EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE

Transcription

1 Agenda - English EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE A meeting of the Joint Committee will be held at 09:30hrs On Tuesday St Cadoc's Hospital Lodge Road Caerleon Newport NP18 3XQ Video Conference Facilities are available: Please advise if you will be joining the meeting via VC. Within NHS Wales dial 51 Meeting Room 2123 AGENDA Development discussion / presentation on Demand & Capacity until 10am Part 1- Preliminary Matters 1.1 Welcome & Introductions Chair Oral 10: Apologies for Absence Chair Oral 1.3 Declarations of Interest Members must declare if they have any personal or business pecuniary interests, direct or indirect, in any contract, proposed contract, or other matter that is the subject of consideration on any item on the agenda for the meeting. 1.4 To receive the unconfirmed minutes of the Emergency Ambulance Services Committee Meeting held on 22 November Action Log Matters Arising not considered within the Action Log Part 2- Provider Issues Chair Oral Chair Attachment 10:05 Chair Attachment 10: To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in Wales Deputy Chief Executive WAST Attachment 10:15 Emergency Ambulance Services Committee Meeting -17/01/17 1 of 73

2 Agenda - English Part 3 Updates of Relevance to the Committee 3.1 Chair s Report Chair Oral 10: Chief Ambulance Services Commissioner s Report (to include): Directory of Services Update on NEPTS Update on EMRTS WAO Review of Emergency Ambulance Services Commissioning Report 3.3 Independent Evaluation of Clinical Response Model (to receive the final report) via QAIP CASC Attachment 10:55 CASC Attachment 11: Draft Integrated Medium Term Plan 2017 CASC / WAST Presentation 11:15 Part 4 Governance & Assurance 4.1 To Receive and Endorse Chairs updates from the established EASC Sub Groups NEPTS Commissioning and Delivery Assurance Group Collaborative Performance Delivery Group Quality Assurance and Improvement Panel (QAIP) CASC Attachment 11: EASC updated Risk Register Board Sec / CASC Attachment 11: Outline Business Case Executive Summary for 111 Wales Richard Bowen Attachment 12: EASC Finance Report Month 9 Director of Finance Attachment 12: EASC Forward Work Plan Chair/ Attachment 12:20 Board Sec. 4.6 Any other urgent business Chair Oral 12:25 Date of Next Meeting: 28 th March :30pm; Venue to be confirmed. 2 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

3 Agenda - Cymraeg PWYLLGOR GWASANAETHAU AMBIWLANS BRYS Cynhelir cyfarfod y Cyd-bwyllgor am 09:30pm Dydd Mawrth 17 Ionawr 2017 Ysbyty Sant Cadog Ffordd y Lodj Caerllion Casnewydd NP18 3XQ Bydd Cyfleusterau Fideogynadledda ar gael: Rhowch wybod os byddwch yn ymuno â r cyfarfod drwy Fideogynadledda. AGENDA Rhan 1. Materion Rhagarweiniol 1.1 Croesawu a Chyflwyno Cadeirydd Ar Lafar 10: Ymddiheuriadau am Absenoldeb Cadeirydd Ar Lafar 1.3 Datganiad o Fuddiannau Rhaid i aelodau ddatgan os oes ganddynt unrhyw fuddiannau ariannol personol neu fusnes, uniongyrchol neu anuniongyrchol, mewn unrhyw gytundeb, cytundeb arfaethedig, neu faterion eraill sydd o dan ystyriaeth ar unrhyw eitem agenda r cyfarfod 1.4 Derbyn y cofnodion heb eu cadarnhau cyfarfod y Cyd-bwyllgor Gwasanaethau Ambiwlans Brys a gynhaliwyd ar 22 Tachwedd Log Gweithredu Materion yn codi nad ystyriwyd yn y Log Gweithredu Cadeirydd Ar Lafar Cadeirydd Atodiad 10:05 Cadeirydd Atodiad 10:10 Rhan 2- Materion Darparwyr 2.1 Derbyn adroddiad diweddaru gan Ymddiriedolaeth Gwasanaethau Ambiwlans Cymru ar drafodaethau bandio parafeddygion a r gweithrediad arfaethedig yng Nghymru Dirprwy Brif Weithredwr WAST Atodiad 10:15 Emergency Ambulance Services Committee Meeting -17/01/17 3 of 73

4 Agenda - Cymraeg Rhan 3 Diweddariadau Perthnasol i r Cyd-bwyllgor 3.1 Adroddiad y Cadeirydd Cadeirydd Ar Lafar 10: Adroddiad y Prif Gomisiynydd Gwasanaethau Ambiwlans (i w gynnwys); Cyfeiriaduron Gwasanaethau Diweddariad ar NEPTS Diweddariad ar EMRTS Adolygiad Swyddfa Archwilio Cymru o r Adroddiad Comisiynu Gwasanaethau Ambiwlans Brys 3.3 Gwerthusiad Annibynnol y Model Ymateb Clinigol (derbyn yr adroddiad terfynol) drwy QAIP CASC Atodiad 10:55 CASC Atodiad 11: Derbyn Cynllun Tymor Canolig Integredig 2017 CASC / WAST Cyflwyniad 11:15 Rhan 4 Llywodraethu & Sicrwydd 4.1 Derbyn a Chymeradwyo diweddariadau gan Gadeiryddion yr Is-grwpïau sefydledig EASC NEPTS Grŵp Sicrwydd Comisiynu a Chyflenwi Grŵp Cyflenwi Perfformaid Cydweithredol Panel Sicrwydd Ansawdd a Gwella (QAIP) 4.2 Cofrestr Risgiau Diweddaredig EASC Ysgrifennydd y Bwrdd / CASC CASC Atodiadau 11:45 Atodiad 11: Achos Busnes Amlinellol i Brosiect 111 Cymru Richard Bowen Atodiad 12: Adroddiad Cyllid Mis 9 EASC Cyfarwyddwr Atodiad Cyllid 12: Cynllun Gwaith Blaengar EASC Cadeirydd/ Atodiad Ysgrifennydd y 12:20 Bwrdd 4.6 Unrhyw Fusnes Brys Arall Cadeirydd Ar Lafar 12:25 Dyddiad y Cyfarfod Nesaf: Cadeirydd Ar Lafar 28 Mawrth :30; lleoliad i w gadarnhau 4 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

5 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING UNCONFIRMED MINUTES OF THE MEETING HELD 22 NOVEMBER 2016 PRESENT Members: Mrs Allison Williams Mr Gary Doherty Mr Stephen Harrhy Dr Sharon Hopkins Mrs Judith Paget Mrs Jill Paterson Mr Paul Roberts Mrs Carol Shillabeer Mrs Clare Vaughan In Attendance: Mr Julian Baker Ms Hannah Evans Mr Stuart Davies Dr Dinhendra Gill Mr Shane Mills Mr Ross Whitehead Mr Robert Williams Part 1. PRELIMINARY MATTERS Chief Executive, Cwm Taf UHB Chief Executive, Betsi Cadwaladr UHB (Via Video Conference) Chief Ambulance Services Commissioner Acting Chief Executive, Cardiff & Vale UHB Chief Executive, Aneurin Bevan UHB Executive Director, Hywel Dda UHB Chief Executive, ABM UHB Chief Executive, Powys tlhb Director of Workforce & OD, WAST (in part) Director, National Collaborative Commissioning Director of Planning & Performance, Welsh Ambulance Services Trust (in part) Director of Finance, WHSSC Interim National Director, EMRTS (in part) Clinical Lead, National Collaborative Commissioning Assistant Chief Ambulance Services Commissioner Committee Secretary / Board Secretary Host Body Action EASC 16/73 WELCOME AND INTRODUCTIONS Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 1 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 5 of 73

6 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Mrs Allison Williams, Vice Chair of the Joint Committee, explained that unfortunately Professor McClelland, Chair was unwell and had asked her to Chair the meeting in her absence. Mrs A Williams welcomed Members to the meeting of the Emergency Ambulance Services Committee and those present introduced themselves. EASC 16/74 APOLOGIES FOR ABSENCE Apologies for absence were received from, Professor Siobhan McClelland, Chair, Dr Tracey Cooper, Public Health Wales, Mr Steve Ham, Velindre NHS Trust, Mr Steve Moore, Hywel Dda UHB and Ms Tracy Myhill, Welsh Ambulance Services Trust. EASC 16/75 DECLARATIONS OF INTERESTS There were no additional interests, to those already declared. EASC 16/76 MINUTES OF THE MEETING HELD ON 27 SEPTEMBER Members CONFIRMED the minutes of the meeting held on 27 September Committee Secretary EASC 16/77 ACTION LOG Members received the action log and NOTED that progress with some of the related matters would be considered within the substantive business meeting agenda. EASC 16/11 & 16/58 (111 Strategic Outline Case) Ms J Paget confirmed that the Strategic Outline Case (SOC) had now been approved and whilst Mr Richard Bowen was not available to attend today s meeting due to a related workshop, Ms J Paget suggested, as Senior Responsible Officer (SRO) that the SOC will need to be received by the Joint Committee, as the governance framework is being utilised, and where appropriate, also reflected within the Joint Committee s governance arrangements. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 2 of 17 Emergency Ambulance Services Committee 6 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

7 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Mrs Paget confirmed that there will be a national roll out plan and that good progress is being made in Abertawe Bro Morganwwg UHB. Mrs A Williams asked that any learning and early feedback from ABM UHBs experience is shared with those who may be next to roll out the implementation. Members were encouraged to note that the new model did not appear to be impacting adversely on secondary care. EASC 16/26 & 16/40 & 16/59 (Demand & Capacity work) Members NOTED that the intended approach was to commence the January Joint Committee meeting with a development discussion on progress with the demand and capacity work. EASC 16/43 (Sub Groups) Members NOTED that work associated with the Sub Group structure and membership, along with any related governance recommendations, will be developed following receipt of the Wales Audit Office report on a National Review of Emergency Ambulance Services Commissioning. EASC 16/78 The Committee RESOLVED to: NOTE the Action Log. MATTERS ARISING EASC 16/56 WAO Review of EASC Arrangements (Refers). The Chief Ambulance Services Commissioner provided an update on the status of the Wales Audit Office National Review of Emergency Ambulance Services Commissioning, noting that the related final report was delayed and will not now be received until the January 2017 meeting, assuming the draft report and comments on factual accuracy are provided within the related timescale. Members NOTED the intention to share the report when received. EASC 16/60 Evaluation of the new Clinical Response Model (Refers). The Chief Ambulance Services Commissioner provided an update on the finalisation of the report relating to the independent evaluation. It was anticipated that the final report is shared with Members and considered via the Quality Assurance and Improvement Panel (QAIP) prior to consideration by the Joint Committee at CASC CASC Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 3 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 7 of 73

8 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 its January 2017 meeting. EASC 16/62 Finance Report (Refers) In relation to the reported EASC financial position, Members asked that clarity is provided in relation to the additional non recurring financial allocation made available via Welsh Government, as it was important to accurately reflect this in relation to development of the Integrated Medium Term Plan (IMTP), from a commissioning and a provider perspective. Mr S Davies explained that in recognising the overall financial envelope of 135.6m, the 8m development allocation was included within this overall total. Mrs C Shillabeer emphasised the importance of learning from the process and Mr S M Harrhy clarified that it was important from the outset, for the Joint Committee to provide clarity against its commissioning intentions. The assumption that the resource envelope for the Framework Agreement overall is 135.6m needs to be confirmed by all Member Boards through the Directors of Finance in advance of consideration by Chief Executives. EASC 16/66 Team Resource (Refers) Members NOTED that discussions were ongoing in relation to the EASC Team resource, a matter which Wales Audit Office will also comment on in its National Report. EASC 16/67 Clinical Risk Assurance Review (Refers) Members NOTED that work continued to progress with WAST on the development of arrangements for Clinical Risk Assurance and a further update will be provided at the next Joint Committee meeting. CASC CASC Part 2. PROVIDER ISSUES EASC 16/79 EMERGENCY MEDICAL RETRIEVAL & RESPONSE SERVICE (EMRTS) The Chair welcomed Dr Dinhendra Gill, Interim National Director, EMRTS, members noting that the Committee had already received the cover report, the Commissioning Framework and the Evaluation Review Report. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 4 of 17 Emergency Ambulance Services Committee 8 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

