public meeting of the council of governorsopen forum verbal all 1155 1235 8 outcome of the kpmg well...

Meeting of the Council of Governors – Thursday 19 April 2018

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Public Meeting of the Council of Governors

Agenda

Thursday 19 April 2018 at 11.00hrs Taunton Rugby Club, Hyde Lane, Taunton, TA2 8BU Chairman: Tony Fox, Chairman of the NHS Foundation Trust and Council of Governors

No Topic Format Presenter Timing

1 Welcome, Introduction & Apologies Verbal Tony Fox 1100

2 Declarations of Conflicts of Interest Verbal Tony Fox

3 Minutes of the Meeting of the Council of Governors – 18 January 2018

Paper 1 Marty McAuley 1105

4 Action Point Register Paper 2 Marty McAuley

5 Chairman’s Announcements Verbal Tony Fox 1110

6 Performance Update from the Chief Executive Paper 3 Ken Wenman 1115

BREAK 1145

7

Update with the Non-Executive Directors

Table Time

Open Forum

Verbal All

1155

1235

8 Outcome of the KPMG Well Led Review Paper 4 and Presentation

Tony Fox 1255

LUNCH 1315

9 Staff Survey 2017 Presentation Amy Beet 1345

10 A Patient’s Experience Video Vanessa Williams 1400

11 Patient Safety and Experience Report Paper 5 Vanessa Williams 1405


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12 MacMillan Project Presentation Jo Stonehouse 1420

13 Patient and Public Engagement Presentation Sharifa Hashem 1435

14

Governor PPI Feedback from Members and Public:

Board of Directors 25 January 2018

Board of Directors 29 March 2018

Bath and North East Somerset Swindon and Wiltshire Sustainability and Transformation Partnership - 18 April 2018

Verbal

John Hawkins,

Torquil MacInnes and Dee Nix

Craig Holmes and

Rae Care

Torquil MacInnes and Dee Nix

1445

15 Update from the Lead Governor Verbal Adrian Rutter 1500

16 Governor and Membership Update Paper 6 Helen Braid 1505

17

Any Other Business

Items to be notified to the Trust Secretary three clear working days before the meeting.

Verbal Tony Fox 1515

18

Exclusion of the Press and Public

To consider whether pursuant to the provisions of section 1(2) of the Public Bodies (Admission to Meetings) Act 1960, the press and public be excluded from the remainder of the meeting on the grounds that publicity would be prejudicial to the public interest by reason of the confidential nature of the business about to be transacted.

Verbal Tony Fox 1520

Date of the Next Meeting: Thursday 5 July 2018

Flybe Training Academy, Exeter International Airport, Exeter, EX5 2LJ


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Members of the Council of Governors:

Rae Care Public Governor, Bristol & B&NES

Andy Phillips Public Governor, Cornwall

William Thomas Public Governor, Cornwall

Phil Ford Public Governor, Devon

Ray Foss Public Governor, Devon

David Pinder-White Public Governor, Devon

Adrian Rutter Public Governor, Devon

Andrew Freemantle Public Governor, Dorset

Clare Head Public Governor, Dorset

Craig Holmes Public Governor, Gloucestershire

Steve Manning Public Governor, Isles of Scilly

John Hawkins Public Governor, Somerset

Anthony Leak Public Governor, Somerset

Simon Michell Public Governor, Somerset

Torquil MacInnes Public Governor, Wiltshire & Swindon

Dee Nix Public Governor, Wiltshire & Swindon

David Shephard Staff Governor, A&E (Dorset and Somerset)

Mark Stubbs Staff Governor, A&E (Bristol, B&NES, Gloucestershire, North Somerset, South Gloucestershire, Swindon and Wiltshire)

Sarah Lennard Staff Governor, A&E (Cornwall & Devon)

Neil Hunt Staff Governor, Administration & Support Services

Sandy Turner Staff Governor, Urgent Care Services

Mark Norbury Staff Governor, Volunteers

Bill Sivewright Appointed Governor, Air Ambulance Charities

Dr Blair Millar Appointed Governor, Clinical Commissioning Groups

Paul Walker Appointed Governor, Fire & Rescue Services

Non-Executive Directors:

Gail Bragg Non-Executive Director and Chairman of the Finance Committee

Venessa James Non-Executive Director, Deputy Chairman, Senior Independent Director and Chairman of the Quality Committee

Minesh Khashu Non-Executive Director

Paul Love Non-Executive Director and Chairman of the Audit & Assurance Committee

Rakhee Rankin Non-Executive Director, Chairman of the People & Culture Committee

Dr Ian Reynolds Non-Executive Director and Chairman of the Charitable Funds Committee

Susan Reynolds Associate Non-Executive Director

Officers:

Ken Wenman Chief Executive


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Marty McAuley Trust Secretary

Amy Beet Director of Human Resources and Organisational Development

Helen Braid Committees & Membership Manager

Vanessa Williams Head of Quality

Jo Stonehouse Macmillan Cancer Care Project Manager

Sharifa Hashem Patient Engagement Manager

Corrie Payne Council of Governors & Membership Co-Ordinator

Emma Mitchell Board & Committee Co-Ordinator

Minutes of the Council of Governors Meeting – 18 January 2018

Page 1 of 16

Public Council of Governors Meeting

Minutes

Thursday 18 January 2018 at 1100hrs Aztec West Hotel, Almondsbury, Bristol, BS32 4TS Chairman: Tony Fox, Chairman of the NHS Foundation Trust and Council of Governors Minutes: Emma Mitchell, Board and Committee Co-Ordinator

No Agenda Item Action

1.0 Welcome, Introduction & Apologies

1.1 1.2 1.3

Apologies received from Ken Wenman – Chief Executive Rakhee Rankin – Non-Executive Director Robert Day - Public Governor Dorset Simon Michell - Public Governor for Somerset Paul Walker - Appointed Governor, Fire & Rescue Services The Chairman welcomed the Governors to the meeting. Minesh Khashu, Non-Executive Director, and Susan Bradford, Associate Non-Executive Director, introduced themselves and provided some background about their areas of work and interests.

2.0 Declarations of Conflict of Interest

2.1 No declarations of Conflict of Interest were made.

3.0 Patient Experience

3.1

Due to technical difficulties it was not possible to view the patient experience video and the Trust Secretary confirmed that this would now be shown at the April meeting.

4.0 Minutes of the Meeting of the Council of Governors – 13 September 2017

4.1

The Trust Secretary presented the Minutes of the previous meeting for approval.


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4.2 4.3 4.4

It was noted that Adrian Rutter had given his comments to the Committee Team prior to the meeting and the Trust Secretary confirmed that these amendments would be made. It was noted that Anthony Leak and Torquil MacInnes were to be added to the attendance. With the exception of the above changes the Minutes of the Public Council of Governors Meeting of 13 September 2017 were agreed as a true and accurate record.

5.0 Action Point Register

5.1 The Trust Secretary presented the action point register to the Council of Governors and advised that all the actions were complete.

6.0 Chairman’s Announcements

6.1 6.2 6.3 6.4

The Trust Chairman gave the Governors an update on Trust Activity and on his involvement since September which included: Culture Review

Professor Duncan Lewis, a professor of management and a specialist in workplace culture who has undertaken cultural review work across the NHS, will work in partnership with Unison to undertake an independent review of the Trust in the spring;

The aim of the review is to encourage engagement and feedback from across the Trust as to the prevailing culture and how this informs job satisfaction, team and interpersonal interactions and communication and the way in which the organisation works as a whole;

The outcome of the review will be published and jointly owned by Unison and SWASFT and will be used to inform further recommendations as to how the Trust can develop and improve working lives.

Performance over Christmas and the New Year Period

The Trust was hugely challenged over the Christmas and New Year Period which an increase of over 1,000 incidents per day when compared to the same period in 2015.

There were times when after all resources were deployed and active on calls The Trust still had almost 300 non-life threatening but very unwell patients without an ambulance or a paramedic car to send.

Carter Review

The Chairman advised that he had attended the third Operational Productivity Advisory Board during the previous week. The key themes of the review were becoming clear and focused on people and performance, productivity and performance, clinical skills and


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6.5 6.6 6.7 6.8 6.9 6.10 6.11

organizational structures.

As a starting point the review was comparing a number of areas across ambulance trusts to identify best practice and where efficiencies could be achieved. These areas included fleet and fuel, estates, corporate services and operating models.

It was noted that at present data was recorded and monitored differently across trusts, so one piece of work was to standardize data so that comparisons could be made.

ACTION: The Chairman agreed to provide an update at each CoG meeting regarding the progress of the Carter Review. SWASFT and Dorset Police Liaison / PCC The Chief Executive had recently met with the Dorset Police and Crime Commissioner and Chief Officer to discuss the challenges which each service is facing and to see the similarities in order to form a more collaborative way of working. South West Chairs Meeting The Chairman advised that he attended the South West Chairs Meeting with Neil Le Chevalier to discuss the Ambulance Response Programme (ARP) which was a useful session to gain a flavor of the challenges that the Acute Trusts have to face as well as the challenges that Ambulance Services have to face. Monthly call with NEDs Each month in between Board and Committee Meetings the Chairman and Non-Executive Directors (NEDs) have a regular phone call. The most recent call covered the upcoming appraisals and feedback on visits to stations by NEDs.

January Board of Directors – Wiltshire CCG It was noted that four Governors were due to attend the meeting and the Chairman reminded the Governors that they are welcome to attend all Public Board Meetings as well as Committee Meetings. These meetings provide a good opportunity to see the NEDs in action and would help Governors to hold the NEDs to account. ACTION: The Trust Secretary to provide an update of the Board and Committee Meeting schedule to the Governors through the Notice Board. KPMG – Well Led Review The Chairman provided the Council with an overview of the KPMG review and advised that the Trust had been given 11 recommendations rated as medium or low risk, with the overall outcome being that the organisation is well-led.

TF MM


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6.12 6.13 6.14 6.15 6.16 6.17 6.18 6.19

The full KPMG report is to be shared the Board of Directors taking place on 25 January 2018 and will be shared with the Council of Governors at the next meeting. ACTION Board Development Session The Board will be receiving some development sessions provided by an external organisation, the first session will be taking place at the January Board meeting. The purpose of the development sessions is to ensure the Board is effective in discharging its duties, collectively and individually. Student Paramedic Conference 10 March 2018 Governors were informed about the upcoming conference and that they were welcome to attend if they wished. Any Governor who wished to attend should liaise with the Board and Committee Co-Ordinator. Major Service Interruption The Chairman provided an update on the Major Service Interruption in December 2017 which occurred when both Hubs “went down” and the Trust was supported by South Central Ambulance Service to ensure that calls were answered. It was noted at this stage the Trust was not aware of any serious harm to patients, but that a Serious Incident (SI) Panel will be held to reach an understanding as to what had happened and actions that could be taken to prevent it happening in the future. This Panel would include Gail Bragg as representative of the NEDs and Audit & Assurance Committee. Governors queried how the NEDs gained assurance that business continuity arrangements were in place for the clinical hubs and it was noted that regular reports were made to the Audit & Assurance Committee and that the robustness of these arrangements would be reviewed as part of the investigation, together with the impact of the service interruption on Trust operations. It was noted that this is the first SI investigation which NEDs have asked to be involved with from start to finish which highlights its seriousness and importance. Whilst it was agreed that it would be preferable to not only plan for worst case scenarios, but also to test them, it was acknowledged that this was not always possible due to the number of partner agencies that would need to be involved. The Chairman reiterated that the SI Panel and Investigation will look at all aspects including the route case and ensuring an affective business continuity plan is in place moving forward. He added that the outcomes of the review will be monitored through the Audit and Assurance Committee.

MM


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6.20

The Governors took assurance form the updates provided by the Chairman.

7.0 Performance Update from the Executive Director of Operations

7.1 7.2 7.2

Jessica Hodgman introduced herself to the Governors and advised that she would take the Integrated Corporate Performance Report as read by the Governors and use this as a basis for her update. Highlights:

Currently running on the latest version of ARP (Ambulance Response Programme):

- There will be a Spring review driven nationally by Professor Jonathan Benger across all Ambulance Services to look at ensuring reporting is consistent across ARP;

- During January Ambulance Services nationally raised a few issues with ARP to NHS England. A lot of the issues SWASFT were having have been raised by other Ambulance Services and so there is likely to be a further change in the Programme.

Calls to the Clinical Hubs have reached unprecedented levels, with daily levels reaching up to 3500;

Whilst pressure is lowering, the Trust is not expecting things to be back to “Business as Usual” until the end of January. There will be a decision to see if the “Winter Pressures Period” is extended further than the already extended deadline of the end of January;

Weekly performance meetings between the Heads of Operations, Head of Clinical Hubs and Executive Director of Operations are being held to review resourcing. The Trust is currently putting out its “core” resource which is what the Trust is 100% funded for, this has helped with the Winter months;

Work is underway to reach full establishment in North Division, East Division and the Clinical Hubs. West Division is at full establishment however experiencing on-going difficulties with hand over delays especially over the Christmas period;

With regard to urgent care, the Trust now only holds to contracts for the Dorset 111 Service and Out of Hours Service (OOH) with all other contracts having ended. The Cornwall 111 contract was handed over on 1 November 2017. The handover went very smoothly, with the Trust managing to retain most of the staff through its other services.

A resourcing review had identified that a significant number of additional operational staff were required to deliver the Trust’s contract obligations. This was being addressed with commissioners.

The following issues were discussed:

The actions taken to reduce hours lost due to handover delays and how these could be escalated during times of high pressure.


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7.3

With regard to other agencies supporting the Trust, whilst the Trust does not currently use St Johns, it does use Bristol Ambulance Service and there is a Memorandum Of Understanding and a contract with them to provide agency vehicles and crews which are of equivalent standard to the Trust’s own.

The Trust’s primary staffing objective is to fill the establishment, but that working time directives protect frontline crews and ensure managers are looking at good compliance, monitoring how much over time is being given to ensure fatigue within the workforce is not happening in meeting this objective.

It isn’t anticipated that the current activity levels will reduce and so the Trust is permanently looking at maximising the productivity of the service and this is also the focus of the Carter Review.

The Trust has 12 Clinical Commissioning Groups and so has to work to achieve 12 responses when it is looking at contact negotiations etc. The Trust is working with CCGs very closely and they are aware of the gap between the performance the service is delivering and the performance which we are being given funding for. The Trust Board are challenging the Commissioners so that they can manage the messages from the Trust to CCGs to the CCGs Board. It is difficult as all CCGs are in very different positions with their own funding.

NEDs are continually seeking assurance with regard to performance measurement. Venessa James and Paul Love have worked with the Performance team on reviving the presentation of data and Executive Summary section of the Integrated Corporate Performance Report to ensure that the document is user friendly and gives Non-Executive Directors what they need to take assurance around Trust Performance. At Board level the Executive Directors are clear to Non-Executive Directors about the changes when they occur to ensure there is a clear understanding.

The Governors took assurance from update of the Executive Director of Operations. The Chairman thanked her and highlighted the excellent job that staff are doing under very challenging circumstances.

8.0 Reviewing Concerns Raised by the Unions

8.1 8.2 8.3

The Director of Human Resources and Organisational Development, gave a presentation to the Council of Governors in respect of the concerns which had been raised by the GMB Union and also the 2016 Staff Survey results. It was noted that the same level of detail provided to the Council was also made available to all staff and also published so that the Trust’s results could be compared with those of other Trusts. The Trust Secretary advised that the team would circulate the Concerns Raised by GMB presentation and the Staff Survey Presentation to the Governors. ACTION

EM


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8.4

The Council of Governors took assurance from the presentation by the Director of Human Resources and Organisational Development.

9.0 Update and Q&A with the Non-Executive Directors

9.1 9.2

Paul Love gave an update to the Governors on his activity over the last few months which included:

Being interviewed as part of the KPMG Well-Led Review;

Attending a meeting with the Welsh Ambulance Service. This meeting was with the Non-Executive Directors who Chair a SWASFT Committee and the Chairman of the Board with their counter-part/equivalent from the Welsh Ambulance Service. The meeting focused on sharing good practices and understanding the governance around each organisations Committee structures;

One Audit and Assurance Committee had taken place since the last Council of Governors Meeting. The Major Service Interruption was brought as an urgent extra item and the discussion surrounding this item have driven the Serious Incident Panel at which Gail Bragg will represent the NEDs and Audit and Assurance Committee at;

He had attended the West Division Long Service Award Ceremony in Wadebridge. Paul advised that it was a great opportunity to talk to staff and volunteers. He continued by saying that he had very interesting volunteers and gave the example of some volunteers letting him know that they would find it helpful if they were able to offer more pain relief to patients. Paul was then able to feed this back to the Executive Medical Director and his team;

Paul had visited Wiltshire, Chippenham and Swindon stations with Governor Dee Nix;

He had the opportunity to go out with a crew from Oakhampton Station for an over-night third manning shift;

As Devon is a particularly challenging CCG area and with this in mind the Audit Committee Meeting Chairs in Devon across partner agencies have started meeting on a quarterly basis. SWASFT are hosting the next meeting and attendees will be given the opportunity to have a tour of the hubs really good way to get the other health authorities involved in the work the Trust does;

Finally, he had been working with the Trust Secretary and procurement team on the Internal Audit contract tender.

Venessa James gave an update to the Governors of her activity over the last few months which included:

Station visits had been made to Taunton Station, Weston-Super-Mare Station, Exeter Station and Exeter Clinical Hub, Bristol Station and St James Clinical Hub, Dorchester Station and Weymouth Station. Venessa advised that even amongst this small number of stations visits it is clear that there are differences between buildings, working conditions and staff


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9.3

morale;

She had attended an SI review panel through which maximum learning was gained for the member of staff involved;

Ian Reynolds had Chaired the last Quality Committee on her behalf, but Venessa that she would be chairing the February meeting and Governors were welcome to attend;

Being interviewed as part of the KPMG Well-Led review;

NED to NED Welsh Ambulance Service Meeting at St James A, which had included a 1:1 with the Chair from Welsh Ambulance Service Quality Committee along with a group session with all NEDs and the Chair of the Welsh Ambulance Service;

Involved in the Interview Panel to appoint the Deputy Director of Nursing. Venessa advised that there had been a number of very strong candidates for the role;

Attended as an observer and as the guardian of good governance a an HR disciplinary panel. The panel members had handled the issue with extreme sensitivity and the skills shown in managing the hearing were exceptional. The member of staff involved was very happy that they had been understood well;

Completed the Senior Independent Director review on NHS111 and the report had been submitted to NHS Improvement;

Venessa had undertaken a review of the Trust’s Freedom To Speak Up arrangements in her role as the Freedom To Speak Up Guardian for the Trust and as a result she will make a recommendation to the Board that the Trust undertake a full review;

Venessa advised that as part of the SID role she will be conducting Tony’s appraisal and the Governors will be asked for feedback;

Finally Venessa added that as the Chair of the Quality Committee and since the 111 CQC/ NHS Improvement review she had continued to Chair regular assurance calls to monitor the Service Line Improvement Plan with senior members the Integrated Urgent Care team to gain regular assurance. Feedback is then provided to the Quality Committee.

Gail Bragg gave an update to the Governors of her activity over the last few months which included:

Gail advised that she is the Chair of the Finance Committee and one of the major pieces of work being looked at by this Committee is around this year’s and next year’s financial plan. A deep dive into performance targets is also being undertaken, looking in particular at the financial implications of the performance and also at strategic projects and estates.

Looking at the QPIP (Quality Performance Improvement Plan) project and understanding the balance between quality of the care and the money required to deliver that care;

In Rakhee’s absence, Gail informed the Governors that the People and Workforce Committee met for the first time in November. The Committee will have an overview on the people and organisational development


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9.4 9.5

strategy.

