Minutes of the 2023 Annual General Meeting of the East Of England Ambulance Service NHS Trust

Present:

Public session

1.0 WELCOME

1.1 Mrunal Sisodia, Trust Chair (TC) welcomed those present to the 2022-23 Annual General meeting (AGM) of the East of England Ambulance Service NHS Trust.

2.0 MINUTES FROM THE PREVIOUS MEETING

2.1 The minutes of the 2021 – 2022 AGM, held on 27.09.2021, were received and approved with no amendments.

3.0 TRUST CHAIR UPDATE

3.1 The TC extended his thanks to colleagues, volunteers, patients, partners and all those who had contributed to delivering an excellent service to patients under challenging circumstances, both personally and professionally. The events of previous years had tested the world in unexpected and unanticipated ways, testing the resilience of the Trust’s people, operations, partnerships and our patients. He was proud of the dedication, passion, commitment and compassion shown by all Trust staff and volunteers, which was consistent to the Trust’s core values and vision to deliver outstanding care, with exceptional people, every hour of every day. This would not have been achieved without the ongoing support of the public. There had been a fantastic response from local communities and organisations to assist the Trust in different ways, alongside an outpouring of support through cards, messages and donations, as well as those volunteering their time to support.

3.2 The AGM would be supported by the annual report and accounts and quality account which were available to view on the website. The TC extended his thanks to all those who had contributed to the development of these reports.

3.3 The TC reflected on the changing Board, and extended his thanks to Nicola Scrivings, who left the role of Trust Chair in June 2023. Nicola Scrivings had worked with EEAST during a period of significant challenge, including cultural challenges and the consistency in which patients and colleagues were supported. She had led the Trust through the pandemic response which had significant implications for staff welfare, patients and communities, passionately working alongside teams to support EEAST to become an excellent place to work and provide professional and compassionate care. There had been other NED departures in year including Neville Hounsome and Carolan Davidge, the TC extended his thanks to both individuals for the support they had provided during a challenging period.

3.4 The Board was focussed on providing outstanding care to patients and supporting the development of communities through partnership working. The Trust continued to work with regulators as part of the SOFT4 (National Recovery Support Programme) regime and action plan to ensure improvements needed were embedded and patients and colleagues were safe and supported.

3.5 The TC introduced the Board members which included several new appointments in year including George Lynn, Catherine Glickman and Chris Brook who took up post in 2023/24 as Non-Executive Directors. He welcomed them to the Trust Board, and further extended his thanks to all Board members for the advice, guidance and leadership provided which was crucial in enabling the Trust to respond effectively.

3.6 The Trust had risen to the many challenges presented over the preceding year including huge service demand and significant handover delays. The focus remained on ensuring the foundations were in place, ensuring collaborative, co-created and comprehensive approaches to providing quality and safe care, whilst supporting the delivery of key transformation programmes which would enhance the effectiveness of service delivery. There remained further activity required to deliver a sustainable service but important progress had been made.

3.7 As a Board, the aim was to support progress as an open, honest and inclusive place to work which people wanted to join. By listening and working together would enable the Trust to make the required changes to improve the experience for colleagues, partners and patients. This co-production was central to the Trust’s aims, listening, partnering and working with staff, patients and stakeholders across the health and care system to deliver the Trust’s goals. Not only was this the right thing to do, but the consequences of failing to listen, partner, support and challenge were brought starkly apparent through the recent Nurse Letby case.

3.8 Demand for the service remained high, with 1,393,675 calls received to the emergency operations centre during 2022/23, averaging 2881 calls per day. The Trust attended 754,460 incidents providing care to over half a million very unwell patients. 14% of patients were categorised as the highest priority (immediately life threatening) and 58% were the second highest category (serious condition).

