WMAS Board Meeting Minutes – Wednesday 29th January 2025

Present

• Prof. I Cumming – Non-Executive Director (Chairman) and voting member
• Mr AC Marsh – Chief Executive Officer and voting member
• Ms S Banks – Non-Executive Director and voting member
• Ms C Beechey – Director of People and voting member
• Mr M Fessal – Non-Executive Director and voting member
• Mr N Hudson – Performance and Improvement Director and voting member
• Mrs J Jasper – Non-Executive Director and voting member
• Mr M Khan – Non-Executive Director and voting member
• Mr V Khashu – Strategy and Engagement Director
• Mr S Nat – Non-Executive Director and voting member
• Ms K Rutter – Director of Finance and voting member
• Dr R. Steyn Medical Director and voting member
• Mr A Brown – CEO Chief of Staff and Head of Enhanced Care
• Mr P. Higgins – Governance Director and Trust Secretary
• Ms K Freeman – Private Secretary, Office of the Chief Executive
• Ms R Farrington – Staff Side Representative
• Mrs M Capper – Member of Staff (part of meeting)
• Mr Sarb Singh – Patient (part of meeting)
• Ms R Meredith – Paramedic (part of meeting)
• Mr J Arrowsmith – Head of Communications
• Mr M Sproston – Member of Staff
• Mr L Rowlett – Member of Staff
• Mrs E Cov – Lead Governor
• Ms S Lawson – Staff Governor
• Mr B Murray
• Mr I Syme – Member of the Public
• Ms C Tilley – Press
• Ms J Haynes – Press

Minutes

01/25/01 – Welcome, Apologies and Chairman’s Matters

Apologies for absence were received from Mr MacGregor, Mr Henry, Mrs Eyre and Professor Hopkins.

The Chairman welcomed everyone to the meeting and said we would be amending the agenda slightly and taking the patient story as the first item next.

01/25/02

Patient Story

Mrs Capper introduced Mr Sarb Singh and one of the Paramedics that attended Ms R Meredith.

Mrs Capper in introducing the Patient Story provided the Board with the background. The Board was informed that a call was received on 26 November 2020 at 07:52 hours, as the patient had breathing problems/chest pain. The call was triaged with a category 2 disposition.  An ambulance was assigned at 07:56 hours, and arrived on scene at 07:58 hours, 6 minutes after the initial call and on arrival of the crew, the patient was in visible pain, patient assessed, alert call made to Primary Percutaneous coronary intervention – PPCI, observations were stable until arrival at hospital where on arrival at Resus patient arrested twice and following an intervention by clinicians a ROSC was achieved.

Mr Sarb Singh addressed the Board and said that he was clinically dead for 45 minutes. If it had not been the swift actions of the Paramedics that attended and the initiative of the clinicians he would certainly have died.  Mr Singh said that morning he woke up clutching his chest due to pain, as a result his wife rang 999. He indicated that at the time he didn’t know, but he was suffering a heart attack. The Ambulance Service transported him to hospital but he suffered a cardiac arrest on route. However, due to the skills of the clinicians Mr Singh made a full recovery and that is why people call him miracle man, or the bionic man now, but none of that would have been possible without the paramedics in the first place.  Mr Singh stated that you can teach certain things at training and medical school, but it cannot teach you to go above and beyond and show the love and care that he felt he was given. There is not a morning that goes by when he does not appreciate the clinicians that treated him and gave him back his life. He wanted to come to Board today to thank the paramedics and the Trust. He indicated that it was his birthday and he could not find the words to thank the Paramedics and the clinicians that cannot thank them enough and he could not think of a better way to spend his birthday.

Mr Singh said he was only saved thanks to a doctor’s insistence of using a technique which was not part of national guidelines at the time. Double external sequential defibrillation, which saw two defibs shock him at the same time. Mr Singh said he had multiple organ failure and was in an induced coma and a brain scan results were not optimistic for a full recovery. The seriousness of the situation he stated was that he suffered a major heart attack and 4 cardiac arrests.  Mr Singh was resuscitated by a doctor who used a pioneering technique and that as a result his story made international headlines. Despite being clinically dead for 45 minutes, Mr Singh went on to survive a 3 week coma, brain damage, paralysis, and trauma to reclaim his life in the most impossible way.

