WMAS Board Meeting Minutes – Wednesday 30th October 2024

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) and voting member
• Ms S Banks – Non-Executive Director and voting member
• Ms C Beechey – Director of People and voting member
• Mrs C Eyre – Director of Nursing and voting member
• Mr M Fessal – Non-Executive Director and voting member
• Mr N Henry – Paramedic Practice and Patient Safety Director
• Mr N Hudson – Performance and Improvement Director 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
• Mrs N Kooner – Non-Executive Director and voting member
• Mr M MacGregor – Communications Director
• Ms K Rutter – Director of Finance and voting member
• Dr A. Walker – Medical Director and voting member
• Ms D Scott – Interim Organisational Assurance Director
• Mr Sukhjeevan Nat – Appointed NED (Took up role 5/11/24)
• Mr A Brown – CEO Chief of Staff and Head of Enhanced Care
• Mr P. Higgins – Governance Director and Trust Secretary
• Ms K Freeman – Private Secretary, Office of the Chief Executive
• Ms R Farrington – Staff Side Representative
• Mrs M Capper – Member of Staff (part of meeting)
• Mrs V Whorton – Member of Staff (part of meeting)
• Mrs P B – Mother of the patient for patient story (part of meeting)
• Miss S B – Patient story item (part of meeting)
• Mrs P Wall – Head of Strategic Planning / FTSU Guardian (part of meeting)

Minutes

10/24/01

Welcome, Apologies and Chairman’s Matters

There were no apologies for absence.

The Chairman welcomed everyone to the meeting and welcomed Mr Sukhjeeven Nat to the meeting.  Mr Nat takes up his role of Non-Executive Director (NED) from 5 November 2024.  The Chairman explained that today is the last formal Board meeting for two members of the Board.  The Chairman thanked Mrs. Narinder Kooner who was retiring from the Board on 4 November 2024 for her tremendous contribution, knowledge and insight she had brought to the Board during her term as a Non Executive Director.

The Chairman also acknowledged that the Medical Director Dr Alison Walker was stepping down at the end of November 2024. Dr Richard Steyn was taking up the role of Medical Director and voting member of the Board on 1 December 2024. Dr Walker the Chairman stated that she has made a tremendous contribution to the Trust in her work as Medical Director and had always acted in the interests of the Trust and its patients conscientiously and with resilience, especially in relation to handover delays.  The Chairman indicated that both Mrs Kooner and Dr Walker have been invited to attend a lunch on 18 December immediately after the Board meeting that day to give colleagues the opportunity to say a proper goodbye and thank you. 

10/24/02

Patient Story

The Chairman welcomed Mrs P B mother of SB to the Board meeting. They were supported by Mrs Capper the Trust’s Head of Patient Experience and Mrs V Whorton, the Trust’s IEUC Clinical Commander.

The Chairman said one of the most important parts of the Board meeting is for the members of the Board to hear a ‘patient story’ these assist in setting the context of the meeting and focuses the Board on what the purpose of the Board meeting is and that is to maintain and sustain safe and effective care for our patients and the public we serve. It is a chance for members of the Public to explain cases where things went well, while other stories enable the patient to bring a story where we could make improvements and learn from the event. 

The Chairman asked The Nursing Director, Caron Eyre to introduce the patient story and those attending the meeting.  Caron Eyre stated that the Board will hear SB’s story. SB, at the time of the incident was five years old, and whilst at school in the playground was injured with a broken femur. It had taken six hours for a response from the Ambulance Service following the first call. In addition, which compounded an already difficult set of circumstances, there was a disagreement with the hospitals as to which A&E Department SB should be taken to delaying her treatment further.  After presenting the facts Caron Eyre invited SB’s mother, PB to address the Board and as part of her presentation she felt the call taker at the Trust could have been more compassionate and demonstrated empathy for a mother speaking about her child. 

The Director of Performance & Improvement, Nathan Hudson thanked PB and SB for attending and indicated that it was a very powerful story for the Board to hear. He apologized to the parents and SB for having to go through what they went through and there were clearly lessons that the Trust have taken on Board. In conclusion he indicated that the Board had agreed to put in place additional resources to mitigate the impact of Handover delays and the impact it has on patients like SB.

The Chairman on behalf of the NHS also apologized to SB and her parents and assured them that the Trust was doing all it can to mitigate the effect of handover delays to get a quicker response to patients by freeing up ambulances outside hospitals to get to patients in need. In addition the Chairman indicated that there were issues that had come out of the audits undertaken into this matter that the Trust have taken on Board and learning for staff to understand and handle calls similar to this in a different manner going forward. The Chairman asked specifically for more details about the disagreement between the Trauma Desk and the Acute Hospital.

