105 TH MEETING OF THE SCOTTISH AMBULANCE SERVICE BOARD AT 10:00AM ON 25 TH NOVEMBER 2009 IN THE CONFERENCE ROOM, NATIONAL HEADQUARTERS, EDINBURGH

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1 105 TH MEETING OF THE SCOTTISH AMBULANCE SERVICE BOARD AT 10:00AM ON 25 TH NOVEMBER 2009 IN THE CONFERENCE ROOM, NATIONAL HEADQUARTERS, EDINBURGH Present: Mr David Garbutt, Chairman Ms Suzanne Dawson, Non-Executive Director Ms Theresa Houston, Non-Executive Director Ms Pauline Howie, Chief Executive Mrs Christine Humphries, Non-Executive Director Mr Doug Marr, Non-Executive Director Mr Andrew Richmond, Non-Executive Director Ms Shirley Rogers, Director of Human Resources & OD Mr Matt Bell, Employee Director Ms Theresa Houston, Non-Executive Director Mr David Alexander, Non-Executive Director Dr George Crooks, Medical Director In Attendance: Kathleen Lowson, Secretary to the Board Pamela McLauchlan, Interim Director of Finance Sharon Hammell, Head of Communications Corrine Telford, Project Manager Stephanie Phillips, Interim General Manager for PPU Ian Shanley, General Manager, ICT Jenny Neville, Head of Procurement (from Item 4a onwards) Member of the public Member of the public Item 1. Minutes of the meeting held on the 30 th September 2009 One change was made to the minutes; Theresa Houston was not present at the meeting on the 30 th September With this one change, the minutes were approved. Item 2. Matter Arising The Board noted the matters arising. Andrew Richmond enquired if the Board Risk day would follow the same format as previous years and Pauline Howie confirmed this was the case. Item 3. HEAT targets and summary Pauline Howie introduced this item and indicated that the Patient Transport targets were performing well as were the Islands. It was also highlighted that the finance, sickness absence and Category A target were behind target. Pauline Howie reminded the Board that in terms of clinical performance for percentage of cardiac arrest patients responded to in 8 minutes, the Scottish Ambulance Service was performing exceptionally well. Page 1 of 15

2 The Board notes the HEAT summary H1: ROSC Category Health Improvement Re f H1 Objecti ve Save More Lives PI Maintain rates of survival of cardiac arrest on arrival at hospital within band of reasonableness Current 15.8% 17.3% George Crooks spoke on this item and stated that performance in this area had improved in October to 15.8% compared to 15.5% in September. Year to date performance remained within target with all Divisions ahead of target for the year. Christine Humphries underlined the importance of keeping the Clinical Governance Committee informed of progress in this area. The Chairman indicated that he felt it would be appropriate to have a presentation of the TOPCAT study at the Board. Other Board members agreed with this suggestion and the Board Secretary agreed to arrange this for a future meeting. Action Board Secretary to arrange for a presentation of the TOPCAT study to the Board before the end of March 2010 The Board noted the position H2: Category A Chest Pain Patients Category Re f Health H2 Cat A chest pain patients Objective PI Current % of cardiac arrest patients responded to with 8 minutes 80.8% 80.1% George Crooks highlighted performance in the target which was 80.8% for the month of October. The importance of this target was noted. Page 2 of 15

