Minutes of the 2024 Annual General Meeting of the East Of England Ambulance Service NHS Trust

Public session

AGM24/09/1.1 OPENING ADMINISTRATION

1.0 Welcome

1.1.1 Mrunal Sisodia, Trust Chair (TC), welcomed those present to the Annual General Meeting of the East of England Ambulance Service for 2023/24.

1.2 Minutes of the Previous Meeting

1.2.1 The minutes from the meeting held on 06.09.2023 were approved with no amendments.

1.3 Overview

1.3.1 The TC confirmed the AGM was informed by the Annual Report and Accounts and the Quality Account. He commended the work of teams to produce these high-quality reports. The AGM would focus on the four organisation goals;

• Be an exceptional place to work, volunteer and learn
• Provide outstanding quality of care and performance to our patients.
• Delivering outstanding care, with exceptional people, every hour of the day.
• Be excellent collaborators and innovators as system partners.

The TC became chair in June 2023, after working for three years previously as a Non-Executive Director at EEAST. He recognised the continuous change within the organisation and environment and reflected on the challenges and progress in the preceding year. He had prioritised meeting as many staff, volunteers and patients as possible to listen to feedback from these individuals which would help to support future innovation and improvement. The Trust was proud of the passion and commitment demonstrated by all those within EEAST which was true to the core values and vision to deliver outstanding care, with exceptional people, every hour of every day. He extended his thanks to all colleagues, volunteers, patients and partners who had contributed to delivering an excellent service to patients.

1.3.2 The Trust goals were centred around the objectives to continue the cultural change journey and improve the wellbeing of staff, to reduce C2 response times and to improve the navigation of 999 calls. These goals were underpinned by the clinical strategy, people strategy and sustainability strategy. The Trust had delivered a significant amount over the previous year including;

• Setting up unscheduled care hubs
• Reducing hospital handover delays
• Exiting NOF4

However, there was further progress required. The challenge was to consolidate these improvements and translate them into improved performance for patients. The Trust was in the process of developing a new five-year strategy.

1.3.3 The TC introduced the members of the EEAST Board of Directors and extended his thanks to those who had left the Trust during the period, namely; Neville Hounsome, Non-Executive Director, Alison Wigg, Non-Executive Director and Emma de Carteret, Director of Corporate Affairs and Performance. He also extended his thanks to Tom Abell, former Chief Executive Officer who had made significant progress whilst in post to stabilise the Trust, and Kate Vaughton, Director of Integration and acting Chief Executive Officer following Tom Abell’s departure. Neill Moloney had been appointed as the incoming Chief Executive Officer.

AGM24/09/2.1 BE AN EXCEPTIONAL PLACE TO WORK, VOLUNTEER AND LEARN

2.1.1 Marika Stephenson, Director of People Services (DoPS) reflected that the Trusts people were the beating heart of the service. Central to this vision was the steadfast belief that EEAST should not only be a place to work, but also a community where individuals felt valued, supported and inspired. It was recognised that the Trusts success was dependent on the wellbeing, engagement and professional development of all its people.

2.1.2 While the colleagues on the front line, those in control rooms and those who provided non-emergency services were the ‘face’ known by the public, there were a wealth of support functions, including mechanics, fleet, education and training, finance, HR, IT, Workforce, Estates and Facilities, all of which played a key role in delivering a quality service for patients. EEAST employed more than 5,000 staff operating from over 120 sites and was supported by more than 1,000 dedicated volunteers working in a variety of roles. It was a relatively young workforce with over three-quarters of staff below the age of 50. The Trust had made significant progress including;

• the recruitment of over 700 frontline staff
• a reduction in staff turnover and improved wellbeing in the workplace, resulting in lower sickness rates
• continued improvements in staff survey results.

Turnover and retention remained key issues generally within the NHS, however EEAST had delivered considerable improvements during this time. EEAST's turnover rate decreased steadily from 12% in April 2023 to 9% by March 2024, due to long-term interventions. To achieve this, the Trust worked closely with national and regional partners, aligning efforts with initiatives like the Regional Retention Improvement Plan, and implemented internal strategies contained in the Retention Improvement Plan, in line with the People Strategy and Wellbeing Plan.

2.1.4 The Staff survey had a completion rate of 52% which although lower than previous years was comparable with other ambulance services across the Trust.

• 93% of questions scored more positively than in 2022, which retained EEAST the accolade for most improved survey results, for the second year in a row.
• EEAST saw a 10% improvement in staff recommending the organisation as a great place to work, compared to 2022.
• The Trust continued to improve colleague perception and experience, particularly in areas around development and support which held the largest satisfaction increases in the 2023 survey
• This trend was also reflected in the local pulse surveys conducted over the last year, which highlighted an upward improvement in positive responses in all of EEAST’s nine engagement measures.

As a result of this position EEAST expanded the number of programmes supporting colleague experience development from 5 to 14, which encompassed a wider range of initiatives to be introduced. All this activity was tracked to a programme plan and delivery outputs and measured via the culture dashboard, which showed a month on month improvement.

2.1.5 The Trust had focussed on the improvements required to deliver the six objectives to enhance colleague experience;

• Culture of belonging and inclusivity
• An embedded learning culture
• Right leadership capability and capacity
• Healthy, well supported and safe workforce
• Well embedded professional behaviours and values
• We listen to colleague feedback and build trust.

The approach was to continually build momentum and impact following each annual staff survey. EEAST continued to implement ‘additions’ each year to support an increase in the level of engagement with our people – this wasn’t just about results, but also working together to co-create solutions. The Board was confident the survey results demonstrated a step forward in the ambition to become a great place to work.

