WMAS Board Meeting Minutes – Wednesday 10th December 2025

Present

• Prof. I Cumming – Non-Executive Director (Chairman) and voting member
• Mr AC Marsh – Chief Executive Officer and voting member
• Prof A Hopkins – Non-Executive Director (Deputy Chair)
• Ms S Banks – Non-Executive Director and voting member
• Mr A Brown – Service Transformation and Patient Safety Director
• Mr M Fessal – Non-Executive Director and voting member
• Mr N Hudson – Chief Operating Officer and voting member
• Mrs J. Jasper – Non-Executive Director and voting member
• Mr M Khan – Non-Executive Director and voting member
• Mr V Khashu – Strategy and Engagement Director
• Mr S Nat – Non-Executive Director and voting member
• Ms K Rutter – Director of Finance and voting member
• Dr R. Steyn – Medical Director and voting member
• Ms D Scott – Interim Organisational Assurance Director
• Ms K Freeman – Private Secretary – Office of the Chief Executive
• Ms R. Farrington – Staff Side Representative
• Mr M. Brown – Head of Risk and Information Governance (part of meeting)

Minutes

12/25/01 – Welcome, Apologies and Chairman’s Matters

Apologies for absence were received from Mr P Higgins, Mrs C Beechey, Mrs C Eyre, and Mr M MacGregor

12/25/02 – Declarations of Interest

The Strategy & Engagement Director declared a conflict of interest related to the PTS item as his brother worked for the North West Finance Team.

12/25/03 – Board Minutes

To agree the minutes of the meeting of the Board of Directors held on 26 November 2025.  

12/25/04 – Board Minute Log

The Board Log that contains the schedule of matters upon which the Board have asked for further action or information to be submitted. Matters on this log can only be deleted through resolution of the Board. (For the avoidance of doubt unless specified below all matters contained on the Board log will remain on the log until the Board resolves that the matter can be discharged).

12/25/05 – Board Assurance Framework

The report of the Director of Nursing on the contents of the BAF attached thereto was submitted.

The Head of Risk & Information Governance gave an update and highlighted the following:

• November 2025 saw C2 mean performance deteriorate slightly to 28:51.

• Positive work has been undertaken around sexual safety culture with the sexual misconduct support framework now ratified and imminently due to be launched and promoted to all staff.

• The risk in the delivery of the 2025/26 c£20m CIP, including the required reductions to corporate cost growth, has been fully mitigated with all programmes identified and the overall programme forecast to over deliver against the target. 

• Work now resumes at pace with the DSPT V8.

• As part of the Board Development session on 29 October205, a number of actions have been identified for the BAF and Risk Appetite.  A deep dive is scheduled for 19 January 2026 at the Finance & Performance Committee.  The terminology within the risk appetite is being updated to provide clarity on the external issues and the strong view that we do not wish to tolerate risks posed by the impact of handover delays.  The updates need to include a “threshold” for action and escalation to enable the Organisation into a redirection – the 25 scoring ceiling may not adequately reflect the seriousness of the risk to patient safety – engagement across the system and ensuring system risks are sighted and understood.  An in depth report to be completed on the history and timeline of all 7 risks, including evidence/data, work undertaken, mitigating actions and outstanding risks.  Discussion took place regarding integrating the 12 and Above Risks within the BAF report for assurance.  This report will be available from January 2026.

Mr Nat thanked Mr Brown for the update and the granularity of the report on SR1. Mr Nat then asked, with regard to the cyber security briefing when this will be submitted to Committees.  The Head of Risk & Information Governance confirmed this had been drafted but was waiting for clarification on the content then it will be submitted to the next Audit Committee meeting, and this will also be submitted to the Board.  Mr Nat also asked about the staff survey response rate.  The CEO confirmed this will be discussed once we receive the results of the staff survey.  The CEO acknowledged that staff are not happy with the ongoing handover delays and the knock on effect this has on morale and work environment.  When asked about the potential working with East Midlands Ambulance Service (EMAS) the CEO confirmed this is being kept under review. 

Mr Fessal asked why the risks over 12 will now be submitted to the Board. The Head of Risk & Information Governance confirmed it was for awareness but also to enable the Board to have sight of how the risks are being managed to prevent them escalating, in addition it enables horizon scanning and planning on a no surprises principle.

