Northern Ireland Ambulance Service€¦ · 11.1 HR & Corporate Services End of Year Activity Report 2009/10 TB/10/23/09/10 11.2 Stress Management Procedure TB/11/23/09/10 11.3 Programme

A Meeting of Trust Board/AGM to be held on Thursday, 23 September 2010 at 1.30pm, in the Boardroom at NIAS Headquarters, Knockbracken Healthcare Park,

Saintfield Road, Belfast, BT8 8SG

NORTHERN IRELAND AMBULANCE SERVICE

A G E N D A

Welcome, Introduction and Format of Meeting

Paper Enclosed

1.0

Apologies

2.0 Procedure: Declaration of potential Conflict of Interest: Quorum:

3.0 Suspension of Standing Orders

ANNUAL GENERAL MEETING

i. Presentation of Annual Report 2009/10

TB/1/23/09/10 (To be tabled at meeting)

ii. Presentation of Annual Accounts 2009/10

TB/2/23/09/10 (To be tabled at meeting)

iii. Question and Answer Session

FINISH

4.0 Re-instate Standing Orders

5.0 Minutes of the previous meeting of the Trust Board held 1 July 2010 (for approval and signature)

TB/3/23/09/10

6.0 Matters Arising

6.1 Financial Stability 2010/11

7.0 Chairman’s Business

7.1 Chairman’s Update

8.0 Chief Executive’s Business

8.1 Chief Executive’s Update

9.0 Assurance Framework as at 31 July 2010

TB/4/23/09/10

10.0

Polices/Procedures (for approval)

10.1 10.2

Health and Wellbeing Strategy (including Health & Wellbeing Attendance Management Action Plan 2010/11) Attendance Management Policy

TB/5/23/09/10 TB/6/23/09/10

10.3 Mental Health and Wellbeing Policy TB/7/23/09/10 10.4 Overtime Policy TB/8/23/09/10 10.5 Voluntary Transfer Policy TB/9/23/09/10 11.0 For Noting 11.1 HR & Corporate Services End of Year Activity Report 2009/10 TB/10/23/09/10 11.2 Stress Management Procedure TB/11/23/09/10 11.3 Programme for Cohesion Sharing and Integration TB/12/23/09/10 11.4 Minutes of Audit Committee held 16 June 2010 TB/13/23/09/10 11.5 Long Service Medal Ceremonies

19 November & 6 December 2010

11.6 Trust Delivery Plan 2010-11 TB/14/23/09/10 11.7 Response to Consultation “Proposals for a Safe & Sustainable

Urgent Care Network in the South Eastern Trust TB/15/23/09/10

11.8 Regional Health & Social Care Board Invitation – February/March 2011

TB/16/23/09/10

11.9 Correspondence from Chief Constable, PSNI TB/17/23/09/10 11.10 Correspondence from the Scottish Parliament TB/18/23/09/10 12.0

Application of Trust Seal

13.0 Forum for Questions 14.0

Any Other Business

Next meeting of Trust Board will be held on Thursday, 25 November 2010 in the Eastern Division, venue to be confirmed.

Meeting to be held on Thursday, 23 September 2010 at 1.30pm in the Boardroom, NIAS Headquarters, Knockbracken Healthcare Park,

Saintfield Road, Belfast. BT8 8SG

TRUST BOARD

TB/1/23/09/10

ANNUAL REPORT (to be tabled at meeting)

TB/2/23/09/10

ANNUAL ACCOUNTS

(to be tabled at meeting)

TB/3/23/09/10

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Minutes of a Meeting of Trust Board held on Thursday, 1 July 2010 at 2.00pm at Holiday Inn Express Antrim, Junction One Leisure Park,

Ballymena Road, Antrim. BT41 4LL


Present:

Mr P Archer Chairman Mr L McIvor Chief Executive Mr Frank Hughes Non-Executive Director Mr N McKinley Non-Executive Director Mr S Mullan Non-Executive Director Mr S Shields Non- Executive Director Prof M Hanratty Non- Executive Director Mr B McNeill Director of Operations Dr D McManus Medical Director Mrs S McCue Director of Finance & ICT

In Attendance:

Mrs M Crawford Executive Administrator Miss K Baxter Senior Secretary

Welcome and Format of the Meeting

The Chairman opened the meeting by welcoming members of the public and Trust Board and explained the arrangements for receiving questions from the public. He advised that Mr Dixon, Patient & Client Council is unable to join the meeting today. 1.0

Apologies

Ms R O’Hara, Director of Human Resources & Corporate Services Dr D McManus, Medical Director Mr B McNeill, Director of Operations

2.0 Procedure

Quorum : Declaration of potential Conflict of Interest

No potential conflicts of interests were declared and the Board is confirmed as

Quorate.

3.0

Minutes of the Previous Meeting of the Trust Board held on 29 April 2010

Members accepted the minutes as a true and accurate record of proceedings on the

proposal of Mr McKinley, seconded by Mr Hughes.

4.0

Matters Arising

4.1

NIAS Governance Arrangements

To be discussed under Items 10 & 11.

4.2

Efficiency Savings and Comprehensive Spending Review Investment

The Chief Executive advised that efficiency savings are in place and the

Trust is progressing on the basis that we receive planned investment. Additional savings have been requested for the 2010-2011 financial year, and proposals have been presented to the HSC Board.

5.0

Chairman’s Business

5.1 Senior Executive Remuneration

The Chairman advised that he had met with the Department in relation to this matter and is still awaiting a response.

5.2 Chairman’s Update

The Chairman gave a brief outline of his diary commitments since the last Board meeting:

• Visited stations in the Western and Northern Divisions. • Attended DHSSPS Leadership Walkaround Event. • Met with Chairs from the Belfast and South Eastern Trusts. • Carried out appraisals of Non Executive Directors. • Attended a Trust Board meeting in relation to final accounts. • Attended a Northern Ireland Confederation (NICON) reception for the

retirement of their Director Mr Alan Gilbert. • Attended a breakfast briefing in regard to Strategic Policy with Mr

Nigel Edwards, acting Chief Executive of NHS Confederation speaking.

• Continues weekly meetings with the Chief Executive.

5.3 Visit to Antrim Ambulance Station

The Board wished to extend their thanks to the staff for their warm welcome today. The facility was noted to be very good although parking was minimal. The station is very busy and has been dealing with the impact of the reconfiguration of Whiteabbey and Magherafelt. The Chairman commented that the site visits are a great opportunity for the Board to meet with staff and discuss any issues they may have.

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6.0

Chief Executive’s Business

6.1

Chief Executive’s Update

The Chief Executive gave a brief outline of his activities since the last Board meeting:

• Attended the Ambulance Leadership Forum in London. • Has been appointed a member of Ambulance Service Network (ASN)

Board and will be attending regular meetings in London. • Attended a major strategic event between Scotland, Wales and

Northern Ireland in Cardiff where he was able to appraise others of the Trust’s developments and aspirations.

• Attended the opening of Downe Hospital where the Service was commended for their assistance during this transition.

• Attended end of year Accountability Review meeting at the Department.

• Met with Chair and Chief Executive of the NHS Confederation.

The Board wished to extend their congratulations to the Chief Executive on his appointment to the ASN Board.

7.0

Performance Reporting as at 31 May 2010 (Draft Assurance Framework) This item to be dealt with after items 8 and 9.

8.0 Trust Delivery Plan

This item to be dealt with after item 9.

9.0 2009/10 Year End account Review

The Chief Executive referred to correspondence within the papers which had been received from the HSC Board in relation to the Trust’s performance where most targets had been achieved. Performance was also discussed at the yearend Accountability Meeting with the Department and the HSC Board. This meeting was very useful and the work of staff was commended. The Trust has identified initiatives to deal with demand and emerging pressures while continuing to deliver safe high quality care. The Board noted the good results and wished to commend the work of staff. The Chief Executive responded by saying that these targets put into context the work of all in the Service and demonstrates an exemplary response to difficult circumstances.

8.0 Trust Delivery Plan (TDP)

The TDP was presented to the Board as a draft document pending consideration by the HSC Board and approval by the Department. The document has also been shared in confidence with Trade Unions. Unison has requested a meeting which the Trust is happy to facilitate. The plan is in line with guidance provided by the Department. It shows what NIAS has achieved, the challenges ahead and reflects the Trust’s Priorities for Action. The Trust will continue to align operational structures to allow the Trust to deliver objectives. It was advised that bids for funds should be easier when dealing with 1 Board where previously the Trust had to work with 4 Boards. Additional savings have been requested, with 2% savings required within payroll. Proposals have been made and the Trust will continue to focus resources on those most in need. The Trust is currently awaiting written confirmation from the Department in relation to further investment and is working on the basis that these funds are still available. The Board expressed their concern at the requirement for further savings and hoped that the savings can be achieved without the loss of jobs. The Chief Executive responded by advising that the latest proposals should be delivered without risk to current employees, however if the situation changes he will report back to the Board and will commence discussions with Trade Unions in line with requirements. The issue of Agenda for Change (AFC) was raised in relation to the element of risk attached for the remaining posts to be formally banded. The Director of Finance advised that there is no outcome at present for the remaining posts which have gone to full job evaluation. The Trust continues to work in partnership with Unions and is following due process. She further advised that the Trust’s auditors have confirmed the Trust’s financial position is based on reasonable assumptions at this time. The Board agreed that the TDP is a good succinct document which has covered all aspects of the Trust’s service and outlines the challenges ahead. The TDP was approved on the proposal of Mr Hughes seconded by Prof Hanratty.

7.0 Performance Reporting as at 31 May 2010 (Draft Assurance Framework)

The Chief Executive introduced the new Assurance Framework advising that it is very different from the previous method of reporting performance. He hoped that this will be a showcase for the Trust’s activity. The document will also incorporate assessment of risk against the delivery of objectives. The document is still being developed and further changes will be required. He wished to give the Board an opportunity to consider and shape the document. The document was discussed in some detail with the following highlighted.

• Contents page – Ministerial actions highlighted in red with Trust actions in blue.

• Incorporates the roles and objectives of the Department. • Populated with data normally reported. • Reports on matters of interest to the Board. • Reflects the work of NIAS within the 7 key themes of Ministerial priorities. • Aligns with other Trusts.

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Consideration is to be given to the following:

• Highlight areas where NIAS has sole responsibility. • Performance to be summarised in a single table. • Refine colour coding – measures of performance. • Emergency Preparedness – identify due date for completion. • Cat A Response – develop and show graphically.

The Board welcomed the Assurance Framework stating that the information provided is clearer and it is easier to identify principle risks. They considered that the document would contribute significantly to shaping the agenda for both the Audit and Assurance Committees. It was agreed that a workshop would be arranged for the Board to consider the 6 Governance Principles and how the agenda for Committees should capture these and establish a programme for the year ahead. The Chairman and Chief Executive will meet initially to plan a workshop to follow. The Chief Executive presented a summary of performance as follows:

• Cat A response is down in April and May 2010. This is due to the impact of Year 3 efficiency savings which came into effect in April 2010. He advised that the Control team need time to adjust to the changes in resources. There has also been the additional impact of closures at Whiteabbey and Mid Ulster, the situation is being managed hour by hour and it is hoped that it can be sustained. He added that the performance for June has improved at 73%. The Chief Executive is to work closely with the Director of Operations in an effort to deliver targets.

• Cat A&B – currently at 94.5%. • Cat C – 99.7%

The Medical Director and Director of Operations are to review GP urgent calls; with the need to identify clinical urgency and need. It was advised that further reconfiguration of A&E will result in longer journey times which will impact on response times. Some discussion took place regarding the type of calls received at the Control Centre, approximate figures are as follows:

• 120,000 - 999 calls • 40,000 – Cat A – potentially life threatening calls • 50 – 60,000 - Cat B calls – urgent but not life threatening • 20 – 30,000 - Cat C calls – non urgent

The Board noted that the Western and Southern Divisions appear to have the lowest response times. The Chief Executive advised that this is not just the fact that these have large rural areas but that other factors affect responses such as; availability of specialist clinical services, road networks, signage and GIS mapping (provided by OSNI) which is not always as up to date as in urban areas.

It was confirmed that a tactical deployment plan operates which seeks to deploy resources to where there is the greatest likelihood of incidents occurring. The Board noted that performance in the Northern Division has improved recently and the Chief Executive advised that more resources have been invested in this area which has helped to improve response times. The issue of First Responders was raised and the Chief Executive appraised the Board of work undertaken in this area and potential issues with further development. The Chief Executive advised that the target for absenteeism is unlikely to be achieved. The HSC Board and the Permanent Secretary have been advised. He stated that NIAS is very different to other NI Health Trusts with such a high concentration of front-line staff and welcomed suggestions on additional measures to improve attendance which might be applied. The Director of Finance detailed Finance performance highlighting the following: • Ensure financial stability and the effective use of resources – the Board were

advised that the financial challenge facing the Trust at present is unprecedented. She advised that based on current assumptions the Trust is predicting a breakeven position at the end of May 2010. She added that assumptions and risks could change which would cause the Trust not to achieve financial breakeven.

• The Board were concerned and asked if confirmation of investment is expected

soon. The Director of Finance responded saying that the HSC Board have been advised that the Trust is operating on the basis of receiving this funding. If the funding is not received other measures will be required.

• Information Requests – The Board requested that outstanding requests are

shown and a legend is required for abbreviations. • Invoices paid within 30 days – Currently at 91.42%, work is ongoing in this area

which continues to be monitored closely. • Infrastructure Investment – A4 status reported. The recurrent fleet replacement

business case is currently with the Department for approval.

The Board commented on the compliments received which show the Service at its best. It demonstrates the dedication and professionalism of NIAS staff.

The Board formally approved the Assurance Framework and wished to commend the work of the Executive Team in producing this new reporting document. Action: Meeting to be arranged to discuss how the Assurance Framework can shape the Agendas of Committees with a view to establishing a programme for the year. The Chairman and Chief Executive are to meet initially with a workshop to follow.

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10.0

Review of Governance - Standing Orders, Standing Financial Instructions & Scheme of Delegation

It was agreed to deal with Items 10 & 11 together. The Standing Orders were discussed in some detail with the following comments received: Page 21 – for consistency it was agreed that a sentence should be added to the Terms of Reference for the Remuneration Committee in regard to how frequent the Committee should meet. Page 89, 24.1.3 – The Director of Information Technology, should read as “Director of Finance”. The Terms of Reference for all Committees were approved. The Chairman thanked the Board for their input into the new governance arrangements and the revision of the Standing Orders and Terms of Reference for the Committees. The Board considered that the outcome will be a more cohesive Board. The Chairman advised that the new structure becomes effective from today and he outlined the membership of each Committee. Assurance Committee Prof Hanratty, Chair Mr Hughes Mr Shields Chair of Audit Committee (Mr McKinley) Audit Committee Mr Mullan, Chair (until 21/07/10) Mr McKinley, Chair (from 22/07/10) Mr Shields Chair of Assurance Committee (Prof Hanratty) Remuneration Committee Mr Archer, Chair Mr McKinley Mr Shields

Subject to the minor amendments noted to the Standing Orders all documents were

approved on the proposal of Mr Hughes seconded by Mr McKinley.

11.0 Terms of Reference

11.1 Assurance Committee

– Approved by Trust Board

11.2 Audit Committee


11.3 Remuneration Committee


12.0

Policies/Procedures

12.1

Policy and Procedure for the Purchase, Management and Disposal of Medical Devices, Equipment and Supplies

The Chair of the Assurance Committee recommended approval of the Policy. The Board queried whether the purchase of goods through the Central Procurement Department (CPU) of BSO was the most cost-effective way to purchase goods. The Director of Finance stated that as a member of the Procurement Board she can advise that CPU is monitored closely on how it performs. She stated that the procurement decision takes into consideration a range of issues – Value for Money throughout the life of the product, performance against specification etc. The Director of Finance also advised that procurement processes needed to be enacted in compliance with NIAS’s Standing Financial Instructions and Scheme of Delegation. Given the importance of balancing these factors in a structured manner it is an expectation of the DHSSPS that procurement is influenced by the Centre of Procurement Excellence. The Director of Finance to rewrite paragraph 2.4 on Page 2 to clarify funding source. Subject to this minor amendment the Policy was approved on the proposal of Mr Shields and Mr Mullan. Action: Director of Finance to rewrite paragraph 2.4.

13.0 For Noting

13.1

Minutes of Clinical Governance Committee held on 25 February 2010

Noted.

13.2 Minutes of Risk Management Committee held on 25 February 2010

Noted.

13.3 Minutes of Audit Committee held 20 May 2010

Noted.

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14.0

Application of Trust Seal

The Trust Seal has not been used since the last Trust Board meeting.

15.0

FORUM FOR QUESTIONS

No questions received from the floor.

16.0

Any Other Business

The Chairman advised that Mr Mullan completes his service with the Trust on the 21 July 2010 and wished to thank him on behalf of the Board for his input over the past 8 years. A token of appreciation was presented at a private meeting of the Board.

Date, Time and Venue of Next Meeting

The next meeting of the Trust Board will be held on Thursday, 23 September 2010 at Trust Headquarters followed by the Annual General Meeting.

The Chairman thanked those present for attending and called proceedings to a close. Signed: _____________________ Date: ______________________ Chairman

ASSURANCE FRAMEWORK

(AS AT 31 JULY 2010)

TB/4/23/09/10

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Legend for Performance Assessment: A1=Achieved: A2=Substantially Achieved: A3= On Track for Achievement: A4=Delayed: X=Unlikely to be Achieved: N/A= Not Applicable

Legend for Risk Assessment; 0-5=Very Low; 6-10=Low; 11-15=Moderate; 16-20=High; 21-25=Catastrophic

Contents PREFACE ............................................................................................................................................................................................ 4

PRIORITIES FOR ACTION 2010-2011 – AN INTRODUCTION ...................................................................................... 5

NIAS PERFORMANCE MANAGEMENT PROCESS .............................................................................................................. 5

ASSURANCE SUMMARY TABLE – PERFORMANCE & RISK ........................................................................................... 7

PRIORITY AREA 1: IMPROVE THE HEALTH STATUS OF THE POPULATION AND REDUCE HEALTH INEQUALITIES .............................................................................................................................................................................. 11

PfA1.1 Emergency Preparedness ................................................................................................................................ 13

PfA1.2… Business Continuity ............................................................................................................................................. 15

PRIORITY AREA 2: ENSURE SERVICES ARE SAFE & SUSTAINABLE, ACCESSIBLE & PATIENT-CENTRED ................................................................................................................................................................ ............................................. 16

PfA2.1… Category A Ambulance Response– Potentially Life-Threatening 999 ........................................... 17

TA2.1… Ambulance Response - Non-Life-Threatening 999 Calls ..................................................................... 19

TA2.2… Ambulance Response - Non-Life-Threatening Urgent Calls ............................................................... 23

PfA2.3…A&E Discharges ...................................................................................................................................................... 25

PfA2.4… Stroke services ...................................................................................................................................................... 26

PfA2.6… Healthcare associated infections ................................................................................................................... 29

PfA2.7… Hygiene and cleanliness .................................................................................................................................... 30

PfA2.8… Patient Experience ............................................................................................................................................... 31

PfA2.9… Patient involvement ............................................................................................................................................ 32

PfA2.10… Service Frameworks ......................................................................................................................................... 33

TA2.3…Adverse Event Learning ....................................................................................................................................... 34

TA2.4…Clinical Quality ......................................................................................................................................................... 35

PRIORITY AREA 3: INTEGRATE PRIMARY, COMMUNITY AND SECONDARY CARE SERVICES .................. 37

PfA3.1… Pathway management ........................................................................................................................................ 38

PRIORITY AREA 4: HELP OLDER PEOPLE TO LIVE INDEPENDENTLY ................................................................ 40

PRIORITY AREA 5: IMPROVE CHILDREN’S HEALTH AND WELL-BEING ............................................................ 40

PRIORITY AREA 6: IMPROVE MENTAL HEALTH SERVICES AND SERVICES FOR PEOPLE WITH DISABILITIES ................................................................................................................................................................ ................ 40

PRIORITY AREA 7: ENSURE FINANCIAL STABILITY AND THE EFFECTIVE USE OF RESOURCES ............ 42

PfA7.1… Financial Breakeven ............................................................................................................................................ 43

PfA7.2… Efficiency savings ................................................................................................................................................. 45

TA7.1… Infrastructure Investment ................................................................................................................................. 46

TA7.2… Purchasing & Supplies Management ............................................................................................................. 47

TA7.3…Information Requests ........................................................................................................................................... 48

PfA7.4… Absenteeism ........................................................................................................................................................... 50

PfA7.6… Staff Health and Wellbeing ............................................................................................................................... 52

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TA7.4… Grievance Management ....................................................................................................................................... 53

TA7.5… Disciplinary Management .................................................................................................................................. 54

TA7.6… Harmonious Work Environment ..................................................................................................................... 56

TA7.7… Industrial Tribunals .............................................................................................................................................. 57

TA7.8… Training ................................................................................................................................................................ ..... 58

TA7.9… Knowledge and Skills Framework .................................................................................................................. 59

TA7.10… Complaints & Compliments ............................................................................................................................ 60

TA7.11… Media Management ............................................................................................................................................ 62

TA7.12… Community Education ...................................................................................................................................... 63

TA7.13… Statutory compliance ........................................................................................................................................ 64

Appendix 1 ................................................................................................................................................................ ................ 65

Table Template ................................................................................................................................................................... 65

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PREFACE Guidance provided by DHSSPS on introduction and use of Assurance Frameworks is intended to help the boards of HSC organizations, and other arm’s length bodies of The Department of Health, Social Services & Public Safety (DHSSPS), improve the effectiveness of their systems of internal control. It does this by showing how the evidence for adequate control can be marshalled, tested and strengthened within an Assurance Framework.

