In Public Board Minutes - July 2024

PUB24/07/1 WELCOME

1.1

The meeting commenced at 09:30

1.2

Mrunal Sisodia, Trust Chair (TC) welcomed those present to the Public Board meeting of the East of England Ambulance Service Trust (EEAST). He advised that questions received from the public to OCE.EEAST@eastamb.nhs.uk would be addressed at the end of the meeting.

PUB24/07/2 APOLOGIES FOR ABSENCE

2.1

Apologies were received from:

• Wendy Thomas, Non-Executive Director
• Julie Thallon, Non-Executive Director
• Shiraji, Associate Non-Executive Director
• Kate Vaughton, Director of Integration and Deputy CEO

PUB24/07/3 DECLARATIONS OF INTEREST

3.1 There were no new interests declared.

PUB24/07/4 VOLUNTEER AND PUBLIC ENGAGEMENT STORY

4.1

Rachel Morris, Head of Patient Experience (HoPE) and Rhys Hibbert (RH), a representative of the Trust’s Community Engagement Group (CEG), joined the meeting.

4.1.1

Simon Chase, Chief Paramedic and Director of Quality (CP-DoQ) introduced a volunteer and public engagement video that demonstrated the importance of volunteers to the organisation. He thanked the volunteers and Patient and Public Involvement team for their contribution to the video; highlights included:

4.1.2

Benefits obtained from volunteering:

• Enjoyment through educating the public about the available pathways for non-emergency care and how to avoid ill-health, particularly with older populations.
• Pride and satisfaction in the knowledge that volunteers helped the ambulance service and promoted its work within the community.
• Contributing to the evolution and development of EEAST.
• Good patient and public engagement saved lives, removed barriers, and inspired young people to work for the ambulance service.
• Volunteers represented EEAST within diverse and geographically remote communities.
• The progression of Community First Responders (CFRs) from volunteers to staff.
• Increased collaboration and co-production was welcomed.

4.1.3

Challenges faced:

• The increasing focus on public engagement presented a challenge for the Patient and Public Involvement team who had limited capacity and resources to provide opportunities and meet the needs of everyone who wished to be involved.
• There was no abstraction for staff volunteers; activity was undertaken outside of work hours.
• It was difficult to access fully-equipped ambulances or rapid response vehicles for school visits.
• Volunteers were spread in considerable numbers across the whole region but there was a lack of equipment.

4.1.4

Recommended improvements:

• Funding for the basics.
• Joined-up thinking.
• Integration of the patient and public collaboration to enhance the workforce.
• Recognition of the power generated through public engagement.

PUB24/07/5 VOLUNTEERING AND PUBLIC ENGAGEMENT AT EEAST

5.1

The Board received and considered the Volunteering and Public Engagement at EEAST presentation. The HoPE shared the following highlights:

5.1.1

• EEAST engaged with the public in many different ways and was very dependent upon its volunteers for much of this engagement (Community Engagement Groups, Community First Responders and staff volunteers); EEAST had a responsibility to support all of its volunteers.
• To increase resources and transparency when engaging with the public, EEAST planned to work with HealthWatch and the Integrated Care Systems (ICSs) to undertake a review of the Unscheduled Care Hubs.
• The 2025-30 Strategy development consultation was delayed due to the pre-election period; time had been allowed for face-to-face public engagement and for the recent patient voice to be heard.
• The patient voice was currently positive, but there were areas of dissatisfaction.
• Patient and public engagement was invited on specific projects to better understand people’s needs.
• More diverse communities would be engaged to understand their particular needs.
• Work was ongoing to support and increase the impact of volunteers and the volunteer voice within the organisation.

5.1.2

RH reported that EEAST was the only ambulance service with a CEG and the patient voice was heard through many different mediums: from those in clinical roles, engagement at public events and schools, and networking with ICBs, HealthWatch and other NHS Trusts across the region. The CEG engaged with front-line staff, providing an opportunity for data collection and feedback through critical friend analysis, they were involved in policy reviews and were able to scrutinise and review complaints with impartiality. They were also able to support staff well-being through mentoring, and help to re-educate the public and change opinions through positive messaging. RH requested more support and time from Board members; he considered it essential that they work together with the CEG to deliver the workplan and make EEAST the best ambulance service in the UK.

