WELSH AMBULANCE SERVICES NHS TRUST

UNCONFIRMED MINUTES OF THE OPEN SESSION OF THE MEETING OF THE FINANCE AND RESOURCES COMMITTEE HELD 25 JANUARY 2018 AT VANTAGE

POINT HOUSE, CWMBRAN WITH VC FROM HM STANLEY SITE, ST ASAPH

PRESENT :

Martin WoodfordHelen BirtwhistleProfessor Kevin DaviesPam HallJames Mycroft

Non Executive Director and ChairNon Executive Director Non Executive Director Non Executive Director (VC St Asaph)Non Executive Director

MWHBKDPHaJM

DIRECTORS:

Hannah EvansRichard LeePatsy Roseblade

Claire Vaughan

Director of Planning and PerformanceDirector of OperationsExecutive Director of Finance & Deputy Chief Executive OfficerDirector of Workforce and Organisational Development (OD) (Part)

HERLPR

CV

IN ATTENDANCE:

Hywel Daniel

Richard DaviesMark HarrisNathan HolmanPaul HollardGwen KohlerSteve Owen

Deputy Director of Workforce and Organisational Development (Part)Assistant Director of Capital and EstatesNEPTS General Manager South East RegionTrade Union PartnerNon Executive Director (Part)Financial Planning ManagerCorporate Governance Officer

HD

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APOLOGIES

Bleddyn RobertsChris Turley

Trade Union PartnerDeputy Director of Finance

01/18 PROCEDURAL MATTERS

The Chairman welcomed all to the meeting and reminded attendees that the meeting was being audio recorded. The standing declaration of interest of Nathan Holman being a Member of the Cross Hands Community Health Council (CHC) was

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recorded; no other declarations of interest were declared.

Minutes

The Minutes of the open and closed sessions of 26 October 2017 were confirmed as a correct record subject to clarity on attendance at the closed session; furthermore, extra wording to provide evidence of a fuller discussion was to be added to the closed session on Minute 5/17.

Action Log

Members considered the action log in detail:

1. Action number 14, First bullet point, the words ‘Long Term Financial’ were to be inserted at the beginning. Third bullet point, insert Corporate Risk Register.

2. Action numbers 19, 23, 26, 28 and 29 were on the Agenda as separate Items and were therefore annotated as completed.

RESOLVED: That

(1) the Minutes of the Open and Closed sessions of the 26 October 2017 FRC meeting were confirmed as a correct record subject to further wording being added in the Closed session and clarity on attendance of some Members at that session;

(2) the standing declaration of Nathan Holman being a member of the Cross Hands CHC was recorded; and

(3) the action log was considered and updated as required.

02/18 COMMITTEE FORWARD PLAN

The Committee considered the forward plan and recognised that going forward a further iteration would be required; furthermore, a forward plan for policies coming to the Committee was required. This was added to the action log for action by the Corporate Governance Manager.

RESOLVED: That the forward plan was considered and amended as described above.

03/18 INTEGRATED MEDIUM TERM PLAN

The Director of Planning and Performance, Hannah Evans presented the Committee with a thorough power point presentation in which detailed background information relevant to the plan was initially referred to.

This included the challenges and the impact of system pressures being faced and how the Trust intended to tackle them. HE also advised the Committee how the plan had been developed including how each iteration had progressed taking into account the commitment to continue to build a clinically led and quality driven organisation.

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Workforce

The Deputy Director of Workforce and Organisational Development HD, continued with the presentation which focused on the workforce aspect of the plan. He drew the Committee’s attention to several areas which had been developed; this included the implementation of a robust workforce plan. Members were informed of further details which HD expanded upon as follows:

1. Recruitment2. Reduction in overtime3. Band 6 pay for paramedics4. Introduction of EMT 3 role5. Development of Apprentices6. Delivery of Treating People Fairly7. Staff awards8. Wellbeing of staff (Including mental health)9. Achievement of Corporate Gold Standard10.Advanced Paramedic Practitioner (APP) and Community Paramedic roles11.Training and Education strategy12.Leadership and Management development13.Strategic actions: volunteering, need to maximise

Finance

The Financial Planning Manager GK, provided an overview of the key changes from the 2017/18 plan in terms of a financial perspective.