9 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Dr Gill s presentation focused in summary on the key findings from the first phase of the 3 part evaluation process. Mr S Harrhy provided a perspective on the strength of evidence supporting the issue of inequity of service provision across Wales. Mr G Doherty raised concern about the issues reported on equity and the importance of it not being dismissed if the report is to inform commissioning intentions going forward. Mr G Doherty emphasised the reports terminology on inequity linked to both qualitative and quantitative information and was keen to take this forward within commissioning arrangements. Mr Doherty sought clarity as to whether we are seeking to get all the related work completed on the key messages from the report in advance of informing commissioning intentions from April Dr Gill clarified the limitation of the current coverage and some of the solutions going forward which will require discussion, including issues associated with the Caernarfon base and operational management (aligning more closely with EMRTS governance), the crew capacity, including paramedic staffing and also do we need a more hybrid model between bases covering the north of Wales. Members discussed other issues of inequity, which cover many services. Mrs C Shillabeer sought clarity on outcomes data and implications within Powys, where road traffic accidents (RTAs) and access to secondary care are a real feature for the LHB and Dr Gill made reference to variable uptake on TARN and ICNARC outcomes data across Wales. Mrs J Paget emphasised that value for money needs to align with the outcomes and associated costs that will ultimately inform commissioning intentions going forward. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 5 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 9 of 73

10 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Following a detailed discussion on Dr Gill s presentation members NOTED that EMRTS was not initially set up as a commissioned emergency service and it was important to emphasise the differentiation between the commissioning perspective and the independent evaluation report which was not commissioner focused. Members AGREED that there was a need going forward for a clear specification that informs commissioning intentions, which also needs to take into account resource demand, delivery and benefits realisation which also includes implications on other providers e.g. WAST, as it should be releasing resource. Members NOTED that there were some important questions to be considered, including; should this be a 24 hour service; should coverage, particularly in North Wales be strengthened and expanded. Members AGREED the need for a commissioning specification which informs the expected service standard and agreed performance measures and its linkages to other provider services. Members NOTED potential considerations of service redesign, including Major Trauma Centre for South Wales and the need to factor such changes into any service specification. Mr P Roberts thanked Dr D Gill and his team on his leadership and related work in establishing EMRTS within NHS Wales. Members NOTED that Dr Gill planned to step down as the Interim National Director, EMRTS at the end of March and endorsed the thanks conveyed by Mr Roberts. Mr S Harrhy made reference to the developing commissioning framework, a draft for which was attached to the meeting papers. Members NOTED the use of the Collaborative Commissioning Framework and the further related work being taken forward through the Delivery & Assurance Group, which would result in a more developed framework coming forward to January meeting of EASC. Members NOTED that reasonable progress had been made to date. In terms of North Wales some specific task focused working group had been established and which equity featured prominently in its work. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 6 of 17 Emergency Ambulance Services Committee 10 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

11 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Members considered it would be important to capture the related commissioning questions posed in consideration and discussion following Dr Gill s presentation and Mr S Harrhy agreed to do so and issue to members. CASC The Committee RESOLVED to: NOTE the update presented and discussed the progress made with the EMRTS Commissioning framework agreement, which will be developed further for the EASC meeting in January. (Dr D Gill left the meeting) EASC 16/80 WELSH AMBULANCE SERVICES NHS TRUST UPDATE (WAST) Members received an oral update from the Director of Planning and Director of Workforce & OD, Welsh Ambulance Services Trust, which outlined progress in relation to the following key areas: Refreshed IMTP Ms H Evans, Director of Planning, provided an oral update on progress with the development of the refreshed IMTP. Members NOTED the close working with the CASC, Health Boards and Welsh Government, on winter planning and preparedness and members noted that a further related meeting was scheduled to take place next week. Members NOTED that the Demand & Capacity work has been a key driver to the IMTP work and this would be shared with the CASC in advance of the January 2017 meeting of the Committee. Ms H Evans made reference to current performance, which was challenging, having deteriorated recently, particularly in relation to the Amber category of patients. Members were informed that 6 Serious Adverse Incidents had recently been reported to Welsh Government over the last 10 days, all of which are currently being reviewed and the outcomes from which will need to feedback into the Clinical Risk Assurance work. WAST WAST Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 7 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 11 of 73

12 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Mrs A Williams referenced the Demand & Capacity work, which will be a key factor going forward in the refresh of the IMTP and its important to ensure alignment with Health Board Demand & Capacity (D&C) work. Mrs A Williams also asked that the presentation of this work references the contributions of any specific innovative schemes which, if providing some yield, should be factored into any potential D&C gaps. Mrs Shillabeer emphasised the type and not just volume of demand is important to understand some of the related reasons that inform deployment of resource and conveyancing of patients. Members NOTED that the data available to the service now provides more granularity than ever before. Members NOTED that it was also important to recognise the acuity of those presenting to hospital, which is resulting in a different demand on secondary care services. National development of a band 6 paramedic profile Mrs A Williams, reaffirmed her previously declared interest, in that her husband is a paramedic and working in WAST. Further to discussions on this development at the September meeting of the Joint Committee, Mrs C Vaughan provided a detailed update on the context and current status of developing negotiations and their potential implications on WAST in NHS Wales. Members agreed to note the context to this development, and the pace of negotiations and change in England and the package of measures being negotiated. In acknowledging the publication of a national Band 6 paramedic role profile, Members NOTED its potential impact on the expectations of the paramedic workforce in Wales. Members NOTED the context and drivers to the introduction of a Band 6 role and Members were reassured to hear that WAST recognises the need to take time to understand what this means in the context of existing job descriptions, clinical skills and practice within Wales, to better understand how this Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 8 of 17 Emergency Ambulance Services Committee 12 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

13 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 development supports the triple aims of improved patient outcomes, improved value for money and improved patient experience for NHS Wales. Members NOTED that WAST Directors have been representing Wales strongly in national discussions, noting that NHS Wales operates in a different political and operational context, and that there was a need to work collaboratively between the service, commissioners and Welsh Government to develop an implementation plan (including mechanics for local negotiation) and a timetable that may mean moving towards a Band 6 paramedic role may take a little longer in Wales. Members acknowledged potential risks to staff recruitment, retention and morale as a result of any delay in moving to implementing a Band 6 role in Wales, and also in negotiating a potentially different deal to that in England. Members NOTED the active engagement with staff side locally and internal arrangements to communicate progress with WAST staff. Members NOTED that there will be financial implications and that these have yet to be fully quantified in the context of the overall financial plan for 2017/18 and pose a potential risk to this year s financial plan, if Wales follows NHS England s approach (who have agreed to backdate implementation to the 31 December 2016). Members NOTED the challenge and its potential impact, with limitations of the service to fully mitigate and manage all related risks. Mrs C Vaughan confirmed that colleagues at Welsh Government were fully informed and aware of the related issues. Mrs Shillabeer expressed concern about any approach to move away from A4C arrangements in NHS Wales or the development of an automatic escalator, which is not done for any other professional group under A4C. Members were encouraged to note that, as part of its implementation planning, WAST intends to use the output from the capacity and demand project analysis and career pathway development to inform requirements of skill mix and numbers of Band 6 roles, including developments such as the community paramedic role. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 9 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 13 of 73

14 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Members NOTED that opportunities presented by the development of the Band 6 Paramedic role and the focus of EASC as commissioners, to exploit the strengths of the Welsh system, including the new clinical response model and Ambulance Quality Indicator (AQI) data, to ensure we maximise this opportunity as a means to improve the key metrics of hear and treat, see and treat and non-conveyance. If implemented appropriately, this development has clear potential to help deliver future improvements in the unscheduled care system and also provide an enhanced role for paramedics across the care pathway. Members NOTED that the demand and capacity work, which was due to be updated at this meeting, would now feature prominently at the next Joint Committee meeting, which Members AGREED would commence in development with a discussion on this work. Members RESOLVED to: NOTE the update provided by Ms H Evans, Director of Planning and Mrs Clare Vaughan, Director of Workforce & OD. (Mrs C Vaughan and Ms H Evans left the meeting) Part 3. UPDATES OF RELEVANCE TO THE COMMITTEE EASC 16/81 CHIEF AMBULANCE SERVICES COMMISSIONER S REPORT Progress with Board Visits Mr S Harrhy confirmed that he and the Chair had either visited or had visits planned for all Health Boards. Development session January meeting 09:30 start Mr S M Harrhy confirmed arrangements for a focused discussion of around 30 minutes that will inform the direction of the Demand and Capacity work. Independent Evaluation of the Clinical Response Model Interim Report update Members NOTED that the planned discussion of the report will now take place at the QAIP meeting on 8 December 2016, following which, the report will need to be considered and Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 10 of 17 Emergency Ambulance Services Committee 14 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

15 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 approved by the Joint Committee at the January 2017 meeting, for onward submission to the Cabinet Secretary for his decision. Integrated Medium Term Plan Members NOTED that a draft plan will need to be considered by the January 2017 Joint Committee meeting, in advance of its submission to Welsh Government in March Members NOTED the role of EASC in WAST s IMTP and also the requirement for EASC to submit. In response to a query from Dr S Hopkins, Mr Harrhy explained the EASC plan is in effect its Integrated Commissioning Plan. CASC WAST/CASC Members NOTED the agreement in WHSS Joint Committee earlier that a core set of agreed common assumptions would be fed through to Providers and it was suggested that EASC adopt a similar approach. Directory of Services Members NOTED that to date, responses received, confirm broadly that they are currently being updated by Health Board and that some of this work was also informing preparation in relation to the roll out of the 111 programme. Hear and Treat Members NOTED that this is working well and some non recurrent financial support had been provided by Welsh Government, which will impact on any recurring financial implications. Members NOTED the intention of WAST to temporarily deploy staff to support this work for 3 months, but expressed concern this may have on crew capacity and deployment in the winter months. The CASC AGREED to clarify the arrangements with WAST. Members RESOLVED to: CASC NOTE the Commissioner s update report. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 11 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 15 of 73

16 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 EASC 16/82 AMBULANCE QUALITY INDICATORS Members RECEIVED and NOTED the latest quarterly publication of the Ambulance Quality Indicators (AQI s), for the period 1 July 2016 to 30 September 2016, published on 26 October Members NOTED the quarter 2 publication and discussed some of the related findings. Issues associated with Amber performance remained an area of further focus, although it was important to note that overall amber performance had improved, but that the last week had not been good with the service coming under significant pressure. Members NOTED that Hywel Dda is improving in terms of its category red response. Mrs A Williams sought clarity on re-contact rates and the effectiveness of hear & treat on conveyancing rates. Mr S Harrhy explained that the level of crews dispatched has not reduced significantly to date and there was further work needed in this area of WAST s work, which WAST were aware of. Members suggested that hear and treat needs to be very different to clinical triage if EASC is being asked to invest in this as a service development. Members RESOLVED to: NOTE the recently published quarterly AQIs. Part 4. GOVERNANCE & ASSURANCE EASC 16/83 CLINICAL RISK ASSURANCE REVIEW UPDATE Mr S Mills provided an update on the review undertaken by him and the Assistant CASC of 200 of the 100,000 backlog forms relating to clinical audit / clinical risk data. On completion of the review work, the plan is to consider additional temporary resource to assist the process. Mr S Harrhy expressed concern about the related risk that needed to be assessed and captured in relation to this issue and Members also NOTED that it was important that Mr Mills and Mr Whitehead do not end up doing the work that should be a routine feature of WAST s work. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 12 of 17 Emergency Ambulance Services Committee 16 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