5.1.3

The TC thanked the HoPE and RH for a powerful presentation which offered both support and challenge; he confirmed that the issues raised were regularly discussed by the Board. He thanked the CEG for their continued hard work and asked them to tell the Board what was working at EEAST and what it was getting wrong; he noted the plea for more support. It was important that the Board should hear the diverse voice of the public across the East of England, those that were disadvantaged either socially, ethnically, geographically, by age or special condition; he welcomed updates from this work. Furthermore, the Board needed to know what EEAST was doing with this diverse voice, how it was influencing and changing decision-making; this should be embedded within and across the organisation going forwards. The TC asked that a proposal be submitted to formalise CEG involvement at group, Committee and Board level, to ensure that the patient and public voice was heard.

5.1.4

George Lynn, Non-Executive Director (NED-GL) recognised the enormous support offered by volunteers and proposed that NEDs could support this work through attendance at public engagement events.

5.1.5

Dr Hein Scheffer, Director of Strategy, Culture and Education (DoSCE) stressed the importance of not rushing the 2025-30 Strategy development as engagement with the public and patients was essential to this work. He added that the Trust was working with NHSE on the Volunteer to Career pilot programme which offered CFRs a career pathway to paid employment with EEAST.

5.1.6

Dr Simon Walsh, Medical Director (MD) reflected that the good and important work undertaken by volunteers had become part of the Trust’s core business; he agreed that the Board should support this work.

5.1.7

Chris Brook, Non-Executive Director (NED-CB) noted the decline in patient satisfaction around the Trust’s change in approach and delivery; he asked the Board to consider how this was communicated to the public through the Strategy development work. The CP-DoQ replied that a lot of work was being undertaken around the new EEAST website and educating the public; simple language and support was needed that would translate across all communities. Responsibility for this messaging sat with the staff and volunteer workforce. He added that, although the presentation had clearly demonstrated the value of the Trust’s volunteer workforce, the support that volunteers gave to EEAST staff and, indirectly, their patients was invaluable and should not be overlooked.

The Board noted the report.

ACTION: Rachel Morris, Head of Patient Experience (HoPE) to submit a proposal to formalise CEG involvement at group, Committee and Board level, to ensure that the patient and public voice was heard and embedded at all levels throughout the organisation.

PUB24/07/6 TRUST CHAIR AND NON-EXECUTIVE DIRECTOR’S REPORT

6.1

The Board received and considered the Trust Chair’s report which offered a summary of the work undertaken by the TC and Non-Executive Directors (NEDs) in the past two months; this was closely aligned to the Trust’s priorities, identified risks and strategies. The TC addressed the key points:

6.1.1

• Tom Abell had resigned from his post as Chief Executive Officer (CEO) in May. The Trust had engaged with staff, patients and the public prior to commencing an open recruitment campaign for a new CEO; this engagement would continue throughout the recruitment process. Interviews were planned for week commencing 15 July.
• Although considerable work had been undertaken, performance remained too variable for Board assurance. Work was therefore ongoing to address this, with particular focus on response times.
• Work was progressing on the initial stages of the Connected Planning project to review and better understand the available data and connectivity between activities.
• 2025-30 Strategy – the Clinical, Workforce and Sustainability strategies were being refreshed in consultation with staff and the public so all EEAST strategies would run for 5-years to 2030.
• The annual Fit and Proper Persons assessment for the Trust Board had been submitted to NHS England.

6.1.2

The DoSCE reflected that the high number of applications received for the CEO post was indicative of the advancements made by the Trust in recent years.

The Board noted the report.

PUB24/07/7 CHIEF EXECUTIVE’S REPORT, INCLUDING FREEDOM TO SPEAK UP (FTSU) QUARTERLY REPORT

7.1

The Board received and considered the CEO’s report. Tom Abell, Chief Executive Officer (CEO), provided an update on the following key points:

7.1.2

• Implementation of the CQC’s Single Assessment Framework was being monitored by the Continuous Improvement Group.
• The departure of EEAST’s Freedom to Speak Up (FTSU) Lead Guardian had presented an opportunity for the Trust to consider the future of the FTSU service. The Guardian Service, an external partner, would deliver an independent, impartial and trustworthy service, providing 24-7 cover from 01 August 2024. Quarterly updates would continue to be submitted for Board assurance.
• Congratulations were extended to five Advanced Practitioners upon completion of their Level 7 education.
• The first Southern Ambulance Collaboration workshop was held on 07 June; this was an exciting opportunity for EEAST.