2.1.6 Speaking up and enabling staff to raise their concerns helps to improve the quality of care provided to patients, improve the working experience for staff and supports the trust to promote learning and improvement from the concerns or improvement suggestions raised.

• The ability to speak up within the Trust evolved with the embedding of two new Deputy Guardians and the establishment of 15 FTSU Ambassadors. This led to an increase in the staff and organisational understanding of what speaking up is, improved visibility, availability, capacity and resilience of the FTSU team, which inevitably led to an increase in the number of new cases raised.
• There was a focus on enabling and supporting managers to resolve staff concerns locally and more informally where appropriate which was supported by the unions. The organisational drive to encourage and direct staff towards the many different routes for escalation of concerns has been strengthened. The increased skill, resource and capacity within the People Services and Strategy Culture and Education directorates have increased the HR, Employment Relations and the Wellbeing offer as well as the progression of the Leadership Development Manager roles and the training and support being provided to our managers via the Time to Lead programme.
• In June 2023, the National Guardians Office published an analysis of the speaking up questions from the 2022 NHS Staff Survey, which replaced the preceding FTSU index. The survey identified that EEAST was 3rd in the top ten most improved FTSU score for trusts. The report also identified that whilst we have improved significantly, the Trust also scored least well for all four FTSU questions, which identified there was still work to be done to gain the trust and confidence of all staff. The National Staff Survey evidenced a 3% increase in the number of staff feeling safe to speak up about their concerns. Although it provided assurance that the challenging work underway was making a difference to the culture of speaking up within EEAST, the score was below the national average for all trusts.

2.1.7 A triangulation was undertaken of all staff feedback, including the national staff survey with other staff data, such as employee relation cases, patient safety cases and Freedom to Speak up information, to identify trends across EEAST and put suitable action plans in place where required. Cross directorate sharing forums had been implemented between multi-disciplinary teams to review this data and provide support where required. 3. Through the Raising Concerns Forum, seven key themes for further review and action were identified.

• Staff perceptions of work
• Team working
• Line Management
• Health and Wellbeing
• Bullying and Harassment
• Appraisals
• Advocacy and trust.

Work is ongoing to support how we resolve these issues.

2.1.11 In 2023/24 the Trust made significant strides towards realising the vision of fostering an intentionally inclusive environment for colleagues and patients. These achievements reflected EEAST's aim of fostering an environment which was intentionally inclusive, improving diversity and promoting equality. The Trust was dedicated to building on this progress and creating a workplace where everyone felt valued and empowered. The Inclusivity Plan is crucial in creating a workplace that celebrates diversity, fosters inclusivity, and attracts and retains talent. Inclusivity is an integral part of building a stronger, reliant and sustainable Trust in todays’ culturally diverse society. Key initiatives that started in 2023/24 include:

• Achieving Disability Confident Level 2 Employer status
• Collaborating with Jobcentre Plus on a Positive Action project for long-term unemployed BME individuals and people with disabilities
• Finalising the implementation of Cultural Inclusion Agents, with six new members to be in place by Autumn 2024.

2.1.12 Over the past few years, colleagues within EEAST and the rest of the NHS, have been faced with immense demand and emotional exhaustion caused initially by the pandemic but largely impacted by the incredible jobs staff undertake. Recognising these pressures, it became increasingly clear that prioritising the development of wellbeing capabilities at all levels was crucial. Equally important was the need to enhance support for colleagues facing mental health challenges. EEAST made significant strides in expanding the health and wellbeing team, focusing on strategic and transformative wellbeing activities with a greater emphasis on prevention. Some key initiatives included:

• Building a robust health and wellbeing team.
• Launching a wellbeing network and a monthly newsletter.
• Committing to the Blue Light Mental Health initiative at work.
• Officially launching the welfare wagons.
• Expanding our Trauma Risk Management (TRiM) teams, including advanced TRiM practitioners.
• Offering mental health awareness courses, delivered by MIND, for managers and wellbeing champions.
• Producing a suicide prevention and postvention resource pack.
• Establishing a suicide prevention working group.
• Creating a mental health awareness video in collaboration with Magneto and colleagues.
• Initiating menopause awareness sessions.

AGM24/09/2.2 PROVIDE OUTSTANDING QUALITY OF CARE AND PERFORMANCE

2.2.1 Simon Chase, Chief Paramedic and Director of Quality confirmed that the Trusts commitment to patient care and staff wellbeing, including volunteers, drove every aspect of the clinical vision and performance. He was confident that the lifting of a number of the conditions by the CQC came about because of the overhaul of the policies and processes to ensure both quality and safety monitoring was at the core of decision making as well as the commitment of staff and volunteers to strive to improve the quality of every contact made.

2.2.2 The Trust was committed to improving pre-hospital clinical outcomes and the overall experience of patients. The Trust, staff, and volunteers along with system partners was dedicated to delivering a high quality service to communities whilst balancing the pressure the national health service continues to face. A collaborative approach was being prioritised with staff and stakeholders to inform the reshaping of the clinical strategic vision. EEAST utilised the Quality Improvement Innovation links to partner with Clever Together, a company with a successful record of improvement stakeholder engagement across many healthcare providers promoting further quality improvements. Reviewing clinical performance against the priorities for last year, it was heartening to see the progress made. The clinical supervision model for all patient facing staff has been established and the continued learning from complaints, clinical incidents, patient, staff, and community experiences helps provide constructive feedback to continue to develop our services for the better.

