In Public Board Minutes - February 2025

PUB25/02/1 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). The TC advised that any questions received from the public would be addressed at the end of the meeting. Three members of the public attended the meeting.

PUB25/02/2 APOLOGIES FOR ABSENCE

2.1 Apologies were received from:

• Wendy Thomas, Non-Executive Director
• George Lynn, Non-Executive Director
• Omid Shiraji, Associate Non-Executive Director
• Marika Stephenson, Chief People Officer / Deputy CEO
• Melissa Dowdeswell, Chief of Clinical Operations

PUB25/02/3 DECLARATIONS OF INTEREST

3.1 There were no new declarations.

PUB25/02/4 PATIENT STORY

4.1 Patient Safety and Non-Conveyance

4.1.1 Simon Chase, Chief Paramedic and Director of Quality (CP-DoQ) introduced a video that addressed the Patient Safety Incident Response Framework (PSIRF) and non-conveyance. The story related to Marjorie Wilson (94) who was attended by an ambulance following a fall at home. Following assessment, the crew had determined that Marjorie was safe to be left at home with advice regarding pain relief and support from her GP. A second ambulance attended Marjorie some days later, she was admitted to hospital with a broken arm, broken ribs and a chest infection; her condition deteriorated and she sadly died. The CP-DoQ thanked Jonathan and Julie, Marjorie’s son and daughter-in-law, for participating in the discovery interview and for allowing Marjorie’s story to be presented to the Trust Board.

4.1.2 The CP-DoQ advised that a thematic review into 100 non-conveyance cases had recently been presented to the Quality Governance Committee (QGC). The report confirmed that the Safe Discharge Care Bundle was 98% effective when used as a support tool to aid the safety of non-conveyed patients, however the review confirmed that the care bundle had not been completed for Marjorie Wilson.

4.1.3 Liam Dunn, Head of Patient Safety (HoPS) introduced PSIRF as a framework that supported the review of patient safety incidents within NHS organisations. Replacing the Serious Incident Framework, it encouraged the involvement of patients who had been affected by incidents (and their families) in the review process, together with staff who had been involved in the incident, at all stages. It gave everyone involved the opportunity to highlight their concerns and to also celebrate success when things went well; this maximised the learning potential from incidents. The main point identified from the thematic review into non-conveyance was that the Safe Discharge Care Bundle was not being utilised correctly on a routine basis. It was proposed that shared decision-making should become a mandatory element of the care bundle, to be completed before a patient was discharged into the care of the GP or community.

4.1.4 The following actions were identified for ongoing improvement:

• Appropriate use of the Safe Discharge Care Bundle to be audited on a monthly basis.
• Staff to be empowered to share their decision-making to improve the overall safety of non-conveyances.
• Patient Safety team to attend engagement sessions to share learning.
• Advanced Paramedics to adopt and promote the use of the Safe Discharge Care Bundle in front-line operations.
• Ongoing review of non-conveyance data to ensure that the improvements made had been embedded across the organisation, and to identify further improvements.

4.1.5 Julie Thallon, Non-Executive Director (NED-JT) acknowledged that the audit of the identified improvement actions would be reported to the QGC; she asked if this would include both safe and unsafe discharge data? The HoPS confirmed that the audit would include data on all discharges. He added that the Safe Discharge Care Bundle supported staff and aided decision-making through three tiers of safety, and the Trust was encouraging the shared decision-making element of this bundle; the process involved the seeking of dedicated advice from a healthcare professional.

4.1.6 The CP-DoQ added that Local Clinical Managers (LCMs) had been involved in the process as supervisors since the report was published in October 2024; he anticipated a reduction in the number of incidents recorded.

4.1.7 Chris Brook, Non-Executive Director (NED-CB) had expected the first paramedic who attended Marjorie to be more risk averse as they were newly qualified. He asked what actions the Trust had introduced to better enable decision-making? The HoPS replied that clinical supervision was embedded across the organisation and the new LCMs were supporting front-line staff in their decision-making. Shared decision-making had previously not always taken place and gaps had been identified within the process; the infrastructure and staffing were now in place to support this.

4.1.8 Neill Moloney, Chief Executive Officer (CEO) thanked the family for participating in the investigation. He recognised that no decision could be taken without risk, and he stressed the importance of staff using the available tools to support decision-making.