The Assurance Framework is a pivotal mechanism through which boards exert control over their organizations. As was stated when the guidance first appeared, the essential point of a robust Assurance Framework is that it provides a stronger basis for effective challenge and better-informed decision-making in the boardroom. It will also be of direct relevance to senior executives, risk and governance managers, and clinical and social care professionals – to all those, in fact, with responsibility for good governance.

The board of each Health and Social Care (HSC) organization, and of each of the Department’s NDPBs, has therefore a duty, on behalf of its service users, carers, staff and local communities, to ensure that the organization is carrying out its responsibilities within a system of effective control and in line with the objectives set by Ministers. Their organizations must also demonstrate value for money, maximizing resources to support the highest standards of service.

The Framework supplies boards with an instrument for making fuller use of the existing governance capacity:

• in terms of how the various aspects of governance relate to organizational responsibilities, accountability and to each other;

• in relation to the information they need to discharge their responsibilities and accountability;

• to know how the different facets of governance are working; and

• to ensure the effective management of risk.

Trusts have a duty to protect service users, carers, staff and others in the planning and delivery of services. Reducing risk is not just about financial or management probity. It is also – indeed, it is primarily– concerned with improving the safety, quality and user experience of services. This means that equal priority needs to be given to the obligations of governance across all aspects of the business, whether financial, organizational or in clinical and social care, together with a need for governance to suffuse each organization’s culture. Good governance depends on having clear objectives, sound practices, a clear understanding of the risks associated with the organization’s business and effective monitoring arrangements – in other words, a sound system of organization-wide risk management.

The six core principles of good governance, as set out in the Good Governance Standard for Public Service are:

• Focusing on the organization’s purpose and on outcomes for citizens and service users

• Performing effectively in clearly defined functions and roles

• Promoting values for the whole organization and demonstrating the values of good governance through behaviour

• Taking informed, transparent decisions and managing risk

• Developing the capacity and capability of the governing body to be effective

• Engaging stakeholders and making accountability real

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PRIORITIES FOR ACTION 2010-2011 – AN INTRODUCTION The overall aim of the Department of Health, Social Services and Public Safety is to improve the health and well being of the people of Northern Ireland. In pursuing this aim through the health and social care (HSC) system, the key objective of the Department is to improve outcomes through a reduction in preventable disease and ill health by providing effective and high quality interventions and services, equitably and efficiently, to the whole population.

Consistent with this aim and objective the Minister’s expectation, for 2010-11 and beyond, is that – as far as possible within the resources made available by the Executive – the public will see continuing improvements to services across six key priority areas, namely:

Priority Area 1: Improve the health status of the population and reduce health inequalities

Priority Area 2: Ensure services are safe and sustainable, accessible and patient-centred

Priority Area 3: Integrate primary, community and secondary care services

Priority Area 4: Help older people to live independently

Priority Area 5: Improve children’s health and well-being

Priority Area 6: Improve mental health services and services for people with disabilities.

In addition, Priorities for Action 2010/11 includes a seventh priority area which, particularly in the current financial context is critical, namely:

Priority Area 7: Ensure financial stability and the effective use of resources.

It is inevitable that the substantial reduction in resources available for service developments as a result of the Executive’s cut in the budget for health and social care will severely limit the progress that can be made across a number of the key PfA themes in 2010/11. However this document should nonetheless be taken as a clear signal to HSC organisations of the direction of travel in the short to medium term. It is more important than ever for commissioners and providers to ensure that every penny of the funding available to the HSC is spent economically, efficiently and effectively in pursuit of the Department’s aim and objective as stated above. At the same time it must be acknowledged that within the funding available for health and social care in Northern Ireland it will not always be possible to provide the local population with access to every new service that becomes available.

NIAS PERFORMANCE MANAGEMENT PROCESS The Northern Ireland Ambulance Service (NIAS) fully supports these aims and objectives and seeks to deliver safe, high-quality ambulance services within the financial resources available.

This Assurance Framework outlines the key actions which NIAS has identified as being necessary to deliver strategic objectives, and identifies principal risks to delivery of objectives. In addition, we have presented additional objectives and actions, inextricably linked to the continued delivery of safe, high-quality services within financial resources, but not specifically referenced in PfA objectives, and aligned these with the relevant PfA theme. Where possible objective measures of performance against objectives are presented in support of an internal self-assessment of performance against objectives and key actions.

The objectives set by the Trust Board are cascaded through the Chief Executive, the Executive Directors, and through senior managers and embedded within service delivery models for all aspects of the organisation. This process seeks to align activity with objectives reflecting Ministerial priorities, which correspond to the delivery of safe, high-quality care within available resources.

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A performance management framework is in place whereby the chief executive meets weekly with executive directors to review activity and performance issues by exception and where necessary provide direction and intervention to achieve goals. In addition, the chief executive meets monthly with each director on an individual basis to consider and address specific issues relevant to their area. Executive directors similarly meet with their senior managers and teams on a regular basis to review performance against objectives, identify issues and address.

Progress against objectives and risks to delivery of objectives are presented to the Trust Board through the Assurance Framework to report ongoing performance against delivery of objectives and highlight, by exception, risks to delivery of objectives. Trust Board committees have been established to provide necessary assurance as to the existence and effectiveness of control systems and processes within the organisation, as outlined in the terms of reference of each committee.

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ASSURANCE SUMMARY TABLE – PERFORMANCE & RISK

PfA1.1…Emergency Preparedness Performance Assessment

ON TRACK FOR ACHIEVEMENT

Risk Assessment

LOW

PfA1.2… Business Continuity

Performance Assessment


Risk Assessment

LOW

PfA2.1… Category A Ambulance Response


DELAYED

Risk Assessment

MODERATE

TA2.1…Non-Life-Threatening Calls - Ambulance Response


DELAYED

Risk Assessment

LOW

TA2.2… Ambulance Response - Non-Life-Threatening Urgent Calls


DELAYED

Risk Assessment

MODERATE

PfA2.3…A&E Discharges Performance Assessment


Risk Assessment

LOW

PfA2.4… Stroke services Performance Assessment


Risk Assessment

LOW

PfA2.6… Healthcare associated infections



Risk Assessment

LOW

PfA2.7… Hygiene and cleanliness Performance Assessment


Risk Assessment

LOW

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PfA2.8… Patient Experience Performance Assessment


Risk Assessment

LOW

PfA2.9… Patient involvement Performance Assessment


Risk Assessment

LOW

PfA2.10… Service Frameworks Performance Assessment


Risk Assessment

LOW

TA2.3…Adverse Event Learning Performance Assessment


Risk Assessment

LOW

TA2.4…Clinical Quality Performance Assessment


Risk Assessment

LOW

PfA3.1… Pathway management



Risk Assessment

LOW

PfA7.1… Financial Breakeven Performance Assessment


Risk Assessment

MODERATE

PfA7.2… Efficiency savings Performance Assessment


Risk Assessment

LOW

TA7.1… Infrastructure Investment Performance Assessment

DELAYED

Risk Assessment

MODERATE

TA7.2… Purchasing & Supplies Management


ON TRACK FOR

Risk Assessment

LOW

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ACHIEVEMENT

TA7.3…Information Requests Performance Assessment


Risk Assessment

LOW

PfA7.4… Absenteeism Performance Assessment

UNLIKELY TO BE ACHIEVED

Risk Assessment

MODERATE

PfA7.6… Staff Health and Wellbeing Performance Assessment


Risk Assessment

LOW

TA7.4… Grievance Management Performance Assessment


Risk Assessment

LOW

TA7.5… Disciplinary Management Performance Assessment


Risk Assessment

LOW

TA7.6… Harmonious Work Environment



Risk Assessment

LOW

TA7.7… Industrial Tribunals Performance Assessment


Risk Assessment

LOW

TA7.8… Training Performance Assessment


Risk Assessment

LOW

TA7.9… Knowledge and Skills Framework



Risk Assessment

LOW

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TA7.10… Complaints & Compliments Performance Assessment


Risk Assessment

LOW

TA7.11… Media Management Performance Assessment


Risk Assessment

LOW

TA7.12… Community Education Performance Assessment


Risk Assessment

LOW

TA7.13… Statutory compliance Performance Assessment


Risk Assessment

LOW

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PRIORITY AREA 1: IMPROVE THE HEALTH STATUS OF THE POPULATION AND REDUCE HEALTH INEQUALITIES Aim: to improve the health status of the entire population and reduce inequalities in health status between population groups and geographical areas.

Improving health and well-being status remains one of the most fundamental ways of improving people’s quality of life in Northern Ireland. The Department’s aim is to maintain and improve the health status of the entire population and to reduce inequalities in health status between population groups and geographical areas.

With healthcare costs continuing to rise and chronic care consuming an ever increasing share of spending, it is essential that a step-change improvement is secured in relation to prevention and health improvement activities and interventions, leveraging all opportunities within the health and social care service and beyond to promote key public health messages. The Public Health Agency should ensure that all key stakeholder organisations and individuals – within the HSC family, other statutory sectors and the community and voluntary sector – are fully and appropriately involved and working in partnership to improve public health and address inequalities. All stakeholders must be clear about their respective roles and responsibilities and the Agency should establish appropriate oversight arrangements to ensure timely and effective delivery of real improvements.

Tackling inequalities

A key priority for the Department is to reduce inequalities in health status between population groups and geographical areas. This will require the social determinants of ill-health (employment, housing, education, poverty (including fuel poverty), etc) to be addressed, and social capital to be built within communities, through partnership working with key stakeholders.

Tobacco

The prevalence of smoking in Northern Ireland has fallen only marginally in recent years, with little real improvement following the initial impact of the smoking ban in 2007. The Department’s aim is to re-energise the drive to reduce smoking across Northern Ireland through a multi-component policy, community and societal level prevention approach. Particular focus will be given to those geographical areas with the highest rates of prevalence, and on pregnant women, manual workers and young people.

Alcohol and drugs

Tacking the harm from alcohol and drug misuse will continue to be a key priority in 2010-11 and beyond. During 2011 the Department will review and update its strategy document – a New Strategic Direction for Alcohol and Drugs – focussing on a number of existing and emerging issues including the misuse of prescribed drugs, misuse of legal highs, reducing general alcohol consumption (not just binge drinking), encouraging recovery amongst clients, addressing cocaine misuse, and delivering support and information to parents and carers.

Obesity

Addressing obesity in children and adults remains a significant challenge. By October 2010 the Department will develop and publish a comprehensive framework to prevent and address overweight and obesity across the whole life course. The framework will contain actions to improve nutritional intake, increase participation in physical activity, and improve the evidence base. The level of resources available to address this issue, along with the buy-in and support of key partners to address the obesity issues, will have a direct impact on the framework’s effectiveness. The Public Health Agency should lead on the development and implementation of a comprehensive action plan to deliver the framework.

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Mental health and suicide

The Department’s aim is to promote improved emotional well-being and reduce deaths by suicides by: building resilience within individuals and communities; reducing stigma; promoting the early recognition of signs of mental ill health; providing appropriate training (for HSC and non-HSC staff) and sign-posting to appropriate referral pathways; and, providing a range of high quality, responsive services which are both available and accessible (including preventive initiatives and support for bereaved, both community-based and statutory).

Sexual health and teenage pregnancy

The promotion of good sexual health and wellbeing, and further reducing the overall rate of teenage pregnancy and variations in local teenage pregnancy rates are key priorities.

Screening

Screening plays a vital role in preventing illness before symptoms appear. A new screening programme for bowel cancer will be introduced on a phased basis during 2010-11 for men and women aged 60 to 69. The Public Health Agency, working with the HSC Board, Trusts and other relevant organisations should ensure that this programme is implemented in a manner that is cost effective and meets quality assurance requirements. During 2010-11 the Public Health Agency should work with the HSC Board and Trusts to commence preparatory work for the phased introduction of screening arrangements for abdominal aortic aneurysm.

Emergency preparedness

The purpose of planning for emergencies in the HSC is to ensure preparedness for an effective response to any emergency and to ensure that organisations fully recover to normal services as quickly as possible.

Business Continuity Planning

Both emergency and business continuity plans are essential components of each HSC organisation’s planning, commissioning and delivery of HSC services to the wider population. Each HSC organisation must have the appropriate structures and mechanisms in place to continue to meet its core objectives even whilst under sudden or sustained pressure, whether as a result of factors outside or within the organisation. Putting in place plans and testing and validating these arrangements in order to ensure an effective response to threats and hazards can be delivered needs to be given high priority.

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PFA1.1 EMERGENCY PREPAREDNESS PfA1.1…Emergency Preparedness Performance Assessment


Risk Assessment

LOW

Objective

Emergency Preparedness: by March 2011, all relevant HSC organisations should review, test and update their emergency and business continuity plans, including building on the lessons learned from recent incidents, exercises and the response to swine flu together with any regional and national developments for pandemic flu preparedness.

Performance Commentary.

On track for achievement.

The NIAS Major Incident Plan and associated emergency plans were reviewed and reprinted in 2009. Work will commence for the next review in early 2011. The Trust’ s Emergency Planning Officers are involved in emergency planning developments at regional and national level with Government Departments and other Ambulance and Emergency Services. The Incident and Emergency Plans continue to be exercised with post-exercise and post-incident debriefing to facilitate identification of any necessary actions and learning. In the past two months, NIAS has participated in five multi-agency exercises with another six such exercises planned for the next two months. Further detail is available in the Emergency Planning Officer’s report attached to this document.

The development of a Hazardous Area Response capability (HART) continues with training in rope rescue, urban search and rescue and the use of CR1 suits commencing during the summer of 2010. This training is being undertaken jointly with PSNI, NIFRS and the Maritime & Coastguard Agency

The Trust is substantively compliant with the Emergency Planning Controls Assurance Standard.

Key Actions (to deliver objective) Due Date Progress Update

Q1 Q2 Q3 Q4

Review and update NIAS Emergency Plans A3

Benchmark with other ambulance services and national standards

A3

Exercise Major Incident and Emergency Plans and apply lessons learned

Ongoing A3

Continue to participate in the regional and national planning for major incidents, pandemic flu and CBRN

Ongoing A2

The provision of a HART capability in accordance with the funding provided by the commissioners

March 2010

A3

Ensure compliance with Emergency Planning Controls Assurance Standard

Feb 2011 A3

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Risk Commentary.

NIAS has considered the 2009 Northern Ireland Civil Contingencies Risk Assessment as published by the Civil Contingencies Policies Branch (OFMDFM) and has assessed the risk to NIAS as low. The EPO attends meetings with the Regional Risk Assessment Forum and ensures NIAS representation at other risk assessment fora. NIAS needs to consider the NICC risk assessment in reviewing its major incident and business continuity plans. It is recommended that this is done on an annual basis.

There is a risk to the delivery of a HART capability by March 2011 due to difficulties in the release of paramedics due to operational pressures and constraints on training capacity in other agencies at regional and national level who provide HART training, for example PSNI, NIFRS, MCA etc. Currently training is on schedule and this risk is low at present.

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PFA1.2… BUSINESS CONTINUITY PfA1.2… Business Continuity



Risk Assessment

LOW

Objective

Business Continuity Planning: by March 2011, each HSC organisation should ensure it has a fully tested and operational Business Continuity Plan in place. Performance Commentary.

On Track to achieve

A NIAS Business Continuity Plan has been drafted and considered by the Executive Directors with comments received and amendments currently being made. This amended document will be presented to the Senior Management Team within the next few months for finalisation and presentation to the Trust’s Assurance Committee and Trust Board. The Trust’s Business Continuity Management arrangements were subject to peer review by representatives of the East Midlands and Scottish Ambulance Services in June 2010, and the NIAS Emergency Planning Officer participated in a review of the Business Continuity arrangements in the Yorkshire and the London Ambulance Services. NIAS also participated in a national UK Ambulance Services Fuel Resilience Benchmarking Exercise in May 2010 as part of the NHS Ambulance Chief Executives Group Business Continuity Workstream. A number of recommendations have arisen from this process and the CEO, the Medical Director, the Risk Manager and the Emergency Planning Officer have met in September 2010 and an action plan arising from these recommendations is now being developed. A Business Continuity Strategy and Implementation Plan will be developed within the current year as well as the ongoing review of current Business Continuity plans and contingencies. A number of these contingencies, most notably the continuity arrangements in the event of the evacuation of REMDC, have been exercised in September 2010 and further progress reports will be provided to the Trust’s Assurance Committee and the Trust Board. Business Continuity Plans were developed as part of our response to the recent flu pandemic and remain in place should a further surge in flu occur this winter. A Regional Escalation Action Plan (REAP) developed during the recent pandemic is still in use by REMDC. Business Continuity Plans were implemented in Belfast during a period of civil unrest in July 2010.


Q1 Q2 Q3 Q4

Review and update NIAS Business Continuity Plans A3

Exercise Business Continuity Plans and apply lessons learned

A3

Benchmark with other ambulance services and national standards

A2

Risk Commentary.

There is a risk to the Trust from the failure to review, update and test the internal disaster management plans. This risk is being managed through the Emergency Planning Officer currently reviewing such plans in every Department. REMDC recovery plans are now in place and have been tested within the past month and are currently being updated as a result of learning from this exercise.

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PRIORITY AREA 2: ENSURE SERVICES ARE SAFE & SUSTAINABLE, ACCESSIBLE & PATIENT-CENTRED Aim: to ensure that patients and clients have timely access to high quality services responsive to their particular needs and delivered locally where this can be done safely, sustainably and cost-effectively.

Quality and safety

The first dimension of quality must be that we do no harm to patients or clients.

A strengthened system of regulation and robust standards of care and treatment have been established through linkages with NICE and SCIE. Commissioners and Trusts must ensure that services are delivered to common agreed standards, and that there is no inappropriate variation in the care and treatment that people are receiving. Clinicians and practitioners will be expected to look closely at their own practice and ensure that it is fully in line with current best practice. Within the context of available resources, it is expected that patients will continue to have access to the majority of NICE approved drugs and technologies and approved vaccines.

During 2010-11, Commissioners and Trusts should ensure that appropriate clinical and social care governance structures are in place to ensure satisfactory progress is made towards the full implementation of all endorsed best practice guidance (NICE, SCIE, NPSA, GAIN). Trusts should evidence that they are participating in Safety Forum collaboratives and develop action plans for any learning sets.

Accessibility

Ensuring that the population has timely access to high quality healthcare remains a key priority.

Significant improvement in waiting times had been achieved in recent years, but performance has slipped back in 2009-10 in a number of specialties. It will be a key priority for the HSC Board and Trusts in 2010-11 to ensure that, within available resources, in-house capacity is increased and as many specialties as possible are brought into recurrent balance, with the independent sector only being used in exceptional circumstances, and then only with the prior approval of the HSC Board. By March 2011 it is expected that all outpatients will be seen within nine weeks following GP referral; it is recognised that the current 13-week standard for treatment is not achievable across all specialties within the resources available in 2010-11, but nonetheless Trusts should ensure that maximum treatment waiting times are – at worst – maintained at March 2010 levels for all specialties being brought into recurrent balance in 2010-11, and in the small number of remaining specialties, waiting times for treatment do not exceed the maximums stated later in this section.