2.2.3 The Trust was proud of the hard work and dedication of volunteers. The volunteer workforce included; community first responders, co-responders (military and other blue light personnel), car drivers within our patient transport services, chaplains and other faith representatives. We are also supported by our community engagement group, and our British Association for Immediate Care (BASIC) doctors and paramedics.

• We had more than 1200 active volunteers who supported our communities and patients last year. EEAST started to develop dedicated volunteer support for all volunteer roles within EEAST, which included new roles for volunteers and increased our volunteer membership in all roles.
• Community first responders are volunteers within our local communities attending a wide variety of calls on behalf of our ambulance services. Calls range from being the first ambulance service resource at a prehospital cardiac arrest to assisting with a care line call activation.
• This commitment to their local community goes beyond that of a community first responder, many volunteers support their local communities through community awareness sessions, and ongoing social support for the vulnerable within their local communities.
• Volunteers accounted for 300,000 volunteer hours in local communities and attended over 24,000 patients
• EEAST launched EEAST Heart in partnership with the East of England Ambulance Service Charity to deliver training sessions to the local communities in Basic life support and AED awareness. Over 80 volunteers supported this initiative.
• Volunteer car drivers support the Non-Emergency Patient Transport Services (NEPTS) operated within our PTS contracts. Their role is to support EEAST by taking patients to and from routine hospital appointments. In the coming year there are plans to increase recruitment for this opportunity and develop further volunteering roles within the NEPTS teams.

2.2.4 We continue to support and expand our falls community first responders enabling them through enhanced training, to attend non injured patients who required assistance in getting up from the floor. Teams were able to discharge the patient from scene with the support of the clinical advice line. We also worked with our Urgent Community Response teams to dispatch CFRs directly from the Community Hubs where they have been established. This enabled us to attend patients who had falls more quickly, and made a difference to many patients experience and care over the course of the year. We undertook ongoing refresher training during the year to maintain volunteer skills and competence.

2.2.5 Through charity funding we have mobilised CFR cars around the Trust, these cars enabled volunteers to travel further distances to life threatening emergencies and also patients who have fallen providing volunteer care to more communities, irrespective of socio-economic demographics.

2.2.6 EEAST continues to increase the skills and qualifications offered to volunteers. Our trainers had the opportunity to undertake the Award in Education and Training (AET) and the Certificate in Assessing Vocational Achievement (CAVA), to assist them with a recognised training and assessment qualification, along with offering invigilator training for them to assist with the assessments for the induction course. These training courses not only value our volunteers in providing them with transferable skills, but also supports the capacity within the training team to deliver training and provides a standard for local training. The Trust is currently reviewing the volunteer role under the wellbeing umbrella and looking at how we can develop roles that will support a diverse organisation. How we can support both integration through our staff networks, and developing volunteer roles that can support colleague wellbeing. We also have a wealth of expertise in our volunteers that could be utilised to support other parts of the Trust such as data and analytics and a register of skills and interests is being complied to further develop this concept.

2.2.7 The feedback we receive from patients and stakeholders is vital for the Trust to continue to learn from - this includes direct engaging with patients, carers, family members and professional colleagues to use their lived experience. It is about encouraging colleagues to be honest and open, by providing a supportive environment where a just culture can thrive. Face-to-Face engagement events have provided an opportunity to meet with the public and gain feedback from people who may not usually have contacted the Trust. This gives us the added opportunity to provide education around first aid and CPR training, health promotion and what to expect when you call an ambulance. This work has included attendance at events, school visits and work with community groups and has been undertaken by the Public and Patient Involvement team, frontline staff, and volunteers. The team received great feedback from these events, including a young person who put their first aid training into action whilst out shopping, just weeks after receiving the training which is humbling and amazing to hear. EEAST’s discovery interviews with patients or their families supplemented our other feedback received by giving people the opportunity to share their story, in their own words. These are filmed and are shown at public board meetings and discussed by the board. We have used them this year to support learning from complaints and serious incidents and find that hearing directly from the patient was a powerful learning tool. This year we have completed discovery interviews on areas such as end of life, non-conveyance to hospital, a patients experience of being treated whilst under the influence of alcohol and stroke care.

4.2.8 I’m proud that compliments continue to far outweigh concerns or complaints received. 3634 compliments were reported to EEAST during last year, which equated to an average of 302 per month, a significant increase on the previous year’s average of 225 per month.

• Compliments are reported to the trust board and directly to the individual colleague whilst being recorded on their personnel files.
• Due to the large volume of intelligence, the Trust has started looking at themes arising from compliments to also help learning. The common themes included kindness and compassion, calmness and reassurance, professionalism, good clinical assessment and treatment, which many compliments described as lifesaving.
• We acknowledge the great work that all our teams do to strive to provide the excellent care expected and one way we sahre this with the people of EEAST is through the shout out on a Thursday to say thank you to our amazing staff and volunteers who continue to be dedicated during the challenging times we are experiencing.

2.2.9 It's important to closely monitor the number and themes of complaints received and use this learning to support service improvement.

• During 2023/24, 0.06% of our interactions with patients resulted in complaints and concerns. This was a reduction on 2022/2023, when 0.07% of our patient interactions resulted in complaints and concerns, and suggests an improvement in patient experience.
• All complaints and concerns which cannot be resolved under our early resolution approach, received a local investigation and depending on the nature of the complaint or concern, was further reviewed by the patient safety team. Complainants were supported through the process of raising a complaint and investigation by our patient experience coordinators, and upon receiving a written response, face-to-face meetings were arranged where complainants required further support.
• The number of re-opened complaints does remained low, meaning complainants were usually satisfied that our responses addressed their questions and concerns and where able resolved.
• The main themes from complaints and concerns last year were: -- Delay - these mostly related to delays in the Patient Transport Service, with only 22% of delay complaints relating to Emergency Operations Centres and Emergency Services. -- Transport and Driving - which mostly related to the Patient Transport Service, which accounted for 93% of these -- Clinical Assessment and Treatment - of which 89.5% were for Emergency Operations Centres and Emergency Services.