7.1.3

Catherine Glickman, Non-Executive Director (NED-CG) reported that she had met with the Chief Executive of The Guardian Service and was impressed with the dedicated support that would be offered by the two EEAST FTSU Guardians; they would build a relationship with EEAST staff, on the ground, and would hold the organisation to account.

The Board noted the report.

PUB24/07/8 MINUTES OF THE PREVIOUS MEETING

8.1

The minutes of the meeting held on 08 May 2024 were approved as an accurate record.

PUB24/07/9 MATTERS ARISING AND ACTION TRACKER

9.1

The TC was assured that all outstanding actions would either be addressed within the meeting agenda or were ongoing.

PUB24/07/10 PERFORMANCE, RISK AND GOVERNANCE

10.1

Integrated Performance Report (IPR). The Board received and considered the Integrated Performance Report.

10.1.1

Melissa Dowdeswell, Chief of Clinical Operations (CCO) provided an update on Operations:

• New ambulances were arriving each month, with several already on the road.
• Performance metrics showed sustainable but fluctuating improvement. The movement of Emergency Operations Centre (EOC) call-handlers into the wider organisation was excellent for career pathways but impacted negatively on performance metrics.
• EOC Hear & Treat rates were improving with the arrival of new staff to the clinical assessment service. Further changes to resolve technology issues would continue for 12-18 months.
• Improvement was needed in both C1 and C2 performance; high impact actions had been identified in the Operational Performance Improvement Plan (OPIP).
• Response times:
  • A 6% growth in demand was recorded in May and June, higher than the expected 3%; this had a significant impact on delivery.
  • Clinical Workforce Plan – recruitment was on target but new staff were not as productive as existing, more experienced staff.
  • Learning and education was ongoing for new and junior staff; the workforce effective target for new staff was 12-weeks.
  • Private Ambulance Services (PAS) – averaging 5,000 hours per week.
  • Overtime – on target at 6,000+ hours per week.
  • Hospital hand-over delays (more than 15-minutes) – the maximum target of 2,000 hours, shared across all regional A&Es, had been achieved for the first time during the week commencing 01 July.
  • Job cycle time and on-scene time – target 41 minutes conveyed and 1 hour 7 minutes non-conveyed (currently 46 minutes and 1 hour 11 minutes).
  • Vehicles Off-Road (VOR) had reduced over a four-month period from 6,000 to 2,900 hours. Improvements were being made, aided by the arrival of new ambulances to replace the aging fleet.
• Some issues could not be addressed as they were beyond EEAST’s control. The Trust was, however, working with digital colleagues to link the available data in order to better understand the information behind the data.

10.1.1.1

In response to a question from NED-GL, the CCO confirmed that the increase in demand was tracked month-on-month, and planning for Winter 2024-25 would be re-forecast if the upward trend continued. Increased demand was reported by all ambulance services.

10.1.2

Marika Stephenson, Director of People Services (DoPS), highlighted the main points for People Services:

• Staff turnover – the downward trend continued; currently 8.81%.
• Sickness absence – continued to decline; currently 7.67%.
• Employee Relations (ER) – the number of new cases was again increasing with 33 new cases recorded in June. 85% of cases were closed within the agreed timescale in May (above target). There had been a decrease in suspensions (from 17 to 13), the lowest in some time. Many of the new cases were disciplinary and had resulted from improved leadership training.
• Workforce Plan (Time to Lead) – 36 Local Operations Managers (LOMs) had been appointed and would start in post the following week; a two-week intense training programme would follow. Recruitment had commenced to the Team Leaders role.

