In Public Board Minutes - November 2024

PUB24/11/1 WELCOME

The meeting commenced at 09:30

1.1 Mrunal Sisodia, Trust Chair (TC) welcomed those present to the Public Board meeting of the East of England Ambulance Service NHS Trust (EEAST). At the invitation of the Trust Board and as part of a new initiative to improve the patient and public voice, John Newman was attending the meeting for the first time as a representative of the Trust’s Community Engagement Group, demonstrating the Board’s commitment to involving both staff, patients and the public in co-production. The TC advised that any questions received from the public to OCE.EEAST@eastamb.nhs.uk would be addressed at the end of the meeting.

PUB24/11/2 APOLOGIES FOR ABSENCE

Apologies were received from:

• Omid Shiraji, Associate Non-Executive Director

PUB24/11/3 DECLARATIONS OF INTEREST

3.1 The TC advised that he would be supporting NHS Providers with training for potential directors. No other declarations were made.

PUB24/11/4 PATIENT STORY

4.1 Simon Chase, Chief Paramedic and Director of Quality (CP-DoQ) introduced a video that addressed the Trust’s response to a serious leg injury. He thanked Mr Richard Snell for participating in the discovery interview, and acknowledged the confusion and concern that Mr Snell had experienced as a result of the call-handling process.

4.1.1

The CP-DoQ advised that an audit of the call-handling process found both the initial and subsequent 999 call to be compliant: the first was identified as Category 3 (C3), the second as Category 2 (C2) as the patient was deteriorating. He acknowledged the distress that the situation had caused to members of the public and offered assurance that good investment had been made into the Clinical Assessment Service (CAS). The service continued to expand and improve and, at times of pressure, the Trust must ensure that the best possible service was delivered.

4.1.2

Responsibility for the Emergency Operations Centres (EOCs) sat with Rachael Edwards, Deputy Chief of Clinical Operations (DCCO). She advised that five actions had been identified from this incident in relation to clinical triage:

• More staff were being recruited to support clinical navigation and validation, offering oversight of all patients waiting in the queue for an ambulance. The DCCO confirmed that Mr Snell’s call had been escalated from C3 to C2 by the clinical navigator before the second 999 call was received.
• EEAST was working with its Integrated Care Board (ICB) partners to improve access to alternative care pathways through the Unscheduled Care Co-ordination Hubs (UCCHs). This included Access to the Stack which enabled patients to be directly referred to community services, negating the need for an ambulance to be dispatched.
• Community response resources were being used to release front-line resources for emergencies.
• Advanced Practice teams were providing support to ambulance crews on the road.
• The Medical Director was leading a project to address hospital handover delays which would release more ambulances into the community and enable a faster response to emergency calls.

4.1.3

The TC asked if Mr Snell would receive the same response from the call-handling process if he made the same 999 call today? The CP-DoQ replied that the call had been escalated and reprioritised from C3 to C2 within 10-minutes of the first 999 call. Work was being undertaken to review the call-handlers’ script, and increased clinical navigation ensured quicker escalation; he assured the Board that oversight of waiting calls was improving. The DCCO added that the CAS Improvement Plan was addressing call response, and a 5-minute hold on vehicle dispatch allowed clinical staff time to undertake a quick patient assessment; if this determined that an immediate response was required, the Category would be upgraded. Cases that did not require an immediate response would go into the queue for a clinician to validate through call-back with a full clinical assessment undertaken. Early dispatch was a priority and processes were in place to clear the lines quickly when the service was busy; this included an exit script for call-handlers when under pressure which were reviewed annually as part of the Clinical Safety Plan.