Aidan Brown, The CEO’s Chief of Staff & Head of Enhanced Care stated that the CEO had asked him to listen to the call and was able to confirm that there are lessons for both the Trust and the Acute hospital. The case has been raised with the Trauma Network and the outcome of that will be fed back to the relevant acute. In addition, he assured the Board that he had instructed Paramedics that work on the Trauma Desk to follow the Trauma Decision Making Tool and that if there are any issues with an Acute in terms of conveyance, they must comply with the tool and convey the patient. Any issues can be picked up afterwards through the Trauma Network, so that the patient is not delayed in terms of care. PB indicated that she had raised it as a complaint to the acute concerned in this matter and was not satisfied with the response. The CEO indicated that this Trust would take that matter up also and would be willing to share the outcome of the Trauma Network discussion with SB’s parents.

Dr Walker, the Trust’s Medical Director explained the reasoning behind the establishment of the Trauma Network and indicated she would be content to pick this up with her colleagues in the acute and the Trauma Network. In addition, Dr Walker outlined the improvements that are being made nationally in access for Paramedics to pain relief for children, and that she was personally leading on that area of work which was progressing with the support of a number agencies including the Home Office.

Members of the Board then thanked SB and her mother for attending and also welcomed the news that there had been learning. The members of the Board asked about the impact of this trauma on SB and her mother. PB outlined the personal and emotional impact. In response to a question on what she felt the Trust could do differently PB responded that the Trust needed to learn from the incident and show empathy by recognizing as in this case with a child injured the difference between an angry person and a parent concerned for the wellbeing of their child and felt that she felt that she wasn’t been heard by the call taker. PB said that she recognized it was a difficult role and that the call assessor needed to follow a check list to enable triage, but given the circumstances there should be a point at which they will look at the matter in a more subjective manner.

The Chief Executive Officer (CEO) acknowledged that this would be acted on. He noted that there are many incidents where such a set of circumstances may be out of the Trust’s control, but given the points made by PB there clearly is learning for the Trust and the acute involved. The CEO indicated that this will be fed back to the call handlers through the management team and would expect to receive an update by the end of the week. The Chairman asked whether as part of the audit procedure whether care and compassion was also reviewed. Reena Farrington one of the supervisors in the IUEC indicated, in response to the Chairman that they were reviewed already. Reena indicated that she and Vicky Whorton, who reviewed this case will also do a deep dive on this issue to identify detailed learning. 

PB concluded by stating that SB, who is now six and had the plate removed from her leg and is making a good recovery.

The Chairman on behalf of the, Board thanked PB and SB for attending today’s meeting and sharing their story. He concluded by apologizing on behalf of the Trust and the NHS for how this matter was handled.

PB SB, Mrs Capper and Mrs Whorton left the meeting.

The Chairman noted the important learning from today’s presentation. Obviously the 6 hour delay is not something we can easily resolve but some things are within our remit.

10/24/03

Declarations of Interest

There were no conflicts of interest declared by anyone attending the meeting in relation to any matters on the agenda.

10/24/04

Questions from the Public

There were no questions submitted.

10/24/05

Board Minutes

To agree the Minutes of the meeting of the Board of Directors held on 31 July May 2024.

10/24/06

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).

Matter arising:

Reena Farrington left the meeting at this point

10/24/07

Board Assurance Framework (BAF)

07a – Overarching Summary Report

A report of the Paramedic Practice & Patient Safety Director was submitted.

The Paramedic Practice & Patient Safety Director explained the reasons for the paper’s submission given that the Trust has been reporting within the BAF hospital delays and call stacking risks at their highest-level rating of 25, since October 2023.  There have been formal reviews of the risk rating to see whether they could reduce at meetings of the Executive Management Board (EMB) during the summer 2024. There had been an initial plan to recommend reducing the rating down to 20 at this meeting. However, due to the number of delays during September 2024 which has continued into October, it was agreed by EMB that the ratings remain at the highest levels of risk in these areas i.e. a risk rating of 25 risk rating.  It was reported that this was based on the current trajectory for October which is expected to exceed 42,000 lost hours. This relates to the equivalent of losing circa 130 ambulance crews out of circa 600 every single day. October 2024 is on trajectory to be the second worst month on record for lost handover hours.  The Trust had considered whether this was demand driven but was satisfied following analysis that it was not.

The Trust had also looked at the national picture to gain an understanding as well and although this Trust has the second worst impact of handover delays it is still the second best for category 2 responses in the Country. This was primarily due to the actions the Board agreed at its meeting in February 2024 to increase operational resourcing in the interests of patient care, but the Trust is still continuing to lose resources to be able to respond due to handover delays. The Trust has also elevated the patient safety incidents as an NHS body to NHS concern with three of the worst Acute Trusts so that they are aware and are having conversations internally around the issue of handover delays.  The Paramedic Practice & Patient Safety Director concluded by stating that the recommendation was that the BAF risk rating remains at the highest risk score of 25 for hospital delays and call stacking despite all the mitigation in place. The work led by NHSE on implementing the 45 Minute maximum hospital handover had commenced, but no improvement has been seen at this stage. Handover delays are also having an impact on staff as well due to delays in ending shifts and also impact on morale as they wish to be out responding to patient needs.