The Head of Risk and Information Governance left the meeting.

12/25/06 – Cheshire PTS Contract Timeline

A report of the Chief Executive Officer was submitted.

The CEO advised the Board that the timeline was drawn up and collated to update the Board in a transparent manner the engagement that has taken place between WMAS and the Commissioners in relation to the Cheshire contract.  The CEO explained that the document submitted summarised each interaction with the commissioning ICB, but for reasons of commercial sensitivity and data protection regulations, have not been attached to the document. These documents are available to members of the Board upon request to the Director of Finance. 

The CEO pointed out that this matter has been going on for nearly two years. Earlier this year the ICB said they were preparing to go out to tender again to test the market, yet they have still not gone out to tender and the Trust have continued to operate the contract. The Commissioners have now resolved the funding for this year 2025/26 and have asked WMAS to continue for a third extension year.  The CEO pointed out that we cannot continue with the contract as the estate leases mutually terminate at the end of April / early May 2026.  The Trust has stopped recruiting, and the fleet is over age. The CEO confirmed that a letter was sent to the Commissioners the previous week confirming our position and asking for confirmation of the new provider for the TUPE process.  This is in the hands of the ICB.  

The Director of Finance pointed out that the timeline is very detailed explicit.  Some of the contract documentation is commercially confidential classed as Commercial in Confidence and/or contain identifiable personal information but in the spirit of transparency as Board Members they are available upon request.

In conclusion Mr Nat felt that the timeline was good for audit purposes.

12/25/07 – Progress on Winter Plan (to include flu vaccination programme)

The CEO gave an update and said colleagues will be aware that the Trust’s Winter Planning for this year had commenced earlier than previous years. The Plan now presented has been through various iterations and had been previously approved by the Board of Directors and Council of Governors.  The CEO pointed out that Winter Planning as set out in the document has served WMAS well in previous years and will continue to do so. 

The CEO said colleagues will have seen in the media seasonal influenza is particularly high in the Midlands and North West regions.  The rest of the Country is slowly following the same trend.  It is believed that the Midlands and Northwest have not yet peaked.  Because of this the Trust has been holding a number of cases, with over 500 emergencies held at one point.   We have reviewed our Resource Escalation Action Plan (REAP) level, and we have now moved to REAP level 4.  The CEO had circulated the IIMARCH briefing note to Board Members via email. 

The CEO explained that included in the papers today is the PowerPoint presentation previously presented to the Board.  We have addressed each of the points raised in the presentation.

Regarding the flu vaccination programme, the CEO said the Trust take this programme very seriously.  The last couple of years the Trust has been one of the top organisations in the Country in terms of vaccine take up.  This year so far, WMAS is the highest Trust in the Midlands Region.  The CEO advised Board Members that the latest position shows the Trust at just over 61%.  When you look at the variances this is from 10% to 61%.  The Trust’s target is 69%, which is very good.

The CEO advised the Board that at the Executive Management Board (EMB) meeting held on the previous day had agreed that with effect from 11 December 2025 the Trust will be mandating the wearing of face masks for all front line clinicians with face to face patient contact. This was due to the reported numbers for flu symptoms continuing to increase and the risk to NHS staff.  Mask wearing is not mandated in non-clinical areas. We are taking this action to protect our staff and the public.

Mrs Jasper questioned the reasons for some organisations setting the target so low for their flu vaccination programme, it was suggested that it was set low so that they overachieve as the bar was set so low initially. Mrs Jasper agreed that the WMAS target was set at a satisfactory level.  Mrs Jasper noted the serious incidents in BSoL and the Black Country with the number of hospital beds taken up by patients with flu.  On the incentives Mrs Jasper suggested that days would be lost if we had not incentivized our staff to get their vaccinations.  If staff are vaccinated, you do not lose staff to sickness which confirms the action taken.  Mr Fessal said that this had been discussed at the People Committee in more detail, and it was felt that the incentive scheme pays for itself in terms of vaccine take up and the general wellbeing of our staff.