3.9 The Medical Director, Simon Walsh (MD) was introduced to discuss the care provided to patients in 2022/23.

4.0 OUR PATIENTS – CARE

4.1 Patients were at the heart of the Trust’s activity during 2022/23., Standards were set to ensure the level of clinical care provided to patients met the expectations we would expect to be provided to our family and friends. The Ambulance Clinical Quality Indicators (ACQIs) were nationally set indicators for specific patient groups which enabled ambulance services to benchmark themselves against the national average for these indicators. Within the top five indicators, four outcome measures were set for patients in cardiac arrest and one measurement of compliance in administering a nationally recommended care bundle. The Utstein group were a subgroup of patients expected to have a better chance of survival because their cardiac arrest was witnesses and presenting rhythm was shockable. The Trust was reporting slightly below the national average for ROSC for all cardiac arrests including the Utstein subgroup and survival to discharge. The Trust was reporting slightly above the national average for survival to discharge for Utstein patients and significantly above the national average for the delivery of the ROSC care bundle, reporting at 97.8% against a national average of 76.9%. This situated the Trust as the highest performing ambulance service against this indicator.

4.2 Work was being undertaken with air ambulance partners, volunteers and the region’s Heart Attack Centres and the Circuit National Defibrillator Network to further improve outcomes for patients experiencing a cardiac arrest. Within the clinical strategy, advancing practice would support even more practitioners and those with enhanced skills to attend the most critically ill patients in the region. Within the ACQIs, there were three indicators for patients receiving a nationally recommended care bundle for heart attack, stroke and sepsis, EEAST reported at significantly above the national average for the delivery of all of these care bundles.

4.3 The top three priorities for patients were safety, clinical effectiveness and patient experience. As part of the new Patient Safety Incident Response Framework (PSIRF) from 01.10.2023 no Trust would declare serious incidents, however moderate and severe incidents would continue to be monitored. The PSIR plan supported the identification of key risks to identify how systems and processes needed to evolve to improve patient safety.

4.4 Within clinical effectiveness, clinical supervision was being implemented which built on informal supervision into a formal framework and 1:1 supervision sessions for clinicians.

4.5 Within patient experience, the Trust was receiving feedback from key and difficult to reach patient groups such as those with learning difficulties, dementia, younger people and those from BME backgrounds.

4.6 There had been a significant increase in serious incidents declared during 2022/23 compared with 2021/22. This was partly attributed to sustained operational pressures leading to increased response times but was also reflective of the level of scrutiny and openness when reviewing incidents. The serious incident action plan was used to deliver the improvements required as part of the incident scrutiny process. An action plan had been developed to improve all elements within the Trust’s control. A key element of this action plan was to maintain the close working relationship between EEAST and system partners. An outcome of this collaboration was the development of a framework for the system to investigate incidents together, allowing for an end-to-end review of a patients care. An action setting group was established in early 2023 to ensure actions agreed were specific, measurable, achievable, relevant and timebound. This group had enabled operational teams to meet with the central team to develop and agree actions from serious incidents, more easily follow up on actions, confirm completion and review the impact. This had resulted in an improvement in the number of actions completed and the engagement with operational teams to appreciate the importance of learning from incidents. The patient safety incident investigation methodology was used to review groups of incidents where there were common themes in advance of the rollout of the PSIRF in September 2023.

4.7 Compliments continued to outweigh the level of complaints received. During 2022/23 the Trust received 2702 compliments regarding the service, averaging 225 per month. Compliments were reported to the Trust Board and to each individual staff member with local management teams copied in so they could be acknowledged and recorded on the staff members personnel file. Complaints and concerns accounted for less than 0.07% of contacts from patients. In 2022/23 there were clear themes from complaints and concerns received from members of the public and representatives. These themes included delays in sending an ambulance and occasions when patients were asked to make their own way to hospital. These measures were put in place during periods of sustained and extreme pressures in the wider system. The Trust had developed a clear action plan and was working with system partners across the region to support patients as safely as possible.

4.8 The MD took the opportunity to acknowledge the excellent work of teams to provide outstanding care. This was also acknowledged on ‘thank you Thursday’ in which the Trust did a shout out to say thank you to the amazing staff who continued to dedicate their time and experience to deliver fantastic care during challenging times.