The Chairman noted the report and indicated that there are patients that have come to harm and have died as a result of the continuing issue of handover delays. He highlighted that recently there had been a 19/20 hour delay outside an acute which obviously will impact on the patient and the staff involved in such a delay.  The Strategy & Engagement Director informed the Board that staff are using the FTSU process (as well as other avenues) to raise their concerns on the impact this is having on them as staff and also their patients. 

The Chairman advised the Board that he will be contacting Dr Henrietta Hughes, the Patient Safety Commissioner for England. Her new role is to help the NHS gain a greater understanding of what they can do to put patients first, better understand the importance of the views of patients, and promote the safety of patients in general. Given the current state of handover delays it was yet another avenue the Trust will utilize to try and get traction in terms of addressing this ongoing issue by the Leadership of the NHS. Especially as the Trust has maintained its BAF the highest Risk Rating at 25 for hospital delays and call stacking despite all the mitigation in place now for over a year. The Board endorsed the Chairmans suggestion especially in the light of the patient story earlier in the meeting.

The CEO explained what the mitigating actions the Trust was putting in place to address the impact of the handover delays on patient safety which is set out in the report. The Board of Directors had agreed to introduce an Operational Oversight Board Chaired by the CEO as a task & finish committee to manage the response to the regulation 12 notice from the CQC. The Operational Oversight Board is still in operation to date, given the ongoing challenges being experienced. This committee has focused on the growth in operational workforce by ending secondments and focusing operational staff to be responding to patients.  Increasing the operational workforce to mitigate the expected increases in hospital delays has been a positive step for patients and staff. If this decision had not been made, it has been calculated Cat2 performance would likely be circa 40 minutes, based on a projected end of year total of 300,000 hours being lost at hospitals and no growth in the operational workforce.

The CEO said the Trust has taken further steps to support the delivery of the safest service possible heading into the Winter period by:

• Implementing its Winter Plan
• Agreed an increase in the operational E&U fleet by retention of 15 x 4×4 ambulances and 10 ambulances, that were due to be replaced as part of the fleet replacement programme. This is an increase in 25 emergency ambulances
• Additional recruitment of additional 999 call handlers to bring forward attrition replacement staff. It was not intended to increase the size of the workforce on a recurrent basis it is being met by bringing forward the usual planned attrition from Quarters 3 & 4.
• Additional 2 cohorts of Student Paramedic in Jan and Feb 2025 

With reference to the 45 Minute Maximum Handover Delay proposal, The CEO said that he was not confident in the successful implementation of the 45-minute maximum handover proposal, given the current scale of handover delays but the Trust would support where required.

The above are the actions the Trust has taken to mitigate patient harm as a result of the handover delays.

The Chairman concluded the discussion that there was nothing further to add and that the Board and the Trust must continue to reassure the public and its staff that it is doing all it can in these difficult circumstances.

07b – Review and Approval of the Board Assurance Framework

The report of the Director of Nursing was submitted, attached thereto was current Board Assurance Framework and strategic risks, controls and mitigations.

The Director of Nursing outlined the revisions to the BAF since it was last reviewed by the Board

Strategic Risk 1 – Hospital Delays

Given the content of the previous paper to the Board on the current impact of Handover Delays on patient care and the possibility of serious harm the Board agreed that the Risk Rating remain at 25 even after applying mitigation

Strategic Risk 2 – Call Stacking

It was again indicated given the previous paper to the Board on the current impact of the Handover Delays on patient care and the possibility of serious harm the Board agreed that the risk rating remain at 25 even after applying mitigation.

Strategic Risk 6 – Innovation

The Director of Nursing explained that at the Board Briefing in September 2024 it had discussed this item and whether given it was rated as a risk of 8 this risk should be managed internally within the Trust as part of the corporate risk register. The Board agreed.

Given the growing threat of cyber terrorism and the importance of cyber security it was proposed that Strategic Risk 6 within the BAF will be varied to reporting on the Trust’s effectiveness in relation to Cyber Security and Cyber Terrorism. The Director of Nursing reported that colleagues within the IT section of the Trust are reviewing the risks, controls and mitigation. This will then be incorporated into the BAF in terms of future iterations.

Subject to the above the BAF as submitted was recommended for approval.

07c – Review & Approval of the Board Risk Appetite Statement

A report of the Director Nursing was submitted attached thereto was the Board Risk Appetite Statement for formal review and approval. The Risk Appetite Statement had been reviewed by the Board at its Board Briefing in September 2024.