3 E1 Meet Financial Targets Category Re f Efficiency E1 Meet Financial Targets Objective PI Current Operate within revenue and capital limits; meet the cash requirement 26, Pamela McLauchlan reported on this target and highlighted that with regards the regards the revenue resource, income was under recovered by 32K, due in main to the Air Ambulance and Private Hire being behind target. Pay was overspent by 250K due to high levels of overtime still being worked. Overtime was currently 572K overspent. Three divisions had maintained their reduction in overtime usage worked in September (paid October). North and East Central usage had increased, partly due to high sickness absence. In relation to non pay the overall position was an overspend of 315K. Pamela McLauchlan highlighted the key areas of concern which were: Air Ambulance, Medical Consumables and Parts and Accessories. Depreciation was underspent by 349, due to ongoing delays in the vehicle replacement programme and the reassessment of current defibrillator asset lives. Andrew Richmond made a comment on p.5, note (a) and asked if the figures could be broken down more. He also requested that a comparison be made with the delay in vehicles and the depreciation. Andrew Richmond then made reference to p.1 of the report and queried if vacancies were more of an issue than in previous years and Pamela McLauchlan stated that there were a number of factors at play and that vacancies were not the only one. Pamela McLauchlan then went on to report on the Balance Sheet which showed a cash balance of 767K, which was within acceptable limits. With regards Capital it was noted that the A&E Unit programme was behind schedule. The Glasgow stations budget had been reduced by 624K in respect of the proposed Pollock station works and the disposal budget by 632K for the sale of Sheildhall. It was now also proposed that a transfer of properties would be concluded with NHS Greater Glasgow and Clyde, with the latter also being responsible for any refurbishment costs. Page 3 of 15

4 Pauline Howie confirmed that this was a complex arrangement but that the correct governance processes were in place and that it may be helpful for Board members to have a written briefing on the arrangements. (Action - Pamela McLauchlan to provide Board members with a written briefing on arrangements re the Glasgow properties Christine Humphries commented that the financial position was tight and asked Pamela McLauchlan if she could forecast a year end position. Pamela McLauchlan stated that the Scottish Ambulance Service would meet its financial targets as it had in previous years although the position was tighter than it had been for a number of years. E2 Meet Efficiency Target Category Ref Objective PI Current Efficiency E2 Meet Cash Efficiency Cash releasing savings achieved 125,000 3,451,000 The current position was noted and Pamela McLauchlan underlined that although the Scottish Government target for 2009/10 was 3.9million, the Service had identified further savings that could be achieved this year and an internal target had been set for Receipts from property equated to 49K from the sale of Pitlochry and 86K from Beattock. It was also highlighted that through the See and Treat protocols, savings to the whole NHS Scotland economy could be demonstrated. The total efficiency improvements achieved at the end of October were 4.9milion. Divisions had been able to use the additional savings to put in place initiatives to sustain performance across Scotland and to develop the clinical leadership roles across both PTS and A&E. The Chairman asked if the Board could see more details of the See and Treat savings and Pamela McLauchlan agreed that these would come to the January Board. Shirley Rogers reported that there had been a full report given to the Staff Governance and Remuneration Committee the previous day on this target and no causes for concern had been identified. Christine Humphries stated that she was pleased to see the live connections to the Strategy work in the PDP development. The Board noted the position E4 Sickness Absence Page 4 of 15

5 Category Ref Objective PI Current Efficiency E4 Reduce Sickness Absence Rate of Sickness Absence 5.5% 4.9% Shirley Rogers reported on this target which was 5.8% for the month of October. Given that this was a rise, Shirley Rogers took some time to give the Board an update on the reasons for sickness absence. Back problems accounted for 14% of reported sickness absence. The impact of flu was discussed and it as noted that 11% of the sickness absence figure for October were attributed to flu. Shirley Rogers underlined that the detailed breakdown of reasons were available to Divisions and that they were actively managing their sickness absence rates. With regards the vaccination programme it was noted that 1401 staff members had been vaccinated against H1N1 and 979 against seasonal flu. These figures were a significant improvement from previous years. Suzanne Dawson commented that while it was assuring to hear about the proactive work she did have a concern about the absence rate creeping up, especially with winter approaching. Shirley Rogers advised that this was an NHS Scotland wide issue and that the Scottish Ambulance Service was very active in managing its sickness absence. The Board noted the position E5 Universal use of CHI number Category Re f Efficiency E5 Utilisation of CHI Objective PI Current Number of patient transport registrations where CHI number is used 85.5% 83.7% The Board noted the position E6 Reduce Emissions Category Re f Objective PI Current Page 5 of 15