4.9 Patient and public involvement remained paramount and ensured patients remained at the heart of the service. Networks continued to be developed with patient and public involvement groups across the region which had supported the coproduction of a Young People’s Mental Health Instagram Survey and an Easy Read Survey. These were co-produced alongside patients with lived experiences, the Trust was confident that the results of these surveys would support the Trust to further develop the way in which we support patients with mental illness or learning disabilities. The Trust had also co-produced the Patient and Public Engagement Strategy which was published as a case study of best practice within the NHS statutory guidance for Working with People and Communities.

4.10 The Community Engagement Group (CEG) had extended the reach of the patient and public involvement team. Working with these volunteers had enabled the Trust to link with representatives of communities and those with a specialist interest in the service within the region. CEG members regularly attended strategic meetings with Trust staff, undertook station visits and audits, recommending ways the service could be improved for patients and the public.

4.11 Face to face engagement events had provided the opportunity to speak with the public about the service and gain feedback, particularly from those who may not ordinarily have contacted the Trust.

4.12 The MD introduced Marika Stephenson, Director of People Services (DoPS) who discussed how the Trust was developing as an excellent place to work, volunteer and learn.

5.0 OUR PEOPLE

5.1 The Trust had undergone a period of transformation during 2022/23, continuing to focus on improving the organisation’s culture and addressing the long-standing concerns raised by colleagues and stakeholders. One significant accomplishment was the resolution of over 91% of long-standing legacy employee relations cases. This demonstrated the commitment to fostering a supportive and inclusive working environment where everybody felt valued and respected. There had also been a reduction in incidences of bullying and harassment, with a 71% drop in the number of reported incidents of sexual harassment which as testament to the ongoing efforts to create a culture of civility and respect.

5.2 Those on the frontline, in control rooms and providing non-emergency services were the public face of the organisation, but there remained a range of colleagues supporting them to carry out these vital roles such as mechanics, education and training, clinicians and corporate functions including finance, IT, workforce, estates, facilities, supplies, distribution and communications. These staff played a vital role in supporting the delivery of a quality service to the patient. EEAST was unique in reporting an almost 50:50 split between male and female staff which was untypical of NHS organisations.

5.3 The largest staffing group, at 3699 delivered frontline operational services. The workforce remained relatively young with over three quarters of staff below the age of 50.

5.4 The People Strategy and Wellbeing lan was launched in 2022/23. Turnover remained a critical issue across the NHS, with EEAST experiencing high turnover rates during the period although long term interventions were beginning to realise some improvements. In April 2022, EEAST reported a turnover rate of 13%, which spiked to 14% in September 2022 and reduced to 12% by March 2023. Improvement and recovery began to be evidenced which was led by local actions including: • Enhanced recruitment and onboarding processes to improve candidate experience. • Career development pathways to support and develop our staff. • Improvements from the HR business partner team to exit processes. • Improved data gathering providing the evidence to adjust organisational strategies.

Combined, these measures improved staff retention and ensured our people had a great experience from the beginning to the end of their employment with EEAST.

5.5 The recent BME survey was a step change for EEAST in 2022 and demonstrated the Trust’s continued commitment to addressing the underlying cultural challenges to achieving true inclusivity. There had been a focus on improving the support provided to people who declared a disability, including additional leadership training and awareness events. Executive and senior leadership teams championed these awareness campaigns which led to an increase in colleagues declaring disabilities via the internal processes.

5.6 In recognition of the challenges our people experience, the Trust had worked to ensure people were equipped with the personal skills and resources to manage their own wellbeing effectively. The Wellbeing Strategic Plan had been published in 2022/23 which outlined the actions EEAST was seeking to achieve over the following three-year period to improve the service provision for colleagues. This focussed on overall mental health and work undertaken with the occupational health provider to improve access to other health treatments including musculoskeletal referrals. The focus of the Wellbeing Strategic Plan was twofold, providing additional wellbeing support for our people and training and awareness for our leaders. As a result, it became apparent that developing wellbeing capabilities at individuals, manager and leader level was an urgent, high priority alongside providing enhanced support for those managing mental health challenges.