Ensuring services are person-centred

Personal and Public Involvement (PPI) is about giving people and communities a say in the planning, commissioning and delivery of their health and social care services. Person-centred care means organising services around the needs of the individual patient, meeting their clinical needs, working in partnership and treating them with dignity and respect. It means providing timely and convenient services that help prevent – as well as treat ill-health.

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PFA2.1… CATEGORY A AMBULANCE RESPONSE– POTENTIALLY LIFE-THREATENING 999 PfA2.1… Category A Ambulance Response


DELAYED

Risk Assessment

MODERATE

Objective

Ambulance services (PSA 2.8): from April 2010, the HSC Board and NIAS should ensure an average of 72.5% of Category A (life-threatening) calls are responded to within eight minutes, increasing to an average of 75% by March 2011 (and not less than 67.5 % in any LCG area).


After four months activity, performance is 1% below target. We need to achieve 73% Cat A or better for the next 7 months to achieve target. Performance for June indicates that this is achievable. Given the requirement to achieve 75% for March 2010, NIAS needs to have measures in place to deliver this in Quarter 4 to provide confidence.


Q1 Q2 Q3 Q4

The introduction of additional rapid response staff and vehicles to provide flexible targeted paramedic response to emergency calls

April 2010 A2 A2

The introduction of additional intermediate care hours of cover to provide flexible targeted non-emergency patient transportation to increase capacity for emergency calls and timely response for non-emergency calls

Ad Hoc A2 A2

The targeting of Accident & Emergency hours of cover, principally at week-end and nights, to match demand and provide flexible targeted paramedic response to emergency calls and patient transportation where appropriate

April 2010 A2 A2

Use Clinicians (GPs) in Ambulance Control to provide clinical triage of non life-threatening 999 calls and alternative care pathways which negate where appropriate ambulance transportation/attendance (pilot in the first instance).

April 2010 A1 A1

Continue to work with local communities in the development of Community First Response on a Northern Ireland basis with an emphasis on rural areas in the first instance and the provision of essential support and governance arrangements, again consistent with best practice and recent recommendations by the Health Care Commission in the UK.

Ongoing A4 A4

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Risk Commentary.

Principal concerns in respect of this objective are; further acute service changes in Down and Mid-Ulster areas (which may/may not attract funding); increasing dissident activity impacting on response activity and traffic congestion; uncertainty and distraction arising from 2011-14 savings/cuts; hospital congestion leading to longer hand-over times for ambulance staff; winter pressures around flu & weather.

Category A : % Response within 8 minutes

Area Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Cum

NI 71.6 70.2 73.0 71.5 71.6

Belfast 87.3 85.0 86.4 84.4 85.8

North 65.8 64.4 71.2 71.8 70.4

SthEast 70.4 68.4 66.8 63.8 65.2

South 63.6 62.4 65.3 66.7 64.5

West 61.7 62.9 67.0 65.3 64.2

Category A : % Conveyance Resource Response arriving within 21 minutes

Area Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

NI 92.7 92.7 94.5 93.4

Belfast 97.4 97.4 96.7 97.3

North 93.0 93.0 94.8 91.5

SthEast 90.4 90.4 94.1 91.0

South 89.6 89.6 93.2 93.5

West 90.4 90.4 92.3 92.3

Category A : % Non-Conveying Resource contribution to Response within 8 minutes


NI 41.9 43.3 40.8 37.7

Belfast 45.3 43.0 43.9 40.8

North 39.5 39.1 39.9 34.0

SthEast 40.9 40.0 39.1 41.0

South 48.9 45.2 39.5 37.4

West 29.9 31.7 38.3 30.2

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Category A : Demand Profile – Responses arriving at scene


NI 3516 3547 3543 3469

Belfast 992 977 1029 959

North 604 602 624 570

SthEast 784 836 742 829

South 588 550 567 558

West 548 582 581 553

TA2.1… AMBULANCE RESPONSE - NON-LIFE-THREATENING 999 CALLS TA2.1…Non-Life-Threatening Calls - Ambulance Response


DELAYED

Risk Assessment

LOW

Objective: From April 2010 the HSCB and NIAS should ensure that 95% of Category B calls are responded to in 21 minutes and that 95% of Category C calls are responded to in 60 minutes.


The category B21 target has been achieved in Belfast Area only. The category C60 has been achieved for all areas of Northern Ireland. NIAS needs to realise a 3.5% cumulative improvement to achieve the B21 target. It is anticipated that the performance improvement work on the PfA A8 target will contribute towards improving the B21 target, some specific work will be undertaken in the Control Room focusing on the management of category B calls. NIAS will also work with the HSCB Commissioners in developing plans to reduce delays at A&E Departments, increasing the availability of A&E Ambulances to respond to category A and B calls.

The GP in Control pilot project has now finished. The GPs will now be integrated into the call handling processes with the emergency control room. NIAS will continue to review its protocols to maximise opportunities to redirect category C calls to the GPs.

NIAS continues to engage with other HSC Trusts and bodies to explore the development of alternative care and referral pathways with, for example, GP Out of Hours organisations at regional and local level.


Q1 Q2 Q3 Q4

Review control call take and dispatch protocols Sept 10 A3

Introduce additional intermediate care hours to support A&E tier

Nov 10 A4

Review operational deployment plans: Status Plan, Job Cycle Monitoring, Hospital Turnaround Times

Dec 10 A4

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Risk Commentary.

Risk of failure to achieve the target is low provided number of category B calls does not continue to rise, and NIAS does not experience any adverse impact on this call category as a consequence of acute service changes.

There is a risk to the achievement of this target due to the potential failure to obtain support and engagement from other key external stakeholders such as GPs, A&E Departments, etc. for the implementation of proposed new call handling processes and procedures.

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Category B: % Response within 21 minutes


NI 93.0 92.8 94.3 93.5 91.5

Belfast 96.7 97.4 97.9 97.8 97.4

North 93.7 91.0 93.0 93.5 92.8

SthEast 91.8 91.4 93.1 91.1 91.9

South 90.7 92.4 94.2 93.4 92.7

West 90.6 90.6 92.5 91.1 91.2

Category B: % Conveyance Resource Response arriving within 21 minutes


NI 89.4 89.2 90.6 90.2 89.8

Belfast 93.5 93.5 93.6 94.8 93.8

North 90.4 87.2 87.9 90.0 88.9

SthEast 87.7 87.0 88.8 86.9 87.6

South 86.1 89.5 91.9 90.7 89.5

West 87.7 88.3 90.6 89.0 88.9

Category B : Demand Profile – Responses arriving at scene


NI 5301 5538 5431 5580

Belfast 1334 1332 1279 1273

North 923 973 941 941

SthEast 1385 1492 1414 1467

South 869 935 845 863

West 790 806 742 807

Category C Response within 60 minutes – Monthly Performance


NI 99.9 99.6 99.7 99.7 99.7

Belfast 100 99.6 99.4 99.8 99.7

North 100 99.7 99.7 99.3 99.7

SthEast 100 99.8 99.7 99.7 99.8

South 99.6 99.1 100 100 99.7

West 100 99.6 100 99.5 99.8

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Category C : Demand Profile – Emergency Calls Received


NI 1498 1833 1627 1686

Belfast 435 494 506 506

North 275 385 311 316

SthEast 313 446 346 408

South 263 249 269 238

West 212 259 195 218

Category C : % Calls Resulting in not transporting patient to hospital by emergency ambulance


NI

Belfast

North

SthEast

South

West

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TA2.2… AMBULANCE RESPONSE - NON-LIFE-THREATENING URGENT CALLS TA2.2… Ambulance Response - Non-Life-Threatening Urgent Calls


DELAYED

Risk Assessment

MODERATE

Objective

NIAS will seek to respond to 95% of Urgent calls within 15 minutes of time specified by the clinician requesting transport.


NIAS have consistently failed to meet this target. This is primarily due to Urgent calls being processed differently from the Emergency calls processed through the AMPDS software system within the Control room. There needs to be a review of the call management process and standards, with outcomes that will meet patient’s needs and that are safe and sustainable. The Trust recognises that management of GP urgent calls is a priority and will be commencing the review in early October.


Q1 Q2 Q3 Q4

Review call take and dispatch protocols for urgent calls.

Oct 10 A3

Agree performance measurement and standards for Urgent calls with HSCB commissioners.

Nov 10 A4

Risk Commentary.

There is a significant risk of failing to achieve the target should the current operational processes and standards remain. This risk will increase should there be a significant increase in demand due to winter pressures.

There is a risk to the achievement of this target due to the potential failure to obtain support and engagement from other key external stakeholders such as GPs, A&E Departments, etc. for the implementation of proposed new call handling processes and procedures. For example other service providers may not agree to accept direct referrals from ambulance services, but the Medical Directors are engaging with other HSC Trusts and service providers to agree these procedures, in particular with GP Out of Hours services etc.

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Urgent Response: % within standard


NI 58.0 57.5 58.8 59.4 59.4

Belfast 62.2 58.6 61.4 61.7 61.7

North 62.6 55.5 58.9 59.2 59.2

SthEast 58.8 62.0 70.0 60.7 60.7

South 48.9 53.1 54.1 56.3 56.3

West 55.0 54.6 55.4 55.8 55.8

Urgent Calls: % undertaken by Non-Emergency Ambulance


NI 27.1 28.9 31.2 28.9

Belfast 27.6 33.6 32.9 30.3

North 23.4 20.5 25.9 23.0

SthEast 35.1 38.5 44.1 40.9

South 19.7 16.5 20.3 18.4

West 25.8 29.3 24.0 21.9

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PFA2.3…A&E DISCHARGES PfA2.3…A&E Discharges Performance Assessment


Risk Assessment

LOW

Objective

A&E: from April 2010, HSC Board and Trusts should ensure 95% of patients attending any A&E department are either treated and discharged home, or admitted within four hours of their arrival in the department. No patient should wait longer than 12 hours.


While this is an Acute Trust-led target, NIAS will work with them to identify and deliver relevant requirements for patient transportation.


Q1 Q2 Q3 Q4

Introduce measures to identify A&E discharge patients requiring non-emergency transport by ambulance

Introduce measures to assign priority to discharge patients requiring non-emergency transport by ambulance

Introduce monthly audit of compliance

Risk Commentary.

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PFA2.4… STROKE SERVICES PfA2.4… Stroke services Performance Assessment


Risk Assessment

LOW

Objective

Stroke services (PSA 2.6): by March 2011, the HSC Board and Trusts should ensure that appropriate arrangements are in place to monitor and ensure – as far as possible within available funding – patients attending hospital within 90 minutes of the onset of stroke symptoms receive a CT scan and report within a maximum of a further 90 minutes to inform the appropriate use of thrombolysis.


While this is an Acute Trust-led target, NIAS has fully participated in the regional development and implementation of stroke care pathways and continues to participate in the monitoring of performance. A NIAS protocol for the management of acute stroke in keeping with the regional framework and NICE Guidelines was introduced in 2009. NIAS is currently monitoring performance in relation to the arrival of patients with actual or suspected acute stroke at hospital within an appropriate timeframe and a clinical performance indicator for the management of acute stroke has been developed and is subject to regular audit. This shows a high level of compliance with current guidelines and protocols and is presented below.


Q1 Q2 Q3 Q4

Introduce guidance and protocols for effective management of Stroke patients to ensure hospital attendance within 90 minutes

A2

Participate in the regional stroke implementation group and engage with specialist stroke care providers in the development of stroke pathways

A2

Monitor ambulance performance in relation to timeframe of call to hospital and arrival for patients with actual or potential acute stroke

A3

Risk Commentary.

The risk to achieving this objective is low. Patients with actual or potential stroke will be treated as a high priority to ensure arrival at an appropriate facility within 90 minutes and all staff have been issued with a protocol for the appropriate clinical management of patients with actual or suspected acute stroke in accordance with regional and national best practice. The NIAS PRF has been amended accordingly and subsequent clinical audit is demonstrating a high degree of compliance with the protocol.

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Stroke Services: % of ALL 999 patients at hospital within 90 minutes


NI 98.1 96.4 99.5 99.5

Belfast 100 100 100 100

North 95.5 100 100 100

SthEast 100 94.2 100 100

South 100 95.5 95.8 100

West 94.1 90 100 97.1

Clinical Performance Indicator – Acute Stroke Indicator Set

Performance Area

Inclusion Indicator Description Exceptions Expected Patient Benefit

Evidence Base

Acute Stroke Patients with a clinical diagnosis of stroke / TIA

CVA1 FAST assessment fully recorded on PRF

Patient unconscious

Patient refusal

Patient does not understand request

Secondary head injury / trauma

Improved assessment and management of ischaemic and haemorrhagic stroke

JRCALC Clinical guidelines 2006

Stroke Association Guidelines

CVA2 Airway assessed as ‘CLEAR’ on PRF or managed appropriately

Reduced risk of aspiration

CVA3 Blood glucose recorded on PRF

Patient refusal

CVA4 Blood pressure recorded

Patient refusal

Over-riding critical feature i.e. airway or breathing problem

CVA5 Local stroke team contacted

Time of onset of symptoms to assessment >3 hrs or patient awoke with symptoms

No local stroke team available

Increased access to thrombolysis for patients with ischaemic stroke

CVA6 Glasgow Coma Scale section of PRF completed

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1393 NIAS Patient Report Forms sampled from Nov 2008 to April 2009– CVA/TIA management results:

NIAS - All divisions Nov 2008-Apr 2009 Early 2008 data (for comparison)

Estimated Number of suspect TIA/CVA per month 230 70

Number sampled 1393 404

FAST Performed 1393 (100%) 100%

FAST Exceptions 0% 0%

Blood Glucose 564 (40%) 37%

Blood Glucose Exceptions 0% 0%

Blood Pressure 1172 (84%) 88%

Blood Pressure Exceptions 0% 0%

Airway manage 881 (63%) 93%

GCS Complete 1319 (95%) 95%

Local Stroke Team contact Not known* Not known

Criteria for inclusion in sample = CVA/TIA Assessment = Facial Weakness = “YES” – or – Arm Weakness=”YES” –or—Speech Impairment=”YES”

*Local stroke team information not currently recorded on Patient Report Form – this will be reviewed at annual PRF reformat/updates.

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PFA2.6… HEALTHCARE ASSOCIATED INFECTIONS PfA2.6… Healthcare associated infections



Risk Assessment

LOW

Objective

Healthcare associated infections (PSA 2.1): in the year to by March 2011, the Public Health Agency and Trusts should secure a further reduction of 20% in MRSA and C.difficile infections compared to the position in 2009-10.


While this is an Acute Trust-led target, NIAS continues to work with Commissioners and RQIA to identify and deliver relevant requirements from an ambulance perspective. No healthcare acquired infections arising within the Trust have been reported within the current year. The Trust’s Infection Prevention and Control Group continues to meet on a bimonthly basis with regular reports provided to relevant sub-committees of Trust Board. The Trust’s revised Infection Prevention and Control Policy and Procedures have been issued to all staff and continue to be updated on the basis of emerging national guidelines. NIAS continues to participate in the National UK Ambulance Services Infection Prevention and Control Group and benchmarking with other UK Ambulance Services. Further workshops have been arranged for Station Officers to improve the reporting and monitoring of vehicle cleaning. A review of hygiene and cleanliness within the Trust was undertaken by RQIA in May 2010 but their report is still awaited. Substantive compliance with controls assurance standards May 2010. An audit of compliance with IPC procedures completed in March 2010 and compliance with hand hygiene measures will be re-audited in October 2010.


Q1 Q2 Q3 Q4

Monitoring and reporting of performance in relation to standards of healthcare acquired infections to Trust Board.

A2

Implement recommendations arising from NIAS 2010 Audit of Compliance with IPC Practice and Procedures

A3

Risk Commentary.

NIAS has still been unable to secure formal arrangements to access external expert infection prevention and control advice. Work is continuing in this regard and during September 2010 NIAS has indicated its willingness to participate in a Public Health Agency regional “HCAI Forum”. This forum will provide a platform for engagement, discussion, partnership working and sharing of best practice/learning for HCAI prevention and provide all Trust colleagues with opportunity to inform future HCAI policy development and HCAI action plans going forward.

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PFA2.7… HYGIENE AND CLEANLINESS PfA2.7… Hygiene and cleanliness Performance Assessment


Risk Assessment

LOW

Objective

Hygiene and cleanliness: from September 2010, each of the five HSC Trusts should put in place arrangements to routinely review compliance with standards of hygiene and cleanliness. Trust review arrangements should include consideration at Trust board.


A regional tender in regard to contract cleaning of NIAS facilities was issued in July 2010 with a number of responses received. The tender will close at the end of August 2010. Issues of cleanliness and hygiene will continue to be monitored by the Trust’s Infection Prevention and Control Group and Health and Safety Committee. A review of hygiene and cleanliness arrangements and standards within the Trust was undertaken by RQIA in May 2010. Their report is still awaited. A review of Clinical Waste Policy is currently ongoing and a programme for the review and audit of station cleanliness has been developed and will commence in September 2010.


Q1 Q2 Q3 Q4

Monitoring and reporting of performance in relation to standards of cleanliness and hygiene to Trust Board.

A3

Implementation of recommendations arising from 2010 RQIA Hygiene & Cleanliness Inspection

A4

Participation in the development and implementation of ambulance specific standards of hygiene and cleanliness regionally and nationally

A3

Ensure Compliance with relevant DHSSPS targets and controls assurance standard.

A3

Formally secure/engage expert ICP advice and support for Trust.

A4

Risk Commentary.

NIAS has still been unable to secure formal arrangements to access external expert infection prevention and control advice. Work is continuing in this regard and during September 2010 NIAS has indicated its willingness to participate in a Public Health Agency regional “HCAI Forum”. This forum will provide a platform for engagement, discussion, partnership working and sharing of best practice/learning for HCAI prevention and provide all Trust colleagues with opportunity to inform future HCAI policy development and HCAI action plans going forward.

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PFA2.8… PATIENT EXPERIENCE PfA2.8… Patient Experience Performance Assessment


Risk Assessment

LOW

Objective

Patient Experience: following the adoption of the Patient and Client Experience standards in 2009, Trusts should extend the clinical care areas monitored and increase the range of monitoring tools, and ensure appropriate reporting and follow-up, consistent with direction from the Public Health Agency.


NIAS continues to be represented on both the PHA Steering Group and the Regional Working Group, established to develop and implement a methodology to monitor the standards. Currently surveys are issued to a sample of patients across all HSC Trusts in respect of the standards which included questions relating to the experiences of those who had travelled by ambulance. Work is progressing to develop additional monitoring tools such as Observations of Practice and Gathering Patient Stories.

Within NIAS survey results were analysed and a report submitted to HSCB. A copy of the reports from the first two quarters of 2010-11 is provided for information.


Q1 Q2 Q3 Q4

Engagement with the Patient and Client Council and Service Users to develop an ambulance service user group and membership scheme

A3 A3

Involvement in regional work streams to develop and extend methodology to monitor patient experience across HSC generally and including NIAS specifically

A1 A1

Analysis of monitoring information in respect of patient experience standards and submission of quarterly report to Performance Management and Service Improvement Directorate of HSCB

A1 A1

Risk Commentary.

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PFA2.9… PATIENT INVOLVEMENT PfA2.9… Patient involvement Performance Assessment


Risk Assessment

LOW

Objective

Patient involvement: by March 2011, the Public Health Agency in partnership with the HSC Board should: establish a regional Health and Social Care forum, with appropriate Patient Client Council and Public representation, to drive the PPI agenda; develop and implement a regional Health and Social Care Action Plan for PPI including arrangements to promote and evidence active PPI; arrange for the publication of an annual summary of PPI activity across Health and Social Care Organisations.


NIAS continues to be represented on the Public Health Agency’s PPI Regional Forum. Approval was received for the NIAS Consultation Scheme (developed in compliance with a statutory duty for PPI under the Health and Social Care Reform Act 2009) from DHSSPS on 6th August 2010, including permission to begin implementation of the Scheme to work towards development of a PPI Strategy.


Q1 Q2 Q3 Q4

NIAS Strategy for the implementation of Personal and Public Involvement to be developed and implemented

A3 A3

NIAS will participate in the development and implementation of Regional plans and arrangements for the implementation, monitoring and reporting of PPI arrangements

A3 A3

Ongoing monitoring of compliance with relevant PPI standards and requirements with regular reports to Trust Board

A3 A3

Risk Commentary.

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PFA2.10… SERVICE FRAMEWORKS PfA2.10… Service Frameworks Performance Assessment


Risk Assessment

LOW

Objective

Service Frameworks: by March 2011, ensure the implementation of agreed standards from the Cancer Framework in accordance with guidance to be issued by the Department in October 2010.