These themes reflected the improvements in emergency ambulance attendance times achieved via EEAST’s delay action plan. A significant number of the clinical assessment and treatment complaints related to either ‘no sends’ or ‘treatment at home’ under the same plan, suggesting that some patients did not feel confident that the alternative care pathways offered, were right for them. These complaint themes also reflected a challenging year for the patient transport service, with some of our services delivering journey volumes more than the contracted levels resulting in a poor patient experience.

2.2.10 Simon Walsh, Medical Director (MD) reflected that the standards were set to ensure the level of clinical care given to patients is what we would want for our own family and friends. The clinical priorities were developed based on priorities that the Board agree, performance against mandated national quality metrics and regional targets. 2023/24 was the first full year of delivery of the Clinical Strategy, including the Clinical Operating Model which was developed alongside system partners. The Trust had;

• Delivered C2 segmentation, which means we respond to the sickest patients first and make further checks on other calls to make sure they get the appropriate level of clinical response
• Supported the establishment of an unscheduled care hub with our Integrated Care Boards in each of our six systems, which are now delivering improved access to the most appropriate providers of care, reducing unnecessary admissions.
• Developed the advancing practice offer and recruited 7 additional advanced practitioners, and an additional 36 in training, to support our most complex patients with
• Delivered the clinical workforce plan to increase our patient-facing clinicians by 240 against a target of 220.

2.2.11 In October 2023, in line with a national directive, EEAST moved onto to the new Patient Safety Incident Response Framework (PSIRF) and began to phase out the Serious Incident Framework. Since adopting the new framework, the Trust refreshed its approach to improving safety at a system level by completing in-depth reviews of incidents according to identified themes. EEAST continued to review serious incidents (SI) declared until the end of September 2023 and identified learning from every review undertaken. Work towards delivering the national patient safety strategy continued and patients should expect a continually improved and safer service in future years. There was a significant decrease in patient safety events during last year compared with the previous year. This was partly attributed to an improvement in system delays throughout the year following the implementation of EEAST’s delays action plan, as well as the proactive work undertaken between EEAST and system partners across the region.

4.2.12 Achievements in 2023/24;

• Following the adoption of the Learning from Deaths programme the aim for the year was to embed the process to improve the quality of care delivered to service users, both when things go well, and when things could have been done differently. Part of this included the implementation of a robust review process to ensure improvements in the delivery of care and a reduction in harm to patients.
• The PSIRF allows for more in-depth thematic reviews so that Trust-wide and System-wide learning can take place, leading to improvements in patient care and reduction in future harm. A number of new roles for patient safety specialists and partners have been recruited to and the first thematic report, relating to cardiac care, will be shared with the Integrated Care Boards.
• The aim for the year was to implement an overarching Continuous Improvement Assurance Framework to link up a number of important processes and reporting functions including our CQC recommendations, improvement plan actions, audit programmes and processes including internal audit and to undertake monitoring, identify good practice and further areas for improvement.
• EEAST embeds clinical supervision in the patient-facing workforce, delivered by approved supervisors, in a relationship-based education and training system that is work- focused and which manages, supports, develops and evaluates the work. Clinical supervision has now been implemented across all six operational sectors.
• EEAST continued to develop its patient experience and engagement activity and explored new methods to obtain feedback and to ensure the voice of patients within seldom heard groups were heard.
• We’ve also set up public Engagement Forums to improve engagement with members of the public

2.2.13 The Ambulance Clinical Quality Indicators are a nationally set group of indicators for specific groups of patients, which allow each ambulance service to benchmark themselves against other ambulance services in these domains. For the fourth year running, EEAST exceeded the national ambulance average for its quality indicators; heart attack, stroke, and cardiac arrest survival to discharge for those patients where the arrest was bystander witnessed and the initial heart rhythm was ventricular fibrillation or ventricular tachycardia (Utstein comparator). The Trust has maintained its ambulance care quality indicators well above the national average, seen an improvement on all ambulance responses, particularly in relation to our response to category 2 calls (average 22 minutes reduction ) and category 3 calls (average 2 ½ hour reduction). We have continued to work closely with our partner organisations across the region to further improve outcomes from cardiac arrest and we have strong representation on the national NHS England Expert Advisory Group for Cardiac Arrest.

AGM24/09/2.3 OUTSTANDING PEOPLE, EXCEPTIONAL CARE EVERY HOUR OF EVERY DAY

2.3.1 Melissa Dowdeswell, Chief of Clinical Operations (CCO) provided an update on the operating environment in 2023/24. There had been a significant increase in demand in 2023/24.

• In June, hospitals reported that they dealt with more than 2.29 million attendances to their A&E departments and over half a million emergency admissions (536,884) – more than any other June to date.
• Ambulance services responded to 729,345 incidents and answered 800,288 calls to 999, more calls per day than the month before and in June 2023. However, response times for category 1, 2 and 3 callouts were all slower than the month before.
• Significant improvements had been made in category 2 response times over the past two years. However, the Trust was not meeting the target response times set by NHS England of 30 minutes. In July the average response time for category 2 calls was 38 minutes, and the Trust was on track for a 33-minute response time in August. Hospital handover times significantly affected the ability to respond to patients, EEAST was working with the hospitals across the region to reduce handover times.
• The operational performance improvement plan (OPIP) has been developed for 24/25 with a key focus on C2 improvement, based on four priority areas: Reducing job cycle time, Increasing vehicle availability, Increasing our hear and treat rate of our calls and Improving our productive patient facing staff hours.