5.7 There had been a review of how wellbeing wagons were managed and the purchase of six new vehicles to further support wellbeing. The model was translated to a mobile wellbeing service to better meet the needs of colleagues across the region, with the vehicles providing a confidential space for individuals to talk, staffed by a team of welfare volunteers. The wagons also provided counselling and physiotherapy services and were supported by chaplains and therapy dogs.

5.8 To further support wellbeing the Trust had enhances its outdoor spaces to provide areas for colleagues to decompress, which was supported by the East of England Ambulance Service Charity. The Charity helped to support several wellbeing gardens across the Trust, providing colleagues and volunteers with an area for relaxation, reflection and respite. Volunteers even gave up their own time to support these projects for their colleagues. In 2022 the Trust was the recipient of a garden created for the 2021 RHS Chelsea Flower Show as a space for staff to enjoy and unwind. It was donated and redesigned to fit land identified at Chelmsford Ambulance Station by a local garden design and landscaping company. The Trust had partnered with Essex Wildlife Trust and Nextdoor Nature Project to rewild ambulance stations. Fruit trees, hedging and spring bulbs would be planted in Thurrock with further sites being identified.

5.9 The Trust had developed improvements in employee relations case volumes over the preceding year. In April 2022 EEAST reported 174 cases, which spiked to 214 by May 2022 and reduced to 90 by March 2023. This was further supported by a refreshed suspension process which drove a reduction in the average length of suspension from 121 days in April 2022, to 108 days in March 2023. Over the last year, there had been a consistent level of concerns raised to the Freedom to Speak Up team each month. Wider strategic activity was underway on the culture and behaviours within the organisation, the number of new cases remained proportionate to the pace of cultural change. This gave rise to multiple, complex cases requiring increased case management. To meet the increased demand the FTSU team was increased to three full time, permanent guardians supported by 21 ambassadors.

5.10 The DoPS introduced Hein Scheffer, Director of Strategy, Culture and Education (DoSCE) who spoke on culture, training and development.

5.11 One of the key components in making EEAST a great place to work, volunteer and learn was the ability to provide a breadth of career pathways and development opportunities for our people. The priority was to create the best possible organisational culture which demonstrated the values and behaviours and listened and learnt from colleagues. Over the last year, activity had expanded to include interactive values awareness workshops for everyone, to support individuals to challenge poor behaviours.

5.12 The 2022 NHS staff survey obtained the highest completion rate seen by EEAST, at 60% which compared favourably against other ambulance trusts in terms of response rates. Positive steps had been taken in colleague experience, with 46% of questions scoring more positively than in 2021 and 45% remaining unchanged. This demonstrated that in the majority of areas there were improvements in the perceptions and experiences of our people. This trend was further reflected in the pulse survey conducted in January 2023, which demonstrated an improvement from August 2022. Staff survey data had been triangulated with other key data sources such as employee relations cases, patient safety cases and FTSU information to identify trends across the organisation for the implementation of action plans where required.

5.13 The Trust conducted targeted surveys for three minority groups (BME, LGBT+ and disability and neurodiverse) as part of the three-year inclusivity plan, this was to understand the baseline lived experiences of our people, to support the development of targeted and relevant improvement plans. The BME survey had a 48% return rate, with the LGBT+ survey and disability and neurodiverse survey response rates exceeding 50%. Bespoke improvement plans had been developed based on the survey responses and supported by the equality networks. These survey findings had highlighted the poor experiences of individuals dating back several years. There had been indications that our people were either too scared to raise a concern or felt that when a concern was raised it was not acted on quickly enough. Improvement plans had been developed to address this.

5.14 Staff networks were pivotal to developing an inclusive culture at EEAST. In 2022 each of the five networks went from strength to strength, with increasing membership and awareness events hosted throughout the year. In 2022/23 the men’s wellbeing network was also introduced with a specific focus on men’s wellbeing in the workplace.

5.15 The cultural ambassador pool had been expanded and provided a critical resource to promote equality in formal procedures such as recruitment and selection panels or disciplinary related processes. The Trust’s ambition remained to continue to expand the number of cultural ambassadors in the Trust and their representation across the organisation.