The Director of Nursing said the Board is requested to determine whether the current risk appetite remains relevant and continues to progress towards risk maturity. The Board was asked to decide whether any changes are required considering tolerance, appetite, culture, and risk attitude against current and emerging workstreams, which includes the CQC report and performance action plan. Mrs Jasper pointed out that in the executive summary second paragraph there is refence to outstanding – this needs amending. 

10/24/08 – Report of the Freedom to Speak Up (FTSU) Guardian

The FTSU Guardian attended and presented the submitted report.

Mr Nat asked if one of the channels open for staff was to phone in to raise concerns.  The FTSU Guardian explained that there is not a central number for staff to ring in on, but the Guardian could be contacted through the switchboard number. There were a number channels through which the Ambassadors or the Guardian could be contacted as the names are advertised and in most cases there will be a telephone number on the email lists.

Mrs Kooner thanked the FTSU Guardian for all the hard work undertaken and indicated that the increasing reporting numbers was welcome. Mrs Kooner asked about the diversity of the Ambassadors and if the Guardian was using the Staff Networks to recruit FTSU Ambassadors to ensure that there is a diverse group of Ambassadors.  The FTSU Guardian said in relation to the Ambassadors that we do link in with the Staff Networks and undertake a lot of collaboration. The Guardian was looking at whether the Network Chairs could also be Ambassadors.  The diversity of the Ambassadors will be included in the next report to the Board for reassurance. Mrs Kooner asked if there could be more work on reassuring staff who feel that they can’t openly report and wish to remain anonymous. In addition Mrs Kooner asked if the Guardian could report on some of the positive suggestions coming from staff.  Finally in relation to the local reporting categories Mrs Kooner asked if racism, inappropriate language and sexual conduct would be helpful subcategories to report against. The Guardian responded that she would look at these for future reporting.

Mr Fessal said that the attendance of the NGO at the September Board Briefing was welcome especially leading the Board discussion. He enquired whether the NGO Office was to be subject to review in terms of its effectiveness. The Guardian reported that the NGO support for FTSU was generally good. However, like all organizations there should always be a review of the way they operate. Whilst congratulating the Guardian on the work undertaken Mr Fessal asked if the Guardian could facilitate staff forums to understand why staff prefer anonymity to enable the Board to have an understanding as the reasons for preferring anonymity in reporting.

The Chairman pointed out that there have been a small number of malicious concerns raised through the FTSU process and asked whether a transparent system for closing these down could be developed to avoid unnecessary delay and work. 

The Chairman thanked the FTSU Guardian for her update today and the work undertaken.

10/24/09

Chief Executive Officer (CEO) Update

A report of the Chief Executive Officer was submitted.

10/24/10

Executive Scorecard & ICS Scorecard relating to Performance for the Month of September 2024.

The Executive Scorecard of KPIs for the month of September 2024 was submitted. The key indicators and trends were set out for review by the Board. The indicators covered operational performance, finance, workforce, and high-level clinical indicators. The scorecard was submitted in addition to the Trust Information Pack which contains Trust wide performance data and information and is circulated separately to the agenda.

10/24/11

CQC Regulation 12 Notice – Performance Improvement Action Plan. (Discharged)

A report of the Director of Performance & Improvement was submitted.

10/24/12

Winter Plan

The Winter Plan was submitted

The CEO said the Plan was seen previously by the Board at its Briefing in September.  This has also been reviewed widely including the Council of Governors and ICB partners.  The Plan was submitted to this meeting for formal ratification.

Mr Khan indicated that he was of the opinion that if the CEO had not shown leadership in terms preparing for the Winter and addressing the consequences of the Handover delays by putting additional resources in place; the Trust would be unprepared for Winter and this will impact directly on the ability of this Trust to be able to respond to patients and provide care. He did though caution that the Trust must not be complacent as the Finance & Performance Committee at its meeting held on the previous day had discussed trends and there remains significant concerns and risks with future predictions particularly around Cat 2 performance given the continued issues we are facing which are outside of our control. 

The Chairman asked about the opening of the Midlands Metropolitan University Hospital (MMUH) and the closure of City and Sandwell Hospital and if there was any data available of its impact. The Strategy & Engagement Director informed the Board that the final move takes place on 10 November 2024, and after that date there will be a more informed position on its impact.  Mr Khan informed the Board that this was an item discussed at the meeting of the Finance & Performance Committee held on the previous day.  He indicated that given that there were fewer bed numbers the position does need to monitored and its impact on this Trust. 

10/24/13

Reports of the Director of Finance

13a – Finance Update

A report of the Director of Finance using powerpoint slides was submitted.