Attended the Audit and Assurance Committee;

Working with Ian Reynolds and the Deputy Chief Executive/Executive Director of Finance’s team on the Trust Strategy attending regular Strategic Direction Working Group Meetings and calls;

Working with the Executive Director of IM&T on the Digital Strategy;

She had the opportunity to go out with a crew from Bristol Station for a third manning shift;

Had a tour of stations which are part of the Strategic Estates plan these were stations which need a bit of extra “TLC”;

Being interviewed as part of the KPMG Well-Led review;

Attended the Welsh Ambulance Service Meeting which Paul and Venessa have spoken about;

Attended an SI Panel as an observer. Gail advised that observing the SI Panel reiterated to her that SWASFT is very much a “learning organisation”;

Visited the Bristol Clinical hub, Exeter Station and Taunton Station. Minesh Khashu gave an update to the Governors of his activity over the last few months which included:

Largely getting to know the Trust and people;

Visited the St Leonards Clinical Hub;

Attended Quality Committee and help to provide the Committee with a perspective from a clinical point of view;

Minesh advised that he feels there are ways of looking at the Trust’s Performance data and from a Quality perspective he has noticed ways in which reporting can be enhanced;

One main focus for him over the next 12 months will be to help provide the Trust with a clinical point of view to things as a fresh perspective from an “outsiders” point of view;

Ian Reynolds gave an update to the Governors of his activity over the last few months which included:

Chairing the Charitable Funds Committee which makes sure the funds are being looked after and distributed towards appropriate activity. Moving towards actively raising funds for the Trust Charity and widening what the Trust is doing as a charity;

Launched a virgin money giving page for the South Western Ambulance Service Charity;

Managing the “inheritance” of £100K plus coming in to the Charity from a house sale which is expected to come through in late 2018 early 2019;

Considering carefully what the Charity Funds are spent on.

Chairing the Strategic Direction Working Group which is a sub- committee of the Finance Committee focusing on engaging, listening and working through the steps towards building the overall Trust Strategy.

Ian also indicated that the Trust Secretary will be asking Governors to


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9.6 9.7 9.8 9.9

establish a task and finish group to support the development of the strategic plan. Susan Bradford gave an update to the Governors of her activity over the last few months which included:

Settling in and getting to know people and the Trust;

She had the opportunity to go out with a crew from Bath Station on a third manning shift which she found very interesting and helpful. Had a good discussion with the Paramedic about people with mental health issues and this is an area which she is interested in going forward. This also prompted a discussion around frequent callers which she’d like to learn more around the process for handling frequent callers;

Attended a KPMG NED network which was useful.

The Lead Governor advised that he in particular had found the updates from the NEDS very useful to get an idea of the work NEDs do “behind the scenes” and asked whether NEDS received protected time to collate their thoughts and feedback on visits to stations etc. The Chairman advised that yes they do. Mark Norbury requested an update regarding the work that the Trust has been undertaking in respect of the Accreditation of Investment in Volunteers. The Trust Secretary advised that he would pick this item up with Mark outside of the meeting and the Chairman advised that an item could be brought to a future Council of Governors Meeting and also People and Culture Committee. ACTION The Governors noted the content of the NEDs updates and the Chairman thanked the NEDs for their updates.

MM

10.0 Electronic Patient Clinical Record (EPCR)

10.1 10.2 10.3

Clinical Development Manager, Dave Partlow gave an overview and demonstration on the Electronic Patient Clinical record (ECPR). Dave explained that the Trust designed this product and the clinical configuration; then an external company, Autovas, produced the product for the Trust. It took three months to get an initial product together and then approximately three years to role the system out Trust wide. Dave advised that he is not aware of any other product/machine that does what this does. Dave demonstrated that the system can be used for all kinds of reasons not just to collect patient data. It can also be used to take photographs so if Paramedics attend a job and have safeguarding concerns they can capture the issues live and save them to the patient’s record. It can also be used to send messages to the Emergency Department (ED) or Intensive Care Units (ITU) if the crew feels that hospital staff needs to be made aware of anything


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10.4 10.5 10.6

in advance of them arriving with the patient. Dave also advised that the ECPR system can hold 500 – 600 records and can still be used if the IT systems “go down”. Regular updates are completed on the system, these happen approximately every six weeks and can include fixes or updated protocols or training guides. The following points were noted:

the Trust was considering commercial options with regard to the model and the data it can collect, with it being highlighted that patient confidentiality would never be compromised;

whether a patient was conscious or unconscious did not impact on the data as there was an option for paramedics to record this;

the messaging function allowed for two way communication between the crew and the receiving hospital prior to admission;

the paramedic still controlled overall decision-making and treatment, with the system providing guidance through access to clinical guidelines;

the intellectual property credentials were not owned by the Trust, but that all data was; and

consent was obtained prior to the ECPR being used to take photographs in accordance with the Trust’s Clinical Photography Policy..

The Governors noted the content of Dave’s presentation and the Chairman thanked Dave for his presentation.

11.0 Communications Update

11.1

Claire Warner provided an update on the recent work of the Communications team which included:

Working on developing an Engagement and Communications Plan;

Significant increase in positive media coverage which is a result of lots of hard work from the Communications team focusing on positive and proactive campaigns to try and re-balance the Trust media coverage and help the Trust to recover from a few bad news stories which have been in the media over the past year or so;

The Trust appeared on the TV programme “999 What’s Your Emergency” which received great viewing figures of between 1.6M – 2M;

Positive stories have included the “Man who swallowed a fish” in Dorset and Restart a Heat Day which focused on teaching CPR in schools;

The Victoria Derbyshire show is interested in covering a piece on frequent callers so that is something exciting coming up;

Neil Le Chevalier, Director of Operational Services, was awarded the Queens Ambulance Service Medal at Buckingham Palace;

Encouraging engagement from the HOSCS, local MP and key stakeholders for example Johnny Mercer MP had spent a night shift with


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11.2 11.3

a crew in Plymouth;

Followers on Facebook reached over 100K;

Two Community First Responders were nominated for the Sun Awards they attended the award ceremony recently in London and tweeted a photo with the Head of NHS England which received 6500 retweets;

Moving in to the Winter Period the Communications team has been working hard to promote probative positive messages on how to deal with health concerns over this period of time and when it is appropriate to call for an Ambulance. The Trust has been working with lots of partner agencies and have has a campaign running which has been overseen by the Commissioners which has been a more organised and consistent approach; and

Jo Stonehouse has been doing tremendous work around the Macmillan Cancer Care Project.

The Trust’s use of Twitter was discussed, with it being noted that it was regularly used as part of recruitment campaigns. The Governors took assurance from Claire’s update. The Chairman thanked Claire for her presentation.

12.0 Communication with Members and the Public

12.1 12.2 12.3

Marty McAuley and Claire Warner presented the Communications with Members presentation which provided an overview on the Trust’s Communication with Staff, Members, Volunteers and Public. Highlights included:

The new-style weekly bulletin which launched on 4 October 2017 which is interactive and staff can “like” and comment on the posts;

Governors receiving a bi-weekly newsletter to inform them on Trust news including media articles, key dates and diary updates and links to the other useful documents such as the ICPR;

The Trust has a private “Governor Zone” on the External Website which Governors can log onto to access a range of information;

An overview of the purpose of the Trust Membership and what the benefits are of becoming a Governor;

A relaunch of the member newsletter which will be happening in the near future;

A summary of engagement events attended by the Trust was presented and the work being carried out with other Trusts and Healthwatch;

A look at the Volunteers/Community First Responders bi-monthly bulletin.

The following points were discussed:

Staff accessed the Chief Executive’s Bulletin via email and the Trust Intranet;


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12.4

Volunteers were not able to access to Bulletin, but they have their own bi-monthly bulletin;

That Facebook could be a quick and effective way of contacting members and be used as part of a recruitment drive;

A wide range of communication methods had been used to engage with members, and some just did not want to engage; and

The Governors noted the content of the presentation and the Chairman thanked Claire and Marty for their update.

13.0 Communication & Engagement Task & Finish Group Update

13.1 This item was not covered.

14.0 Membership and Governor Update

14.1 14.2 14.3 14.4 14.5 14.6

The Trust Secretary presented the Membership and Governor update to the Governors. It was noted that the report still cited Alan Peak as the Accident and Emergency: North Division Staff Governor and this should be amended to Mark Stubbs. ACTION The role of Appointed Governors was considered with it being noted that any Appointed Governors who had left the role had done so due to changes in employment so they were no longer eligible, rather than disappointment in the role, but that there were difficulties in securing appointments due to the pressure of work at partner organisations. In response to queries raised by Public Governors the Appointed Governors provided some context to their appointment with it being noted that Blair Millar was nominated Dorset CCG to represent all the CCGs. He used his role as a Governor to feedback to Dorset CCGs Board on the current themes which the Trust are looking at and the “mood” of SWASFT. The information can then be disseminated to other CCGs. Blair continued by saying that sometimes it was sometimes difficult for him to challenge as he didn’t want it to look as though he was always “fighting the corner” of the CCGs, he would prefer to observe and then challenge a NED during a quiet moment. Bill Sivewright advised that he was nominated by his other Air Ambulance colleagues to take up the role of Appointed Governor. He felt that it was helpful for the Air Ambulance Charities to be represented at the Council of Governors as it helped to keep “Hot topics” on the radar for the Charities. It was also noted that the Air Ambulance Charities meet on a quarterly basis with Ken Wenman. Resolved that a Task and Finish Group be established with the remit of

MM


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reviewing and reporting back to the Council of Governors in respect of:

the purpose and expectations of Appointed Governors to the Trust;

the allocation of Appointed Governor seats; and

the allocation of Governor seats in the Public Constituencies of Gloucestershire and Bristol and Bath & North East Somerset.

15.0 Governor Feedback:

Prospective Governor Workshops – William Thomas, Sarah Lennard, Rae Care, Craig Holmes and Mark Stubbs

September Board Meeting – Sarah Lenard

November Board Meeting – Torquil MacInnes

SWGEN Meeting – Rae Care, Robert Day and David Pinder-White

15.1 15.2

Prospective Governor Workshops - William Thomas, Sarah Lennard, Rae Care, Craig Holmes and Mark Stubbs It was noted that these were interesting days for Governors, but that attendance levels had been low. September Board Meeting – Sarah Lenard Sarah advised that she found this a very interesting meeting and it was helpful to attend. November Board Meeting – Torquil MacInnes Torquil advised that it was great to attend and was brilliant to see the Board in “action” helps to see the NEDs challenging the Executives.

SWGEN Meeting – Rae Care, Robert Day and David Pinder-White David Pinder-White advised that it was a good day and they were given four presentations in total. The CQC Inspection Management presentation was particularly interesting demonstrating how the models and regulations work and advised that the CQC are changing the way the system is going to be organised and how that will impact of the Trust. The Chairman thanked the Governors for their updates.

16.0 Update from the Lead Governor

16.1 16.2

Adrian Rutter provided the meeting with an update on work undertaken by the Governors and future projects. Adrian asked Governors if after the meeting they could each think of three words which described what went well and what didn’t go so well at the Council of Governors Meeting and email it through to the governor email address this information could then be set out in a word cloud and circulated. ACTION

EM/MM


Page 15 of 16

17.0 Any Other Business Items to be notified to the Trust Secretary three clear working days before the meeting

17.1 No other business was discussed.

Signed (Chair): ___________________________________________________________

Dated:

Copies of the approved final minutes are available from the Trust Secretary on request.


Page 16 of 16

Attendance Chairman: Tony Fox, Chairman of the NHS Foundation Trust and Council of Governors Members of the Council of Governors in attendance:

Rae Care Public Governor, Bristol & B&NES

William Thomas Public Governor, Cornwall

Ray Foss Public Governor, Devon

Phil Ford Public Governor, Devon

David Pinder-White Public Governor, Devon

Adrian Rutter Public Governor, Devon

Craig Holmes Public Governor, Gloucestershire

John Hawkins Public Governor, Somerset

Anthony Leak Public Governor, Somerset

Torquil MacInnes Public Governor, Wiltshire & Swindon

Dee Nix Public Governor, Wiltshire & Swindon

Sarah Lennard Staff Governor, A&E (Devon and Cornwall)

David Shephard Staff Governor, A&E (Dorset and Somerset)

Mark Stubbs Staff Governor, A&E (Bristol, B&NES, Gloucestershire, North Somerset, South Gloucestershire, Swindon and Wiltshire)

Neil Hunt Staff Governor, Administration & Support Services

Sandy Turner Staff Governor, Urgent Care Services

Mark Norbury Staff Governor, Volunteers

Dr Blair Millar Appointed Governor, Clinical Commissioning Groups

Bill Sivewright Appointed Governor, Air Ambulance Charities

Non-Executive Directors in attendance: Venessa James Non-Executive Director Gail Bragg Non-Executive Director Paul Love Non-Executive Director Minesh Khashu Non-Executive Director Ian Reynolds Non-Executive Director Susan Bradford Associate Non-Executive Director Officers in attendance:

Jessica Hodgman Interim Executive Director of Operations Amy Beet Director of HR and OD Dave Partlow Consultant Paramedic Marty McAuley Trust Secretary Claire Warner Head of PR, Marketing and Communications Emma Mitchell Board & Committee Co-Ordinator

Date of

Meeting

Minute

RefAgenda Item (Topic) Action Allocated To Deadline Progress Date Completed

18/01/2018 9.8 Update from the NEDs

An item in respect of the Trust's Accreditation of

Investors in Volunteers to be included on a

future agenda of the Council of Governors and

People and Culture Committee.

MM

Update April 2018

Item to be included on the agenda for the July 2018 Council of

Governors meeting.

Item to be incorporated into the work programme of the People &

Culture Committee.

18/01/2018 14.6Membership and

Governor Update

Task and Finish Group to be established to

review Appointed Governor role and seats and

allocation of public seats in Gloucestershire and

Bristol and Bath & North East Somerset.

MM

Update April 2018

Volunteers sought for group membership. First meeting to be

scheduled in May 2018.

18/01/2018 6.4Chairman’s

Announcements

Craig advised that it would be helpful to have a

regular update on the Carter Review. The

Chairman agreed to provide an update at each

CoG meeting.

TF

Update April 2018

Carter Update to be included in the Chairman's Announcements

at each CoG meeting.

ACTION COMPLETE

18/01/2018 6.8Chairman’s

Announcements

The Trust Secretary to provide an update of the

Board and Committee Meeting schedule to the

Governors through the notice Board.

MM

Update April 2018

Each Noticeboard contains the update to date Board and

Committee meeting Schedule with any amendments highlighted.

ACTION COMPLETE

18/01/2018 6.9Chairman’s

Announcements

The full KPMG report is to be shared the Board

of directors next week and will be shared with

the Council of Governors at the next meeting.

MM

Update April 2018

Well Led Review included on agenda for 19 April 2018.

ACTION COMPLETE

18/01/2018 8.3Reviewing Concerns

Raised by the Unions

The Trust Secretary advised that the team

would circulate the Concerns Raised by GMB

presentation and the Staff Survey Presentation

to the Governors.

EM

Update April 2018

Presentations circulated via Noticeboard and to be included

within the Governor Zone.

ACTION COMPLETE

Council of Governors Public Action Point Register - 2017/18

At each Meeting meeting action points are recorded throughout the meeting to note items which need further development, additional work or raise other issues which need to be considered or discussed. This

document has been created to keep a record of these action points. This will be a yearly document and incomplete action points will be reported to each Meeting along with action points which have been completed

since the last meeting.

Date of

Meeting

Minute

RefAgenda Item (Topic) Action Allocated To Deadline Progress Date Completed

18/01/2018 14.2Membership and

Governor Update

Reference to the Accident and Emergency:

North Division Staff Governor be updated from

Alan Peak to Mark Stubbs.

MM

Update April 2018

Reference to A&E North Division Governor updated in

Membership and Governor update.

ACTION COMPLETE

18/01/2018 16.2Update from the Lead

Governor

Each Governor to think of three words which

describe what went well and what didn’t go so

well at the Council of Governors Meeting.

Words to be used to creat word cloud for

Governors to consider.

EM/MM

Update April 2018

Word cloud circulated in Governor Noticeboard of 9 April 2018.

ACTION COMPLETE

Council of Governors Meeting – 19 April 2018

Page 1 of 1

Council of Governors Meeting

Date: Thursday 19 April 2018

Paper Title: Performance Update

Prepared by: Paul Quick, Performance Manager

Presented by: Ken Wenman, Chief Executive

Action: Assurance

Recommendation:

The Council of Governors is asked to:

note further detail of the Trust’s performance contained within this report and the Integrated Corporate Performance Report; and

raise any questions with Non-Executive Directors.

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Integrated Corporate Performance Report

February 2018

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Integrated Corporate Performance Report

Introduction 1.

The Integrated Corporate Performance Report (ICPR) includes: 1.1.

An Executive Summary - highlights the key areas of note and interest to the Trust Board. This summary includes details of any areas of significant exception where the Trust is either ‘off plan’ or below target, together with the key actions that are being taken to address under-performance;

A RAG rating Dashboard - summarises the RAG ratings of the key metrics monitored by the Trust. In order to promote consistency these are ordered according to the key headings contained within the A&E (999) Operating Plan for 2017/18;

An Information Pack – the comprehensive data set includes graphs and tables covering the full list of KPIs and metrics monitored by the Trust.

Ambulance Response Programme (ARP) 2.

New standards, indicators and measures have been introduced through the ARP for 2.1.

publication in the NHSE Ambulance Quality Indicators. All ambulance trusts in England were required to commence reporting against the new standards by 30 November 2017.

Compliance against the new standards is expected from September 2018. Until then the 2.2.

standards proposed are to be used for monitoring purposes only to enable ambulance trusts to update their operating models to deliver the new performance standards.

SWASFT implemented the new response time reporting standards required for ARP v2.3 2.3.

with effect from 23 November 2017. This report therefore includes data in relation to the old metrics up to and including 22 November 2017 and reporting on the new metrics with effect from 23 November 2017. Further details on the new performance standards can be found in the Information Pack included with this report.

A&E (999) Performance 3.

A&E Incident Numbers Following the unprecedented high levels of A&E incident numbers in December 2017, the 3.1.

activity levels in January 2018 and February 2018 were closer to expected levels. Incident numbers in February 2018 were 5.40% higher than those reported in February 2017 but were 3.32% lower than the contracted volumes for February 2018. Year to date (April 2017 to February 2018) the Trust is 0.92% below contracted volumes (up 1.99% on the equivalent period in the last financial year).

Weekly incident numbers during February 2018 were around 17,750 to 18,000 incidents per 3.2.

week (compared to over 19,000 incidents per week at peak demand in December 2017). It should be noted that whilst lower than the activity in December 2017, the weekly incident numbers are still significantly higher than the numbers seen in Quarter 1 and Quarter 2 of 2017/18 when weekly activity was consistently below 17,000 incidents per week.

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At the end of February, leading into the start of March 2018 the adverse weather conditions 3.3.

including significant snowfall increased the activity levels in the week commencing 26 February 2018 to 18,729 incidents per week. This additional activity continued into the following week (commencing 5 March 2018) when activity volumes increased to 19,060 incidents, including 3 consecutive days (3 to 5 March 2018) with activity of around 3,000 incidents per day.

In February 2018 activity volumes were 5.40% above the volumes reported in February 3.4.

2017, the level of variance across the CCG areas continues, with activity in Somerset CCG increased by 13.64% and Swindon CCG 12.95% higher. All CCG areas reported activity higher than last year, with the lowest growth in Bath & North East Somerset CCG of 1.81%. ARP Response Times

The summary of performance against the new monitoring standards for December 2017 to 3.5.

February 2018 is included within the table below.

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National Standard December 2017 January 2018 February 2018

Category 1 Mean Response Time (Mins)

7 minutes 10 mins 18 secs 9 mins 12 secs 9 mins 18 secs

Category 1 90

th Centile Response

Time (Mins) 15 minutes 18 mins 36 secs 16 mins 48 secs 17 mins 00 secs

Category 2 Mean Response Time (Mins)

18 minutes 37 mins 01 secs 29 mins 54 secs 31 mins 54 secs

Category 2 90

th Centile Response

Time (Mins) 40 minutes 1 hr 17 mins 00 secs 1 hr 2 mins 48 secs 1 hr 5 mins 36 secs

Category 3 90

th Centile Response

Time (Mins) 2 hours 3 hrs 37 mins 00 secs 2 hrs 29 mins 06 secs 2 hrs 38 mins 42 secs

Category 4 (999) 90

th Centile Response

Time (Mins) 3 hours 4 hrs 56 mins 12 secs 3 hrs 32 mins 42 secs 4 hrs 42 mins 00 secs

Mean Category 1 incident response times across the Trust show expected variation in the 3.6.

month of February 2018, with the longest mean response time in Kernow CCG (11 mins 42 secs), NEW Devon CCG and Wiltshire CCG (both 10 mins 00 secs) compared to the shortest time of 7 mins 12 secs in Bristol CCG and 7 mins 30 secs in Swindon CCG.