Mr Fessal asked what the ICBs were doing to help with hospital handover delays (HHD).  The Service Transformation and Patient Safety Director advised the Board that HHD is out of sole control of the Trust despite all the work being undertaken by the Trust. The CEO pointed out that if the trend for the first 9 days in December continues for the rest of the month this will be the worst December and month ever on record for handover delays.  The CEO said the Region had written to him saying HHD is the top priority and this has been the case for the previous three years; and we need some heroic actions to resolve this matter. The Chairman highlighted the Southwest Ambulance Service and the actions taken which seems to have improved significantly due to them implementing a “drop and go” system.  The Chairman asked what was preventing WMAS doing the same.   The CEO informed the Board that the Midlands Region does not support this scheme. The other issue was that there is nowhere to transport the patient given the delays. The Strategy & Engagement Director pointed out that what has happened in the South West is causing embarrassment for our partners in the region. The Region has said that the Acute Trusts will take these plans to their Board.  We have said that their BAFs should be updated to include patient harm.  Mr Khan said this has been discussed a lot at the F&P committee.  It has been going on for so long, we receive no confidence that it will improve is not assured. 

The Service Transformation and Patient Safety Director pointed out that we have met with three separate Trusts who have given us different trajectories and processes.   We serve 20 Acute Trusts and we need one target and that is 45 minutes.  This must be supported by the Acute Trusts with the ability to offload. 

Mrs Farrington, Staff representative advised not to underestimate the pressure on our staff, there is a feeling of being overwhelmed and demoralized. Crews starting their shift are being sent not to new calls but to hospital to release other staff still waiting outside hospital to off load their patients.    Mrs Farrington stressed the precarious positions of clinicians are in and said it is important that we get this right.  Mrs Farrington said it would be helpful to put something out to staff informing them why we are in this current position.  Mrs Jasper agreed and said we cannot fully appreciate the impact on staff morale. The Chairman said we will come back to this at future meetings,

Mr Khan referred to the statements made about the success of the South West Ambulance Service  model.  Mr Khan asked what it was that got that got that Trust engaged.  The Service Transformation and Patient safety Director confirmed that it was the support of the NHSE Regional office in the South West that enabled greater support from the different partners to make the model so successful.  The Strategy & Engagement Director agreed and pointed out that the Region sets the tone for any intervention.  The Strategy & Engagement Director believed the South West Trusts were directed into a response by their Region with engagement with all Trusts.  This is about system change.

The Chief Operating Officer pointed out that this is about ownership and responsibility.  It was noted that in November 2025 the whole of the South West lost 7,000 hours due to hospital handover delays and the West Midlands Ambulance Service had lost 7,000 hours at one hospital in the north of the region alone. 

The Chairman referred to the need for leadership through engagement and the suggestion about Board to Board meetings had merit. However, it would be helpful to first arrange Chair and CEO meetings with the Hospital Trusts with the worst handover delays.  The Chairman indicated that he would pick this up outside the meeting.

Professor Hopkins asked Mrs Farrington to let staff know how concerned the Board are about the ongoing situation with hospital handover delays and the impact on staff wellbeing and morale. It was agreed that an article to reflecting the concerns of the Board and the actions proposed should be included in weekly briefing and also raised at the Regional Partnership Forum (Where Trust management engages with staff representatives).

12/25/08 – Report of the Director of People

8a – Learning, Disability and Autism Mandatory Training

A report of the Director of People was submitted.

In the absence of the Director of People the CEO gave an update and explained that the paper is self-explanatory and sets out the requirements for all organisations.  The CEO explained that the Oliver McGowan training is mandated by NHSE.  The recommended model of delivery requires face to face input from those with lived experience (this has proven logistically impractical and the package is not deemed fit for purpose for the prehospital setting). The North East Ambulance Service has developed a package to be used and adopted which is considered best practice / gold standard.  The CQC have been engaged and are supportive of this proactive solution based approach as long as the training is fit for role, justified and auditable through a governance decision making process.  The only element that will not be compliant is the face to face delivery from those with lived experience, however their input is still part of the training but through video recordings rather than a live environment.

This proposal will see relevant and appropriate training delivered to all our patient facing / contact staff (PTS, E&U and EOC) and therefore compliance rates will be achieved.

Mr Fessal confirmed this was supported at the People Committee but noted this may differ to others in the NHS.  The CEO informed the Board that the NHS are looking at the training package that the ambulance sector has approved.  NHS England are impressed by the ambulance sector approach and are looking to roll this out.  