The Director of Finance gave an update and informed the Board that at Month 6, the Trust reported an adverse variance of £10.3M of which c. £9.0 mill was due to income & expenditure and c. £1.0 M was due to a donated asset adjustment and is a technical accounting adjustment.  The deficit at the end of Month 6 follows the expenditure patterns shown since the start of the financial year and remains the result of the additional investment in workforce associated with meeting performance targets required.  The overspend is slightly less than the cost to the Trust of the lost hours resulting from hospital handover delays (cost of lost hours to end September £11.1M) the adverse variance was due to addressing the impact of Handover delays and the likely affect on the provision of patient care. The Capital Plan was on track and is being closely monitored.   The Better Payments Practice Code (BPPC) results are all above the target measures required.  This is an important measure to assure suppliers that the Trust adheres to the payment terms agreed.  A significant amount of work has been undertaken to improve meeting this target and continues to ensure that the performance is maintained.

We have sufficient cash balances for the rest of the year.  If nothing changes with regard handover delays in terms of the cost of lost hours and our deficit there will be a cash problem at this time in the next financial year. CIPs are identified in full, and delivery will be monitored throughout the financial year.  Meetings have now taken place with all senior budget holders/Directors to confirm delivery of identified CIPs, to explore areas for further efficiencies and to focus on identification of the 2025/26 CIP.  The balance sheet remains healthy at the end of Month 6 and we will keep it under review.

The Director of Finance advised the Board that a meeting took place with NHS England (NHSE) and the ICB on 24 October.  At that meeting it was agreed that additional funding would be made available to the Trust for the first half of the year, which effectively placed the Trust in breakeven position at the end of month 6. There was also a clear message from NHSE that it was for the ICB to resolve the issues for the remainder of the financial year regarding lost hours due to hospital handover delays. It was observed that the work NHSE was undertaking in relation the 45 minute maximum handover delays programme which was being rolled out.

The Chairman acknowledged it was speculative but asked given the Chancellors Budget that afternoon; employers National Insurance contributions were likely to increase and also the living wage is likely to be increased.  If confirmed it will impact on the Trust’s finances and asked if there had been any briefings on whether these would be funded.  The Director of Finance had not heard anything but suspected it would not be funded.  Assurances have been received that the full pay award for this year would be funded.  The Director of Finance did not think any further funding would be received this year. The Chairman indicated that it was speculative anyway at this stage and that it should be kept under review as the budget details become clearer. 

Vivek Khashu noted that HMG has announced that the National Minimum Wage will rise and this will have implications for the Trust as it will affect the lowest NHS pay bands such as PTS contract staff. Mr Fessal asked about the impact of the National Living Wage was more of a concern.  The Director of People advised the Board that the Trust does not pay the living wage it pays the minimum wage. The Chairman indicated that this may need to reviewed.  Mrs Farrington confirmed that discussions on the living wage were discussed and consequently reviewing the Agenda for Change Band 2 was already on the agenda. 

13b – Quality Impact Assessment (QIA) / Equality Impact Assessment (EIA) in Relation to each Cost Improvement Programme (CIP)

A report of the Director of Finance was submitted.

The Director of Finance informed the Board that the paper includes the full list of Cost Improvement Programme schemes that have been identified for the current financial year and are in progress.    All individual impact assessments have been completed and signed off by the respective lead for each scheme.  The governance arrangements are being finalised and tracked for each individual scheme.   All documents have been shared individually with Board members for review.

The Director of Finance pointed out that the process for the QIAs and EIAs needs to begin earlier and could be slicker and less bureaucratic  and not just a finance focus consequently the paperwork surrounding the QIA and EIA needs review. In mitigation the Board was advised that the process this year was later due to the protracted discussions on funding and the final plans.  For next year this process will be complete by the end of March.  Work has already commenced on the plans for 2025/26. 

The Strategy & Engagement Director said it is a significant undertaking to prepare the QIAs / EIAs for 60 schemes and agreed the process does need review and that is underway. The clinical directors have reviewed the schedule and there were some residual questions that require clarification. In conclusion he stated that identifying CiPs is getting harder each year.

Mrs Banks said that at the last meeting of the Quality Governance Committee the QIA schedule had been reviewed as part of the Governance process. Concerns were raised by the clinical colleagues regarding the Stage 2 QIAs and that some decisions had been made to not to proceed to stage 2 and this was reinforced at the Audit Committee in the light of the internal auditors report. The Clinical Directors had agreed to meet separately to review the content of the QIA and CIP schemes.  Mrs Banks said that the Committee welcomed an earlier start in the process so that clinical directors in the Trust have sufficient opportunity to review the schemes. 

13c – Investigation and Intervention Reports and Narrative and Phase 2 Progress

A report of the Director of Finance was submitted.