17 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Mr S Harrhy was asked to seek confirmation from the WAST Chief Executive of the planned timescale they are working to in order to address the backlog and complete this work. Mr Whitehead clarified that the backlog related to validation of the penned data to export to a digital record. CASC/ WAST CEO Members RESOLVED to: NOTE the update. EASC 16/84 CHAIRS UPDATES FROM EASC SUB GROUPS Members NOTED the updates provided by the Chairs of the sub groups established by the Joint Committee, these being: The Quality Assurance & Improvement Panel (QAIP). The Collaborative Performance Delivery Group. The NEPTS Commissioning & Delivery Assurance Group Members NOTED the work required on receipt of the WAO Review Report in order to review the groups, their membership and related reporting arrangements. CASC Members RESOLVED to: NOTE the summary updates received. EASC 16/85 NATIONAL COLLABORATIVE COMMISSIONING QUALITY & DELIVERY FRAMEWORK AGREEMENT 6 MONTHLY REVIEW Mr J Baker provided an update of progress to date and explained the schedule going forward and confirmed that there is a refresh of the documentation process included in the papers. To compliment the report, Mr Baker tabled an updated EASC 2017 summarised commissioning intentions for 2017/18. Members NOTED that the approach is being shared with WAST; Directors of Planning and Welsh Government over the next 2 weeks to better inform this work going forward. An electronic set would also be circulated to Members not present or on Video Conference. Mr J Baker Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 13 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 17 of 73

18 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 Mr J Baker made reference to and explained the commissioning intentions and the level of detail the Joint Committee, as Commissioners would wish to see going forward and how these will further develop the IMTP assumptions for EASC, WAST and Health Boards. Members NOTED that this was work in progress and evidence of how the framework is being developed to inform commissioning intentions. Members discussed the extent of the data set and how it was being received by WAST and Mr S Harrhy explained that in terms of the maturity of this work, its considered a reasonable expectation from a commissioner perspective, with the emphasis of relationship with the provider being collaborative. Mr Whitehead added that the framework is the menu of indicators that can be provided to a variety of stakeholders. Mr S Davies clarified that the resource envelope informing the Framework Agreement overall is 135.6m, Mrs A Williams explained that this assumption must be formally confirmed with Member Boards. Members NOTED that there was an expectation from WAST that their internal efficiencies e.g. workforce shift from Agency / overtime premium costs would occur. Mr S Harrhy confirmed that a more detailed update would be considered in December and Members emphasised the importance of closing the governance line on this matter in order that discussions can move away from finance. Members considered that it would be helpful if the financial matters can be concluded and agreed via Directors of Finance, in advance of consideration by Chief Executives. Members also AGREED that Mrs A Williams as Vice Chair of EASC can liaise directly with the CASC to inform all Wales CEOs of progress. ALL Mrs A Williams / CASC Members RESOLVED to: NOTE the update. EASC 16/86 EASC/WHSSC DE-COUPLING UPDATE Mr R Williams, Committee Secretary / Host Body Board Secretary provided an update on matters progressed that related to the de-coupling of EASC from WHSSC. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 14 of 17 Emergency Ambulance Services Committee 18 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

19 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 In presenting the report Mr R Williams, made reference to the further progress needed, some of which will be informed following receipt of the WAO National Report and recommendations relating to the Joint Committee s Sub Group arrangements. Board Secretary Members NOTED the matters progressed and further actions, including some discussed during the meeting relating to 111 and Non Emergency Patient Transport Services (NEPTS) that needed to be reflected, along with any recommendations on sub groups made by the Wales Audit Office. In reviewing the 3 appendices documents attached to the covering report, Members recognised the extent of the related work progressed. In relation to Standing Financial Instructions and the related Scheme of Delegation, Members considered the most appropriate way forward and AGREED that the SFIs of the host body be adopted. ALL Members RESOLVED to: NOTE the update provided relating to the EASC / WHSSC de-coupling; ENDORSE the further actions needed to fully conclude this work. EASC 16/87 FINANCE REPORT Mr S Davies presented the Month 7 EASC Finance Report and made reference to discussions earlier in the meeting relating to financial matters. Mrs A Williams asked that the CASC write out to Directors of Finance (copy to CEOs) asking for confirmation of actions to address the outstanding cash management issues. Members NOTED that there was no anticipation of any under spend against the overall resource envelope of 135.6m and that EASC continues to assume the WAST break even position. Mr S Harrhy agreed to seek confirmation from Welsh Government regarding any funding shortfalls. CASC CASC Members RESOLVED to: NOTE the Month 7 finance report update. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 15 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 19 of 73

20 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 EASC 16/88 UPDATED RISK REGISTER Mr R Williams, Committee Secretary / Host Body Board Secretary presented the updated Joint Committee Risk Register. Members NOTED that the only adjustment to the risk register was an increased risk rating associated with the resource envelope, which was discussed in some detail at the last Joint Committee meeting. The risk rating following review had been re-assessed to 9 from 6. Following discussion, Members asked that the next review consider the following matters: Add a new risk to the risk register on staffing, which aligns to potential financial and operational service risks as national discussions on Band 6 role progress; Non Emergency Patient Transport Services and matters relating to the plurality model and associated issues. Members RESOLVED to: NOTE the contents of the report; and ENDORSE the updated risk register. EASC 16/89 JOINT COMMITTEE FORWARD PLAN The Committee Secretary / Host Body Board Secretary presented the forward plan and identified some of the changes agreed in advance of the meeting and those matters raised during the meeting. This included a delay in the Demand & Capacity work reporting until January 2017; receipt of the WAO National Review on EASC Report to January 2017; progress with IMTP refresh for WAST and EASC to January 2017 and receipt of the Independent Evaluation of the Clinical Response Model for January CASC Members RESOLVED to: NOTE the Forward Plan and the suggested amendments. Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 16 of 17 Emergency Ambulance Services Committee 20 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

21 1.4 To receive the unconfirmed minutes of the EASC meeting held on 22 November 2016 AGENDA ITEM 1.4 OTHER MATTERS EASC 16/90 ANY OTHER BUSINESS Mrs A Williams, Vice Chair, asked those who were not Members of the Committee to withdraw, in order to proceed with an In Committee item. EASC 16/91 DATE AND TIME OF NEXT MEETING The date of the next Joint Committee meeting was scheduled for 09:30am on, venue to be confirmed. Committee Secretary Signed (Chair) Date Unconfirmed Minutes of the EAS Joint Committee Meeting 22 November 2016 Page 17 of 17 Emergency Ambulance Services Committee Emergency Ambulance Services Committee Meeting -17/01/17 21 of 73

22 22 of 73 Emergency Ambulance Services Committee Meeting -17/01/17 Action Log JOINT COMMITTEE MEETING Held on 22 November 2016 Agenda Item Minute Action Lead Progress EASC 16/11 & EASC 16/58 Richard Bowen EASC 16/26 & EASC 16/40 & EASC 16/59 & EASC 16/80 EASC 16/43 EASC 16/56 & 16/ Strategic Outline Case Clarity on the critical path noting the complex and inter-related issues between system providers and GP OOH services to be provided with timescales. Demand and Capacity Modelling - Members noted the ongoing demand and capacity work being progressed. Whilst an interim report would be available in July 2016, it was unclear whether the final report would be ready for the September meeting. It was agreed that Mr S Harrhy discuss the timetabling of this item with Ms T Myhill. Information to be shared with the CASC in advance of the January EAS Committee Sub Groups Update summary on the role, function and membership of the sub groups as well as the progress on the work with WAST on the Clinical Governance Plan. WAO Review of EASC Commissioning Arrangements Members agreed to provide comments particularly regarding the journey of the Committee and the progress made when the draft report was shared Further progress to be made following the receipt of the report particularly on sub group arrangements CASC WAST CASC All CASC Strategic Outline Case to be presented to the Committee - TBC Development Session agenda item Completed Pending formal receipt of WAO report January 2017 Awaiting receipt of final report Action log Action Log Page 1 of 3 Emergency Ambulance Services Committee 22 November 2016

23 Emergency Ambulance Services Committee Meeting -17/01/17 Minute Action Lead Progress EASC 16/60 Evaluation of the new clinical response model & 16/81 Additional information to be provided following discussion at QAIP to be shared with members at the January meeting CASC Agenda item 3.3 To receive a report for approval at the January 2017 meeting, for onward submission to the Cabinet Secretary for his decision. CASC Agenda item 3.3 EASC 16/69 Emergency Medical Retrieval and Transport Service To circulate the Welsh Government commissioned evaluation report link here (Appendix to Action log) CASC Completed EASC 16/78 & 16/67 & 16/80 & 16/83 EASC 16/79 EASC 16/81 EASC 16/85 Clinical Risk Assurance Review Work progressing with WAST, further update at next meeting. WAST to share outcomes from serious adverse incident investigations The CASC would confirm with WAST s CEO regarding their timescale to complete the backlog of the review of clinical audit /clinical risk data Emergency Medical Retrieval and Response Service To receive a more developed EMRTS framework, based on the Collaborative Commissioning Framework Asst CASC & Clinical Lead Collab Comm WAST CASC Asst CASC & Clinical Lead Collab Comm /CASC Was January now March 2017 March 2017 Was January now March 2017 Share the related commissioning questions following the presentation with the Members CASC Discussed at DAG Integrated Medium Term Plan To receive a draft plan at the January 2017 Joint Committee WAST Agenda item 3.4 meeting, in advance of its submission to Welsh Government in March Hear and Treat The CASC agreed to clarify the arrangements with WAST to temporarily deploy staff to support the work for 3 months and the impact this would have on crew capacity and deployment in the winter months. Resource Envelope for WAST The assumption that the resource envelope for the Framework Agreement overall is 135.6m, this needs to be confirmed by all Member Boards through the Directors of Finance in advance of CASC ALL Completed TBC Mrs A Williams and CASC to provide update on Action log 23 of 73 Action Log Page 2 of 3 Emergency Ambulance Services Committee 22 November 2016

24 24 of 73 Emergency Ambulance Services Committee Meeting -17/01/17 Minute Action Lead Progress consideration by CEOs. progress EASC 16/86 EASC/WHSSC De Coupling Update Members AGREED to adopt the Standing Financial Instructions of the host body. All Completed EASC 16/87 Finance Report CASC to write to Directors of Finance to ask for confirmation of DOF/CASC actions to address the outstanding cash management issues. Completed Action log Action Log Page 3 of 3 Emergency Ambulance Services Committee 22 November 2016

25 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W AGENDA ITEM 2.1 Emergency Ambulance Services Committee Report UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Executive Lead: WAST Executive Director of Workforce & OD Author: Claire Vaughan WAST Executive Director of Workforce& OD Contact Details for further information: claire.vaughan@wales.nhs.uk Purpose of the Emergency Ambulance Services Committee Report The paper is in response to the request from EASC to have an update on the national Paramedic banding position and proposed implementation in Wales. Governance Link to the Commissioning Agreement Supporting evidence The Committee s overarching role is to ensure its Commissioning Strategy for Emergency Ambulance Services utilising the five step patient pathway outlined within the National Collaborative Commissioning Quality and Delivery Agreement and the related outcomes for each care standard aligned with the Institute of Healthcare Improvement's (IHI) Triple Aim are being progressed. This report focuses on all the above objectives, but specifically on providing strong governance and assurance. Appendix 1 Estimated Transition Costs Appendix 2 Letter from Julie Rogers, Director, Workforce & Organisational Development, Health and Social Services Group, Welsh Government Engagement Who has been involved in this work? Welsh Ambulance Service NHS Trust, Trades Unions, Welsh Government, Chief Ambulance Services Commissioner, Emergency Ambulance Service Committee. UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 1 of 9 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 25 of 73

26 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W Emergency Ambulance Services Committee Resolution To: APPROVE ENDORSE DISCUSS NOTE Recommendation The EASC is asked to: NOTE the contents of this paper, particularly the estimated cost implications and next steps in the negotiating process. CONSIDER the role and position of Commissioners during the negotiating process and advise accordingly. SUPPORT the proposal to exclude the costs of implementation pending outcome of local negotiations and further discussion and agreement on funding of this development. Summarise the Impact of the EAS Committee Report Equality and diversity Legal implications Population Health Quality, Safety & Patient Experience Resources Risks and Assurance Health & Care Standards Workforce Freedom of information status No impact identified. No specific impact identified Improved clinical practice including hear & treat, see & treat and reduced conveyance. Improved clinical practice including hear & treat, see & treat and reduced conveyance. Potentially an estimated 1m (17/18) and 1.5m for 5 years thereafter. Recruitment and retention. Industrial action. The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes: Staying Healthy; Safe Care; Effective Care; Dignified Care; Timely Care; Individual Care; Staff & Resources 064/24729_Health%20Standards%20Framework _2015_E1.pdf The work reported in this summary and related annexes take into account many of the related quality themes, in particular, effective care and staff & resources. Paramedics in pay band 5 transition moving to band 6 with agreed clinical practice improvements which impact on performance and patient experience. Open. UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 2 of 9 Emergency Ambulance Services Committee Meeting 26 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