5.16 In 2022 the number of career pathways available to new and existing colleagues was expanded. These pathways were designed to attract and retain skills colleagues whilst providing career progression options underpinned by academic study and funded by the apprenticeship levy. An innovate Allied Health Professional (AHP) pathway was introduced which provided a transitional educational course for AHPs to become paramedics. Two cohorts, totalling 34 candidates had successfully progress through this pathway since it was introduced, with a further 12 candidates who had commenced.

5.17 Investments in clinical professional development had been strengthened in 2022/23, with over 358 courses being offered to clinical staff, an increase of 45% since the previous year. This amounted to over 5,600 colleagues attending face to face training, leading to improved skills, knowledge and patient experience. Positive progress was made to increase the amount of protected time available for clinical colleagues to undertake training, with 24 hours provided per AHP to undertake continued professional development and mandatory training. Those undertaking a degree apprenticeship had been expanded through the expansion of this to non-clinical colleagues.

5.18 The DoSCE introduced Jo Fletcher, Deputy Director of Urgent and Emergency Care Provision (DDoUECP) who spoke on how EEAST was working to achieve the goal of being excellent collaborators and innovators as system partners.

6.0 OUR PARTNERS

6.1 It was recognised that partnership and system engagement was a valuable and necessary part of all the work of EEAST. This included the volunteer workforce. The Trust’s volunteer workforce was highly varied, including community first responders, co-responders such as other military and blue light personnel, non-clinical care drivers, chaplains and other faith representatives. In addition support was provided by the CEG and British Association for Immediate Care (BASICS) doctors and paramedics. The Trust was supported by over 1200 active volunteers supporting communities and patients in 2022/23.

6.2 Community First Responder (CFRs) were volunteers within local communities who attended a wide variety of calls on behalf of the ambulance services. Call types ranged from the first ambulance service resource at a pre-hospital cardiac arrest to assisting with a care line call activation. CFRs commitment extended beyond first response, supporting local communities through community awareness sessions and providing ongoing social support for the vulnerable in local communities. In 2022/23 over 300,000 volunteer hours were provided to local communities, attending over 24,000 patients.

6.3 EEAST launched the EEAST Heart, in partnership with the East of England Ambulance Service Charity which supported the delivery of training sessions to local communities in basic life support and defibrillator awareness. Over 80 volunteers had supported this initiative. The Trust was also the first ambulance service nationally to launch the ‘staywise’ education platform. This was a free learning platform aimed at children aged 3-11 which brought together educational resources for emergency services and charities in a single platform, enabling teachers and parents to access these resources focussed on safety and prevention topics, including when to call 999. This was a national platform funded by the National Fire Chief Council and had been accessed over 3500 times with 100 EEAST colleagues registered as education advocates. It was available via all frontline operational crews iPads and EPCR devices enabling the delivery of education and prevention advice in a pre-hospital setting.

6.4 Volunteer car drivers supported the delivery of non-emergency patient transport services, transporting patients to and from routine hospital appointments. Over the coming year, there are plans to increase recruitment to these roles alongside further volunteering roles in the service.

6.5 The Trust continued to support and expand the falls community first responders, enabling them through enhanced training and to attend non injured patients who required assistance following a fall. Teams could discharge patients from the scene with the support of the clinical advice line. In addition the Trust worked with Urgent Community Response Teams to dispatch CFRRs directly from community hubs. This enabled a swifter response to patients experiencing falls, enhancing the patients experience and care over the last year. Ongoing refresher training was provided to volunteers to maintain volunteer skills and competence. Charity funding had enabled the mobilisation of CFR cars supporting volunteers to travel further to attend life threatening emergencies and falls in more communities regardless of socio-economic demographic.

