Welcome and Introduction

MINUTES OF 141 ST PUBLIC MEETING OF THE SCOTTISH AMBULANCE SERVICE BOARD AT 10.30 A.M. ON WEDNESDAY 26 NOVEMBER 2014 IN NATIONAL HEADQUARTERS, GYLE, EDINBURGH Present: David Garbutt, Chair David Alexander, Non Executive Director Moi Ali, Non Executive Director Neelam Bakshi, Non Executive Director Alan Bickerstaff, Employee Director Eddie Frizzell, Non Executive Director Pauline Howie, Chief Executive Pamela McLauchlan, Director of Finance and Logistics Andrew Richmond, Non Executive Director Esther Roberton, Non Executive Director Martin Togneri, Non Executive Director Jim Ward, Medical Director In Attendance: Garry Fraser, General Manager, South West Sharon Hammell, Head of Corporate Affairs and Engagement Andrew Johnston, Communications Assistant Heather Kenney, Director of Strategic Planning and Quality Improvement Julie Macleod, Personal Assistant Daren Mochrie, Director of Service Delivery Lindsey Ralph, Board Secretary (minutes) John Riggins, Paramedic Team Leader, Millport Natalie Shering, Member of the Public (except item 4) Claire Smillie, Communications and Engagement Manager Welcome and Introduction The Chair welcomed everyone to the 141 st Scottish Ambulance Service Board meeting and apologies were noted from Theresa Houston, Non Executive Director and Karen Wilson, Director of Health Professions and Nursing Care. He informed Board members that John Riggins was in attendance and would replace Alan Bickerstaff as Employee Director, when he retired from the Service on 30 November. Twitter messages would be sent from this meeting. Item 1 Minutes of meeting held on 24 September 2014 The following changes were requested by Neelam Bakshi. Page 2, Item 4a Person Centred Care update, sixth paragraph, first sentence amended to read: Neelam Bakshi asked that the support available to staff was included in the Public Protection Policy. Doc: Name 2014-11-26 Public Board Minutes approved Page 1 Author: Board Secretary

Page 8, Item 8b Staff Governance Committee, first bullet point, first sentence amended to read: Moi Ali, Non Executive member of the Staff Governance Committee had left the Committee to join the Clinical Governance Committee. In response to a question from Martin Togneri about the timescale for the Complaints Handling Audit Report referred to in Item 4a, Sharon Hammell confirmed that the framework would be in place by March 2015. The minutes were approved subject to the above amendments. Item 2 Matters Arising The Board approved the removal of items 135/3/4a(i), 137/3/4a, 137/5/5a, 138/2/1c, 139/2/4a, 139/3/5. Action: Board Secretary to update the Matters Arising paper. Item 3 Declaration of Interests Item 7c, Audit Scotland Report NHS Financial Performance - Neelam Bakshi declared a potential conflict of interest in her role as a Non Executive Director, Scottish Government. Item 4 Person Centred Care As the Service developed new care pathways to support the 2020 vision and help keep patients at home, or in a homely setting, West Central Division has worked in partnership with NHS Lanarkshire s Age Specialist Service Emergency Team (ASSET), which allowed older people in North Lanarkshire to remain at home. The ASSET team in Lanarkshire won the Service s Partnership Award at the 2014 West Recognition and Awards event in Glasgow. Board members were shown a video of a patient s experience of ASSET. This was a very positive experience for the patient, who was able to remain in her home, rather than in a hospital setting. The patient described a number of benefits including being cared for in the comfort of her own home; feeling her family members were under less pressure since they did not have to co-ordinate hospital visits and the tasks associated with these; understanding what was happening in relation to care at home with explanations shared with the patient and her family; feeling confident about being able to stay at home safely since all parties in the partnership were liaising about her care and feeling good about the caring nature of the people involved in her care. Pauline Howie explained that the ASSET team was one of several different hospital at home concepts across NHS Scotland. The Service had invested part of its unscheduled care funding to the ASSET team to test the concept. The patient experience and clinical outcomes were very positive. The next stage was to see whether the Service could extend the scope beyond Lanarkshire. In response to a question from David Alexander, Heather Kenney confirmed that the local authority was involved in the ASSET team model. Board members agreed that this was an excellent example of joint working for the benefit of patients. The model integrated the Service with other parts of the health service and was a good example of a cohesive approach to patient care. Doc: Name 2014-11-26 Public Board Minutes approved Page 2 Author: Board Secretary