27 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES 1. SITUATION / PURPOSE OF REPORT 1.1 At its November 2016 meeting, the Emergency Ambulance Service Committee (EASC) received a further verbal update on national discussions regarding the banding of the paramedic workforce, developments in England and the implications in Wales. 1.2 It was requested the Committee receive a formal written paper to its January 2017 meeting setting out the position and indicative costs of implementation of a Band 6 paramedic role in Wales. 2. BACKGROUND / INTRODUCTION 2.1 The development of a Band 6 paramedic job evaluation profile and its potential implications have been the subject of much discussion both within the Welsh Ambulance Service NHS Trust, between Directors, Board Members and Trade Union Representatives, and also with Commissioners and Welsh Government who have been regularly briefed since August Welsh Ambulance Service paramedics are currently employed on a Band 5. At December the Trust employs 839 Band 5 paramedics 1 (staff in post). 2.3 The 2015 pay settlement (England) between Ministers and the Trades Unions agreed that employers would work with Trades Unions to address recruitment and retention issues, either through changes to use of job profiles and bandings or through application of recruitment and retention premia. Following the threat of possible industrial action, talks between Employers, NHS Employers and Trades Unions in England gained significant momentum and a package of measures for implementation of a Band 6 for paramedics has now been agreed. This includes the following: The publication nationally of the Band 6 paramedic job evaluation profile and agreement to move forward with local job matching to an agreed national timetable. The introduction of a national Implementation Board with representatives from all sides to oversee implementation of this change within England Agreement to the introduction of a Band 5 newly qualified paramedic role within a clear consolidation of learning framework, and development of a NQ Band 5 Job Evaluation Profile WTE UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 3 of 9 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 27 of 73

28 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W Agreement to an implementation date of 1 April 2017, backdated to an effective date of 31 December 2016 for transition of paramedics to a Band 6. Agreement to work collaboratively to adopt the practice changes of the Urgent and Emergency Care Review (UECR) for paramedic roles and develop future job descriptions to support greater consistency in the scope of paramedic practice. 2.4 When these proposed changes are implemented, it will affect the banding and pay of a substantial number of paramedic posts, with potential for significant cost pressures for ambulance services across the UK. A statement confirming that funding has been agreed by the Department of Health, NHS England and NHS Improvement to support delivery of the agreement with funding in future years linked to agreements between Ambulance Trusts and commissioners on delivery of the Urgent and Emergency Care review, was released on Friday 9 December Welsh Ambulance Service Directors have been actively involved in the Band 6 debate on a UK-wide basis but, clearly, health is an area devolved to the Welsh Government and the agreed package of measures and funding deal in England does not extend to Wales. Hence the need to work closely with Commissioners, Welsh Government and Trades Unions to understand the implications of what has been agreed in England and to swiftly enter into national discussions to reach agreement on what this means for paramedics who live, train and work here in Wales. 3. ASSESSMENT / GOVERNANCE AND RISK ISSUES Opportunities 3.1 WAST is absolutely committed to ensuring that its paramedic workforce is properly rewarded for its skills, in line with other clinical professionals, and welcomes the publication of a Band 6 profile and the scope that it offers to expand clinical practice and critical decision making as a means to improve the key metrics of hear and treat, see and treat and non-conveyance Wales is unique in having a collaborative commissioning agreement with clear five step Ambulance Care Pathway and regularly published Ambulance Quality Indicators (AQIs) which include seven clinical indicators. This is the framework against which service developments, priorities and future actions are set, and which will enable WAST to truly focus on clinical outcomes that will support improved clinical practice, education and drive professionalism as we move forward. 3.3 This opportunity should be positively received, and if implemented correctly, has the potential to both reward and recognise staff for the work that they do, and contribute to delivery of future improvements across the unscheduled care system, providing an enhanced role for paramedics meeting the changing needs of patients with a range of complex and long- UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 4 of 9 Emergency Ambulance Services Committee Meeting 28 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

29 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W term illness and diseases within the Primary Care setting. Key to the realisation of such future benefits are high quality clinical education, training, and strengthened clinical leadership, a clear career pathway and support to clinicians on a day to day basis. Costs 3.4 If all WAST paramedics currently in pay band 5 transition into pay band 6, in line with an agreed new national profile, based on an assimilation as opposed to promotion approach 2, the estimated cost of making this change (transition and longer term) in Wales is c. 1m in year one, with an additional cost of c 1.5m each and every year thereafter for at least the next 5 years, i.e. by 2022/23 an increase of some 8.5m per annum over and above the current cost base (at 2016/17 prices) as detailed in Appendix 1. Calculated incremental costs for 17/18 based on the funded Band 5 Paramedic establishment is 0.315m. This shows that 71% of Paramedic Band 5 workforce (as at 1 st October 2016) was at top of scale. NB: Final costs will be determined by local outcomes (JE process) and the % allocation of paramedic jobs into the higher pay band (band 6). 3.5 Commissioners through the Emergency Ambulance Services Committee (EASC) have previously advised WAST that they will seek Welsh Government advice on how any additional cost pressures arising should be treated as part of financial planning for 2017/18 and beyond. This matter requires consistent resolution at a national level. 3.6 WAST cannot afford the increase in workforce costs resulting from all paramedics being employed in the higher pay band (pay band 6). Further pay modelling is required to determine the actual level of cost pressure and then how much of that could be absorbed by the Trust being offset by efficiency savings and productivity gains elsewhere in the service This will also look to be described as such in the upcoming IMTP refresh, which is planned to include a baseline financial plan for the Trust excluding the cost impact of this development, along with clarity over the net additional costs expected of this over life of this plan. As noted above, there will then be further clarity on the actual cost impact based on local outcomes of the JE and implementation process. Potential Risks 3.7 There is a potential risk to recruitment and retention of current and future paramedics, particularly newly qualified paramedics and those employed in parts of Wales which border England, should Band 6 paramedic posts be available in England and not Wales. 2 Assimilation means that, where there is crossover on the pay banding between a Band 5 (top three pay points) and Band 6 (first three pay points), an individual will simply move across to the new pay band on the same salary. Promotional rules (if applied) would mean an individual moves across and up one pay point. In England it has been agreed that assimilation rules, not promotion apply. UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 5 of 9 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 29 of 73

30 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W 3.8 WAST managers and local Trades Unions been working together to address the causes of poor morale and ill health, particularly related to shift over runs, meal breaks and support for mental health and wellbeing. There is perceived to be a significant further risk to morale should WAST fail to move in the direction of England and implement a Band 6 for paramedics swiftly. 3.9 The industrial relations climate in England has been tense, perhaps less so in Wales. Whilst constructive dialogue has taken place locally with our (Wales) Trades Unions, there still remains a risk of industrial action in Wales if no resolution (at a national level) is found to the key grading and pay issue and linked funding requirement Increasing pressure is being brought to bear by local Trades Unions Representatives for agreement on a similar deal and package of measures to that discussed in England. Any form of industrial action would pose a risk to patient safety and undermine confidence in the service at a time when demand is increasing, performance targets are being met and sustained, and public perception and reputation of the Service continue to improve. Views of Key Stakeholders 3.11 The Chief Ambulance Services Commissioner has confirmed his expectation that any developments within Wales must support the triple aims of improved patient outcomes; improved value for money for NHS Wales and improved patient experience; that this will be informed by the demand and capacity project outputs; and the need for this development to be included within the collaborative commissioning framework. This is the context within which we must now frame local discussions and negotiations, while we continue to better understand the financial consequences and seek assurance and assistance particularly in regard to identification of funding As with colleagues in England, Welsh Ambulance Service Trades Unions believe that the paramedic job has developed over recent years and as a result most paramedics now meet the role specification of a band 6 professional and should receive the benefits of higher basic pay. Locally, Welsh Trades Unions are seeking swift progress on a national process and implementation plan to be agreed which includes: WAST matching paramedic job description to the new profile with an expectation that most, if not all, will transition to the higher band 6 level, to an agreed timetable that runs closely with that of England. Sign up to an effective date of change at 31 December 2016, in line with England. Improvements in the training and clinical leadership of paramedics, ensuring adequate clinical supervision is in place to support staff. Continued improvements not only to the pay and conditions of staff, but to the overall staff experience which should support the wider health and well-being agenda. UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 6 of 9 Emergency Ambulance Services Committee Meeting 30 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

31 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W 3.13 The view of Welsh Government and the Cabinet Secretary for Health, Wellbeing and Sport is set out in a letter from Julie Rogers, Director, Workforce & Organisational Development, Health and Social Services Group, Welsh Government attached at appendix 2. This confirms the support of the Cabinet Secretary to taking forward this development in partnership with trade union colleagues, the mechanism for negotiation and the expectation that WAST, EASC and Welsh Government will work together to ensure a nationally consistent approach to managing any resulting cost pressures, and that funding does not present a barrier to implementation of the new role. Next Steps 3.14The Welsh Partnership Forum has been asked to establish a paramedic negotiating sub group, which will be chaired by Richard Tompkins, Director, NHS Wales Employers. A start date of the 19 January 2017 has been proposed for commencement of negotiations, with a desired timeline to reach agreement in principle subject to approval of the Welsh Partnership Forum, to identified funding and Commissioner/Welsh Government support on the Wales Offer by the end of February 2017, if possible. 3.15WAST s starting position for negotiations in Wales will be: the requirement for Band 6 paramedics should be informed by the output of the Trust s capacity and demand work. there is a place for an experienced band 5 role within the Welsh skill mix. the effective date of change will be subject to local Wales negotiations and must be subject to affordability and funding availability. WAST will consider introduction of the new consolidation of learning role for a Newly Qualified/Registered Paramedic at a band 5 as part of its discussions and skill mix review. transition will be treated as an assimilation under AfC and not one of promotion, as in England. assurances will need to be in place in regard to identification of funding of the additional cost pressures an expectation that (within a realistic timeframe) all Band 6 paramedics will develop and show the necessary skills and critical analysis and decision making required to expand clinical assessment and treatment of patients with a range of complex and long-term illness and diseases in the Primary Care setting The role and position that Commissioners will take during the negotiation process has yet to be clearly identified, and EASC is asked to provide a steer on this to inform the set up and conduct of the national negotiations. 3.17Given the timeline for negotiations, it is unlikely that the detail of this development will be known and fully worked through in time to inform UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 7 of 9 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 31 of 73

32 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W IMTP planning submission deadlines, with first draft due at the end of January Until funding for re-banding can be agreed, it is proposed to exclude the costs of implementing the re-banding from the base case within our IMTP submission (in January 2017), as described at paragraph 12 above. Details of the excluded costs will be supplied under separate cover along with details on the status of local negotiations and ongoing discussions with EASC. 4. RECOMMENDATION Members of the Emergency Ambulance Services Committee are asked to: NOTE the contents of this paper, particularly the estimated cost implications and next steps in the negotiating process. CONSIDER the role and position of Commissioners during the negotiating process and advise accordingly. SUPPORT the proposal to exclude the costs of implementation pending outcome of local negotiations and further discussion and agreement on funding of this development. Freedom of information status Open UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 8 of 9 Emergency Ambulance Services Committee Meeting 32 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

33 2.1 To receive an update report from the Welsh Ambulance Services Trust on national paramedic banding discussions and proposed implementation in W Appendix 1 Appendix 1 17/18 18/19 19/20 20/21 21/22 22/ Assimilation Costs Base Salary Increase 510 Average Unsocial 117 Employers On Increased Overtime Costs 228 Increased Overrun Costs 26 Total Assimilation Costs 1,051 Incremental Costs Base Salary Increase Average Unsocial Employers On ,217 1,217 1,217 1,217 1,217 Overtime Premium Costs Overrun Premium Costs Total Incremental Costs 1,471 1,471 1,471 1,471 1,471 Annual Increase in Pay Costs 1,051 1,471 1,471 1,471 1,471 1,471 Cumulative Increase in Pay Costs 1,051 2,522 3,992 5,463 6,934 8,405 UPDATE ON NATIONAL PARAMEDIC BANDING DISCUSSIONS AND PROPOSED IMPLEMENTATION IN WALES Page 9 of 9 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 33 of 73