The graph below shows the Trust Category 1 Mean Response time by day throughout the 3.7.

period 1 February 2018 to 11 March 2018, the level of variance across is relatively small, but can be seen more prominently during the adverse weather conditions at the beginning of March 2018 (1 and 2 March 2018) when mean response times extended over 13 minutes in length. It is important to note that the Category 1 incidents represent around 6.5% of all incidents received by the Trust (equating to around 160 to 170 incidents per day).

The ARP performance figures for ambulance trusts in England are included within the 3.8.

Information Pack for reference for the month of February 2018. The Trust is currently in the lower quartile for Category 1 Mean response times and whilst some of this national variance will be due to the extremely rural nature of the South West geography, the Trust has made contact with other ambulance trusts to identify any best practices which may assist in reducing the mean response times closer to the 7 minute response time target.

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To deliver performance improvements and where possible reduce the Trust response times 3.9.

to all categories of incident the Trust has undertaken a three phase approach:

Phase One - Trust wide rota review to align rotas and fleet ratios to meet the new (increased) demand profiles and tackle inefficiencies. To ensure the right number of staff on duty at the right time in the right place.

Phase Two – Quality Performance Improvement Plans to improve patient safety and performance by maximising resource availability. To provide additional capacity to focus on a small number of high impact actions across the Trust.

Phase Three – Performance Improvement Plan – to address the performance gaps (after Phase 1 and 2) as per ORH analysis – started in February 2018 and on-going.

Phase One - Rota Review

The new rotas improve the alignment of available resources to demand and are expected to 3.10.

deliver an improvement in performance across all call categories. The North Division introduced their new rotas on 3 April 2017 and the revised rotas for the East and West Divisions went live on 3 July 2017.

The benefit of the rota changes (introduced in Q1 and Q2 of 2017/18) on performance will 3.11.

only be fully realised when recruitment matches required establishment levels within each of the operational areas filling current vacancies within the rota patterns. Therefore recruitment to the funded establishment levels within each Division is seen as a key area of focus for the Trust.

Details on the Trust forecast establishment position are included within the Information Pack 3.12.

accompanying this report.

Phase Two - Quality Performance Improvement Plan (QPIP) The Trust has developed an internal Quality Performance Improvement Plan (QPIP). The 3.13.

aim of the QPIP is to improve patient safety and performance by maximising resource availability.

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The QPIP contains a number of high impact actions to deliver efficiencies and increase 3.14.

productivity of Operational and Hub resources. These actions are being managed by a designated QPIP Lead within the organisation with a view to delivering performance improvements.

QPIP Phase 1 commenced in September 2017 and identified a number of key areas of 3.15.

performance was completed in December 2017. A second phase, QPIP2, has now been developed and will focus on further areas of performance and productivity improvements. QPIP2 is currently scheduled to run through to the end of June 2018.

QPIP2 the Trust has identified a group of actions to deliver improvements in patient safety 3.16.

and performance by maximising resource availability:

Reduction in inappropriate Shift Overruns;

Deliver and launch the ‘Time to Care’ campaign;

Review of the Trust Rest Break SOP;

Production of a performance handbook for Operational Managers to include both operational and clinical performance;

Identification of the key reasons for Late Shift Booking On and develop actions to reduce these occurrences where appropriate;

Review of key reasons for extended On Scene times and develop actions to remove barriers to leaving scene and/or support staff in making decisions at scene;

Reduction in inappropriate time lost to extended ‘wrap up’ time at hospital following the handover of patients;

Identification of best practices in relation to sickness management and rollout across the Trust.

Shift Overruns Shift Overruns - a trial with the aim of reducing shift overruns for operational resources 3.17.

commenced on 19 February 2018 for a period of four weeks in the North Division. This trial provides additional protection of resources from certain types of allocation during the last 30 minutes of their shift.

The impact of the initial stages of this trial have been difficult to assess as it coincided with 3.18.

the period of adverse weather and heightened activity levels, however no adverse impact has been noted. Daily and weekly monitoring metric have been established and will continue to be monitored for the duration of the trial which finishes on 19 March 2018. After this date a full evaluation report will be presented to Directors. Time to Care

At its core, Time to Care is about working together to improve staff wellbeing and job 3.19.

satisfaction. Our organisation has some basic, but vital building blocks:

Staff – more than 4,000 staff across 10,000 square miles

Patients – we manage nearly 1 million incidents a year

Money – everything we do has to provide affordable quality

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The demands faced by our staff on a daily basis are significant and growing. It is vital we 3.20.

improve the working environment in a way that sustains the delivery of safe and high quality services that provide benefits for staff, patients and the Trust.

‘Time to Care’ was launched to managers at the Trust Strategic Away Day held on 7 3.21.

February 2018 and to operational staff on 28 February 2018. Seven staff focus groups have been held recruiting 80 staff champions to galvanise staff in developing solutions.

From the launch events and staff focus groups over 300 pieces of feedback have been 3.22.

received. Some items are specific to local areas, but the majority of the challenges identified are experienced across the Trust.

A number of key themes are present and the feedback provides a wealth of solutions. Most 3.23.

are within the control of the Trust and achievable although some will prove more challenging to deliver than others and may require an ‘invest to save’ approach.

Any issues which have a high impact on staff wellbeing and job satisfaction will also impact 3.24.

on operational service delivery. It is vital that Time to Care continues to develop momentum, with managers taking responsibility and ownership of actions. The approach must focus on developing and building relationships between staff and departments through positive engagement.

The intention is for Time to Care to become embedded within the Trust as a sustained 3.25.

approach to staff engagement and continuous improvement.

Phase Three - Performance Improvement Plan (PIP) The PIP commenced in February 2018 and has a number of key areas of focus to help 3.26.

deliver further performance improvements and close the performance gaps identified by ORH including:

Reduction in extended response times;

Improvements in Call Answering performance;

Appropriate improvements in the proportion of incidents resolved through the Hear & Treat outcome (ie telephone advice/referral);

Recruitment of Hub Clinicians to fill current vacancies;

Reduce the impact of inappropriate activity transferred from NHS 111 to the ambulance service;

Improve consistency of frontline resourcing levels in line with operational plans;

Deliver improvements in operational call cycles where appropriate.

NHS 111 Performance 4.

NHS 111 Call Answering performance during February 2018 was below the national target 4.1.

level of 95%, but 90.88% of calls were answered within 60 seconds in Dorset. This is the second consecutive month where the service has reported performance above 90%. Call abandonment rates are now consistently below (better than) the target level of 5% and were 1.33% in February 2018.

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Whilst performance remains below the target levels, call answering performance has 4.2.

improved significantly and throughout January and February 2018 were consistently above the national average performance levels as represented in the graph below.

GP Out of Hours Service Performance (GP OOH) 5.

The Quality Requirements relating to Urgent Treatment Centre appointments and Urgent 5.1.

Home Visits remain the greatest challenge for the Dorset GP OOH service. The Trust has not been able to deliver these standards consistently although the patient numbers outside of the target are small.

In February 2018 the Dorset GP OOH service was partially compliant against the Urgent 5.2.

Treatment Centre Appointments standard (90.75% compared to the target of 95%).

The Trust missed the 2 hour target on 21 of the 227 cases, of which the majority are 5.3.

missed’ during the busier weekend periods. For Less Urgent Treatment Centre appointments the Trust was compliant with 98.62% of appointments completed within the 6 hour target (3.62% better than the 95% target).

The Trust was also partially compliant for Urgent Home Visits in February 2018 with 399 of 5.4.

the 423 visits completed within the 2 hour urgent target (94.23% compared to the target of 95%). Whilst it is acknowledged that home visits are more difficult to target in view of the large geographical spread of a relatively low number of urgent incidents (average of 6 missed visits per week in February 2018), operational managers are reviewing the appropriateness of the current profile of mobile resources.

For Less Urgent Visits in February 2018 the Trust achieved 98.93% of visits within 6 hours 5.5.

and was therefore compliant against the 95% performance target.

Urgent Care Centre (Tiverton) Performance 6.

The primary performance measure within this contract is the 4 hour waiting time standard. 6.1.

In February 2018, 1,021 of 1,027 patients were seen within 4 hours giving performance of

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99.42% against the 95% performance target. Performance above target levels has been delivered consistently since contract inception along with a local standard to triage patients within 15 minutes. In February 2018, 98.64% of patients were triaged in 15 minutes against a target of 95%.

Finance and Use of Resources 7.

NHSI introduced the Single Oversight Framework from 1 October 2016 and the Trust is 7.1.

assessed against the Use of Resource Metric which replaced the Financial Sustainability Risk Rating. Under the Use of Resource Metric the best score is 1 and the worse score is 4. As the Trust has not accepted its control total for 2017/18 the highest score the Trust can achieve is a 2.

The Trust delivered a Use of Resource Metric of 2 at the end of February 2018. The score 7.2.

of 2 is based on the Trust delivering against the control total derived by NHS Improvement from the Trust financial plan.

The financial information is based on the eleventh month of the financial year and includes 7.3.

the actual and year end forecast position for the Trust against the 2017/18 Financial Plan:

The Trust delivered a £1k surplus at the end of February 2018;

The Trust delivered the derived NHS Improvement measure of £18k surplus in line with plan;

The Trust has received additional income than plan which has been matched by expenditure so the Trust has not maintained the I&E margin compared to plan which is a score of 2 against this metric;

The position includes an under spend on basic pay relating to vacancies which has been offset by the use of overtime, agency and third parties;

The annual Cost Improvement target for 2017/18 is £10,466k and the Trust is forecasting delivery;

The Capital Plan for 2017/18 is £13,381k. The month eleven position shows an actual position of £9,650k compared to a plan of £12,669k (76%). This variance relates to slippage in the delivery of vehicles, estates projects and ICT plans;

The Trust cash position at the end of February 2018 is £23,300k compared to the plan of £16,354k This variance relates to timing differences of expenditure payments;

The debtors’ over 90 days past due has decreased from 8.32% to 6.19%. The outstanding balance over 90 days has increased from £278k to £292k but the Trust the overall value of debtor has increased to £3,946k due to the timing of quarter end invoices;

The Trust has been set an annual agency spend cap of £9,900k by NHS Improvement. The Trust year to date agency spend is £1,644k.

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Appendix A: ICPR Dashboard – February 2018

Clinical Quality & Patient Care Our People Operational Resources Productivity Performance Finance & Use of Resources Activity

AQI ROSC following Cardiac Arrest is above (better than) the local threshold (all patients and the Utstein Comparator Group).

999 Establishment Levels

Lead Clinicians are currently forecast to be 53.48 WTE below the funded establishment level of 1,644.29 WTE at the end of March 2018, improving to 4.36 WTE vacancies at March 2019.

Support Clinicians are forecast to be 9.98 WTE below establishment levels at the end of March 2018. Based on the planned recruitment and associated training courses for 2018/19 this position improves to 14.25 WTE over establishment levels at the end of March 2019.

Staff Appraisals are now above target levels at 90.61% at the end of February 2018.

Revised Operational Rotas were successfully implemented in the North Division on 3 April 2017. East and West Division rotas were implemented on 3 July 2017 in line with the A&E Operating Plan.

999 Sickness levels are showing an improvement compared to last year. Sickness levels in February 2018 have reduced, following the seasonal increase seen in January 2018, to 5.10%.

Sickness within NHS 111 and the A&E Clinical Hubs remain priorities to address.

Hear & Treat Rates are above (better than) local threshold levels.

Further improvements rely on increasing the number of Clinicians in the Hubs through recruitment.

ARP response protocols have reduced the average number of resources arriving at scene per incident.

The KPI Scorecard for Operational Managers was launched at the end of May 2017 and was rolled out to the Heads of Operations in June 2017.

Tiverton Urgent Care Centre continues to report performance better than 95% for the 4 hour A&E standard and 15 minute triage metrics.

Performance against NHS111 clinical KPIs have been improving.

NHS 111 Call Abandonment rates were lower (better) than the 5% target

Out of Hours Service performance in Dorset for Less Urgent Treatment Centre Appointments and Home Visits was complaint in February.

The financial year-end forecast at 28 February 2018 remains in line with Trust financial plans.

CIP plans remain on target at the end of February 2018.

A&E incidents were 3.32% below contract in February 2018, but were 5.40% higher than the number of incidents recorded in February 2017.

A&E incident volumes for the YTD remain 0.92% below contract (1.99% higher than the equivalent period last year April 2016 to February 2017).

Right Care: Non-Conveyance to ED is below 2016/17 outturn levels however the Trust continues to report the highest (best) non conveyance rates amongst ambulance trusts in England.

The Training Plan for 2017/18 has been agreed; the headlines are set out within the A&E Operating Plan and this will be used for monitoring purposes.

Recruitment of new 999 call advisors has been successful and has shown significant improvements in resourcing levels in recent months. There is a lag between recruitment and operational impact. Further groups of new call advisors are to be introduced into the Clinical Hubs in March 2018.

These additional resources have delivered improved resilience and call answering performance from December 2017.

Consultation within the East and West Divisions has resulted in some changes to the rota recommendations.

The expectation remains that the Divisions ‘make up’ any performance deficit arising as a result of changing rotas away from the recommendations.

Updated modelling and associated reports have been received from ORH based on the revised resourcing and activity levels. These reports will be used to inform A&E Operational Plans.

On Scene times and Wrap Up time improvements are expected as per the A&E Operating Plan for 2017/18.

Performance Management reports are produced on a monthly basis to assist local operational managers in benchmarking performance, identifying best practice and identifying individual outliers.

Figures for the most recent seven months (August 2017 to February 2018) evidence some improvements, with the percentage of Handover to Clear (Wrap Up) times over 15 minutes falling to 33.96% in January 2018 (compared to 44.39% in June 2017).

Revised AQI documentation to reflect the ARP changes was released in August 2017 and further updated in September 2017. New metrics were introduced for reporting purposes on 23 November 2017 but further work will be required to deliver national consistency of all the new AQI metrics across ambulance trusts in England over the coming months.

The ICPR will be updated to reflect any changes that are made and will be updated to include national benchmarking data when it is published by NHS England.

ORH resource modelling has previously identified the challenge to deliver response time targets for Category 2 incidents.

Capital Expenditure was at 76% of the YTD plan at the end of February 2018 and is forecasting 75% delivery of plan at the end of March 2018. The variance relates to a delay of vehicle conversions and slippage in the delivery of Estates and ICT capital expenditure plans.

The percentage of Debtors over 90 days improved from 30% in December 2017 to 6.19% in February 2018. The outstanding balance of £292k mainly relates to the band 6 Paramedic funding.

Revised rota patterns were introduced into the East and West Divisions at the beginning of July 2017 following extensive re-modelling of operational resources.

The revised rotas introduced across all 3 Divisions are designed to align operational resources to current demand patterns.

The expected performance improvement will not be fully realised until the shifts are filled. The ability to fulfil the revised shift patterns on a consistent basis is linked to the delivery of funded establishment levels.

AQI STEMI PPCI patients receiving angioplasty within 150 minutes is below (worse than) the local threshold.

AQI Stroke patients receiving thrombolysis at hyper-acute centre within 60 minutes is below (worse than) the local threshold.

AQI STEMI patients receiving an appropriate care bundle is below the local threshold.

AQI Stroke patients (assessed face to face) receiving an appropriate care bundle is below local threshold.

AQI Cardiac Arrest Survival to Discharge rate is below local threshold (all patients and the Utstein Comparator Group).

Time to Answer Calls is included within the new ARP metrics, with the Mean, 95

th and 99

th centile

figures now reported.

Improvements have been seen in recent months and in February 2018 the Trust reported a Mean call answering time of 7 seconds, 95

th centile of 33 seconds and

99th centile of 74 seconds. All

three metrics were below (better than) the national average.

The Trust is expecting further improvements during Quarter 4 of 2017/18 as a result of the additional recruitment which should deliver improved rota cover and resilience within the call taking resources.

The under establishment (in line with forecast) in the North and East Divisions, and higher abstraction levels in the West Division is impacting on the ability to deliver consistent resourcing to meet the new rota schedules on a daily basis.

Mitigation for the current under establishment includes overtime, agency and third party use until vacancies are filled and abstractions are managed back to planned levels.

Handover Delays, whilst showing improvements for the year to date, pressures on the health community during December and January saw the operational time lost to delays increase substantially.

The position recovered slightly in February but still remains a substantial impact on Trust resources, with 34% of handovers experiencing a delay and an average of 81 hours of operational resource hours lost per day.

Time lost to these delays impact directly on the number of resources available.

Response Times for Category 1 and Category 2 incidents in particular were above the new proposed national standards in February 2018.

The national standards have been introduced for monitoring through to the end of March 2018 acknowledging that ambulance trusts need to undertake operational model changes to meet the new AQI standards.

Out of Hours Service performance in Dorset for Urgent Treatment Centre Appointments and Home Visits was partially compliant in February 2018.

NHS 111 Call Answering performance was below 95%, but is consistently above 90% on a weekly basis and was above national average levels in February 2018.

There is considerable variation in CCG activity levels.

Wiltshire CCG is 3.11% above contract in the first eleven months of the year.

The other four CCGs with activity above plan are Bristol (0.09%), North Somerset (1.45%), Somerset (0.12%) and Swindon (1.76%).

At the other end of the scale Dorset CCG is 4.36% below contract and Bath & North East Somerset CCG is 2.76% below.

Council of Governors Meeting – 19 April 2018

Page 1 of 1



Paper Title: KPMG Well Led Review

Prepared by: Corrie Payne, Council of Governor Membership Co-ordinator

Presented by: Tony Fox, Chairman

Action: Assurance

Recommendation:

The Council of Governors is asked to take assurance from the KPMG Well Led Review

Executive Summary:

That Trust is required to carry out a “Well Led Governance Review” which is undertaken by an external auditor. Following a tender process, the review was carried out by KPMG who concluded that the Trust was well-led. A detailed outcome report was produced by KPMG and the Trust has developed an action plan to respond to the five medium and six low level recommendations within the report. At the January meeting of the Council, the Trust Chairman confirmed that the full report would be presented for information and assurance.

Well-Led Governance Review findingsSouth Western Ambulance Service NHS Foundation TrustJanuary 2018

www.kpmg.co.uk

http://www.kpmg.co.uk/

2© 2018 KPMG LLP, a UK limited liability partnership and a member firm of the KPMG network of independent member firms affiliated with KPMG International Cooperative (“KPMG International”), a Swiss entity. All rights reserved.

Document Classification: KPMG Confidential

ContentsPage

Introduction

Executive summary

Recommendations

Detailed findings

4

6

8

14

Appendices

1. Stakeholder involvement

2. Stakeholder feedback

3. Focus Group feedback

4. Meeting Observations

33

34

35

36

The contacts at KPMG in connection with this report are:

Jonathan BrownPartner, KPMG LLP

Tel: 0117 905 [email protected]

Rees BatleyDirector, KPMG LLP


Melanie WatsonSenior Manager, KPMG LLP


Item Date

Draft report issued: Monday 27 November

Factual accuracies: Wednesday 29 November

Final report issued: 3 January 2018



Important notice

Our work commenced on 12 September 2017 and our fieldwork was completed on 27 November 2017. We have not undertaken to update our report forevents or circumstances arising after that date.In preparing our report, our primary source has been internal management information and representations made to us by management. We do not acceptresponsibility for such information which remains the responsibility of management. A list of individuals with whom we had discussions is also set out inappendix 1. We have satisfied ourselves, so far as possible, that the information presented in our report is consistent with other information which wasmade available to us in the course of our work in accordance with the terms of our Engagement Letter. We have not, however, sought to establish thereliability of the sources by reference to other evidence.This engagement is not an assurance engagement conducted in accordance with any generally accepted assurance standards and consequently noassurance opinion is expressed.Our report is for the benefit and information of the addressee only and should not be copied, referred to or disclosed, in whole or in part, without our priorwritten consent, except as specifically permitted in our contract letter. The scope of work for this report included has been agreed by the addressee and tothe fullest extent permitted by law we will not accept responsibility or liability to any other party (including the addressee’s legal and other professionaladvisors) in respect of our work or the report.