Item 4a Person Centred Care Update In Karen Wilson s absence, Pauline Howie presented this paper for discussion. The Patient Experience Manager, would start on 1 December 2014 and co-ordinate the delivery of the Service s person centred health and care programme. The Service continued to review its approach to Patient Focus Public Involvement (PFPI) and held a network event on 20 November with representatives from the Scottish Health Council and staff from the Service. Non Executive Directors would provide support for PFPI through their participation in Divisional Involving People Groups. Pauline Howie invited Non Executive Directors who attended the event to provide their feedback and views on how the Service would take forward this work. The Chair referred to NHS Scotland s Stronger Voice, a programme designed to make sure the views and experience of service users and the public defined health and social care. Proposals from a wide ranging consultation would be submitted to the Cabinet Secretary for Health, Wellbeing and Strategy, to help support policy development in how the public sector involved people in the development and delivery of services. He referred to a Citizens Jury, an effective model which would involve the wider community in the decision making process. Esther Roberton said that she was reassured that every public service was trying to do this and a joined up approach would be required for it to be successful. Sharon Hammell reported that three of the See and Treat/Hear and Treat Workshops, to check public and patient understanding of the Service s protocols, had taken place and early reports indicated that these new ways of working were well received. A full report would be available at the end of November 2014. The Feedback and Complaints Annual Report 2013/14, which would form part of the Service s overall public reporting, was included for the Board s information. Martin Togneri asked about the status of the Complaints and Feedback Annual Report 2013/14. Sharon Hammell confirmed that it was published on the Service s website on 25 November 2014 and would form part of the Service s full Annual Report. It was noted that while this report was already published, it could be amended before it formed part of the Service s Annual Report for 2013/14. Non Executive Directors provided feedback on the draft report. Martin Togneri suggested that it would be helpful, in the absence of a clear definition of the difference between a complaint and a concern, if the Service could provide the public with an explanation of what it considered the difference to be. Neelam Bakshi referred to the photographs and requested that it was made clear that the associated quotes were illustrative. She suggested that it would be useful if there was context around the unscheduled care themes that were categorised in terms of feedback. Moi Ali suggested that the narrative should be more person centred care focused in future reports as she did not get a sense from this report that the Service clearly acknowledged how the patient felt throughout their experience. Doc: Name 2014-11-26 Public Board Minutes approved Page 3 Author: Board Secretary

Alan Bickerstaff referred to page 4 of the report and noted that it referred to four themes and five were listed. He also referred to the percentages used and said that without more explanation, it did not contextualise how the Service compared to other parts of NHS Scotland. Following feedback, it was agreed that the Complaints and Feedback Annual Report 2013/14 would be reviewed to include the suggested changes, before the information was included in the full Annual Report. Sharon Hammell advised that she would circulate the Annual Report 2013/14 to Board members for feedback before it was published. The Chair requested that these reports were better aligned to meet timescales in future. Actions: Head of Corporate Affairs and Engagement to:- 1. Make suggested amendments to the Feedback and Complaints Annual Report 2013/14. 2. To circulate Annual Report 2013/14 to Board members for comment and approval. 3. To align future reports to meet timescales. Item 5a Towards 2020: Taking Care to the Patient Strategy 2015-2020 Pauline Howie presented this paper for approval. The draft strategic framework set out the vision, mission and strategic aims of the Service over the next five years. This framework would be supported by the Service s Corporate Plan and Local Delivery Plan, which would set out the detailed actions and financial plan each year, over the next five years. This framework was aligned closely to Scottish Government s 2020 vision for health and social care that, by 2020, everyone was able to live longer healthier lives at home, or in a homely setting. She said that there was overwhelming support for the direction of travel from both internal and external stakeholders. An early draft of the Service s Strategic Workforce Plan, which would support the Strategy, would be discussed at the National Partnership Forum on 3 December and Staff Governance Committee on 4 December. As previously discussed at the Board Development Session in October, the timescale for the publication of the Strategic Workforce Plan in June was not aligned to the Corporate Plan and the budget setting process, which both required to be approved by the Board in March. Following previous discussions by the Board about this, a draft Strategic Workforce Plan would be presented to the Board in January 2015, to try and align discussions more closely. One of the factors that would determine the pace of the strategic framework to reach 2020, and the specific milestones to achieve this, was the transitional funding. At this stage, the Service had indicative budgets for 2015/16. The draft budget would be presented to the Board in January 2015. Pauline Howie thanked everyone involved in the engagement and development of the strategic framework. The Chair reported that the strategic framework provided the Service with an opportunity to change how it worked in an effective way. Scottish Government was supportive of the Service s approach and the patient benefits it would provide across Scotland. The Chair invited feedback from Non Executive Directors on the draft strategic framework. Doc: Name 2014-11-26 Public Board Minutes approved Page 4 Author: Board Secretary