4.1.9 The TC concluded that the Board should feel discomfort when hearing patient stories. Partnership working was key to this story; paramedics and ambulance crews often worked in isolation, however the Trust was strategically committed to ensuring that support was available from the wider system. Compliance was another key theme; training, governance and accountability must not be compromised in exchange for patient safety.

The Board noted the report.

PUB25/02/5 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) since the last meeting; this was closely aligned to the Trust’s priorities, identified risks and strategies.

5.1.1 The TC addressed the key points:

• It had been a difficult winter for the NHS and ambulance service; hospital handover delays had peaked at ~9,500 hours in one week, with more than 50% of the fleet waiting outside A&E departments, putting enormous strain on the service.
• Performance: Category 2 calls had improved by 10-minutes compared to January 2024, but the 41-minutes recorded in January was not good enough. The work to develop the Winter Plan was gaining traction and EEAST continued to work towards an interim deadline of 30-minutes and a clinical deadline of 18-minutes. The TC acknowledged the hard work undertaken and the absence of complacency.
• The Care Quality Commission (CQC) visit to EEAST in November 2024 had identified several areas of concern; an update would be provided later in the meeting under agenda item PUB25/02/11.1 Care Quality Commission.

The Board noted the report.

PUB25/02/6 CHIEF EXECUTIVE OFFICER’S REPORT

6.1 The Board received and considered the CEO’s report; the following points were recorded:

6.1.1 The CEO had been out with EEAST staff between Christmas and New Year, and he had encountered the difficulties experienced by staff in handing over patients; on one occasion, more than 20 ambulances had been waiting outside a hospital. While recognising the challenges faced by hospitals, these delays impacted severely and negatively on patient safety and experience, and EEAST’s ability to respond to emergency calls. As a result, patient response times had deteriorated to an unacceptable level.

6.1.2 NHS Planning Guidance had been published for 2025-26:

• It would be a challenging year financially.
• There was commitment to delivering a maximum hospital handover time of 45-minutes, moving towards 15-minutes.
• Hear & Treat acceptance rates must increase for response times to improve.
• Category 2 (C2) performance target remained unchanged at 30-minutes.

6.1.3 The Raising Concerns Forum addressed key concerns within the Trust:

• Employee Relations – the high number of cases was a concern; actions to address the back-log were being considered.
• Sexual Harassment – the high number of cases was a concern, as were the increasing numbers of postventions which arose from concerns around individual members of staff.
• Health and Wellbeing – increased staff welfare support was being considered through the Business Planning process; monitored by People Committee.

6.1.4 Kate Vaughton, Director of Integration and Deputy Chief Executive Officer – following a successful secondment to the Cambridgeshire and Peterborough Integrated Care Board (ICB), Kate had accepted a permanent role as Chief Officer of Partnerships and Integration.

6.1.5 Marika Stephenson, Chief People Officer, had been appointed to the post of Deputy Chief Executive Officer.

6.1.6 The CEO extended his sympathy to the families and friends of the five EEAST colleagues who had recently passed:

• Julie Walker, Make Ready Supervisor at Peterborough ambulance station
• Neil Galaud, Leading Operations Manager at Southend ambulance station
• Andy Stuart, Norwich Emergency Operations Centre
• Emma-Louise Williamson, Emergency Care Assistant, West Essex
• George Coppin, Community First Responder and bank Ambulance Care Assistant, North Essex Patient Transport Services

6.1.7 NED-JT noted, with regard to the Handover 45 Release to Respond initiative (HO45), that the Trust was reporting reasonable compliance yet the hours lost were the highest recorded. The CEO replied that some improvement had been seen since the introduction of HO45 in November 2024, although not all systems had signed-up to the initiative. Some hospitals had experienced substantial delays over the festive period, and this had impacted on EEAST’s ability to achieve HO45. Unscheduled emergency care was most effective when the whole NHS system worked together, and EEAST continued to work with systems and welcomed their ongoing commitment and support for HO45; this work would continue through the 2025-26 year.

The Board noted the report.