34 2.1.2 Appendix 2 Letter from Julie Rogers to Claire Vaughan WAST Grŵp Iechyd a Gwasanaethau Cymdeithasol Health and Social Services Group Claire Vaughan Director Workforce and OD WAST Sent via Claire.vaughan@wales.nhs.uk 15 December 2016 Dear Claire Thank you for the paper setting out the background and WAST position on the rebanding of paramedics following agreement about implementation in England. In your paper, you set out WAST s starting position for negotiations in Wales and the Cabinet Secretary has noted these. You also asked for a steer on three main areas and the Cabinet Secretary has agreed the following:- The Wales Offer as set out in your paper. Welsh Government notes the current position of WAST based on their discussions with the Ambulance Service Commissioners and EASC. Welsh Government value the work of all our paramedics in Wales and are pleased about the significant change that is being delivered through partnership in WAST which has resulted in significant benefits for the people of Wales. In the same spirit we are keen to see national negotiation of a new Wales Offer for paramedics who live, train and work in Wales which is affordable and sustainable, delivers the flexible capacity to meet demands on the service and delivers enhanced services for the people of Wales. Implementation plan and timetable The agreed mechanism in Wales for negotiation is the Wales Partnership Forum (WPF). Welsh Government will ask the WPF to establish a Paramedic negotiating sub group with nominated representatives of employers and staff side. Welsh Government will arrange and facilitate the meetings and support the development of a realistic agreed timetable for the process. Parc Cathays Cathays Park Caerdydd Cardiff CF10 3NQ Ffôn Tel julie.rogers@wales.gsi.gov.uk Gwefan website: 34 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

35 2.1.2 Appendix 2 Letter from Julie Rogers to Claire Vaughan WAST Welsh Government will provide advice to the Cabinet Secretary as necessary during the negotiating process. Cost and funding requirements Welsh Government recognises that it is not possible at this stage to identify the precise costs of any new arrangements for paramedics. As proposals develop we recognise that it will be necessary to reach a nationally consistent approach to manage any cost pressures that result. We will expect WAST to work with the Commissioners and Welsh Government, as appropriate, to ensure that funding is not a barrier to the implementation of the new role. I will formally ask the Welsh Partnership Forum to establish a sub group to reach a negotiated position on the implementation of Band 6 in Wales so that we can offer further advice to the Cabinet Secretary to enable him to make a decision on the matter. Helen Arthur will be managing this work for Welsh Government. Helen may be contacted on or at Helen.Arthur@Wales.gsi.gov.uk. And it would be helpful if you could ensure that Helen is sent copies of all relevant correspondence on this issue as work progresses. Yours sincerely Julie Rogers, FCIPD Director, Workforce & Organisational Development Cyfarwyddwr, Yr Gweithlu a Datblygu Sefydliadol Cc Tracy Myhill, Chief Executive, WAST Helen Arthur, Welsh Government Carl Eley, Welsh Government Aled Brown, Welsh Government Emergency Ambulance Services Committee Meeting -17/01/17 35 of 73

36 3.2 Chief Ambulance Services Commissioner's Report AGENDA ITEM 3.2 Emergency Ambulance Services Committee Report CHIEF AMBULANCE SERVICES COMMISSIONER S UPDATE REPORT Executive Lead: Chief Ambulance Services Commissioner Author: Chief Ambulance Services Commissioner Contact Details for further information: Robert Williams, or Robert.Williams@wales.nhs.uk Purpose of the Emergency Ambulance Services Committee Report The purpose of this report is for the Committee to receive an update on key matters related to the work of the Chief Ambulance Services Commissioner. Governance Link to the Commissioning Agreement Supporting evidence The Committee s overarching role is to ensure its Commissioning Strategy for Emergency Ambulance Services utilising the five step patient pathway outlined within the National Collaborative Commissioning Quality and Delivery Agreement and the related outcomes for each care standard aligned with the Institute of Healthcare Improvement's (IHI) Triple Aim are being progressed. This report focuses on all the above objectives, but specifically on providing strong governance and assurance. The development of this report has where appropriate been informed by updates provided through established governance processes. A number of the issues highlighted within the report are covered in more detail within the main agenda of the Committee meeting. Engagement Who has been involved in this work? The Emergency Ambulance Services Commissioning Team has contributed to the development of information contained within this report. Update from the Chief Ambulance Services Commissioner Page 1 of 4 Emergency Ambulance Services Committee Meeting 36 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

37 3.2 Chief Ambulance Services Commissioner's Report Emergency Ambulance Services Committee Resolution To; APPROVE ENDORSE DISCUSS NOTE Recommendation The Emergency Ambulance Services Committee is asked to: DISCUSS and NOTE the report ENDORSE Chair s Action for final response to WAO. Summarise the Impact of the EASC Report Equality and diversity Legal implications Population Health Quality, Safety & Patient Experience Resources Risks and Assurance Health and Care Standards Workforce Freedom of information status There are no equality and diversity implications contained within this report. There are no legal implications contained within this report. No impact. Ensuring the Committee and its Sub Groups make fully informed decisions is dependent on the quality and accuracy of the information presented and considered by those making decisions. Informed decisions are more likely to impact favourably on the quality, safety and experience of patients and staff. No impact. Ensuring the Committee is fully sighted on key areas of its business is essential to Board Assurance processes and related risks. The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes; Staying Healthy; Safe Care; Effective Care Dignified Care; Timely Care; Individual Care; Staff & Resources within an overarching Governance Framework. Welsh Government Health & Care Standards Framework 2015 This report focuses mainly on Governance & Accountability but also spans some of the 7 quality themes. No impact. Open Update from the Chief Ambulance Services Commissioner Page 2 of 4 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 37 of 73

38 3.2 Chief Ambulance Services Commissioner's Report CHIEF AMBULANCE SERVICES COMMISSIONER S UPDATE REPORT 1. SITUATION / PURPOSE OF REPORT The purpose of this report is for the Committee to receive an update on key matters related to the work of the Chief Ambulance Services Commissioner (CASC). 2. BACKGROUND / INTRODUCTION Since the last Committee meeting progress has been made against a number of key areas which for ease of reference are listed below: Directories of Services Update on NEPTS Update on EMERTS WAO Review of Emergency Ambulance Services Commissioning Report 3. ASSESSMENT / GOVERNANCE AND RISK ISSUES Directories of Services Members will recall previous discussions in respect of the production of a Directory of Services for each local health board area in relation to ambulance service pathways. Letters were sent to all health boards asking for local area information to be provided within a template for standardisation across Wales. Unfortunately, the response to this was disappointing despite sending out reminder letters, therefore it has now been agreed that a number of key areas for pathways will be prioritised. These are as follows: - Falls - Breathing difficulties - Never events to include blocked catheters and repeat prescriptions - Mental Health Update on Non Emergency Patient Transport Services (NEPTS) Members will wish to note that the Delivery Assurance Group the development of the Collaborative Commissioning Agreement for Non Emergency Patient Transport Services continues to meet on a regular basis. Members will recall that the draft Framework has been discussed and agreed previously. Work is now focusing on populating the Agreement with information (which has been requested) from Health Boards and WAST. Unfortunately, returns remain outstanding and this is adding risk to the successful implementation of the agreed Framework. Update from the Chief Ambulance Services Commissioner Page 3 of 4 Emergency Ambulance Services Committee Meeting 38 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

39 3.2 Chief Ambulance Services Commissioner's Report Update on Emergency Medical Retrieval and Transport Service (EMRTS) Members will wish to note that the draft Framework previously considered by the EAS Committee has been discussed, refined and agreed at the EMRTS Delivery and Assurance Group (DAG) on 6 December Work is ongoing to ensure completion of the Framework by April Members will wish to note that discussions are underway to appoint a National Director on a permanent basis for the EMRT Service. Members will wish to note that a report considering the options for extending the EMRTS operational remit into an airbase in Caernarfon was discussed at the December EMRTS DAG meeting and a preferred option was identified and detailed work is now progressing to develop an outline business case for consideration by the EAS Committee. WAO Review of Emergency Ambulance Services Commissioning Report Members will be aware that the first draft of the above report has been received and comments from Members have been requested. The comments have been collated and are attached as Appendix 1. Following discussion at the meeting the Committee is asked to ENDORSE Chair s action to submit final comments. The final report will be circulated to Members once received. 4. RECOMMENDATION The Emergency Ambulance Services Committee is asked to: DISCUSS and NOTE the report ENDORSE Chair s action for the response to the draft WAO report. Freedom of information status Open Update from the Chief Ambulance Services Commissioner Page 4 of 4 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 39 of 73

40 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 WALES AUDIT OFFICE REVIEW OF THE EMERGENCY AMBULANCE SERVICES COMMITTEE General Comments Before commenting on matters of fact, the report is welcomed and generally positive overall, and reflects some of the areas for action that the Committee has already recognised and accepts need to be addressed. However, there seems to be an imbalance in parts of the report with regards that the provider influence does not always appear to be supported by fact. There is also little comment on how the provider or indeed Welsh Government, key stakeholders in this area of NHS business use EASC and its work. The report recognises the current position as a Joint Committee but makes little comparison to where it has come from and that (the journey) could have been stronger within the report. This was discussed at the initial feedback with the WAO team at the EASC Committee meeting. Readers felt that there is contradiction throughout the report with regards EASC being too operational and not strategic enough and then operational examples are used as not featuring prominently enough at Committee e.g. hand over delays. Factual Accuracy Page No/Paragraph 5/bullet point 3 5/bullet point 4 5/bullet point 10 8/first paragraph 9/point 18 Comment Handover times are a shared target with health boards. Response times are a Tier 1 target. Need to include the NHS Direct component. See general comments below regarding the significant role of the Chair and the progress that has been made (the journey discussed by Members at the EASC meeting with WAO). The decision to move to the new clinical response model was made by Welsh Government. There was a written statement made in July 2015 which should also be referenced. This was a pilot which was extended (following advice from EASC) until March 2017 at which point the Cabinet Secretary will make a further decision. When the new model was announced EASC were asked to commission an independent review of the new model (to inform advice to the minister) and to publish the Ambulance Quality Indicators. At the end of the paragraph it referred to NHS bodies and EASC, which implied that EASC is an organisation in its own right and we need to be clear that EASC is a statutory Joint Committee of the Health Boards of 73 Emergency Ambulance Services Committee Meeting -17/01/17

41 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 Page No/Paragraph 10/point 22 10/point 23 10/point 24 Comment Comments received on this point included: Not sure it is the correct interpretation to say that funding was still to be agreed at month 7 questions were asked about whether this was a conclusion drawn from interviews or Committee minutes? This was not accurate - the resource envelope was very clear in terms of 135.6m (which included the 8m for development / service improvement support this funding was not specifically for the WAST bottom line). The decision making for the commitment of funding also needs to be clear e.g. corporate approval from health boards and have clear delegation arrangements in place for Health Board representatives. Comments received included on participating fully ; this was felt to very much overstate the case. Attendance and contribution at the EASC was still felt to be somewhat variable and development still required to become more strategic commissioners. Other comments received explained the requirement within a provider / commissioner relationship that information must be provided to support the commissioning process. The reference to the heavy burden was questioned, for example how would this be benchmarked and potentially also a reflection on the lack of understanding on the journey of development by the Committee with the provider since 2014 which was felt to be a maturing process as the commissioning relationship develops. Health Boards as an example also have to provide a plethora of data / information to a whole host of commissioners / Welsh Government etc. Other comments felt that using the word onerous to describe the information required was pejorative and subjective. Members did not think that WAST had been required to produce was any different to the requirement for health boards. Comments received on this point questioned how this was quantified as it was felt to be rather naïve for WAO to suggest that the only commissioning dynamic between Health Boards / WAST was via EASC which meets broadly bimonthly. Comments agreed that the EASC needed to continue to strengthen and mature arrangements but it understated what was currently taking place outside of the Joint 2 Emergency Ambulance Services Committee Meeting -17/01/17 41 of 73