Martin Togneri requested that prior to publication the paper be reviewed to ensure it was written in plain English, with the public in mind, as it was too technical in its current format. He referred to the importance of encouraging greater transparency of the Service to increase acceptance and understanding from the public about what the Service was trying to achieve. Eddie Frizzell expressed his view that the Service would need to work very hard to make sure members of the public understood the see and treat model. He asked if the Service clearly understood how long it would take staff to see and treat patients instead of taking them to a hospital setting and the impact this would have on resources. Pauline Howie explained that the Service was preparing the resource model to support the strategic framework and determine what the impact on resources would be by 2020. Time spent on scene would depend on the condition of the patient and whether they required hospital treatment. The current average time per incident was approximately 1 hour 11 minutes. See and treat incidents were often less than this as the crew did not have the journey and handover time at the hospital. The resource model to support the strategic framework was extremely complex and it would be reviewed robustly as the Service developed its models of care. Jim Ward explained that the strategic framework was about the Service making the right decision, first time, for every patient on whether or not they required hospital treatment. It was about quality decision making at every part of the patient journey to achieve the best outcome for the patient and their carers. The proposed performance measures for 2015/16, to support the strategic framework, were more focused on clinical outcomes. Further suggestions included:- Page 6 and 25 our NHS values equality was missing from the table on page 25. Page 22 wording about the co-response model to be amended to make sure that it was more clearly explained where the single crewed paramedic fitted in to this model. Introduction goals these should be reviewed to ensure the areas that would make a difference were clearly set out (e.g. Improve access to healthcare, improve outcomes for patients, evidencing the shift in the balance of care more clearly described the Service s priorities for the next five years). Reduce the story so far section to make it easier to read and focus more on what the Service was going to do next. If any technical terms were included in the final version, a glossary should be provided. Pauline Howie confirmed that the Strategy would be launched on 3 February 2015. The Service would have an additional summarised version of the strategic framework, together with a video of patient experience of the Service, available to the public. The Board approved the strategic framework in principle, subject to the document being revised to incorporate the presentational comments and suggestions made by Board members. A revised version of the strategic framework document would be circulated to Board members, before formal approval at the Board meeting in January. Action: Director of Strategic Planning and Quality Improvement to make sure the document was written in plain English and included the suggested changes made by Board members. The revised document would be circulated to Board members before final approval in January 2015. Doc: Name 2014-11-26 Public Board Minutes approved Page 5 Author: Board Secretary