PUB25/02/7 MINUTES OF THE PREVIOUS MEETING

7.1 The minutes of the meeting held on 06 November 2024 were approved as an accurate record.

7.1.1 NED-JT enquired about item 9.1.5 Integrated Performance Report (Finance and Risk), the update of actions and residual risk. The CEO had advised that the Executive Directors would take responsibility for robustly updating the action plans, however the report remained unchanged with no new actions identified. The CEO replied that this work was in progress and further work was needed to mitigate and update the actions and risk scores.

7.1.2 Stanley Mukwenya, Deputy Director of Corporate Affairs (DDoCA) advised that the current BAF descriptors would be reviewed and alignment checked against the controls and actions in place at the Board’s annual Risk Management Workshop in March. The TC concluded that, following this Workshop, the Board should agree the risk descriptors, scoring and mitigating actions for each of the strategic risks. The CEO highlighted the role of Committees in reviewing and being assured that the mitigating actions were sufficient to address the risk held.

ACTION: Board to review the BAF descriptors and alignment against the controls and actions in place at the Risk Management Workshop on 13 March.

PUB25/02/8 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) reported that good progress had been made in refining the IPR, making it shorter and more concise. The revised IPR would be submitted for review by the Executive Leadership Team (ELT) during w/c 17 March, with the new IPR submitted to the Trust Board in May. The Board noted the progress made and agreed that the action should remain open until the Public Board meeting on 07 May. Action ongoing.

8.2 PUB24/07/10.1.3.4 – (IPR) EOC Statistics and Performance Melissa Dowdeswell, Chief of Clinical Operations (CCO) to ensure there was increased scrutiny and planning between EOC statistics and performance.

8.2.1 Darren Meads, Deputy Chief of Clinical Operations (DCCO) advised that this scrutiny was an important step forward in an area that related to the performance monitoring of clinicians who undertook telephone triage and advice from the Control Rooms. The Trust was comparing and supporting the performance of these staff through manual collation and surveillance in readiness for a move towards a model that would include remote clinical advice and support. The next steps were to automate the reporting mechanism and embed this into a framework that allowed ongoing scrutiny. This information had been used over the Winter period to support staff through performance improvement processes. Action ongoing.

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

8.3.1 A detailed paper was submitted for review by Private Board on 12.02.2025; action plans to address the top three reasons for sickness absence would be discussed. Sudha Pavan, Deputy Director of People Services (DDoPS) reported that there was variation in sickness absence reporting compared to other ambulance service Trusts. EEAST was the only Trust to include duty sick within its sickness reporting, providing more representative and accurate data, but it left EEAST at the bottom of the ambulance service sickness league table. A Task and Finish Group had been set-up to consider how assurance could be offered, and to manage sickness absence more proactively at local-level.

8.4 The Board resolved to close the following actions:

• PUB24/09/10.1.6 – Freedom to Speak Up Report
• PUB24/11/10.1 – Freedom to Speak Up Report

PUB25/02/9 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 The DDoPS highlighted the key points for People Services:

• Staff vacancies and turnover – an improved position was reported with vacancies at 4.63% (target 10%), and turnover at 8.12% (target 10%). The peak in Quarter 3 was attributed to the Patient Transport Services (PTS) staff transfer.

9.1.2 Employee Relations (ER) – the 50% capacity was addressed within the CEO’s report. NHS England’s (NHSE) 100 conversation was focussed on avoidable harm, and EEAST was working with the Southside Partnership to identify earlier resolution through informal arrangements for less complex ER cases. As a result of this new approach, 62% of new cases were closed via informal resolution during January. The addition of a sexual harassment model to the Leadership Development Framework had resulted in an increased case load.

9.1.3 Mandatory and statutory training – 82% compliance (85% target).

• EEAST was exploring the possibility of entering into a Memorandum of Understanding (MOU) with other NHS organisations that would allow new paramedics and other front-line staff joining EEAST to transfer their valid mandatory and statutory training. While clinical risk and patient quality remained a priority, work was ongoing with leaders and HR Business Partners to ensure that front-line staff were given time to complete essential training.
• Anthony Kitchener, Deputy Director of Education, was undertaking a review to identify the key mandatory and statutory training modules.

9.1.4 In response to a question from the CEO, the DDoPS was unable to confirm a correlation between the high rate of sickness absence in December 2024 and low staff vaccination rates. Catherine Glickman, Non-Executive Director (NED-CG) noted the inclusion of 2% duty sick within the sickness absence data, however this did not explain the increase. The TC asked that this information be circulated to the Board post-meeting.