6 Efficiency E6 Reduce Emissions Reduce Energy Consumption 3.1% 3.1% Pamela McLauchlan reported on this quarterly target which indicated that performance was slightly above the 2% target, sitting at 3.065%. The North East Division were not achieving this target but were aware of action required to improve. A1 Response to Category A Incidents Category Re f Access A1 Improve response time to Life threatening calls Objective PI Current % Cat A incidents responded to within 8 minutes 71.9% 73.4% Shirley Rogers advised that performance against this target for the month of October was 71.9%, year to date performance was 73.4%. All five Divisions fell below target for the month of October. The challenges in the coming winter months around spikes in demand were outlined. The Divisional General Managers were gaining a deeper understanding of demand in their own areas and had worked together to pull together the Christmas and New Year plans which had been signed off. Shirley Rogers outlined her concerns around performance and advised that she was working with the Scottish Government and NHS Lothian and NHS Lanarkshire around particular issues. Pete Ripley, the incoming Director of Service Delivery, had been kept up to date and was comfortable with the direction of travel. Shirley Rogers asked the Board to reflect on the excellent work that the frontline staff had been carrying out recently, especially in the areas affected by floods. The Board agreed and thanked operational staff for all of their efforts over the last seven days. The Chairman stated that compared to the year to date position the previous year the current position, while showing a dip, was a vast improvement. He asked if the Board s thanks to operational staff could be expressed in the weekly Chief Executive s bulletin and Pauline Howie agreed to take this forward. Suzanne Dawson enquired if the Scottish Ambulance Service had provided any support for colleagues in Cumbria who had been hit by the floods and Shirley Rogers confirmed that strategic support had been offered. Page 6 of 15

7 Christine Humphries thanked Shirley Rogers for all her work in the Operational Directorate and stated that she welcomed the joint work with NHS Lothian around IHT and that that was a step closer to getting some resource transfer from the other Health Boards. Shirley Rogers clarified that while she saw an increased willingness from Health Boards to work with the Scottish Ambulance Service, there was still no real indication of a willingness to transfer resource at this stage. George Crooks made the point that more work was required with the Territorial Boards around the decisions to close hospitals and acute receiving units. The risk to the whole NHS needed to be taken into account when the decision was made. David Alexander asked for more information about the Sunday demand. Shirley Rogers advised that this related to the volume of transfers and was most obvious at the Edinburgh Royal Infirmary. Suzanne Dawson asked about relationship building with other Health boards and the Chairman indicated that this was ongoing at a number of different levels, including on a Chair to Chair basis. Pauline Howie confirmed that under the strategic framework, if approved, the engagement strategy would be revisited. Doug Marr asked if it was likely that the target for Category A would be met and Pauline Howie advised that continuous improvement would be demonstrated but it was unlikely that the full year target would be met. Shirley Rogers commented that there were a number of very complex organisations working together, with pressures in the background and that all levels of the Service needed to work together. A2 Response to Category B Incidents Category Ref Objective PI Current Performan ce Access A2 Improve response time to serious but not life threatening calls % of Cat B incidents responded to within 14,19 or 21 minutes 94.6% 94.7% Shirley Rogers commented that she was proud that performance in this area had been maintained. Page 7 of 15

8 A3 Response to Emergencies on Island Boards Category Ref Objective PI Current Performan ce Access A3 Improve response times in Island Boards % of Emergency incidents responded to within 8 minutes 57.1% 52.7% in September and October across all three Island Boards was significantly improved on August, up to 57.2% and 57.1% respectively. Andrew Richmond asked for some more information on the retained service in Shetland. Pauline Howie indicated that response for volunteers had not been sufficient to cover all of the shifts so an alternative plan was being followed which involved having a scheme in Lerwick. More details of the scheme were given and it was noted that by 2010 there were plans to have technicians in place. So far the response to this has been good and a pool of people had been interviewed and begun a training programme. Shirley Rogers expressed her thanks to Andy Fuller for all his work. A4 - PTS Priority 1 punctuality for appointment Category Ref Objective PI Current Performan ce Access A4 Punctuality for appointment % of P1 patients at hospital 30 minutes prior to appointment 74.6% 72.7% A5 - PTS Priority 1 punctuality for pick up Category Ref Objective PI Current Performan ce Access A5 Punctuality for pick up after appointment % of P1 patient picked up 30 minutes after appointment 85.5% 84.9% Page 8 of 15