Item 5b Quality Strategy Update Heather Kenney presented this paper for discussion. For scheduled care, the key highlights included that Autoplan was being implemented. The manual system would be switched off after some initial technical issues were dealt with. The early evidence was that Autoplan was improving the utilisation of journeys. In response to a question from Alan Bickerstaff, Heather Kenney confirmed that the roll out of Autoplan across the Service would be completed by February 2015. For unscheduled care, it was reported that the National Triage Tool would be discussed by the National Major Trauma Oversight group on 5 December 2014 with a view to having it endorsed by the expert group. Esther Roberton requested further information of the average call answering times for scheduled care during October. Heather Kenney explained that the Service was aiming for a call answering time of one minute and performance during November had improved, with ninety per cent of calls answered within one minute. David Alexander referred to Item 2.3.3, public access defibrillators. It was confirmed that the date should read 23 November 2014 not 2015. The Chair asked for clarification on 2.4.2 Key information Summary (KIS). Pamela Mclauchlan described the way the Service could access information about patients who had long term conditions if their key information was recorded. This was currently available for 400,000 people across Scotland. In previous trials, it had taken a long time to download this information to the crews. The changes described in the paper would mean that this information would be downloaded to crews in one minute. It was proposed that it would be trialled at Livingston Station following approval by the Clinical Governance Committee. The Delivering Future Leaders and Managers workshops were underway, with four of the twelve workshops completed so far. This programme was to make sure frontline leaders and managers had the skills and knowledge they need to effectively undertake their role. Feedback was positive from those who had attended the course. Alan Bickerstaff advised that the successful implementation of the new strategy would rely heavily on staff having the opportunity to learn and improve and the dedicated time to do this. The Chair said that this was recognised by the Board. Esther Roberton asked for clarification on Item 2.4.3 Electronic Patient Report Form (e-prf). Pamela Mclauchlan confirmed that this was a labour intensive piece of work for the Service as individual meetings had to be arranged with all Health Boards in Scotland to discuss the Service s capability to pass e-prf information electronically to hospitals and GPs. Item 6 Quality Improvement Indicators Pauline Howie presented this paper for discussion and provided the key highlights and patient benefits during the reporting period. Clinical Excellence Clinical performance had improved again in the last reporting period and was in line with the strategy framework about ensuring the most appropriate response for the Doc: Name 2014-11-26 Public Board Minutes approved Page 6 Author: Board Secretary

patient s clinical conditions. Board members were reminded that the Service was developing a more clinically focused suite of performance measures for 2015/16. Overall Performance There was a partial improvement in performance indicators. This was due to continuing significant challenges around unscheduled care activity, in line with demographic and disease changes in Scotland. For Category A response within 8 minutes, the Service continued to reach more patients more quickly than ever before, with an average response time of 6.5 minutes, against a challenging financial background. Referring to clinical excellence measures, the Chair asked for further information about bystander cardiac pulmonary resuscitation. He asked if the Service was content that enough public access defibrillator devices were available across Scotland. Jim Ward reported that the biggest challenge was to ensure the information about where these devices were held was available to the Ambulance Control Centres. He added that it also required a governance framework to ensure that the devices were maintained. While the Service would have a key coordinating role, the process required to be done in partnership with other organisations. In response to a request for further information about hyper acute stroke, Jim Ward said that the Service s current measure was to make sure patients reached a facility with a CT scanner within one hour. He said that the reason the Service had not achieved this target was as a result of call volume which had increased by 12%. Other factors included the on scene times which had increased and some NHS Boards were re-organising their pathways which impacted on the Service. He referred to a number of initiatives started to address these issues which included a review of the guidance for on scene activity. Compared to the previous year, the Service had attended 1,000 more hyper acute stroke calls. Daren Mochrie referred to unscheduled care performance and reported that the Service had a challenging month as demand continued to rise. There was a 2.8% increase, which equated to 11,000 calls, in the first eight months in comparison to the previous year. These calls were mainly from partner agencies. The increase in the number of calls related to falls was 8.7% compared to the previous year. More detailed work would be done before the end of 2014 with partner agencies to address these issues. Board members recognised that all health boards were experiencing challenges around hospital diverts, closures and resources which all had a knock on effect on the Service. Andrew Richmond asked about the steady deterioration in Category A response within 8 minutes performance in recent months. Pauline Howie said that as Board members were aware, the Service did not provide these services in isolation and demand had increased across all unscheduled care services. The Service was seeing more frail elderly people who needed hospital care as there were no alternatives available in the community. There was an increasing acknowledgement by Scottish Government that the Service was part of the wider health care system and was doing what it could to support this. The Service s performance remained strong in comparison to other ambulance services in the UK and there were improvement plans in place. Andrew Richmond referred to delayed discharges and asked whether this was as a result of patients being discharged from hospital too early and then being readmitted. Jim Ward said that the demographics were that people were living longer with multiple conditions and acknowledged that there was stress on all parts of the health system. Doc: Name 2014-11-26 Public Board Minutes approved Page 7 Author: Board Secretary