4.1.4

Julie Thallon, Non-Executive Director (NED-JT) highlighted the importance of the initial 999 call and the response received. She was concerned that the audit undertaken had supported the initial C3 decision as current practice would refer the call to the UCCH, resulting in further delay. The CP-DoQ replied that the priority dispatch system was impersonal; its response was determined by the National Academy. Mr Snell had expected an ambulance to be dispatched immediately based on the information he provided; the call had been correctly coded but escalation was identified and requested. The CP-DoQ acknowledged that there was risk around Category 3-5 calls, and learning would be fed into the academy system which was reviewed annually. The DCCO added that the coding system currently used at EEAST was a call categorisation system. NHS Pathways was being introduced to ambulance services across the country; this clinical assessment system would eliminate many of the challenges currently faced.

4.1.5

Neill Moloney, Chief Executive Officer (CEO) reflected on the process and the caller’s experience. He was concerned by the generic ambulance waiting time statement and advised that there was ambition to move to a new system through NHS Pathways that would address the categorisation of patients and ensure a swifter response.

4.1.6

Melissa Dowdeswell, Chief of Clinical Operations (CCO) noted that the patient story related to call response rather than clinical response; she added that 999 calls were abrupt and could be alarming for the caller. She proposed that communication should be addressed, and offered assurance from a patient safety perspective that certain C3 calls would not be referred to the Hubs.

4.1.7

In response to a question from the TC, the DCCO advised that the CAS team should be fully staffed by February 2025.

4.1.8

The TC reflected that the ambulance service’s priority was to its patients and the public, however Board discussion had focussed on the process rather than the patient. He asked the Board to consider what could be done differently. He thanked the CP-DoQ for bringing the patient story to the Board’s attention and reinforced the importance of these stories in driving forward organisational learning and improvement.

The Board noted the report.

PUB24/11/5 TRUST CHAIR AND NON-EXECUTIVE DIRECTOR’S REPORT

5.1 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) across the region since the last meeting; this was closely aligned to the Trust’s priorities, identified risks and strategies. The TC addressed the key points:

• The Board focus was on performance and the Winter Plan, particularly patient and staff welfare.
• There was a drive to better understand operations, specifically analytical tools.
• The TC drew particular attention to three events he had attended:
  • The Stars of EEAST Awards Evening – celebrating staff and volunteers
  • Opening of the Bury St. Edmunds ambulance hub
  • Marauding Terrorist Attack exercise at Papworth Hospital

The Board noted the report.

PUB24/11/6 CHIEF EXECUTIVE OFFICER’S REPORT

6.1 The Board received and considered the CEO’s report. Neill Moloney, Chief Executive Officer (CEO), highlighted the following points:

• Category 2 (C2) performance remained a priority for the Trust. The drop in performance during September and October was driven by increased demand and a substantial increase in hospital handover times (a 100% increase since August).
• The Operational Performance Improvement Plan (OPIP) was focussed on Hear & Treat, job cycle time, and right care, first time.
• The Trust’s monthly meeting with NHS England had focussed on C2 performance; EEAST was involved in a Regional event to address the handling of emergency care.
• EEAST’s contribution to hub development.
• Bereavement – the Board’s sympathies were extended to the family and friends of Mike Sibley, a long-term EEAST colleague who had passed away in October.
• EEAST continued to work with the Southern Ambulance Services Collaboration (SASC) on three priority areas:
• Shared procurement capability
• To develop two or three cases for AI technology within the EOC to support staff welfare and patient care
• To develop an optimum model for double-crewed ambulances

The Board noted the report.

PUB24/11/7 MINUTES OF THE PREVIOUS MEETING

7.1 The minutes of the meeting held on 11 September 2024 were approved as an accurate record, subject to two typographical corrections.

PUB24/11/8 MATTERS ARISING AND ACTION TRACKER

8.1

PUB24/02/9.1 – Integrated Performance Report (IPR) Executive team to provide the Board with detailed and digestible intelligence at a more local-level to inform the Trust’s longer-term strategy and empower local managers.