2.3.2 Demand on the ambulance service grows every year, which means the volume of 999 calls handled by the EOC teams increases. Across the year we have seen periods of challenge and pressure which is further impacted by seasonal variations, time of year, weekends, and bank holidays when access to NHS primary care services is often limited. Significant events across the region like music concerts, a football match, or an outbreak of a healthcare condition such as Flu can also increase call demand.

• We received 1,384,547 calls to our Emergency Operation Centres last year, which was 3,500 less than the year before, but still averaged over 2,750 calls a day.
• We attended 754,460 incidents – caring for over half a million very unwell patients.
• 14% of these were categorised as the highest priority (immediately life threatening)
• 58% were the second highest category (serious condition)

Call handlers record information about the nature of the patient’s illness or injury using sophisticated software to make sure they get the right kind of medical help. This is known as triaging and allows us to ensure that the most seriously ill patients can be prioritised and get the fastest and most appropriate response.

2.3.3 Our commitment to providing exceptional care and improving our service has led to good progress in priority areas for improvement. Over recent years there had been a significant loss of ‘ambulance hours’ because of delays in handing patients over to hospital care, this created a delay in responding to other emergencies. In 2023/24 we secured a 10% increase in ambulance hours on the road, totalling approximately 12,300 hours per day. Our staffing has seen a significant boost, with over 200 more clinicians now working on the frontline. These numbers not only represent our growth but also our relentless dedication to meeting the ever-increasing demands of the community. The Trust has worked hard to change our service, seen through a doubling of referrals to alternative pathways, which increased by 120% over the course of 2023/24. This leap forward in patient care efficiency exemplifies the commitment to adopt more effective and responsive care delivery models. We aim to further increase our ambulance hours on the road by over 5%, while continuing to focus on efficiency, productivity, and engagement. Our plans to expand the use of alternative pathways and to develop targeted strategies for improving clinical outcomes in emergencies like cardiac arrests and falls, highlight the ongoing commitment to improving patient care.

2.3.4 Ambulance services across England are measured and report against 11 Ambulance Quality Indicators, which allow performance to be compared with that of other services across the country. The indicators are split into ambulance systems and clinical outcomes. EEAST achieved an improvement in all categories when compared to the previous year. We responded to our sickest patients (Category 1) in an average of 9 minutes and 3 seconds, and to 9 out of 10 in 17 minutes and 4 seconds. This is outside of the national standard, but is an improvement on the same reporting period in the previous year.

2.3.5 The Trust covers 7500 square miles and has some of the most rural areas in England, as a result, the road network is challenged often at peak holiday periods due to the extensive coastline. Its essential to utilise resources wisely and it is not always possible to reach some destinations as quickly as we would like. That is why the Emergency Operating Centres have experienced clinicians to thoroughly assess patients, ensuring the right level of care to patients by the right service. This could mean that patients will be passed onto the local unscheduled care services which have access to a wider choice of services to meet patient needs. We also have a dedicated team of Community First Responders, living locally that can quickly attend to the patients, we even have paramedics on bicycles. The Emergency Operating Centres play a fundamental role in ensuring the safety of patients through numerous processes to ensure the right care is delivered as timely as possible. Any call that is triaged as a category 1 call, meaning there is an imminent threat to life have a crew dispatched often before the call has even finished.

2.3.6 Ambulance services across England are measured on 999 emergency call answer time. The national standard is to answer 999 emergency calls within 5 seconds, with 9 out of 10 calls being answered within this time frame. This standard ensures that calls for the most unwell patients, such as those in cardiac arrest or with a life-threatening emergency, are answered as quickly as possible and that help is organised as soon as possible. In a time critical life-threatening emergency every second makes a difference, and our teams are often the first link in the chain of survival. Through clinical navigation, the Trust can manually identify and transfer calls to other health care providers, a system known as ‘access to the stack’. With oversight of the Trust Medical Director and the Senior Clinical Managers within the Emergency Operations Centre, the digital team have successfully created and are piloting an automated AI bot to identify, select and transfer low acuity falls responses after the call has passed through the call handling process. The pilot is being monitored with clinical oversight and if successful, will be expanded.

2.3.7 A number of people who call 999 do not need an ambulance, but need advice, guidance or signposting to other services. On average, around 10% of all 999 calls can be managed safely through the clinical assessment service ‘hear and treat’.

2.3.8 EEAST implemented the national principles of C2 segmentation last autumn. This was to ensure that we classify the risk within the C2 category, C2 accounts for over 60% of calls we receive. EEAST has managed C2 calls via ‘hear and treat’ for many years, so the focus has been on increasing staffing and improving processes. Since the process went live, EEAST has increased the number of C2s receiving an appropriate ‘hear and treat’ outcome from 4% to 6%.