9 Shirley Rogers advised that there had been continuous improvement in both PTS targets and progress was being made in West Central. T1 Improve Health Outcome for Patients Pauline Howie reported on this target and advised that the final report had been received from NHS QIS. An overview of the findings were given and it was noted that the Service had made an overall improvement. Key strengths included the use of technology, innovation in clinical areas and partnership working. Actions would be monitored via the Clinical Governance Committee. The Chairman agreed that this was a strong performance and thanked all the staff involved in the process. The Board noted the overall score of 11 for the NHS QIS review. T2 Healthcare Acquired Infection Shirley Rogers reported on this target and advised that the SGHD HAI Action Plan RAGS report now showed compliance across all areas. Shirley Rogers went on to state that the Service was currently being audited by Health Facilities Scotland (HFS), with the audit window being November 17 th to 23 rd November. The audit is to check that the principles of the National Cleaning Services Specification are being met. Shirley Rogers outlined the challenges for the Service and stated that she was confident that there would be few issues around the clinical areas in terms of infection control, but less so in terms of the organisation s estate. David Alexander asked if the Executive team were comfortable that the inspection process was fit for purpose. Pauline Howie stated that the inspection team were new and not familiar with the ambulance healthcare environment. Shirley Rogers advised that it was important to communicate to the inspection team that our clinical environment was a vehicle and not buildings. T3 Reduce Hospital Admissions Category Ref Objective PI Current Performan ce Treatment T3 Reduce hospital admissions % of emergency calls treated at scene 11.8% 11.6% Page 9 of 15

10 George Crooks outlined performance against this indicator which was 11.8% for October. Year to date performance remained ahead of target at 11.6% T4 Scottish Early Warning System Categor y Treatme nt Ref Objective PI Current Performan ce T4 SEWS % patients with SEWS score above 4 taken to hospital 96.1% 97.7% George Crook advised that performance was 97.7% year to date and that the few cases that had been left at home had been checked and found to be the most appropriate course of action. T5 Hyper Acute Stroke Categor y Treatme nt Ref Objective PI Current Performan ce T5 Hyper Acute Stoke % hyper acute stroke patients taken to hospital within 55 minutes 67.4% 71.6% for quarter 2 fell to 67.4% giving a year to date performance of 71.6%. George Crooks reminded the Board that this was a developmental target and part of a wider NHS development of stroke services. Item 4(a) Service Quality Improvement The Board noted this paper which covered a range of topics including: Air Ambulance, Air Ambulance Service Reprocurement, Clinical, Communications and Engagement, Education and Training, Equality and Diversity, Finance, Fleet, Health and Safety, ICT, PTS, Risk and Staffing Issues. Page 10 of 15

