AGENDA ITEM 2.2d MINUTES OF THE EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING HELD 16 SEPTEMBER 2014

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1 AGENDA ITEM 2.2d MINUTES OF THE EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING HELD 16 SEPTEMBER 2014 MEETING ROOM, NHS SHARED SERVICES PARTNERHIP, LLANHARAN PRESENT Members: Mr Bob Hudson (Vice Chair) Mr Adam Cairns Mrs Judith Paget Mrs Karen Howells Prof Trevor Purt Mr Paul Roberts Mrs Allison Williams Mrs Tracey Cooper In Attendance: Mr Julian Baker Mr Stuart Davies Mrs Patsy Roseblade Miss Pam Wenger Chief Executive, Powys THB Chief Executive, Cardiff and Vale UHB Interim Chief Executive, Aneurin Bevan UHB Chief Executive, Hywel Dda LHB Chief Executive, Betsi Cadwaladr UHB Chief Executive, Abertawe Bro Morgannwg UHB Chief Executive, Cwm Taf UHB Chief Executive, Public Health Wales Collaborative Commissioning Lead Director of Finance, WHSSC Executive Director of Finance and ICT, WAST Committee Secretary, Minutes of Meeting Held 16 September 2014 Page 1 of 7

2 WAST Reps PRELIMINARY MATTERS Action EASC 14/28 WELCOME AND INTRODUCTIONS The Vice Chair welcomed all to the meeting of the Emergency Ambulance Services Joint Committee. Members noted that in the Chairs absence Mr Hudson would chair the meeting. Members stated that there was some confusion in terms of the timing of the meeting and that a number of members would need to leave early. EASC 14/29 EASC 14/30 APOLOGIES FOR ABSENCE Professor S McClelland. DECLARATIONS OF INTEREST No new declarations were received other than those already declared. EASC 14/31 REPORT FROM THE AMBULANCE COMMISSIONER Mr B Hudson welcomed Mr S Ide to his first meeting of the Emergency Ambulance Services Committee. Mr S Ide provided a detailed update on this initial impressions since taking up the role of Ambulance Services Commissioner. Mr Ide drew Members attention to specific issues in his report which included: Minutes of Meeting Held 16 September 2014 Page 2 of 7

3 Confusion between WAST accountability in WG and the NHS Wales structure; Issues regarding the performance of WAST and operational capacity to deliver the service; WAST perspective in terms of the actions required to address the performance deficit Refocusing of effect on staff and operational management and, subsequently, improved organisational performance in the emergency ambulance service; and Opportunity to develop a clinically based ambulance service, as part of a developing and comprehensive unscheduled primary care system for Wales. Members discussed in some detail the initial views and whilst recognising the issues, concern was raised over the suggestion that additional monies was required to be invested into the service. Members agreed the approach taken which should enable the ambulance service to deliver performance, and transform the service within the existing financial envelope. Mr S Ide discussed specifically the suggested actions to be addressed by EASC. Members discussed the EASC structure as described in the papers and supported in principle. Members agreed that the financial arrangements would need to be finalised. Minutes of Meeting Held 16 September 2014 Page 3 of 7

4 Members discussed the issue of PCS and acknowledged that whilst this may be a matter the Committee would wish to consider in future, the main priority was addressing ambulance performance. Miss P Wenger confirmed the remit of EASC and that this not included. Members agreed that this matter and EMRTs would require further consideration. Members agreed to QPRD group leading concerted work to address the mitigation of WAST controlled performance indicators alongside the performance management role of WAST. Following a detailed discussion on the report members agreed the actions for EASC with the exception of the PCS/EMRTS as this required further consideration. Members RESOLVED to: Note the report; Agree in principle the EASC structure; Agree the EASC/WAST accountability chart; Agree a single point of contact in each Health Board; Agree support for further investigation of sponsoring paramedic skill training and education; Agree to the QPRD leading the work on non WAST performance inhibitors; and Agree further work on proactive media relations and stakeholder communications. Minutes of Meeting Held 16 September 2014 Page 4 of 7