Esther Roberton asked if the Service could reach a position where it could map out and demonstrate what the rise in demand meant. With pressures everywhere in the system, decisions would need to be made about what the health service could realistically do. Pauline Howie confirmed that this would be discussed at the Board Development session in February 2015 and was covered in the Matters Arising paper. Neelam Bakshi asked about the extra pressure that was put on the Service as a result of health boards redesigning services. She said redesign had to be at a national level and she sought assurance that conversations about this were taking place with Scottish Government. Pauline Howie assured the Board that discussions were taking place about the challenges faced by NHS Scotland with Scottish Government at Chairs and Chief Executives meetings. Pauline Howie drew Board members attention to sickness absence on page 16 of the report. She said that the key area of concern was West Central Patient Transport Service and Ambulance Control Centre. Most of this increase related to long term sickness absence. Board members discussed best practice that was initiated in recent months and asked if there was anything else the Service could do. The new OHS arrangements were introduced and it was acknowledged that it was too early to see the full benefits. A Wellbeing Strategy would be implemented in the near future. Moi Ali asked for the impact of initiatives to be included in the trajectory of future reports. The Chair advised that the Service faced ongoing challenges with demand increases year on year and the impact of this on performance had to be taken in to account. Action: Director of Strategic Planning and Quality Improvement to include the impact of initiatives relating to sickness absence in the trajectory. Financial Performance Pamela Mclauchlan presented the financial position to end October 2014. The Service was in a revenue overspend position of 432k which was a slight improvement from the previous month. The capital was on track. Since the publication of the paper, Scottish Government had asked if the Service could defer some of its telehealth expenditure to early in the 2015/16 financial year. This was to enable the Scottish Government to achieve the capital position required for NHS Scotland. From 1 April 2015, the Service planned to implement Parental Leave, with an effective date of 1 April 2014. This would have a significant financial impact and the Service would require strong financial management as the year progressed. In response to a question from Neelam Bakshi, Pamela Mclauchlan clarified that the Non Cash Del funding source would cease at the end of 2014/15. Neelam Bakshi asked how staff were informed about the Service s financial position. Pamela Mclauchlan reported that meetings were held with operational divisions on a monthly basis, with financial recovery plans in place as required, which were closely monitored. In respect of cash releasing efficiency savings, a recent Chief Executive s Bulletin, had invited staff suggestions for areas where savings could be achieved. Doc: Name 2014-11-26 Public Board Minutes approved Page 8 Author: Board Secretary

The Chair said that the Service faced a big challenge this year and an active review would be ongoing to ensure the Service achieved its financial stability. Item 6a Patient and Staff Safety: Healthcare Associated Infection update In Karen Wilson s absence, Susan Wilson presented this paper for discussion. A 16 week action plan progress report was provided to the Healthcare Environment Inspectorate (HEI) on 24 October 2014 and no response had been received yet. The new national Healthcare Associated Infection standards would be published in December following consultation. Future Healthcare Environment Inspectorate inspections would be based on these standards. The Chair referred to the hand hygiene compliance report for West Central Division and asked if there had been a collapse in procedures in this area. Susan Wilson reported that when audits were carried out at different hospital sites, there was often a drop in results. The Service would target these hospitals to ensure improvement for the future. Item 7a Specialist Transport and Retrieval (ScotSTAR) Update Daren Mochrie presented this paper for noting. The Service had hosted ScotSTAR since April 2014. A number of deliverables contained in the paper were being worked on and engagement with health boards was ongoing. Board members were assured that the Service was on track in terms of the deliverables outlined in the paper. It was now a more sustainable service with a more robust quality standards framework. There were no concerns about demand or finances at this stage. Item 7b Scottish Ambulance Service Winter Plan Daren Mochrie presented this paper for approval. Moi Ali referred to the mobile fuel bowsers and asked how many days supply this would provide. Daren Mochrie confirmed that it was seven days supply, however, if there were issues around access to fuel at fuel stations, the Service would have priority. Andrew Richmond asked if the fuel bowsers were checked and maintained and it was confirmed that these were. Pauline Howie reported that there was no extra funding in NHS Scotland for winter pressures this year so far, other than Local Unscheduled Care Action Plan (LUCAP) allocations and the solution was in the redesign of services. Her concerns around winter pressures related to substantial increases in demand and workforce availability, based on historical working practices. The Board approved the paper. Action: Director of Service Delivery to publish the Service s Winter Plan on the website. Doc: Name 2014-11-26 Public Board Minutes approved Page 9 Author: Board Secretary