NIAS has been actively engaged with the Regional Cancer Network and the primary care group of NICAN and has participated in meetings and workshops for end of life care, the Palliative Care Strategy and various aspects of other service frameworks including aspects of condition-specific terminal and palliative care, for example in the Respiratory and Cardiovascular Frameworks. Most recently discussions have taken place with the Northern Health and Social Care Trust regarding the role of the Northern Ireland Ambulance Service in end of life care for children. This work has focused on the notification of special clinical needs of such patients to responding ambulance crews, liaison with other specialist healthcare professionals in these circumstances, Do Not Attempt Resuscitation (DNAR) agreements, and the development of mechanisms to facilitate information sharing and population of the NIAS patient clinical database.


Q1 Q2 Q3 Q4

To participate in, deliver and monitor ambulance related elements of clinical service frameworks for cancer

A3

To participate in, deliver and monitor ambulance related elements of clinical service frameworks for stroke services

A2

To participate in, deliver and monitor ambulance related elements of clinical service frameworks for cardiovascular disease

A2

To participate in, deliver and monitor ambulance related elements of clinical service frameworks for respiratory disease

A3

To participate in, deliver and monitor ambulance related elements of clinical service frameworks for palliative and end of life care

A3

Risk Commentary.

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TA2.3…ADVERSE EVENT LEARNING TA2.3…Adverse Event Learning Performance Assessment


Risk Assessment

LOW

Objective

During 2010-11 the PHA in partnership with the HSCB should establish effective arrangements to ensure that lessons learnt from adverse events are taken forward by Trusts, primary care and other providers


NIAS participates in the Regional Patient Safety Forum and will participate in the Advanced Patient Safety Development Programme in October 2010. The Trust’s Serious Adverse Incident Reporting procedures have been reviewed in line with the new regional reporting mechanisms and NIAS is participating in the introduction of the Regional Adverse Incident Learning (RAIL) arrangements. The Executive Directors, Risk Manager, Complaints Manager and Employee Relations Manager now meet quarterly to facilitate appropriate action and learning from untoward incidents, complaints, disciplinary procedures etc. as well as reports from the wider healthcare system.


Q1 Q2 Q3 Q4

Participate in, review and introduce patient safety initiatives and apply learning from Patient Safety Officer Executive Program

A3

Review and develop arrangements to ensure learning from adverse incidents both within the Trust and the wider HSC system.

A3

Extend Learning Forum in NIAS to include; complaints; disciplinaries; grievances; legal claims; etc.

A3

Risk Commentary.

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TA2.4…CLINICAL QUALITY TA2.4…Clinical Quality Performance Assessment


Risk Assessment

LOW

Objective

To ensure that patients and clients have timely access to high quality services responsive to their particular needs and delivered locally where this can be done safely, sustainably and cost-effectively

Performance Commentary. (Refer also to PfA2.1; TA2.1: TA2.2)

Regular clinical audit reports are provided to the Trust’s Assurance Committee and to support a number of regional and national audits, for example stroke and acute cardiac care. Work is currently being undertaken to further support the clinical audit function within the Trust and to review the Trust’s Patient Report Form (PRF) and associated systems and processes.

New pharmacy arrangements have now been introduced throughout the Trust and new pain packs introduced to test the pharmacy arrangements in advance of the introduction of controlled drugs which is anticipated in the next two to three months. Once this is achieved, regular audit and monitoring of these arrangements can occur. RQIA reviewed the Trust’s Medicines Management Policies and Procedures as part of their inspection in March 2010 and their report is awaited.


Q1 Q2 Q3 Q4

Regular reporting and audit of clinical performance using condition-specific clinical performance indicators including the development and enhancement of governance structures, functions and processes to support this

A2

Introduction of controlled drugs and regular audit of use in compliance with relevant legislation.

A4

Audit and monitoring of new pharmacy arrangements.

A3

Ensure compliance with medicines management controls assurance standard and with new regional legislative requirements for controlled drugs.

A2

Review and develop arrangements to ensure learning from adverse incidents both within the Trust and the wider HSC system.

A2

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Risk Commentary.

The significant risk to NIAS around previous pharmacy arrangements, which were disparate, has now been resolved with the single regional supply contract with Victoria Pharmacy that is now in place.

There is a risk to the Trust that following the introduction of the regional pharmacy contract between NIAS and Victoria Pharmacy that there may be difficulties in maintaining the continuity of the supply chain by external suppliers to Victoria Pharmacy and NIAS. This risk is being managed through regular meetings with senior personnel in Victoria Pharmacy and their development of clear communication links between suppliers Victoria Pharmacy and NIAS to alert us in advance of any potential manufacturing problems or product shortages to allow the use of alternative products. This risk is currently therefore felt to be low. A weekly review of all medicine-related incidents is being undertaken by the Medical Director, Assistant Medical Director and Risk Management with the supply chain being monitored by the NIAS Stores Manager.

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PRIORITY AREA 3: INTEGRATE PRIMARY, COMMUNITY AND SECONDARY CARE SERVICES Aim: to ensure greater engagement between secondary and primary care clinicians and practitioners to agree clinical pathways which reduce the use of hospital services and increase the capability of primary care to manage patients more locally.

Ever increasing demands are being placed on hospitals. Patient flows must be more effectively managed so that patients are seen, diagnosed and treated in the right setting by the right person at the right time. Much of the care provided in hospital or other institutional settings could be delivered in community settings. Many referrals and unplanned admissions to hospital, outpatient appointments and diagnostic tests could be more appropriately managed in the community. Moving care from hospitals to community settings and patients’ own homes should not only improve efficiency but should also drive improvements in quality.

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PFA3.1… PATHWAY MANAGEMENT PfA3.1… Pathway management



Risk Assessment

LOW

Objective

Pathway management: by March 2011, the HSC Board should establish: (i) models of integrated care in community settings which incorporate integration along clinical care pathways and address the wider determinants of health; and (ii) models of unscheduled care in hospital settings which integrate primary care out-of-hours services with ambulance and A&E services.


NIAS is engaged with the Regional GP Out of Hours Review Group and has provided activity data to support their work. The reintroduction of a call triage pilot with one of the GP Out of Hours providers is currently being considered. The pilot of Category C call triage by GPs in REMDC has now been completed and evaluated and the GP call handling process will be fully integrated within the call handling process and the remit of GPs in the Control Room extended to facilitate, for example, advice to responding ambulance crews etc.

Paramedic administered thrombolysis continues to be available on a regional basis and its administration is being monitored. An increasing number of patients are being taken directly to the cardiac catheterisation lab for PPCI and work in this regard is ongoing in conjunction with the Belfast and Southern HSC Trusts.

A number of condition-specific treat and leave and treat and refer protocols are being developed, with a review of arrangements in other Ambulance Services both nationally and internationally currently being undertaken.


Q1 Q2 Q3 Q4

Further develop the use of Clinician Call Triage in REMDC to facilitate the avoidance of unnecessary hospital attendance through treatment and referral at scene

A3

Introduce a number of condition specific protocols for the treatment and discharge of patients at scene

A3

Engage with secondary and other care providers to implement the relevant standards from service frameworks such as the provision of thrombolysis and access to PPCI to patients with STEMI, the facilitation of emergency hospital admission to patients with actual or suspected stroke, the provision of relevant clinical information to attending ambulance crews to patients with chronic disease such as COPD and cancer etc

A2

Engage with GP OOH providers & commissioners & contribute to the development of secondary call triage and care pathways both in and out of hours and to facilitate the development of a regional OOH service, single point triage and patient management

A3

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Risk Commentary.

There is a risk to the achievement of this objective due to the potential failure to obtain support, co-operation and engagement from other key external stakeholders such as GPs, A&E Departments, GP Out of Hours organisations, Social Services, etc. for the implementation of proposed new call management processes and procedures. For example other service providers may not agree to accept direct referrals from ambulance services arising from treat and refer protocols. The NIAS Medical Directors are engaging with other HSC Trusts and service providers to agree these procedures, in particular with GP Out of Hours services etc.

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PRIORITY AREA 4: HELP OLDER PEOPLE TO LIVE INDEPENDENTLY Aim: to ensure that older people are able to remain independent in their own homes and communities with a good quality of life for as long as possible.

With life expectancy increasing, it is important that the HSC supports people to remain healthy both physically and mentally for as long as possible. During 2010-11 Commissioners and Trusts should continue to provide support to help older people live independent lives through ensuring local access to day care and respite services, together with the provision of targeted domiciliary care support, and effective management of long term conditions and end of life care.

PRIORITY AREA 5: IMPROVE CHILDREN’S HEALTH AND WELL-BEING Aim: to improve the health and well-being of children, to protect vulnerable children, to help families stay together and to improve outcomes for children and young people including those leaving care.

The Department’s key policy priorities are set out in Families Matter and Care Matters both of which have now been approved by the Executive. The emphasis is on early intervention and prevention to help all families and parents to be confident and responsible in helping their children reach their full potential and reduce the number of children who have to be taken into care. The two strategies provide a continuum of support with Families Matter focusing on universal and targeted support and Care Matters focussing on higher level need.

PRIORITY AREA 6: IMPROVE MENTAL HEALTH SERVICES AND SERVICES FOR PEOPLE WITH DISABILITIES Aim: to improve the mental health of the population and to respond effectively to the needs of individuals with a mental health condition or a learning disability or physical/ sensory disability, and to support them to lead fulfilling lives in their own home and communities.

Mental health services

One in four people will suffer a mental health condition at some stage in their lives. Not only does this impact on the individual but also has a potential to have a profound social and economic impact on our society and on the lives of children and families.

The focus on mental health services should include the promotion of mental wellbeing and prevention of mental health conditions, where possible. During 2010-11, Commissioners and Trusts should ensure that the provision of services to people with a mental health need should be through a stepped care approach, recognising that the majority of services should be delivered in primary and community care settings through multidisciplinary and cost-effective approaches. Improving access to psychological therapies should be an integral part of a modern service and be incorporated within the stepped care approach. Inappropriate admission to hospital must be avoided and, where admission is necessary, a focus on access to therapeutic interventions is essential, and early discharge must be facilitated.

Learning disability services

The focus for learning disability will be a “whole life approach” to early intervention, assessment, diagnosis, treatment, care planning and support. This requires a multi-agency approach at local and regional levels. The Department expects a greater focus on “purposeful lives” which supports the individual to live as independently as possible.

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Changing demographics and improvements in treatment and care mean that not only will there be an ageing population of individuals with a learning disability but also an increasing number of people with more severe learning disabilities. At the same time the average age of those caring for them is also increasing. In developing community services, Commissioners and Trusts should ensure a co-ordinated whole life approach that values individuals as welcome members of society.

Physical and sensory disability

The key driver for physical and sensory disability services will be the forthcoming disability strategy which will be issued for consultation in late-2010. This will be complemented by the soon-to-be- published Acquired Brain Injury Action Plan and consultation on a new Speech and Language Therapy Action Plan for children. All of these documents will set strategic direction for future years recognising, of course, that implementation will take some time to achieve.

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PRIORITY AREA 7: ENSURE FINANCIAL STABILITY AND THE EFFECTIVE USE OF RESOURCES Aim – to ensure that all of the resources available to the NI health and social care service are used appropriately and effectively to improve the health and wellbeing of the NI population and to provide better treatment and care, and that the service lives within available resources.

Finance and productivity

The scale of the financial challenge facing the Department and the HSC in 2010-11 is unprecedented. Under existing CSR07 plans the HSC had been already required to deliver cumulative savings of £249m by the end of 2010-11; this requirement was recently increased by a further £105m following the Executive’s decision to cut the planned 2010-11 budget for health and social care.

During 2010-11 Commissioners and Trust must protect and improve frontline services – consistent with the policy direction detailed earlier in this document – while at the same time making further productivity gains and taking forward key reforms. It is essential that the HSC ensures the best possible use of available resources and maintains strong financial control; this will be vital to the continued provision of high quality health and social care.

The focus should be on securing value for money for every pound invested, prioritising the most effective treatments, reducing errors and waste and keeping people healthy and independent for as long as possible. This will require innovation and radical thinking, as well as consistent sharing of best practice and the rolling out of the best examples of providing routine healthcare that is efficient and effective. As far as possible, reforms should be taken forward on a robust, consistent, co-ordinated basis across the HSC.

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PFA7.1… FINANCIAL BREAKEVEN PfA7.1… Financial Breakeven Performance Assessment


Risk Assessment

MODERATE

Objective

Financial Breakeven (PSA 7.1): during 2010-11, the Department and all HSC organisations should live within the resources allocated and achieve in-year financial breakeven and establish a medium and longer-term financially sustainable position.


The position at the end of July 2010 (Month 4) is a deficit of £70k. This includes a movement in provisions of £37k, which leaves a small underlying financial deficit of £33k. The Trust continues to forecast a breakeven position at year end, subject to assumptions in relation to efficiency savings and investment. These assumptions are regularly discussed by HSC Board and NIAS and assessed on an ongoing basis to determine the impact which may significantly affect “break-even”.


Q1 Q2 Q3 Q4

Submission of Trust Delivery Plan Jun 2010 A1

Approval of TDP by HSCB Aug 2010 A2 A1

Approval of TDP by DHSSPS Sep 2010 A2

Secure confirmation of CSR investment for 2010/11 Sep 2010 A2

Ongoing monitoring of expenditure, developments and pressures, through Trust Monitoring Returns, Reports to Trust Board and Budgetary Control.

Monthly A1

Secure confirmation of HSCB and DHSSPS support for developments and pressures, subsequent contract variations both in year and recurrently.

Monthly A2

Risk Commentary.

There remain uncertainties in the current economic climate that may impact on the ability of the Trust to maintain financial balance.

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Financial Breakeven Assessment Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Mar

Expenditure £k £k £k £k

Staff Costs N/A 7,540 11,145 14,480

Depreciation N/A 644 966 1,288

Other Expenditure N/A 1,885 2,380 3,359

Expenditure Total N/A 10,069 14,491 19,527

Income N/A 274 411 548

Net Expenditure N/A 9,795 14,080 18,979

Adjustments (Depreciation, Cost of Capital & Services Provided) N/A (644) (967) (1,289)

Net Resource Outturn N/A 9,151 13,113 17,690

Revenue Resource Limit (RRL) N/A 9,151 13,100 17,620

Surplus/(Deficit) against RRL N/A 0 (13) (70)

Invoices paid within 30 days (%) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

In Month 92.3% 90.4% 88.8% 90.0%

Cumulative 92.3% 91.4% 90.5% 90.4%

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PFA7.2… EFFICIENCY SAVINGS PfA7.2… Efficiency savings Performance Assessment


Risk Assessment

LOW

Objective

Efficiency savings (PSA 7.1): from April 2010, the HSC Board and Trusts should establish effective arrangements to ensure the full delivery of agreed efficiency savings during 2010-11.


Years 1, 2 and 3 of the Trust’s efficiency savings programme totalling £4.449M by 2010/11 have been actioned consistent with Ministerial decisions following NIAS public consultation. Given additional pressures on public sector finances, NIAS will respond to any further requests for savings. The HSC Board have implemented a Financial Stability Programme which will include an assessment of each HSC Trust’s ability to achieve the expected level of cash releasing savings. The Trust has been assessed as ‘amber green’, “successful delivery of the agreed cost savings appears probable; however, risks will need to be carefully managed”.


Q1 Q2 Q3 Q4

Submission of efficiency savings proposals to HSCB/DHSSPS.

Jul 2010 A1

Secure approval of HSCB/DHSSPS Sep 2010 A2

Quarterly Monitoring & Reporting Quarterly A1

Participation and achievement of Financial Stability Programme

Ongoing A2

Risk Commentary.

There remain uncertainties in the current economic climate that may impact on the ability of the Trust to maintain financial balance.

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TA7.1… INFRASTRUCTURE INVESTMENT TA7.1… Infrastructure Investment Performance Assessment

DELAYED

Risk Assessment

MODERATE

Objective

Infrastructure Investment

NIAS is committed to investing in the fleet, clinical equipment, estate and technology necessary to deliver safe, high-quality ambulance services.


The Trust has received £1.0m Capital Resource Limit for 2010-11 (General Capital £500k : Estate £500k).

Approval to invest in fleet replacement during 2010-11 has not yet been secured from DHSSPS/DFP. NIAS has still to develop an expenditure programme for estate. The business case for a replacement ambulance base in Ballymena is progressing on-schedule.


Q1 Q2 Q3 Q4

Liaison with DHSSPS Capital Investment Unit/Strategic Investment Group

Ongoing A2

Implementation and Monitoring of Capital Programme

Monthly A1

Risk Commentary.

This delay in fleet approval and estate planning places the capital expenditure programme at risk. Early resolution is required to facilitate expenditure in-year and address issues around maintaining fleet and estate in an appropriate, operationally effective condition.

Capital Spend - Priority Areas Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Fleet 0 0 3 171

Estate & Equipment 0 0 0 0

Information Technology 0 0 0 0

Other 0 0 0 0

Asset Disposals Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Proposed Disposals (£) N/A 0 4 13

Actual Disposals (£) N/A 0 4 13

Fleet Profile (% less than 5 years old) Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Emergency Ambulances 48.8 52.8 61.5 61.5

Non-Emergency Ambulances 45.7 45.7 45.7 45.7

Rapid Response Vehicles 61.2 65.7 67.6 75

Support Vehicles 42.3 41.2 40 42

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TA7.2… PURCHASING & SUPPLIES MANAGEMENT TA7.2… Purchasing & Supplies Management



Risk Assessment

LOW

Objective

Purchasing & Supplies Management: NIAS will develop and introduce key indicators capable of showing improvements in management of purchasing and supply and/or providing early warning of risk at all levels of the organisation, including the board.


The Business Services Organisation provides a range of services to The Trust, including Procurement and Logistics Services (PaLS), Legal Services, Technology Services and Internal Audit. New reporting arrangements for the Service Level Agreements have identified the following Key Performance Indicators in respect of Purchasing and Supply. At this early stage of the year, these targets have been met for processing of requisitions and products supplied within a timeframe.


Q1 Q2 Q3 Q4

Monitoring & report performance Quarterly A1

Review by Internal Audit Oct 2010 A2

Risk Commentary.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Average Processing Time Per Requisition (Target 5 Days) Days 1.43 4.67 3.51 2.06

Percentage of Products Supplied on First Request (Target 95%) % 98.1 99.4 97.6 97.6

Number of Lines Issued (Stock and Non Stock) Lines 608 606 829 542

Value of Spend (Stock and Non Stock) £k 86 89 368 148

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TA7.3…INFORMATION REQUESTS TA7.3…Information Requests Performance Assessment


Risk Assessment

LOW

Objective

NIAS will respond promptly and effectively to requests for Information.

DHSSPS

These take the form of Assembly Questions Oral (AQOs), Assembly Questions Written (AQWs), TOFs (a letter from a member of the public to the Minister), CORs (a piece of correspondence from a public representative or anyone else whom the Minister's Private Office deems requires a reply) and INV (an invitation to meet with the Minister or for the Minister to attend an event). To respond to the requests requires information; background notes or substantial written briefs. Timescales are set by the Private Office and are normally required to be responded to within 1-5 days of receipt of the correspondence. All questions received will relate directly to the Trust or HSC in general.

Data Protection

Under the Data Protection Act (DPA), individuals can ask for information about themselves which is held on computer and in some paper records. NIAS will seek to respond to all Subject Access Requests received under the DPA within the 40 day period turnaround.

Freedom of Information

NIAS will seek to respond to Freedom of Information Requests within the 20 days turnaround time target identified in legislative principles


At this stage of the year correspondence continues to be processed in line with timescales required. There was a significant increase in FoI requests in July 2010 in respect of acute service reform.


Q1 Q2 Q3 Q4

Monitor & report performance Monthly A1

Risk Commentary.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Data Protection

Number of Requests Received 2 4 2 0 1

Completed Requests processed within 40 days or less 2 3 1 0

Completed Requests exceeding 40 days 0 0 1 0

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Freedom of information

Number of Requests Received 3 5 3 18 5

Completed Requests processed within 20 days or less 3 4 3 17

Completed Requests exceeding 20 days 0 1 0 1

Number of Records Fully Disclosed 3 5 3 17

Vexatious Requests 0 0 0 0

Number of Records for which records not held 0 0 0 2

Requests where exemptions wholly/partially applied 0 0 0 1

Referrals for Independent Review 0 0 0 0

Appeals to the Information Commissioner 0 0 0 0

DHSSPS/AQ’s/CORs/TOF’s/INV’s

Assembly Questions (Oral) 0 0 2 0

Assembly Questions (Written) 2 5 19 0

CORs Received 0 1 1 1

TOFs Received 1 1 0 0

INVs Received 0 0 0 1

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PFA7.4… ABSENTEEISM PfA7.4… Absenteeism Performance Assessment

UNLIKELY TO BE ACHIEVED

Risk Assessment

MODERATE

Objective

Absenteeism (PSA 7.2): each Trust should reduce its level of absenteeism to no more than 5.2% in the year to March 2011.