10.1.3

Dr Hein Scheffer, Director of Strategy, Culture and Education (DoSCE) provided an update on Strategy, Culture and Education:

• A gradual and continued increase was noted in the Disability and BME figures.
• Although mandatory and clinical skills training were on target at 85%, completion of mandatory training had reduced in recent months.
• Appraisals – a slight improvement was recorded but completion was below target at 65.7%. The Learning and Development team were developing a “how to deliver a good appraisal” guide for managers. Further improvement was expected by September 2024 when the new Team Leaders would be in post.

10.1.3.1

NED-GL noted the four key areas of focus highlighted within the paper, however, the impact of these figures on the delivery of key priorities was unclear; the data appeared to affect different outcomes. He enquired about the relationship between the drop in staff turnover and priorities. The CEO replied that the Trust was reviewing data differently to better understand how the underlying contributing measures were affecting output. The CCO added that the reduction in staff turnover impacted positively on patient-facing staff hours (PFSH), however the organisation was not able to demonstrate this impact from the available data.

10.1.3.2

Jo Cripps, Interim Director of Corporate Affairs and Performance (IDoCAP) explained that the Connected Planning project was still in its early stages, and the impact on PFSH could not yet be determined. There was still considerable work to be undertaken, however, if the key assumptions around operational performance improvement were accurate, the Trust should be able to deliver the trajectories agreed with its regulators.

10.1.3.3

The TC agreed that a line needed to be drawn between the underlying assumptions and enablers around performance, and how they interacted to deliver performance; it was a learning and iterative process.

10.1.3.4

In response to a question from the TC, the CCO confirmed that the EOC Hear & Treat team was carrying 39 vacancies. Staff turnover and sickness was higher within this team, but high turnover was normal within ambulance service call centres. She advised that a recruitment campaign had been completed and start dates agreed. The TC requested a higher level of scrutiny and planning between the EOC statistics and performance.

ACTION: CCO to ensure there was increased scrutiny and planning between EOC statistics and performance.

10.1.4

In the absence of Kate Vaughton, Director of Integration, the CEO provided an update on Integration:

• Work was ongoing to address the staffing of the Unscheduled Care Hubs; the Trust was committed to employing one member of staff within each hub, in addition to the Advanced Practitioners.
• Steps had been taken to mitigate the financial risk around the Patient Transport Service (PTS) and the position had stabilised.

10.1.5

Simon Chase, Chief Paramedic and Director of Quality (CP-DoQ) and Dr Simon Walsh, Medical Director (MD) provided an update on Clinical Quality and Safety:

• Quality indicators remained strong for care bundles, well above the national average; this position had been maintained for 9-months.
• 67% of registrants had attended the new Level 3 Safeguarding training, a face-to-face webinar delivered by the Safeguarding team (80% target by September 2024).
• Level 1 Safeguarding training (eLearning) undertaken by all staff, including volunteers, had dropped to 1% below the 90% target. All other mandatory Safeguarding training was above target.
• A decrease was noted in the number of complaints received during May 2024, and 60% were closed within the agreed timeframe; further improvement was required. Only one complaint was referred to the Parliamentary and Health Service Ombudsman (PHSO) in the rolling 12-month calendar year.
• The first thematic review had been completed since the introduction of the Patient Safety Incident Response Framework (PSIRF) in October 2023; this addressed the failed recognition of STEMIs. 41 cases were reviewed by the Patient Safety team over a 12-month period, alongside 250 questionnaires sent randomly to clinicians. Three areas of focus were identified: human factor, mis-interpretation of ECG, and decision-making. Continued professional development was subsequently offered to clinicians, and a Clinical Supervision Model introduced with the ambition of having 40 Clinical Supervisors across the Trust. Patients and their families were being involved within the thematic review process and the next review into non-conveyance would include family involvement.

10.1.5.1

The MD reported that, although improvements in handover delays had been recorded, too many hours were still being lost. EEAST was learning from the London Ambulance Service (LAS) who had introduced a programme to reduce handover delays to 45-minutes across the London region in 2023. The LAS had engaged with its ICBs to improve flow, enabling ambulances to wait at an Emergency Department (ED) for 45-minutes then hand a patient over and leave. Although this had placed increased pressure on the EDs, the LAS had successfully implemented the 45-minute handover. EEAST was liaising with its six ICBs to see if a similar process could be introduced across the East of England to reduce the long delays that caused severe harm. The Board was reminded that the national standard for the handover of patients was 15-minutes.