8b – Training Days (TDA) and Training Needs Analysis (TNA) 2026/27

A report of the Director of People was submitted

In the absence of the Director of People the CEO reported that the TDA details the number of training days required and planned to be delivered in 2026/27 resulting in an abstraction from operational deployment and availability.  The plan has been put together based on the workforce plan for Student Paramedics and Graduate Paramedics presented for 2026/27.  This includes all statutory and mandatory training, AAP and graduate inductions and training programmes.  As discussed earlier this year there is the additional days training required to deliver the Oliver McGowan equivalent training as learning disability and autism education.

The TNA shows the statutory and mandatory training updates for E&U and NEPTS for the 2026/27 and the cycle will begin in April 2026. Topics for the updates are selected from the Education and Training Needs Analysis, taking into account recommendations and learning from Patient Safety Incident Response Framework (PSIRF), changes to guidelines, or the introduction of new equipment. Other core topics remain guided by national standards. For E&U staff during 2026/27, we will continue using a blended learning approach. Days 1 and 2 will consist of in-person sessions delivered by an Education and Training Officer (ETO), followed by dedicated time to complete the eLearning packages.

Professor Hopkins noted the need to ensure learning outcomes are identified and staff understand the reasons for some training and relate it back to case reviews. We need to ensue all universities understand the required curriculum.   The Chairman asked how we deliver the relative priorities for example Prevent training.  The CEO said if you look at the TNA prevent training is already on there.  The Chief Operating Officer confirmed this was undertaken extensively in 2023/24.  From a clinical perspective the track record is good. 

8c – Workforce Plan 2026/27

A report of the Director of People was submitted.

In the absence of the Director of People the CEO gave an update and informed the Board that as of 31 March 2026 the plan is for 4,150 WTE due to be in post.  The budgeted establishment for 2026/27 is 4,242 WTE.  Plus, an allocated budget for overtime of equivalent to 100 WTE.

Total budgeted establishment is 4,342 WTE.  The plan is for:

• 2 X SP cohorts in recruitment and training plan (84 WTE)
• 5 X Graduate cohorts in recruitment and training plan (210 WTE)

Total recruitment and training places planned is 294.  Attrition is currently at circa 180 WTE per year (15 per month).

Mr Nat said that the plan is predicated on lost hours of 400,000 if this reduces and we over perform can we control overtime expenditure.  The CEO confirmed if this did happen, we would reduce overtime in the first place; then stop staff recruitment and stop offering contracts of employment and we would not run as many cohorts.     If lost hours reduced from 400,000 to 250,00 we would then come up with an action plan and work with other ambulance services. 

The Chairman pointed out that we are increasing operational staff by 3% but there is no increase in Double Crewed Ambulances (DCAs).  The Chief Operating Officer explained that the new capacity will mainly be nights. Mrs Banks asked what the impact of the new staff will be on the Operational Managers (OMs) and Senior Operational Managers (SOMs).  The Chief Operating Officer explained that it is about risk management.  There is pressure but not having the staff and being able to get to patients is a bigger risk.  Mr Fessal believed a greater risk is the OMs and the staff ratio. 

The Chairman asked if we could afford the proposed plan.  The Director of Finance confirmed the Trust can afford this plan.  The Trust’s requirement is break even and we have a break-even plan. The Director of Finance confirmed the requirement for the next two years as it stands, we are all comfortable with this.

12/25/09 – Reports of the Director of Finance

9a – Finance and Capital Funding Update

The Director of Finance gave an update and informed the Board that at Month 8 the Trust is showing an £88k surplus.  The end of year forecast is breakeven.  There are some in month and year to date variances which will be reported in full when the final position is produced but these are, as in previous months, as a result of the Trust reporting an improved position following the mediation outcome and the level of income being made available from West Midlands ICBs. Whilst breakeven is the forecast, this assumes that the lost hours to handovers will not be above 400,000 and that there will be no increased spending for the remaining 4 months of the financial year beyond that planned.

This position includes a Cost Improvement Programme (CIP) which is currently running above planned levels with a forecast assumption that the CIP will be delivered above planned levels.

Capital resources are fully planned with additional allocations pending.  At Month 8 the spend is running to plan with some adjustments for PDC allocations but it is expected that the capital programme will be fully delivered over the year with associated resources fully utilised.