The Trust has prioritised the management of absence requirements and has engaged in a process of reviewing the measurement of % absence, setting and monitoring monthly performance targets, reviewing the measurement of attendance and related action plans and information requirements.


Q1 Q2 Q3 Q4

Develop Health & Wellbeing and Attendance Management Action Plan

Aug 2010 A3 A1

Agree Health & Wellbeing and Attendance Management Action Plan

Aug 2010 A3 A1

Implement Health & Wellbeing and Attendance Management Action Plan

Sept 2010 A3 A3

Risk Commentary.

The risk associated with not achieving the PFA target is moderate as failure to meet the PFA target will not necessarily directly impact on delivery of an Ambulance Service to patients due to measures in place to manage absence and maintain business continuity. Previous data would indicate a lack of correlation between higher levels of sickness absence and operational performance, as a result of pre-existing management contingency measures in place. Risk will continue to be reflected on local Human Resource and Operations Risk Registers.

PFA TARGET 2010/11 = 5.2% TOTAL YEAR TO DATE ABSENCE = 6.29%

Attendance Management Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Target absenteeism 2009/10 (%) 5.50 5.50 5.50 5.50 5.50 5.50 5.50 5.50 5.50 5.50 5.50 5.50

NIAS absenteeism 2009/10 (%) 5.84 6.67 6.70 7.38 6.51 6.48 6.54 6.64 6.76 9.24 7.63 6.72

Target absenteeism 2010/11 (%) 5.20 5.20 5.20 5.20 5.20 5.20 5.20 5.20 5.20 5.20 5.20 5.20

NIAS absenteeism 2010/11 (%) 6.78 5.93 6.78 6.31 5.86

% short term absenteeism 3.06 2.56 3.14 2.81 2.52

% long term absenteeism 3.72 3.37 3.64 3.49 3.35

No. of employees on half pay 2 4 7 6 6

No. of employees on no pay 3 1 6 4 4

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Comparative Analysis of HSC Absence - half yearly

Staff Group

2009-10 Q3&4

NIAS

2009-10 Q3&4

HSC

2010-11 Q1&2

NIAS

2010-11 Q1&2

HSC

Admin & Clerical 4.88% 4.83%

Paramedics 8.23% N/A

Station Supervisors & Clinical Support Officers 6.36% N/A

Nursing & Midwifery N/A 6.25%

ACAs / EMTs 7.79% N/A

Control Staff 8.48% N/A

Support Staff N/A 7.78%

Works & Maintenance 50.0% 5.06%

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PFA7.6… STAFF HEALTH AND WELLBEING PfA7.6… Staff Health and Wellbeing Performance Assessment


Risk Assessment

LOW

Objective

Staff Health and Wellbeing: all HSC organisations should put in place organisational health and well being strategies including being pro-active in improving the quality of and speeding up access to occupational health services, and strengthen board accountability for the management of sickness and absence.


On Track to achieve


Q1 Q2 Q3 Q4

Benchmark Best Practice June 2010 A1 A1

Develop Health & Wellbeing Strategy Aug 2010 A3 A1

Agree Health & Wellbeing Strategy Sept 2010 A3 A1

Implement Health & Wellbeing Strategy Oct 2010 N/A A3

Risk Commentary.

The likelihood of NIAS not achieving the PFA target is unlikely, however the consequence of NIAS not achieving the PFA target is insignificant. The associated risk is low. Failure to meet the PFA target will not directly impact on delivery of an Ambulance Service to patients. Failure to put in place an health and well being strategy may impact on the ability of the Trust to reduce absence levels however given the relief tier is funded at a higher % level than the current % level of sickness absence the risk to service delivery is very low. In addition there is no evident correlation between higher levels of sickness absence directly affecting operational performance. Risk will be reflected on local Human Resource and Operations Risk Registers.

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TA7.4… GRIEVANCE MANAGEMENT TA7.4… Grievance Management Performance Assessment


Risk Assessment

LOW

Objective

Grievance Management; NIAS will ensure that the grievance procedure provides employees with the opportunity to have their grievance considered quickly and effectively. Management should seek to ensure that all grievances raised under this Procedure are addressed as quickly as possible


Grievances continue to be managed in line with the Trust's Procedure


Q1 Q2 Q3 Q4

Develop robust HR Protocols to support application of the Procedure

Oct 2010 A3 A3

Develop and implement HR performance management framework to monitor application of the Procedure and resultant learning

Nov 2010 A3 A3

Risk Commentary.

The likelihood that the Trust will not deal with all grievances quickly and effectively is possible. However the consequences are minor therefore the risk to the Trust is low. Failure to address grievances as quickly as possible will not impact on Service delivery. The risk to the Trust in failing to address grievances quickly and effectively relates to the impact on staff morale that may impact on absence levels, and industrial relations climate.

Grievance Standards Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

No. of Grievances received 4 1 4 1 1

Grievances acknowledged within 2 days 1 1 4 0 1

Grievances at Informal Stage 1 0 2 1 1

Grievances resolved informally / withdrawn 3 1 0 0 0

Stage 1 hearing arranged within 15 working days 0 0 1 0 0

Stage 1 outcome conveyed within 7 working days of hearing 0 0 0 0 0

Stage 1 Grievance appealed within 15 working days 0 0 0 0 0

Stage II hearing arranged within 15 working days of notification 0 0 0 0 0

Stage II outcome conveyed within 7 0 0 0 0 0

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working days of hearing

Grievance Cases Closed 3 1 1 0 0

TA7.5… DISCIPLINARY MANAGEMENT TA7.5… Disciplinary Management Performance Assessment


Risk Assessment

LOW

Objective

Disciplinary Management: NIAS Disciplinary Procedure is designed to help & encourage all employees to achieve & maintain appropriate standards of conduct, performance & behaviour. The aim of the procedure is to ensure: - the trust can operate effectively as an organisation, to ensure action taken is fair, appropriate, and consistent and that all involved in the process are treated with dignity and respect and that all staff are aware of their rights & obligations under the Disciplinary Procedure.

All stages of the Disciplinary proceedings will be completed as quickly as possible.


Disciplinaries continue to be managed in line with the Trust's Disciplinary Procedures


Q1 Q2 Q3 Q4


Oct 2010 A3 A3


Nov 2010 A3 A3

Risk Commentary.

The likelihood that the Trust will not deal with all disciplinaries quickly and effectively is possible. However the consequences are minor therefore the risk to the Trust is low. Failure to address disciplinaries as quickly as possible will not impact on Service delivery. The risk to the Trust in failing to address disciplinaries quickly and effectively relates to the impact on staff morale that may impact on absence levels, and industrial relations climate.

Discipline Standards Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar

Number of disciplinary cases 1 1 0 2 0

Number of HPC referrals 0 0 0 2 0

Number of suspensions 0 0 0 2 0

Decision to suspend is reviewed every 4 weeks 0 0 0 0 0

Formal investigations ongoing 1 1 0 2 0

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Formal investigations completed as soon as is reasonable 0 0 0 0 0

Document disclosure exchanged 5 working days prior to disciplinary hearing 0 0 0 0 0

Decision of Stage I Panel conveyed within 7 working days of date of hearing 0 0 0 0 0

Employee will be given 7 working days notice of appeal hearing 0 0 0 0 0

Decision of Stage II Appeal panel conveyed within 7 working days of date of hearing 0 0 0 0 0

Disciplinary Cases Closed 0 0 0 0 0

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TA7.6… HARMONIOUS WORK ENVIRONMENT TA7.6… Harmonious Work Environment



Risk Assessment

LOW

Objective

Harmonious Work Environment; As part of its overall commitment to equality of opportunity, the Northern Ireland Ambulance Service is fully committed to promoting a harmonious working environment where every employee is treated with respect and dignity, and where no employee feels threatened, intimidated, victimised or harassed


Harassment complaints continue to be managed in line with the Trust's Harassment Procedure


Q1 Q2 Q3 Q4


Oct 2010 A3 A3


Nov 2010 A3 A3

Review Trust Harassment Policy and Procedure Nov 2010 A3 A3

Risk Commentary.

The likelihood that the Trust will not deal with all harassment complaints quickly and effectively is unlikely, with the consequences being assessed as minor, therefore the risk to the Trust is very low. Failure to address harassment complaints as quickly as possible will not impact on Service delivery. The risk to the Trust in failing to address harassment complaints quickly and effectively relates to the impact on staff morale that may impact on absence levels, and industrial relations climate.

Harassment Standards Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Number of harassment cases 0 1 0 0 2

Number of informal cases 0 0 0 0 0

Number of formal cases 0 1 0 0 0

HR rep meets complainant within 5 working days of receipt of complaint 0 1 0 0 0

Investigating officer meets complainant within 5 working days of their appointment 0 1 0 0 0

Investigation complete within 30 working days of receipt of complaint 0 0 0 0 0

Harassment Cases Closed 0 0 0 0 0

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TA7.7… INDUSTRIAL TRIBUNALS TA7.7… Industrial Tribunals Performance Assessment


Risk Assessment

LOW

Objective

Industrial Tribunals: NIAS will seek to ensure that Industrial Tribunals are managed within Tribunal Guidelines. Management should seek to ensure that matters should be resolved internally if possible


Industrial tribunal cases continue to be managed in line with the Tribunal Guidelines


Q1 Q2 Q3 Q4

Establish Legal SLA Mar 2011 A3 A3

Develop robust HR Protocols to support application of Statutory Processes

Oct 2010 A3 A3

Develop and implement HR performance management framework to monitor application of Statutory Processes and resultant learning

Nov 2010 A3 A3

Risk Commentary.

The likelihood that the Trust will not deal with all Industrial Tribunal cases quickly and effectively is unlikely, with the consequences being assessed as minor, therefore the risk to the Trust is very low. Failure to address Industrial Tribunal cases within Statutory timeframes will not impact on Service delivery. The risk to the Trust in failing to address Industrial Tribunal cases quickly and effectively relates to the impact on staff morale that may impact on absence levels, and industrial relations climate.

Industrial Tribunal Standards Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

No. of lT Applications received 0 0 0 0 0

Response to IT Applications within 28 days 0 0 0 0 0

IT Cases Closed 0 0 0 0 0

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TA7.8… TRAINING TA7.8… Training Performance Assessment


Risk Assessment

LOW

Objective

Training: NIAS will seek to deliver the Training identified within the 2010-11 Training Plan


Training continues to be provided in line with the 2010-11 Training Plan


Q1 Q2 Q3 Q4

Develop 2010-2011 Training Plan July 2010 A1 A1

Agree 2010-2011 Training Plan Aug 2010 A1 A1

Implement 2010-2011 Training Plan Aug 2010 A3 A1

Risk Commentary.

No risk identified. Training Plan has been developed, agreed and will be implemented within identified budget.

Key Actions Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Accredited Clinical Training Programmes

Paramedic-In-Training Programmes A2 A2 A2 A2 A1

BTEC Ambulance Care Assistance Programme N/A N/A N/A N/A N/A

Mandatory Refresher Training Programmes

Develop Mandatory Refresher Training Workbook A3 A3 A3 A3 A2

Annual Assessment – Paramedic & EMT N/A N/A N/A N/A N/A

Annual Assessment - PCS N/A N/A N/A N/A N/A

Moving People Training Programme N/A N/A N/A N/A N/A

Moving People Refresher Training Programme N/A N/A N/A N/A N/A

Continuous Professional Development (CPD)

Foundations of Paramedic Practice N/A N/A N/A N/A N/A

PGCHE (RATC Training Officers) A2 A2 A1 A1 A1

Supervision of Clinical Practice A3 A3 A3 A3 A3

IHCD Instructional Methods Module N/A N/A N/A N/A N/A

Management Training

Develop Management Training Action Plan N/A N/A N/A N/A A3

Deliver Management Training Programme N/A N/A N/A N/A N/A

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TA7.9… KNOWLEDGE AND SKILLS FRAMEWORK TA7.9… Knowledge and Skills Framework



Risk Assessment

LOW

Objective

Knowledge and Skills Framework : Implement Knowledge and Skills Framework (KSF)


The Trust continues to implement KSF in partnership in line with the Agenda for Change Joint Working Group’s Regional Action Plan. This includes participating with the regional KSF sub-group, liaising with the regional KSF Project Manager, and participating in a regional working group to develop a regional Gateway Policy.


Q1 Q2 Q3 Q4

Develop KSF Action Plan Sept 2010 A3 A3

Agree KSF Action Plan Sept 2010 A3 A3

Implement KSF Action Plan Oct 2010 A3 A3

Risk Commentary.

The likelihood of not achieving the objective is assessed as unlikely, with the consequence insignificant to the provision of an Ambulance Service in the year 2010/2011. The National Terms and Conditions are being adhered to, including the provision for gateway progression as KSF is rolled out within the Trusts.

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TA7.10… COMPLAINTS & COMPLIMENTS TA7.10… Complaints & Compliments Performance Assessment


Risk Assessment

LOW

Objective

Complaints & Compliments: NIAS will seek to respond promptly and effectively to Complaints & Compliments and apply learning from each to improve performance.


On Track to achieve


Q1 Q2 Q3 Q4

Review and implement Policy and Procedure Oct-2010 A3 A2

Develop Action Plan for implementation of performance management framework to monitor application of the Procedure and learning outcomes

Nov-2010 A3 A3

Implement Level 1 and Level 2 Investigation Training Mar-2011 A3 A3

Risk Commentary.

The likelihood of not achieving the target is unlikely and the consequence of non-achievement has been assessed as moderate/minor. However there are mechanisms in place to review learning and improve performance. The associated risk is low. Failure to meet the key actions will not directly impact on delivery of an Ambulance Service to patients.

2010-11 2009-10 (total)

COMPLAINTS RECEIVED Count % Count %

Total complaints received at 31/07/2010 34 98 HANDLING TIMES OF COMPLAINTS

Acknowledged within 2 working days 34 100% 86 88%

Acknowledged after 2 working days 0 0% 12 12%

Response within 20 working days 3 9% 26 27%

Response after 20 working days 11 32% 62 63%

Complaints Investigations ongoing 20 59% 10 10% SERVICE AREA OF COMPLAINTS

Accident & Emergency (plus RRV) 12 35% 37 37%

Patient Care Service 10 29% 31 32%

Control & Communications 11 33% 26 27%

Other 1 3% 3 3%

Voluntary Car Service 0 0% 1 1%

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NATURE OF COMPLAINTS RECEIVED

Staff Attitude 8 24% 37 38%

Ambulance Late/No Arrival 11 32% 46 47%

Clinical Incident 8 23% 13 13%

Suitability of Equipment/Vehicle 3 9% 2 2%

Other 4 12% 0 0%

Patient Property 0 0% 0 0% COMPLIMENTS RECEIVED

TOTAL COMPLIMENTS 36 87 SERVICE AREA OF COMPLIMENTS RECEIVED

Accident & Emergency (plus RRV) 29 81% 33 38%

Control & Communications 0 0% 21 24%

Patient Care Service 7 19% 30 35%

Voluntary Car Service 0 0% 0 0%

Other 0 0% 3 3%

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TA7.11… MEDIA MANAGEMENT TA7.11… Media Management Performance Assessment


Risk Assessment

LOW

Objective

Media Management: NIAS will seek to maintain open and transparent relationships with Local and Regional Press and Media outlets, responding to all enquiries within an appropriate time frame


On Track to achieve


Q1 Q2 Q3 Q4

Review and update media protocols Sept 2010 A3 A2

Monitor and report on media activity Quarterly A1 A1

Risk Commentary.

The likelihood of not achieving the objective is unlikely and the consequence of NIAS not achieving the PFA target is moderate. The associated risk is low, however failure to meet the key actions will not directly impact on delivery of an Ambulance Service to patients.

Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

Daily Media - Response within same day

Number of enquiries received * 8 23 14 30

Number of responses issued on day of receipt * 8 23 14 30

Weekly Media - Response within three days

Number of enquiries received * 3 14 4 5

Number of responses issued within three days of receipt * 3 14 4 5

Number of responses resulting in Media Coverage * 11 30 14 33

* Please note that data for media enquiries was not recorded during April 2010.

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TA7.12… COMMUNITY EDUCATION TA7.12… Community Education Performance Assessment


Risk Assessment

LOW

Objective

Community Education : NIAS will seek to deliver Community Education Programme within budget


On Track to achieve


Q1 Q2 Q3 Q4

Develop Community Education Action Plan Sept 2010 A2 A2

Agree Community Education Action Plan Sept 2010 A3 A3

Measure, report and evaluate activity Quarterly A1 A1

Risk Commentary.

The likelihood of not achieving the objective is rare and the consequence of NIAS not achieving the PFA target is moderate. The associated risk is low, however failure to meet the key actions will not directly impact on delivery of an Ambulance Service to patients. The Community Education programme has a good track record in terms of planning and actioning within budget.


Number of visits delivered 14 19 22 16

Performance Assessment A3 A3 A3 A3

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TA7.13… STATUTORY COMPLIANCE TA7.13… Statutory compliance Performance Assessment


Risk Assessment

LOW

Objective

Section 75: Statutory compliance.

NIAS will seek to comply with its duties under Section 75 of the NI Act and the Disability Discrimination Order


Following engagement with the Equality Commission for Northern Ireland (ECNI) and disability sector organisations, NIAS submitted a one year Disability Action Plan to ECNI in compliance with its duties under the DDO.

In addition, the Trust submitted its Annual Progress Report to ECNI on 31 August, outlining key work in discharging its statutory duties, in compliance with requirements under Section 75.

Work in respect of CSR Monitoring continues including a recent presentation of monitoring proposals to trade union representatives.

The Trust continues to engage with Business in the Community in respect of its Corporate Social Responsibility agenda.

The Trust is fully involved in regional workstreams to undertake an Audit of inequalities.


Q1 Q2 Q3 Q4

Develop and implement a programme of work to ensure compliance with revised S75 Guidance

MAY 2011 A3 A3

Engage with Equality Commission for Northern Ireland and Disability Sector groups on development of updated Disability Action Plan

1 Jul 2010 A1 A1

Develop CSR Monitoring Framework and consult with staffside

Dec 2010 A3 A3

Develop and implement Corporate and Social Responsibility Action Plan

Ongoing A1 A1

Engage with Business in the Community on development of updated Action Plan

Ongoing A1 A1

Risk Commentary.

The likelihood of not meeting the Trust’s Statutory Duty is unlikely and the consequence is moderate, with the associate risk low. Failure to meet the Statutory Duty will not directly impact on the delivery of an Ambulance Service to patients and there are robust systems in place to ensure compliance.


Completed Policy S75 Screenings 0 0 1 1 0 7

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APPENDIX 1

TABLE TEMPLATE Performance Assessment


Risk Assessment

LOW

Objective



Q1 Q2 Q3 Q4

Risk Commentary.

Corporate Risks (Including any Gaps in Control or Assurance Identified.)