5 EASC 14/32 GOVERNANCE AND RESOURCING STRUCTURE Members received and supported the structures. Members RESOLVED to: Agree the governance structure for EASC. EASC 14/33 APPOINTMENT OF CHIEF AMBULANCE SERVICES COMMISSIONER Mr Hudson provided an update on progressing the appointment of the Chief Ambulance Commissioner. Members RESOLVED to: Note the update in terms of the recruitment process. EASC 14/34 WELSH AMBULANCE SERVICE IMPROVEMENT PLAN Members welcomed Mrs P Roseblade to the meeting. Mrs Roseblade presented to Members the updated Improvement Plan and highlighted the keys areas of risk. Mrs Roseblade explained some of the challenges surrounding the implementation of policies in particular, the Rest Break Policy. Members noted the employee relation issues as a result of the proposed changes to the policy. Members were supportive of the approach being taken by WAST and offered any support that could be provided. Minutes of Meeting Held 16 September 2014 Page 5 of 7

6 Members accepted the challenges in terms of the change process that was being followed through, however, reducing the clinical risk and improving the ambulance was critical. Mrs Roseblade provided an update in relation to the development of the Clinical Response Model. Members noted that there has been some delay in progress and the assurances that this was being addressed. Mr A Cairns left the meeting Mrs A Williams left the meeting Mrs K Howells left the meeting Prof T Purt left the meeting Members RESOLVED to: Note the report; and Support the progress being made to address the performance EASC 14/35 COLLABORATIVE COMMISSIONING GROUP Mr J Baker presented an brief update in relation to progress. As the committee was not quorate, Mr Hudson agreed to deal with matter out of committee under urgent action. Committee Secretary EASC 14/36 FINANCIAL REPORTING ARRANGEMENTS Mr S Davies provided a brief update on the financial arrangements for EASC. Members recognised there were some resources which were additional and would need to be Committee Secretary Minutes of Meeting Held 16 September 2014 Page 6 of 7

7 funded via the Health Boards including: Ambulance Commissioner, Chair, Governance and Committee Secretariat. As the committee was not quorate, Mr Hudson agreed to deal with matter out of committee under urgent action. EASC 14/37 MINUTES OF THE MEETING HELD ON 24 JUNE 2014 As the committee was not quorate, Mr Hudson agreed to deal with matter out of committee under urgent action. Committee Secretary OTHER MATTERS EASC 14/39 Any Other Business There were no matters raised under this item. EASC 14/40 Date of next meeting The date of the next Joint Committee meeting was confirmed as 25 November Signed Date (Chair) Minutes of Meeting Held 16 September 2014 Page 7 of 7

8 AGENDA ITEM 2.2e MINUTES OF THE SPECIAL EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING HELD 21 OCTOBER 2014 MEETING ROOM 4.03, WELSH GOVERNMENT, CATHAYS PARK, CARDIFF PRESENT Members: Professor Siobhan McClelland Mr Adam Cairns Mr Stuart Ide Mrs Judith Paget Mrs Karen Howell Mr Bob Hudson Professor Trevor Purt Mr Paul Roberts Mrs Allison Williams Mrs Tracey Cooper In Attendance: Mr Stuart Davies Miss Pam Wenger Mr Simon Dean Mrs Tracy Myhill Chair Chief Executive, Cardiff and Vale UHB Emergency Ambulance Commissioner Chief Executive, Aneurin Bevan UHB Interim Chief Executive, Hywel Dda LHB Chief Executive, Powys THB Chief Executive, Betsi Cadwaladr UHB Chief Executive, Abertawe Bro Morgannwg UHB Chief Executive, Cwm Taf UHB Chief Executive, Public Health Wales Director of Finance, WHSSC Committee Secretary, WHSSC Deputy Chief Executive, NHS Wales Interim Chief Executive, WAST Minutes of the Special Meeting 21 October 2014 Page 1 of 8