9.1.5 The TC noted that several of the mandatory training modules were not core modules for all staff; he asked that the list be more focussed and achievable with only the most important training being identified as mandatory. He added that compliance with mandatory training and appraisals was not optional, more scrutiny was needed. NED-CG observed that staff did not have sufficient time within work hours to complete or refresh their mandatory training and read the many new or updated policies. The CEO supported the review of core mandatory training modules. The TC asked that staff be given time to undertake this work.

ACTIONS:

• Circulate to the Board post-meeting a breakdown of sickness absence data for December 2024, correlated against the staff vaccination data.
• Mandatory training modules to be more focussed and achievable, and staff to be given time during work hours to ensure compliance with new/refreshed mandatory training and policies.

9.1.2 The DCCO provided the Operations update:

• Activity – a significant increase was reported in both the number of 999 calls received and the number of patients to whom EEAST had responded in December 2024.
• Winter pressure – the number of patients referred to and accepted by Hear & Treat exceeded 12% and continued to increase. The highest level of capacity offered by the Trust was recorded over the Winter period due, in part, to recruitment and training. The C2 performance was unacceptable, however, this must be considered alongside the challenges presented by the hospital handover delays, the highest ever recorded by the Trust.

9.1.2.1 The TC acknowledged that EEAST continued to work in partnership with systems to address and mitigate the external pressures; he asked what EEAST was doing internally to address this? The DCCO replied that the PA Consulting model had enabled EEAST to identify the metrics that were key to improved operational performance. The Organisational Performance Improvement Plan (OPIP) had been distilled into eight points that could be referenced and tracked, and which PA Consulting had confirmed as the most important elements to impact on C2 performance; these included out of service, on-scene times and Hear & Treat. These metrics would be reviewed monthly and presented to Performance Committee, with an overview to the Trust Board.

9.1.2.2 The TC recognised that the changes developed and implemented over the past 12-months were having an impact on the effectiveness and efficiency of the service: the increase in Hear & Treat rates, the reduced number of vehicles off-road, and the decrease in hand-over to clear times, however there was still work to do. The CEO added that the new hand-over to clear approach automatically put a crew back into service once a patient had been handed over to the hospital, dramatically reducing lost time. A substantial number of calls were also being transferred to alternative care pathways via the Unscheduled Urgent Care Hubs (UUCH), and it was EEAST’s ambition to increase this number.

9.1.2.3 In relation to call-handling times, the DCCO highlighted the importance of supporting and training staff to enable them to be more efficient; clarity was also required around workforce plans, particularly Emergency Operations Centre (EOC) staffing.

9.1.2.4 With regard to EOC staffing and following on from the Patient Story at the last Public Board meeting, the TC observed that the commitments made in November had not been met; EEAST must address this. The CEO advised that the number of staff leaving the EOC was higher than the number of new staff joining; a workforce plan was needed to achieve the 5-second target response time and reduce staff turnover.

9.1.2.5 .NED-JT welcomed the improvements in the IPR but requested clarity around the risks; the impact from each action needed to be distilled, confirming which action had resulted in the greatest impact/success. The CEO confirmed that this work had commenced but needed to be further developed.

9.1.3 The CP-DoQ provided an update on Clinical Quality and Safety:

• Complaints – the reduction in the number of complaints received was anticipated. A decision was taken not to send complaints letters during the Christmas and New Year period; this action did not detract from the investigations or outcomes. Local investigation was causing delays to the complaints process as considerable time was spent liaising with complainants to fully understand their complaint, however metrics confirmed a low re-contact rate and low onward referral to the Parliamentary and Health Service Ombudsman (PHSO). The quality of complaint response remained good but investigations must be completed quicker; the Executive Clinical Group (ECG) had agreed that this metric should be monitored.
• Level 1 Safeguarding – the reduction in compliance seen at the last meeting had been reversed.

9.1.3.1 The CEO reflected that the response time for complaints was not good enough; EEAST had set its own response target at two-months and work was needed to ensure compliance with this target.