2.3.9 The increased demand on services and the handover delays experienced at hospitals within the year has also contributed to the delays seen in attending patients. To improve performance, we have worked hard with our system partners and implemented a number of actions such as, co-horting of patients at hospitals to release ambulance clinicians back into the community and moving calls to community providers via the Access to Stack process which is now embedded and consistent. The Trust routinely moves across 4000 calls a month of which 70% are accepted by the community providers. This allows the patient to receive the most appropriate service when they dial 999. There is continued work with establishing the six Unscheduled Care Coordination Hubs to deliver the appropriate care to patients. Over recent years we have experienced a significant loss of ‘ambulance hours’ because of delays in handing patients over to hospital care, and this created a delay in responding to other emergencies. As a result, we worked collaboratively with regulators, commissioners, and hospitals to reduce the delays, so that our patients in the community are waiting less time for an ambulance. As a healthcare system, we continued to implement a handover escalation protocol which helps all organisations rapidly identify any offloading issues and then work together to accelerate care and reduce delays.

2.3.10 Our resilience and specialist operations teams were involved in both responding to, and helping EEAST to prepare in the event of any untoward, adverse or major incidents, or terrorist attacks. The team engaged during the year with the six Local Resilience Forums across the east of England as well as with numerous Safety Advisory Groups which operate across the region.

• In 2023/24 resilience managers attended just under 1,000 Local Resilience Forum meetings with partner agencies, while also attending just over 800 Safety Advisory Group (SAG) meetings to support events.
• The number of meetings and the time these meetings are taking is increasing year on year as SAG chairs start to consider the learning coming from the Manchester Arena Inquiry and the engagement which is expected to come from the Protect Duty.
• The Hazardous Area Response Team (HART) respond to patients requiring medical care in any hazardous environment, including at height, in confined spaces and in and around water. The team also support ambulance crews responding to patients who are not necessarily in a hazardous area but who are hard-to-reach or where multiple clinicians are required.
• Each year English NHS trusts complete a statutory annual self-assessment and review of compliance against the NHS Emergency Preparedness, Resilience and Response Framework, in line with the Civil Contingencies Act 2004.
• We maintained our overall compliance as SUBSTANTIAL and compliance with interoperable capabilities was also rated as SUBSTANTIAL. To ensure continual development and following external audit, the department maintains and manages an action plan to ensure the Trust develops and can deliver a high-level service.

2.3.11 In 2023/24 EEAST provided non-emergency patient transport services for patients needing non-emergency transport to and from hospital, treatment centres and other similar facilities within Cambridgeshire, parts of Essex, Bedfordshire and Hertfordshire.

• During 2023/24 we undertook 437, 647 patient journeys and 41,728 escort journeys – a total of 479, 375 journeys.
• In the pursuit of delivering exceptional healthcare services, we remained committed to continuously enhancing patient transport services. Over the past year, we have embarked on a journey of innovation and improvement, driven by an unwavering dedication to ensure the seamless transportation of patients to and from medical facilities.
• The Trust is steadfast in our dedication to continually enhancing patient transport services, ensuring that every patient receives the care and attention they deserve from the moment they embark on their journey with us.
• Procurement of Wheelchair Accessible Vehicles (WAVS) to Meet Rising Travel Needs - As the demand for patient transport services continues to grow, particularly considering evolving healthcare needs, we recognise the importance of equipping our fleet with suitable vehicles. To address this, we secured several wheelchair accessible vehicles to cater to the increasing procurement travel requirements. These WAVS not only enhance accessibility but also signify our commitment to ensuring that every patient receives transportation that is tailored to their specific needs.
• Relocation of Control Rooms for Improved Efficiency - Recognising the importance of operational efficiency in delivering timely and effective patient transport services, we undertook the relocation of control rooms. This strategic initiative aimed to centralise and optimise control room operations, resulting in improved coordination, faster response times, and enhanced overall efficiency. By relocating control rooms, we have further strengthened our capacity to deliver seamless transportation solutions that prioritise patient welfare and satisfaction.
• Negotiating Contract Variations and Extensions -In a dynamic healthcare landscape, flexibility and adaptability are paramount. Throughout the year, EEAST negotiated contract variations and extensions with commissioners. These negotiations were essential in ensuring that our services remained responsive to the evolving needs of our patients while upholding the highest standards of quality and reliability. The successful outcomes of these negotiations demonstrated our proactive approach to service optimisation and resource management.

AGM24/09/2.4 BE EXCELLENT COLLABORATORS AND INNOVATORS AS SYSTEM PARTNERS

2.4.1 Chris McGregor, Interim Director of Integration and Commercial Services reflected on system partnership as a valuable element in all of the Trusts activity. Collaboration with fire services and the establishment of Community Wellbeing Officer teams had expanded the Trusts reach and co-response capabilities. There were 13 Fire Stations actively responding to Category 1 calls, and community-first responders provided invaluable support, which had strengthened the collective ability to respond more effectively to emergencies. This work helped to deliver faster responses to patients, with improvements across all call categories, in particular of note we have responded 34% faster to Category 2 incidents and seen a significant reduction in patient safety incidents related to delayed responses to patients. We understand the importance of EEAST working collaboratively across our region to deliver quality patient care. Consequently, in 2023/24 we have worked very closely with local acute, primary and secondary care services, community health, mental health and social care partners and with the voluntary sector.