Introduction

Background

South West Ambulance Service NHS Foundation Trust (‘the Trust’) procured this review in line with NHS Improvements (NHSI) ‘Developmental reviews of leadership and governance using the well-led framework: guidance for NHS trusts and NHS foundation trusts’ (Well-Led Framework) published in June 2017.

This guidance replaced ‘Well-led framework for governance reviews: guidance for NHS foundation trusts’ and the structure is now shared with the Care Quality Commission (CQC). It is designed to support providers in maintaining and developing the effectiveness of leadership and governance arrangements.

The guidance retains a strong focus on integrated quality, operational and financial governance and includes a new framework of 8 key lines of enquiry (KLOEs). The guidance does not stipulate a specific scoring methodology, therefore the Trust has developed a methodology to self assess its performance against each KLOE.

We have reviewed the self assessment and supporting evidence pack, and have assessed the Trust’s position for each of the KLOE, noting where we agree with the self assessment, and where we believe this may be over or understated. We have also noted any recommendations identified as part of our work.

Self assessment ratings

The Trust self assessment ratings against the KLOEs are based on the CQC rating methodology:

Acknowledgement

We would like to thank all of the individuals at the Trust who have supported the completion of this review, and have been welcomed by all staff at all sites that we have visited.

Outstanding: The service is performing exceptionally well.

Good: The service is performing well and meeting our expectations.

Requires improvement: The service isn't performing as well as it should and we have told the service how it must improve.

Inadequate: The service is performing badly and we've taken action against the person or organisation that runs it.



The Trust Board completed a self assessment and rated their performance against the NHSI Well-Led 8 questions. The final version of the self assessment was discussed and agreed at the Trust Board in DATE.

We reviewed the self assessment and pack of supporting evidence against each of the KLOEs set out in the Well Led framework. We reviewed the findings of any NHSI/CQC reviews and any prompts made around focus areas for governance.

We discussed the detailed scope of the review with the Trust during October 2017 and agreed key meetings and overall plan fro completion. We identified key areas of focus and investigation and ways to minimise disruption to the Trust e.g. joint meetings . We worked closely with the Board Secretary to identify any further documentation we needed to review to address any gaps we had identified. We planned meetings with a wide range of stakeholders to confirm that what was described in the self assessment and support was working in practice.

Introduction

Scope

Our review has been completed in line with the following process:

1. Review of Trust’s self assessment

2. Determine the scope of review

We completed our documentation review of the evidence pack provided to support your self assessment. We held interviews with all Board members and other stakeholders as detailed in Appendix 1. We observed the Board and a number of its subcommittees. Our findings from these observations is set our in appendix X We met with staff at the Clinical Hub at St James Place and the Urgent Care Hub at St Leonards, as well as a representative group of Governors. We also met with

3 key stakeholders from NHSI and commissioners. Details of feedback from these meetings is summarised within appendix Y.

We have provided our findings and recommendations to the Trust in this report and plan to present this report to the Board on 30 November 2017. The Trust Chair will be required to write to NHSI to inform them that the review has taken place, setting out any material issues that have been identified and the

proposed action plan to address these.

3. Detailed Review

4. Board report and action planning



Executive Summary

Conclusion

There are sufficient arrangements in place to ensure that South Western Ambulance Service NHS Foundation Trust (the ‘Trust’) is well led, which we assessed against the KLOEs set out in NHSI’s Well Led Framework.

The makeup of the Board ensures that the information provided is subject to robust scrutiny and challenge, which was demonstrated when we observed these meetings. Observing sub-committees provided assurance that the Board is appropriately informed of key issues on a timely basis. We canvassed feedback from a range of stakeholders including focus groups at all three hubs to ensure a broad range of internal and external views were captured, the results of which have been generally very positive and have added a weight of evidence supporting our conclusion.

The Trust has completed a summary self assessment, supported by an indexed suite of information. We have agreed with the Trust’s self assessment ratings in all of the 8 Well-Led framework’s key questions. However, we note that for question 2 regarding strategy that the Trust is in the process of refreshing their strategy and this still needs wider discussion with commissioners and STP leads.

Within the table on the next page, we have summarised the key findings for each question within the framework.

In summary, the Trust has a large number of effective processes and controls in place to support compliance with the governance framework. However we did identify some areas that require strengthening to fully meet the requirements of the Framework. We have provided our recommendations in Section 2 and detailed findings in Section 3.

Overall we have raised 11 recommendations in a number of areas to support the Trust in their improvement journey including:

• 0 high priority recommendations – these recommendations address significant weakness in the governance arrangements, which is putting you at serious risk of not achieving your strategic aims and objectives. Addressing these issues will be key to developing the Trust score for each of the key questions of the Well-Led Governance Framework. Any recommendations in this category would require immediate attention.

• 5 medium priority recommendations – these recommendations address potentially significant or medium level weakness in the governance arrangements in place at the Trust. The issues leading to these recommendations have been summarised in the executive summary table. Addressing these issues will be key to developing the Trust score for each of the key questions of the Well-Led Governance Framework.

• 6 low priority recommendations – which could improve the efficiency and/or the effectiveness of the governance arrangements in place at the Trust. These are generally issues of good practice which we could consider would achieve better outcomes.

Section one



Executive Summary

This table summaries the result of the Trust’s self-assessment, and our view of the Trust’s performance against the Well-led Framework. Further details can be found in the subsequent pages.

Section one

# Well-led Framework key line of enquirySWASFT

AssessmentKPMG

Assessment

1 Is there the leadership capacity and capability to deliver high quality, sustainable care? Good Good

2 Is there a clear vision and credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver? Good Good but with

specific comments

3 Is there a culture of high-quality sustainable care Good Good

4 Are there clear responsibilities, roles and systems of accountability to support good governance and management? Good Good

5 Are there clear and effective processes for managing risks, issues and performance? Good Good

6 Is appropriate and accurate information being effectively processed, challenged and acted on? Good Good

7 Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services?

Requires Improvement

Requires Improvement

8 Are there robust systems and processes for learning, continuous improvement and innovation? Good Good



Recommendations

This section summarises the recommendations that we have identified as a result of this review. We have discussed these recommendations with the Board and have documented the Trust’s management response to each recommendation. We have attached a risk rating to these recommendations as per the following table:

Section two

Risk rating for recommendations raised

High priority (one): A significant weakness in the system or process which is putting you at serious risk of not achieving your strategic aims and objectives. In particular: significant adverse impact on reputation; non-compliance with key statutory requirements; or substantially raising the likelihood that any of the Trust’s strategic risks will occur. Any recommendations in this category would require immediate attention.

Medium priority (two): A potentially significant or medium level weakness in the system or process which could put you at risk of not achieving your strategic aims and objectives. In particular, having the potential for adverse impact on the Trust’s reputation or for raising the likelihood of the Trust's strategic risks occurring.

Low priority (three): Recommendations which could improve the efficiency and/or effectiveness of the system or process but which are not vital to achieving the Trust’s strategic aims and objectives. These are generally issues of good practice that the auditors consider would achieve better outcomes.

No. Risk RecommendationManagement response, officer responsible and deadline

1

Split of agenda between public and private session at Board meeting

We noted certain items within the private session of the Board that arguably could have been included within the public session e.g. finance overview, serious incidents report. With a continued focus on increased transparency, the Board should challenge the private agenda at the end of each meeting to ensure all items that are not commercial or otherwise sensitive should in future be included within the public domain.

2

Forward looking performance and risk information

We noted that the performance reporting was predominantly backward looking and whilst it included comparisons to other ambulance trusts, it did not show any future expected trajectories. This makes it hard to understand Board expectations on what the accepted Trust target level of performance is (rather than just the National target), the actions being taken, and the expected length of time for performance to revert to target. We recommend that forward trajectories for quarter and year end performance are included within the performance reporting pack, and will share examples where relevant. In addition the Trust should align its performance report with its strategy to enable better monitoring of achievement against strategic goals.



Recommendations (cont.)Section two


3

Formalisation of station visit feedback to Board/committees

Positively each NED is allocated a geographical location within the Trust and as per the role requirements set out in the New Ways of Working document is expected to undertake regular visits to stations and hubs. Such visits are an invaluable way of gaining insight into frontline services and to triangulate evidence presented in reports to board and committee meetings. They can also be used to escalate issues of concern.

NEDs have commented that they find the visits helpful, but the current feedback mechanism from visits is informal and inconsistent. The Trust may be missing opportunities to use the feedback to take actions or ensure continuous improvement.

The Trust should develop a formal mechanism to record outcomes or issues from a station visit and to ensure these are reported and actions taken. This could be adapted from existing good practice such as the NHS 15 Steps Challenge framework used for ward walk-arounds which provides a toolkit and an aide memoire to inform visits.





4

Developing and articulating strategic priorities

The Trust’s updated strategy will have a focus on achieving Category 1 call performance resulting in a less proactive approach for NHS 111 and other urgent care services. While many STPs and the NHS 5 year forward view is moving towards integrated care and the link up of emergency and urgent care, the updated strategy may be perceived as more inward looking, and therefore care will be needed to explain this to the commissioners. This is exacerbated by the fact that the impact of the introduction of the Ambulance Response Programme (ARP) does not appear to be fully understood by all commissioners.

There is also more scope to enable non-executive board members to engage with their counterparts in the wider health economy. This would increase their visibility with partners, help build reciprocal understanding of the wider commissioning and regulatory contexts, and compare that against the narrative they receive internally.

Though restricted to some degree by the ability to fully brief stakeholders about the ARP, given the pilot nature of the project until now, the Trust could be more proactive at helping commissioners and other external stakeholders understand what the implications are likely to be and what this means for future service performance management and the Trust’s strategic plan.

The Trust should develop an engagement plan that:• Helps commissioners and other external stakeholders understand the likely implications of

the ARP and what this means for future service performance management;• Involves commissioners and other stakeholders in dialogue about the Trust’s overall

ambition and its developing strategic plan; • Clarifies roles and responsibilities of executive and non-executive board members in

engaging with key stakeholders including prioritising and allocating key partner contacts to relevant board members.





5

Freedom to Speak Up (FTSU) guardian

The Trust’s Freedom to Speak Up (FTSU) guardian is currently a NED with a medical background. We interviewed the FTSU guardian and discussed the role and how it works. The post holder has had several contacts and is currently following up on some issues, which can be quite operational.

Best practice suggests that the FTSU guardian works best when the role is undertaken by an employee with operational experience. The Trust should consider how its current model fits with the role of the NED and what other support such as Champions could be implemented to strengthen the role and promote openness and transparency across the Trust

6

Staff survey responses

The Trust’s most recent annual staff survey in 2016 showed a number of improvements over the previous year. Commissioners praised the Trust on the results of its staff survey and theTrust’s staff engagement score at 3.57 (out of 5) was above average compared to similar trusts.

Despite a positive set of results when compared to other ambulance trusts, results in absolute terms were low. For example, only a third of staff views were represented by the survey. One of the most improved areas from the previous survey was the action taken by the Trust to ensure well-being. While this is to be congratulated, only 35% of respondents agreed and only 29% said their manager involved them in important decisions.Though comparison with other trusts provides context, the Trust should be ambitious to significantly improve results in the future, particularly in the poorest performing departments such as the Hubs.





7

Board Development Programme

The Trust does not have a formal or published Board Development Plan in place.

The Trust Board has a number of new NEDs and EDs, so the development of a formal programme to identify and then programme in relevant development activities would be helpful to ensure effectiveness of board operations.

8

BoardAlthough the Board was well chaired and good challenge was observed, the Trust has scope to improve governance further through:• Avoiding duplication through expecting assurance at Board for detailed papers that have already

received assurance at a sub-committee. For example QIP, patient experience, and patient safety had already received assurance at a previous Quality Committee

• Increasing transparency by including more items, such as financial reports in the public part of the Board;

9

Improving diversity of the Board and GovernorsThere is scope to improve diversity in terms of age profile of the Trust’s Governors, which is skewed in favour of older participants.In order to better match the population that SWASFT covers the Trust should develop opportunities for younger people to sit on the Board or become governors. This could be done by linking to other organisations in the region that have already established ‘Young Ambassador’ or Youth Board type schemes, or by offering ‘associate’ non-executive positions to younger people to introduce them to the role of a NED.





10

Meeting managementThe meetings we observed were generally well managed. However, we identified a number of areas where this could be further enhanced or strengthened.Although the majority of meetings we observed ran to time, the Trust does not include indicative timings on its agenda for each item. It is good practice to set indicative times to guide discussion and to ensure that issues of most importance are afforded the most time on the agenda.At two meetings we noted that the committee chair did not take the opportunity to agree with the meeting items that should be escalated to the board.The Trust should ensure that:• It provides indicative discussion times on each meeting agenda item;• Committee chairs clarify what action has been agreed for each paper presented e.g. assurance,

information, approval etc.• Committee chairs should agree with meeting participants the items requiring escalation to the

board

11

Risk registerThe Trust board regularly reviews its risk register and we can evidence changes made as a result of that review.Many aspects of the Risk register are in line with good practice. For example we note that it is linked to strategic goals and has forecast ratings post action. However a target rating is not set for each risk, forecast ratings are often set for long periods but not achieved and a number of risks have remained on the register for a considerable time i.e. since 2012.The use of the risk register as an effective monitoring and reporting tool could be enhanced by:• Including a target rating against each risk;• Ensuring that forecast ratings are realistic, and are regularly reviewed to ensure they remain

realistic and relevant; and• Reviewing longstanding risks to ensure that mitigating actions or controls are having an impact.



Detailed FindingsKey lines of enquiry (KLOEs)

This section sets out our detailed findings in relation to our work. We have themed our findings by Key Line of Enquiry as set out within the well led framework. These are as follows:

Each of the KLOE’s above is supplemented by characteristics of good organisations and detailed descriptions of good practice within the well led reviews guidance issued for Trusts, and we have used these descriptors to assess the Trust and critique its self assessment on the following pages.

Section three



Detailed Findings (cont.)1. Is there the leadership capacity and capability to deliver high quality, sustainable care?

The Board benefits from an experienced and diverse membership. The new board chair is implementing a number of changes to board structures and operations to improve effectiveness, such as aligning NED and executive roles to portfolios and geographies, making expectations for board members clear and measurable and rotating meeting venues to improve visibility and accessibility for governors, staff and public. The Trust has successful mechanisms in place to identify and develop talent amongst managers and senior leaders, with examples of how this has been used to fill executive positions when they become vacant.Both non-executive and executive board members proactively visit staff locations such as the Hubs and stations, and roadshows to every emergency department have been undertaken to maximise contact with front-line staff.

Trust Rating Good

KPMG Assessment Good

‘Good’ characteristic Findings and Recommendations

Leaders have the experience, capacity, capability and integrity to ensure that the strategy can be delivered and risks to performance addressed.

- The Trust Chair was appointed in March 2017, however he had been a non-executive director (NED) at the Trust for over 4 years previously, ensuring continuity and experience. Feedback from other NED’S highlighted that the Chair was approachable and promoted an open and honest culture at the Trust.

- The Trust benefits from a group of non-executive directors with a diverse set of skills and backgrounds. This includes clinical, financial, commercial and governance expertise, in both the public and private sectors.

- We noted evidence of good and appropriate challenge at committee and Board level. Behaviours at Board and sub-committee meetingsare professional and members work effectively as a team. The new chair is facilitating NED challenge and questioning of executives.

- We liked that Board sessions rotate between seminars and meetings to allow time to discuss strategic issues as well as operational matters, and feedback from other Executives and NEDs supported this.

- The Chair has introduced an accountability framework that clarifies board member roles and responsibilities and aligns NED’s with lead portfolios that compliment their skill set and background. For example Gail Bragg leads on the Commercial and Risk portfolios while Ian Reynolds leads on corporate strategy.

- The framework, known as New Ways of Working, sets clear expectations for NEDs in their role, such as attendance rates at Board and committees, involvement in a specific number of Serious Incident (SI) reviews each year, and coaching staff on the Trust’s talent programme. These expectations will form the basis of an assessment as part of an annual appraisal and half-year review by the Chair.

- The Trust Board has experienced some turnover with the appointment of two new NEDs and the departure of an experienced executive director (ED). However, the Trust has partly mitigated any loss of continuity by implementing succession plans which see the newly appointed ED for Operations supported by the previous Director of Operations, and the Interim Director of HR having been developed as part of the Trust’s talent management programme.

- Though NEDs and EDs benefit from development sessions as part of bi-monthly strategic away-days, the Trust does not have a formal or published Board Development Plan, despite a number of board members being relatively new to the Trust Recommendation seven.

Section three





The leadership is knowledgeable about issues and priorities for the quality and sustainability of services, understands what the challenges are and takes action to address them.

- We found that NEDs participate in a monthly call between board and seminar meetings with the Chair and Chief Executive, to keep up to date with developing Trust business.

- Executive Directors meet weekly to discuss operational issues and any emerging risks. Once per month these meetings are extended to include the wider Senior Management Team.

- Head of Operations, operational managers and officers meet regularly with the Executive Director of Operations. A key area of focus is performance that is highlighted through newly developed KPI scorecards.

- Clinical operational managers all do frontline shifts, enabling them to interact with staff and understand the issues they face. It also enables effective cascade of organisational messages.

- Our discussions with NEDs highlighted that Committee’s roles and reporting structure is clear. The main sub committees to the Board are Audit, Quality and Finance, and we observed the chair of each of the committees provide a highlights report outlining the key discussion areas and present this at Board.

- Feedback supported the view that Board members interact with staff in various forums such as station/Hub visits or at Paid Staff meetings.- We observed an excellent understanding of the quality, operational and financial issues facing the Trust in our interviews with both

Executive and Non Executive Board members, supported by a recent Board seminar to promote debate about the relative tensions between these three priorities.

Compassionate, inclusive and effective leadership is sustained through a leadership strategy and development programme and effective selection, development, deployment and support processes and succession-planning.

- The Trust operates a leadership development programme linked closely to the NHS Healthcare Leadership model. The programme runs over a period of seven to eight months, with participants attending a workshop every four to six weeks, and working in teams to address Trust and wider system issues.

- We noted that a review of leadership development centres at the Trust in July concluded that participants generally demonstrated the expected competencies. A programme of further development was approved to address any identified gaps.

- We agree that the Trust has a proactive approach to developing talent through its Aspire programme and can evidence a number of successes with participants being promoted to senior positions such as Operations and HR. The Trust also operates a Mentoring Scheme for senior managers. Mentor’s role profiles enable potential mentees to select someone who is appropriate to their learning needs.

- Feedback received highlighted that career conversations have improved as a result of the new tool that has been launched. However, appraisal rates are still low. However the Board are aware of this and we saw evidence of a plan to address (via KPI dashboard to operational managers).

- We received challenge at one of our focus group that key training and career development opportunities were limited to ‘those in the South’. We discussed this within our interviews and there was an expectation that many of the career development opportunities would be at Trust HQ, which is based in the South.

Section three





Leaders at every level are visible and approachable.

- Rotation of venues around the Trust geography for Board meetings utilizing Trust and public venues, enabling Governor and publicattendance to be increased. Although this has yet to result in public attending.

- Negative comments on this from the focus group – demonstrated by Board meeting held there the day before and nobody went to see them – although note there is additional challenge due to geography.

- CEO roadshows to every emergency department in the region. Engaged with front-line staff and identified issues of concern. The Staying Well Service and Right Care teams are jointly running a series of roadshows to engage ambulance staff and hospital emergency department (ED) staff.