The Director of Finance explained that the Investigation & Intervention (I&I) process was mandated by NHSE for those systems with the greatest financial deficit. The Black Country system engaged with PA Consulting for this work. The reports submitted had already been reviewed at the Board Briefing in September for review and are submitted to this meeting as the NHSE requested that these were submitted to a formal meeting of the Board of Directors of the provider trusts. Hence the submission to this meeting.  The Phase 1 report was submitted and the Phase 2 work was defined by NHSE as a 12-week piece of work.  The Black Country system had agreed that the work should be completed over a 4-6 week period.  There is currently no report coming out of the Phase 2 work at present and the work has commenced on the phase 3 work. The phased work was very heavily focussed on the acutes and the only work streams that apply to the ambulance sector are workforce, discretionary spend and procurement.

The phase 3 work which has now commenced is focussed on delivery and additional support. This Trust was considering engaging a firm to assist with a “lean” review of the Trust, but this would only go ahead if the ICB funded it. The CEO suggested that the national Senior Responsible Owner for ambulance productivity should be approached to advise.

In conclusion the Director of Finance indicated that the Trust will focus on delivering its progamme of CIP for next year and improvements in productivity and efficiency will fall out of that work. The Board will receive updates as the work progresses.

13d – 2025-26 Budget Setting Timelines

A report of the Director Finance was submitted.

The Director of Finance informed the Board that the submitted slide deck sets out information, assumptions and a timeline for the approach to setting next financial year’s budget.  This is provided at a point in time and will be updated as and when guidance from NHSE is issued and/or local priorities are required from Black Country ICB. Slide 16 sets out the draft timeline. The Financial Management Team will engage with the relevant Directors and senior budget holders to ensure that the required information can be produced. This information will be shared ahead of the EMB Planning Day on 26 November in order that a high level 2025/26 financial position/plan can be produced for discussion on that day. This meeting will identify any CiPs required to meet any shortfall.   Updated information and budget proposals will be presented to the Board at a future meeting, with the aim of final approval at the March meeting of the Board of Directors.  The Director of Finance said the EMB will concentrate on triangulating the workforce, finance and performance plans.

In conclusion the Chairman indicated that the Board should be given regular updates and that the Board Briefing should also be used to ensure that the Board is aware of progress.

10/24/14

Reports of the Director of People

14a – NHSE Visit to WMAS

A report of the Director of People was submitted.

The Director of People explained that the paper provides feedback on the visit that took place on 12 August 2024.   The visit was undertaken in the light of the People Promise Exemplar Programme which focussed on achieving improved outcomes and optimum staff satisfaction and retention. It was related to the Ambulance Sector, and particularly this Trust. The visit was a great opportunity for the Trust to share its plans, and the feedback received was very positive.  In conclusion the Director of People thanked everyone involved in the successful outcome and it was observed how integrated the approach was across the Trust.

14b – Sexual Safety Update

A report of the Director of People was submitted.

The Director of People gave an update and explained that a year ago the Trust received an escalation letter from NHS England, Midlands Workforce Training & Education, setting out serious concerns about the experience of paramedic students whilst on placement within West Midlands Ambulance Service (WMAS).  The action logs at Appendices 1 and 2 were implemented and both are now complete and closed.  They were submitted to the Executive Management Board (EMB) and People Committee for review prior to submission to the meeting of the Board today. The purpose of submitting to this meeting was to formally close them down in an open and transparent manner. 

The Director of People explained that the Sexual Safety Taskforce continues to meet monthly.  This is a multi-disciplinary task force not just HR and the action log from this group is also submitted to this meeting.

The Sexual Safety & Wellbeing Group chaired by Alex Hopkins; Non-Executive Director (NED) and Deputy Chair meets quarterly.  A review of the Terms of Reference is due to take place at the November 2024 meeting when consideration will be given to its continued frequency and / or whether the group can be stood down.  The Director of People explained that the group is scheduled to further and consider the Worker Protection Act which came into force on 26 October 2024 and changes the duty on employers from redress to prevention of harassment.   The group will also review and discuss next steps to be taken following the NHS launching on 16 October 2024 a Sexual Misconduct policy, framework, training and communications campaign.  The Director of People was minded to retain the Group to have oversight of these big pieces of regulation and workstreams.

The Director of People also referred to the presentation to the Board Briefing session in September 2024 by Bronwen Biddle. The presentation was attached as an appendix for reasons of transparency. The Director of People explained that Bronwen worked for the Association of Ambulance Chief Executives leading the national ambulance programme of work to bring about cultural maturity, the prevention of sexualized behaviours and alignment with the NHS England Sexual Safety Charter and Codes of Conduct. There were recommendations towards the end of the presentation for the board to consider and the Director of People provided the current organisation position on each for information and assurance of the Board and areas where the Trust is working to strengthen.