Mr Singh said his story against all odds would not have been possible if the paramedics had not acted on multiple occasions enroute to the hospital.  Mr Singh wanted to thank them personally and also let the crew, and the entire service know that he is now a professional motivational speaker using his experiences as the basis of his talks to inspire the power of resilience and the human mind to recover.

The Chairman thanked Mr Singh for attending today to give his truly remarkable story and for the hearing about some of the work Mr Singh has been doing especially motivating young people.

Aidan Brown, The CEO Chief of Staff / Head of Enhanced Care responded to say that it was a very emotional story to listen to and he said to Ricky Meredith that the team achieved such a good outcome, the quality of resuscitation must have been extremely good.  It is important that we all do our jobs as best we can.  It was noted in particular that the procedure has now been introduced into the guidelines.

The Chairman concluded by thanking Mr Singh for sharing with the Board.

01/25/03

Declarations of Interest

There were no conflicts of interest declared by anyone attending the meeting in relation to any matters on the agenda.

01/25/04

Questions from the Public

There were no questions.

01/25/05

Board Minutes

To agree the minutes of the meeting of the Board of Directors held on 18 December 2024.    The response to the question from the Member of the public at the last Board meeting was also attached to the minutes to for the purposes of transparency.

01/25/06

Board Minute Log

The Board Log that contains the schedule of matters upon which the Board have asked for further action or information to be submitted. Matters on this log can only be deleted through resolution of the Board. (For the avoidance of doubt unless specified below all matters contained on the Board log will remain on the log until the Board resolves that the matter can be discharged).

01/25/07

Chief Executive Officer (CEO) Update

A report of the Chief Executive Officer was submitted.

The CEO advised the Board that following a Mass Casualty Major Incident (MI) Exercise the Trusts Communications Plan for a major incident was revised and improved.   The EPRR core standards were reviewed by EMB and then submitted to NHS England.

Matt Brown, Head of Risk, joined the meeting.

01/25/08

Executive Scorecard & ICS Scorecard relating to Performance for the Month of December 2024

The Executive Scorecard of Key Performance Indicators (KPIs) for the month of September 2024 was submitted.

The key indicators and trends were set out for review by the Board. The indicators covered operational performance, finance, workforce, and high-level clinical indicators. The scorecard was submitted in addition to the Trust Information Pack which contains Trust wide performance data and information and is circulated separately to the agenda.

01/25/09

Pandemic Plan 2025/26 for Approval

The Trust’s operational Pandemic Plan was submitted following review by EMB and Gold Commanders.

The CEO informed the Board that all our plans are regularly reviewed.  This was the second review of this plan which was led by the Head of EP and the Head of IP&C.   The plan was reviewed by the EMB and is submitted today for approval by the Board. 

The planned review reflected and incorporated the lessons learnt from the recent COVID-19 Inquiry.  This aligns with national and regional guidance, and incorporates improved processes for infection prevention and control, resource allocation, and stakeholder communication. The CEO explained that the major incident and pandemic plans are different.  The major incident plan relates to incidents which generally occur with no notice and are short lived.  The pandemic plan by its nature could last months or years.

Mr Fessal asked whether all NHS organisations were drawing up a Pandemic Plan or is it just WMAS.  The CEO said all organisations should have such a plan. The Chairman pointed out that the plan refers to virus although it could be bacteria and asked if this could be amended to a “pathogen”. 

Reena Farrington joined the meeting.

01/25/10

Board Assurance Framework (BAF)

The Board Assurance Framework, including Board Level Risks was submitted for review.

The Head of Risk gave an update and informed the Board that the top two risks remain at 25.  As referenced in the last report, following discussion at Board, innovation has been removed from the BAF and replaced with Cyber. Innovation will now be overseen at directorate level as opposed to inclusion on the BAF. Cyber Security resilience is part of the Data Security and Protection Toolkit (DSPT) and relevant evidence and assurances are provided via that work, as well as discussed at Digital Transformation and Oversight Group (DTOG).