6.6 The Trust continued to increase the skills and qualifications offered to volunteers. Trainers were provided with the opportunity to undertake the award in Education and Training (AET_ and the Certificate in Assessing Vocational Achievement (CAVA) to assist them with achieving a recognised training and assessment qualification and offering invigilator training to assist with the assessments for the induction course. These training courses not only valued volunteers in providing them with the transferable skills, but also supported the capacity within the training team to deliver training and setting the standard for local training. The Trust was reviewing the volunteer role from a wellbeing perspective to support a diverse organisation. This included a focus on supporting integration through staff networks and developing roles to support colleague wellbeing. There was a wealth of volunteer expertise which could be used to support other Trust areas such as data and analytics, a register of skills and interest was being developed.

6.7 The importance of EEAST working collaboratively across the region to deliver quality patient care was recognised. As a result, the Trust had worked closely with local acute, primary and secondary care services as well as community health, mental health and social care partners within the voluntary sector. The Trust had jointly produced the Urgent Care Clinical Strategy and had established a new model for supporting lower acuity patients in partnership with Urgent Community Response teams in each ICB. This was a multi partner piece of work across all six integrated care systems. Partners included: Advanced Paramedics within Care Homes Essex Blue Light Collaboration Mental Health Street Triage (MHST) Mental Health Joint Response Vehicles Rapid Intervention Service Emergency Department Avoidance Military Co-Response

6.8 Call EEAST, the non-emergency and commercial contact centre offered a range of contact centre solutions to commercial organisations and NHS Trusts. The team had supported 80 contracts, handling more than 850,000 calls in the last year with a focus on continuing to increase the portfolio and support partners to develop customer and patient focussed services. The service provided the call handling and eligibility screening for non-emergency Patient Transport Service (PTS) as well as additional services such as virtual receptionists, bespoke inbound call handling and signposting services. The Trust had supported a range of partners within the NHS and commercial organisations such as Birmingham Community Health Care, GP surgeries, solicitors and Iceland.

6.9 Train EEAST was the Trust’s commercial training department. It had supported the training of over 5000 people in pre hospital emergency care and 999 emergency protocols. Customers and partners included businesses, NHS Trusts, police, social care, GP surgeries, airports, hotels and others. The most popular course was lifesaving interventions in the workplace. This included first aid at work, emergency first aid at work, basic life support, intermediate life support, first responder emergency care, moving and handling, police firearms medic, falls intervention training and requalification and refresher training.

6.10 The National Performance Advisory Group brought services together nationally to share best practice and showcase industry development across the NHS, enabling innovation and efficiency. The focus was to expand and enable network growth and continue to promote innovation across the NHS. As a result of structural changes in 2022/23 the National Performance Advisory group was working more closely with EEAST.

6.11 Melissa Dowdeswell, Director of Nursing (DoN) was introduced to discuss the operational and care delivery in 2022/23.

7.0 URGENT AND EMERGENCY SERVICES

7.1 The DoN reflected on a challenging environment and context in 2022/23, with more 999 calls responded to than ever before. The volume of calls presented to the emergency operating centre (EOC) was influenced by a range of factors including the time of year and seasonal variations. Often more calls were received on bank holidays and weekends as well as when there were high footfall events such as concerts or football matches or prevalence of flu. A high proportion of those calling 999 did not need an ambulance response, but did require advice, guidance or signposting to other services. On average, 10% of all 999 calls could be manage safely through the clinical assessment service ‘hear and treat’. Alternative care pathways were found for approximately 8% of cases through the ‘hear and treat’ service. This team of senior experienced clinicians was based in the EOC and operated to review cases, speak with the patient and source an alternative solution to best support the patient where needed. This alternative treatment could include a pharmacist, GP or another patient pathway in the community.

7.2 Partnership collaboration with unscheduled care services meant up to 26% of calls were assessed by the local unscheduled care hub supported by the multi-disciplinary teams, delivering care closed to the home with the ability to assess more patient information. Calls passed to unscheduled care hubs did not require an ambulance response. This had reduced the number of patients requiring clinical assessment within EEAST, enabling these patients to be assessed by their local service. A single point of contact had been established to enable all colleagues to support patients to access the right care to meet their needs. This was a 24/7 phone line which was available to all colleagues and provided the ability to refer patients to a range of different services such as diabetic education and social care teams.