Mr Nat left the meeting.

9a – Medium Term Plan – Board Assurance Statement

The Director of Finance gave an update and advised the Board that the Medium Term Planning Guidance was issued by NHS England Planning guidance at the end of October setting out the expectations for three-year operational plans. 

There is a clear message that the plans submitted (both first and final) need to be triangulated both internally and are expected to align with local system and other partners’ plans.  This will form part of the assurance undertaken by ICBs and NHSE on each provider’s plans. All plans (activity/performance, workforce, and finance) alongside evidence of triangulation of plans through the integrated planning template and capital plans were required to be submitted to Black Country ICB by Tuesday 9 December 2025.  The Board Assurance Statement is required to be submitted to support the plans submitted and to ensure that the appropriate governance has been undertaken.

It is expected that feedback from NHSE will be received regarding the first plan submission in early January 2026, with any amendments reflected in the final submission (early February).  A final Board Assurance Statement will also form part of the final submission.

The Board Assurance Statement supporting the first plan submission is attached for approval and for sharing with Black Country ICB for endorsement of the first plan submission, before the submission to NHSE by noon on Wednesday 17 December 2025.

EMB had reviewed and identified the following changes to the document in the papers.  The Board reviewed the Board Assurance Statement and the EMB recommended changes were approved as follows:

• No 3 – change to maturing.
• No 5 – change to fully embedded.
• No 6 – change to fully embedded.
• No 10 – change to maturing.
• No 12 – adds narrative.
• No 15 – change to maturity.

The Director of Finance will make the above changes before signing off by the CEO and Chairman and will incorporate this into the submission to NHSE on 17 December 2025.

12/25/10 – Draft Five Year Strategic Plan Update

The Strategy & Engagement Director gave an update and informed the Board that further to the Board of Directors discussions in September and October, an updated Strategic Priorities Framework has been developed and is set out within this paper, it has prioritised work areas to underpin each strategic objective. 

Stakeholder engagement activity has commenced; this paper sets out the initial feedback received and the plan / timescale to engage a 360-degree view of our stakeholder landscape. 

Following the last discussion at the Board, engagement events have been held with the Council of Governors and our lead commissioner / host Integrated Care Board (ICB) alongside the Urgent and Emergency Care Commissioning leads across all of the Integrated Care Boards we are aligned to.  The first discussion with staff via a senior management (SMT) team meeting has taken place.

The Chairman asked about the timeline.  The Strategy & Engagement Director confirmed there is a window for feedback.  This starts from January 2026, and the plan is to submit back to the Board in March / April 2026.  The Chairman noted the need at some point to discuss how we launch the new strategy with staff.  The Chairman said we are not reaching all our staff at present, so we need to ensure a big launch.

12/25/11 – Patient Experience Strategy

The Service Transformation and Patient Safety Director informed the Board that the revised strategy is submitted today for approval.  This has been through all the relevant governance processes. 

12/25/11 – Patient Experience Strategy

The Service Transformation and Patient Safety Director informed the Board that the revised strategy is submitted today for approval.  This has been through all the relevant governance processes. 

12/25/12 – Service Delivery Report

The Chief Operating Officer gave an update and reported that November saw some improvement in Cat 2 mean performance compared to October.  This was due to the Doctors strike which saw reduced handover delays.   Resourcing was strong.  Compliance with mandatory training is good.

The Chief Operating Officer referred to the comparison data (2019 compared to 2025) on page 8.    It was noted that hospital handover delays in a year used to be around 84,000 hours with a Cat 2 performance of 12 minutes.  Now the position is 50 minutes.  Staff have increased by nearly 1,000 but we have recruited nearly 2,000 people.    Hear and treat is up to 22%.  See and convey has reduced.  The Chief Operating Officer said it is interesting to see where we were and where we are today. 

The Chief Operating Officer reported that during November the Trust reported 18 over 2 minute delays, answering 999 calls.  This is the best in the Country by far. On pages 13 onwards you can clearly see the correlation with hospital handover delays to deterioration in cat 1, 2 and 3 performance. 

12/25/13 – Any Other Business

There was no other business.

12/25/14 – The Date of the Next Meeting

Wednesday 28^th January 2026