- HR roadshow at a number of venues to discuss career conversations, staff survey and issues of concern.- The paid staff meetings are held annually in venues across the Trust’s operating area to maximise the opportunity for staff to attend. The

Chief Executive and his Executive Team lead the meetings and provide staff with an overview of Trust initiatives, challenges being faced and areas of concern. In 2016 around 200 staff attended at various venues.

- Executive directors attend divisional strategy away-days to discuss key issues and initiatives with divisional staff, such as performance, patient safety and finance.

- NEDs noted that they did do walk rounds & station visits – although there is no formal framework for this and no formal reporting mechanism. The Trust should develop a framework (such as the 15 steps challenge) and appropriate tools to report findings. This will help triangulate any issues / share things that may need to be followed up elsewhere. Recommendation three

- Though external partners interact with executive board members, interaction with non-executive members is limited, which is a missed opportunity for NEDs to get an external perspective on how the Trust is viewed by partners. Recommendation four

Section three



Detailed Findings (cont.)2. Is there a clear vision and a credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver?

The Trust is currently reviewing its Strategic Plan one year early. It had the strategic foresight to recognise that the current plan was no longer appropriate. The Trust is constrained in working with local health communities due to the varying level of maturity of its seven STPs. The revised plan is expected to align more with national policy with a move away from a focus on urgent care. The Trust needs to ensure that this will not adversely impact on performance and hinder plans to reduce patient demand in the health system.The Trust recognises the need to engage effectively with stakeholders in the development of the plan and has extended its planning timelines to enable this. There is a healthy tension between operational performance, financial performance and quality and this is well discussed and articulated by the Board who have had specific Board strategy days to discuss and challenge.

Trust Rating Good



There is a clear statement of vision and values, driven by quality and sustainability. It has been translated into a robust and realistic strategy and well-defined objectives that are achievable and relevant.

- Our review and discussions highlighted that there has been a clear vision and set of values and four key strategic goals. Plans are in place to update the strategy and there is a working group in place, lead by a NED.

- The current strategy covers key operational, financial and quality objectives: (1. safe, clinically appropriate response, 2. right people, right skills, right values, 3. 24/7 emergency and urgent care, 4. creating organisational strength)

- There was a lack of discussion or reference to this strategy at the Board meeting we attended, and the ICPR is not aligned against the strategy, making it difficult to determine how successful they are being at meeting their strategic goals. Recommendation two

The strategy is aligned to local plans in the wider health and social care economy and services are planned to meet the needs of the relevant population.

- The Trust has an existing IBP (Integrated Business Plan 2014/15 to 2018/19) but the Board has agreed to create a new plan with a 5 year timeframe from 2018/19 to 2022/23. The rationale for dropping the last year of the existing plan is due to significant material changes to the existing landscape that it is no longer fit for purpose.

- The new accountability framework developed by the chair aligns a NED and an executive to an STP to ensure coverage. Executives reported they attend various STP meetings and feed back verbally to Board meetings. Our feedback highlighted that NEDs aren’t actively engaged with STPs and seem unsure what their role should be here. Recommendation four

- STPs boards are attended well in order to understand the potential impact on the Trust position – i.e. to see if there is a risk that they should be aware of and to ensure the ambulance service is covered, such as with the closure of Weston General Hospital, and if anyone considered the additional time and challenge facing the ambulances. Executives we asked confirmed they had attended previous STP meetings.

- The Trust is engaged with both local and national work regarding the sustainability of the service in the medium term, most notably in the Ambulance Response Programme (ARP). SWASFT has been a pilot site and is held out as an exemplar by other Trusts.

- Strategic planning via board seminar and working group of board members (Strategic Direction Group) established to develop a new strategy. Being informed by national strategy/policy, informed by input from senior managers (bottom up SWOT).

Section three



Detailed Findings (cont.)

2. Is there a clear vision and a credible strategy to deliver high quality, sustainable care to people, and robust plans to deliver? (continued)


The strategy is aligned to local plans in the wider health and social care economy and services are planned to meet the needs of the relevant population.

- It is fair to say that the updated strategy will have a focus on Category 1 call performance with many respondents commenting that SWASFT needs to focus on this measure first, resulting in a less proactive approach for NHS 111 and other urgent care services. Where many STPs and the NHS 5 year forward view is moving towards integrated care and the link up of emergency and urgent care, theupdated strategy may look more inward looking, and therefore care will be needed to explain this to the commissioners. Recommendation four

Staff in all areas know, understand and support the vision, values and strategic goals and how their role helps in achieving them.

- Our site visits and discussions with staff highlighted that staff are able to articulate the values and overall vision of the Trust and recognise the imperative of providing quality services to patients.

- Trust staff survey results continue to be good and represent top performance out of ambulance trusts. Trust values and expectations of staff are explicit in induction and staff appraisal documentation.

- The Trust is not complacent and plans to improve staff engagement in the development of the new strategy is a positive step.

The vision, values and strategy have been developed through a structured planning process in collaboration with people who use the service, staff and external partners.

- The Trust is well represented on National Bodies and many of the Executives and NEDs are directly or indirectly involved in National improvement work.

- The Trust is in the early stages of developing the new strategy, which is being facilitated through a board working group (Strategic Direction Group), and informed by a board away-day.

- Feedback from commissioners and NHSI mentioned that SWASFT needed to involve partners more rather than giving a perception of‘ploughing their own furrow’. They were unaware of a new strategy and look forward to engaging with the Trust on any new endeavours. Recommendations four

Progress against delivery of the strategy and local plans is monitored and reviewed, and there is evidence of this. Quantifiable and measurable outcomes support strategic objectives, which are cascaded throughout the organisation. The challenges to achieving the strategy, including relevant local health economy factors, are understood and an action plan is in place.

- The Trust’s Strategy is currently being refreshed, demonstrating that leaders are regularly reviewing this and determining if it remains relevant and appropriate.

- A Board Assurance Framework (BAF) is in place aligned to strategic objectives and includes actions to mitigate known risks to the achievement of strategic goals. This is reviewed by the board at each meeting and progress noted.

Section three



Detailed Findings (cont.)3. Is there a culture of high quality, sustainable care?

Staff and managers are clearly passionate about providing a good quality service to patients. Mechanisms are in place to report quality concerns and staff survey results demonstrate that reporting rates compare well with similar Trusts and that staff feel supported in this process.Clinical audits are planned and delivered, and the Trust can evidence examples of where learning has been applied to improve services following incidents. Governance arrangements are in place to escalate matters of concern.Staff are supported through a well thought of well-being services and are recognised through award ceremony’s and feedback on patient compliments. The Trust has developed a performance scorecard for frontline managers to make performance more transparent and drive improvement. It has recognised the need for a greater focus of staff appraisals and actions are starting to improve completion rates.

Trust Rating GoodKPMG Assessment Good‘Good’ characteristic Findings and Recommendations

Leaders at every level live the vision and embody shared values, prioritise high quality, sustainable and compassionate care, and promote equality and diversity. They encourage pride and positivity in the organisation and focus attention on the needs and experiences of people who use services. Behaviour and performance inconsistent with the vision and values are acted on regardless of seniority.

- It is clear from everyone spoken to that patient care is key for them – they believe they make a real difference and save lives and they were proud to be doing that. This is further evidenced in the staff survey where over two thirds of staff recognised that patient care was the organisation’s top priority

- Staff survey results were amongst the best in the ambulance service, but absolute results are still low. Action plans are in place to continue to improve. Recommendation six

- The Trust has developed a plan on a page – this was visible and displayed around the locations we visited. Some even pointed to it! This sets out values, vision and mission clearly and is also available online.

- The Trust’s appraisals framework is aligned with the organisations values and behaviours such as compassion and working together for the patient.

Candour, openness, honesty, transparency and challenges to poor practice are the norm. The leadership actively promotes staff empowerment to drive improvement, and raising concerns is encouraged and valued. Staff actively raise concerns and those who do (including external whistle-blowers) are supported. Concerns are investigated sensitively and confidentially, and lessons are shared and acted on. When something goes wrong, people receive a sincere and timely apology and are told about any actions being taken to prevent the same happening again.

- The Trust has a high number of incidents reported each year, but these are mainly low or negligible harm in nature, indicating a positive reporting culture.

- We have spoken to the Trust’s Freedom to Speak Up (FTSU) guardian who is one of the NEDs. Though she has a clinical background and is positive about encouraging transparency, good practice in the health sector suggests that FTSU guardians work best when they are operational staff rather than in a non-executive position. Recommendation five

‒ The Trust is using learning from the review of Serious Incidents (SI) to make service improvements. NEDs are expected to be involved in at least two SI reviews each year. This helps improve understanding of the management of such incidents at board level and ensures issues are acted on and receive senior input.

- The Trust has a proactive clinical audit programme with all audits being completed as planned. The audit plan is presented at clinical effectiveness group and summary to the audit committee.

‒ A ‘no blame’ culture is reinforced at the Trust enabling a positive approach to reporting incidents and these are viewed as learning opportunities. At our focus groups staff knew who how to report incidents and felt they were well supported in doing this by their managers.

Section three




3. Is there a culture of high quality, sustainable care? (continued)


There are processes for providing all staff at every level with the development they need, including high-quality appraisal and career development conversations.

- We have seen that the Trust’s career conversation process enables staff to identify areas for development and rates for the completion of mandatory training regularly exceed the 90% Trust target.

- The Trust has recognised that appraisal rates are below their targets, but close scrutiny and regular monitoring by operational managers (via the KPI Scorecard) and the Quality Committee are starting to see completion rates improving. In August, rates were at 74% compared to a Trust target of 85%.

Leaders model and encourage compassionate, inclusive and supportive relationships among staff so that they feel respected, valued and supported. There are processes to support staff and promote their positive wellbeing.

- Focus group feedback commented on support they felt from managers. This is consistent with the 2016 staff survey which saw a significant increase in respondents agreeing that the Trust takes positive action on staff well-being. Staff in focus groups were also positive about the Trust’s well-being service.

- The leadership recognise staff achievements. A staff award ceremony is held, and the chief executive writes personally to staff receiving positive patient feedback.

- Organisational development strategy – QIP in place and actively monitored and reviewed. Equality and diversity are actively promoted and the causes of any workforce inequality are identified and action taken to address these. Staff, including those with protected characteristics under the Equality Act, feel they are treated equitably.

- We have reviewed the Equality and Diversity Policy (April 2017) relating to Trust staff, volunteers and contractors. The policy is in line with Trust values of dignity and respect. The Board aims to review equality and diversity monitoring reports on an annual basis.

- The Trust has met with a number of patient stakeholder groups representing patients with protected characteristics under the Equality Act 2010, in locations across the Trust region to hear their views on the Trust’s approach to equality and diversity.

- The Trust Board is diverse in terms of gender and ethnicity. As with many Trusts there is scope to improve the age profile of the governors,. Recommendation nine

There is a culture of collective responsibility between teams and services. There are positive relationships between staff and teams, where conflicts are resolved quickly and constructively and responsibility is shared.

- We noted evidence of good collaboration between teams, such as the Finance team and Quality team working closely together to ensure that initiatives to save money do not impact on quality.

- The HR team are involved in organisational changes such as the Rota Review to ensure that people aspects are appropriately considered alongside operational imperatives.

- Technology is enabling working across the region. For example a virtual hub also allowed South and North Hub teams to share calls and data.

- Clinical teams regularly go out on shifts with colleagues which enables them to get valuable insight into issues faced that can them be used to inform improved training or service changes

- We noted that the weekly CEO Bulletin provides information about activities across the Trust. This includes links to the incident reporting system, Datix to encourage reporting.

Section three



Detailed Findings (cont.)4. Are there clear responsibilities, roles and systems of accountability to support good governance and management?

The board chair’s New Ways of Working model make the roles, accountabilities and expectations for board members very clear, including how they interact with partners. The Board and each committee have a forward plan of business and committee structures enable clear reporting lines for escalation or information. Governors are engaged and provide challenge to board members. Terms of reference are in place for each board committee.Meetings are well chaired with appropriate levels of challenge. However, the balance of business between the public and private board meetings could be improved.

Trust Rating Good



Structures, processes and systems of accountability, including the governance and management of partnerships, joint working arrangements and shared services, are clearly set out, understood and effective.

- The New Ways of Working document clear sets out roles and responsibilities for the Board internally and with STP partners.- The Board Chairman and NEDs have clear job descriptions that set out their accountabilities and responsibilities.- A Memorandum of Understanding and a joint working party is in place with the five air ambulance charities operating in the Trust’s area.- A strategic partnership board is in place to manage the Trust’s relationship with it’s twelve CCG commissioners.- External partners we spoke to are positive about the working relationships they have with the Trust, and comment that the Strategic

Partnership Board is effective.

The board and other levels of governance in the organisation function effectively and interact with each other appropriately.

- Board, Council of Governor and Committee meetings have Actions Point Registers that are reviewed at every meeting, clearly identifying the responsible person and time frame. The meetings we observed were well chaired and effectively run.

- The Trust is supported by an experienced Board Secretary. The Board Secretary attends all sub-Committees of the Board and has been key in ensuring the administration of the committees.

- Board meetings are held six times a year and agendas focus on internal control and governance; quality and patient safety; performance and finance; people and workforce; regulation; and policies. The confidential section of the Board considers items that are commercially sensitive, or confidential, but also consider other items that are generally considered in public session at other Trusts such as the serious incident reports, and minutes from the Executive Directors Group. Recommendation one

- The Audit Committee meets five times per year and its terms of reference are in line with best practice. We observed that the committee was well chaired and there was significant challenge from the Chair and NEDs to a number of items on the agenda. NEDs used their roles on other Committee’s to triangulate information and challenge internal audit findings such as over the rating associated with clinical audit.

continued

Section three



Detailed Findings (cont.)4. Are there clear responsibilities, roles and systems of accountability to support good governance and management? (continued)


The board and other levels of governance in the organisation function effectively and interact with each other appropriately. (contd.)

- The majority of the Finance Committee meeting related to forward looking content. For example, the Finance Report included a clear ‘heads-up’ to NEDs on future potential issues such as debtors. Again good challenge was seen from both NEDs and executives.

- The Quality Committee meeting we observed had a lot of papers often with long appendices presented for assurance. Despite the length of the agenda, the meeting was well chaired and finished ahead of time.

- From our observations we noted some opportunities for minor improvements that the committees could consider. Recommendation ten- The Committee structure has recently been reviewed and a People and Workforce Committee established. The committee had its first

meeting in November, which we did not observe.

The board and other levels of governance in the organisation function effectively and interact with each other appropriately (continued)

- We have noted that all committees have terms of reference setting out purpose and operation, which includes requirements to report to the Board and undertake an annual review of effectiveness. The Board and its sub-committees have a stable, regularly attending membership and operate within their terms of reference.

Staff are clear on their roles and accountabilities.

- Board members were clear on their portfolio and expectations of the chair, the New Ways of Working document gave clear guidance to NED’s on this.

- Staff we spoke to at the focus groups raised no concerns and appeared clear on their roles and responsibilities.

Section three



Detailed Findings (cont.)5. Are there clear and effective processes for managing risks, issues and performance?

The Trust has worked to improve its reporting of performance and now has detailed information down to Head of Performance and Operational Manager level. The Board gains assurance from a comprehensive Integrated Corporate Performance Report (ICPR) .Governance arrangements for risk management are in place, strategic risks are aligned to strategic goals and are regularly reviewed. However, the risk register includes a number of longstanding risks and forecast gradings that prove unachievable.The Trust has a good understanding of its financial and service pressures and is developing initiatives to address these, though the impact of those initiatives is yet to be seen.

Trust Rating Good



There is an effective and comprehensive process to identify, understand, monitor and address current and future risks.

- We have reviewed the Trust’s Risk register and note that it is linked to strategic goals and has forecast ratings post action in line with good practice. However a target rating is not set for each risk forecast ratings are often set for long periods but not achieved and a number of risks have remained on the register for a considerable time i.e. since 2012. Recommendation eleven

- We note that the number of the highest rated risks have reduced over the past six months from 36 to 31 (reaching a high of 39 at one point). Amber rated risks have also reduced from 30 to 25. The register is regularly reviewed and we have seen evidence of risks being removed and returned to directorate control, or added such as with GDPR.

- The Trust has a business continuity plan in place. This details the arrangements in place in the event of equipment failure for example the telephone or computer systems and issues in relation to the building and staffing.

- The Trust has comprehensive action plans in place to address under performance or issues highlighted by external reviews such as the urgent care review by CQC. The quality improvement plan is reviewed by the Quality Development Group which reports to SLT and the Quality Committee. The Board receives the quality improvement plan and assurance via the Quality Committee chair’s report.

- Roles and responsibilities for governance and management of risk are clearly documented.

Financial pressures are managed so that they do not compromise the quality of care. Service developments and efficiency changes are developed and assessed with input from clinicians so that their impact on the quality of care is understood.

- We noted evidence of good collaboration between teams, such as the Finance team and Quality team working closely together to ensure that initiatives to save money do not impact on quality.

- A Equality Impact Assessment process and associated tools are in place to ensure new initiatives do not negatively effect quality.

Section three




5. Are there clear and effective processes for managing risks, issues and performance? (continued)


The organisation has the processes to manage current and future performance.

- We have reviewed the Trust’s integrated performance report (ICPR). It is detailed, including management information covering activity across the Trust and provides some up-front narrative on key variance. However, we have identified scope to improve the report to enhance monitoring and strengthen the assurance it provides. Recommendation two

- We have observed good examples of triangulating evidence through NEDs using their experience on other committees and through information obtained during visits to stations, hubs and offices.

- Approval routes for reports are clear, such as the Quality Improvement Plan that is reviewed at the Quality Committee and then by the Board. However, there is scope to reduce duplication, or the level of detail reviewed at Board which currently also gives assurance that has already been achieved at a sub-committee. Recommendation eight

- We note that the Trust utilises advice from external experts to identify opportunities for improvement. For example, a review of productivity has identified scope to meet resourcing needs by reducing the time of a call cycle by ten minutes. As a result the Trust is developing an initiative – the Ten Minute Challenge - to help address response times and increase availability of crews.

Performance issues are escalated to the appropriate committees and the board through clear structures and processes.

- We have reviewed newly developed KPI Scorecards include metrics related to clinical effectiveness, workforce, quality and finance, to monitor performance at Operations Manager and Head of Operations level. Metrics are RAG rated and used by the Executive Director of Operations to identify and manage performance issues.

- The Trust is able to demonstrate how it addresses underperformance. For example, completion rate of appraisals has slipped at the Trust. The Board is therefore putting focus on addressing this, with weekly updates being provided to the Quality Committee Chair. A ranking system for compliance against targets is provided as part of the report. The Trust has also established a People and Workforce Committee to provide a greater focus on workforce related issues. Review of the appraisal process and the tools used has also been undertaken. Rates have increased since June from 66% to 82% (August).

Clinical and internal audit processes function well and have a positive impact on quality governance, with clear evidence of action to resolve concerns.

- All reviews in the clinical audit programme are completed within the year as programmed.- Internal audits are presented to the Audit Committee where we observed they receive challenge from NEDS to fully understand risk and of

executives to ensure they were addressing the recommendations raised.

Section three



Detailed Findings (cont.)6. Is appropriate and accurate information being effectively processes, challenged and acted on?

The Trust is developing the information it uses to be able to determine performance at a more granular level. Real-time performance data is available, and the Trust has recently developed KPI Scorecards that include data to highlight performance across a number of domains down to an Operations Manager level. The Trust reports performance to Board via an integrated performance report (the Integrated Corporate Performance Report (ICPR)) which is a compendium of information related to quality, financial and performance data. This report has recently been improved, but we have identified a number of further improvements that could enhance the effectiveness of this report as an assurance tool. Governance arrangements are in place to ensure that the quality of data and information are assured.

Trust Rating Good


CQC Prompt Findings and Recommendations

Quality and sustainability both receive sufficient coverage in relevant meetings at all levels.

Staff receive helpful data on a daily basis, which supports them to adjust and improve performance as necessary.