7.3 Key winter planning was the drive to reduce handover times of patients at hospitals. Delays in this process had an impact on the patient and increased the time before the crew could respond to another emergency in the community. This could also impact on call handling as patients tried to call for an estimated timeframe for an ambulance, delaying other emergency calls. In 2022/23 the Trust lost a significant number of ‘ambulance hours’ due to delays in handing patients over to hospital care, which created a delay in responding to other emergencies. As a result, the Trust had worked collaboratively with regulators, commissioners and hospitals to reduce handover delays so that patients in the community had a reduced waiting time for an ambulance. As a healthcare system, the Trust continued to implement a handover escalation protocol which helped organisations to rapidly identify offloading issues and work together to accelerate care and reduce delays.

7.4 The Trust also provided a non-emergency patient transport service (NEPTS) under five separate contracts across Bedfordshire, Cambridgeshire, Hertfordshire, North-East Essex and West Essex. The service model encompassed an eligibility screening call handling and booking service known as CallEEAST, as well as some bookings via an online booking system available at numerous hospital sites across the region. For patients who were not eligible for patient transport, the Trust continued to offer advice on alternative transport options such as community car schemes, voluntary sector providers or bus and taxi services.

7.5 The planning and dispatch of NEPTS was undertaken by locality operational teams and supported patients attending essential hospital appointments for renal dialysis, chemotherapy and radiotherapy as well as routine hospital outpatient appointments. In addition, the Trust provided transfers between treatment centres and back to their place of residence following discharge. In 2022/23 the NEPTS delivered over 500,000 journeys. As the restrictions from the pandemic eased, the Trust continued to see higher than usual levels of patients who must travel alone, which demonstrated a delay in returning to business-as-usual processes with some clinics and patients favouring individual journeys which had caused challenges in meeting the levels of demand and resulting in the continued use of private ambulance provision and taxis which had increased cost associations. The focus was therefore on reviewing efficiency and maximising vehicle loading where appropriate. The Trust continued to invest in the PTS fleet, and had approval for the procurement of 96 new vehicles which would commence rollout and would deliver a significant improvement in vehicle reliability and a more comfortable journey for patients.

7.6 Staff engagement remained a key focus, with engagement events held in both face to face and remote settings. In addition networking sessions were held for peer staff groups such as discharge co-ordinators, front of house and entry level managers. These sessions were successful in ensuring teams could share best practice and develop a support network.

7.7 Trust resilience and specialist operations teams were involved in responding to and helping EEAST in preparation for the potential of an untoward, adverse or serious major incident or terrorist attack. The team engaged in local resilience meetings and COVID learning events which helped ensure the Trust was better prepared to respond to a future pandemic. In 2022/23 resilience managers attended just under 1000 local resilience forum meetings with partner agencies, whilst also attending over 600 Safety Advisory group meetings to support event and learning from cases such as the Manchester Arena Enquiry.

7.8 The Hazardous Area Response Team (HART) responded to patients requiring medical care in any hazardous environment, as well as support ambulance crews to attend to patients in hard-to-reach areas or where multiple clinicians were required. This included responding to patients in and around water, heights and confined spaces.

7.9 The DoN introduced Kevin Smith, Director of Finance (DoF) to discuss the Trust’s resources.

8.0 OUR RESOURCES

8.1 The Trust continued to embed environmental sustainability across EEAST, using its influence with partners and suppliers. Increasingly, colleagues were interested in working in a more sustainable way. This had led to the green champions network which supported activity across the Trust to achieve the Green Plan. This was supported by non-executive director, Julie Thallon who was also Net zero lead to support full Board oversight. The sustainability strategy was updated and continued to be reviewed to ensure it steered the transformation needed to meet net zero targets. The Trust had new statutory duties relating to net zero and environmental sustainability through the Health and Care Act 2022. Fleet was an important aspect for sustainability. Since 2019 fleet emissions reduced by 24% since the 2019/20 baseline exceeding the 15% emissions reduction target for fleet. This was as a result of the move from Mercedes double staffed ambulances to lighter and more fuel-efficient Fiats, a reduction in fleet vehicles and vehicle decarbonisation through the rollout of hybrid and electric vehicles.