The Director of People commended the report and attachments to the Board.

14c – E&U Recruitment Update

A report of the Director of People was submitted.

The Director of People explained that the workforce plan was last submitted to The Board in March 2024.  The modelling formulae has been updated to reflect Q1 and Q2 actual positions of attrition and hospital handover delays. Attrition has reduced from 17 WTE per month to an average of 14 per month during Q1 and Q2. The target workforce and recruitment plan for 2024/25 has been amended to 316 Student Paramedics and 234 Graduate Paramedics (total 550 combined target across both roles). A further Student Paramedic cohort has also been added to the recruitment and training plan commencing in February 2025 to offset against those earlier cohorts that were not filled to training capacity places and / or balance any shortfall in anticipated graduate numbers.

14d – Workforce Race Equality Standards (WRES) & Workforce Disability Equality Standards (WDES)

A report of the Director of People was submitted.

The Director of people explained that the Board at its meeting on 25 September 2024 reviewed the data submissions and authorised the Director of People to proceed to publish the data as required on the Trust’s website by the deadline of 31October 2024.  The Action Plans are being reviewed and will be submitted to the next meeting of the People Committee prior to submission to the Board of Directors.

14e – Professional Registration and Medical Revalidation Assurance

A report of the Director of People was submitted.

The Director of People informed the Board that the Trust has a duty of care to ensure that all healthcare professionals employed by the Trust or undertaking work on behalf of the Trust are appropriately registered and licensed to practice in the United Kingdom.

10/24/15

Combined Clinical Directors Quality Report

A report of the clinical directors was submitted.

The Paramedic Practice & Patient Safety Director gave an update and informed the Board that hospital handover delays continue to impact on service delivery and contributes to delayed responses to patients in the community. The month of August did see a reduction in delays to 16,563 hours lost, although September significantly increased to 28,215 hours.  Clinical audit scores are still not improving, and further work is required to support improvements. Further review of audits will be completed following the introduction of changes to the Electronic Patient Record to better support clinicians.  There is a continuing increase in Learning from Death (LFD) reports, this is in line with the national trend. This increase has meant greater support has been required to the Trusts LFD Lead to manage this demand.  PSIRF continues to be under strain and has seen 108 responses identified and the Trust continues to work with staff, the ICB and system partners to bed in the new ways of working.  Patient safety Serious Incidents and recommendations are within timelines. There remains only 1 open SI, and this is paused as a police investigation is involved.

The Medical Director echoed what had already been said and wished to signpost Board Members to the presentation in today’s papers which the Medical Director had delivered at various external meetings including the regional and ICB Medical Directors Groups. It highlights and triangulates operational performance, patient safety and also working in a collaborative manner.

The Director of Nursing said the Parliamentary & Health Service Ombudsman Cases so far for 2024/25 are reported and of 12 contacts that were received only 5 of those required more information. 

10/24/16

Service Delivery Report

16a – Service Delivery Report

A report of the Director of Performance and Improvement was submitted.

The Director of Performance & Improvement gave an update and informed the Board that the Trust has a paramedic on every vehicle. Hear & Treat is in a good position.  Sickness is being managed well.  The Trust is making good progress with the mandatory training and workbooks all are on track. 

The Chairman congratulated the CEO and Director of Performance and Improvement on performance despite the challenges of Handover delays. In addition he was of the opinion that the way in which the Trust manages sickness is an exemplar in the NHS, as it is managed robustly and those with genuine sickness managed with kindness empathy and support. 

16b – Implementation of the National Requirement for the 45 Minute Maximum Ambulance Handover

A report of the Director of Performance & Improvement was submitted.

The Director of Performance & Improvement informed the Board that the paper provides the Board with an update on the implementation of the 45-minute maximum handover as per the London Ambulance Service Model and provided trajectories of go live by each of the Integrated Care System across the WMAS footprint.  The NHSE have mandated that each ICB, Acute and Ambulance Service, nationally were to implement the 45-minute LAS handover model. Its stated aim was to improve category 2 performance reducing the risk to those patients in the community awaiting an ambulance response.  The Director of Performance & Improvement informed the Board that whilst the Trust would support the initiative as it was nationally mandated; he could not offer any reassurance to the Board that this would have any impact on improving the current position in relation to handover delays going into winter period. 

10/24/17

Reports of the Strategy and Engagement Director

17a – The Lord Darzi Report

A report of the Strategy & Engagement Director was submitted.

The Strategy & Engagement Director explained that the paper is to brief the Board of Directors on the report by Lord Darzi of Denham into NHS performance, at the request of the new Secretary of State of Health and Social Care.   The report has a number of key themes for exploration in the proposed ten year NHS Plan by the Government.

The Strategy & Engagement Director suggested this be discussed further at the November Board Briefing when the Board will also be requested to review its Strategy document. 