9 PRELIMINARY MATTERS Action EASC 14/241 WELCOME AND INTRODUCTIONS The Chair welcomed Members to the special meeting of the Emergency Ambulance Services Committee. The Chair welcomed Mrs T Myhill to the meeting and Mr S Dean as Observers. The Chair confirmed that she had called the urgent meeting in accordance with the Standing Orders to discuss the urgent position in relation to the A8 Performance Target. EASC 14/42 EASC 14/43 APOLOGIES FOR ABSENCE None. DECLARATIONS OF INTEREST No new declarations were received other than those already declared. EASC 14/44 AMBULANCE PERFORMANCE TARGET A8 The Chair updated Members on the current position in terms of the A8 Target. The Chair confirmed that the Committee would need to agree a set of actions, performance management arrangements and timescales by the end of the meeting. Members received a copy of the presentation and the updated Recovery and Service Improvement Plan. Mr S Ide provided an update in terms of the performance position of the A8 target, and confirmed that the current performance was 54.5%. Members noted the deteriorating position from the previous month and the projection for the end of October was 55%. Mr Ide provided an overview of some of the Minutes of the Special Meeting 21 October 2014 Page 2 of 8

10 current issues which were contributing to the poor performance including delayed transfers of care, accident and emergency capacity, delayed handovers in ED, patient demand and changing clinical need as well as the challenging A8 performance target. Members noted and supported the requirement for the changes required to support the delivery of the target and in particular the specific actions included within the delivery plan. Mr Ide drew Members attention to the Recovery and Service Improvement Plan and discussed in detail each of the specific actions. Members noted that a patient safety notice had been issued by Mr Ide as he considered that the service was not safe and was not operating within the industry standards. Members discussed the governance around this notice and agreed that an escalation process with governance arrangements would need to be clarified. Ambulance Commissioner/ Committee Secretary Mr Ide advised that WAST need to manage urgent cases more appropriately. Members noted that WAST were not routinely using Card 35 to establish and agree clinically appropriate hospital admission times. Mr Ide explained that the capacity and efficiency of the resources needed to be maximised. Mr Ide outlined the next steps in terms of the immediate actions required to ensure improvements in the A8 target. Members noted the issues around the use of private ambulances and first response and agreed that it was vital to utilise all available resources to improve the patient flow across the urgent care system. Mrs Myhill re-iterated the importance of ensuring the patient is at the centre, and that WAST was fully committed to reducing the clinical risks and the delivery of a sustainable service whilst meeting the targets. The Chair re-iterated the key priority was to ensure the delivery of a safe service based on Minutes of the Special Meeting 21 October 2014 Page 3 of 8

11 clinical need with the patient at the centre. Mr A Cairns raised the issue in terms of the focus of the discussion and sought clarity if it was in relation to the A8 target or improvements across the unscheduled care system. Members agreed that whilst this was a whole system approach the urgent focus was on the improvements of the A8 target. Mrs Williams raised the issue of whether there could be a better balance between Rapid Response Vehicles (RRVs) and Ambulances responding to 999 calls. Members discussed the issue and recognised the benefits of utilising RRVs and considered some of the barriers to the change. Mrs Williams also suggested that she would be keen to pilot a scheme locally where GP urgent calls are diverted through bed bureau. Professor Purt raised the issue of the A8 target and sought clarification for the reasons why this was not being achieved. Mr Ide provided an update and confirmed that there were not enough resources to respond to the clinical demand. Members also discussed the current protocols that were in place which would need to change as these were a significant contributory factor. Mrs Cooper suggested that there was a requirement to better manage the service and that more ambulance resources were required. Members discussed the performance data and considered whether there was a better way of dealing with recurrent attendees. Mrs Paget stated that it was important to understand the demand and the peaks in the system. Members agreed that there was a need to re-shape the service and the patient flow through the unscheduled care system. Mr Cairns suggested that one option could be to consider booking a number of urgent slots in outpatient clinics as a pilot. This potentially could Minutes of the Special Meeting 21 October 2014 Page 4 of 8