- We observed that detailed management information is available to managers and the Chief executive to review performance in real time.- KPI Scorecards include monthly performance data across a number of themes such as Quality & Patient Care; People Management &

Staff Engagement; Financial & Use of Resources; and Clinical Care & Effectiveness, at Head of Performance and individual operations manager level.

- Our observation of meetings confirmed that quality and financial aspects of business both receive sufficient coverage on meeting agendas, for example, cost implications of the Quality Improvement Plan at Quality Committee.

Integrated reporting supports effective decision-making. There is a holistic understanding of performance, which sufficiently covers and integrates the views of people, with quality, operational and financial information.

- The ICPR includes management information related to operational, financial and quality metrics- We noted that the performance reporting was predominantly backward looking and whilst it included comparisons to other ambulance

trusts, it did not show any future expected trajectories. Recommendation two

Performance information is used to hold management and staff to account.

- KPI scorecards are reviewed by the Executive Director of Operations in one-to-ones with her departmental managers on a regular basis.

The information used in reporting, performance management and delivering quality care is usually accurate, valid, reliable, timely and relevant, with plans to address any weaknesses.

- The Trust has a framework for ensuring data quality. Checks and validations are undertaken to assess data accuracy and relevance. For example an audit of free text fields in electronic patient records, identified areas for improvement, and a re-audit of missing data on vital signs records showed improvement. The Trust is currently reviewing data and definitions related to the new ARP measures.

- The Trust’s 2017-18 internal audit programme includes reviews of data quality, governance and security.

Section three




6. Is appropriate and accurate information being effectively processes, challenged and acted on? (continued)

CQC Prompt Findings and Recommendations

Information technology systems are used effectively to monitor and improve the quality of care.

- We noted the use of cameras to improve clinician decision making on the most appropriate destination for burns patients in Dorset. - The Trust is currently streamlining its call triage approach from two systems into one to improve consistency, resilience and efficiency.- The Trust has a business continuity plan in place. This details the arrangements in place in the event of equipment failure for example the

telephone or computer systems and issues in relation to the building and staffing.

Data or notifications are consistently submitted to external organisations as required.

- The Trust reviews and approves an annual Information Governance (IG) Toolkit submission.

There are robust arrangements for the availability, integrity and confidentiality of patient identifiable data, records and data management systems.

- The Trust has a suite of policies and strategies governing integrity, security and management of information systems. This includes an Information Governance Strategy, IM&T Security Policy, Security Management Strategy and Security Policy.

- We noted that the Trust achieved a satisfactory rating for IG in 2016-17.

Section three



Detailed Findings (cont.)7. Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services?

The Trust uses a diverse range of methods to gather feedback from staff, governors, patients and other stakeholders, including groups representing protected characteristics. It is revising its approaches in 2018 to get feedback from a more diverse population.Leadership proactively engages with staff through station and Hub visits or through meeting crews at Emergency Departments across the region. More formal mechanisms for staff engagement also include an annual staff survey, Paid Staff meetings and geographically based meetings. Although our focus groups with staff were generally positive about the Trust and their engagement with senior management, staff from the North Hub were more critical and felt that management were less visible to them.External partners are positive about the Trust’s engagement with partners across its region, but it has more to do to help partners understand its developing strategy and implications of the new response model. Trust Rating Requires improvement

KPMG Assessment Requires improvement


A full and diverse range of people’s views and concerns is encouraged, heard and acted on to shape services and culture.

- The Trust engages with a wide range of stakeholders in a number of ways such as attendance at public events, open days and county fairs; regular meetings and bi-annual development days with Governors alongside an annual members meeting; and attendance at each of the STP Boards across the region.

- It recognises that current activities to engage with the public need to target a wider representation of the population. As a result it has decided to scale back attendance at country shows next year and target events attracting a different demographic. A Governors task group has been established looking at public/member engagement.

- The Trust has consulted with patient interest groups representing people with protected diversity characteristics, and Healthwatch on a variety of topics such as safeguarding and patient experience.

- The age profile of Governors is biased towards older adults, younger people appear to be under-represented. This is not untypical of governors groups, but it is an opportunity for the Trust to try and re-set the balance. Recommendation nine

- External partners are largely positive about the Trust’s engagement with them. Strong governance structures to ensure collaborative commissioning through the Strategic Partnership Board enable the Trust to have one conversation with commissioners rather than multiple ones across its 12 CCGs.

The service proactively engages and involves all staff (including those with protected equality characteristics) and ensures that the voices of all staff are heard and acted on to shape services and culture.

- The Trust’s most recent annual staff survey in 2016 showed a number of improvements over the previous year. Commissioners praised the Trust on its survey results and the Trust’s staff engagement score at 3.57 (out of 5) was above average compared to similar trusts.

- Despite a positive set of results when compared to other ambulance trusts, results in absolute terms were low. For example, only a third of staff views were represented by the survey (response rate of 36%). One of the most improved areas from the previous survey was the action taken by the Trust to ensure staff well-being. This has been a key focus for the Trust. While this is to be congratulated, only 35% of respondents agreed and only 29% said their manager involved them in important decisions.

Section three



Detailed Findings (cont.)7. Are the people who use services, the public, staff and external partners engaged and involved to support high quality sustainable services?


The service proactively engages and involves all staff (including those with protected equality characteristics) and ensures that the voices of all staff are heard and acted on to shape services and culture. (continued)

- The Trust talent management programme is reviewed twice a year to ensure representation from various staff groups. A review identified a lack of women in the talent pool pipeline in West region so women-only development training was undertaken in an attempt to boost numbers.

- Trust-wide Senior management away days are held twice per year to cascade information and focus on key issues. In addition divisional away days each attracting 70-80 attendees are held annually. These days include workshops to encourage staff to provide ideas on, for example, STP engagement, and Board strategy development.

- Extensive staff engagement was undertaken prior to the implementation of a staff rota review.

The service is transparent, collaborative and open with all relevant stakeholders about performance, to build a shared understanding of challenges to the system and the needs of the population and to design improvements to meet them.

- The impact of the introduction of ARP is not yet fully understood by all commissioners. The Trust could be more proactive at helping commissioners and other external stakeholders understand what the implications are likely to be and what this means for future service performance management. Recommendation four

- The Trust’s ability to make swift decisions can sometimes be at the detriment of collaborative working, or result in unilateral changes that do not sit well with commissioners. The Trust could develop a greater understanding of commissioners needs which include greaterintegration and early intervention rather than just core Trust operations. Recommendation four

- The annual Governors meeting included clear and easy to understand presentations on the Trust’s operational and financial performance.- Governors receive a helpful induction when they join that is structured and focused. Two Development Days are held each year and

include workshops or speakers on a range of topics. The Lead Governor inputs to the programme design.- Accessible Information Standard action plan in place

Section three



Detailed Findings (cont.)8. Are there robust systems and processes for learning, continuous improvement and innovation?

The Trust is recognised by external partners as innovative, receptive to new ideas, and quick to develop these into action, as evidenced by its early development of the ARP. The Trust has a strong focus on incident reporting and mechanisms in place to share learning Trust-wide. A ‘no blame’ culture is reinforced at the Trust enabling a positive approach to reporting incidents and these are viewed as learning opportunities. At our focus groups staff knew who how to report incidents and felt they were well supported in doing this by their managers. The Trust is able to evidence actions taken following review of incidents or themes, such as improved training or changes to service operation. Completion rates for mandatory training and development days is high.

Trust Rating Good



There is a strong focus on continuous learning and improvement at all levels of the organisation, including through appropriate use of external accreditation and participation in research.

- A ‘no blame’ culture is reinforced at the Trust enabling a positive approach to reporting incidents and these are viewed as learning opportunities. At our focus groups staff knew who how to report incidents and felt they were well supported in doing this by their managers.

- The Trust has a team of clinical development officers who work closely with the quality team (some of whom are also clinicians who regularly undertake shifts) to identify issues for further action. For example, alcohol was identified as a theme in a number of incidents, and as a result the clinical team designed specific training to assist staff in dealing with future cases more effectively.

- A review of burns cases identified that patients were often turned away from the specialist burns unit at Salisbury Hospital as they were not ill enough. This necessitated another journey to a different hospital some miles away. As a result of this review crews now send clinical information and a picture of the burns to Salisbury before conveyance to allow a clinician to make an assessment. This then enables efficient conveyance to the most appropriate hospital.

- Managers work with partners to improve service efficiency. For example, moving the handover logging to a tablet rather than a workstation that ambulance staff had restricted access to has improved handover times at a Bristol hospital.

There is knowledge of improvement methods and the skills to use them at all levels of the organisation.

- Learning development officers regularly attend shifts and use this to inform future learning and development programmes. For example, officers had seen an increase in the number of manual handling incidents. This enabled them to implement new training to address the issue.

- The Trust has a number of governance arrangements in place to learn and apply lessons. For example the Learning from Experience Group includes a wide membership across the Trust with a remit to share learning and positive practice.

- The Clinical Effectiveness Group provides specialist clinical advice to all areas of the Trust, oversees research and development activities and leads on clinical innovation.

Section three




8. Are there robust systems and processes for learning, continuous improvement and innovation? (continued)


The service makes effective use of internal and external reviews, and learning is shared effectively and used to make improvements.

- The Trust has an annual clinical audit programme and an annual internal audit programme in place.- The Trust is using learning from the review of Serious Incidents (SI) to make service improvements. For example, alcohol was identified as a

theme in a number of incidents, and as a result the clinical team designed specific training to assist staff in dealing with future cases more effectively.

- NEDs are expected to be involved in at least two SI reviews each year. This helps improve understanding of the management of such incidents at board level. In addition, an overview of serious incidents and key issues is regularly reported to the Quality Committee in the Patient Safety Report

- The Trust has responded positively and promptly to a CQC inspection of the 111 service. An action plan was established and progress closely monitored.

Staff are encouraged to use information and regularly take time out to review individual and team objectives, processes and performance. This is used to make improvements.

- Feedback received highlighted that career conversations have improved as a result of the new tool that has been launched. However, appraisal rates are still below target. However the Board are aware of this and we saw evidence of a plan to address (for example, via KPI dashboard reporting to operational managers).

- The completion of mandatory training and attendance at annual development days is high and consistently exceeds targets.

There are organisational systems to support improvement and innovation work, including staff objectives, rewards, data systems and ways of sharing improvement work.

- The Datix system is used to report and share incidents and concerns. It is well used by staff. The Trust has a high number of incidents reported each year, but these are mainly low or negligible harm in nature, indicating a positive reporting culture.

- Staff receiving compliments from service users are formally congratulated by the Chief Executive.- The Trust operates divisional Awards ceremony for staff to recognise good performance.- The Trust is open to innovative and new ways of working. For example it is working with a CCG providing specialist paramedic expertise and

a response vehicle as part of a successful falls response service.

Section three

Appendices1. Stakeholder involvement

2. Stakeholder feedback

3. Meeting Observations

• Board

• Audit Committee

• Finance Committee

• Quality Committee

• Governor meeting

• Annual members



Stakeholder involvementAppendix one

We held discussions with the following staff as part of the review:

Name Job title

Tony Fox Board Chairman

Paul Love NED (Audit Committee Chair)

Venessa James NED (Quality Committee Chair)

Gail Bragg NED (Finance and Investment Committee Chair)

Ian Reynolds NED

Professor Minesh Khashu NED

Ken Wenman Chief Executive

Jennie Kingston Deputy Chief Executive/Executive Director of Finance

Francis Gillen Executive Director of IM&T

Emma Wood Executive Director of HR

Amy Beet Deputy Director of HR

Jenny Winslade Executive Director of Nursing and Quality

Adrian South Consultant Paramedic and Deputy Medical Director

Jess Hodgman Executive Director of Operations

Jonathan James Deputy Director of Finance

Marty McAuley Trust Secretary

We held focus groups with staff/governors as follows:

Group Location

Clinical Hub St James Place

Urgent Care Hub St Leonards

Governors St James Place

We held discussions with the following external stakeholders as part of this review:

Name Job Title and organisation

Victoria Keilthy Deputy Regional Director at NHS Improvement

Sue Sutton Deputy Director of Urgent and Emergency Care

Dorset Clinical Commissioning Group

Dominic Morgan Urgent Care Network Programme Lead

NHS Bath and North East Somerset Clinical Commissioning Group



We interviewed external stakeholders, including NHSI, Dorset CCG and BANES CCG, in order to gather feedback on the key lines of enquiry of the well led framework.

Appendix two

Stakeholder feedback

Positive Feedback Negative Feedback

• Despite being spread thinly, the Trust engages well with each of its STP partners. Executives are well respected, and bring value from the different perspectives they bring to the table.

• Executives are competent and professional and driven by the right values, for example patient quality.

• The Trust responds quickly and positively to known concerns e.g. 111.

• The leadership has the ability to maintain grip on the detail while being strategic e.g. successful rota review .

• The Strategic Partnership Board structure to manage commissioner interface with the Trust works well.

• The Trust is recognised as innovative and receptive to new ideas, evidenced by its high profile nationally in leading on new initiatives, such as ARP.

• Commissioners and the Trust are reviewing the effectiveness and impact of a number of projects, such as the falls response project in B&NES to determine which could be continued and potentially widened across the Trust area.

• The Trust’s ability to make swift decisions can sometimes be at the detriment of collaborative working, or result in unilateral changes that do not sit well with commissioners. The Trust could develop a greater understanding of commissioners needs which include greater integration and early intervention rather than just core Trust operations. Recommendation four

• Commissioners are not clear on the Trust’s future strategic focus and how it will work with STP partners to take that forward. Recommendation four

• The Trust could work harder to reach consensus on which projects its takes forward with commissioners, to ensure greater consistency across the region.

• NEDs are not visible to external stakeholders. This is a missed opportunity for them to understand the wider commissioning and regulatory contexts, and compare that against the narrative they receive internally. Recommendation four

• The Trust has not been proactive in briefing wider stakeholders, such as Health & Wellbeing Boards, A&E Delivery boards and STP boards on the implications of the new response model. Recommendation four



We held focus groups with three staff groups and one group of governors, in order to gather feedback on the key lines of enquiry of the well led framework.

Appendix three

Focus Group feedback

Positive Feedback Negative Feedback

Governors• Governors were suitably involved in the appointment of the new Board Chair.• The Trust is open and transparent with governors.• Non-executive directors respond appropriately to governors concerns.• Governors have received good induction, and benefit from two development days

each year.

Staff• The feeling that staff can help patients. They are proud to work for the Trust. • Working with a passionate and dedicated team.• There is a supportive environment on the floor. Staff generally feel supported by

immediate managers.• The new building has had a positive impact on the work. • ‘Stay well’ visit once a month to improve staff welfare.• Staff are focused and try hard to provide quality service.• Staff are able to raise concerns – it is encouraged.• St Leonards staff reported interaction with senior managers such as the ED of

Operations.• Don’t have time to read CEO bulletins between calls, so read on weekends. Staff

suggested introducing a huddle– 15 minutes before shift, to go through key messages that have come out and make sure everyone is clear on any changes or updates that impact them.

Governors

• Information can be overwhelming and reports very long, but they are well written.

• Vast geographical spread of the Trust makes public engagement difficult. Governors have not yet sought ideas from similarly dispersed trusts on ideas to improve engagement.

• Difficult to attract new governors and few are young. Recommendation nine

Staff

• There has been a lot of change (CAD, telephone system, estates, rotas) and morale is low.

• Feeling [from North Hub staff] that there are more opportunities for training and role change in the South

• The staff can view strategy on the CE bulletin. However, they do not feel they have the time to do this, given the demands of work.

• The South could improve morale in the North simply by recognising their work and thanking them for it.

• Staff [in our North Hub focus groups] don’t see NEDs or executive directors. Staff do not feel supported by senior management.



Following our attendance at the Board and sub-committee meetings we made the following observations on the effectiveness of their operation.

Conclusion

Board and sub-committee meetings operate well, with time prioritised towards the most important elements of the agenda and strong engagement by committee members to improve the information received and the quality of debate.

There was a consistently good level of debate noted across all meetings observed. The NEDs demonstrated a strong level of challenge. There were strong levels of participation and contribution from most, but not all, Committee members. This is however discussed within NED appraisal however.

There were strong performances by the Chairs, who consistently provided good summaries setting out what had been discussed, decisions made if any, matters escalated to Board and future discussions planned.

Appendix four

Meeting observations

Areas of good practice Areas for development

• Agenda items for each Board / sub-committee we attended were appropriate.

• There was a consistently good level of debate, with powerful patient stories to bring the business to life.

• There was consistent consideration of outside context and stakeholders where appropriate.

• Strong performances from respective Chairs. Debate was focused on key risks and considerations. In each case the Chair arrived early to ensure that they were prepared.

• Consistently high level of NED questions and challenge.

• Private Board almost entirely future focused and strategic.

• There was a well organised procession of staff attending the Quality Committee for short time frames to present on specific issues. Actions were agreed in a timely manner and noted for update at a subsequent committee.

• Good reference to work of Committees during the meeting; it was clear that Board used Committees appropriately to review matters in more depth and relied on their work.

• Actions followed up well in both parts of the Board meeting and sub-committees

• The level of information included within the private Board agenda should be appraised to ensure that it is all sensitive and could not easily be taken within the public part of the meeting Recommendation two

• Potential duplication of level of detail available at both Board and Committee level – Board detail could be reduced if Committee have scrutinised the detail

• Clarity of Board /committee action taken could be improved by the meeting chair e.g. assurance, information, approval etc Recommendation ten



Board ObservationSummary of the Board of Directors Meeting from observation on 28 September 2017

Appendix four

Breakdown of topics discussed

Opening Business• Welcome, introduction, and apologies• A Patient’s experience• Report from the Chairman and Chief Executive• Questions from the Public• Minutes from previous meeting (27/07/17)• Action Point Register• Communications Update

Quality and Patient Safety• Patient safety and experience• Chair of Quality Committee Update• CQC Next Phase of Regulation and Action Plan Update• Grenfell Tower Assurance Report• Safety Improvement Plan

People and Workforce• Health, safety, and security• Violence and Aggression

Performance and finance• Integrated Corporate Performance Report• Trust Finance Position

Charitable funds• Chair of Charitable Funds Committee Update• Trust Charitable Funds Annual Accounts, Reduced Disclosure

Exemptions, Letter of Representation• Auditors Review of the Charitable Funds Financial Statements for the

year ended 31 March 2017Regulation

• NHSI Activity ReportInternal Control and Governance

• Risk Register and Board Assurance Framework• Chair of Audit and Assurance Committee Update• People and Workforce Committee Team

Closing Business• Questions arising

Min

utes

Agenda

5

5

20

10

35

45

2015

5 10

1510

0

20

40

60

80

100

120

140

160

180

200

Openingbusiness

Quality andPatientSafety

People andWorkforce

Performanceand Finance

CharitableFunds

Regulation InternalControl andGovernance

ClosingBusiness

Information

Decision



Board Observation (cont.)

Appendix four

How was the time spent...

Planned Meeting Time: 3 hours 15 minutes ( )

Total Meeting Time:2 hours 25 minutes

What did you do with the items...

3.0 -

15.0 3.0

4.0 - 1.0 1.0 5.0

12.0 4.0

8.0 5.0 1.0

5.0

7.0

11.0

15.0

19.0

7.0 1.0

7.0 2.0 4.0 2.0

6.0 - -

(5.0)

15.0

35.0

55.0

75.0

95.0

115.0

135.0

155.0

175.0

195.0

Min

utes

Break

Assurance

Information

Approval

What did the items focus on...

Forward/ backwardlooking content

Forward looking content

Backward looking content



Board Observation (cont.)

Appendix four

Positive Observations

Powerful patient story. Board also had time to reflect on the story and think about the learning and impact. Staff there as well so Board can recognise their efforts. Action point register had outstanding actions – but the delays were explained as part of presenting the paper. The key items on the agenda had the longest discussion (ICPR and patient story). Good level of NED challenge throughout, such as challenging level of evidence to give assurance, and the cost implications of plans. Board ran under time, though items appeared to have sufficient discussion time. No real distinction between how items of ‘assurance’ and ‘approval’ were treated. Scope to reduce content and duplication. E.g. lot of approval and update on action plans which instead could be getting assurance from the committees e.g. QIP,

patient experience, and patient safety already received assurance at previous Quality Committee. Recommendation eight Limited discussion on strategy and not clear how this is monitored or managed. Expected agenda items in the public session that were in fact dealt with in the private meeting e.g. financial update. Recommendation one Verbal update provided for the Trust financial position. ICPR – summary is very wordy and lack of forecasts included. Not clear how Board gets assurance that there will be improvement or where the actions to be taken are.