Target Risk Rating

Current Risk Rating

Q1 Q2 Q3 Q4

APPENDIX 3

PRIORITIES FOR ACTION TARGET FOR 2009/2010: PATIENT/CLIENT EXPERIENCE STANDARDS

MONITORING REPORT FOR QUARTER ENDING MARCH 2010

Submitted: 30 April 2010

2

1.0 Introduction In April 2009 the Department of Health, Social Services and Public Safety (DHSSPS) published the ‘Improving the Patient & Client Experience’ document which detailed new standards to promote the delivery of high quality, effective care by ensuring a positive patient/client experience. The document sets out the following five core standards which are key to promoting a positive patient/client experience:- Respect Attitude Behaviour Communication Privacy & dignity

Priorities for Action 2009/2010 included the following target: ‘By September 2009 Trusts should adopt Patient and Client Experience Standards in relation to Respect, Attitude, Behaviour, Communication, and Privacy and Dignity, and have put in place arrangements to monitor and report performance against these standards on a quarterly basis’ The December 2009 monitoring report included confirmation that the Trust had achieved this target. 2.0 Development and Testing of Methodologies for Monitoring Compliance

against the Patient/Client Experience Standards As outlined in the first report, the regional working group has been tasked with the development of methodologies which can then be tested in order to determine their efficacy as a monitoring tool for measurement of compliance against the Patient/Client Experience Standards. It has been agreed that a range of methodologies will be developed and tested in order to facilitate comprehensive measurement of compliance against the five standards. These will include:- Patient/user feedback (patient/client satisfaction surveys, patient/client stories, review

of compliments and complaints) Observations of practice Staff feedback Audit of organisational arrangements Due to the need to ensure that the methodologies used are robust, a phased approach has been agreed with the Regional Steering Group. The first methodology developed was a patient satisfaction survey which was tested in an adult acute medical ward in each Trust during the quarter ending December 2009. The learning from this quarter was implemented and the satisfaction questionnaire rolled out the following priority areas over quarter ending March 2010: An adult acute mental health in patient ward in each Trust An adult rehabilitation/non acute medical ward in each Trust

3

The other methodologies outlined above will be developed and tested through the work programme for 2010/2011 and beyond. 3.0 Development and Testing of the Patient Satisfaction Survey Methodology

during the Quarter Ending March 2010 The following section summarises the methodology adopted for the survey undertaken in the adult acute mental health in patient ward and an adult rehabilitation/non acute medical ward in each Trust during the quarter ending March 2010: Sample size: In each hospital 40 questionnaires were issued to patients on

discharge from:

• An adult acute mental health in patient ward • An adult rehabilitation/non acute medical ward

In response to learning from the previous quarter, wards were provided with a questionnaire for completion by the Carer where the patient was unable to complete himself/herself due to inability to communicate or extent of cognitive impairment.

Return of Questionnaires Two options for return of questionnaire were provided,

• via free post return envelope directly to the Audit Dept • placed in a sealed envelope on the ward on day of discharge to be

forwarded to Audit Dept

Results in respect of NIAS were then forwarded to NIAS from each of the five Trusts.

Response rate: Each of the 5 other Trusts will provide response rates in the context of the numbers of questionnaires issued. Information provided to NIAS from the Trusts relates only to ambulance results. In this regard: Adult acute mental health inpatient ward: 16 patients (51.61 % of respondents who provided an answer as to whether or not they travelled by ambulance) travelled by ambulance.

Adult rehabilitation/non acute medical ward: 45 patients (69.23% of respondents who provided an answer as to whether or not they travelled by ambulance) travelled by ambulance. 4.0 Evaluation of Patient Satisfaction Methodology for Quarter ending December

March 2010 As agreed with the regional steering group and with the Performance Management Service Improvement Directorate (PMSI) at the Health & Social Care Board, the focus for the monitoring reports for the quarters ending December 2009 and March 2010 is on evaluation of the methodologies being tested i.e. patient satisfaction survey.

4

Although results of the surveys undertaken are presented as Appendix 1: Adult acute mental health inpatient ward and Appendix 2: Adult rehabilitation/non acute medical ward. The following section summarises the extent to which the survey methodology was

successful in measuring patient satisfaction in relation to the Patient/Client Experience Standards within an adult acute mental health inpatient ward and an adult rehabilitation/non acute medical inpatient ward in each Trust during the quarter ending March 2010.

Issues identified: (Trust Specific)

Design of the questionnaire: The ambulance element of the questionnaires is different given the patient interface is likely to relate to a single episode. Answers therefore are based on a “yes/no” approach rather than “always/sometimes/never.” The R/A/G ratings relating to always/sometimes/never are not directly applicable. Distribution and return of the questionnaire: Distribution within the hospitals which includes the entire patient journey, including experience of the ambulance service avoids duplication with a separately administered ambulance survey. Response rate: As indicated above the response rate for the Adult Acute Mental Health inpatient wards was from an ambulance perspective, considerably lower than the response rate in the Adult rehabilitation/non acute medical ward. Analysis of questionnaire: As indicated above, in order to use the R/A/G system within NIAS we had to base the analysis on those who answered ‘yes’ rather than ‘always’. Given the very small numbers involved in the results from the Chronic Mental Health Ward the responses from just a few respondents has a significant impact on the analysis of the results. In addition some responses indicated either ‘can’t remember’ or provided no answer to certain questions. In this context the R/A/G analysis was based on the number of respondents who answered yes as a percentage of those who provided an answer to the question. Equality issues: Issues around accessibility of questionnaires and adjustments needed were dealt with at distribution within each of the 5 Trusts. In light of the learning arising from testing of the survey methodology with patients within an adult acute mental health inpatient ward and an adult rehabilitation/non acute medical ward in the 5 Trusts:- The above amendments will be used to inform the design/methodology being developed for the roll out of the surveys

5

5.0 Results from the Patient Satisfaction Survey undertaken during the Quarter Ending March 2010

The following section summarises the results obtained from the satisfaction survey undertaken in an adult acute mental health inpatient ward and an adult rehabilitation/non acute medical ward during the quarter ending March 2010 in each of the Trusts. A decision has been taken on a regional basis, and in agreement with PMSI Directorate at the HSC Board, that whilst acknowledging that the focus for this quarter remained on testing the methodology as opposed to actual performance, the results would be colour coded using the RAG performance system (Red, Amber and Green) The responses were categorised as follows: 90% or above of respondents who indicated; Yes – coded green Between 80% and 89% (inclusive) of respondents indicated: Yes –coded amber Less than 80% of respondents indicated Yes– coded red

6

APPENDIX 1 Adult acute mental health inpatient ward:


January – March 2010

Monitoring of five core standards – RAG (Red, Amber, Green) Assessment

ADULT ACUTE MENTAL HEALTH WARD

7

QUESTION(as per satisfaction survey

questionnaire)% result

Yes >90% = Yes 80-89%Yes <=79%

51.61%Yes 16No 15Can't remember 0Not Stated 2


Q3. Did you feel the ambulance staff … 80.00%Yes 12No 3Can't remember 0

a) Were polite and courteous? Not Stated 792.31%

Yes 12No 1Can't remember 0Not Stated 7


Journey to Q1. Did you travel to hospital by ambulance?

Q2. If yes, did the ambulance staff introduce themselves to you?

RESULTS -RAG colour code

ADULT ACU

c) Treated you as an individual?

b) Were caring and compassionate towards you?

8






92.86%Yes 13No 1Can't remember 0Not Stated 7i) Behaved in a professional manner?

g) Made you feel safe and secure?

h) Maintained your privacy and dignity?

e) Spoke to you in a way which you could easily understand?

f) Explained what was happening in relation to your treatment and care?

d) Considered and respected your wishes?

9

APPENDIX 2 Adult rehabilitation/non acute medical ward


January 2010 – March 2010

Monitoring of five core standards – RAG (Red, Amber, Green) Assessment

Chronic Medical/Rehab Ward

10

QUESTION(as per satisfaction survey

questionnaire)% result

Yes >90% = Yes 80-89%Yes <=79%



Q3. Did you feel the ambulance staff …

97.73%

Yes 43No 1Can't remember 0

a) Were polite and courteous? Not Stated 895.45%

Yes 42No 2Can't remember 0Not Stated 8


Journey to hospital: Q1. Did you travel to hospital by ambulance?

Q2. If yes, did the ambulance staff introduce themselves to you?

RESULTS -RAG colour code

CHRONIC MEDICAL/REHAB W

c) Treated you as an individual?

b) Were caring and compassionate towards you?

11







i) Behaved in a professional manner?

g) Made you feel safe and secure?

h) Maintained your privacy and dignity?

e) Spoke to you in a way which you could easily understand?

f) Explained what was happening in relation to your treatment and care?

d) Considered and respected your wishes?

APPENDIX 4

Patient Client Experience Standards

Monitoring Report

Quarter Ending 30 June 2010

2

1. Background.

In April 2009, the DHSSPS published the ‘Improving the Patient & Client Experience’ document. The document set out the following five core standards:

• Respect • Attitude • Behaviour • Communication • Privacy and Dignity

All Trusts adopted these standards during 2009/10 and arrangements were put in to develop methodologies through a regional working group to allow the standards to be monitored. Priorities for Action 2010/11 includes the following target: ‘Following the adoption of the Patient and Client Experience Standards in 2009, Trusts should extend the clinical care areas monitored and increase the range of monitoring tools, and ensure appropriate reporting and follow up consistent with direction from the Public Health Agency’

2. Development of Monitoring Tools and Extension of Monitoring to Additional Clinical Areas.

The use of patient satisfaction surveys was tested during the third and fourth quarters of 2009/10. The surveys were tested in acute medical wards, non acute rehabilitation wards and acute mental health inpatient wards. Questionnaires have been revised to reflect the learning from the surveys undertaken. During 2010/11, the surveys will be rolled out to other wards within these areas and will also be extended to other clinical areas including acute surgical wards and learning disability services. The Regional Patient Client Experience Working Group has developed a work plan for 2010/11 in agreement with the Public Health Agency and HSC Board to further develop the methodologies for monitoring the compliance against the five core standards. The additional monitoring tools to be developed and tested will include the following:

• Patient/Client stories • Review of compliments and complaints • Observations of practice • Staff Feedback • Audit of organisational arrangements

Trusts will provide a monitoring report to the HSC Board on the activities undertaken each quarter. In the current quarter a further three medical wards have been surveyed and the results relevant to the ambulance service provided to NIAS.

3

A regional methodology was agreed by the Patient Experience Working Group and a reporting template for ambulance results was developed by NIAS and agreed by the regional group. Each Trust agreed to complete this template and submit results to NIAS. NIAS then analysed results from each Trust and aggregated the results to present a regional picture of patient experience in respect of the ambulance service for the quarter.

Patient Satisfaction Survey - Report

Trust: Northern Ireland Ambulance Service HSC Trust

Ward: Selected medical wards across all HSC Trusts

Quarter Ending:

30 June 2010

Sample Size:

80 questionnaires were provided to the ward to be issued to each patient on discharge over a nine week period. 20 separate questionnaires were provided for completion by a carer.

Return of Questionnaire:

Two options for return of questionnaires were provided: • Via freepost return envelope to the Safe &Effective Care

Department • Placed in a sealed envelope on the ward on day of

discharge and then forwarded to the Safe &Effective Care Department

Response Rate:

Of the 690 questionnaires issued across the 4 Trusts, 238 were returned. This equates to a response rate of 34.5% (238/690). Of those who responded to the survey, 53.4% (124/232) travelled to hospital by ambulance.

4

The following table outlines the level of patient satisfaction against each of the five Patient and Client Standards.

RAG Assessment of Patient Client Experience Standards

Did you feel the ambulance staff: Respect 99.2% (119/120)

treated you as an individual

99.2% (118/119) considered and respected your wishes

99.1% (112/113) made you feel safe and secure

Attitude 98.3% (118/120) were polite and courteous

Behaviour were caring and compassionate 98.3% (118/120)

behaved in a professional manner 99.2% (119/120)

Communication 96.1% (99/103) Did the ambulance staff introduce themselves?

100% (119/119) spoke to you in a way which you could easily understand

97.5% (115/118) explained what was happening in relation to your care and treatment

Privacy & Dignity

99.2% (119/120) maintained your privacy and dignity

5

Issues Identified:

Unfortunately, the Belfast HSC Trust was unable to provide a report for this quarter and consequently this report includes results for the Northern, Southern, Western and South Eastern HSC Trusts only. The response rate for Western HSC Trust was particularly low, with only 10 patient and carer surveys returned. These issues will be considered by individual Trusts. Issues around accessibility of questionnaires and adjustments needed in order to ensure equality of access and participation were dealt with at the distribution stage of surveys within each of the Trusts. Comments received from patients/carers in respect of the ambulance service element of questionnaires:

Daisy Hill Hospital medical Stroke Ward Level 6

Any comments from patients or carers: “My elderly father has had to wait 5+ hours on an ambulance to take him home.” How could we improve the service? “Improve ambulance services for discharge of patient home.”

6

Learning and Taking Action

The results of surveys this quarter in terms of ambulance services are positive and represent an improvement on the previous quarter where it was indicated that staff were not always introducing themselves or always explaining care and treatment. NIAS is keen to learn from experiences of all those who use our services. We have identified some actions below in order to reinforce our commitment to the standards and the responsibilities of all staff in this regard.

Action Plan

Issue Action Planned Responsibility and Timescales

Communication – awareness of Patient and Client Experience standards. NIAS was not provided initially with sufficient Patient and Client Experience leaflets for each member of staff and so previously supplied staff attending awareness sessions around the standards with a copy.

Patient and Client Experience leaflets to be distributed to each member of staff via pay slips with a covering letter from the Chief Executive.

Equality and PPI – by Nov 10

Need to reinforce of responsibilities of staff for Patient and Client Experience standards, particularly the need for staff to introduce themselves and explain what is happening in relation to the patient’s care.

Correspondence from Medical Director to Training Department to ensure explicitly reflecting in training to included Induction Training.

Medical Director, Equality and Pt Experience Manager by 30 Sept 2010

Perceived delays in ambulance provision for discharge of patients from hospital.

NIAS is engaging with Commissioners and other key stakeholders to review current arrangements in respect of Patient Care Services.

Ongoing

APPENDIX 2

EMERGENCY PLANNING REPORT

2

Report for the June to August 2010 Period

Total from April No. of Potential Major Incidents 4 No. of Declared Major Incidents

1

No. of Airport alerts Belfast International Airport 1 Belfast city Airport 2 City of Derry Airport 1 St Angelo Airport Newtownards Airfield Business Continuity 5 Hazardous Material Incidents

2

Exercises Live 3 Tabletop 3 Observer

Potential Major Incidents On the 12 August 2010 a potential major incident was called for a report of a Road Traffic Collision on the Strangford Road involving a lorry and a bus carrying 16 children. At the scene were 5 A&E crews, 2 ICV crews, 1 Rapid Response Vehicle (RRV), 3 Officers and 1 Doctor and in addition 1 Officer was tasked to the Down Hospital to act as Hospital Liaison Officer. A further 2 Officers were stood down whilst en-route. Three children and one adult were taken to hospital with minor injuries. The remainder of the children were taken to Glebe House, Outdoor Pursuit Centre.

Major Incidents On the 11 July 2010 a Major Incident was declared for a report of a vehicle driven into a crowd at the bonfire on the Donegal Road, first report was 4-5 casualties, four crews despatched to scene, first report back to control stated that there were 9 patients so an additional 4 crews were despatched. Oscar 48 was despatched as the On Call Officer. A declared major incident message was sent out by pager. The Emergency Equipment Vehicle and the Mobile Control Vehicle were held on station for deployment. During the incident there was an Officer in the Police Silver Command Room, this enabled the two Services to manage the incident with the resources on duty without having to call in additional crews. Nine patients were transported to Royal Victoria Hospital with minor injuries.

3

Airport Alerts On the 23 June 2010 there was a call for a helicopter with engine failure at George Best Belfast City Airport. Tasked to the call Romeo 6, E124, E223, Oscar 8, and Oscar 51. The call was entered incorrectly into the system thus not activating an “Airport Alert”. On the 8 August 2010 there was a Airport Alert for a helicopter crashing on the runway in the City of Derry Airport. The initial report confirmed one person on board; further reports confirmed Pilot had left the aircraft not injured. En-route to the airport W122, Romeo 16 and Oscar 15. The patient was assessed by Paramedics at scene and patient refused to travel. On the 12 August 2010 a call was received for the Belfast International Airport for a report of a military aircraft having difficulty landing, with an estimated time arrival of 5 minutes. En-route to the scene: 3 A&E crews, 1 RRV, 2 Doctors, Oscar 14 and the Mobile Control Vehicle & Emergency Equipment Vehicle the aircraft landed safely after 10 minutes, No patients were treated or transported. There was an issue with the pager message; some officers reported only getting the stand down message. BUSINESS CONTINUITY The Business Continuity for the evacuation of a station was implemented for Ardoyne Station as part of the arrangements for “the summer contingencies”. The plan was kept in operation for four days from the 11 - 14 July 2010. This was a direct response to multi-agency emergency planning. On the 13 July 2010 part of the Business Continuity plans for the Regional Emergency Medical Dispatch Centre was utilised for a four hour period, in that Control staff “went to paper” to allow an upgrade to C3 to be installed. On the 14 July 2010 the Regional Non-Emergency Medical Dispatch Centre “went to paper” to allow an upgrade of the C3 Patient Care Service. On the 2 July 2010 the over capacity part of the Regional Non-Emergency Medical Dispatch Centre Business Continuity Plan was activated due to a failure of the 999 system in Scotland. This lasted for a number of hours until the systems were fully restored. On the 8 & 9 July 2010 the Emergency Planning Officer carried out an audit of the East of England Ambulance Service, Business Continuity Plans. This is part of a national drive to raise the standard of business continuity planning within ambulance services; it is to be seen as a peer review more than an audit. On the 28 August 2010 the Business Continuity for the evacuation of a station was implemented for Ardoyne Ambulance Station in response to civil unrest in the area. HAZMAT On the 2 August 2010 there was a Carbon Monoxide poisoning incident in Castlerock, Co Londonderry.

4

HAZARDOUS AREA RESPONSE TEAM (HART) Four members of the team attended the “Inside the Cordon” Conference in England, a number of staff also attended the Conference at their own expense. Radiation Awareness Training held by Medical Physics Agency Northern Ireland (Lissue) The HART Project Manager and the Emergency Planning Officers met with the Northern Ireland Fire Rescue Service to discuss Self Contained Breathing Apparatus (SCBA) training. The 26 August 2010, 9 RRV staff attended a HART training day in Lissue. NIAS During July and August 2010 the summer contingencies were again prepared and in the event had to be implemented on several occasions due to civil unrest. Due to planning for staff annual leave, very little emergency planning training was held and the number of exercises were also reduced. It is planned that this will increase from September 2010. ___________________ William Newton EMERGENCY PLANNING OFFICER

COMPLAINTS CLOSED JUNE - JULY 2010

Ref Description Outcome Action takenCOMP/0164 Complaint regarding the

treatment and care provided by ambulance personnel during the discharge of a patient from hospital to a nursing home.

Complaint not upheld. Investigation found that patient was transferred appropriately and no evidence of mistreatment of patient was found.

Letter of explanation sent.

COMP/156 Complaint regarding the delay in ambulance response to emergency call.

Complaint not upheld. Investigation confirmed that the crew responded to the call appropriately and provided the appropriate treatment throughout.

No Further Action

COMP/0169 Complaint regarding the alleged refusal by a crew to utilise a wheelchair to bring a patient from home to the ambulance and then around the hospital.

Complaint not upheld. Crew advised that patient's mobility is such that they are required to use a wheelchair to transport them from the house to ambulance and then from ambulance to clinic. Both sets of crew clearly recall using a wheelchair on all occasions.

Patient has raised concerns about being transported by one of the crew members working on ambulance which regularly provides transport. As a temporary measure this call, where possible, will be planned to another crew.

PCS Control to input a warning on this patient's house to the effect that they must be transported to and from the home in a wheelchair and must not be walked any distance.

COMP/0170 Complaint received from Minister of Health. Complaint regarding the attitude of ambulance personnel during a patient transfer to hospital.

Complaint upheld. Investigation found that attitude of crew member was below the standards expected by NIAS. Matter referred to disciplinary procedure.

Complaint referred to Disciplinary Procedure. Letter of apology issued

COMP/0168 Delay in ambulance response. Ambulance requested by Out of Hours Doctors was sent to wrong address.

Complaint upheld. EMD did not follow protocol in confirming details of the address. Matter referred to Disciplinary Procedure.


COMP/160 Complaint regarding care and treatment provided by ambulance personnel.

Complaint partly upheld. Investigation found that 2 personnel involved acted inappropriately and that they should be subject to disciplinary action to prevent reoccurrence.

A clinical review of the incident will be undertaken with the personnel involved.

COMP/185 Complaint regarding the delay in providing ambulance conveyance for a patient during a 999 call.

Investigation found that the delay in providing a conveying ambulance was due to the high volume of emergency calls being dealt with within this area and the wider area at the time of the call.

No action identified. Letter of explanation provided.

COMP/166 Complaint regarding the alleged behaviour of staff towards a member of the public.

Complaint upheld. Matter referred to Disciplinary Procedure.


COMPLIMENTS RECEIVED JUNE - JULY 2010

Page 1 of 2

Date Received Description

06/06/2010

I phoned for an Ambulance as I was having severe chest pains. I would like someone to thank the Paramedics who attended me. These people I can't thank enough for saving my life, not only that but the kindness and reassurance they managed to convey to me helped me stay calm. They managed to go about working on me while at the same time talking to me to keep me calm all the while reassuring me. Also the Paramedic who then took me from the Ulster Hospital to the Royal Hospital were equally special people. My heroes.