10.1.5.2

The TC concluded that this was part of the risk appetite discussion, both for EEAST and the ICBs; a balance was needed across the region.

10.1.6

Kevin Smith, Director of Finance (DoF) delivered a Finance update:

• The 2023-24 Annual Report and Accounts were submitted; a small surplus was reported.
• 2024-25 year (month 2) – finances were ahead of plan; a minor error was noted in the report: the Trust surplus was £1.18m. Draft month 3 position was break-even.
• Cost Improvement Plan (CIP) – the requirement had been met through non-recurrent underspend; Finance and Sustainability Committee was monitoring the ongoing risk.
• The overspend variances included PTS which had stabilised in month 3. Fleet and Operations Support had also overspent; action had been taken to recover the position.
• Capital spend was on target; the Executive team was reviewing the best use of the available capital.
• The reported reduction in cash was temporary and related to the flow of money from the NHS; this was not an area for concern.

10.1.6.1

With regard to non-recurrent savings, NED-GL enquired about the conflict between targets and the performance plan. The DoF replied that insufficient resource was available to meet all the targets, and any savings realised through the planned productivity efficiencies would be reinvested to improve PFSH; the organisation’s priority was patient safety.

The Board noted the report.

10.2

Modern Slavery Statement

10.2.1

The Board received and considered the annual Modern Slavery Statement which all NHS organisations were required to submit. The DoF appraised the Board of the changes that had been incorporated to reflect the introduction of the Procurement and Social Value Acts; these would impact on suppliers through the tender evaluation process.

The Board approved the Statement.

10.3

Data Protection and Security Toolkit submission

10.3.1

The Board received and considered the annual Data Protection and Security Toolkit submission which all NHS organisations were required to submit. The IDoCAP reported the initial submission as “not meeting the standards” due to procurement issues with a system that logged issues and records in the event of cyber-attack. Following discussion with NHSE, it was agreed that this should change to “approaching standards” with a 6-month improvement plan to allow time for procurement. Cyber-security had become an area of increased focus and risk, and an urgent review was needed following the recent attacks in London. Board assurance was required, and Omid Shiraji, Associate Non-Executive Director (NED-OS) would support this work.

The Board ratified the return.

PUB24/07/11 OBJECTIVE 2: PROVIDE OUTSTANDING QUALITY OF CARE AND PERFORMANCE

11.1

CQC Quality Improvement Plan – Progress Report

11.1.1

The Board received and considered the CQC Quality Improvement Plan Progress Report which showed the progress made against the MUST Dos and SHOULD Dos since the CQC core inspection in 2022.

11.1.2

The CP-DoQ reported the following points:

• 56 of the remaining 69 actions (initially 176) had been completed, with 13 still in progress. Two further MUST do actions (3.2 Culture and Talent Management, and 6.1 Oversight) had been recommended for completion.
• A significant amount of work was being undertaken to address the outstanding MUST dos, and the inspectors were re-assured by the progress made.

11.1.3

The DoSCE advised that 3.2 and 6.1 had been reduced to 30% completion. The implementation of a digital appraisal tool and management training would support talent management and, although progress had been made in recent years, a lot of work and time was needed to embed culture change.

11.1.4

The TC noted that two years had passed since the CQC inspection; the Board required a clear explanation for the open MUST dos and evidence of sustainable change. The CP-DoQ accepted these comments and re-assured the Board that the next report would focus on the narrative around the open actions and measure the progress made against the original MUST dos.

11.1.5

NED-GL asked if an independent review was undertaken when an action was closed? The CP-DoQ confirmed that the evidence requested was submitted to the regulator; this included internal challenge and self-assessment.

The Board noted the report.

ACTION: CP-DoQ to ensure that the next CQC Quality Improvement Plan progress report provided the Board with a clear explanation for the open MUST dos and evidence of sustainable change.