11 Key issues were highlighted by the appropriate member of the Executive team. With regards Air Ambulance Service it was noted that demand continued to increase and Christine Humphries stated that as well as managing the demand, there was also an equity of access issue. Pauline Howie went on to advise that the Air Ambulance Reprocurement Project Board had met on the 2 nd of October and that work was ongoing to engage with users to feed into the specification. The sustainability issue was noted as was the challenge to the whole of NHS Scotland around what was required of the Air Ambulance service in the future. With regards Clinical, George Crooks advised that four out of the five clinical lead posts had been appointed. A pilot in the North Division around anticipatory care was also highlighted. The Board also noted that work was ongoing to refine and improve the existing systems and protocols in place to triage callers to the EMDCs. A review of Category A codes was underway to identify conditions, such as cardiac arrest, where the 8 minute response time would have a significant impact on survival and longer term outcomes for the patient. Shirley Rogers highlighted the ongoing work of the Communications and Corporate Affairs teams around supporting the Strategy Framework. The Scottish Health Council were offering their support around the Strategy which had been welcomed. A review of the complaints system was also taking place. With regards Education and Training, Shirley Rogers stated that progress was steady. The revised driver training programme for A&E staff was under review by the Service s lawyers, for compliance with the Road Safety Act It was noted that Gerry Kelly had retired and the Board expressed their thanks to him. John Burnham had been appointed as the replacement and the Board passed on their congratulations to him. The Board noted the update in respect of Equality and Diversity and in particular the Disability Equality Review, which would be published on the 4 th of December 2009 and the ongoing work around the Participation Standard. Pamela McLauchlan gave an update on Finance and highlighted the benefits of the new banking contract as well as an update on purchase of the leasehold for Maitland Street station. In response to a question from Suzanne Dawson about the risk of the Scottish Ambulance Service being left with the building, Pamela McLauchlan gave an assurance that there was no risk. An update was given in respect of Fleet and it was noted that a more detailed update would be given in the private session. Pauline Howie suggested that it would be appropriate for the Board to see the newest vehicles for both PTS and A&E at the February development session. Action Board Secretary to speak to the General Manager for Fleet to arrange for new vehicles to be shown to the Board in February 2010 Shirley Rogers gave an update in respect of Health and Safety. The H1N1 vaccination programme had been successful with 1436 staff having the jab. Page 11 of 15

12 Pauline Howie reported on ICT and the monitoring arrangements in terms of the Mobile Radio project were noted. With regards PTS, Pauline Howie underlined the focus that was on reducing the number of journeys cancelled by the Scottish Ambulance Service. More focussed performance management by General Managers was cited as the main reason for improvement in this key area. The Risk register was noted as was the date of the next Risk session for the Board in January. The increase in the reporting of near missed was noted as positive step to encourage learning. Shirley Rogers gave an update in respect of Staffing issues, in particular the ce for Improvement work was highlighted as was the work around the staff governance action plan. Item 4(b) Capacity Management Plan: Winter 2009/10 Pauline Howie introduced this item and advised that during winter, A&E and PTS activity increases and in addition to this are other pressures such as flu. The capacity management plan was designed to set out the organisational arrangements to manage such changes in activity or resource availability over the winter period. A significant amount of engagement with local Boards had been carried out, in particular around trigger points and the Senior Management Team had been fully involved in the development of the plan. Doug Marr stated that the wording should be changed to the Board approve rather than endorse the plan and this was agreed. He asked what the changes were to the previous plan. Pauline Howie gave some details on this and stated that the REAP levels were now consistent with the rest of the UK. The Board approved the plan. Item 4 (c ) Better Heart Disease and Stroke Care Action Plan Pauline Howie gave some background to this document which had been taken from the Scottish Governments Action Plan, published in June The Board were asked to note the action plan and that progress would be reported to the spring meeting of the Clinical Governance Committee. The Board noted the plan. Item 4(d) Inter Hospital Transfers: Development of National Co-ordination Arrangements Pauline Howie reminded the Board that proposals had been made in December 2005 for a dedicated IHT service to support the increase in routine and specialist transfers. Page 12 of 15

