NHS FT action log
Meeting Agenda Action Point Owner Completio Report to: Status: Comments / Update
Date item n Date (C, IP,
R)
26.7.16 063/16 The Board to receive further assurance as to the training, Ian Ferguson October Board IP WWC received asurance on workforce
ongoing development and staffing to establishment plans of call planning and recruitment on 20 Sept as
takers and despatchers in October (IF). a preliminary step to providing
assurance.
On October Board draft agenda.
26.7.16 064/16 The Red3 patient impact review to be shared with directors in Rory McCrae September Board C On agenda - October.
August (RM).
26.7.16 069/16 A paper to the Board on incident reporting metrics and themes Emma Wadey October Board C On agenda - October
(October).
26.7.16 071/16 The format of subsequent SLIC reports to the Board evidence Emma Wadey October Board IP Links to SI paper on agenda - and
much more overtly what has been learned and how the Trust’s development of Quality & Safety
practice has been changed as a result to safeguarding, incident Report
reporting and investigation, complaints investigations and claims
(October, RM, AN).
26.7.16 071/16 RM, AN and KS to work with TP in relation to learning from Rory McCrae, Andy Autumn Board Not yet
safeguarding practice (autumn 16). Newton due.
(Emma Wadey)
26.7.16 071/16 A paper on mortality, mortality review and harm incidence to the Rory McCrae, Andy October Board C On agenda - October
Board (October, RM, AN). Newton
26.7.16 076/16 The Executive to clarify the arrangements for sighting the Board Rory McCrae September Board IP Serious Incident Policy remains under
in real time on serious incidents and as fast as reasonably (Emma Wadey) review. This action aligns with 071/16 .
practical on the learning and change in practice arising from
incident investigation (September, RM).
26.7.16 086/16 The Board to participate in a workshop on cash and working David Hammond September Board IP Outstanding but planned for FIC item
capital to support the Trust’s liquidity (September, DH). 20 October
26.7.16 097/16 A paper for the October Board setting out if patient harm had Andy Newton October Board C On agenda - October
occurred as a result of the Trust’s defibrillator arrangements – Rory McCrae
AN, RM.
26.7.16 103/16 A paper for the November Board on planning for winter Steve Graham November Board C On agenda - October
pressures (in particular human resource planning). SG; IF. Ian Ferguson
26.7.16 103/16 Staff retention would be added as a risk to the risk register. Steve Graham Immediate Risk register C Added to the Risk Register
(Immediate, SG).
26.7.16 103/16 A paper to the October Board on the east Kent 111 service Ian Ferguson October Board C On agenda - October
extension (IF). Board
26.7.16 103/16 999 improvement trajectories to be reported in the integrated Ian Ferguson October Board C Included
performance report (October, IF). Board
26.7.16 104/16 A paper to the October Board on improvements to clinical Emma Wadey October Board IP Verbal update provided at October
governance (EW). Board board with a paper to Nov Board
26.7.16 104/16 A paper to the October Board on reducing the backlog of Emma Wadey October Board C On agenda - October
incidents yet to be investigated (EW). Board
26.7.16 105/16 The Executive to collate a management response to each of the Exec Team Immediate Circulate C Circulated to board members by email
points escalated within the escalated reports resulting from QPS outside on 4 October 2016
and WWC committees, and to circulate them to the Board in the meeting
following week (Exec Team).