11.2

Quality Governance Committee Assurance Report

11.2.1

The Board received and considered the Quality Governance Committee (QGC) assurance report. NED-CG (Committee Chair), addressed the report highlights for the meeting held on 24 June 2024:

11.2.2

• Quality Metrics – with the exception of STEMIs, the ACQI performance was above the national average.
• Overlap between QGC, Performance and Safety Committee, and People Committee remained an issue; the Committee Chairs were working with the CP-DoQ and CCO to address this.
• PSIRF – three themes had emerged from the first bi-annual review: missed STEMIs, non-conveyance and PTS injury. The Committee was assured that rigour had been applied to the process, and it would receive the approved reports that resulted from each thematic review. The definition of harm had changed with the introduction of PSIRF to “actions that may have contributed towards”. The MD confirmed that there had been no increase in the number of fatalities recorded since the introduction of PSIRF, but the number of recorded incidents had increased.
• The Patient Experience team was asked to engage with the ICBs and HealthWatch to access data collected from their communities.
• PHSO Complaints Framework – the Committee agreed to the full recording of complaints, where every concern would be logged as a complaint under the new framework.
• Task & Finish Group – the Committee noted that some of the recommendations made by the Independent Reviewer in April 2023 had been overtaken by time and other actions; progress would continue to be monitored.
• Implementation of Corpuls software – roll-out had commenced; impact report requested for September 2024.
• Clinical Audit Annual Report – fully completed for the first time in 10-years; verified through internal audit.
• Board Assurance Framework – risks remained high.

11.2.3

The DoPS questioned the referral of CFRs and the increased use of volunteer capacity to People Committee. NED-CG explained that QGC had debated with which Committee this remit should sit. The TC determined that the Committee Chairs should discuss offline.

The Board noted the report.

11.3

Performance and Safety Committee Assurance Report

11.3.1

The Board received and considered the Performance and Safety Committee (PASC) assurance report. In the absence of Julie Thallon, Non-Executive Director and Committee Chair, NED-CG addressed the report highlights from the meeting held on 26 June 2024:

11.3.2

• Performance metrics were improving, however C2 response times, hospital handover delays and EOC sickness levels remained a challenge.
• Safety metrics were reviewed to determine which should be reported to and monitored by PASC.
• The Fleet Availability Improvement Plan was well received by the Committee; notable progress had been made in both service and support. PASC would continue to monitor.
• Concern was expressed around the analytics that supported the Transformation Programmes.
• Patient Transport Services (PTS) – the ICBs were asking more of the Trust than it was able to deliver; there was strong support for co-creation. Escalated to the Trust Board for review.
• Integration – inconsistent improvement was noted in the Unscheduled Care Hubs; staffing remained a challenge.

The Board noted the report.

PUB24/07/12 OBJECTIVE 1: BE AN EXCEPTIONAL PLACE TO WORK, VOLUNTEER AND LEARN

12.1

Disability Support Network: Calibre Awards Story

12.1.1

The Board received and considered the Disability Support Network Calibre Awards Story. Dean Nock, EOC Retention, Health and Wellbeing Lead (DN) and Liam Walker, Senior EOC Manager (LW) joined the meeting.

12.1.2

DN outlined the purpose of the Calibre Awards, his employment history and interview experience at EEAST. Diagnosed with complex PTSD as a result of traumatic front-line work, DN had used the Calibre programme to develop his career at EEAST. However, a neurodiverse condition and PTSD symptoms adversely affected his interview experience. DN applied for three jobs internally to EEAST and received differing responses to his request for reasonable adjustments to be made at interview. He then challenged the Trust to remove the barriers that were preventing himself and others from progressing their careers and pushed for EEAST to become a gold standard Disability Confident employer.

12.1.3

Changes were subsequently made to the recruitment and interview process that removed the barriers for disabled applicants. In 2021, only 8.78% of disabled applicants were shortlisted for interview; this increased to 13.52% as a result of Calibre. 13 disabled staff were employed by EEAST in 2020; this number had since increased to 192. EEAST was the first Trust to receive the British Dyslexia Associate (BDA) bronze accreditation and was on target to achieve both silver and gold. It had a Workplace Needs Assessor to support staff at the start and throughout their employment journey, and a Reasonable Adjustments Lead.

12.1.4

In April 2024, DN had commenced an apprenticeship in Health and Care Management at Arden University; he was comfortable at work and felt supported by his line manager and senior staff.