42 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 Page No/Paragraph 11/point 25 11/point 27 12/point29 12/top of page Comment Committee, even if there were areas of sub group work etc that needed to be strengthened. Members agreed with the need to review and clarify sub group arrangements, roles, delegated authority etc as the arrangements were not always clear and clarification was needed. Ownership appeared to be a continuous theme however comments received included that all Health Board receive the minutes - i.e all members of the Joint Committee receive the minutes but they are not necessarily formally received by Health Boards. It was felt that a distinction should be made regarding internal processing by Members. Comments received regarding this issue sought clarity on the use of regional and why this was important for the commissioning of services? By definition, it was felt that services crossed over HB boundaries and the Committee did actually discuss the return to footprint etc. Cross-border activity is, a very small percentage of the activity and this should be referenced in order to ensure a proportionate response. With both of these Members asked for the evidence to support the assertion that this is a major issue. It was felt that it would be WASTs role to manage resource deployment and this could be an area confusing provider and commissioner responsibilities. Members asked for clarity on some of the terminology used. Within the red summary at the top of the page it stated that data on patient outcomes and experience is absent. It was felt that this was not an accurate reflection of the current situation as there is considerable data on clinical outcomes which obviously relate to patients in the AQIs and elsewhere. Where the gap exists it suggest that it was not data per se but information on patient reported outcomes (if this is what is meant) which was felt to be a legitimate comment as is the point about patient experience (to which I would add public acceptability/trust etc) and we will be focusing on this. Recommendations section Page 12 Page Comment No/Paragraph 12 Members were unsure why this was identified as a Recommendation 1 recommendation. It appears that the governance for EASC is not fully understood by the WAO. Also, in terms of the people interviewed by the WAO team it was a little surprising that the Committee Secretary had not been identified as key to explain the governance and processes 3 42 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

43 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 Page No/Paragraph Comment for the committee. The SI that established EASC as a Joint Committee of Health Boards, was adopted by all NHS bodies / Boards in 2014 when established. It is not simply an issue of creating up to date Terms of Reference. Also, a comment was received about the cross over of terms of reference to the Health Boards and Trusts Recommendation 2 The EAS joint committee in effect oversees the commissioning framework that WAST as provider commits to delivering. Comments received alluded to Members being unsure if the time spent by WAST at EASC on a bimonthly basis overly contributed to a burden of scrutiny..again it was felt that this confused EASC as something separate from Health Boards whereas the EASC is a Joint Committee of all HBs. Recommendation 4 Recommendation 5 In terms of the relationship between WAST and the health board at a planning level this has been under review and would need to be part of any work on this area The reference to cross border / region and cross boundary flows, whilst Members recognised this being raised, it was felt that a national view / approach was taken at Joint Committee - although this was not reflected in the report. It was accepted that this focus could be strengthened in line with the previous comments above. Members felt that cross-border and boundary flows is a WAST Deployment issue and should only be escalated to EASC by WAST by exception only Recommendation 6 Members felt that this issue would need further consideration regarding the implications with regards to resourcing the team and the role of the EASC. Recommendation 7 Linked to R9 and R12 Members commented on: Duplication of entry that they were unsure why this was a recommendation in the report as they felt the allocation was clear (see previous comments). The reference to EASCs reliance on WHSSC for funding which to the uniformed reader can be confusing. (WHSSC provide the financial support to broker EASC resources), these bullet points need further consideration/comment as it was felt to be confusing for the reader Comments were received included: The requirement to develop a more integrated performance framework to support the commissioning model and bring 4 Emergency Ambulance Services Committee Meeting -17/01/17 43 of 73

44 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 Page No/Paragraph Comment together the activity, funding, performance and outcomes. It was not clear where this work would be progressed but would improve discussion and planning Other comments Page Comment No/Paragraph 17/point 38 Members felt it would be inappropriate for EASC to discuss / address solutions to the delays in hand over - the EASC progressed the Ambulance Release Protocol for this very reason.. 18/point 40 Comments have been made previously about the Governance and advice could be sought from the Committee Secretary who was not interviewed as part of the work. 20/point 55 Comments received felt that there was a lot of information about the infrastructure and the comparison with the support provided within the other Joint Committee (WHSSC). It was felt to be unhelpful as that they are Statutory Joint Committees of the Board. EASC has 1 provider / 1 service whilst WHSSC has multiple providers and services. The Unscheduled Care Director role/function and admin support is a matter for WG and not this EAS Joint Committee. Clearly, the resource provided in order for EASC to discharge the delegated responsibilities of the Joint Committee requires review and further consideration and discussion by the Committee. In terms of papers being distributed late before the meetings, again the Committee Secretary may have been helpful in explaining issues and increasing understanding. Additional information about the effect this was having on members would be useful to be included, if available. 39/point 123 Comments received included potentially that better distinction be made between patient experience and clinical outcomes, the latter has been a key focus of the work of EASC and arguably one can impact on the other. but in relation to para 123 there is little reference here to the role of WAST in relation to monitoring Patient Experience (which EASC would seek) of 73 Emergency Ambulance Services Committee Meeting -17/01/17

45 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 Wider Points/Omissions: There does not appear to be any discussion on how WAST Board use the commissioning arrangements e.g. the CCQDF or AQIs to shape their Board and Committee discussions. This would appear to be critical in governance terms. Also, readers were surprised that no question was posed as to why the CAS Commissioner is not invited to WAST Board meetings (or indeed Chair of EASC) to provide any input from commissioning perspective. In terms of the people interviewed as part of the work comments were received regarding the questions around the governance framework for EASC why the Committee Secretary, or Board Secretary from another Health Board or Trust were not included. Another key organisational cross over would be the Chief Operating Officers in Health Boards who may have also given a perspective for the work, particularly for handover performance. Overall, comments were received regarding the appearance of an imbalance in the report between Commissioners and the Provider (WAST) and the weighting ascribed to the various views exchanged. Generally, the report lacked any comment on WAST processes or indeed any learning for WAST and this is felt to be a major omission given that the role of the provider is key in any commissioning arrangements. The list of complimentary schemes to reduce the WAST burden excludes demand management schemes, which are not part of and therefore, not the whole picture is being outlined. The report does not highlight any issues with the CAREMORE approach; whilst in theory it is well structured in reality it has become overemphasised on schedules than what is required at service level. Therefore it is suggested that this has over complicated the process at times and hasn t supported Health Board engagement. General Tone and Balance: Overall, it was felt that the review focused on the commissioning part and omitted discussion of the provider role and how this was being fulfilled. Readers felt that this could lead to a lack of balance in the discussion and only provides for half of the discussion required to move forward. It was felt that there was a sense of critique of Health Boards but none of WAST as the provider. Comments received appreciated that the review was a snapshot but felt it failed to make any reference to the very significant progress made since 6 Emergency Ambulance Services Committee Meeting -17/01/17 45 of 73

46 Appendix 1 Comments received on WAO Review of EASC Agenda item 3.2 Appendix 1 the inception of the commissioning arrangements. This was raised in the feedback meeting when the team met with EASC. EASC Members agreed that the report stated rightly that there was limited support from all parties in the early months of EASC and then stated that the changes in personnel such as the CEO of WAST and CASC and support from Deputy Minister provided impetus. This was supported but comments received felt that this failed to acknowledge that the Chair of EASC (also the author of the review) provided consistent (and indeed persistent) leadership to ensure that the new way of working was taken forward and this was supported by some staff in Welsh Government particularly those who had been involved in the Review with the Chair. Without that level of personal commitment from the Chair, it is entirely possible the current CASC would not have been appointed as there was significant resistance to appointing to the role. Comments received supported the information in the report regarding that a significant period of time had been spent focusing on activity, performance and funding and the report was somewhat critical of this. It was felt that this needed to be in context. The arrangements were not in place for the provider organisation to be commissioned when the EASC was originally set up and it was imperative that the financial, activity and performance issues were rigorously addressed. At this time, WAST was classified as a failing organisation, in special measures and in effect the work EASC and the CASC and his team did was a turnaround process to bring WAST to a point where it is no longer in special measures. This process, has not always been easy and understandably there has been some resistance from WAST at various points. Comments received suggest that this has now moved on and the EASC can look at the more strategic and clinical outcome and patient experience issues. But, all of this has been the process, which readers felt should be included in the report. Clinical outcomes have been a key area of focus for EASC in the AQIs. Comments received suggest that the report confuses patient reported outcomes and patient experience with clinical outcomes. Certainly with the former it is accepted that there is a lot of work to do but in respect of the latter this has been developed although there is much more to do to develop this further and use it more effectively. However, it must be noted that WAST has not itself had a focus on clinical outcomes nor had a robust clinical governance structure. The process to becoming a full clinical service it has a very long way to go to develop this and the data which will support it and this will be something the Committee will be pushing for in 2017/ of 73 Emergency Ambulance Services Committee Meeting -17/01/17

47 3.3 Independent Evaluation of the Clinical Response Model AGENDA ITEM 3.3 Emergency Ambulance Services Committee Report INDEPENDENT EVALUATION OF THE CLINICAL RESPONSE MODEL PILOT Executive Lead: Chief Ambulance Services Commissioner Author: Assistant Ambulance Services Commissioner Contact Details for further information: Purpose of the Emergency Ambulance Services Committee Report The purpose of the report is to provide the Committee with an update on the draft final evaluation report of the Clinical Response Model. Governance Link to the The Committee s overarching role is to ensure its Commissioning Commissioning Strategy for Emergency Ambulance Agreement Services utilising the five step patient pathway outlined within the National Collaborative Commissioning Quality and Delivery Agreement and the related outcomes for each care standard aligned with the Institute of Healthcare Improvement's (IHI) Triple Aim are being progressed. This report focuses on all the above objectives, but specifically on providing strong governance and assurance. Supporting evidence The Collaborative Commissioning Quality and Delivery Framework for Emergency Medical Services Engagement Who has been involved in this work? WAST; EASC; Health Boards, Welsh Government Emergency Ambulance Services Committee Resolution To: APPROVE ENDORSE DISCUSS NOTE Recommendation Members of the Emergency Ambulance Services Committee are asked to: NOTE the report. DISCUSS the next steps for progressing the final report ENDORSE that Chair s action is undertaken to submit the final report to the Cabinet Secretary. Independent Evaluation of the Clinical Response Model Page 1 of 4 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 47 of 73

48 3.3 Independent Evaluation of the Clinical Response Model Summarise the Impact of the Emergency Ambulance Services Committee Report Equality and There are no implications arising directly from diversity this report. Legal implications There are no implications arising directly from this report. Population Health The purpose of the evaluation is to ensure the clinical response model is safe and effective Quality, Safety & The purpose of the evaluation is to ensure the Patient Experience clinical response model is safe and effective Resources Risks and Assurance Health & Care Standards Workforce Freedom of information status All resource implications are contained within the Framework The purpose of the evaluation is to ensure the clinical response model is safe and effective The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes: Staying Healthy; Safe Care; Effective Care; Dignified Care; Timely Care; Individual Care; Staff & Resources 064/24729_Health%20Standards%20Framework _2015_E1.pdf The work reported in this summary and related annexes take into account many of the related quality themes in particular timely care. All workforce implications are contained within the Framework Open Independent Evaluation of the Clinical Response Model Page 2 of 4 Emergency Ambulance Services Committee Meeting 48 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