9.1.4 The DoST provided an update on Strategy and Transformation:

• Innovation and system partnership reporting was not to the required standard; to be improved for the next Board meeting.
• Access to the Stack – 4,885 calls were transferred in December 2024; all systems exceeded 50% acceptance, and the average regional rate was 65%. The highest was East Suffolk and North Essex NHS Foundation Trust (ESNEFT) at 88%, the lowest Cambridgeshire and Peterborough (C&P) at 48%.
• Patient Transport Services (PTS) – expenditure at Month 9 was £1M over budget; an improvement against a forecast overspend of £3.3M. Remodelling for Bedfordshire and Luton was in the final stage and should be implemented during the 2025-26 year. Remodelling for Herts and West Essex was progressing.
• Business and Partnerships – work was ongoing with Finance and the local operational teams to enable the PA Consulting recommendations.
• Community First Responders (CFRs) – Category 1 (C1) response training was being delivered, including falls and blood glucose monitoring; training would continue in order to extend CFR utilisation. Work was ongoing with the EOCs to ensure a higher level of CFR dispatch.
• Blue Light collaboration – Cambridgeshire and Essex had confirmed their 40% contribution; EEAST would contribute 60%.

9.1.4.1 The CEO congratulated colleagues for the significant increase achieved by the CFR utilisation pilot. Discussions were ongoing to determine if this could be extended and rolled-out for the 2025-26 year.

9.1.4.2 Stephen Rose, Community Engagement Group representative (CEG-SR) noted the drop in the number of times he was dispatched during a shift compared to when he first became a CFR; other volunteers reported the same and, subsequently, were not signing-on for a shift. He added that equipment was not being made available to CFRs. He recommended that fewer, better trained CFRs was the way forward. The TC asked People Committee to monitor the use of CFRs. The CEO added that more CFRs were needed in some parts of the region, there was no ambition to reduce the number.

9.1.4.3 With regard to Access to the Stack, the TC noted the continued increase in the number of calls transferred and accepted by the UUCHs, and asked if the number tracked (65%) was correct, or if the 38.83% reported was the impact of EEAST’s collaboration in the UUCH? He enquired about the number of calls that were rejected and the reasons for rejection and asked if EEAST should accept the rejected referrals as these impacted negatively on the patient experience. The CEO advised that both indicators were important: the work within EEAST’s control and its ambition to successfully transfer as many C3-C5 calls to the UUCHs, while working with partners and sharing information to enable them to put the required services in place.

9.1.4.4 NED-JT reflected that the absolute numbers remained low compared to the number of calls received; to be discussed in more detail at Performance Committee.

ACTIONS:

• People Committee to monitor CFR utilisation.
• Performance Committee to discuss the low absolute numbers.

9.1.5 Kevin Smith, Director of Finance (DoF) delivered the Finance update at December, month 9 of the 2024-25 financial year:

• Financial position – in surplus and ahead of plan; EEAST should achieve the plan for this year and return a small surplus.
• Capital spend – although considerable financial resource had been committed to the new Ipswich ambulance hub, an underspend was expected.
• Operations Support and PTS – action and management planning had reduced the anticipated overspend in these two areas.
• The 2025-26 financial year would be a challenge; EEAST anticipated similar income to this year but with inflationary pressures.

9.1.5.1 In response to a question from the TC regarding the run-rate and staffing levels, the DoF confirmed that the overtime incentives offered had been planned and had not impacted on the budget.

The Board noted the report.

9.2 Winter Plan 2024-25 Update

9.2.1 The Board received and considered the 2024-25 Winter Plan Update. The DCCO reported that the strategy had focused on demand management, working with the systems and acute Trusts. Operational changes had been applied before Christmas, including the automation of hand-over to clear and the implementation of Local Operations Cells (LOCs). Debriefing meetings were planned to understand, learn and inform next year’s Winter plan. The Board noted the report.

PUB25/02/10 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 Freedom to Speak Up (FTSU) report from The Guardian Service (TGS). Guardians, Danielle Marshall (TGS-DM) and Kimberley Gillingham (TGS-KG) joined the meeting and TGS-KG reported the following points:

10.1.2

• 87 cases were recorded during the five months to 31 December 2024.
• All red cases raised were responded to and dealt with promptly by the Trust. The majority of cases raised were responded to within the agreed RAG protocols. Failure to respond occurred on only a few occasions and these were escalated.
• Comments and recommendations had been made; some were already being addressed and actions implemented.
• Three reported themes: -- Systems and processes – recruitment issues were being addressed. -- Management issues – staff were raising concerns with their managers but these were either not supported or staff were directed towards an unwanted formal process. Staff also felt they were being bullied by their manager. --Behaviour and relationships – some staff were not adhering to the Trust’s values.
• FTSU contact to date indicated that the culture at EEAST was improving, however staff were still afraid to speak-up; they were afraid to raise issues with their managers and fearful of the repercussions. TGS-KG asked the Board to encourage its staff to speak-up, either to their managers or to TGS; all concerns raised by staff should be welcomed and supported by the Board.