12.1.5

The DoSCE congratulated DN on his inspiring journey and achievements within the Trust. The Calibre programme and Awards had demonstrated the talent that was available within the organisation; he was pleased to note that the recruitment process had been overhauled to accommodate applicants with disabilities.

12.1.6

The TC thanked DN for sharing his story with the Board. He acknowledged the benefit to the organisation in achieving the full talents from all of its staff, and challenged the EDI team to obtain full accreditation at the highest level for EEAST as a Disability Confident employer.

ACTION: DoSCE and EDI team to pursue Gold-standard accreditation for EEAST as a Disability Confident employer (referred to People Committee).

12.2

People Committee Assurance Report

12.2.1

The Board received and considered the People Committee assurance report. In the absence of Wendy Thomas, Non-Executive Director and Committee Chair, NED-GL provided the following update from the meeting held on 15 May 2024:

12.2.2

• Continued excellent progress was recorded across all People metrics.
• Sustained improvement was noted in the NHS Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) 2023-24 annual submission; the Committee requested that WRES and WDES be incorporated into one overall Inclusivity Plan.
• The LGBT+ Network Chair presented an update; the great work undertaken by the group was noted.
• BME survey results – 93% of questions showed improved scores, and 78% of respondents felt that the initiatives made in the last year had a positive impact on culture.
• The 2023-24 Gender Pay Gap had reduced from 11.5 to 7.4%
• The 2023-24 Ethnicity Pay Gap was unchanged; actions were identified to address this within the Inclusivity Plan.
• The apprenticeship training quality was 40% above the national average.
• The Committee Chair was encouraged by the progress and positivity reflected in the reports.

12.2.3

The DoSCE advised that NHSE supported the proposal of a single Inclusivity Plan, incorporating all aspects of EDI. Good progress had subsequently been made and a draft Inclusivity Plan would be submitted for review by People Committee.

The Board noted the report.

12.3

Remuneration and Nomination Committee Assurance Report

12.3.1

The Board received and considered the Remuneration and Nomination Committee assurance report. NED-CG (Committee Chair) provided the following update from the meeting held on 29 May 2024:

12.3.2

• Executive Leadership Team (ELT) appraisals and proposed objectives for 2024-25 were discussed; more information was requested on targets and measurable outcomes. The Committee agreed that the Quality Cost Improvement Programme (QCIP) should be a collective objective for ELT.
• The draft 2023-24 Remuneration Report was approved for publication with the Annual Report.
• Succession planning – larger and wider talent pools were required.
• The updated Terms of Reference were approved.
• The remuneration package for the Acting CEO was agreed.
• Director Lease Scheme – the Committee agreed to cease the current scheme; affected staff would move to a standard car allowance with the transition managed equitably.

The Board noted the report.

PUB24/07/15 OBJECTIVE 4: BE AN ENVIRONMENTALLY AND FINANCIALLY SUSTAINABLE ORGANISATION

15.1

Sustainability Strategy 2024-25

15.1.1

The Board received and considered the Sustainability Strategy 2024-25. Presented as a holding document while the longer-term Clinical, Workforce and Sustainability Strategies were developed and finalised for 2025-30, the DoSCE advised that it had been debated and supported at People Committee and Private Board. It incorporated financial sustainability, digital support, procurement, environment, estates, fleet, make-ready, medical devices and building a sustainable workforce.

The Board noted the Strategy.

15.2

Audit Committee Assurance Report

15.2.1

The Board received and considered the Audit Committee assurance report. NED-GL (Committee Chair) provided the following update from the meetings held on 15 May and 19 June 2024:

15.2.2

• Board Assurance Framework and Risk Management – the Board had agreed at the Risk Workshop in March 2024 that the Trust’s strategic risk had not changed. Eight new risks were identified, and more focus and definition was required on digital and cyber risks.
• The control and mitigation of risk was overseen by the Compliance and Risk Group (CRG) which reported into Audit Committee. Committee members expressed a desire to attend/observe CRG meetings and the four sub-groups that underpinned CRG and Audit Committee to better understand the interrogation and mitigation of risks. Three sub-groups offered reasonable assurance, one offered substantial, and there were no escalations.
• A deep-dive was undertaken into the Operations directorate risk register; 82 risks were identified; 3 keys risks were discussed in detail.
• Freedom of Information (FOI) Annual Report – the reinstatement of the EEAST website had resulted in a decrease in the number of new FOI requests received.
• Body-worn cameras – a 222% year-on-year increase in requests for the sharing of footage was noted; Information Governance Group to consider the strategic response to the increasing workload, including options for automated response.
• Financial management reports – the Losses and Special Payments, and Tenders and Waivers reports were reviewed.
• Annual Report and Accounts 2023-24 – the audit was progressing well with very few issues identified and no significant accounting changes from the previous year.