In terms of income, there had been an increase in income of £11.5m and a total increase in expenditure of £15.7m. She advised that the gap was being addressed as part of the savings plan going forward; and was confident this would be bridged within the next couple of months.

With regard to savings delivery, the Committee were given details and informed that the majority of the schemes were being delivered. In terms of the assumptions within the plan, GK gave further details on each one and was confident that the Trust could deliver a balanced financial plan.

Estates

HE gave an overview of the priorities in terms of the estate going forward underpinned by a Strategic Outline Plan which included :

1. Progress on the move away from HM Stanley to Unit 7, St Asaph Business Park

2. Relocation of the organisation’s regional Central and West administrative and training centre at Cefn Coed Hospital, Swansea.

3. Development of an Ambulance Resource Centre in Cardiff.

Whilst these projects were being implemented, HE advised that a degree of agility would be required to bring them to a successful conclusion.

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Health Informatics (HI)

Members were advised that the Trust’s focus from an HI perspective included:

1. Introduction of a Qlik reporting solution 2. Continue to roll out a suite of mobile applications 3. National 111 rollout support4. Continue to provide requirements from EASC5. Compliance with the General Data Protection Regulation (GDPR) 6. Develop a Records Management programme 7. Supporting the development of the Trust’s long-term digital innovation and

transformation programme8. Supporting the development and introduction of Phase 2 of the CAD

(Computer Aided Dispatch) programme.

HE summarised the presentation and gave details of the delivery and the timelines of the plan going forward adding there was still further work to be completed.

In discussing the presentation Members raised several comments and points as follows:

1.Non Emergency Patient Transport Services (NEPTS) – Concern was expressed that there should be more clinical leadership afforded to the NEPTS staff operationally on a local basis. The Executive Director of Finance & Deputy Chief Executive Officer PR advised that the relevant management support would be available going forward. The NEPTS general manager for the South East region MH commented that overall, the vast majority of supervision had improved. Members recognised the potential issue and agreed it would be of great benefit to reinforce the message that Team Leader training was aiding development of the relationship between clinical and NEPTS personnel.

2.The Committee appreciated that the Trust needed to maximise its internal efficiencies in order to achieve the ‘shift left’ principle by treating more patients in primary care or in the community.

3. In terms of Amber calls, the Director of Operations RL, referred to the 95th percentile tail advising the Committee that a plan was being developed to address the issue.

4.The handover delays of patients at hospitals were continuing to have a detrimental effect on the Trust’s ability to meet its performance target.

5.Members considered in further detail the funding and impact of the APP and Community Paramedic roles.

6.The Committee recognised that following a review there was a scarcity of administrative resources at ambulance stations and other areas within the Trust and it was noted that this was being addressed in order to maximise efficiency going forward.

7.Following a query in terms of savings and maximising internal efficiencies, PR advised that it needed to be made clear that the funding received was being committed for the purpose of delivering the Commissioner’s intentions.

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8.With regards to assumptions on sickness levels, the Committee was informed that an element of caution had been built into the savings figure; GK added there may be scope for further savings going forward. Members recognised there were underlying cost pressures and suggested it would be useful to be informed of these.

9.Members suggested that in terms of providing clarity, the main document should contain headings that mirrored the National Strategy; clarification on some general phrases throughout the plan and reference to the Electronic Patient Clinical Record (EPCR) should be more implicit. PR informed the Committee that the Medical and Operational Directorate was developing a project to look at a WAST specific EPCR and any other options on the market adding it would require capital expenditure and be clinically led.

10. In terms of Informatics and the reference made to the long term Strategy, HE confirmed that she would re-word to remove any ambiguity.

The Committee recognised and acknowledged the work undertaken by all those involved in producing the plan and it was agreed that the issues raised would be contained within the covering document being presented to Trust Board on 30 January 2018.

RESOLVED: That the plan was noted and commented upon.