10.1.3 The TC requested that the TGS share with the Trust Board any learning they gained from their work with other organisations.

10.1.4 NED-CG was confident that protocols were being met; one serious issue had been raised and dealt with quickly by the Trust. She added that relatively few sexual safety issues were being raised through TGS, these were being raised with managers and Employee Relations. With regard to recruitment processes, people did not feel that selection was fair; clear and honest feedback must be offered to all candidates.

10.1.5 NED-JT noted the absence of the usual drop in FTSU cases during December, which had been attributed to the change in provider and staff feeling more able to speak-up; she was concerned that these reasons may not be proven. NED-JT welcomed the list of recommended improvements and asked if the Trust would adopt all or some of the recommendations? The CEO agreed that all of the recommendations proposed by TGS would be taken forward at EEAST.

10.1.6 The DDoPS advised that the staff recruitment process continued to be strengthened, with a focus on removing nepotism. Assessment centres were now being run for all leadership roles, chaired by independent panellists, with the aim of appointing the right people with the right skills and expertise to drive forward EEAST’s vision. The themes and trends identified by TGS were being explored to ensure focus in the right areas. Staff feedback on recruitment systems and processes was also received through the Cultural Inclusion Agents, the Culture, Strategy and Education inbox, and directly to the Chief People Officer. Managing applicants’ perceptions was equally important.

10.1.7 The CEO reported that a review of the recruitment process would be undertaken, and this would include feedback from recent new appointments. The DDoPS added that the “First Year at EEAST” survey had recently been launched. The Board noted that the year one staff attrition rate had reduced significantly in recent years.

10.1.8 The TC invited further guidance and recommendations from TGS; those already offered would be followed up through the Raising Concerns Forum and People Committee. He reported that a Board Development Workshop had been undertaken with the National Guardian’s Office in December 2024, however, this did not detract from staff willingness to speak-up. The key metrics from the 2023 Staff Survey was that only 49% of people were comfortable speaking-up (the 2024 results showed a marginal improvement), and only 34% of people felt that, if they did speak-up, something would happen. Although considerable good work had been undertaken to positively improve the situation for EEAST staff, there was still considerable work to do.

The Board noted the report.

ACTIONS:

• TGS to share with the Trust Board any learning gained from their work with other NHS organisations.
• Raising Concerns Forum and People Committee to follow-up on the recommendations made by TGS.

10.2 People Committee Assurance Report

10.2.1 The Board received and considered the People Committee Assurance Report. In the absence of Wendy Thomas, Non-Executive Director and Committee Chair, NED-CG provided the following update from the meeting held on 30 October 2024:

10.2.2

• Dyslexia – significant progress was reported; 200+ staff were being supported.
• Inappropriate Behaviours report – progress was being made but significant work still needed to be undertaken.
• Sickness – a thorough review of sickness absence was undertaken. Duty sick was now being monitored; initially high, this was being managed down.
• Appraisals – 85-89% compliance had been achieved as a result of commitment to and focus on an agreed plan.

The Board noted the 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 27 November 2024:

10.3.2

• The Committee recognised the difficulties experienced in leadership roles and committed to ensuring that people were supported.
• Fit and Proper Persons audit – reasonable assurance was offered; actions were being tracked.
• Changes to the leadership structure: -- Leadership and Culture/EDI had transferred to the People Services directorate. -- Clinical Education now reported to the Chief Paramedic and Director of Quality. -- Director of Digital Innovation – a new role to lead change – was pending advert. -- Consideration was being given to a new Director of Governance role, subject to a review of the governance structure.
• Employee Relations – more innovative case management was required.

The Board noted the report.