15.2.3

The IDoCAP reported that the Executive Clinical Group (ECG) had subsequently authorised Deputy Directors to sign-off FOI responses in order to streamline the process. With regard to body-worn cameras, a Trust-wide policy and guidance was being drafted. The CP-DoQ added that body-worn cameras were provided for the safety of Trust staff, to protect them from threat or aggression.

The Board noted the report.

15.3

Finance and Sustainability Committee Assurance Report

15.3.1

The Board received and considered the Finance and Sustainability Committee assurance report. NED-CB (Committee Chair) provided the following update from the meeting held on 26 June 2024:

15.3.2

• Good assurance was offered around budget management.
• Financial modelling and planning – long-term scenarios demonstrated how the Trust could reduce the £5.5m deficit. Some concerns were expressed by the Committee around the delivery of recurrent QCIP savings.
• Transformation Programmes update – Integrated Transformation Planning, Digital, and QCIP. Conversation focussed on QCIP performance and the lack of delivery; escalated to ELT.
• Sustainability – several initiatives were ongoing and progress was noted.

The Board noted the report.

PUB24/07/16 CLOSING ADMINISTRATION

16.1

Items Referred to/from Other Committees

• People Committee: DoSCE and EDI team to pursue Gold-standard accreditation for EEAST as a Disability Confident employer.

16.2

Key Messages and Risks Identified

16.2.1

The TC summarised the focus of the meeting as:

• Following a strong presentation, the public voice became a theme through several agenda items; continued focus was needed on both the staff and public voice.
• The Connected Planning project was starting to have an impact across the organisation. It was important for Board governance to review the whole picture, with a focus on impact to drive improved outcomes.

16.3

Questions received from the Public

16.3.1

1. Fleet strategic enabling plan Q. In line with the Carter Report for ambulance services, please confirm if the future purchase and replacement of new ambulances will all be of the same type/model?

16.3.1.1

A. Written in 2018, the CCO stated that the Carter Report reviewed recommendations around ambulances and provisions. She advised that EEAST operated different types of ambulance but each had a common loading list for equipment and standard practice was followed. The Trust had a mix of C1 licences and B-class vehicles, and its ambition was to move to an all-electric fleet; the current fleet was 100% diesel. Early work was being undertaken through the Southern Ambulance Collaboration to review how these resources could become more cost effective.

16.3.2

18. Make-ready strategic enabling plan Q. In line with the Carter Report for ambulance services to having make-ready resource and local Members of Parliament being informed of the continuous roll-out of make-ready resource, and the Trust having an initial strategic plan of 18 make-ready hubs. How far has the Trust moved forward with 18 make-ready hubs and what are the time-frames for make-ready hubs still to be rolled-out to that strategic plan.

16.3.2.1

A. The CCO advised that the example used in the Carter Report was from an urban area, which was not representative in the East of England. She confirmed that some smaller stations were being closed in favour of larger hubs, however, the new Bury St. Edmunds hub would open in September 2024 and none of the surrounding smaller stations would close due to the geography of the area. Make-ready was incorporated into all main hubs, but not all stations; standardisation would follow within the next 12-18 months.

16.4

Reflection on Meeting

16.4.1

The MD offered the following reflections:

• The quality of the papers was of a good standard.
• Constructive challenge had been made by the Chair and other members.
• An honest discussion had taken place around the outstanding CQC MUST and SHOULD dos.
• There had been good participation from Board members.
• The verbal Committee assurance reports were too detailed and lengthy.
• It was a supportive and respectful meeting.

16.5

Date of Next Meeting

Wednesday 11 September 2024 (09:30 – 12:30)