04/18 MONTHLY INTEGRATED QUALITY AND PERFORMANCE REPORT (IPR)

HE provided an overview of performance against key quality and performance indicators for November 2017, which included performance data over the previous quarters. The following highlights within the report were brought to the Committee’s attention and discussed further as shown:

1. Delays with the hand-over of patients at hospitals and the impact on service delivery

2. Increase of Frequent callers; RL explained that was a plan in place to address this

3. The Committee discussed conveyance rates to hospital noting they were 1,000 less than November 2016: RL explained in detail how the figures within the report were illustrated and how they related to actual conveyance in terms of percentage figures.

4. Following an enquiry as to why certain areas of the report appeared not be fully up to date, RL advised that due to implementation of the new CAD, there were certain items of information at this stage that were not being extracted from the system due to the significant amount of work involved. PR gave a further explanation referring Members to the change in script for HCP calls which had occurred as a result of switching over the new CAD and advised that this particular irregularity had been addressed.

5. Members were keen to receive feedback from the next EASC meeting regarding any improvements actions to alleviate the system pressures being considered going forward; HE agreed to provide details of the feedback at the next FRC meeting.

6. Members expressed concern at the lack of senior staff within Health Boards attending operational meetings and commented that this issue should be addressed at a higher level; the Chairman would highlight this at the next Chairs Working Group meeting.

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RESOLVED: That

(1) the report was noted; and

(2) the actions in paragraphs five and six above be added to the action log.

05/18 FINANCE PERFORMANCE AS AT MONTH 9 2017/18

GK presented the report which updated the Committee on the financial performance and position of the Trust at Month nine. She highlighted there was a year to date deficit of £65k which had primarily been caused by system pressures affecting the Trust’s performance and had subsequently required the use of additional taxis. Furthermore the increase in the cost of fuel had been a factor.

It should be noted that the Trust was experiencing the impact of the winter pressures facing the whole of NHS Wales, and thus was currently identifying and developing ways of mitigating hospital delays and assisting in the wider unscheduled care system. These had included measures such as increasing overtime and other variable costs, which as at Month nine were not factored into the forecast, however following the formal notification from Welsh Government (WG) of support for winter pressures, the Trust would be implementing these initiatives and costs and the confirmed funding and additional costs this would support would be included within the forecast going forward.

In terms of the overall financial position, GK was confident the Trust would break-even by the end of the financial year.

Members considered the report and raised the following:

Concern was expressed that the impact of the increase in overtime could have a detrimental effect on the wellbeing of some staff. RL gave a detailed explanation in to the elements where overtime would be used for example the use of Hospital Ambulance Liaison Officers, adding that in the main, overtime would be utilised to increase capacity in the Clinical Contact Centres.

RESOLVED: That the current year to date revenue financial position and performance of the Trust, key drivers and risks within this, and the resulting year end forecast was noted.

06/18 SAVINGS HIGHLIGHT REPORT – SAVINGS DELIVERY 2017/18 – UPDATE

GK presented the report which illustrated that the Trust’s planned year to date savings was £3.671m (75%), with actual savings delivered of £3.512m (72%). At this stage therefore there was an overall underachievement of £159k across the total savings plan, this represented an improvement from the first and second quarters when the level of underachievement stood at £251k, and £204k respectively.

GK drew the Committee’s attention to the details illustrated within the report as described below:

1. The levels of private providers and some aspects of variable pay had

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continued to reduce with savings of £1.0m achieved to date

2. Despite savings delivery of £27k within Quarter two there remained an under-achievement of £122k against the savings attributed to NEPTS.

3. Through management of non-operational vacancies, more than £779k had been achieved. This has already exceeded the annual target of £400k by £379k

4. Underspends against estates and utilities had continued into 2017/18. The scale and scope of these savings would be expanded in future years

5. As a result of rising forecourt prices savings against fuel had slowed during 2017/18. The Trust would continue to maximise the benefits of discounted fuel through the use of All-Star fuel cards at specified garages with additional monitoring information to be provided at a local level

6. Non-pay costs had been contained which was reflected in the delivery of £600k of savings

7. There had been detailed analysis undertaken to determine options that would reduce travel costs which included extending the use and availability of pool cars;

8. There were a number of local schemes, some of which were attracting additional income rather than reducing costs. The level of delivery of savings had increased and an over delivery of £143k was reported at 31 December.