Risk Tolerance Statement

The Head of Risk indicated that the highest risk at present for the Trust at present is responding to the patients waiting in the community due to crews being stuck at hospital.  We are aiming to align the risk appetite statement with our Reap Plan.  This is reflected in the risks contained in the BAF. The Board was asked to review and comment on the risks and information included and endorse the Risk Tolerance Matrix and the revised Risk Tolerance Statement.

Matt Brown left the meeting.

01/25/11

Reports of the Director of Finance

11a – Month 9 Financial Update

The Month 9 Financial Update was submitted.

The Director of Finance gave an update and informed the Board that at Month 9, the Trust reported a surplus of £1.6M. This improvement to the reported position is as a result of the inclusion of the £10M confirmed by NHSE as a contribution to cover the cost of lost hours for the first half of the year plus invoices raised to the West Midlands ICBs for their proportion of the lost hours to the Trust.  In month 9 the Trust has undertaken an accounting adjustment to reclassify the property at Navigation Point as an asset held for sale. As a result, the value of the property has been impaired by £0.9M in line with the marketed value.

CIPs are identified in full, and delivery will be monitored throughout the financial year. Meetings have taken place with all senior budget holders/Directors to confirm delivery of identified CIPs, to explore areas for further efficiencies and to focus on identification of the 2025/26 CIP. Capital spend recorded to date is as planned and full spend of operational capital is expected throughout the year. The capital programme activities continue to be reviewed at the Trust’s Financial Investment Group to ensure that the capital allocation is fully utilised, all business cases have been approved and that there is sufficient lead time where dealing with suppliers.  There is no concern regarding the full and appropriate utilisation of the operational capital allocation.

The Better Payments Practice Code (BPPC) results are all above the target measures required – paying 95% of suppliers within 30 days and measured by NHS/non NHS in terms of invoice value and invoice volume. This is an important measure to assure suppliers that the Trust adheres to the payment terms agreed. A significant amount of work continues to ensure the Trust meets this target and that the performance above target is maintained. Mr Fessal indicated that he considered this an important performance criterion and was pleased to see the progress on this indicator. 

Mrs Jasper informed the Board that the Financial Update was discussed at the Finance & Performance meeting, and we had asked for the committees thanks to be passed onto the Finance Team. 

Mr Nat confirmed that the £900k adjustment was discussed at the Finance & Performance Committee meeting held the previous day and received assurance received in relation the adjustment.

The Strategy & Engagement Director asked if there was a risk in relation to reducing cash balance.  The Director of Finance confirmed that the Trust does not have a problem with cash balances in the current financial year but there could be an issue at the end of the next financial year.

The Chairman congratulated the Trust on the remarkable achievement on meetings its CIPs this year but asked how much of this is non-recurrent.  The Director of Finance advised the Board that two thirds of this year’s CIPs were non-recurrent. The Chairman asked the Director of Finance how confident she was that we could find next year’s CIP. The Director of Finance confirmed we know the target, and this has been added into the target for next year.  The CEO confirmed that the Trust will achieve its CIP target this year and next year as it has done in previous years. 

The Chairman asked if there were any risks to the Trusts expected income this year.  The Director of Finance confirmed that Black Country ICB are our lead Commissioner, and they are leading on these discussions.  They have agreements with 5 out of the 6 ICBs so probably less of a risk.  The CEO said it is a low risk.  The Chairman acknowledged what was being said was that there is a high degree of confidence that the income factored into our budgets will be received.   Mr Khan confirmed there had been lengthy discussion at the Finance & Performance Committee yesterday on these two points.  This is a particularly challenging landscape.  Excellent work has been undertaken by the Director of Finance and her Team. Mr Khan said some of the plans put in place this year has put the Trust in a much better position.

11b – Policy and Procedure Update

A report of the Director Finance was submitted.

The Director of Finance gave an update and explained that the report submitted today is to provide assurance to the Board on work to maintain the Trust’s policies, procedures, and strategies due for review prior to the end of March 2025. The Director of Finance gave an update on the finance items and said a number were approved at the last meeting of Audit Committee.  The Director of Finance indicated that it was an intention to submit an up to date report to the March Board.