10.4 Community Engagement Group Quarterly Report

10.4.1 The Board received and considered the quarterly report from the Community Engagement Group (CEG). Stephen Rose, CEG representative (CEG-SR) reported the following key points:

10.4.2

• Feedback from recent public events was positive: the ambulance service was seen as professional, trusted and offering good quality service. The main concern raised was not being able to see a GP, which was impacting negatively on EEAST.
• CEG had engaged with ~800 people in the past 3-months across a variety of community events. Additional funding for promotional items would support the dissemination of EEAST messaging to the public.
• The CEG had ambition to increase their event attendance; the Board was asked to support requests for future events through equipment, vehicles and attendance.
• Young volunteers – safeguarding support was requested.

10.4.3 The CP-DoQ confirmed that an addendum to the Safeguarding policy was being processed, and funds were allocated to the CEG through the Patient Experience team. The TC asked CEG-SR to record and update the requests in the next CEG report.

10.4.4 NED-JT acknowledged the opportunities that the CEG team offered in communicating the Trust’s messages to the public. Julie Hollings, Director of Communications and Engagement (DoCE) added that promotional items had recently been ordered and she would ensure that CEG requests were fulfilled.

The Board noted the report.

PUB25/02/11 OBJECTIVE 2: PROVIDE OUTSTANDING QUALITY OF CARE AND PERFORMANCE

11.1 Care Quality Commission (CQC)

11.1.1 Quality Improvement Plan – Progress Report The Board received and considered the 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 that 93% of actions were now closed, a 6% increase since November 2024.

11.1.2 The CP-DoQ stated that a CQC inspection was ongoing. The first on-site element was undertaken in November, followed-up in January with several virtual focus groups; information had also been requested on urgent and emergency operations and the EOC. The feedback letter received on 18 December had been shared with the Public Board: this confirmed that the FTSU process was positive and widely known, and staff were endeavouring to provide caring and compassionate care. The following areas of improvement were identified:

11.1.3

• Staff training was not up-to-date
• 999 call pick-up times
• EOC staffing was not at the required level
• Culture was vastly improved, but inconsistent within the EOC
• Staff engagement was visible and plans were in place but communication needed to be more effective
• Reporting and closure of the control of medicine incident investigations

11.1.4 A Section 29a warning notice was received on 23 January in relation to the Health and Social Care Act; action on the six areas listed above was required within the next 3-months. A Section 64 notice was received on 27 January (regulation 17 of the Health and Social Care Act); C2 and C3 performance were below the national standard and immediate improvement was required.

11.1.5 The TC stated that the Board accepted the CQC findings and he confirmed that the Trust was aware of and had been addressing many of the issues raised; these were areas of focus that took time to progress and show improvement. The insightful feedback was welcomed by the Board, but the TC was disappointed that the CQC had highlighted areas that could have shown improvement. The Board would reflect on why the CQC was raising these issues and the Trust was not able to manage them.

11.1.6 The CP-DoQ reported that a plan was in place to deliver on the areas identified for improvement; the following internal actions would be undertaken immediately:

• Mandatory training: monitored to ensure Trust-wide compliance by 31 March 2025.
• Performance (C2 and call handling): a weekly report and metrics would be shared with ELT in order that improvement could be measured and monitored. A monthly report would be presented to the CQC Monitoring Group.
• Medicines Management: a weekly oversight meeting had been introduced with the Deputy Clinical Director and the Chief Pharmacist to review ongoing incidents and address the areas of concern raised by the investigation. EEAST needed to understand why issues were not escalated or captured within the DATIX incident reporting system.
• Stakeholder meetings would show how performance was being tracked over the next 12-weeks, and regular reports would be submitted to the QGC.

11.1.7 The CEO was reassured that the issues raised by the CQC were generally known to EEAST. He advised that a strengthened accountability framework would be introduced, supporting local teams in addressing the hygiene elements and providing assurance at Committee-level. Several Transformation Programmes had been running throughout the organisation to address these issues, and the CEO would chair the new Transformation Portfolio Board. A governance review was also ongoing to understand how the organisation managed risk.