13 While there had been support for this improvement, the costs were prohibitive. Over the last three years, activity had continued to increase. The Scottish Ambulance Service IHT Project Board commissioned the Service Redesign team in January to prepare minimal cost solutions which have been developed in conjunction with key stakeholders and signed off by the IHT Project Board. The Board was asked to approve the proposals and to note that updates would be provided at each phase end stage. The Board approved the proposals. Item 5(a) Scottish Ambulance Service Strategic Framework Pauline Howie introduced this item which set out the strategy for the Scottish Ambulance Service for the next 3-5 years. The Service had consulted widely and engaged with a wide range of stakeholders since January Version 12 was presented to the Board and the Board were asked to approve the Strategy, note the report on consultation findings and endorse the delivery mechanisms. Updates would be provided at each meeting and Pauline Howie advised that she believed that this Strategy would allow the Service to deliver the best possible care to patients. Christine Humphries asked where the link was to the governance committees in the implementation. Pauline Howie advised that there would be cross cutting strands that would involve the committees and that the detail was yet to be mapped out. Theresa Huston asked for a minor change to the phrasing will set out on p22 and it was agreed that this change would be made. Pauline Howie thanked the Strategy Project team, in particular Stephanie Phillips and Corrine Telford, for their hard work. The Chairman added his thanks and highlighted the gold standard level of consultation work that had gone on. The Board approved the Strategic Framework. Item 5 (b) Learning Strategy Shirley Rogers gave an overview of this important enabling strategy which had been developed after extensive consultation and within the wider context of the overall Strategy framework for the Service. It was noted that the infrastructure elements of the strategy would come back to the Board for information and approval as required in due course. The strategy covered all grades of staff and aimed to improve access to education and training and ultimately deliver an improved quality of service to patients. John Burnham and Jayne Dunn were thanked for their hard work in preparing this document. Suzanne Dawson asked if there was a plan to communicate the strategy if it were approved and Shirley Rogers confirmed that there this was the case. The Board approved the Learning Strategy. Item 5(c ) ICT Strategy Page 13 of 15

14 Ian Shanley gave an overview of the ICT strategy which had been prepared and consulted on. It had been designed to support the delivery of the Service Strategy. The programmes had been prioritised and costed and included in the draft financial plan in Annex 7. The Board were asked to approve it, subject to detailed project business cases being prepared. Updates would be provided to the Board on a quarterly basis. Andrew Richmond asked if the costings were covered and Pamela McLauchlan indicated that this was the case. The Chairman advised that on his visits to stations some staff had expressed a concern about the number of terminals in each station and Ian Shanley confirmed that a review of this was taking place. The Board thanked Ian Shanley for his work and approved the ICT Strategy. Item 5 (d) Procurement Strategy The Board approved the Procurement Strategy and thanked Jenny Neville for all her work in this area. Item 5(e) Remote and Rural Health Shirley Rogers gave the Board an overview on the paper which covered a range of remote and rural health issues, including a report of the Remote and Rural Implementation Group. The paper covered the considerable progress that has been made by the Service in addressing the particular needs of remote and rural communities. A more integrated response has been developed, working alongside out of hours providers through the development of schemes such as First Responders and community paramedics. The need to manage public expectation around the speed of delivery of the proposals in the Strategy was noted. Shirley Rogers advised that many of the solutions to the delivery of rural healthcare lay in the Scottish Ambulance Service s ability to work closely with other Health boards and partners. With regards RRIG, Pauline Howie advised that she and Roger Gibbon had written to Territorial Health boards asking for a nominated lead. These names had been received and each Board would be visited in early Andrew Richmond commented that he appreciated seeing the map of the First Responder Schemes and would like to see an updated version if possible. The Board noted the summary report and the report of RRIG and supported the direction of travel. Item 6(a) Annual Review 2009 letter from Cabinet Secretary for Health and Wellbeing The Board noted the letter which had been included in the Board s Annual Report. Item 6(b) Chief Executive letters The Board noted the CELs and the actions being taken to progress them. Page 14 of 15

15 Item 6 (c ) Minutes of the Scottish Ambulance Service and NHS24 Joint Working Group The Board noted the minutes of the meeting held on 2 nd of September 2009 which were still in draft form. Item 6 (d) Minutes of Clinical Governance Committee held on 9 th September 2009 and debrief of meeting held in November. Christine Humphries gave an overview of the meeting held in September and a debrief of the more recent meeting held in November was circulated. Item 6(e) Audit Scotland Report, Scotland s Public Finances The Board noted the report and issues raised. Item 7 Any Other Business 7(a) Vehicle Contract This item was discussed in private. Item 8 Date and Time of Next Meeting 27 th January 2010 at National Headquarters, Edinburgh. Page 15 of 15