Mr Fessal asked about the Clinical Audit Procedure and Policy which had a review date of 27 January 2024.  The Director of Finance confirmed that the EMB review this at every meeting with a report that details the progress of all policies. The Director of Finance was happy to share this document with Mr Fessal if he wanted to review it.   

In response to a question from Mr Fessal, The Director of Finance explained that Policy Stat is live on the intranet, the new solution is based on making it easier to use and share documents. The CEO acknowledged the points raised by Mr Fessal and said that the Trust will continue to monitor the current position with regard to the review of Policies so that they remain concurrent.  The CEO indicated that he had been very clear about his expectations and said a review by Mr Fessal would be very welcome.  Mr Fessal indicated that the People Committee will undertake a review to provide assurance to the Board.  The Chief of Staff / Head of Enhanced Care explained that there is good access for staff as all clinical policies and procedures are held on JRCALC.  There are good procedures in place for staff to access the documents.  Mrs Banks pointed out that the process  is flagging in advance so 3 months ahead these documents need to be scheduled in for review.  The CEO confirmed we did this, but we need to improve our ability to follow up.  The Performance & Improvement Director informed the Board that there are several things we are doing to try and change the process.  We are trying to bring the process forward as the documents tend to get stuck at the sub-committees.  We have made some changes, and a paper is going to EMB on 4 February in this regard.  Mrs Farrington confirmed that it is the committees that delays the papers to Policy Group. Policy Group can only dela with so many policies at each meeting although extra meeting dates have been scheduled in the diary.

The Governance Director / Trust Secretary explained there will be a paper going to the EMB and the Board regarding the dates of Board Sub-Committees to ensure they are all more aligned to feed into the Board.

The Governance Director / Trust Secretary pointed out that it should be the Audit Committee that undertakes the deep dive.  

01/25/12

Report of the Director of People

12a – Board Skills Matrix

A report of the Director of People was submitted.

The Director of People explained that the Board is required to annually review its Skills Matrix to ensure that the make-up of the Board is complete and appropriate in terms of undertaking the stewardship of Trust.  The report submitted today to the Board of Directors covers the required annual review of the Board Skills Matrix for consideration, approval, and publication in the Trust’s Annual Report.  The Director of People asked Board Members to feedback to her on anything missing or any new items.  The final version would then be circulated electronically.

01/25/13

Combined Clinical Directors Quality Report

A report of the Clinical Directors was submitted.

The Medical Director presented the salient points contained in the report to the Board. Hospital handover delays continues to pose the greatest risk to patient care which was reflected in the BAF. There was an increase in hospital handover delays in December 2024 with 53,218 hours lost.  The Medical Director explained that the QIAs for the Cat 2 Improvement Action Plan were completed and had been reviewed by the clinical directors prior to submission to the Quality Governance Committee where they were approved. The Chair of the Quality Governance Committee will report later in the meeting to provide assurance to the Board.

On the question of handover delays and the risks to patient care and any possible mitigation, the Chairman asked about the progress with the 45-minute maximum handover implementation across the Region.  The CEO said progress has been slow. The lost hours in December were some of the worst during his tenure as CEO.  The Black Country have gone live with the 45-minute handover, but they have not yet achieved this, but they have substantially reduced their lost hours.  Birmingham goes live on 1 April 2025 although the Trust was still awaiting a date from Shropshire and Coventry & Warwickshire.    The CEO pointed out that where this has gone live it has not yet had the impact that was planned by the NHSE.  The CEO explained that the most improvement of handover delays has mainly been at the new Midlands Metropolitan University Hospital.  The Strategy & Engagement Director said there has been a change in some of the patients self-presenting at A&E.  The Chairman pointed out that it was frustrating that the Board had spent hours and hours on this discussion, and he was confident the Trust was doing everything it can, but this critically about safety of patients.  The concern was for those patients kept waiting in the community for a response. 