8.1.1 Dr Hein Scheffer, Director of Strategy and Transformation (DoST), advised that the OPIP and IPR were being linked, and automating the consequence and impact of negative and positive movement on the organisation was being explored. A draft dashboard had been generated, encompassing both the IPR and PA Consulting recommendations. Good progress had been made and the work was on target for completion in December 2024.

8.2

PUB24/07/12.1 – Disability Support Network – Calibre Awards Story Director of Strategy, Culture and Education and EDI team to pursue Level 3 (Gold standard) accreditation for EEAST as a Disability Confident employer.

8.2.1 The DoST recognised the work that had been undertaken for the Trust to become a Level 2 Disability Confident employer; he anticipated that the ambition to achieve Level 3 (Gold) standard would take a further 12-18 months. Discussed in detail at People Committee, the Inclusivity and Education teams were working towards EEAST becoming the first ambulance service to achieve the Gold standard. The DoST recommended that the Public Board action be closed. Action closed.

8.3

PUB24/09/9.1.1.6 – (IPR) People Services – Sickness Benchmarking The Trust Chair requested that benchmarking be undertaken against the NHS and other ambulance Trusts for both sickness and Duty Sick absence.

8.3.1

Marika Stephenson, Chief People Officer and Deputy CEO (CPO) advised that EEAST received data each month through the National Ambulance Service (NAS) sickness and retention programme. EEAST was currently benchmarked at 9 out of 10 ambulance services for sickness. To August 2024, EEAST was at 7.4 against an average of 6.39 (the highest was 7.6). Although sickness absence at EEAST continued to reduce, this demonstrated that further improvement was needed and the OPIP targets supported this work. Duty sick was not recorded through the NAS sickness and retention programme; EEAST was leading this work (data available from November 2024).

8.4

The Board resolved to close the following actions: PUB24/09/9.1.1.3 – (IPR) People Services – Staff Appraisal Compliance PUB24/07/11.1 – CQC Quality Improvement Plan progress report PUB24/07/5.1 – Volunteering and Public Engagement at EEAST PUB24/09/10.1.4 – Freedom to Speak Up (FTSU) Report PUB24/09/5.1 – Trust Chair and NED Report

PUB24/11/9 PERFORMANCE, RISK AND GOVERNANCE

9.1 Integrated Performance Report (IPR) The Board received and considered the Integrated Performance Report. The TC asked the Executive Directors to focus their reports on key areas of improvement and concern.

9.1.1

Marika Stephenson, Chief People Officer (CPO) highlighted the key points for People Services:

• Staff vacancy rates were improving.
• Staff turnover – the TUPE transfer of Patient Transport Services (Cambridgeshire and Peterborough) had generated a peak, otherwise the position would have improved.
• Sickness absence was at 7.57%, with mental health and anxiety remaining the highest reason for absence (this was common with other ambulance services).
• Employee Relations – fewer new cases were being reported but the volume remained high (143); additional resource had been requested.
• Appraisals – 88% compliance was achieved at 30 October. Two areas of the organisation remained below target and the Trust was supporting them to complete. The introduction of an online appraisal system would make the process easier for all, and managers were motivated to better manage appraisals in future

9.1.1.2

The TC acknowledged the achievement in reaching 88% appraisal compliance; he requested that this be sustained, and that appraisals be meaningful to staff.

9.1.2

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

• C2 performance had declined month-on-month since August 2024.
• Patient-facing staff hours (PFSH) needed to increase over the Winter; the PFSH number fluctuated from day-to-day but was rising as a result of increased staffing and a dramatic reduction in the number of vehicles off-road (12,270 per day in September 2024, compared to 11,250 in September 2023).
• Call volumes had dramatically increased, which had impacted negatively on call pick-up times. EEAST was planning for a further increase through the Winter.
• Hear & Treat numbers were improving steadily as a result of the OPIP focus.
• EEAST was working closely with partners to ensure that the right patients were referred to the Unscheduled Care Co-ordination Hubs (UCCHs).