25/06/2010 Thank you for your quick help and kindness to me the day I had an accident in my car.

25/06/2010

I am writing to express my gratitude and to make you aware of the high level of professionalism showed by two or your paramedics. I am a clinical sister in an emergency department and I had to transfer 10 patients to another hospital. On two occasions the paramedics had brought emergencies to our department and I had happened to mention to them that there were transfers waiting. On both occasions the same crew went out of their way to help facilitate and improve the patient care by transferring patients even though I believe one of them had finished their shift. I was extremely grateful as I was under an awful lot of pressure. I would appreciate if you could pass this on to both paramedics and make their managers aware how professional and diligent they are. They went out of their way to help patients in a very friendly and approachable manner and I believe this should be acknowledged.

30/06/2010

I am writing on behalf of my family to express our deep gratitude for the professional care and attention given to our mother on 22 December. We are grateful for the prompt and efficient service of the Ambulance Staff who attended her at home. We appreciate the skill and compassionate understanding of the many staff who were involved in her care. Under very difficult circumstances we received clear, empathetic and honest communication about our mother's condition and plan of management. For this we are truly grateful.

30/06/2010

I am writing to you in appreciation due to one of your paramedic ambulance crews who were called out to attend me. My family and friends were very grateful to these men who helped me. For myself I do thank very much for their help. I have always appreciated the people like the paramedics and fire crews not forgetting medical and nursing staff who have helped over the years.

30/06/2010

At about noon on 7 May my doctor rang from my home where my wife had collapsed. NIAS arrived within seven to ten minutes and immediately took total control in both an efficient and a proficient manner and continued to monitor her condition until she was placed in the ambulance to be taken to hospital. Unfortunately it was all to no avail. However I am grateful for the care you provided at my home and the confidence you gave me that everything which could be done was being done and I shall always remember that.

30/06/2010

On Monday 31 May my mother was attended by two of your staff. The Ambulance arrived approximately 5mins after the call which was excellent. The crew were reassuring to my mum when they arrived. My mum suffers from chronic pancreatitis and is loath to go to hospital at anytime but the pain is so bad she requires hospital attention. My strongest praise goes to the male paramedic who made the journey much better for mum by constantly reassuring her. The crew member when dropping a patient off at the hospital later that afternoon went out of his way to come and see her again. I really hope you can check out his name and pass on our thanks and appreciation to someone who clearly is a born carer and is doing a fantastic job. It is people like him who restore our faith in the health service and few more like him would be brilliant.

30/06/2010

Just a quick note to say how much I and my family appreciated your help, understanding and compassion which you showed to us when a member of my family died on Sunday 13 June. You might say they were just doing their job but what they did for us was far and above the job. Thank you so much for everything you did.

01/07/2010

I have just returned from a lengthy absence on sick leave and wish to formally record my appreciation of the care which I received from two NIAS staff on the onset of my condition. I was taken to the A&E department of Lagan Valley and discharged that evening in no fit state to take a taxi. The same two paramedics took me home. Before during and after each journey, your two colleagues displayed impeccable professionalism, unpatronising humanity and intelligent good humour. Thanks in no small part to them, my wife and I were able to keep in perspective and painful but no life-threatening discomforts of the day.

COMPLIMENTS RECEIVED JUNE - JULY 2010

Page 2 of 2

Date Received Description

06/07/2010Have had to call upon the Ambulance Service quite a lot in recent months. I can only praise all attending paramedics and technicians for their professionalism and reassuring caring nature. They are a credit to the Service.

06/07/2010 Compliments to the two ambulance crew members who transported me to hospital on a few occasions.

06/07/2010

Over the last year I have had to use the Ambulance Service on four occasions. I felt I had to write to commend the personnel involved. Each time those who came took command of my situation in the highest professional manner, putting me at ease and dealing with my pain. I cannot speak more highly of the attention I received from each and every one who attended me. I want to let you know how deeply I appreciate the Ambulance Service.

19/07/2010

Thanks to the Ambulance Service for the care received by my father over the past five years. The care he received form the ambulance staff was excellent. On most occasions my father was very nervous which was understandable given the seriousness of his condition. The ambulance staff always put him at ease with an excellent balance of humour, comfort and efficiency. They were absolutely superb with my father. I have come to realise the importance of the ambulance service not just in terms of its service at accidents and emergencies but in terms of its other services such as transporting patients to and from hospital. Please emphasise to your colleagues the fact that the quality of their interactions with patients should never be underestimated. Please pass on the thanks of my family to your colleagues.

20/07/2010

I would like to extend our sincere appreciation and thanks for the help and assistance given to me at my Road Traffic accident. The speed and efficiency in which I was helped was wonderful. In an awful situation they helped me - getting me to hospital in a stress-free, professional and calming manner. Please give my gratitude to all the officers concerned/involved in my misfortune. Without their expertise I might not have been so well when I was transferred to hospital.

21/07/2010

I am sending this email to extend my sincere thanks for the service you provide and in particular to thank two of your paramedics. Eleven weeks ago I had to call for an ambulance. I was very scared. Within minutes from making the call the ambulance arrived. The two paramedics immediately started treating me and reassured and put me at ease. They kept me informed with my progress. They were fantastic and really calmed me down. They got me to hospital very quickly where I was immediately taken to theatre. Both of your staff were excellent, professional, caring and a credit to their profession.

22/07/2010 I wish to thank most sincerely everyone who helped me through the recent trauma of my heart attack for the professionalism and kindness. Please convey my thanks to all concerned.

22/07/2010

My husband was recently admitted to hospital by ambulance via the A&E Department. We would like you to know how very much we appreciated the care and attention he received from the ambulance crew and the staff in A&E even though the Department was extremely busy that night. Please let all the staff involved how very much we appreciated this support and attention.

28/07/2010

I am writing to express both my personal gratitude for the outstanding medical assistance rendered to two of my staff receiving in an incident. The actions of the team are a shining example of professional teamwork in the traumatic circumstances. Could I ask that you pass on our thanks and appreciation to the Paramedics involved at the scene for their speedy attendance.

TB/5/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

HEALTH & WELLBEING STRATEGY

Purpose:

SETS OUT THE CONTEXT, COMMITTMENT AND VISION FOR HEALTH & WELLBEING FOR NORTHERN IRELAND AMBULANCE SERVICE

Content:

PROVIDES AN OVERARCHING CO-ORDINATED FRAMEWORK FOR THE TRUST’S ACTIVITIES RELATED TO HEALTH & WELLBEING

Recommendation:

TO BE APPROVED BY TRUST BOARD

Previous Forum:

AGREED VIA HUMAN RESOURCES JOINT CONSULTATIVE GROUP

Prepared by:

MRS LORRAINE GARDNER

Presented by:

MS ROISIN O’HARA

HEALTH & WELLBEING

STRATEGY

2010-2015

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CONTENTS

1. Foreword

2. Executive Summary

3. Introduction

4. Strategic Aims

5. Strategic Commitment

6. Strategic Goals

7. Responsibilities and Key Actions

8. Underpinning Policies, Procedures & Schemes

9. Equality Statement

10. Health and Wellbeing and Attendance Management Action Plan (2010 – 2011)

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1.0 FOREWORD

As Chair of the Northern Ireland Ambulance Service, I am pleased to introduce the first Health and Wellbeing Strategy for the Trust. The Trust delivers a diverse range of services and activities which impact upon the health and well-being of our staff and patients. For the first time, a Strategy has been developed that brings together those areas of the Trust as it tackles our major health and wellbeing challenges, this will be supplemented each year with Health and Wellbeing and Attendance Management Action plans that will prioritise the key work streams each year. Mr Paul Archer CHAIRMAN

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2.0 EXECUTIVE SUMMARY Northern Ireland Ambulance Service Health and Well-Being Strategy sets out an overarching, co-ordinated framework for the Trusts activities related to health and wellbeing, and recognises the many diverse activities undertaken by the Trust which impact upon health and wellbeing. It strengthens and reinforces the Trust Board accountability for Attendance Management and describes the framework with which this will be achieved. The strategy recognises that many policies, procedures and practices that have an influence on health and well-being, are already in place for the Trust. The strategy identifies and brings together a number of overarching priorities and will be underpinned with an annual Health and Wellbeing & Attendance Management Action plan to deliver these.

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3.0 INTRODUCTION

Northern Ireland Ambulance Service (hereafter referred to as the “Trust”) is committed to promoting the health and wellbeing of its staff as its single most valuable asset and resource. This will be achieved by providing a healthy and supportive working environment that promotes positive working relationships and values employees. The Trust recognizes that the health and wellbeing of staff is essential for effective work performance, the provision of high quality services and safe patient care. As a major employer the Trust can significantly contribute to the health of the workforce and in turn shape the health of the organisation and the quality of the services it provides The Trust Health and Wellbeing Strategy 2010 – 2015 aims to protect and promote the on-going improvement in Health and Wellbeing for staff. Whilst health and lifestyle choices are up to the individual, the Trust has a role in providing a healthy environment, promoting and encouraging healthy lifestyle choices as well as supporting and managing staff through the related Trust policies and procedures. Through the implementation of this strategy the Trust will seek to achieve real and measurable improvements in the Health and Wellbeing of staff. This Strategy describes the Trust’s approach to the management of health and well being for staff. It sets out the arrangements to help and support staff at all levels to manage work related factors in themselves and in those they manage by early recognition of risks and implementation of appropriate intervention. The Trust will positively promote the health and wellbeing of all employees through providing relevant information and the creation of working environments that are conducive to good health and safe working practices. This Strategy is underpinned by various Northern Ireland Ambulance Service Policies, Procedures and Practices that support and promote Health and Wellbeing. Implementation of this strategy requires the commitment of Trust Board, Managers, Staff and Trade Union Representatives.

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4.0 STRATEGIC CONTEXT

The Workplace Health Strategy for Northern Ireland (2004) sets the vision of providing a work culture that protects, promotes and supports health and well being. Employment can bring physical, mental and financial benefits whilst conversely work can also bring health risks with around 70,000 people experiencing work related ill health every year in Northern Ireland.

The Health & Safety at Work Northern Ireland Order 1978 states that employers are under a general obligation to safeguard the health, safety and welfare of all their employees, so far as is reasonably practicable. The Management of Health & Safety at Work Regulations 1999 (as amended) and associated regulations strengthen general employer obligations under the Health & Safety at Work Order and this includes the statutory duty to identify and assess risks to employees health and safety and to take appropriate preventative or protective measures to remove or reduce those risks.

In 2010 /2011 a PFA Target was set that requires all HSC Organisations to put in place organisational health and well being strategies including being proactive in improving the quality of and speeding up access to Occupational Health Services, and strengthen board accountability for the management of sickness and absence.

5.0 STRATEGIC COMMITMENT

The Trust Board, Chief Executive Directors and Senior Managers fully accept their responsibility for Health and Wellbeing and Attendance Management in the workplace and commit to the implementation of this strategy and related policy and procedures.

6.0 PURPOSE The purpose of this strategy is to:

• Set out the context, commitment and vision for Health and Wellbeing for the Northern Ireland Ambulance Service

• Strengthen the accountability arrangements within Northern Ireland Ambulance Service for Health and Wellbeing and Attendance Management

• Provide a framework related activity for the Trust and reflect this in the annual action plans

• Promote and maintain a workforce which is healthy in relation to its physical, mental, emotional and social wellbeing

• Provide a workplace which is safe, supportive and health promoting.

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7.0 STRATEGIC AIMS

The Trust has identified the following strategic aims.

7.1 Improve, strengthen and maintain the infrastructure, and lines of accountability to promote Health & Wellbeing and Attendance Management.

7.2 Ensure Health & Wellbeing and Attendance Management priorities are

identified, addressed and measured through robust related policies, procedures and action plans.

7.3 Promote a culture of Health and Wellbeing. 7.4 Support staff in taking responsibility for their own health and enable healthy

choices to be made. 7.5 Promote the Health and Wellbeing of staff through:

• Health and Safety Policies • Effective working practices and related policies and procedures • Provision of Responsive Occupational Health Services and Counselling • Training and Education • Effective leadership and management • The identification and management of the risk of work related pressure • System of Peer Support.

7.6 To develop a proactive, and responsive Occupational Health Service offering

competent advice and support that focuses on Trust priorities and employees access to appropriate rehabilitation services.

7.7 Continue working with Trade Unions at local, regional and nation levels to

build on the successful work that they have already undertaken in partnership with employers to better protect employees from health risks in the workplace.

8.0 RESPONSIBILITIES Trust Board

The overall responsibility for health and wellbeing resides with Trust Board. The Trust Board’s responsibility for ensuring the implementation of this Strategy will be managed through the Director of Human Resources and Corporate Services. Trust Board acknowledges their accountability for the management of sickness and absence and will ensure reporting mechanisms are strengthened to address this. The Trust Board will receive an annual Action Plan for the following year that will be coordinated and managed through the Director of Human Resources and Corporate Services. The Assurance Framework will contribute to accountability and governance arrangement in this regard.

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8.1 Chief Executive

The Chief Executive has responsibility for ensuring that there is an appropriate structure for the monitoring and review of Health and Well Being and Attendance Management arrangements.

The Chief Executive has appointed the Director of Human Resources and Corporate Services as Lead Director with responsibility for establishing and monitoring the implementation of the Workplace Health & Wellbeing Strategy and related Policies and Procedures.

8.1.1 Director of Human Resources and Corporate Services

The Director of Human Resources and Corporate Services is responsible for the Workplace Health & Wellbeing Strategy, related Policies and Procedures and Action Plans within the Trust and will provide strategic leadership, direction and oversight of the health and wellbeing management process.

The Director of Human Resources and Corporate Services will ensure that:

• Guidance is given to Managers on the workplace health and wellbeing strategy

• Support is provided for individuals who have been off sick with work related ill-health or stress

• Arrangements are in place to refer individuals to counselling services or specialist agencies as required

• Support is provided to Managers and individuals in a changing environment; the effectiveness of measures to address health and wellbeing are monitored and improved as appropriate.

8.1.2 Directors

The Chief Executive requires Directors to manage and monitor the implementation of this Strategy and related Policies, Procedures and Action Plans within their area of responsibility.

Directors are required to support this Strategy by ensuring:

• The Health and Wellbeing Strategy, Related Policies and Procedures and Action Plans are promoted and disseminated to all staff and managed

• Strategies and actions to promote health in the workplace are fully implemented

• All staff within their control are competent to discharge their responsibilities • That local performance management systems measure and monitor how

Managers within their directorate promote the health and wellbeing of their staff and manage sickness absence.

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8.1.3 Management responsibilities below Director Level

All Managers, in addition to their duties as employees, are responsible for:

• Managing staff in a positive and empowering manner • Undertaking risk assessments, to ensure as far as possible, that any risks to

the physical and mental health of staff are reduced or removed • Promoting the health and well being of staff • Managing the attendance of their staff in a fair, consistent and effective way • Analysing the causes of ill health amongst the workforce and taking action

where such causes are work related • Seeking advice from Occupational Health and other appropriate

organisations of the effects of health on work and work on health • Raising health awareness at work and supporting the health at work culture • Supporting staff to attend health and wellbeing programmes on an equitable

basis • Ensuring the workplace environments for which they have responsibility are

safe and not adversely affecting the health and well being of staff • Supporting staff on their return to work following sickness absence • Identifying related training needs for staff.

8.2 Employee Responsibilities

All employees will ensure that they:

• Work with their colleagues in a positive and empowering manner • Take personal responsibility for their own Health and Wellbeing • Bring to the attention of their line manager any issues of work related

illness that they feel is having an adverse impact on them or their colleagues

• Comply with any steps taken by their line manager to reduce or eliminate risks

• Report any injury or illness associated with their work, including when they are aware that they are experiencing increased levels of pressure. This includes the use of the Policy for the Management of Adverse Incidents if appropriate

• Accept opportunities for counselling or specialist services when recommended

• Comply with all related policies and procedures. 8.3 Health and Safety Committee and Zero Tolerance Sub Group In accordance with the Safety Representatives and Safety Committees Regulations (N.I) 1979, made under the Health and Safety at Work (N.I) order 1978, The Northern Ireland Ambulance Service has formed a Health and Safety Committee.

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Specific functions for the Committee include:

• To advise the Strategic and Operational Planning Process of the Service in all Health and Safety matters

• The study of Accident and noteifiable Disease Statistics and Trends so that reports can be made to Management on unsafe and unhealthy conditions and practices together with recommendations for corrective action

• Examination of Safety Audit Reports on a similar basis • Continually review the adequacy of the Health and Safety aspects of Policies

and Procedures.

The Zero Tolerance Working Group (ZTWG) is a sub- group of Northern Ireland Ambulance Service Health and Safety Committee. Its overall role is to review the policies, training and operational arrangements that the Trust has in place to deal with incidents of potential or actual assaults against Northern Ireland Ambulance Service staff and to develop and implement any further measures, both pro-active and reactive, to minimise the number and severity of these incidents.

9.0 UNDERPINNING POLICIES, PROCEDURES AND SCHEMES

The Trust already has in place a range of policies, procedures and schemes that support health and well being. These include:

• Workplace action on Smoking Policy • Health & Safety at Work • Risk Management • Adverse Incident Management • Zero Tolerance • Manual Handling • Confidential Staff Counselling • Work Life Balance Policies • Fast Track Physiotherapy • Occupational Health Services • Care and Responsibility Training • Stress Management Procedure • Mental Health and Wellbeing Policy • Attendance Management Policy • Attendance Management Procedure • Cycle to work Policy • Lone Workers Policy • VDU Policy.

This strategy provides a framework for the further development and improvement of existing initiatives.

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10.0 EQUALITY & HUMAN RIGHTS CONSIDERATIONS

The Strategy has been drawn up and reviewed in light of Section 75 of the Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity. In line with the duty of equality, this Policy has been assessed against particular criteria.

.