Overall the year to date variance, given the level of savings target was relatively small; however those areas that were not delivering the savings in full were being addressed going forward.

A lengthy and fruitful discussion ensued in which Members raised a range of points that included:

1. Pool Cars - Members expressed caution in this area and questioned the logic of driving varying distances to pick up a pool car and the added expense this would incur. PR advised that the process of using pool cars was still in development and issues such as this would be focussed upon going forward.

2. Members recognised that savings in Non-operational vacancies had been higher than in other areas and questioned how this was being achieved whilst maintaining efficiency. PR cited Health Informatics as an example advising that the recruitment process had been taking longer than normal; however the vacancies within that department were being addressed.

3. The Committee queried whether taxis were the most cost effective method of transporting patients. RL informed the Committee that work focusing on recruiting more volunteer drivers to minimise the need for taxi drivers was being implemented.

RESOLVED: That progress in delivering the 2017/18 savings plan, the context of this within the overall financial position of the Trust, and actions in progress to ensure delivery was noted.

07/18 WORKFORCE PERFORMANCE REPORT QUARTER 3 2017/18

The report was presented by the Deputy Director of Workforce and Organisational

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Development (OD) HD. The report contained details of performance against the primary Workforce & OD key performance indicators of Sickness, PADR (Statutory and Mandatory Training and Turnover and Recruitment and Employee Relations. The information was based on December 2017, with the exception of sickness data, which reflected up to November 2017.

Sickness Absence

In quarter three of 2017/18, the monthly sickness rate had increased slightly from 6.87% in September to 6.88% in October to 7.18% in November. A Sickness Absence Deep-Dive had been undertaken in October 2017, and this had triggered a number of actions to facilitate a reduction in sickness rates, with particular emphasis on preventative measures and effective, structured case-management of long-term sickness (LTS) cases.

The Committee was advised of the latest figures for December which were not contained in the report and were the highest levels of sickness since 2015. HD explained that sickness had been notably higher in the CCC’s and stated that extraordinary measures had been implemented in mitigation; this included providing counselling support which had been instigated to address the higher demand in calls during the winter period. HD added that this would also be rolled out to frontline staff. Members understood this support had been provided by the ambulance service charity and acknowledged the outstanding assistance it had given to ambulance staff. The Trust was looking to enhance its ability to deal with musculoskeletal injuries sustained by staff through consideration of a business case for physiotherapy services, including preventative methods.

In terms of flu vaccination uptake by staff, HD advised that the figures for front line staff was approximately 33%. The Trust’s campaign to improve this continued to target front-line staff at ambulance stations, outside emergency departments, at NEPTs offices within hospitals and training venues throughout the Trust. He advised that realistically the expected uptake figure would be between 40% – 50%. The attitude to the vaccination within the Trust appeared to be a particular challenge, and advice had been sought from Public Health Wales in relation to attempting to persuade staff to take up the vaccine going forward.

With regard to Long Term Sickness (LTS), HD informed the Committee that following a review into the Trust’s audit process on sickness, more meaningful data was being extracted which would allow the management of LTS to be more effective.

Members were informed that 99.9% of payslips were now available through the Electronic Staff Record with a view to be completely paperless in the near future.

The Committee, having discussed the report in further detail drew attention to the following area:

Flu vaccine

Apprehension was expressed that the message being given to staff regarding the

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effects of the flu vaccine could be misleading; also staff not having the vaccine was potentially a huge risk to them and the patients they treated. Furthermore the Committee suggested that going forward the Trust should target those individuals who have been off sick with flu to confirm whether or not they had taken up the vaccine. HD advised that the guidance from Public Health Wales was to encourage frontline staff to have the vaccine which should reduce the chances of catching the flu. He added that at this stage staff were not mandated to have the vaccine and the Trust was continuing to manage and monitor the associated challenges going forward.