9.1.2.1

Chris Brook, Non-Executive Director (NED-CB) enquired about the increase in call pick-up times, and if this was solely attributed to call volume? The CCO explained that there were multiple elements to this: call volume, the type of call, and the availability of call-handling staff (the latter was being addressed by increasing the number of available staff over the Winter).

9.1.2.2

The CEO acknowledged that high staff turnover in the Emergency Operations Centres (EOCs) was a challenge for the organisation. He advised that PA Consulting would undertake an external review of the EOCs to determine where productivity and performance could be improved, and the appropriate level of resource to enable EEAST to deliver it’s ambition of 95% call pick-up within 5-seconds.

9.1.2.3

The TC concluded that the Board was focussed on two key areas:

1. Its relationship and work with external partners, such as the operation of the UCCHs, and hospital handover delays; these impacted directly on EEAST’s performance.
2. Addressing the operational performance issues that were within EEAST’s control to improve, ie. increasing patient-facing staff hours, reducing the vehicle off-road rate, scrutiny of on-scene times and conveyancing; the OPIP was driving this work.

9.1.3

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

• Risk scoring for the provision of outstanding care remained stable.
• There was good focus around the monitoring of performance measures.
• Patient safety and experience – the complaints ratio had reduced, and compliance with the closure of complaints had improved; work was ongoing to improve compliance. Learning from patient safety incidents had resulted in a low re-contact rate, which was credited to the investigations being undertaken by local teams.
• The high number of complaints received for Patient Transport Services (PTS) was being addressed with local managers.
• C1 cardiac arrest – return of spontaneous circulation (ROSC) had shown improved performance with a 10% increase in the Utstein marker; this demonstrated that mandatory training compliance was positively impacting the public.
• Level 2 Safeguarding compliance was above 90%.

9.1.4

Dr Hein Scheffer, Director of Strategy and Transformation (DoST) provided an update on Strategy and Transformation.

• Patient Transport Services (PTS) – work was ongoing to better understand the value proposition in order to demonstrate the impact on C1 and C2 performance and, for those areas where PTS was not provided, the benefit of a co-designed approach. This information would be available in Quarter 4.
• Community first responders (CFRs): -The Trust was exploring the reasons for a continued reduction in the volunteer hourly rate. -EEAST needed to understand the benefit and impact of CFRs on C1 response (this data was not currently available).

9.1.4.1

The TC acknowledged the huge positive impact that CFRs had on C1 response times. John Newman, Community Engagement Group representative (CEG-JN) added that CFRs were not being deployed as frequently. Their initial purpose was to respond to C1 calls, however this had developed into a much wider scope and a greater depth of skill, knowledge and understanding was now required; the expectation in terms of competence was substantial. He proposed that this be reviewed with different levels of CFR considered, for those who were interested and had the time to commit to additional training. The TC asked the DoST to address the points raised.

**ACTION: ** Director of Strategy and Transformation, to review the purpose of Community First Responders and consider whether different levels of skill, knowledge and training could be accommodated.

9.1.5

Kevin Smith, Director of Finance (DoF) delivered an update on Finance at September, month 6 of the 2024-25 financial year:

• The financial position was satisfactory, slightly better than plan and with a surplus; this would reduce as vacancies were filled.
• There were variances around PTS and Operational Support. PTS costs were reducing although risks may increase. Plans to increase the fleet and workshop workforce should reduce costs.
• The Quality Cost Improvement Plan (QCIP) was behind but close to target; savings were non-recurrent which deferred the cost-saving problem to the 2025-26 financial year.
• Capital spend was in line with plan but under review due to projects being delayed.
• Cash was in a good position and being closely managed.

9.1.5.1

NED-JT enquired about the update of actions around residual risk. The CEO confirmed that the Executive Directors would take responsibility for robustly updating the action plans.

The Board noted the report.