49 3.3 Independent Evaluation of the Clinical Response Model INDEPENDENT EVALUATION OF THE CLINICAL RESPONSE MODEL 1. SITUATION / PURPOSE OF REPORT The purpose of the report is to provide the Committee with an update on the draft final evaluation report of the Clinical Response Model. 2. BACKGROUND / INTRODUCTION Following the introduction of the 12 month clinical response model pilot in October 2015, the Minister requested that the Chair of EASC commission an independent evaluation of the model. The pilot was extended until March 2017, to allow for the evaluation to be completed. Members have previously received the interim report on the Clinical Response Model pilot and requested that the initial report be considered by the Quality Assurance and Improvement Panel. Members will be aware that the final evaluation report was originally due for completion at the end of November 2016, however due to issues with accessing data for the full 12 month pilot, the completion of the final report has been delayed. 3. ASSESSMENT / GOVERNANCE AND RISK ISSUES The initial final draft report was presented and discussed by the Quality Assurance and Improvement Panel on the 8 th December The report used a mixed methods approach to the evaluation that consisted of: Quantitative analysis of operational performance Calls, conveyance, hear and treat, see and treat, resource allocation, hours lost waiting at hospital Qualitative study 30 stakeholder interviews, including local case studies Staff survey Operational and Clinical Contact Centre staff. The findings of the report indicate that implementation of the pilot model was appropriate and over the first 12 months it appears that system risk has not increased. The report further suggests that the removal of time based targets for the majority of calls has allowed for more efficient dispatching of ambulance resources, increased opportunities for hear and treat; and supported timely responses to patients with the greatest clinical need. Independent Evaluation of the Clinical Response Model Page 3 of 4 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 49 of 73

50 3.3 Independent Evaluation of the Clinical Response Model The report makes a number of recommendations for consideration in moving forward with the pilot, broadly these include: Review of call categories IT improvements Increased clinical input to Clinical Contact Centres Review of operational fleet and workforce. Panel members provided comments to the evaluation team on three broad areas: 1. Accuracy of the terminology used 2. Contextual accuracy 3. Factual and statistical accuracy. In addition, the Chair and members of the commissioning team have held further discussions with the evaluation team to ensure all other outstanding issues were addressed. The evaluation team requested a sufficient period of time to consider comments and revise the report. The final draft report is due to be presented to the commissioning team by the 13 th January 2017 and Committee Members will be provided with copies. As the final report will be submitted to the Cabinet Secretary before the next EAS Committee meeting in March, it is suggested that the Committee agrees to provide comments as soon as possible to the Board Secretary for collation and Chair s action is undertaken to meet the Cabinet Secretary s timescales. 4. RECOMMENDATION Members of the Emergency Ambulance Services Committee are asked to: NOTE the report. DISCUSS the next steps for progressing the final report ENDORSE that Chair s action is undertaken to submit the final report to the Cabinet Secretary. Freedom of information status Open Independent Evaluation of the Clinical Response Model Page 4 of 4 Emergency Ambulance Services Committee Meeting 50 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

51 4.1.1 NEPTS Commissioning and Delivery Assurance Group Agenda item Reporting Group Chaired by Lead Director Author and contact details. National Collaborative Commissioning: Non Emergency Patient Transport Services Commissioning and Delivery Assurance Group Mr Stephen Harrhy Chief Ambulance Services Commissioner (CASC) Chief Ambulance Services Commissioner Date of last meeting 28 th November 2016 Summary of key matters including achievements and progress considered by the group and any related decisions made. Development of a National Collaborative Commissioning: Assurance Framework Workbook The group agreed to sign off the updated workbook for 1 st April The updated workbook will be shared at the next EASC meeting 17 th January Key risk relates to WAST s knowledge of the current contractual arrangements in place by welsh health organisations and the expectation for them to be contracted by WAST under the plurality model. There is a dependency upon this information to be provided by organisations. Baseline Assessments Updated Baseline Assessments from ABMU HB, HDd UHB and PtHB were shared at the meeting. Updated Baseline Assessments had not been received from AB UHB, BC UHB, CV UHB, CTUHB, Renal, Velindre and WAST. The group agreed to return outstanding Baseline Assessments by 9 th December. SH agreed to escalate to CEO s all Baseline Assessments not received by 9 th December. Updated Baseline Assessments were not received from AB UHB, CV UHB, CT UHB and Renal and this has been escalated to CEO s. Report to EASC The group noted a detailed report would be provided to the next EASC Meeting. Key risks and issues/matters of concern and any mitigating actions Baseline Assessments are still outstanding. Letters sent to CEO s to escalate. Matters requiring Emergency Ambulance Services Committee level consideration and/or approval There were none. Matters referred to other Sub Groups There were none Chair s Summary Report Non Emergency Patient Transport Services Commissioning and Delivery Assurance Group Page 1 of 1 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 51 of 73

52 4.1.2 Collaborative Performance Delivery Group Agenda item Reporting Group Chaired by Lead Director Author and contact details. Collaborative Performance Delivery Group Mr Stephen Harrhy Date of last meeting 1 st December 2016 Chief Ambulance Services Commissioner (CASC) Chief Ambulance Services Commissioner Summary of key matters including achievements and progress considered by the group and any related decisions made. Update from the CASC The group discussed the process of developing the proposal to make available extra capacity outside emergency departments. It was noted that WAST had decided not to proceed with the proposal and it was agreed that lessons learned should be identified and discussed as part of a review of winter plans in due course. The group was provided with an update on Handover Delays and performance and its implications were discussed. It was noted that information is available on a daily basis and the CASC agreed to ensure that Health Board received this as a matter of course. The group also discussed how they could work together to respond more proactively and as part of this it was agreed that the average day information is helpful and useful at local sites. Ambulance Quality Indicators The group was provided with an update on the Ambulance Quality Indicators. Update on the Unscheduled Care Programme The CASC shared the draft Unscheduled Care Benchmarking Report with the group. The group discussed the key messages from the report. The CASC agreed to provide independent comments on the report and to share the final version of the report when it is received. Key risks and issues/matters of concern and any mitigating actions There were none Matters requiring Emergency Ambulance Services Committee level consideration and/or approval There were none. Matters referred to other Sub Groups There were none Chair s Summary Report Collaborative Performance Delivery Group Page 1 of 1 Emergency Ambulance Services Committee Meeting 52 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

53 4.1.3 Quality Assurance and Improvement Panel Agenda item Reporting Group Quality Assurance and Improvement Panel (QAIP) Chaired by Prof Siobhan McClelland Lead Director Author and contact details Date of last meeting 8 th December 2016 Chief Ambulance Services Commissioner Chief Ambulance Services Commissioner Summary of key matters including achievements and progress considered by the group and any related decisions made. Evaluation of Clinical Response Model Pilot Matt Rooke from Public and Corporate Economic Consultants (PACEC) and Janette Turner, Medical Care Research Unit, University of Sheffield presented the Draft Evaluation of the Clinical Response Model Pilot including the key findings of the report. The group went through the draft report and agreed to provide comments. It was agreed for a further draft of the report to be presented for consideration at EASC. Financial Forecast The group received an update on WAST s financial forecast. An update will be presented at EASC. WAST IMTP 2016/17 WAST presented a report on their IMTP 2016/17 and their progress against the 154 IMTP commitments. Clinical Governance Issues The group discussed an unexpected increase in Serious Untoward Incidents in November. The group reiterated the importance of following agreed escalation and governance processes. Creation of C3 Faculty Programme & Evaluation Work The group were updated on the creation of the C3 programme and evaluation work. Key risks and issues/matters of concern and any mitigating actions There were none Matters requiring Emergency Ambulance Services Committee level consideration and / or approval There were none Matters referred to other Sub Groups There were none Chair s Summary Report Quality Assurance and Improvement Panel Page 1 of 1 Emergency Ambulance Services Committee Meeting 17 January 2016 Emergency Ambulance Services Committee Meeting -17/01/17 53 of 73

54 4.2 EASC Updated Risk Register AGENDA ITEM 4.2 Emergency Ambulance Services Committee Report EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE RISK REGISTER Executive Lead: Board Secretary/Director of Corporate Services and Governance Host Body (Committee Secretary) Author: Board Secretary/Director of Corporate Services and Governance Contact Details for further information: Robert Williams, or Purpose of the Emergency Ambulance Services Committee Report The purpose of this report is for the Emergency Ambulance Services Committee to receive and review the updated Emergency Ambulance Services Joint Committee risk register. Governance Link to the Commissioning Agreement Supporting evidence The Committee s overarching role is to ensure its Commissioning Strategy for Emergency Ambulance Services utilising the five step patient pathway outlined within the National Collaborative Commissioning Quality and Delivery Agreement and the related outcomes for each care standard aligned with the Institute of Healthcare Improvement's (IHI) Triple Aim are being progressed. This report focuses on all the above objectives, but specifically on providing strong governance and assurance. The development of this report has where appropriate been informed by updates provided through established governance processes. Engagement Who has been involved in this work? The Emergency Ambulance Services Commissioning Team has contributed to the development of information contained within this report. EAS Joint Committee Risk Register Page 1 of 7 Emergency Ambulance Services Committee Meeting 54 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

55 4.2 EASC Updated Risk Register Emergency Ambulance Services Committee Resolution To; APPROVE ENDORSE DISCUSS NOTE Recommendation The Emergency Ambulance Services Committee is asked to: NOTE and ENDORSE the Joint Committee s Risk Register. Summarise the Impact of the Emergency Ambulance Services Committee Report Equality and There are no equality and diversity implications diversity contained within this report. Legal implications There are no legal implications contained within this report. Population Health No impact. Quality, Safety & Patient Experience Resources Risks and Assurance Health & Care Standards Ensuring the Committee and its Sub Groups make fully informed decisions is dependent on the quality and accuracy of the information presented and considered by those making decisions. Informed decisions are more likely to impact favourably on the quality, safety and experience of patients and staff. No impact. Ensuring the Committee is fully sighted on key areas of its business and related risks, is essential to robust assurance processes. The 22 Health & Care Standards for NHS Wales are mapped into the 7 Quality Themes but within a Governance Framework. This report focuses mainly on Governance & Accountability but also spans many of the 7 quality themes. Workforce Freedom of Information No impact. Open EAS Joint Committee Risk Register Page 2 of 7 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 55 of 73

56 4.2 EASC Updated Risk Register EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE RISK REGISTER 1. SITUATION / PURPOSE OF REPORT The purpose of this report is for the Emergency Ambulance Services Committee to receive an update on the review and refresh of its risk register in relation to its commissioning arrangements. 2. BACKGROUND / INTRODUCTION The EASC Members have agreed to receive and review the Committee Risk Register routinely at Joint Committee meetings. 3. ASSESSMENT / GOVERNANCE AND RISK ISSUES Risk and Assurance Framework Under the current hosting agreement with Cwm Taf UHB, hosted bodies comply with their Risk Management Strategy and Risk Assurance Framework, Risk Management Policy and Risk Assessment Procedure. The objective of the Risk Management Strategy and Risk Assurance Framework is to define a strategic direction for risk management, which provides a clear path on which all future risk management initiatives are based. The aim of the Risk Management Policy is to: Ensure that the culture of risk management is effectively promoted to staff ensuring that they understand that the risk taker is the risk manager and that risks are owned and managed appropriately Utilise the agreed approach to risk when developing and reviewing the Resource and Operational Plan Embed both the principles and mechanisms of risk management into the organisation Involve staff at all levels in the process and Revitalise its approach to risk management, including health and safety. The risk register is informed by risks identified and assessed, prior to being placed on the Joint Committee risk register for review. The Joint Committee will receive the EASC Risk Register routinely at each of its scheduled meetings. The risk register will be received by the Cwm Taf Quality, Safety & Risk Committee and the Cwm Taf Audit Committee as a standing agenda item. EAS Joint Committee Risk Register Page 3 of 7 Emergency Ambulance Services Committee Meeting 56 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

57 4.2 EASC Updated Risk Register The Committee Risk Register forms part of the process in terms of the identification and management of strategic risks in relation to the commissioning of Emergency Ambulance Services: The Risk Register continues to develop and is a living document and should be in a state of constant change to reflect increases, decreases and the elimination of risks The Risk Register will be subject to continuous review by the Chief Ambulance Services Commissioner and the work of the Joint Committee Sub Groups It is for the Joint Committee to determine whether there is sufficient assurance in the rigour of internal systems to be confident that there are adequate controls over the management of principal risks to the Joint Committees overall strategic commissioning objectives, outlined within related collaborative commissioning framework(s). Following review of the Committee s risks in June 2016, Members agreed arrangements for the work that took place to mitigate the risks operationally to be better captured and reported by EASC s internal processes. Members also discussed risk tolerance and agreed that this would be based on the approach, adopted by the host body, adapted from The Good Governance Guide on NHS Wales Boards (page 28 onwards). On risk appetite, Boards (or the Joint Committee) might ask themselves: What significant risks is the Board (or Joint Committee on behalf of member Board s) willing to take? What are the significant risks the Board is not willing to take? What are the strategic objectives of the organisation? Are they clear? What is explicit and what is implicit in those objectives? Is the Board (Joint Committee) clear about the nature and extent of the significant risks it is willing to take in achieving its strategic objectives? Does the Board (Joint Committee) need to establish clearer governance over the risk appetite and tolerance of the organisation? What steps has the Board (Joint Committee) taken to ensure oversight over the management of the risks? The Committee s Risk Register is also presented and considered by the host body Quality, Safety & Risk Committee and Audit Committee. The Committee is asked to consider the following table, (which also reflects discussions had by the Committee at its November 2016 meeting) as its updated risk register for the commissioning arrangements: EAS Joint Committee Risk Register Page 4 of 7 Emergency Ambulance Services Committee Meeting Emergency Ambulance Services Committee Meeting -17/01/17 57 of 73