The Chairman summarised that Members had vented their disappointment in the low uptake of the flu vaccine from frontline staff and recognised the challenges and the work being undertaken to address the situation.

RESOLVED: That the third quarter ending 31 December 2017 performance against Workforce & OD Key Performance Indicators was received and noted.

08/18 111 UPDATE

A verbal update was given by the Director of Planning and Performance HE, in which the Committee were apprised of the following:

1. The strategic plan which set out the timings for roll out and the resource requirements had been approved

2. Funding for the next phase had been assured3. There was a focus on rolling out in the Powys area which took into consideration

the GP out of hours service currently being provided. The Committee recognised the challenges and risks this raised and were given assurance that the relevant resources were in Powys to positively drive this forward.

Members noted the update and questioned the capability of the IT system to manage the out of hours service. PR advised that the Adastra software system currently being used to manage calls was compatible with other systems.

RESOLVED: That

(1) the update was noted; and

(2) the rescheduling of the roll out of 111 in Powys and the associated risks was noted.

09/18 UPDATE ON 2017/18 CAPITAL PROGRAMME

In providing the update PR, provided an update which set out the Trust’s current and forecast capital expenditure in 2017/18, set against the values previously agreed and approved.

The current total capital programme of the Trust for the financial year 2017/18 was £17.575m. It was currently estimated that this would be underspent by £521k. The Committee were advised of the reasons why this slippage had occurred which included several schemes referred to within the report where under or over spending was achieved/not achieved.

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PR referred to paragraph 21 of the report which illustrated in detail the current forecast spend which had given rise to a variance of £0.190m. Whilst this was a relatively small level of forecast slippage, this was a net figure made up of a number of individual variances that the Committee required to be aware of.

It was noted and recommended that the Trust should bring forward the £521k on expenditure that was going to be spent from the next financial year’s commitment and use it as far as possible for unit seven.

The Assistant Director of Capital and Estates RD, gave an overview of how the £521k would be spent in unit seven, approximately £300k on furniture and equipment; for the remainder, expenditure was being considered such as furniture for Vantage Point House.

A discussion ensued and the Committee were keen to understand what the Trust had learned from this and how it could avoid this type of slippage in the future. PR stressed that the Trust needed to know of any slippages much earlier in the year in order to mitigate against it going forward. Members recognised there would always be some form of slippage and suggested that a pre-considered/pre-agreed internal list be drawn up to, as best it could, prevent this slippage.

Furthermore, Members were keen to understand the merit in moving Urgent Care Service staff from Llandrindod Wells to work from Builth Wells Fire Station. RL explained that various logistical and administrative issues at Llandrindod Wells had necessitated this move.

The Chairman reiterated that it was fundamental for the Trust to learn lessons going forward; for example, scrutinising saving schemes earlier and having an approved list to prevent slippage. PR added that the final slippage figure would be in the range of £521k.

RESOLVED: That

(1) the contents of this update in terms of the capital programme of the Trust in 2017/18 was noted;

(2) the approach to using any residual funding this financial year, to ensure that the Trust delivered to its WG funded Capital Expenditure Limit (CEL) was endorsed; and

(3) the changes referred to in paragraph 21 of the report were endorsed for retrospective approval.

10/18 WREXHAM AMBULANCE AND FIRE SERVICESRESOURCE CENTRE (AFSRC) PROJECT UPDATE

An overview of the report was presented by PR.

The End of Project Report was submitted to and approved at Trust Board on 23 September 2016 where it was noted that the Project had now ended. There had been a number of the End of Project Follow On Actions, the majority which had been completed.

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Members referred to the benefits realisation table within the report and recognised the importance of capturing the lessons learned going forward. PR agreed to circulate further detail of the benefits realisation description referred to in the report to Committee Members following the meeting.