12 reduce the demand and pressures on the ambulance service. Members discussed the top conditions that tend to require an ambulance response and how additional capacity could be created to treat these patients in different parts of the system. Members discussed the response to GP urgents and agreed the urgent need to better manage these requests. Mr P Roberts raised his concerns about the speed of any changes and to ensure that the appropriate clinical risk and governance of such changes were appropriately assessed. Members discussed the issues surrounding delays in handover and the impact this had on being able to release the vehicles. Members also discussed the issues of additional capacity in the short term. 999 Call Answering Compliance Members discussed the issue of compliance and supported the immediate action to improve the timeliness of incoming 999 calls. Review the Clinical Response Model Members received an overview of the current practice and supported the approach to adopt the industry standard and the consistency of reporting. Members discussed the issues around the clinical response model and in particular the need to send a hot response to all Green 1 calls. Members noted that this was due to be implemented imminently. Hospital Turnaround and Handover Members discussed some of the issues relating to turnaround and agreed it was important to separate the issues of handover and turnaround. Members discussed some of the barriers including the different policies and protocols across the Health Boards. Members noted the work by the London Minutes of the Special Meeting 21 October 2014 Page 5 of 8

13 Ambulance Service and agreed the importance of consistency across the Health Boards. Mr Cairns raised the issue of the medical bed capacity and the processes by Social Services not to assess a patient until medically fit. The issue of capacity in A&E Units was discussed and noted in particular that the situation was not improving. A discussion was held in relation to triage and whether this could take place outside of the A&E units to assist in appropriately discharging patients more efficiently. Members discussed in detail the issues and agreed that the plan needed to be developed further with Chief Operating Officers. Members agreed that further discussions would need to take place locally so appropriate action could be agreed. Mr Cairns suggested that it would be helpful to understand which Nursing Homes had embargoes upon them and what can be done to get these open. Members supported the need for change which would include consistent protocols across the unscheduled care system and in A&E Departments across NHS Wales. Card 35 Script Members agreed to the actions and that the Medical Directors would support this work. Mrs Myhill confirmed that the Medical Director of WAST would be taking up post shortly. Unscheduled Care System Mr Ide provided an update of the current process. Mrs Williams re-iterated her suggestion for Cwm Taf UHB to pilot a system linking to Bed Bureau. Members discussed and supported the approach. Mr Ide agreed to ensure this was taken forward. Members discussed the impact on performance and agreed it may be more beneficial if Aneurin Bevan UHB participated as this would potentially have more of an impact on the performance. Judith Paget agreed to take this forward Minutes of the Special Meeting 21 October 2014 Page 6 of 8

14 Holding Areas - Members discussed the issues around setting up holding areas and the fit to sit protocol. Member discussed the issues of reduced bed availability and whether this had any impact on possible outcomes. Mr Dean stated that once the patient had been transported it was his view that the patient was the responsibility of the hospital. Mr Dean confirmed he would pick this up as part of his lead role on unscheduled care. Community First Responders Members discussed the issue of increasing the availability and utilisation of the Community First Responders. Mrs Myhill raised the issue of the current overspend for the Trust of 2.9m. A discussion was held in terms value for money and whether one option was better. A discussion was held in relation to the use of more first responders, double paramedic crew, use of St Johns and Private Providers. Members agreed that it was important to explore all options. Following a detailed discussion on the recovery and improvement plan a number of actions were agreed by the Committee. Delegate the responsibility to QRD and the COOs to agree the local actions and timescales for improvement across the pathway; All COOs expected to attend QRD as the attendance has been variable; Local actions to be discussed and agreed by the end of October 2014; Additional meeting in the form of a teleconference to take place in advance of the next EASC meeting; Review of the demand and the particular hot spots in each Health Board and ensure actions are agreed locally; Circulate the performance data by Health Board; and A response following QRD how the sustained improvement in performance against the target will be delivered and Ambulance Commissioner Health Boards Health Boards Committee Secretary Ambulance Commissioner Ambulance Commissioner Minutes of the Special Meeting 21 October 2014 Page 7 of 8