2.4.2 Some examples of collaborative working in 2023/24 include;

• Integrated Neighbourhood Teams - EEAST is an active member of the Mid and South Essex Integrated Neighbourhoods. A collaboration and a way of existing teams working together in a coordinated and purposeful way. These are networks of multi-agency professionals, volunteers and communities who are all serving their local population in the place where they usually live. EEAST is a member of this collaboration and has worked with system colleagues to address the needs of frequent service users.
• Rapid Intervention Service - This scheme involves an Advanced Paramedic working with GP localities in three primary care network areas in West Essex to provide home visits with the community provider to provide a joint assignment. This has enabled more patients to be treated at home and reduced the number of patients taken into hospital.
• Call Before You Convey: Call before you convey provides ambulance crews with a single phone number within their area to call and either gain clinical advice from the system or to access prompt referrals into alternative care pathways such as frailty assessment, virtual wards, and same day emergency care services.
• Mental Health Joint Response - The Mental Health Joint Response Model is a resource dedicated to responding to patients in need of a specialist response for mental health. To meet mental health needs in the community setting and improve access to appropriate care pathways. In partnership with the local system, EEAST provided the vehicle and emergency clinicians, with mental health professionals from the local mental health provider joining the team. There are Mental Health Joint Response Schemes across the Trust footprint.
• Unscheduled Care Co-ordination Hub - Within each area, an unscheduled care co-ordination hub has been established to support a swift response to emergency calls categorised as C3 - C5. The Unscheduled Care Co-Ordination Hub is a system partnership hosting multi-disciplinary teams of clinicians such as Emergency Department Consultants, Nurse Practitioner and EEAST Paramedics. The team will assess patients and explore the most appropriate care pathway based on the patient’s presenting condition. This supports meeting the patients’ needs out of hospital with more direct referral pathways to other parts of the system. The hubs ensure that alternative care is available for patients in line with their needs.

2.4.3 The East of England Ambulance Service Charity is separate from EEAST and receives no government funding but has had increased impact thanks to the continued support from donors, fundraisers, gifts in wills, and grant opportunities. This generosity enables us to provide vital support to staff, volunteers, and local communities, strengthening the provision of care to patients across the east of England. The Charity’s work is to enhance that of the Trust and is intended to be beyond that ordinarily funded by NHS budgets.

• Following the introduction of the cultural ambassador programme, the charity supported £35k funding to train an additional 30 cultural inclusion agents to aid with the change in culture and the development of cultural competence across EEAST. These new roles directly impact on the experience of EEAST colleagues and volunteers, as they represent all individuals with protected characteristics, specifically around race, disability, and sexual orientation.
• The charity has supported the Good Dog scheme, an internal scheme run by EEAST staff volunteers for EEAST colleagues. The scheme provides access to trained wellbeing dogs (along with their volunteer owners), to visit stations and colleagues when they need it most. In April 2023 the scheme went live with the first two trained GoodDOGs (Lennie and Togo), currently there are 28 dogs across the region with further training planned.
• Support has continued to develop outside spaces for health and wellbeing at stations across the region, as well as inside stations, enhancing crew rooms and wellbeing areas. The charity has supported a further five gardens this year providing calming spaces to relax during busy shifts.

2.4.4 CallEEAST, the contact centre specialising in non-emergency and commercial services, provided a wide range of contact centre services to both commercial organisations and NHS trusts. The team successfully managed services for over 100 clients, received over 850,000 calls. CallEEAST was proud to launch its own website - Enhance Your Customer Experience | 24/7 Contact Centre Services (calleeast.co.uk) which has had a positive impact and generated new business enquiries as well as increasing its online presence. Early in March 2024. CallEEAST launched a virtual ward in collaboration with Suffolk and North East Essex Integrated Care Board and East Suffolk and North Essex NHS Foundation Trust. The partnership designed this service, being the first non-clinical monitoring service, integrated with EEAST’s Clinical Assessment Service, to reduce out-of-hours calls to 999 or 111 services, providing 24/7 seamless service to support patient experience and reduce unnecessary admissions to emergency departments. Early feedback has been positive, and all feedback will continue to ensure the service develops in the best way.

TrainEEAST delivered professional training to organisations and individuals across the east of England and beyond. The trainers are skilled ambulance clinicians, with many years of experience working as Paramedics and Emergency Medical Technicians within EEAST. TrainEEAST offer a range of courses from Basic Life Support to First Response in Emergency Care. The team provided products such as Automated external defibrillators (AEDs) commercially. Last year TrainEEAST trained over 5000 individuals in pre-hospital emergency care and 999 protocols, and received positive feedback from External sources.

The National Performance Advisory group, brings people together nationally to share best practice and showcase industry developments across the NHS, enabling innovation and efficiency. The focus was to expand and enable network growth and continue to promote innovation throughout the NHS across a range of specialisms. In 2023/24 the NPAG team grew in size and memberships across multiple Best Value Groups and a range of specialisms. The team also expanded its training offering with new training courses. Successes this past year also came from NPAGs hosted conferences, Theatres and Decontamination, National District Nurse Conference, Clinical engineering, successfully hosted its first Net Zero Virtual Waste Conference.

AGM24/09/2.5 BE AN ENVIRONMENTALLY AND FINANCIALLY SUSTAINABLE ORGANISATION

2.5.1 Kevin Smith, Director of Finance (DoF) confirmed that in 2023/24 the Trust continued to embed environmental sustainability across the Trust and to use its influence with partners and suppliers. Colleagues were increasingly interested in working in a more sustainable way. The Green Champions network was relaunched with an article on the intranet, East24, and discussions with different departments to raise awareness and grow the network. By the end of the financial year, 10 members had remained in the network with a further 15 colleagues joining. The relaunch meeting provided an opportunity for members to meet each other, discuss sustainability ideas and provide feedback. The Trust continued to support the Green Champions network with a programme of events and projects to gain further momentum. EEAST’s growing team was essential to ensure the Trust embedded sustainability across its operations and most importantly, to achieve our sustainability targets.