17b – Staffordshire Healthwatch Review of UEC in Staffordshire

A report of the Strategy & Engagement Director was submitted.

The Strategy & Engagement Director explained that Healthwatch Staffordshire undertook a deep dive into the patient experience of using the 999 in Staffordshire.  Whilst the report presents some very positive feedback, there are clearly well-founded concerns that patients have, about ambulance response times.  Linked to the concern about response times, both Health Watch and patients could also clearly see the link between ambulance response times and hospital handover delays, with individual patients highlighting their experience.

10/24/18

Board Committee Reports and Minutes

18a – Audit Committee

The Chairs report on the meeting held on 22 October 2024 was submitted along with the minutes of the meeting held on 16 July 2024.

Mrs Jasper, Chair of the Audit Committee reported that no new risks or escalations were raised at the meeting on 22 October.  Two reports were received from Internal Audit.  These were related to financial sustainability the report received partial assurance with improvements required. This was around the CIP process and the lack of identified CIPs until well into the financial year. (NB this was considered earlier in the meeting) It recommended that CIPs process commence much earlier in the year so that they can be identified as part of the budget making process.  The other report was the Data Quality Report – this received significant assurance with minor improvement.

Policies approved at the meeting on 22 October were as follows:

• Claims Handling Policy
• Supplier Representative Policy
• Payroll Charter

Mrs Jasper said that the Committee had reviewed itself against the HFMA questions on the effectiveness of the Committee.  Meetings of the NEDs and both Internal and External Auditors took place with no issues requiring escalation to the Board.  

18b – Finance & Performance Committee

The verbal update on the meeting held on 29 October 2024 was submitted along with the minutes of the meeting held on 30 July 2024.

Mr Khan advised the Board that there were no new risks or issues of escalation to report to the Board.  The Director of Finance had already covered the finance items discussed at the Committee meeting.  Regarding PTS and the Committee will have a deep dive review at its next meeting.  Mr Khan explained that for operations the focus of the Committee was on the CQC regulation 12 action plan.  The Committee had congratulated the operations team on turning round the Cat 2 target. Mr. Khan indicated that the only concern was around the projections for the hospital handover delays.    This will be a challenge as we go into winter and will begin diminishing the Category 2 performance. 

Mr. Khan welcomed the appointment of Mr. Nat and was looking forward to him joining the Finance & Performance Committee. Mr. Khan indicated that Mrs. Kooner had attend her last Finance & Performance Committee meeting and thanked her for her contribution. 

18c – Quality Governance Committee (QGC)

The report of the Chair of the QGC, Suzanne Banks reported on the meeting held on 23 October 2024 and submitted a report.  The Minutes of the meeting of the Committee held on 24 July 2024 was also submitted.

Mrs Banks explained that the Committee reviewed all risks from the previous meeting to ensure they had been addressed.  The Committee then discussed whether the 45 minute maximum handover delay proposal should be a separate risk to the main hospital handover delay risk should be considered.

The Terms of Reference were discussed at length and were attached for approval. 

18d – People Committee

The report of the Chair on the meeting held on 12 August 2024 was submitted. 

The Minutes of the meeting held on 16 May 2024 was also submitted.

Mr Fessal was appreciative of the work undertaken by Mrs Kooner on the Committee as the lead NED on Well being. 

Mr Fessal explained that the 2023/24 WRES action plan shows that the organisation failed to meet the aim of an increase of 2% year on year of recruitment from ME last year, but he was hopeful this will be achieved this year. 

The Committee noted that the Trust does not have a budget for simulation training machine to cover the cost for wear and tear of items for the 15 hubs, approximately £20k worth of upkeep is necessary.  This will be picked up with the Director of Finance and CEO.

Presentation from Engaging Leaders programme positively demonstrated the wonderful work being done to support both individuals and identify new ideas to improve areas of good practice.

It was agreed that at least one meeting of the committee would be held face to face going forward. 

Mr Fessal said it was agreed that staff would appreciate some form of awareness of the discussions held at the Committee meetings and it was agreed to pick this up with the Communications Director.  The Communications Director did not believe it would be helpful to just add papers into the weekly briefing but did say if there is a specific item that has been raised, he would be happy to add that to the weekly briefing.  It was agreed that the Communications Director and Committee Chairs would discuss this further outside the meeting and provide an update at the next Board meeting. (Murray MacGregor)

10/24/19

Board of Directors Schedule of Business

The Schedule of Business was submitted.

10/24/20

Any Other Business

There was no other business.

10/24/21

10/24/22

Review of the Meeting & Identify any new or Increased Risks from the Meeting

The Chairman asked Board Members to feedback any comments to him or the Trust Secretary.

There being no other business for this meeting the Chairman brought proceedings to a close and thanked members for their attendance.