8.2 The Trust was part of the NHS England electric vehicle trial called Zero Emission Emergency Vehicle Pathfinder Programme, the Trust had purchases two Skoda Enyaq iV 80 RRVs and one Vauxhall Vivaro-e mental health/falls van as well as five 22kW dual chargers and one 50kW rapid charger which would be installed on Bedfordshire Fire and Rescue Services’ premises. Monthly Entonox usage data was received from our supplier which enabled the Trust to measure nitrous oxide emissions (which totalled 1,727 tCO2e in 2022/23). This was a 7% reduction on the 2019 - 2020 baseline. The reason for this reduction may be due to increased patient numbers during COVID periods. The Trust had also provided data for the 2023 Greener NHS Fleet Data Collection, the first time ambulance services had been included in this national collection that supplies data for the NHS carbon footprint.

8.3 Arcadis consulting was utilised to support the development of the Trust’s electric vehicle infrastructure, with 27 mobile dual electric vehicle chargers purchased located at sites across the Trust. This provided the flexibility to trial electric vehicle charging prior to installing affixed infrastructure. In addition a charge point management system was procured alongside RFID cards for fleet usage to support decarbonisation. The system included an app which enabled the Trust to offer electric vehicle charging for staff vehicles, collecting payment for electricity used.

8.4 The Trust had worked with Circular Computing to procure re-manufactured laptops rather than new, this was a BSI kitemark certified remanufacturer and certified caron neutral organisation. In 2022/23, the Trust procured 762 remanufactured devices which provided considerable environmental sustainability benefits. For each laptop purchased, the company also planted five trees in partnership with WeForest, meaning 3810 trees were planted on behalf of the Trust. Other initiatives included the progression towards a net zero IT waste to landfill, and reducing the power consumed by IT equipment by maximising smart software to remotely shut down PCs when not in use. The Trust had procured a high proportion of sustainable remanufactured devices which enabled a lower carbon footprint, with all packaging and old assets returned for recycling and remanufacturing at the end of their useful life.

8.5 During 2022/23 the Trust invested £10.4m in capital assets: • £2.9m on IT towards the electronic patient care record (ePCR), data lake, malware protection and frontline digitisation projects. • £5.5m invested in building projects. This was for the development of existing sites, for station refurbishments and for our electric vehicle charging infrastructure. • £1.6m was invested in new vehicles including double staffed ambulance (DSA) chassis, welfare vehicles and resilience vehicles. • £0.4m was invested in training equipment. • The Trust received capital investment of £1.4m to support both digital projects and the ambulance replacement programme. • We disposed of one aged station site, Corringham, relocating the provision of this locally. This generated capital receipts of £0.1m.

8.6 Tom Abell, Chief Executive Officer (CEO) was introduced to discuss the Trust’s priorities moving forward.

9.0 OUR PRIORITIES

9.1 The year had proven challenging but continued to see significant progress within the ambulance service, which was testament to the dedication and exceptional efforts of all of the Trust’s people. These people were at the heart of the service, demonstrating their commitment to saving lives and providing compassionate care in a truly extraordinary manner. The CEO extended his thanks to the talented colleagues and volunteers.

9.2 Reflecting on the accomplishments of 2022/23 it was vital to acknowledge there remained further work required to ensure the Trust was delivering its vision and values. These challenges were eminently surmountable and should be used to inspire the Trust to continually improve, whilst maintaining the commitment to provide exceptional care at the heart of what we do.

9.3 The recognition received from the care Quality Commission (CQC) highlighted a ‘marked improvement’ in several areas of concern raised in previous reports and reflected the collective determination to sustainably address the issues faced. Whilst acknowledging the improvements made it was recognised there remained further work required.

10.0 QUESTIONS FROM THE PUBLIC

10.1 There were no questions from the public.

11.0 CLOSING ADMINISTRATION

11.1 The TC extended his thanks to all colleagues who continued to focus on responding to patients needs and delivering the best possible care during their time in need.

11.2 There was no other business and the meeting closed at 15:15.