9.2

Winter Plan 2024-25

9.2.1

The Board received and considered the 2024-25 Winter Plan. Discussed by the Board throughout the year, the TC advised that EEAST was actively planning and learning from previous years.

9.2.2

The CCO outlined the challenges that Winter presented: increased demand throughout both day and night-time, festivities and events, bad weather, seasonal illnesses, trips and falls, increased staff sickness. To counter this, extra health-checks were undertaken on EEAST vehicles over the Winter, and the Trust worked closely with other health organisations to understand their pressures and Winter plans in order to support one another; this was reviewed annually. There was increased use of the UCCHs throughout the Winter, and a stronger management structure was implemented to better manage hospital handover delays. There was increased emphasis on health and wellbeing during the Winter with the flu and Covid vaccination campaigns, norovirus impacted all health organisations so infection prevention and control (IPC) was enhanced; abstractions (staff annual leave and training) were minimised in order to maximise front-line availability. The EEAST Winter Plan was dynamic and regular contact was maintained with all partner organisations, enabling the plan to be adapted, as required, to meet the needs of the population.

9.2.3

Wendy Thomas, Non-Executive Director (NED-WT) asked what was being done to address the recent increase in hospital handover delays, to ensure patients safety. The CCO replied that the key issues were patient safety and those most at risk in the community who were waiting for an ambulance; the Trust had to consider patients waiting across the whole healthcare system, not just the ambulance service. Dr Simon Walsh, Medical Director (MD), added that the national standard for ambulance handovers to Emergency Departments (EDs) was 15-minutes. In recent Winters, this delay had been several hours. The Trust was working with ICB partners and acute hospitals to address this and to help drive the flow of patients through the urgent and emergency care system.

9.2.4

In response to NED-WT’s questions about recruitment to the Advanced Practitioner (AP) vacancies, and the target increase for Access for the Stack, the CCO confirmed that the budgeted number of APs had been fully recruited, although some were still in training; the Trust was reviewing how best to utilise these skilled staff for maximum effect. Secondly, it was important that C3-C5 patients were transferred to the hubs wherever possible; new targets had been agreed.

9.2.5

NED-CB enquired about the management of demand, and communication with the public at times of pressure. The CCO replied that the public should not be discouraged from dialling 999 as the triage system would determine the call response. There did, however, need to be sufficient capacity within the system to deal with the demand from the community.

9.2.6

The CEO added that it was possible to manage urgent and emergency care within a challenging environment; EEAST would work with the acutes to achieve hospital handover in 45-minutes. There was still work to do with partner organisations around the navigation of patients to the right place, first time as patients within the community was at the greatest risk; this was EEAST’s responsibility and ambition.

9.2.7

NED-JT observed that the Winter Plan was managing the situation rather than trying to do things differently. She recommended that this be more closely linked to the OPIP in order to became business-as-usual and move away from managing a crisis situation to new and different ways of working. The CEO reflected that one of the biggest challenges was the rest of the system as EEAST was part of the emergency care flow. The Trust needed a Workforce Plan to match the challenges faced in order to deliver the level of service required, while working with partners to address the problems within the hospitals. It also needed to maximise PFSH in order to deliver improved and sustained performance. NED-JT countered that the system issue would become less significant if issues internal to EEAST were managed for optimal working.

The Board noted the report.

9.3 Embedding the EEAST Values and Behaviours Framework

9.3.1

The Board received and considered the proposal to embed the EEAST Values and Behaviours Framework. The CPO reported that the Values and Behaviours Framework had resulted from the work undertaken with Clever Together and was co-produced with staff and stakeholders. The proposal comprised two parts: embedding the new values and behaviours across the organisation, and the cultural journey to ensure they were embraced by all staff at every stage of their employment. Work was ongoing to determine where within the organisation the values should feature. The DoST added that the Leadership Development Framework modules had been updated to reflect the new values and behaviours. Line managers had a responsibility to discuss them through the appraisal process, ensuring that staff were enabled and encouraged to speak out against poor values and behaviours; this would improve and shape the future culture of the organisation.