Recommendation two



Audit Committee ObservationAppendix four


Planned Meeting Time: 2 hours ( )

Total Meeting Time 1 hours 50 minutes






Approval

No action noted

Assurance

0.5 0.5 0.5 1.0 6.0

3.0 6.0

3.0

12.0

14.0

9.0 1.0

10.0 4.0

6.0

8.0 1.0

16.0 6.0 1.0 1.0 1.0

-

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Min

utes



Audit Committee Observation

Appendix four

Summary of observation

The majority of the meeting related to backward looking content, although this is expected given the nature of the Audit & Assurance committee. Although the meeting started slightly late, the Committee ran to time. We noted an opportunity to set indicative times on the agenda to guide discussion Recommendation ten The Committee was well chaired, with agenda items introduced and opportunity provided for Executives and NED to raise comments. Longer discussions were also summarised

before being concluded, which ensured the discussions remained relevant and focussed. There was significant challenge from the Chair and NEDs to a number of items on the agenda. Particular areas of good practice were noted regarding:

• NEDs used their roles on other Committee’s to triangulate other information and challenge internal audit findings – for example, challenge over the rating associated with clinical audit.

• Challenge around the areas noted as non-compliant within the GDPR presentation and plans to address, confirming the actions for papers and querying with the relevant author when this was not felt to be appropriate.

The Committee sought advice from external and internal audit at appropriate moments to share best practice – for example, requesting their views on sickness. It was clear that papers had been read by all Committee members. Summaries of papers were presented and the challenge was appropriate given the context of the papers. Sufficient time was given to all agenda items, although we noted an opportunity for the key items to report to the Board to be formally agreed at the meeting Recommendation

ten. Each member of the committee was given appropriate opportunity to present reports, with time also available for relevant challenge. Our analysis noted a relatively even split of

discussion time between NED’s and Trust management, with an appropriate split of time for external providers. The Committee included an agenda item for ‘Hot Topics Discussions’, which was noted as good practice, as this allows the Committee to consider wider issues not included on the

agenda.



Finance Committee Observation

Appendix four


Approval






Planned Meeting Time: 2 hours ( )

Total Meeting Time 1 hours 57.5 minutes

Information

No action noted

Assurance

0.5

28.5 0.5 1.5 2.0 3.0 3.0 8.0

19.0 6.0

4.0 9.0 3.0

4.0

17.0 2.0 3.0 2.0 1.0 1.0

-

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Min

utes



Finance Committee Observation

Appendix four


The majority of the meeting related to forward looking content. For example, the Finance Report included a clear ‘heads-up’ to NEDs on future potential issues such as debtors. The Committee ran to time, though one item was deferred to enable this. We noted an opportunity to set indicative times on the agenda to guide discussion Recommendation

ten The Committee was well chaired, with agenda items introduced and opportunity provided for Executives and NEDs to raise comments. There was appropriate challenge from the Chair, NEDs and some EDs to a number of items on the agenda. Responses from EDs and officers were clear and addressed the

questions. For example:• NEDs pressing for a completion date for a long-running outstanding action.• Clarification required on document purpose i.e. policy or strategy, and the need to improve how the Trust can measure success through procurement in the procurement

strategy.• Not giving full approval to a Business Case (ESMCP) pending additional information.

It was clear that papers had been read by all Committee members. Summaries of papers were presented and the challenge was appropriate given the context of the papers. However for one paper (Business Case) it was clear that a NED had not had access to the full appendices e.g. ref to benefits realisation that was included in the full case. This is

because appendices were only provided electronically and he preferred hard copy formats. Sufficient time was given to all agenda items, although we noted an opportunity for the key items to report to the Board to be formally agreed at the meeting Recommendation ten.

Each member of the committee was given appropriate opportunity to present reports, with time also available for relevant challenge. Our analysis noted a relatively even split of discussion time between NED’s and Trust management.

Summarised key issues at end of meeting Not always clearly signalled that a decision (assurance/approval) had been made. Chair did check NEDs agreed with most items and gave opportunity for questions, but lacked

explicit ref to the decision taken. E.g. ‘approval’ of Board seminar discussions Clear finance report and confident delivery Clear approval of Procurement Strategy subject to some revisions discussed. Deep Dive – brief report for information. Missed opportunity to gain assurance on mitigating actions



Quality Committee Observation

Appendix four


Approval






Planned Meeting Time: 3 hours


Information

No action noted

Assurance

0.5 6.0 1.0

6.0 1.0 8.0 2.0

9.0 6.0 3.0 3.0 3.0 3.0

5.0 1.0 3.0

22.0 2.0 6.0

12.0 4.0 1.0 1.0 -

-

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Min

utes



Quality Committee Observation

Appendix four


The meeting was scheduled to last 3 hours, but actually lasted just 1 hour and 45 minutes Majority of papers presented were for assurance, which is appropriate for a Quality Committee. The agenda was very long with some detailed papers and appendices, but the meeting was efficiently chaired and sufficient discussion was observed on each paper. Given the length of the reports, they were covered very quickly so were reliant on people having read them all thoroughly in advance. There was a brief mention of cost v. benefit in response to a question on Paper 13 on how many people understand the Quality Improvement process, but generally

cost was not explicitly considered Good NED challenge especially from the NED with a clinical background. Little, if any, ED to ED challenge. Generally a good atmosphere in the meeting, and opportunities taken to highlight positive outcomes Although Paper 13 (Clinical Supervision Position Statement) had come for Approval, the Chair suggested it be Noted until it had been through Execs, which seemed

appropriate.



Governors Meeting ObservationAppendix four


Planned Meeting Time: 2 hours 30 minutes ( )







No action noted

Assurance

Approval

0.5 0.5

15.0 2.0 1.0 2.0 2.0

33.0 9.0

24.0 8.0 3.0 2.0

6.0

-

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Min

utes


CEO attended at start of meeting, then handed over to NEDs to respond NEDS very knowledgeable about Trust business and evident they get out into the business to meet staff, members and

patients. Demonstrated via NED updates Patient story provided, but no real follow up on what happened as a result. NEDS responded positively and actively to Governor challenge such as poor communications with members and volunteers

i.e. to be discussed at next Board seminar Sometimes difficult to hear presenters and this reduced the energy in the room e.g. STP discussion. Maybe use mics? Governors engaged well and asked numerous questions and appropriate challenge that was responded to well. Performance update – not clear if ‘Assurance’ was met as not explicitly referred to by chair at end of item. Decision on rem com was clear and explicit.



Annual Members Meeting Observation

Appendix four


Planned Meeting Time: 1 hour 30 minutes ( )

Total Meeting Time 1 hour 30 minutes






Approval

Information

No action noted

Assurance

1.0 2.0 1.0

10.0

26.0

28.0 11.0 1.0

9.0 1.0

-

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

Min

utes


Presentations were informative and clear Good engagement with members attending Majority of attendees were also Governors


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Council of Governors – Thursday 19 April 2018

Page 1 of 6



Paper Title: Patient Safety and Experience Report

Prepared by: Vanessa Williams, Head of Quality

Presented by: Vanessa Williams, Head of Quality

Action: Information

Recommendation:

The Council of Governors is asked to note the contents of the attached paper which was presented to the Board of Directors in March 2018.

Executive Summary:

The Trust is committed to the delivery of high quality services designed around the needs of patients, staff, carers, local communities and the public. We continually seek to improve what we do, but must also consider action where services fall short of what patients and service users expect and deserve. This involves investigating and learning from patient safety incidents and patient feedback which includes serious, moderate and adverse incidents, compliments, PALS, comments, concerns and complaints. This paper provides a summary of feedback and learning which took place during the quarter 1 October 2017 to 31 December 2017. It contains a summary of key information presented to the Board of Directors in March 2018. The principle themes arising from the report relate to:

Delayed responses;

Cross boundary dispatching;

Directory of Services usage;

Support plans;

Clinician call backs;

Non-conveyance.


Page 2 of 6

Patient Safety and Experience Report

1. A&E Service Line 1.1 Serious Incidents

9 serious incidents were confirmed for the A&E service line during the third quarter compared with 13 in 2016/17, a decrease of 4. Five of the 9 confirmed incidents related to non-conveyance, 2 related to treatment and intervention, and the other 2 related to a delay and a communication issue from the Clinical Hub where essential advice was not passed to the caller. There were two additional serious incidents reported which related to IT failures which affected the whole Trust and were not specific to one service line.

1.2 Moderate Incidents

No moderate harm incidents were confirmed for the A&E service line during the reporting period compared with 4 during the same period last year.

1.3 Adverse Incidents (including Healthcare Professional Feedback) The Trust received 1,564 adverse incidents and Health Care Professional Feedbacks (HCPFs) relating to the A&E service line during the reporting period. This compares with 2,204 adverse incidents and HCPFs during the same period in 2016/17, a decrease of 640. The Trust saw a reduction in the number of incidents relating to treatment and intervention, and medical device and equipment issues.

1.4 Key Issues Arising From Patient Safety Incidents The primary themes identified from analysis of A&E service line Patient Safety data from the third quarter of 2017/18 were delays in attending patients and the non-conveyance of patients. Themes within Adverse Incidents included ECPR referrals being sent to the incorrect health service, non-injury fallers in care establishments and inappropriate or unnecessary 999 calls. Actions relating to the following topics were identified following investigations into patient safety incidents during this quarter. Further detail around each of these areas was presented to the Quality Committee as part of the quarterly Patient Safety report:

Cross boundary dispatching;

Clarification of when it is appropriate for EMDs to stand down resources;

Deployment of Specialist Paramedics;

Review of calls where patients who have breathing difficulties become silent on the phone;

EMDs not logging out of phones;

Resource management;

Welfare Calls (the new SOP was issued during this quarter).


Page 3 of 6

1.5 Comments, Concerns and Complaints During the third quarter of the year the Trust received 330 complaints for the A&E service line. The year to date figure as at 31 December 2017 was 914 which is a reduction of 101 on the numbers of complaints received during the first three quarters of 2016/17.

1.6 Themes Arising From Comments, Concerns and Complaints Many complaints are multifaceted, during the third quarter the 330 complaints resulted in the identification of 407 separate areas of concern. The highest area of feedback received this quarter was within the category ‘Access and Waiting’ (177) which is consistent with previous quarters and is to be expected as the Trust continues to face two acute challenges; demand for services at peak times and challenges in resourcing to meet that demand. The second highest area of concern related to Communication (108).

Themes arising from complaints regarding the Clinical Hub included concerns regarding delayed ambulance attendance, triage errors, the attitude of staff and the non-provision of an estimated time of arrival for ambulance resources. In terms of complaints relating to ambulance attendances, trends included the non-conveyance of patients, communication matters, management of patients involved in RTCs, patients being asked to walk to the ambulance and complaints following safeguarding referrals. Actions relating to the following topics were identified following complaint investigations this quarter. The majority of these are local Level 2 actions, further information regarding each of these actions and those relating to lower level complaints, was presented to the Quality Committee as part of the quarterly Complaints report:

The addition of the Management of Clinical Records Policy to the matrix of mandatory policies for staff to read;

Written reflections on topics including empathy, Right Care, securing patients in ambulances, pain management and breakdowns in communication;

Reinforcement of seatbelt usage;

Learning Development Officer shifts.

1.7 Patient Advice and Liaison Service (PALS) The Trust received 232 PALS enquiries for the service line during the quarter. Year to date, 582 PALS enquiries have been received compared to 557 for 2016/17, in increase of 25. PALS enquiries, in general, relate to lost property enquires, signposting and service users looking for closure following the death of a loved one.

1.8 Compliments 799 compliments were received for the A&E service line during the quarter compared to 583 during 2016/17, an increase of 116.


Page 4 of 6

2. Urgent Care Service Line 2.1 Serious Incidents

During the third quarter no serious incidents were confirmed for the UCS service line nor were any reported during the same period for 2016/17.

2.2 Moderate Incidents No moderate incidents were confirmed for the UCS service line during quarter 3. This is

consistent with 2016/17. 2.3 Adverse Incidents and Healthcare Professional Feedback The Trust received 112 adverse incidents and Health Care Professional Feedbacks

(HCPFs) during the reporting period which related to the UCS service line. This compares with 137 adverse incidents and HCPFs during the same period in 2016/17, a decrease of 25.

2.4 Key Issues Arising From Patient Safety Incidents Analysis of UCS service line Patient Safety data identified that there continues to be a

reduction in the number of incidents relating to clinical and treatment issues although it remains the topmost reported theme within 111 incidents relating to the Trust. The majority of incidents reported by the 111 service regarding issues with external organisations related to clinical issues, Directory of Service issues or communication matters.

Actions have been identified in relation to support plans for call advisors, and the

production of training material in the use of the Directory of Services.

2.5 Comments, Concerns and Complaints During the third quarter of the year the Trust received 22 complaints for the UCS service

line. The total received for quarters 1, 2 and 3 was 81 compared 167 for the same period in 2016/17.

2.6 Themes Arising From Comments, Concerns and Complaints Of the 22 complaints received there were 30 separate areas of concern. The complaints

predominantly related to concerns regarding the perception of clinical care (12) and communication issues (11).

Themes identified from complaints regarding the OOH Service related to the perception of

clinical care, this included concerns regarding treatment and missed diagnosis; communication skills, delayed GP and 111 clinician call backs.

Actions relating to the following topics were identified following complaint investigations

this quarter. The majority of these are local Level 2 actions; further information regarding each of these actions and those related to lower level complaints was presented to the Quality Committee as part of the quarterly Complaints report:


Page 5 of 6

Reinforcement of the ‘Bare below the elbows’ campaign;

Organising name badges for all of the GPs;

Written reflections on specific cases;

Dissemination of shared learning regarding Mastoiditis.

In order to try and better manage the periods of extremely high demand and reduce call back times, the NHS 111 service has introduced a weekly resource management meeting where staffing for both call handlers and clinicians for the coming weekend is reviewed.

2.7 Patient Advice & Liaison Service (PALS) The Trust received 5 PALS enquiries for the service line during the quarter. The year to

date figure for PALS enquiries is 16 compared to 12 during 2016/17. 2.8 Compliments 10 compliments were received for the UCS service line during the quarter. This was the

same number received during the third quarter of 2016/17.

3. Duty of Candour 3.1 During the third quarter the Trust met its responsibilities under the statutory Duty of

Candour. Of the 11 serious incidents identified during the quarter, initial contact has been made or attempted in 6 of the cases. In 4 cases the Duty of Candour did not apply as there was no patient harm and the remaining case had not met it’s deadline.

4. Parliamentary and Health Service Ombudsman (PHSO) independent reviews

4.1 During the third quarter the Trust was not asked to submit any complaint files for

independent review. 4.2 The Trust received one outcome report relating to a complaint file that was submitted in

March 2017. Following independent review, the PHSO did not uphold the complainant’s concerns.

5. Claims 5.1 The Trust received 2 clinical negligence claims during the third quarter of 2017/18

compared to 4 for the same period in 2016/17. Both related to the A&E service line. 5.2 The Trust also received 5 potential clinical negligence claims during the quarter which

required investigation, compared to 16 received in the same period in 2016/17. 5.3 One Personal Injury claim was received during the quarter compared to 16 received last

year.


Page 6 of 6

5.4 The Claims and Inquests team also deal with small miscellaneous claims, for example damage to patients property. During the third quarter the Trust received 7 small claims, compared to 4 in 2016/17.

6. Inquests 6.1 No Regulation 28 reports were received during the quarter which related to the Trust. 6.2 The Trust received notification of 30 new inquests during the period; this is a decrease of 7

compared to the same period last year. 6.3 45 Inquests were closed during the third quarter, compared to 30 for the same period last

year.

7. Recommendation 7.1 The Council of Governors is asked to note the content of the Patient Safety and

Experience Report. Vanessa Williams Head of Quality

Council of Governors Meeting – Thursday 19 April 2018 Page 1 of 5

Public Council of Governors Meeting


Paper Title: Governor and Membership Update

Prepared by: Helen Braid, Committees and Membership Manager

Presented by: Helen Braid, Committees and Membership Manager

Action: Assurance and Approval

Recommendation:

The Council of Governors is asked to:

approve the 2018-19 Work Programme at Annex A to this report;

decide how to cast its vote in the NHS Providers Governor Advisory Committee Election; and

take assurance from the 2017-18 membership overview.

Executive Summary:

This report provides Governors with a draft work programme for the Council during 2018-19 which incorporates all statutory and regulatory duties. The report also provides Governors with the candidate statements of those standing for election to the NHS Providers Governor Advisory Committee. Two candidates represent ambulance trusts and eight candidates represent Foundation Trust within the South West region. The Council is asked to decide how to cast its vote in the election. The report provides Governors with an overview of the Trust’s membership in 2017-18, with key points including:

a very slight decline in public membership levels;

the membership being relatively representative of the Trust’s operating area; and

a third of the membership having provided the Trust with an email address for contact purposes.


Governor and Membership Update 1. Introduction 1.1 In addition to providing the Council with its regular membership update, this report also sets

out a draft work programme for 2018-19 and asks the Council to decide how to cast its vote in the NHS Providers Governor Advisory Committee Election.

2. 2018-19 Work Programme 2.1 An annual work programme for the Council is developed to provide a basis for setting the

agenda for each meeting and for ensuring that all statutory and regulatory requirements are planned for the year ahead.

2.2 The work programme records the items which need to be included on the agenda at each

meeting and includes strategies, policies, performance reports, annual updates, minutes from Panels and Sub Groups and other requirements which need to be considered by the Council.

2.3 The programme is used by the Committee Team to support the Trust Chairman and Lead

Governor to develop the Council agendas and enables Governors to be clear on their responsibilities during the year and the requirements of the Council. It is used as a guide but is an evolving document, enabling any issues and items identified to be added to the programme as they arise during the year.

2.4 The draft annual work programme for 2018-19 at Annex A has been developed having

considered the 2017-18 work programme, together with feedback received, and takes into account any identified statutory and regulatory items.

2.5 Recommendation: The Council of Governors is asked to approve the 2018-19 Work

Programme at Annex A to this report.

3. NHS Providers Governor Advisory Committee Elections 2018 3.1 As Governors will be aware from the Noticeboard, NHS Providers are currently holding

elections for Governor members for the Governor Advisory Committee which provides oversight and feedback on the organisation and areas that require debate and action. They Committee helps shape the governor services provided to members such as the GovernWell training programme, annual Governor Focus conference, bespoke training and guidance resources.

3.2 The Trust has the opportunity to vote in these elections, with the voting deadline being 30

April 2018. There are 59 governors standing for election to the Committee. The candidate list has been reviewed, and as for the previous election, we have provided a shortlist which includes those governors who represent ambulance trusts or are from the South West region. The candidate statements of those 10 shortlisted governors are at Annex B.

http://nhsproviders.org/programmes/governwell

http://nhsproviders.org/courses-events/annual-events/governor-focus-conference-2018

http://nhsproviders.org/programmes/governwell/training-courses


3.3 The voting method for the election is “Single Transferrable Vote”. This means that rather than casting a vote for a set number of candidates (eg five votes where there are five seats) the Trust is able to rank as many candidates as it wishes in the order of preference. Accordingly, the Council of Governors is asked to decide not only whether it wishes to support any of the listed candidates, but if so, in what order of preference.

3.4 Recommendation: The Council of Governors is asked to decide how to cast its vote

in the Governor Advisory Committee election.

4. Trust Membership

4.1 This section of the report provides the Trust’s year end position in terms of its public and

staff membership.