15 performance managed. Members RESOLVED to: Note the report; Support the actions outlined in the recovery plan subject to further local discussions and agreement at QRD; Agree that QRD take responsibility for the local discussions and agreement of the actions; and Convene an additional meeting at the beginning of November 2014 OTHER MATTERS EASC 14/45 Any Other Business There were no matters raised under this item. EASC 14/46 Date of next meeting The date of the next Joint Committee meeting was confirmed as 25 November Signed Date (Chair) Minutes of the Special Meeting 21 October 2014 Page 8 of 8

16 AGENDA ITEM 2.2f MINUTES OF THE EXTRA ORDINARY EMERGENCY AMBULANCE SERVICES JOINT COMMITTEE MEETING HELD 10 NOVEMBER 2014 VIA TELEPHONE CONFERENCE PRESENT Members: Professor Siobhan McClelland Mr Adam Cairns Mr Stuart Ide Mrs Judith Paget Mrs Karen Howell Mr Bob Hudson Mr Paul Roberts Mrs Tracey Cooper Mr Stephen Harrhy Mrs Tracy Myhill In Attendance: Mr Stuart Davies Miss Pam Wenger Chair Chief Executive, Cardiff and Vale UHB Interim Emergency Ambulance Commissioner Chief Executive, Aneurin Bevan UHB Interim Chief Executive, Hywel Dda LHB Chief Executive, Powys THB Chief Executive, Abertawe Bro Morgannwg UHB Chief Executive, Public Health Wales Director of Primary Care and Mental Health, Cwm Taf UHB Interim Chief Executive, WAST Director of Finance, WHSSC Committee Secretary, WHSSC PRELIMINARY MATTERS Action EASC 14/47 WELCOME AND INTRODUCTIONS Minutes of the Special Meeting 10 November 2014 Page 1 of 6

17 The Chair welcomed Members to the extra ordinary meeting of the Emergency Ambulance Services Committee. EASC 14/48 EASC 14/49 APOLOGIES FOR ABSENCE Professor T Purt, Miss P Wenger, Mrs A Williams. DECLARATIONS OF INTEREST No new declarations were received other than those already declared. EASC 14/50 TO RECEIVE THE UNCONFIRMED MINUTES OF THE MEETING HELD ON 21 OCTOBER 2014 Members agreed that the unconfirmed minutes of the meeting held on 21 October 2014 would be considered at the formal Joint Committee meeting scheduled for 25 November Committee Secretary EASC 14/51 TO RECEIVE A REPORT FROM THE JOINT COMMITTEE CHAIR The Chair had no urgent issues to report. EASC 14/52 TO RECEIVE AN UPDATE ON THE UNSCHEDULED CARE BOARD Members received an oral update report on the unscheduled care board from Mr A Cairns, Chief Executive of Cardiff and Vale UHB. Mr Cairns reported that the views of the Chief Executives have been received and at present the board is examining variation and working to eliminate unnecessary variation. Mr Cairns provided Members with further detail relating to the three elements to the work with Medical Directors, led by Grant Robinson, to review of the Health Boards unloading and releasing policies and the pattern of out of hours access across Wales and potential models; and a review of in hospital variation. Mr Cairns also reported that examples of changes made within Health Boards which have had a positive impact will be collated and shared. Minutes of the Special Meeting 10 November 2014 Page 2 of 6