The Committee debated and questioned at length whether it was entirely appropriate to formally close the project bearing in mind that all the benefits had not yet been realised. Following the discussion it was agreed to wait until the quarter four benefits realisation report was completed until formal closure of the project

RESOLVED: That it was noted that;

(1) The quarter four benefits realisation report was to be received at the next FRC meeting in order to facilitate the formal closure of the project;

(2) Lessons Learned activities had been completed as part of the End of Project Closure process with the resulting Lessons Learned Report to continue being considered when developing future schemes as appropriate;

(3) Any outstanding Follow On Actions would be managed as part of Business As Usual in operational life by the responsible owners indicated;

(4) The Post Project Evaluation had been completed;

(5) The defects liability period for the facility had now ended;

(6) The two outstanding issues with the facility would be managed in operational life through the Estates Department to ensure satisfactory resolution;

(7) The Benefits Realisation monitoring process had been progressed with relevant data being collected and dashboards being developed, and a report summarising the outcomes will be developed (Q4 2017/2018);

(8) Benefits Realisation would continue to be managed in operational life as part of Business As Usual activities and monitored as part of WAST’s Performance Framework (commencing Q1 2018/2019);

(9) An update on the status of the Gateway 5 Review recommendations would be provided to WG by the SRO; and

(10) The progress made thus far in closing the project.

11/18 EMERGENCY SERVICES MOBILE COMMUNICATIONS PROGRAMME (ESMCP)

In providing the update, the Director of Operations RL, advised the Committee that it had been anticipated there would be a two year delay with the roll out; project teams had been advised to work towards this revised timescale. In terms of funding, this

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had been confirmed for the secondment posts taking into account the two year delay.

RL provided reassurance to the Committee that a project board and team were in place going forward. He added that the delay would not affect the Emergency Services Network; this would go live as planned. The Control Room solution, i.e. the replacement and installation of the required equipment was in line with the original plan. He added that the delay would enable and provide the Trust with more opportunities to conduct further testing on the technical challenges prior to roll out.

It was suggested by RL that once a demonstration version of the system was available it would be of value to present this at a future Board Development day.

RESOLVED: That the update was noted.

12/18 THE ‘BAGLAN’ PROJECT

The Director of Planning and Performance HE, presented the report in which she explained that it had been identified as part of the Trust’s strategic direction that there was a need to vacate the Cefn Coed building. Cefn Coed housed the National Ambulance Training Centre (NATC), the Central and West Non-Emergency Patient Transport Service (NEPTS) contact centre and provided a base for many staff from the Medical, Workforce & Organisational Development, Finance and ICT directorates.

Members were advised that an opportunity had emerged at the Balgan Energy Park. The building is owned by ABMU and the second floor had been vacated by previous occupiers. The options available to the Trust were outlined within the report and they detailed the benefits, risks and known financial implications.

Having considered the report in further detail Members raised the following points:

Grave concern was expressed in terms of the car parking facilities and the apparent lack of office space; it was felt there was insufficient information for the Committee to make a rational judgement as to whether the option as highlighted was feasible. Furthermore, a query arose as to why other options were not being considered. RD advised there would be sufficient parking spaces for the number of staff being relocated.

Members debated in depth the issue regarding car parking spaces and whether they would be in sufficient numbers to accommodate the possible move. It emerged from the discussion that the Trust should consider advising staff to explore alternative modes of transport going forward.

The issue as Members saw it was that staff were required to vacate Cefn Coed and should the option being contemplated be unsuccessful, an alternative plan must be implemented and wanted reassurance that other realistic options were continually being explored and identified as suitable.

HE drew attention to the fact that this potential move was the Trust’s opportunity to test if was fit for purpose through amongst other issues, engaging with those staff that would be potentially affected. She added that this chance was time limited and it would therefore be prudent to explore it further.

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PR summarised that extensive work had been undertaken on other possible solutions adding that the Trust must now take on a more environmentally friendly approach to car parking; the Trust was not in a position to guarantee that parking would be available for every member of staff. This opportunity to explore the option being put forward must be taken; consulting staff in the process.

The Chairman recognised and sensed the Committee’s overall urgency on the need for Cefn Coed to be vacated and a solution to be found.