9.3.2

In response to a question from the TC regarding listening behaviours, the CPO advised that three questions within the Staff Survey addressed listening, and the metrics for each demonstrated good progress.

9.3.3

NED-WT noted the 95% satisfaction achieved from leadership training and had personally witnessed outstanding leadership skills at the recent Marauding Terrorist training; compassion, empathy, accountability and teamwork had all been demonstrated by managers across all levels. She recommended that the Trust consider external assessment of the differences made by leadership training and the introduction of the Values and Behaviours Framework.

9.3.4 The TC acknowledged the excellent and important work that had been undertaken; he agreed that embedding the Values and Behaviours Framework would positively change the organisation. To be reflected in the presentation of Board agendas and papers from December 2024.

The Board approved the proposal.

PUB24/01/10 OBJECTIVE 1: BE AN EXCEPTIONAL PLACE TO WORK, VOLUNTEER AND LEARN

10.1 Freedom to Speak Up Report

10.1.1

The Board received and considered the second Freedom to Speak Up (FTSU) report from The Guardian Service (TGS). Guardian, Danielle Marshall (DM), joined the meeting and the following points were reported:

• There was an increase in the number of concerns raised; this was attributed to the increased visibility of the Guardians around the region.
• The Guardians had received a warm welcome from staff around the region, and they were working with staff to identify solutions to the concerns raised.
• The highest number of complaints related to systems and processes: recruitment, and staff rostering.

10.1.3

Catherine Glickman, Non-Executive Director (NED-CG) noted the positive start. EEAST staff had welcomed the independent, 24-7 service; calls were being received out-of-hours, and the workload was manageable.

10.1.4

In response to a question from the CEO regarding responsiveness and the closure of calls, DM replied that not all staff wanted to formally record a concern, they might want impartial support or someone to speak to. These concerns were recorded and left open for a period of time in case the individual returned to formalise their concern. DM assured the Board that all concerns raised were monitored and managed to resolution.

10.1.5

The CPO remarked that it would be helpful for the Trust to understand the detail behind the concerns raised around systems and processes (a known and ongoing concern at EEAST), and recruitment response times, so these could be addressed. DM agreed to provide the CPO with more detail in these areas. The TC added that known concerns at EEAST were triangulated through the Raising Concerns Forum.

10.1.6

The TC confirmed that the Board Development sessions planned for 04 December would include at FTSU Workshop delivered by the National Guardian’s Office. Currently only 49% of EEAST staff felt comfortable speaking up, and 34% felt that something would be done to address their concerns; the workshop was needed to address this.

The Board noted the report.

ACTION: Danielle Marshall to provide the Chief People Officer with information behind the concerns raised around systems and processes, and recruitment response times, in order that the Trust could ensure these concerns were being addressed.

10.2 People Committee Assurance Report

10.2.1

Due to the short turn-around between meetings, it had been agreed that the People Committee Assurance Report for the meeting held on 30 October 2024 would be presented to the next meeting of Public Board.

10.2.2

NED-WT (Committee Chair) verbally raised one item for escalation:

• A report from the Men’s Wellbeing Network had highlighted the urgent need for support as men found it difficult to discuss concerns and sickness. The Network had observed the inequalities with women who were offered routine cancer screening by the NHS, and wished to investigate how EEAST might provide screening for prostate cancer; the three options proposed would all incur costs. People Committee supported this initiative and asked the Board to consider the options proposed.

10.2.3

As Executive Lead for the Men’s Wellbeing Network, the DoTS supported the proposal to offer a PSA test to all male staff. The TC confirmed Board support and asked the DoTS to investigate and report to People Committee.

The Board noted the verbal report.