18 Following discussion it was agreed that the work of the Board will be captured and monitored through the Recovery and Service Improvement Plan. Mrs T Myhill reported that conveyance rates are starting to emerge in some discussion forums but this is not NHS Wales wide at present. It was agreed that this work should widen to NHS Wales wide. Members RESOLVED to: Note the oral report; and Support the further actions agreed. GOVERNANCE, PERFORMANCE AND ASSURANCE EASC 14/53 TO RECEIVE A REPORT IN RELATION TO THE EMERGENCY AMBULANCE SERVICE PERFORMANCE (A8 TARGET) Members received a report on the Emergency Ambulance Service Performance (A8 Target) from Mr S Ide, Interim Ambulance Commissioner. Mr Ide drew Members attention to the key concerns outlined within the paper including performance failing to improve and the response performance appearing to be unstable; hospital turnaround; and the potential pressures of inclement weather. Mr Ide drew Members attention to the key issues outlined within the paper associated with the current and ongoing performance position including: Under capacity in EMS rota s to meet demand incoming demand; High levels of hospital turnaround delay further reducing available response capacity; and Urgent admission patterns further reducing response capacity and increasing turnaround delays. Members then discussed the recommendations Minutes of the Special Meeting 10 November 2014 Page 3 of 6

19 outlined in the paper in further detail. Mr S Davies noted that with regards to the business plan, a substantive plan has not been received from the Welsh Ambulance Services NHS Trust (WAST). Members discussed further the need to clearly understand the capacity issues, the usage of the previous investment that has been made and what further investment will achieve. Members also discussed the need to understand the cost, investment and services commissioned. It agreed that Mr S Ide would provide further detail with regards to the current cost activities. Ambulance Commissioner Mr Paul Roberts joined the meeting Mrs T Myhill reported that at present WAST is heading for a 3m overspend. She reported that she has instructed that a piece of work be undertaken to look at what can be done for WAST to break even. She emphasised to Members that by breaking even performance will be affected. It was agreed that a small group would be established to work through the issues and allow for further information to be presented to the Joint Committee scheduled for 25 November It was agreed that all Members would share the elements to be considered and included within the paper with Mr S Ide. It was agreed that the improvement work being undertaken within WAST including the recruitment plans, will be captured and monitored through the Recovery and Service Improvement Plan. It was also agreed that Mr S Ide and Mrs T Myhill would circulate the latest and fullest version of the Recovery and Service Improvement Plan. Ambulance Commissioner All Members Ambulance Commissioner /Interim CEO WAST Members discussed whether support could be given at this stage for additional resource at the current estimate required whilst further work is ongoing. Mr S Davies reported that from the information provided WAST is predicting an 8m overspend by the end of the financial year and that the additional resource required is to support Minutes of the Special Meeting 10 November 2014 Page 4 of 6

20 both the current sustainability and further improvements. In her summary the Chair noted that clearly Members were unable to make a decision with regards to the commitment for further funding to WAST. She also noted the need to clarify the role of Welsh Government with WAST. The Chair acknowledged the difficult position for WAST of not having a decision with regards to funding. Mr S Ide provided Members with further detail relating to the Patient Queuing Escalation Policy. Members discussed the need to understand the impact on A&E units, the physical capacity restraints in some units and the governance protocols that are in place within NHS England where this policy has been implemented. Mrs T Cooper left the meeting. Members agreed to the following steps to develop a Patient Queuing Escalation Policy (a) further discussion on a be held with the Medical Directors with Grant Robinson and a consensus approach being reached; (b) the view of the Directors of Nursing to be sought; (c) a short period of consultation with A&E Units and WAST; and (d) the written policy being presented to each LHB Board meeting for ratification. I Ambulance Commissioner Mrs K Howell left the meeting. Members RESOLVED to: Agree the implementation of the Recovery & Service Improvement Plan; Support the commissioning of a joint EASC/WAST demand and capacity review from ABCi; Support the development of an all Wales Patient Queuing Escalation Policy ; Support the implementation of processes to HCP Urgent call handling utilising AMPDS Card 35; and Support the further development of the Integrated Urgent Care Dashboard. OTHER MATTERS Minutes of the Special Meeting 10 November 2014 Page 5 of 6