RESOLVED: That

(1) the need to urgently vacate Cefn Coed was supported;

(2) further evaluation of the Baglan site opportunity was supported

(3) the relocation of affected staff to the Baglan site subject to final financial modelling was supported;

(4) the commencement of engagement with the affected staff was supported;

(5) the issue of a letter confirming the Trust’s intent to ABMU was supported;

(6) the need for the Trust to remain agile to other options and opportunities that may arise was supported; and

(7) the need to initiate formal projects to support relocation of NATC and NETPS control. These will form part of the Estates Programme was noted and supported.

13/18 NON EMERGENCY PATIENT TRANSPORT SERVICES (NEPTS) QUALITY & DELIVERY ASSURANCE FRAMEWORK UPDATE

The NEPTS General Manager South East Region MH, provided the Committee with an update on the progress of the Non-Emergency Patient Transport Service (NEPTS) Quality and Delivery Assurance Framework (QDAF). He explained that the QDAF was the foundation of the NEPTS Commissioning arrangements. A key part of the NEPTS QDAF was the transfer of work from Health Boards to the Trust.

It was expected there would be several iterations to the QDAF prior to formal transition on 1 April 2018. He gave details of the timescales involved for this transition noting that the first Health Board to transfer work would be Cardiff and Vale. In terms of the other Health Boards the Committee were given details of how it was anticipated the transfer of work would be progressed. Of particular note the Committee’s attention was drawn to Betsi Cadwaladr UHB (BCUHB). The Trust had agreed to work with it and a private company called 365 Response to manage and record all BCUHB non-WAST activity and spend over a six month period ending at the end of April 2018.

He referred to the St John contract commenting that it was very stable and at this stage the Trust could not identify barriers to success going forward.

Members reflected upon the update and enquired whether it was expected for the

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Trust to take over the workload from BCUHB from April 2018 subject to agreement on funding. MH explained that BCUHB would either extend the current arrangement they had with 365 Response or make alternative arrangements; adding it was not the Trust’s intention to take this over from April but it was expected the Trust would do at some time thereafter.

RESOLVED: That the report was noted.

14/18 FLEET STRATEGIC OUTLINE PROGRAMME (SOP) AND FLEET BUSINESS JUSTIFICATION CASE (BJC)

The Director of Operations RL, presented the report in which he provided a comprehensive update on the current management actions regarding the development of a Strategic Outline Programme Business Case (SOP) for the Trust’s Fleet services.

He informed the Committee the aim of the report was to provide a funding case to Welsh Government for moving from the yearly cycle of vehicle replacement to a more planned approach.

The ORH demand and capacity work previously conducted had been re-modelled based on a lower demand forecast and had identified the need for additional staff going forward. The re-modeling work had identified the need for an additional 57 vehicles assuming that the increased headcount was implemented in full. These vehicles had been programmed in; however should these not be required, there was an option to adjust the numbers accordingly.

He added that the Trust was considering the feasibility of purchasing four wheel drive ambulances; ambulance box bodies could now be built onto a four wheel drive chassis, and if successful the SOP for future years would be reflected to annotate what percentage of the replacement programme would be based on the four wheel drive chassis.

The Committee were informed there would be constant changes to the document as a result of its alignment with the Estates SOP; changes in maintenance, development of new vehicle technology, alternative fuels and four wheel drive.

In terms of the capital costs involved, Members were informed that the average amount had been reduced by £300k per year over the ten year period.

Members having considered the report in further detail raised the following:

Had consideration been given to the fact that should vehicles have the capability to provide more technical and diagnostic clinical resource would this need to be developed going forward within the ten year plan. RL explained that the programme would take into account the current specification of the ambulance, for example a vehicle being replaced in the future (7 years) would be replaced with whatever the specifications for ambulances were at the time of replacement. PR indicated that any changes to the SOP would be remarked upon within each individual annual BJC.

RESOLVED: That

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(1) the Fleet Strategic Outline Programme and the associated 2018/2019 Business Justification Case was noted and supported subject to the financial tables being updated the latter of which would be circulated to Committee Members;

(2) the submission of both documents as a final draft to Welsh Government to include the updated financial tables for comment was supported; and

(3) the Committee recommended to Trust Board the approval of the Fleet SOP to incorporate the updated financial tables.