10.3 Remuneration and Nomination Committee Assurance Report

10.3.1

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 04 September 2024:

10.3.2

• Interim changes resulting from a review of the Executive structure were agreed: -Director of Strategy and Transformation to assume responsibility for Integration, Partnerships and Digital. -Unscheduled Urgent Care Co-ordination Hubs were transferred to the Operations directorate. -Governance was transferred to the CEO/Chief Paramedic. -Education was transferred to the Chief Paramedic.
• The Executive Director pay award was agreed.
• Marika Stephenson’s appointment as Interim Deputy CEO was agreed.

The Board noted the report.

10.4 Community Engagement Group Involvement Proposal

10.4.1

The Board received and considered the Community Engagement Group (CEG) Involvement Proposal. The CP-DoQ explained that the proposal addressed the need for improved patient and public voice across the Trust. The Board had previously agreed to invite a representative from the CEG to attend each Public Board meeting and submit a quarterly activity report for review by the Board. The CEG also aimed to have a member attend both Quality Governance and People Committee meetings (those most relevant to the patient experience) twice a year.

10.4.2

Rachel Morris, Head of Patient Experience (HoPE), acknowledged the importance of CEG involvement to the Board and Committees. The options recommended were not the limit of the CEG’s ambition, however they were currently dependent upon on a small group of people with the skills required to support this work, and did not want to commit to something that the CEG could not deliver. These skills would over time be transferred to other CEG members, increasing the number of available skilled volunteers.

10.4.3

Stanley Mukwenya, Deputy Director of Corporate Affairs (DDoCA) advised that the Trust had a legal obligation to involve and consult with the community. He asked the Board to consider how this influence could be best utilised within the Trust’s governance framework to inform decision-making.

10.4.4

The TC shared the CEG’s ambition for increased community and patient engagement.

10.4.5

The Board noted the report and supported the proposal for CEG to be invited to attend the Quality Governance and People Committees twice yearly to provide input on patient and public experience, while continuing to attend those sub-group meetings that were most relevant to the patient experience.

10.5 Community Engagement Group Quarterly Report

10.5.1

The Board received and considered the first quarterly report from the Community Engagement Group (CEG). John Newman, CEG representative (CEG-JN) invited constructive feedback and advised that future reports would focus on outcomes. The CEG had attended several meetings to date, including the Research and Involvement Group (contributing to the submission of a grant application) and a public meeting – Stay Well for Winter. CEG-JN stated that the CEG had ambition for the future which required enhanced resources; some of those held were aged and out-of-date. He asked the Board to consider how CEG involvement could be increased across the Trust, if the request for enhanced resources could be supported, and how the Board could support CEG member recruitment.

10.5.2

The TC acknowledged the value and importance of the CEG to the Trust.

10.5.3

NED-JT recognised the significance of the CEG’s contribution and the need to consolidate and build; she offered to help and support the CEG.

The Board noted the report.

PUB24/11/11 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. The CP-DoQ reported the following points:

11.1.2

• Work continued on the MUST and SHOULD dos.
• The Datix Cloud action would be closed by the next Public Board meeting.
• C1 and C2 performance standards remained a challenge and were subject to continuous review by the Executive Leadership Team (ELT) who were confident that the due dates set were realistic and achievable.
• The report narrative explained why the MUST dos had not been closed.

The Board noted the report.

11.2 Quality Governance Committee Assurance Report

11.2.1

The Board received and considered the Quality Governance Committee Assurance Report. NED-CG (Committee Chair), provided the following update from the meeting held on 25 September 2024:

• Stroke Video Triage Project – established during COVID to avoid unnecessary conveyance and provide additional support to front-line staff, funding was in place to support this important work for the 2024-25 year only. The Committee fully supported the request for further funding.
• Patient Safety Incident Response Framework – the Committee received the first PSIRF Thematic Review into Missed STEMIs; the report was informing learning across the organisation.
• Civil Contingencies Act (CCA) – compliance had improved, however EEAST did not have the additional funds that would be needed to meet all the requirements of the Manchester Arena Enquiry; this had been acknowledged by NHS England.
• The Medicines Management Annual Report showed improvement, with tight controls in place.
• The Safeguarding Annual Report demonstrated improvement.