The CEO advised the Board that despite the challenges faced the Trust will achieve the Cat 2 mean target by the end of March 2025.  The Chairman said this was truly remarkable given the issue of delays, but pointed out that this had only been achieved by increasing the number of vehicles.  The Trust was doing all it could to mitigate the serious harm to patients due to the delays. It was noted that there were more than 30 ambulances held outside Stoke Hospital ED at the time of the Board meeting.  Mrs Jasper advised the Board that the CEO was keeping the Non Executives and Council of Governors fully briefed on dvelopments. eek he NEDs, CEO and Chairman had a lengthy discussion on this item and what we are doing about it.  The CEO confirmed that he had also briefed Senior Staff Side Representatives. 

Mr Khan echoed what had already been said and confirmed there has been for a considerable period concern about patient safety due to the impact of hospital handover delays. The Board have supported the investment of  significant resources as a Trust in the interests of patient care to be able to make significant improvement in relation to the Cat 2 target.  The further impact of handover delays is on our staff health and wellbeing.  The CEO agreed and pointed out that this is not just about A&E crews but also about EOC, VPOs, Directors and Assistant Chiefs. The CEO pointed out that after hearing the patient story earlier today not giving up is the right thing. 

01/25/14

Service Delivery Report

The Performance & Improvement Director gave an update and advised the Board that w have put more resource back into the front line.  There was an increase in the Cat 1 calls in December. We lost 53,000 hours in December despite the 10% increase in resourcing.  The year to date position for Cat 2 was 30 minutes 17 seconds for December.  We went to Reap Level 4 in January.  Call answering was exceptional over this period.  All training will be complete by the year end. 

The Chairman asked how many of WMAS calls are answered by other Ambulance Services.  The CEO advised this was small numbers where the call has been incorrectly routed due to a friend or relative phoning on behalf of the patient.  The Chairman has asked the Integrated Emergency & Urgent Care Director to include this in a table for the next Board report. 

The Strategy & Engagement Director informed the Board that activity has increased by 2.5% in year.  What is causing more issue is patients waiting more than 12hours for beds.  Ther is a congestion problem.   The Performance & Improvement Director pointed out that he does not have a resource problem he has a productivity problem.  We have put in extra resource to mitigate the delays.  The Chairman understood that what was being said is that if the Trust had no hospital handover delays then the resource in place is sufficient to meet the needs of the patients in the West Midlands. 

The Chairman took the opportunity to highlight the pressure frontline staff have been under and thanked them for their efforts. He said we all recognise how tough it is out there for staff on the frontline and on behalf of the Board, the Chairman would like to pass on personal thanks to everyone for their efforts. Many of us get the chance to get out and about to do it directly, but obviously we cannot reach everyone. We know staff are giving their all and doing the best they can in challenging and difficult circumstances. The Chairman would like to take this opportunity to reassure them all that we will continue to do our best, as the Board of Directors, to get vehicles free from hospital in order to be able to attend patients in a timely manner and provide the best level of treatment we possibly can.

01/25/15

ICS and WMAS Hub Engagement by WMAS Directors

The Strategy & Engagement Director explained that the paper sets out our relationship management.  This has been updated following changes to the Board of Directors and agreement with the Executive Management Team.  This is submitted today for approval.  The Chairman was happy this is now at a stage for approval and would like to get this out across the Governors etc now. 

01/25/16

Board Committee Reports and Minutes

16a – Finance and Performance Committee

The verbal update on the meeting held on 28 January 2025 was submitted along with the minutes of the meeting held on 29 October 2024.

Mr Khan advised the Board that at the meeting held yesterday there was a lot of scrutiny into finance and performance.  From a financial point of view the Director of Finance has already touched on this.  Ther are challenges with the CIPs.  We had an extensive discussion on performance and as a Trust we have put a significant number of resources into this.  In December there was a record number of hours lost.  This was the highest ever recorded. There are issues with the Acute trust who are not able to implement the 45 minute handover.  Mr Khan pointed out that because of the investment the Trust put in, we are getting incredibly close to the 30 minute Cat 2 time frame.  Mr Khan recognised the incredible work going on in the organisation but pointed out that running hot all the time does impact staff.  

Mr Khan said he was incredibly blessed having some great colleagues on the committee with good collaboration with Executive Directors and everyone comes well prepared for the meetings. 