15/18 RE-PROCUREMENT OF A NEPTS COMPUTER AIDED DISPATCH (CAD) UPDATE

The Committee were given with a progress update on the re-procurement options of the existing Non-Emergency Patient Transport Service (NEPTS) Computer Aided Dispatch (CAD) system by MH.

Going forward, MH explained there were two options; the first (and preferred) option was to explore the opportunity with NHS Wales Shared Services Partnership (NWSSP) Health Courier Service (HCS) of ‘piggy backing’ on their existing agreement and potentially developing a joint approach for 2019 onwards. This may not be possible but was currently being explored with NWSSP.

The second option would be the development of a standalone Business Justification Case that would be submitted to Welsh Government for consideration in early 2018/2019.

Members were concerned that there appeared to be no support arrangements in place. PR confirmed that support was available in the form of an annual maintenance which was renewable on an annual basis. PR added that the server had been replaced which provided a much more robust and resilient system than previously. RESOLVED: That the report was noted.

16/18 NEPTS BUSINESS CASE – BENEFITS REALISATION

The report was presented as read. MH added that some benefits had been agreed as part of the business case going forward in which the latter was still in the process of being implemented.

PR commented that going forward a robust mechanism was needed in order for the business case to be formally closed.

RESOLVED: That

(1) the report was noted; and

(2) a further update on the benefits realisation would be presented at the next meeting.

17/18 POST PRODUCTION LOST HOURS UPDATE

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No update provided

RESOLVED: That due to technical issues in terms of extracting the relevant data from the new CAD, an update was not available

18/18 POLICIES

The Director of Workforce and Organisational Development (OD) CV, informed the Committee the policies being presented were part of the ongoing programme of work by the Corporate team in developing policies going forward.

This report advised the development of three Revised NHS Wales Policies, which were being presented for formal adoption by the Trust:

• NHS Wales Grievance Policy• NHS Wales Secondment Policy• NHS Wales Reserve Forces Training and Mobilisation Policy

Members considered the policies in more detail and agreed to forward any comments/amendments to CV including any suggested additions to the Front Sheets, for example to clearly identify which directorate/department had been consulted on during the development of the policy.

The Committee was assured that no employee had been to their detriment, affected by those policies which had not been in force.

In addition the Committee considered the Trust’s Home Working Policy; CV added it was important to note that staff could apply for permanent homeworking and this would be considered on a case by case by basis.

Business Continuity Policy. Members were informed that all the training had been booked. Members sought assurance that the Trust was working in a joint up manner with regard to business continuity. RL agreed to arrange for the wording in some areas of the policy would be refined to reflect the fact that the Trust does work in a more joined up approach.

CB agreed to discuss with the Board Secretary and the Corporate Governance Manager to amend the policy front sheet template to reflect the discussion and the comments raised.

RESOLVED: That, subject to any anomalies raised the following three revised NHS Wales Policies on behalf of the Trust Board were formally adopted:

NHS Wales Grievance Policy NHS Wales Secondment Policy NHS Wales Reserve Forces Training and Mobilisation Policy; and

The following Trust policy was approved subject to the recording of sign off at various stages through their development:

Home Working Policy; and

The following policy was approved subject to further refinement on the

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wording to explaining in more detail organisational join up, annotating on the front sheet; Trade Union Partners and noting that a review date in January 2019 be added:

Business Continuity.

20/18 UPDATE ON FIXED ASSET MANAGEMENT – WALES AUDIT OFFICE (WAO) RECOMMENDATIONS FROM 2016/17 AUDIT

The report was formally received by the Committee; PR added that the report was written in response to the WAO recommendations regarding fixed asset management.

RESOLVED: That the update was noted.

21/18 LONG TERM FINANCIAL SUSTAINABILITY – UPDATE

The Chairman advised there was no update at this stage and would be deferred to the next meeting.

RESOLVED: That no update was provided.

22/18 RISKS RELEVANT TO FRC FROM THE CORPORATE RISK REGISTER

The report was formally received by the Committee with an overview given by PR.

RESOLVED: That the update was noted.

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