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 20 November 2024:

11.2.2

• Stroke Video Triage Project – funding had been secured to extend this important work into 2025-26.
• Corpuls – the software upgrade was being rolled-out.
• Apprentices – the Committee supported the re-introduction of apprentices to EEAST; this was a positive message for the Trust.
• Patient Safety Incident Response Framework (PSIRF) – the Committee reviewed the second PSIRF Thematic Review into Non-Conveyance.
• LeDeR review – it was agreed that ambulance staff should act as advocates for patients with learning disabilities; training was needed to support crews in identifying these patients and knowing how to act.

The Board noted the report.

11.3 Performance Committee Assurance Report

11.3.1 The Board received and considered the Performance Committee Assurance Report from the meeting held on 20 November 2024. NED-JT (Committee Chair) advised that reporting continued to develop for this new Committee; no items were identified for escalation to the Board.

The Board noted the report.

PUB25/02/12 OBJECTIVE 4: BE AN ENVIRONMENTALLY AND FINANCIALLY SUSTAINABLE ORGANISATION

12.1 Finance and Sustainability Committee Assurance Report

12.1.1 The Board received and considered the Finance and Sustainability Committee assurance report from the meeting held on 27 November 2024. NED-CB confirmed that there were no items for action or escalation to the Board.

The Board noted the report.

PUB25/02/13 CLOSING ADMINISTRATION

13.1 Items Referred to/from Other Committees There were no items identified for referral to the Committees.

13.2 Questions received from the Public

13.2.1 Q1. (agenda item PUB25/02/4 – Patient Story) To what extent had EEAST researched the effect of Emergency Dept handover delays on crew morale: the apparent inevitability and disillusionment, and consequent performance and retention?

13.2.1.1 A. The CEO replied that work was ongoing with AACE to look at moral injury for all ambulance services; this was recognised nationally.

13.2.2 Q2. (agenda item PUB25/02/4 – Patient Story) What would have been different if the Safe Discharge Care Bundle had been implemented in full?

13.2.2.1 A. The HoPS replied that the Safe Discharge Care Bundle, if used correctly, flagged to the crew that the discharge was potentially unsafe and may be detrimental to the patient. Under such circumstances, the crew should phone a clinical supervisor for enhanced decision-making prior to discharge.

13.2.3 Q3. Why had the Board chosen to take the EOC Review report in private, and how would these reports be shared with staff and Unions?

13.2.3.1 A. The CEO replied that EEAST had engaged with its staff throughout the review process; a decision would not be taken by the Board today. Sufficient time was needed to allow for further staff engagement and to understand the implications of each option; maintaining the current situation was not an option that would be considered. A final report and recommendation would be submitted for Board consideration in 2-3 months’ time.

13.2.4 Q4. A petition was submitted to the Board in November 2024 regarding the future of the Bedford EOC; there had been no response and a lack of direct consultation with the representatives and elected leaders of the Bedford EOC. The possible changes would affect a core part of the service and hundreds of jobs. Where had the engagement been to date and how would this improve going forward?

13.2.4.1 A. The CEO replied that engagement and consultation should be considered separately. The Board had agreed that a decision regarding the future of the EOCs would not be taken in private; it had engaged with staff from the beginning of the process around the key questions, including how many EOCs were needed. Four staff engagement events had been held to date, supported by multiple visits to EOCs by the Executive team. Engagement with staff would continue until the exercise was concluded and, once the proposals were agreed, there would be a process of formal consultation with both staff and local stakeholders.

13.2.5 Q5. EOC recruitment was a challenge when recruiting from three communities; reducing this to two communities increased the challenge.

13.2.5.1 A. The CEO acknowledged the importance of this consideration and confirmed that it would be factored into the decision-making when options were considered.

13.3 Reflection on Meeting

13.3.1 NED-JT offered the following reflection:

• Continuation of the journey was a key theme; a lot of work had been undertaken but there was still more to do. The areas that required focus and deep-dive were becoming clearer. Although disappointing to receive, the CQC warning notice provided focus.
• Accountability and compliance was a theme across a number of papers and discussions. She asked if the Board could do more to understand the challenges faced by front-line staff and volunteers, was there a disconnect between thought and reality?
• Excellent CEG report; the Trust should embrace the opportunities they offered.

Invited by the TC to offer his reflection, CEG-SR added that he was pleased to see the attention that was given to both staff and patients.

13.4 Date of Next Meeting: Wednesday 7 May 2025 (09:30 – 12:30)

The meeting closed at 12.38.