Members 31.03.2016 31.03.2017 31.03.2018

Public 14,250 14,080 13,971

Staff 4,914 4,974 4,780

Total 19,164 19,054 18,755

4.2 As at 31 March 2018 the Trust had a public membership of 13,971, fractionally below the

0.26%1 membership target across the entire region previously adopted by the Trust. This overall drop in membership has been due to less of a focus in recruitment in favour of engagement and a number of data cleanses in advance of the recent Governor elections.

4.3 As shown in the table below, there are some constituencies where membership levels are

significantly lower, with these being Bristol and Bath & North East Somerset; Dorset; Gloucestershire; and Wiltshire and Swindon.

Constituency Number of Governors

Minimum No. of Members required

for an election

Actual Number of Members

% of Eligible

Residents

Bristol and Bath & North East Somerset

2 320 1,228 0.19%

Cornwall 2 272 3,017 0.54%

Devon 4 580 3,112 0.26%

Dorset 2 360 1,534 0.19%

Gloucestershire (incl South Gloucestershire)

3 436 1,473 0.16%

Isles of Scilly 1 25 73 3.18%

Somerset (incl North Somerset)

3 375 2,509 0.33%

Wiltshire and Swindon 2 336 1,025 0.14%

1 This figure was contained in the Trust’s Membership Strategy which has now been replaced by the Membership & Engagement Strategy.


4.4 The Trust is required to have a public membership which is representative of its operating

area. Annex C details how the Trust’s public membership compares against its operating area, based upon the reporting categories required by NHS Improvement. As can be seen, the membership is relatively representative with exceptions being an under representation of men and of those members who are under 22. In addition, there would appear to be an under-representation of those who class their ethnicity as “white”, however the fact that just under 9% of members did not respond to this question should be taken into account when considering this under-representation.

4.5 The Trust recognises that members will want to have varying levels of involvement with the

Trust. Accordingly, Trust Membership is split into three levels ranging from simply receiving information through to becoming a Governor. The table below sets out the number of members signed up to each level of membership as at 31 March 2018 and how many of those members have provided an email address to enable electronic communication.

Membership Level Members % of

Membership Email

Addresses % of

Membership

One – Informed Receive newsletters and information about the Trust

11,305 80.91% 3,302 23.63%

Two – Involved Also take part in surveys, consultations and events

1,866 13.36% 881 6.30%

Three – Influential Might also consider becoming a Governor

800 5.73% 476 3.41%

13,971 100% 4,659 33.34%

4.6 Staff Membership during 2017-2018 remained at a high level, with 98% of those employed

staff eligible to become a member doing so. Staff membership eligibility is dependent upon the length of time the employee or volunteer has been with the Trust. If employed staff are on a permanent contract, a fixed term contract for more than 12 months or have been employed by the Trust for more than 12 months they are automatically opted in as members. Volunteers are invited to become a staff member, dependent upon their classification of volunteering, once they have been volunteering continuously for 12 months.

5. Recommendation 5.1 The Council of Governors is asked to: 5.1.1 approve the 2018-19 Work Programme at Annex A to this report; 5.1.2 decide how to cast its vote in the NHS Providers Governor Advisory Committee

Election; and


5.1.3 take assurance from the 2017-18 membership overview.

Helen Braid Committees and Membership Manager

MEETING -19 APRIL 2018 MEETING - 5 JULY 2018MEETING

- 6 SEPTEMBER 2018

ANNUAL MEMBERS MEETING

- 6 SEPTEMBER 2018MEETING - 17 JANUARY 2019

HOLDING TO ACCOUNT HOLDING TO ACCOUNT HOLDING TO ACCOUNT HOLDING TO ACCOUNT

Chairman's Announcements Chairman's Announcements Chairman's Announcements Minutes of Previous Meeting Chairman's Announcements

Update with the NEDs Update with the NEDs Update with the NEDsPresentation of: 2017/18 Annual Report, Annual

Accounts and Quality Account and ReportUpdate with the NEDs

MEMBERSHIP AND ENGAGEMENT MEMBERSHIP AND ENGAGEMENT MEMBERSHIP AND ENGAGEMENT MEMBERSHIP AND ENGAGEMENT

Trust Membership and Governor Update Trust Membership and Governor Update Trust Membership and Governor Update Election of Lead and Deputy Lead Governor Trust Membership and Governor Update

Governor Feedback Governor Feedback Governor Feedback Looking Forward: The Future for SWASFT Governor Feedback

GOVERNOR DUTIES GOVERNOR DUTIES GOVERNOR DUTIES GOVERNOR DUTIES

Outcome of the KPMG Well Led Review Selection of a Quality Priority for Audit Update from the Trust's External AuditorsCode of Conduct for the Council of Governors (to

recommend to Board)

Lead Governor R&R Governor Elections Process Membership and Engagement Strategy

Terms of Reference and Self-Effectiveness

ReviewPolicy for the Composition of the CoG

Policy for the Composition of the Non-Executive

Directors

Reimbursement of Governor Expenses Policy

SUB GROUP REPORTING SUB GROUP REPORTING SUB GROUP REPORTING SUB GROUP REPORTING

Communication & Engagement Task Group -

AMM and Governors Annual Report proposalsCommunication & Engagement Task Group Communication & Engagement Task Group

CoG Composition - Public and Appointed

Governor Seats

Governor Development Task Group - Proposals

for November Development Workshop

OTHER ITEMS OTHER ITEMS OTHER ITEMS OTHER ITEMS

Patient Safety and Experience Report Patient Safety and Experience Report Patient Safety and Experience Report Patient Safety and Experience Report

MacMillan Project Quality Priorities Monitoring Quality Priorities Monitoring Update from the Lead Governor

Patient and Public Engagement Update from the Lead Governor Update from the Lead GovernorQuality Priorities - 2018-19 Update and

Consultation re 2019-20 Priorities

Annual Work Programme 2019-20

OPENING BUSINESS OPENING BUSINESS OPENING BUSINESS OPENING BUSINESS

A Patient's Experience A Patient's Experience A Patient's Experience A Patient's Experience

Minutes of Previous Meeting - 18 Jan 2018 Minutes of Previous Meeting - 19 April 2018 Minutes of Previous Meeting - 15 July 2018 Minutes of Previous Meeting - 6 Sept 2018

Action Point Register Action Point Register Action Point Register Action Point Register

Performance Update from the CEO Performance Update from the CEO Performance Update from the CEO Performance Update from the CEO

MEETING -19 APRIL 2018 MEETING - 5 JULY 2018 MEETING - 6 SEPTEMBER 2018 WORKSHOP - 1 NOVEMBER 2018 MEETING - 17 JANUARY 2019

Minutes of Previous Meeting - 18 Jan 2018 Minutes of Previous Meeting - 19 April 2018 Minutes of Previous Meeting - 15 July 2018Possible Confidential Session - to be held if report

on appointment of Trust Chairman requiredMinutes of Previous Meeting - 6 Sept 2018

Update from the Remuneration &

Recommendations Panel

Proposals for Appointment / Re-Appointment of

Trust ChairmanAnnual Re-Appointment - NEDs

Re-Appointment of Associate NED

Review of Chair and NED Remuneration

PUBLIC COUNCIL OF GOVERNORS ANNUAL WORK PROGRAMME 2018-19

CoG and Membership Annual Report

CONFIDENTIAL COUNCIL OF GOVERNORS ANNUAL CYCLE OF BUSINESS 2018-19

Appendix B

Candidate Statements

Ambulance Trusts Colin Godbold, Public Governor, South Central Ambulance Service NHS Foundation Trust I’m Colin Godbold. I’m seeking election as Ambulance Representative on the NHS Providers’ GAC as I believe I can do a good job of representing the views and needs of governors in the ambulance sector. I have three years’ experience as a public governor of South Central Ambulance Service NHS Foundation Trust, I am starting a second three-year term, and I have time for the role. As a governor I have been a active in public engagement and I believe I have a good understanding of the particular challenges facing front line ambulance trusts, including increasing demand and complexity of need, coverage of large, diverse geographic areas, delays in A&E, staffing and ARP implementation. I have a private sector background delivering large IT-based change programmes and now work part-time as a consultant and charity volunteer. I also bring considerable experience of working in advisory and committee roles in central government, including at DWP, Cabinet Offce and the UK Statistics Authority. I am a strong believer in the importance of good governance in the delivery of public services. If appointed I will seek input from ambulance trust governors across the country to understand what they need from NHS Providers, and provide feedback to keep them informed. I will aim to: - Be a strong voice for ambulance service governors at the GAC - Create an effective two-way communication channel for governors with NHS Providers - Influence the activities of the GAC and NHS Providers on behalf of the ambulance sector. Robert Alabaster, Public Governor, North East Ambulance Service NHS Foundation Trust THE CHALLENGE FACING NHS PROVIDERS The NHS faces extreme workload and financial pressures, notably in the Urgent and Emergency care sector. New thinking and partnership working between different agencies, are required. NHS Providers has an important role in informing its members of new developments and service innovation. MY BACKGROUND I have had an extensive career in Health Management including: • in the Acute Hospital Sector, • as Chief Executive of an Ambulance Service • and as director of a health consultancy company. I have been a Governor of North East Ambulance Service for six years.

MY CONTRIBUTION TO THE GOVERNOR ADVISORY COMMITTEE (GAC) I have been a member of the GAC since 2015 and have supported its role in harnessing the contribution of Governors and in guiding the Governor Support Programme. As well as attending conferences and regional events I have contributed to GAC discussions, especially: - the Ambulance service plays a vital role in the emergency and urgent care system - delayed patient handovers at Hospital A&E departments reduce available Ambulance resources - the 111 system can reduce pressure on A&E departments by guiding patients to more appropriate care. I have proposed topics for inclusion in the Governor Support Programme: - connecting with the wider membership and the public - whole system working and the role of governors within Sustainable Transformation Partnerships - how can governors share best practice in holding their Trusts to account? I would like to continue to work with the GAC in identifying new ways to support governors across the NHS.

Trusts in the South West of England Simon Bishop Public Governor, Dorset County Hospital NHS Foundation Trust I am an elected governor at Dorset County Hospital, being very active in the governance structure, attending and contributing to Council of Governor and Board meetings. My background is as a high level IT analyst for over 40 years. My areas of expertise include; effective management of change, and effective communications. Since my election I have actively participated and overseen processes for effective observing and reporting on various governance meeting channels, including governor observer participation of various board and committee meetings. I am retired, and can contribute considerable effort and expertise to this important position. Amanda Buss Public Governor, Royal United Hospitals Bath NHS Foundation Trust Governor Type: Public Before becoming a Governor in 2012, I trained as a doctor, then worked for a large financial services company and subsequently ran my own business advising companies on the design and implementation of healthcare policies and provisions for their employees. I believe my background in both the medical and corporate sectors gives me a valuable understanding of current healthcare challenges, and enables me to make a unique contribution as a hospital governor. In my current role I: - Belong to Quality, Strategy and Remuneration Working Groups - Attend all Trustboard meetings.

- Am the Governor representative working on the relaunch of the hospital website. - Engage with Staff and Patients at a range of hospital events. My major achievements in the role include the redesign of the monthly Governor data report, preparing a summary of Trustboard highlighting areas that I feel Governors should investigate. Being a Governor has enabled me to expand my understanding of NHS issues, Governance and the Governor role, and to contribute to service delivery at my hospital. I believe that I have made a signifcant contribution to the development of the Council of Governors, and I would like to use this experience at the GAC to share best practice with fellow members, to learn from them and to enhance the support that we receive. I would also like to develop the role of the GAC and the Governor voice at a national level - to enable us to influence and shape the future of the NHS for patients. Michael Fernando Staff Governor, Yeovil District Hospital NHS Foundation Trust I am applying for this role on the Governor Advisory Committee because I would like to share my experience and enthusiasm to offer guidance and advice to NHS Providers in support of Councils of Governors. I have been a Staff Governor for almost 6 years in Yeovil District Hospital and am a Consultant Paediatrician. I work in the Acute Sector of the NHS. I have additional experience which I believe enhances my suitability for this role. Locally, I have been a Trustee of the Yeovil Opportunity Group, a nursery for children with additional needs, for over six years. Regionally, I have been nominated as an Assistant District Governor of Rotary International (which provides support for local, regional and international causes). Internationally, I am a Member of the Rotary Foundation Cadre of Technical Advisers and give expert advice regarding grants for Maternal and Child Health projects globally. I am a Fellow of the Royal College of Paediatrics and Child Health. I have worked in a variety of health care settings, including in the U.K. Bermuda and New Zealand. I am willing and able to attend meetings in London. Alison Fisher Public Governor, Dorset HealthCare University NHS Foundation Trust I was elected as a Public Governor (Dorset and Rest of England and Wales) for Dorset Healthcare University NHS Foundation Trust with a 3- year tenure from September 2017. I am a new Governor having recently moved to Dorset following a career as Chief Executive of a regional Mind – the mental health charity. In addition, I am taking an interest in the regional Governor Network and have recently been accepted as a volunteer Governance Partner for a local voluntary organisation. I have over 20 years Board level experience - as a Director of Voluntary and Community Action and of Healthwatch, both in CentraI Bedfordshire; of Milton Keynes Mind and was a voting Director of my last employer, Mind BLMK. I have taken leadership and ambassadorial roles in local, regional and national mental health sectors, the general voluntary sector and as a representative on key strategic bodies within local authorities and Clinical Commissioning Groups. My experience of oversight within a range of statutory and voluntary agencies entailed attendance at meetings; contributions by way of discussion and team working on Task and Finish projects; feedback to external stakeholders; assimilation of intelligence from a range of quarters; and taking

responsibility for any decisions made. My experience as a Governor is with Dorset, which is a pathfinder Accountable Care System, will inform the Advisory Committee. This experience, together with personal attributes and current activity detailed above, would fit and enhance the Governor Advisory Committee, to which I seek election. Graham Papworth Carer/Patient/Service User Governor, University Hospitals Bristol NHS Foundation Trust I was elected as a Patient/Carer Governor at University Hospitals Bristol in 2017, representing carers of patients under 16. In addition to my governor responsibilities, I am also a member of the Trust’s Carers Strategy Group. I work in Learning Technology and have over 10 years’ experience in the strategic management and development of technology and traditional based learning and support programmes for blue chip companies, Government departments and in the not for proft sector. I have worked with clients on training needs analyses and understand the challenges involved in targeting diverse audience groups and in the production of high quality resources. Working as a main board director, I have experience of chairing meetings at board level, presenting to diverse audience groups and of running workshops. I have worked with clients on campaigns to engage employees and volunteers both in the UK and overseas and am aware of cultural, educational, language and engagement challenges that can be encountered. I believe I have a strong skill set that can add value to the NHS Providers Governor Advisory Committee and help it oversee and strengthen the governor support programme at NHS Providers and would be delighted to undertake the role. Roger Stroud Public Governor, Great Western Hospitals NHS Foundation Trust I have been a serving foundation trust governor for 14 months and from day one fully immersed myself in the role, participating fully in working groups and committees, attending many mini-visits, various governor training sessions and attended the NHS providers 2017 national governors focus conference and participated in the 2017 South West Governors’ Exchange Network event. In November 2017 I was nominated and elected as Lead Governor. Although I have been a governor for a relatively short time I have been totally focused and committed to the role and feel that I have something to offer in terms of the growth from being new and inexperienced, through to being a fully contributing governor who is willing to take on additional governor tasks. I spent my working life on the development of new pharmaceutical products for global markets. I was heavily involved in reading, assimilating, and participating in UK pharmaceutical industry workgroups reviewing proposed UK, European and United States new legislation relating to the registration and approval of pharmaceuticals and successfully made representations to the industries regulators to make sound, scientifcally sound changes to their proposals. I have signifcant experience on committees, find it easy to work with all levels within an organisation and have excellent communication skills. I feel that I have the expertise, enthusiasm, passion, time and energy to make a significant contribution if elected. Finally I am highly motivated, thrive on new challenges and have the skill that is essential in this role - common sense.

Alan Thomas Public Governor, Gloucestershire Hospitals NHS Foundation Trust I believe I am well placed to add value to the GAC through wide experience as both an FT governor and as a contributor to the wider NHS system. Currently in my fifth year as a public governor for Gloucestershire Hospitals NHS FT, I have been Lead Governor for three years. During this time, I have led colleagues in seeing success with the sometimes intractable issue of holding NEDs to account, during a period of major turbulence within the Trust - including a serious failure in financial governance, a problematic introduction of a patient centred IT system, the potential setting up of a subsidiary company, and the prospect of major service reconfiguration. All this in addition to the ‘usual’ national performance issues. Within the wider Gloucestershire health system, I serve as interim chair of Gloucestershire Healthwatch, making me well placed to see how commissioners and providers play out the STP and its ramifications, including the need for public consultations. This wider perspective has helped me to better articulate the issues raised by the Gloucestershire public and to better understand the Governor role of representing the interests of FT members. I am well known to senior local healthcare professionals as someone who can provide an independent voice that is constructively critical when required, either as a member of a small team or as an individual – and in many confidential settings. I have demonstrated an ability to act professionally and with sensitivity, but have always been able to participate actively but constructively Maureen Todd Public Governor, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust For the past two years it has been my privilege to serve as a Public Governor first as an elected interim appointment and now for a further three years. It has already been a roller coaster experience - full of reality checks alongside massive opportunities - involving a Care Quality Commission Inspection, a county led Clinical Services Review and currently merger negotiations. All occurring within a national understanding that 20th century systems are not appropriate for 21st century problems including increased demand, reduced funding and higher expectations. My previous experience as an Advisor and Inspector of schools in London across 12 boroughs meant that I was familiar with Evaluating and understanding the complexity of large institutions Holding institutions and professionals to account Influencing policy and practice Working alongside a range of stakeholders Notwithstanding, without the consistently high quality Governor training received, the regular opportunities to be part of non clinical inspections for example, access to research and attendance at conferences, these past skills in education would not have transferred. It has become clear to me that Governors need more than enthusiasm to make a positive difference. They need advice and examples of good practice to work better as one Body, to add value to their Trust, to enshrine their core values. I would welcome being a member of a committee whose remit is to help all Trusts and their Governors, be the best they can be for the benefit of all.

Annex C Trust Public Membership as at 31 March 2018

No. of

Members % of

Membership Eligible

Membership % of Eligible Membership

Level of Representation

Age 13,971 100.00 5,553,295 100.00

0-16 1 0.01 1,036,325 18.66 -18.65%

17-21 69 0.49 327,696 5.90 -5.41%

22+ 13,019 93.19 4,189,274 75.44 +17.75%

Not stated 882 6.31 0 0.00 n/a

Age 22+ 13,019 93.19 4,189,274 75.44

22-29 1,820 13.03 543,266 9.78 +3.25

30-39 1,659 11.87 637,582 11.48 +0.39

40-49 1,878 13.44 694,285 12.50 +0.94

50-59 2,255 16.14 768,690 13.84 +2.30

60-74 3,331 23.84 990,078 17.83 +6.01

75+ 2,076 14.86 555,373 10.00 +4.86

Gender 13,971 100.00 5,553,294 100.00

Unspecified 4 0.03 0 0.00 n/a

Male 6,037 43.21 2,733,467 49.22 -6.01%

Female 7,930 56.76 2,819,827 50.78 +5.98%

Ethnicity 13,971 100.00 5,288,935 100.00

White 12,410 88.83 5,046,427 95.41 -6.58%

Mixed 92 0.66 71,884 1.36 -0.70%

Asian 117 0.84 105,537 2.0 -1.16%

Black 92 0.67 49,476 0.94 +0.27%

Other Ethnic Groups

12 0.9 15,609 0.30 +0.60%

Not stated 1,247 8.93 0 0.00 n/a

ONS/NHSI Classifications

13,935 99.74 1,588,702 100.00

AB 3,705 26.52 363,132 22.86 +3.66%

C1 4,038 28.90 489,567 30.82 -1.92%

C2 3,038 21.75 367,301 23.12 -1.37%

DE 3,154 22.58 368,702 23.21 -0.63%

ONS/NHSI Classifications:

AB Higher & intermediate managerial, administrative, professional occupations

C1 Supervisory, clerical & junior managerial, administrative, professional occupations

C2 Skilled manual occupations

DE Semi-skilled & unskilled manual occupations, unemployed and lowest grade occupations

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