Item 7c Audit Scotland Report NHS Financial Performance The Chair explained that he had asked for the full report to be circulated to Board members. Pamela Mclauchlan drew Board members attention to the key facts on page 4. She said that the report highlighted that NHS funding across Scotland was extremely tight with little flexibility for any carry forward to the next financial year. Eddie Frizzell informed Board members that this report would be discussed by the Audit Committee at its meeting on 10 December 2015. Item 7d Clinical Governance Committee minutes of 20 August 2014 and verbal update of 13 November 2014 Board members noted the minutes of 20 August 2014. Andrew Richmond, Chair of the Clinical Governance Committee gave a verbal update of the meeting held on 13 November 2014. The key points highlighted included that the Committee:- Evidence that the new clinical structure was working well, particularly in relation to the National Clinical Governance Group, which reported to the Clinical Governance Committee. The annual work plan presented required further refining for the purpose of the Committee. Documents progressing for approval in February 2015 included the Controlled Drugs annual report and the new Public Protection Policy. The Committee discussed the roll out plans for Rapid Resuscitation Response (3RU) Moi Ali, Non Executive Director would chair the Committee from February 2015. Eddie Frizzell advised Board members that the Clinical Governance Audit Report would be discussed by the Audit Committee at its meeting on 10 December 2015. Item 7e Chief Executive Letters CEL 20 (2014) Delivering Everyone Matters 2020 Workforce Vision Implementation Plan 2015-16. Pauline Howie presented this paper for noting. Neelam Bakshi reported that this would be discussed by the Staff Governance Committee on 4 December 2014. She said that this implementation plan required to be aligned with the Staff Governance standard. She said that the Service would need to consider how it was aligned to the Local Delivery Plan rather than in separate plans, and how it was reported. Doc: Name 2014-11-26 Public Board Minutes approved Page 10 Author: Board Secretary

Item 8 (i) Any Other Business Vale of Leven Hospital Inquiry Report The Board Secretary would circulate a copy of the full report to Board members. Pauline Howie advised that the Service would review the report and assess any implications for the Service. Susan Wilson, Infection Control Manager would attend an Executive Team meeting to provide her initial assessment on the recommendations included in the report. Many of the issues had already been actioned and the Board received a regular update on Healthcare Associated Infection. Following a review of the recommendations by the Infection Control Committee, a report would be brought back to a future Board meeting on any implications for the Service Actions: 1. Board Secretary to circulate a copy of the full report to Board members. 2. Director of Health Professions and Nursing Care to provide a report to a future Board meeting on any implications for the Service from the Vale of Leven Hospital Inquiry Report recommendations. (ii) Employee Director On behalf of the Board, the Chair conveyed his thanks to Alan Bickerstaff who would retire from the Service on 30 November 2014. As Employee Director, member of the Board and vice Chair of the Staff Governance Committee, Alan had been at the forefront of moving forward the staff governance agenda. He thanked Alan for the invaluable contribution he had made to the Service, and partnership working, over the last 42 years. Item 9 Date of Next Meeting 10.30 a.m. on Wednesday, 28 January 2015 at the Scottish Ambulance Service, National Headquarters, Edinburgh. The Chair closed the meeting and thanked everyone for their participation. Doc: Name 2014-11-26 Public Board Minutes approved Page 11 Author: Board Secretary