2.5.2 Estate Improvements:

• The Trust continued to improve the energy efficiency and sustainability of the estate via the capital investment programme. The Bury St Edmunds hub would open imminently and was the first site to achieve the independent environmental accreditation of BREEAM Excellent.
• Air source heat pumps provided space heating and hot water, and solar PV panels could produce much of the electricity needed on site. The site had 20 electric vehicle (EV) charging spaces and covered cycle parking.
• Wellbeing was incorporated into the design of the building, with gym facilities and a garden providing a social and calming space for all staff. Planting includes many native and ornamental species, improving biodiversity and providing interest throughout the year.

Fleet fuel emissions

• It was estimated that fleet emissions made up between 40-85% of the direct carbon footprint. The reason for this uncertainty is because like many NHS organisations, we have gaps in data to produce our full fleet emissions footprint and have limited business travel data, particularly for business travel submitted through expenses. This is an important aspect for us to resolve.

• Historically, much of our utilities data was based on estimated meter readings, this made energy management difficult and led to queries with bills. Half-hourly automatic meter reading systems were being installed on all electricity and gas meters to enable more accurate billing and better visibility to target energy efficiency initiatives. With the project very near to completion, we are beginning to see more accurate data. Overall, 2023/24 energy emissions were 2% below the previous year, with a 2% increase in electricity but a 4% decrease in gas.

Waste management

• National strategy calls required all NHS trusts to transisition clinical waste to offensive waste, which has a much lower environmental impact and also saves costs. Hazardous clinical waste is treated with high temperature incineration which produces significant carbon emissions and the heat cannot be recovered, whereas Offensive waste has no hazardous properties and can be treated or disposed of similarly to general municipal waste, which usually includes conventional energy from waste (EfW) treatment.
• Initial assessments of the clinical waste streams indicated that up to 80% could be treated as offensive waste and could be treated in an energy from waste facility. Offensive waste bins were introduced to sites and vehicles across EEAST during January 2024. When this was introduced, we saw 5% of offensive waste in January, 18% in February and 32% in March. The Trust was on track to achieve the national target of 60% segregation by autumn 2024.

Fleet improvements

• Fleet continued to add electric vehicles following the successful trials of response vehicles in the last financial year. 12 Mercedes eVito mental health response vehicles and 15 Skoda Enyaq rapid response vehicles had been ordered, which made up 20% of the new Rapid Response Vehicle fleet.
• The Trust was part of an NHS England trial of electric double-staffed ambulances with the first 3 Ford E-Transit vehicles due for conversion and delivery. More fuel-efficient DSA-type vehicles (Renault and MAN) were purchased as part of the continual replacement of the Mercedes DSA.

Electric vehicle infrastructure

• There are13 electric vehicle (EV) chargers installed at 4 sites across the Trust and we have purchased a back-office charge point management system which allows communication between the vehicle and the charger.

2.5.3 Across 2023/24 EEAST invested £14.6m in capital assets:

• £6.1m invested in building projects. This was for the development of existing sites, for station refurbishments and for the electric vehicle charging infrastructure.
• £5.6m was invested in new vehicles including double staffed ambulance (DSA) chassis, welfare vehicles and resilience vehicles.
• £1.7m on IT towards development of a new website, introducing a system to ensure email security and malware software.
• £1.2m was invested in medical devices and training equipment.
• EEAST received capital investment of £1.9m to support the ambulance replacement programme and building projects, together with £0.5m of donated medical equipment assets.
• We disposed of one aged station site, Dunmow, relocating the provision of this locally. This generated capital receipts of £0.1m.

AGM24/09/2.6 OUR PRIORITIES – LOOKING FORWARD

2.6.1 The TC recognised that reflecting on the accomplishments in 2023/24 there was still some way to go to deliver on the vision and values. These challenges helped to drive the continuous evolution and improvement of the Trust, whilst maintaining the commitment to providing exceptional care. Looking ahead to 2024/25, the Trust was seeking to further increase ambulance hours on the road by over 5%, while continuing the focus on efficiency, productivity, and engagement. Plans to expand the use of alternative pathways and to develop targeted strategies for improving clinical outcomes in emergencies like cardiac arrests and falls, highlighted the ongoing commitment to improving patient care.

2.6.2 In relation to the Infrastructure, EEAST was on track to see the opening of the first new ambulance station for many years in 2024/25 and was beginning work on at least two further stations, this, alongside the planned replacement of over 150 ambulance vehicles demonstrates the commitment to ensure our people have the resources they need to deliver top-tier care and service to communities.

2.6.3 We will continue to drive transformation through further integrating of our service and continued work to improve our culture and regulatory position so we can continue to build an ambulance service that our people and our communities are proud of. We will build on the progress we have made so far with energy and a determination to further improve outcomes for patients and the experience of our people. We have set clear deliverables for the coming year to further improve performance against our priorities. We have also started work on a 2030 strategy for EEAST that is grounded in what the public of the east of England needs from its ambulance service and listening to our people about what they think the service should look like.

2.6.4 The TC welcomed the new CEO who reflected on the fantastic priorities and demonstration of progress over the last year. He recognised there was further work to do which would require working with partners to ensure consistency in outcomes for patients. Sharing this good practice was key. C2 performance would also be a focus, EEAST had some of the most improved performance in the NHS but further focus was required to improve this, in particular reducing hospital handover delays. The wellbeing of staff was a priority. Continuing the work to improve the culture was essential and ensuring staff were listened to and treated with respect, dignity and fairness. The CEO extended his thanks to those he had met who had provided a warm welcome to the organisation. He would be spending some time out and about visiting staff and stakeholders over the coming weeks.

AGM24/09/2.7 QUESTIONS FROM THE PUBLIC

2.7.1 There were no questions received from the public and the meeting closed.