21 EASC 14/54 Any Other Business There were no matters raised under this item. EASC 14/55 Date of next meeting The date of the next Joint Committee meeting was confirmed as 25 November Signed Date (Chair) Minutes of the Special Meeting 10 November 2014 Page 6 of 6

22 Reporting Committee Chaired by Lead Executive Director Author and contact details. AGENDA ITEM 2.2g Emergency Ambulance Services Committee Professor Siobhan McClelland Chief Executive Date of last meeting 10 November 2014 and 25 November 2014 Summary of key matters including achievements and progress considered by the Committee and any related decisions made. 10 November 2014 An extra ordinary meeting of the Emergency Ambulance Committee was called by the Chair in accordance with the Standing Orders. The purpose of the meeting was to discuss the urgent position in relation to the A8 Performance Target. Members noted the current position in terms of the A8 Target and confirmed that the Committee would need to agree a set of actions, performance management arrangements and timescales by the end of the meeting. Confirmed minutes are attached. 25 November 2014 Chairs Report Members ratified the urgent action taken by the Chair following the Joint Committee held in September Members noted the update following the recent meeting with the Minister for Health and Social Services and in particular, the commitment had been given to the Minister regarding the resourcing of the Emergency Ambulance Services CommissioningTeam. Ambulance Commissioner s Report Members received an update from the Vice Chair on behalf of the Interim Ambulance Commissioner. Specifically members noted: Performance pace of change required to deliver improvements against targets within the existing resource envelope; QPRD - focusing on the management of the interim in year collaborative commissioning agreement Local Performance Cells noted the work on the development of the local performance cells. Governance agreed to ensure the governance and committee structure was cost effective maximising the use of existing structures where possible. Committee Chairs report Page 1 of 3 Emergency Ambulance Committee 27 January 2015

23 Members noted the existing performance management arrangements and agreed that the outcome of the review undertaken by Swansea University will assist in establishing any new arrangements. Emergency Ambulance Services Commissioning Team Members noted and agreed a provisional budget for the appointment of staff within the Emergency Ambulance Services Team. Specifically the additional functions will cover : performance management, financial management and back office support including corporate support to the Committee. Appointment of Chief Ambulance Services Commissioner (CASC) Members agreed to progress the appointment of the substantive appointment of the Ambulance Commissioner. Commissioning Agreement and Financial Performance Members received a comprehensive financial and performance report from the Director of Finance, WHSSC. The report set out the financial and performance position and benchmarking data across England and Wales. Members agreed to receive a regular report at each meeting. Financial and Performance Position Welsh Ambulance Services NHS Trust Members noted the current forecast potential financial deficit of 8m which consisted of 4m non delivery of savings relating to the rota review and non reduction in levels of sickness. Members noted to off-set this potential overspend the Trust is in the process of urgently developing a financial recovery plan. Members noted that WAST were in the same position as they were in previous years and discussions were taking place with Welsh Government regarding the current forecasted position. Members agreed to receive a paper outlining the options in terms of finance and performance and this would be discussed at a tripartite meeting between Health Boards, WAST and Welsh Government. Collaborative Commissioning Group Members received an update from the Collaborative Commissioning Group and in particular, the Committee welcomed that the 5 step ambulance care pathway approach was supported at a recent stakeholder event. Clinical Governance and Risk Management arrangements Members noted and supported the proposed arrangements, in relation to the clinical governance and risk management. Members received the risk register and noted the actions being taken to minimise the risks. Committee Chairs report Page 2 of 3 Emergency Ambulance Committee 27 January 2015

24 Key risks and issues/matters of concern and any mitigating actions The Committee as outlined above, considered the financial and performance issues including the mitigating actions required to be being taken to address performance. Matters requiring Board level consideration and/or approval None Matters referred to other Committees None Committee minutes submitted (insert ) Yes X No Date of next meeting 27 January 2015 Committee Chairs report Page 3 of 3 Emergency Ambulance Committee 27 January 2015