16b – Audit Committee

The Chairs report on the meeting held on 21 January 2025 was submitted along with the minutes of the meeting held on 12 November 2024.

Mrs Jasper reported that it was raised at the last Board meeting that we should establish an AI Policy, and the Director of Finance has agreed to take this forward through the Digital Transformation Oversight Group (DTOG). This will come back to EMB and Board.  The key financial controls report received a significant assurance and the quality and granularity of assurance in the Internal Audit reports was acknowledged by the committee. 

External Audit were pleased with how the year end process worked.  The board participated in the Bribery Act awareness training on 27 November 2024.  The following policies and procedures were approved at the meeting:

• Cash and Treasury Management Policy
• Stocktaking Procedure
• Stock Management Policy
• Finance Procedures
• Purchasing and Management of Substances Policy

Mrs Jasper explained that the committee received an in depth briefing on what should be considered to feature on future Board agendas and Mrs Jasper suggested this should be considered at a Board Development session. Mrs Jasper explained that at the end of each committee meeting there is always a private discussion between Committee members, and both sets of Auditors.  There were no issues requiring escalation to the Board. 

16c – People Committee

The report of the Chair of the meeting held on 11 November 2024 was submitted.

Mr Fessal explained that at the meeting in November discussion took place on the Trusts approach to settling employment tribunal cases.  Early settlement is often financially beneficial but needs to be balanced with a culture of settling.  Pay for staff on Band 2 is now below the national living wage.  This is an NHS wide concern. 

Concerns were raised on the increased requirement for management to support staff on wider personal issues beyond direct employment related duties. This has a toll on staff who may feel they are acting as councillors both in terms of their capacity and mental health.  The Health Inequalities Workforce Plan 2024/25 is progressing with comprehensive actions identified across EDI, recruitment, environment, wellbeing, and health condition management. This plan has alignment with some other organisational plans. There is creation of phase 1 incident reporting and risk management system project group, to replace the current use of Datix.   The following documents were approved:

• Additional Hours and Overtime
• DBS
• Flexible Working
• Recruitment & Selection
• Registration Authority
• Public Duties Policy

16d – Quality Governance Committee (QGC)

The report of the Chair of the meeting held on 22 January 2025 was submitted.  The Minutes of the meeting held on 22 October 2024 were submitted. 

Mrs Banks explained that at the meeting last week there was a deep dive session on the Patient Safety Incident Response Framework (PSIRF).  We have already discussed handover delays and the risk to patients.  The committee also discussed how the cold weather has increased the risk to patients waiting in the rear of ambulances suffering with hypothermia and personal care of the patient. There have been several incident reports from staff regarding the running of engines and fume emission whilst waiting to offload patients.  This was also raised at H,S,R&E. The number of NHS to NHS complaints have risen and relationships between WMAS staff and Acute staff were strained.  It was noted that crews had reported they had done a pre-alert to hospital and the patient was not allowed to be off loaded.  There were quite a few information governance risks with data breaches.  There is a comprehensive action plan in place, and this will be submitted to each committee meeting. 

Mrs Banks advised the Board that positive assurance was provided through the reports and presentations at the meeting. The 4 x QIA’s and 1 x EIA relating to the Category 2 Performance Recovery Plan were presented, and helpful discussion took place. There were no changes from QGC members to the impact assessments requested.  It was agreed by QGC that the assessments could be forwarded to the ICB, however, any significant changes to the assessments going forward would be emailed to members of the QGC to save delays and would be an agenda item to the next QGC meeting. An update on the Quality Account priorities for 2025/26 were discussed and will go to EMB and Board for further discussion and approval.

Mrs Banks explained that it has been agreed that the Committee will move from meeting five times a year to six times. 

The Chairman thanked all Committee Chairs or their work and updates.

01/25/17

Board of Directors Schedule of Business

The Schedule of Business was submitted.

01/25/18

Any Other Business

There was no other business.

01/25/19

The Date of the Next Meeting

Wednesday 26 March 2025

There being no other business for this meeting, the Chairman brought proceedings to a close and thanked members for their attendance.