58 58 of 73 Emergency Ambulance Services Committee Meeting -17/01/17 Risk Reference Description of risk identified Initial Score Nov 2016 Score Current Score Overall Trend EASC 07 WAST rosters and associated changes EASC 06 WAST workforce / recruitment plan, including implications of the development of Band 6 Paramedic roles EASC 08 Failure to provide alternative services EASC 09 (Sept 2016) EASC 02 EASC 01 EASC 03 EASC 04 Failure to deliver commissioning arrangements for non emergency patient transport Failure to deliver Emergency Ambulance Performance Targets Red1 Failure to put in place robust Corporate Governance arrangements. Failure to commission safe Emergency Ambulance Services (against the agreed Collaborative Commissioning Framework Agreement) Failure to commission EAS within the resources agreed by the EAS Joint Committee Last Reviewed Jan 2017 Jan 2017 Jan 2017 Jan 2017 Jan 2017 Jan 2017 Jan Jan 2017 Mitigation / Comments Implementation of new arrangements following demand and capacity modelling Able to recruit Workforce redesign essential for further improvement Managing absence National negotiations Directory of services not complete; now concentrating on 5 key areas Collaborative working and information required by WAST and Health Boards Plurality model WAST staffing to required levels Handover delays deteriorating Governance arrangements continue to evolve, mature and strengthen. Awaiting publication of final draft WAO report (March 2017) Framework agreement in place, continue review and monitoring arrangements in place. Agreed plan approved. CASC secure confirmation from Provider body that resource envelope not exceeded. 4.2 EASC Updated Risk Register EAS Joint Committee Risk Register Page 5 of 7 Emergency Ambulance Services Committee Meeting

59 Emergency Ambulance Services Committee Meeting -17/01/17 Risk Reference EASC 05 EASC 10 (Sept 2016) Description of risk identified Failure to deliver the new Ambulance Quality Indicators. Failure to deliver commissioning arrangements for emergency medical retrieval and transfer service Initial Score Nov 2016 Score Current Score Overall Trend Last Reviewed Jan 2017 Jan 2017 Mitigation / Comments Seeking continuous improvement Accurate and timely clinical information essential Collaborative working required by WAST and Health Boards 4.2 EASC Updated Risk Register 59 of 73 EAS Joint Committee Risk Register Page 6 of 7 Emergency Ambulance Services Committee Meeting

60 4.2 EASC Updated Risk Register At the last meeting of the Joint Committee, Members asked that consideration of the risks associated with WAST workforce / recruitment plans are reassessed (EASC 06) in light of the developing discussions on the Paramedic Band 6 role; and also EASC 09, the Non Emergency Patient Transport service and matters relating to the plurality model and associated issues. Members will note that EASC 08, the failure to provide alternative services, that the risk has also been raised. There may also be other risks that the Joint Committee may wish to raise and discuss in order to inform the next update of the Committee risk register in advance of the next Joint Committee meeting. Members should note that some of the risks raised are joint risks that require consideration and ownership within individual organisations and the Welsh Ambulance Services Trust. 4. RECOMMENDATION The Emergency Ambulance Services Committee is asked to:- NOTE and ENDORSE the Joint Committee s Risk Register. Freedom of Information Open EAS Joint Committee Risk Register Page 7 of 7 Emergency Ambulance Services Committee Meeting 60 of 73 Emergency Ambulance Services Committee Meeting -17/01/17

61 4.3 Outline Business Case for 111 Wales Agenda item 4.3 Replacement of NHS Direct Wales Clinical Assessment System & GP Out of Hours Information Systems Outline Business Case Emergency Ambulance Services Committee Meeting -17/01/17 61 of 73

62 4.3 Outline Business Case for 111 Wales 1 Executive Summary 1.1 Introduction This Outline Business Case (OBC) seeks approval for a total investment of 28.8m over 7 years to replace the NHS Direct Wales (NHSDW) clinical assessment system and Local Health Boards (LHB) GP Out of Hours (OoH) information systems (excluding depreciation). It is anticipated that the investment will be made from capital funding secured from Welsh Government (WG) (of circa 13.7m), and revenue monies chiefly delivered through reallocation of existing NHS Wales current system expenditure (up to 15.1m). The information and assumptions set out in the previous Strategic Outline Case (SOC) have been reviewed and supplemented by additional information obtained from market intelligence, supplier engagement and supplier responses to the recent Prior Information Notice (PIN) on likely costs, as well as the benefits and risks. In light of the feedback obtained following submission of the SOC, this OBC will focus only on the requirement to replace the NHSDW Clinical Advice & Streaming (CAS) and the GP OoH IT systems to ensure business continuity. Whilst the wider, significant benefits (and risks) of the introduction of the 111 Wales model that are expected to be delivered for patients and bring to the wider unscheduled care system in Wales are not included as part of this OBC, it should be remembered that the system replacement required will also provide the core technical enabler for delivery of the 111 Wales Service. This OBC has been produced using the 5-Case Model in line with the updated NHS Wales Infrastructure Investment Guidance (WHC 2015(012)) and identifies the preferred option which optimises value for money (VFM). 1.2 Strategic Case The strategic context The implementation of an all Wales 111 service is supported by numerous national strategies; in particular, Setting the Direction (2010) and the national Plan for a Primacy Care Service for Wales up to March The development of an integrated IT solution which supports wider access to NHS held patient information aligns with Informed Health and Care, the national information technology and digital strategy for Wales. The local Primary Care Plans and Integrated Medium Term Plans (IMTPs) produced by the NHS Wales organisations that are partners in 111 Wales roll out and delivery reflect the opportunities that the development of a national service can bring. The implementation of a new IT solution spanning both national and local elements of 111 Wales Service provision is a key enabler for the full delivery of the 111 Wales service model, the development of new ways of working, and provision of new access routes into the service. Investment in a new IT solution will directly support streamlined access from patient perspective and Wales OBC v of 73 Emergency Ambulance Services Committee Meeting -17/01/17

63 4.3 Outline Business Case for 111 Wales maximise the opportunities for service users to Choose Well, using appropriate unscheduled care services other than Emergency Departments. Learning from experience in England and Scotland in delivering a 111 service has highlighted the importance of utilising an IT system with high quality clinical content and flexible decision support tools in order to maximise the potential benefits of 111 service delivery and minimise risk to both the service itself and the wider unscheduled care system The case for change The existing NHSDW software is being utilised to support not only continued delivery of the NHSDW service, but also delivery of the 111 Wales Service pathfinder. This system is used to front-end all calls into the service and provides the call record, a workflow tool and decision support software to support both non-clinical and clinical staff. The current system has been in use since 2001 and is end of life. Whilst recent negotiations have resulted in the extension of the contract to November 2019 at increased cost, the supplier has given a clear indication that further extensions will not be possible. As a result, the fundamental underpinning driver for change is the need to replace the existing NHSDW IT system in order to maintain the viability of NHSDW and the emerging 111 Wales Service. All GP OoH services across Wales utilise different, stand alone versions of the same IT system. The software provides the call record, a workflow product and a prioritisation tool. A clinical decision support tool is available and used by some LHBs. The LHBs utilise via differing payment rates and operate with out of date contractual arrangements. Further, there is variance in the sustainability of server infrastructure across Wales with a combination of supplier hosted and locally housed systems in place. Where systems are hosted locally, there has been limited investment in the server infrastructure and therefore will be a need to refresh hardware or move to a different model of provision over coming years. With the exception of the 111 Wales pathfinder service where specific investment has already been made to link the NHSDW and GP OoH systems, the existing IT systems do not currently have the capability to communicate with each other; leading to duplication of work and an inability to manage demand effectively across current service boundaries. Whilst there are some interfaces with other NHS Wales IT systems in place, these do not provide all users the full information required to support clinical decision making. Further, manual workarounds are in place to compensate for the lack of systems integration. It is not possible to safely implement an effective 111 Wales service without the ability to electronically transfer data between national and local services. Regardless of the IT solution adopted, provision of the 111 service on an all Wales basis will involve additional staff to address unmet service demand, requiring the purchase of additional licenses. This business case considers the most cost effective mechanism to deliver this model as part of the Economic Case Wales OBC v1.9 Emergency Ambulance Services Committee Meeting -17/01/17 63 of 73

64 4.3 Outline Business Case for 111 Wales Investment Objective Following a review of the investment objectives outlined in the SOC there is now a single investment objective for this project. Investment Objective: To replace the existing NHSDW CAS system by November 2019 with a fit-forpurpose, flexible technical platform to support the introduction of a new NHS Wales 111 service via integrated management of calls between current NHSDW and GP OoH services; adopting the most economically advantageous and efficient solution. 1.3 Economic Case The long list The long-list of options was generated considering scope, various technical solutions and varying methods of service delivery and implementation. The following possibilities were critically reviewed against the investment objective and agreed critical success factors to determine a short-list of options: Scope (SCO): 1. Status Quo -Maintaining the current systems for NHSDW and each GP OoH service (x7), with no additional connections beyond the 111 Wales pathfinder(s). 2. Do Minimum - Replacing the existing NHSDW system by 2019 and connecting this to each existing GP OoH service (x7) system. 3. Intermediate - Procurement of a single integrated IT system throughout the NHSDW/111 and GP OoH service with interfaces to critical NHS Wales systems. 4. Do Maximum - Procurement of an extensively integrated single IT system linking NHSDW/111, GP OoH and in hours GP services with the capability to roll out to other public services and Third Sector partners. This solution would incorporate increased functionality utilising, e.g., Artificial Intelligence, Machine Based Learning and provide a platform to deliver multi-channel access. Technical/Contracting Options (TSO): 1. In House - Solution implemented and managed by NHS Wales from an NHS Wales data centre. 2. Fully Managed - Solution provided as a managed service from their own data centre by a commercial supplier. 3. Hybrid - Solution hardware implemented in an NHS Wales data centre and managed by a commercial supplier. 4. Cloud - Solution provided as a managed service on a Cloud basis by a commercial supplier. Service Delivery Options (SDO): 1. Purchase a single commercial solution to replace the current NHSDW and GP OoH systems Wales OBC v of 73 Emergency Ambulance Services Committee Meeting -17/01/17

65 4.3 Outline Business Case for 111 Wales Implementation Options (IMP): 1. Phased implementation as per pathfinder timescales and LHB baseline assessments The short list A thorough analysis of the advantages and disadvantages of each option produced the following short list of options: Option 0 Option 1 Option 2 Option 3 SCO Do Nothing SCO2 Do Minimum SCO3 Intermediate SCO2 Do Maximum N/A Combination* TSO3 Hybrid Solution TSO3 Hybrid Solution TSO3 Hybrid Solution N/A Current Commercial Providers SDO1 Commercial Purchase SDO1 Commercial Purchase SDO1 Commercial Purchase N/A No further implementation IMP1 Phased Implementation IMP1 Phased Implementation IMP1 Phased Implementation * As this option involves the utilisation of existing technical hardware arrangements through extension of current contracts, this means that the technical delivery arrangements will continue to comprise of a mixture of supplier hosted and local organisational infrastructure Key findings The economic appraisal determined the likely cost of each option. provide a comparison position over 10 years. The figures below Wales OBC v1.9 Emergency Ambulance Services Committee Meeting -17/01/17 65 of 73