The Board noted the report.

11.3 Performance Committee Assurance Report

11.3.1

The Board received and considered the Performance Committee Assurance Report. George Lynn, Non-Executive Director (NED-GL) chaired the meeting on 25 September 2024 but was unable to deliver the report due to technical difficulties. The TC accepted the report as read. The Board noted the report.

PUB24/11/12 OBJECTIVE 4: BE AN ENVIRONMENTALLY AND FINANCIALLY SUSTAINABLE ORGANISATION

12.1 Audit Committee Assurance Report

12.1.1

The Board received and considered the Audit Committee assurance report. NED-GL (Committee Chair) was unable to deliver the report from the meeting held on 23 October 2024 due to technical difficulties. The TC accepted the report as read.

12.1.2

NED-WT challenged the financial loss referral; following discussion at People Committee, it had been agreed that the referral should transfer to the Remuneration and Nomination Committee.

The Board noted the report.

12.2 Finance and Sustainability Committee Assurance Report

12.2.1

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 18 September 2024:

• The Committee was assured by the Trust’s year-to-date financial position.
• An internal audit report had raised concerns regarding the controls in place around staff leavers.
• There was one item of escalation to the Board: sustainability appeared to be an area of weakness for the Trust; the Committee wanted to see stronger papers presented to the Board, and to know who was driving the Sustainability agenda.

12.2.2

The TC agreed that more focus was required around sustainability; he confirmed that a Sustainability Workshop was planned for March 2025 as part of the Board Development programme.

The Board noted the report.

PUB24/11/13 CLOSING ADMINISTRATION

13.1 Items referred to/from other committees

There were no items identified for referral to the committees.

13.2 Key Messages and Identified Risks

13.2.1

The TC summarised the focus of the meeting as:

• The impact of Board scrutiny could be seen through improvements in staff appraisal compliance, mandatory training compliance, and Hear & Treat.
• The powerful patient story demonstrated the Trust’s commitment to patient focus.
• The balance of responsibility between EEAST and system partners was evident and should be maintained.

13.3 Questions received from the Public

13.3.1

Question: Were jobs at the Emergency Operations Centre (EOC), Hammond Road, Bedford safe and, if so, when would the recruitment freeze be lifted?

13.3.2

The CEO acknowledged the importance of the question raised by staff at the Bedford EOC. He advised that a review would be undertaken into the EOCs to ensure that facilities safeguarded staff welfare, supported staff and the effectiveness of the service, but no decision had yet been taken around the number of EOCs required in the East of England, or their location. The review would take time: it must be done correctly, with the right decision made. All staff would be engaged to ensure co-production as the work progressed. The CEO confirmed that EOC staffing was being increased to support the current demand on the service.

13.3.3

The TC added that the decision about the number of EOCs required by EEAST, their location and the criteria used to inform that decision, would be undertaken by the Board.

13.4 Reflection on Meeting

13.4.1 NED-CG offered the following reflection:

• She welcomed the opportunity to visit the new Bury St. Edmunds ambulance hub.
• A powerful patient story demonstrated the need to focus on the patient, not the process.
• There was visible improvement in staff appraisal compliance.
• She commended the Operations team for the increase in patient-facing staff hours.
• Resilience was being built into the EOC.
• The financial position was stable.
• There was focus on the Winter Plan and FTSU.
• She welcomed the contribution from the CEG.
• There had been good constructive challenge.

13.4.2

The TC invited CEG-JN to share his reflection on the meeting. CEG-JN considered that progress was being made and was encouraged by the positive energy that was not previously visible.

13.5 Date of Next Meeting

Wednesday 12 February 2025 (09:30 – 12:30)) The meeting was formally closed at 12:39.