12

HEALTH & WELLBEING/ ATTENDANCE MANAGEMENT

ACTION PLAN 2010/11

13

TOPIC ACTION TIMESCALES H&W STRATEGIC

PURPOSE / AIM

Q1 Q2 Q3 Q4

1. Develop 10/11 HR Health & Wellbeing/Attendance Management Action Plan

Review Learning from End of Year Performance and Accountability meetings and best practice. Address key performance areas in the development of the Action Plan Agree action plan with GME Present action plan to Trust Board

July 2010 August 2010 September 2010

7.1 7.2 7.5 7.6

A2 A3

A1 A3 A3

2. Develop and agree in partnership the joint HSC Regional Managing Sickness Absence Strategic Framework with other HSC Trusts, DHSSPS and Trade Unions

April 2010 7.2 7.5 7.6

A1

3. Performance Management and Accountability

7.1 7.2 7.5

3.1 Identify and set local targets to assist with meeting PFA

July 2010 7.1 7.2 7.5

N/A A1

14


PURPOSE /AIM

Q1 Q2 Q3 Q4

3.2 Monthly Performance Meetings with local Managers to monitor achievement and develop actions plans

April 2010 – March 2011

7.1 7.2 7.5

A1 A1

3.3 Develop Accountability and Performance Management of Sickness Absence at Divisional Departmental level.

June 2010 7.1 7.2 7.5

A1 A1

3.4 Continue quarterly case review meetings with Occupational health

April 2010 – March 2011

7.1 7.2 7.5 7.6

A1 A1

3.5 Review of Western O.H. service provision to Western Division

Feb 2011 7.1 7.5 7.6

N/A N/A N/A

3.6 Attendance Performance & Accountability Meetings

Quarterly meetings to continue between – DHR/ERM/Director/Manager to consider under performance against target

16/09/2010 16/12/2010

7.1 7.2 7.5

A2 A1

15


PURPOSE /AIM

Q1 Q2 Q3 Q4

3.7

Quarterly improvement plans to be produced

October 2010 December 2010 March 2011

7.1 7.2 7.5 7.6

A3 N/A N/A

A3 N/A N/A

N/A

3.8

Production of end of year absence report

April 2011 7.1 7.2

N/A N/A

4. Development of Health & Wellbeing Strategy

Strategy to be developed August 2010 7.1, 7.2, 7.3, 7.4, 7.5, 7.6, 7.7

A2 A2

Benchmark & review of literature

June 2010 A1

Final draft to GME August 2010 N/A A3 Consultation with Managers

August 2010 N/A A3

Issue to Trade Unions for consultation

August 2010 N/A A3

Finalise at HR Joint Working Group

September 2010 N/A A3

Complete equality screening exercise

August 2010 N/A A3

Present to Trust Board

23 Sept 2010 N/A A3

Implementation

October 2010 N/A N/A

5. Policy and Procedure Review

16


PURPOSE/ AIM

Q1 Q2 Q3 Q4

5.1 Attendance Management Policy and Procedure Review

Research and prepare draft policy and procedure

June 2010 7.1,7.2.7.3, 7.4, 7.5, 7.6 7.7

A1

Issue for consultation to Trust Managers

June 2010 A1 A1


August 2010 N/A A3



Present to JCNC

26th August 2010 N/A A3

Equality Screening to be completed

August 2010 N/A A3

Agreed by GME August 2010

N/A A3

Presentation Policy to Trust Board

23rd September 2010

N/A A3

Implementation October 10

N/A N/A

5.2 Develop MH&WB Policy


April 2010 7.3,7.4,7.5,7.7 A1 A1


May 2010 – August 2010

A1 A1

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PURPOSE / AIM

Q1 Q2 Q3 Q4



A1 A1




August 2010 N/A A3

Agreed by GME August 2010 N/A A3

Presentation to Trust Board

23 September 2010

N/A A3

Implementation

October 10

5.3 Stress Management Procedure to be developed


April 2010 7.3,7.4,7.5,7.7 A1 A1



A1 A1



A1 A1

Table at HR Joint Working Group for information


18


PURPOSE / AIM

Q1 Q2 Q3 Q4


August 2010 N/A A3

Agreed by GME

August 2010 N/A A3

Implementation

October 10 N/A A3

5.4 Addiction Procedure to be developed


September 2010 7.3,7.4,7.5,7.7 N/A A3




November 2010 N/A N/A





Agreed by GME


Presentation to Trust Board

25 November 2010

N/A N/A N/A

Implementation

December 2010 N/A N/A N/A

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PURPOSE / AIM

Q1 Q2 Q3 Q4

5.5 Mental Illness Procedure to be developed


December 2010 7.3,7.4,7.5,7.7 N/A N/A N/A


January 2011 N/A N/A N/A


January 2011 N/A N/A N/A


February 2011 N/A N/A N/A


March 2011 N/A N/A N/A

Agreed by GME


Implementation


5.6 Review of Harassment Policy and Procedure

Benchmark & review of literature

April – June 2010 7.1,7.3,7.5,7.7 A1

Develop draft policy and procedure


Final draft to GME

Nov 2010 N/A N/A

Consultation with Managers

Sept 2010 N/A N/A

20


PURPOSE / AIM

Q1 Q2 Q3 Q4


Oct 2010 N/A N/A


October 2010

N/A N/A

Complete equality screening exercise


Present Policy to Trust Board

25 November 2010

N/A N/A

Implementation December 2010 N/A N/A 6.0 Information Systems Requirements

6.1 Review and verify establishment, staff in post, vacancy levels

August 2010 7.2,7.5 A3 A2

6.2 Review of Overtime, linking with sickness absence rates, O.H. referrals and return to work interviews

November 2010 7.2,7.3,7.5,7.6 N/A N/A

6.3 Develop system for recording of secondary employment

October 2010 7.1,7.2,7.3,7.5 A3 A3

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PURPOSE / AIM

Q1 Q2 Q3 Q4

6.4 Development of suite of reports for Director and Managers

September 2010 7.1,7.2,7.5 A3 A3

6.5 Monthly analysis of reasons for absence

On-going 7.1,7.2,7.5 A1 A1

6.6 Cross reference violent incidents with sickness related absence

Quarterly (report October 2010, January 2011and March 2011)

7.1,7.2,7.4,7.5 A3 A3

6.7 Revise monthly sickness reporting to include grade/age/gender

September 2010 7.1,7.2,7.5 A3 A3

6.8 Sickness reports to include TC4/TC5/TC2, against TC9/TC2

September 2010 7.1,7.2,7.5 N/A A3

6.9 Include HCS & NHS Ambulance Reports in monthly and quarterly absence recording

September 2010 7.1,7.2,7.5 N/A A3

6.10 Review of unique NIAS identifiers

December 2010 7.1,7.2,7.5 N/A N/A

7. Information Requirements

22


PURPOSE / AIM

Q1 Q2 Q3 Q4

7.1 Benchmark HSC Trusts, National Ambulance Trusts, Private Business and Emergency Services on Attendance Management Policies Procedure and best practice

April/May 2010 7.2,7.3,7.5 A1 A1

7.2

Review Boorman Report and carryout baseline analysis

Sept 2010 7.1,7.2,7.3,7.4, 7.5

A3 A3

7.3 Develop HR Advice Notes

Clarification of working days/shift days

Oct 2010 7.1,7.2 N/A A3

Clarification on part-time workers trigger levels

Oct 2010 7.1,7.2 N/A A3

Recording of reason for uncertified absences.

Oct 2010 7.1,7.2 N/A A3

Secondary Employment October 2010 7.1,7.2,7.3,7.4 N/A A3 7.4 Costs of Absence to be calculated

Benchmark methods of calculations costs of absence Agree NIAS mechanism And provide monthly info on this

October 10 Nov 2010 Jan 2011

7.1,7.2,7.5 N/A A3

7.5 Review Trust Board Reporting on absence

June 2010 7.1 A1 A1

23


PURPOSE / AIM

Q1 Q2 Q3 Q4

8.0 Training and Communication

7.2,7.3,7.4,7.5

8.1 Develop and implement a Training and Communication plan that supports the launch of the Northern Ireland Ambulance Service managing attendance policy and procedure and related strategies, policies and procedures

October 2010 A3 A3

TB/6/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

ATTENDANCE MANAGEMENT POLICY

Purpose:

EFFECTIVE MANAGEMENT OF ATTENDANCE

Content:

POLICY

Recommendation:


Previous Forum:

HUMAN RESOURCES JOINT CONSULTATIVE GROUP

Prepared by:


Presented by:

MS O’HARA

ATTENDANCE MANAGEMENT POLICY

Title: Attendance Management Policy Purpose of Policy: This policy is intended to provide advice and guidance in

relation to the attendance management procedure developed and implemented by the Trust. The policy is to effectively manage the impact and cost of absenteeism to the Trust in accordance with its Health & Wellbeing Strategy.

Directorate Responsible for Policy:

Human Resources Directorate

Name and Title of Author: Mrs. Lorraine Gardiner, Employee Relations Manager

Staff Side Consultation Yes Equality Screened: Yes Date Presented to: Audit Committee Trust Board 23 September 2010 Comments Publication Date: Review: Version: No previous documents to supersede

(01) (02) Circulation List: This Policy was circulated to the following groups for consultation.

- Staff side - Executive Directors and Senior Managers

Following approval, this policy document was circulated to the following staff and groups of staff.

- All Trust Staff - Trust Internet Site/Intranet Site

2

1.0

POLICY STATEMENT

1.1 The Northern Ireland Ambulance Service Health and Social Care Trust (the Trust) recognizes that the health and wellbeing of the workforce is critical to the effective functioning of the organization. The Attendance Management Policy underpins the Regional Policy Framework for Managing Attendance, and the Trust’s Health & Wellbeing Strategy.

1.2 The Trust recognizes that staff sickness absence can affect the quality of patient care

and exacerbate service delivery problems, in addition to placing additional pressure on other staff. Sickness absence also carries a significant financial cost which draws resources away from service delivery and developments in patient care. Therefore the effective management of attendance is a key priority for the Trust and its’ managers.

1.3 The Trust recognizes that its staff is its most valuable asset. It is therefore committed to

managing attendance in a way that reflects Trust values and provides opportunities to improve overall health and wellbeing within the workplace which will ultimately boost organizational productivity and support service improvements for patients. In managing attendance the Trust recognises its duty to support staff when they become ill; to facilitate staff to safely return to work if appropriate; and to explore other options, such as re-deployment, early retirement or termination of contract etc in the management of an employee’s absence. Equally the Trust expects employees to take personal responsibility for their own health and well being.

1.4 The Trust acknowledges the importance of managers directly managing the attendance of their staff and NIAS is committed to supporting managers in this important aspect of their management role. In addition NIAS is committed to ensuring that the Trust’s performance management systems will prioritize the management of attendance throughout the Trust and provide a mechanism to reduce absence levels according.

2.0

KEY AIMS

2.1 To ensure an attendance management procedure is developed and implemented that deals with absenteeism in a fair, consistent and proactive manner by providing clear and effective guidelines on the management and monitoring of absenteeism.

2.2 To improve the health and wellbeing of all employees by facilitating and supporting

initiatives, where appropriate, which addresses causes of absence and enables staff to return to or remain in work.

2.3 To effectively manage the impact and cost of absenteeism to the Trust in accordance with the health and wellbeing strategy.

2.4 To encourage staff to take personal responsibility for achieving and maintaining good

attendance.

3

Equality Statement

The Policy has been drawn up and reviewed in light of Section 75 of the Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity. In line with the duty of equality, this Policy has been assessed against particular criteria.

Review of Policy

This Policy will be monitored on an ongoing basis and will be formally reviewed for effectiveness within 1 year from the date of implementation.

Date of Issue: Date for Review: _________________ Liam McIvor (Mr) CHIEF EXECUTIVE

TB/7/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

MENTAL HEALTH & WELLBEING POLICY

Purpose:

TO PROVIDE A FRAMEWORK FOR THE MANAGEMENT OF MENTAL HEALTH ISSUES WITHIN THE WORKPLACE

Content:

POLICY

Recommendation:


Previous Forum:

HEALTH & SAFETY COMMITTEE

Prepared by:

MRS MARIE MULLAN

Presented by:

MS ROISIN O’HARA

MENTAL HEALTH & WELLBEING POLICY

The Northern Ireland Ambulance Service (NIAS) places a high value on maintaining a healthy and safe working environment for all its employees and recognises it’s duty of care extends to mental and physical health at work. The Trust is committed to implementing a mental health and well being policy for all employees throughout the organisation and will provide a supportive working environment that maintains and promotes the health and wellbeing of all staff.

Mental wellbeing creates a basis for an individual to develop their potential, work productively and effectively, and contribute positively to NIAS priorities.

The Trust acknowledges that due to the emergency nature of providing an ambulance service, staff are expected to deal with potentially stressful situations in carrying out their professional roles. Staff will receive the appropriate education, training and support in order to fulfil this duty successfully.

It is NIAS policy to enable staff to cope successfully with the demands and pressures of work through;

• Promoting and supporting mental health and wellbeing within the workplace; • Providing effective and supportive management; • Applying risk management processes as appropriate; • Providing education and training; • Ensuring staff have access to confidential counselling and occupation health services; • Reviewing workplace practices and developing related procedures to support

individual staff whose mental health and well being has been affected by stress, mental illness or addiction.

This policy will supplement the Trusts existing policies on Health and Safety, attendance, Equal Opportunities and Harassment. This policy has been screened for equality implications as required by Section 75 and Schedule 9 of the Northern Ireland Act 1998. Equality Commission guidance states that the purpose of screening is to identify those policies which are likely to have a significant impact on equality of opportunity so that greatest resources can be devoted to these. Using the Equality Commission’s screening criteria, no significant equality implications have been identified. The policy will therefore not be subject to an equality impact assessment.

TB/8/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

OVERTIME POLICY

Purpose:

PROVIDE ADVICE AND GUIDANCE & EQUALITY OF OPPORTUNITY TO STAFF WHEN THEY WORK OVERTIME

Content:

POLICY

Recommendation:


Previous Forum:


Prepared by:


Presented by:

MS O’HARA

OVERTIME POLICY

Title: Overtime Policy Purpose of Policy: This policy is intended to provide advice and guidance to Trust

staff regarding occasions when staff work beyond their contractual hours. The Trust will ensure that equality of opportunity to overtime opportunities is afforded to all staff.






- Staffside - Executive Directors and Senior Managers



Northern Ireland Ambulance Service Health and Social Care Trust – Overtime Policy

2

1.0

POLICY STATEMENT

NIAS is committed to delivering a first class ambulance service to the population of Northern Ireland. In order to achieve this aim there may be occasions when staffs work beyond their contractual hours. NIAS will ensure that equality of opportunity to overtime opportunities is afforded to all staff, if and when it becomes available, within each area of the Service.

2.0

PRINCIPLES

2.1 All staff in pay bands 1-7 will be eligible for overtime payments. Senior staff paid in pay bands 8 or 9 will not be entitled to overtime payments.

2.2 No member of staff will be permitted to work overtime unless prior approval has been

granted by the line manager/delegated authority. 2.3 There is a single harmonised rate of time-and-a-half for all overtime, with the exception

of work on general public holidays, which will be paid at double time. 2.4 Part-time employees will receive payment at plain time rate for additional hours worked

until their hours exceed the standard hours of 37.5 hours per week. 2.5 Overtime payments will be based on the hourly rate provided by basic pay plus any long

term recruitment and retention premia. 2.6 The single overtime rate will apply when excess hours are worked over full-time hours

unless time off in lieu is taken, provided the employee’s line manager/delegated authority has agreed with the employee to this work being performed outside the standard hours.

2.7 Staff may request to take time off in lieu as an alternative to overtime payments. Staffs

that, for operational reasons, are unable to take time off in lieu within three months must be paid at the overtime rate.

2.8 Time off in lieu of overtime payments will be at plain time rates. 2.10 Once an individual employee has agreed to cover a shift on an overtime basis, it is the

individual’s responsibility to work the total of the agreed hours, and all normal rules and regulations will apply.

2.11 NIAS Managers should, in the first instance, consider options other than overtime to

ensure efficient use of time, resources and value for money, whilst legal requirements are met. It is the responsibility of all managers to monitor the necessity for overtime and the actual ‘added value’ that overtime activities provide to the service.

2.12 NIAS is expected to apply the principles of the Working Time Regulations as far as the

exigencies of the service permit.

Northern Ireland Ambulance Service Health and Social Care Trust – Overtime Policy

3

Equality Statement


Review of Policy



TB/9/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

VOLUNTARY TRANSFER POLICY

Purpose:

PROVIDE ADVICE AND GUIDANCE TO STAFF WHO MAY WISH TO TRANSFER

Content:

POLICY

Recommendation:


Previous Forum:


Prepared by:


Presented by:

MS O’HARA

VOLUNTARY TRANSFER POLICY

Title: Voluntary Transfer Policy Purpose of Policy: This policy is intended to provide advice and guidance to Trust

staff when they may wish to transfer regionally within the service. The policy is to ensure a fair and consistent means of balancing staff preferences with operational needs of service provision.






- Staff side - Executive Directors and Senior Managers



Northern Ireland Ambulance Service Health and Social Care Trust – Voluntary Transfer Policy

2

1.0 POLICY STATEMENT

1.1 The Northern Ireland Ambulance Service (NIAS) provides a regional ambulance service to the population of Northern Ireland and recognises that staff may wish to transfer regionally within the Service.

1.2. This policy aims to set out the means by which all personnel within the Northern Ireland Ambulance Service can apply voluntarily for a permanent transfer from their substantive position.

1.3. This policy is to ensure a fair and consistent means of balancing staff preferences with operational needs of service provision.

2.0 PRINCIPLES

2.1 To be eligible to apply for a voluntary transfer, you must be requesting a transfer to a post comparable to your substantive post which is: - * On the same Agenda for Change Pay Band or same grade; * The same contractual hours; * Has the same job description and personnel specification.

2.2 The Trust is committed to ensuring statutory compliance and best practice HR principles in the implementation of this Policy and associated Procedures.

2.3 All transfer activity will be in line with the Trust’s Equal Opportunities Policy

which means no applicant for transfer will receive less favourable treatment because of their age, gender, race, ethnic or national origin, domestic circumstances, social and employment status, sexual orientation, disability, Political opinion, Union affiliation or on grounds which cannot be justified.

2.4 Assistance with travel expenses to a new base will not be available to staff

transferring voluntarily under the voluntary transfer procedure. 2.5 Staff must specify what station/department/division they wish to transfer to.

Only one transfer request to one station/department/division will be considered at any one time.

2.6 There will be a single regional transfer list for each skill level and/or grade of

staff with no divisional/departmental boundaries 2.6 Job Vacancies that arise will normally be filled in order of the date on which

they became vacant/became available. 2.7 Any transfer potentially affected by exceptional circumstances of the Trust,

will be officially notified to the individual(s) concerned.

Northern Ireland Ambulance Service Health and Social Care Trust – Voluntary Transfer Policy

3

Equality Statement


Review of Policy



TB/10/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

HR AND CORPORATE SERVICES DIRECTORATE – APRIL 2009 – MARCH 2010

Purpose:

TO GIVE AN OVERVIEW OF ALL ACTIVITY FOR HR AND CORPORATE SERVICES

Content:

END OF YEAR ACTIVITY REPORT

Recommendation:


Previous Forum:

NONE

Prepared by:


Presented by:

MS ROISIN O’HARA

HUMAN RESOURCES AND CORPORATE SERVICES DIRECTORATE

TRUST BOARD REPORT

APRIL 2009 – MARCH 2010

HR TRUST BOARD REPORT 2009 - 2010 Page 2

CCOONNTTEENNTTSS PAGE SECTION 1: HUMAN RESOURCES ACTIVITY SUMMARY 4 SECTION 2: PERSONNEL SERVICES DEPARTMENT a)

i. Current Employees 6 EMPLOYEE RESOURCING

ii. Employees Exiting NIAS 6 iii. Recruitments 6 iv. New Appointments 6 v. Contracts of Employment 7 vi. Transfers 7 vii. Attendance Management 7 viii. Ill Health Requirements 8 ix. Maternity Leave Applications 8 x. Lighter Duties 8 xi. Work/Life Balance Applications 8 xii. Use of Recruitment Agencies 9

b) i. Staff Grievances 10 EMPLOYEE RELATIONS

ii. Disciplinary Cases 10 iii. Complaints of Harassment 10

iv. Industrial Tribunals Cases 11 v. Legal Cases 11 vi. Industrial Relations Issues 11

c)

i. Employees 13

EQUAL OPPORTUNITIES FAIR EMPLOYMENT AND MONITORING RETURN

ii. Applicants 13 iii. Appointees 13 iv. Promotes 14 v. Leavers 14

d) i. Terms and Conditions of Service 16 AGENDA FOR CHANGE

ii. AFC Pay Banding 16 iii. Knowledge Skills Framework 17

SECTION 3: REGIONAL AMBULANCE TRAINING CENTRE

i. Summary of Key Achievements 18 ii. Progress Against the Training Plan 18 iii. Higher Education Developments 20 iv. Training Summary Table 21


SECTION 4: EQUALITY i. Efficiency Saving And Comprehensive Spending 23

Review ii. Disability Action Plan 23 iii. Training 23 iv. Emergency Services Disability Training Event 24 v. Provision of Accessible Information 24 vi. Complaints 25

SECTION 5: COMMUNICATIONS

i. Community Education 26 SECTION 6: COMPLAINTS MANAGEMENT

i. Complaints Annual Report (2009-2010) 27


SECTION 1: HUMAN RESOURCES ACTIVITY SUMMARY

THIS ACTIVITY SUMMARY DOES NOT FULLY REFLECT THE HUMAN RESOURCE DIRECTORATE’S FULL ACTIVITY, ONLY THOSE ASPECTS THAT ARE QUANTIFIABLE.

EMPLOYEE RESOURCING

ACTIVITY 01/04/09 -31/03/10

Staff in Post 1126 Leavers 34 Recruitments 22 Application Forms Processed 4040 Short Listing Panels 22 Interviews 658 New Appointments 47 Pre-Employment Medicals (Questionnaire) 47 Health Assessments (OH Referral) 0 Issue of New Contract of Employment 164* Transfers Actioned 65 Statistical Analysis of Sick Absence 12 Home Visits 27 Medical Referrals Processed 192 Ill Health Retirement Applications Processed 7 Maternity Leave Processed 13 Pregnant Workers Policy Processed 13 Lighter Duties 1 Carer’s Leave Processed 180 Career Breaks 7 Job Shares 0 10/11 Month Working 11 Reduced Hours 17

* NOTE: PLEASE REFER TO ITEM (V)”CONTRACTS OF EMPLOYMENT” FOR EXPLANATION REGARDING THE ISSUING OF NEW CONTRACTS OF EMPLOYMENT


EMPLOYEE RELATIONS

ACTIVITY 01/04/09 –31/03/10

Grievances (Notice of Reference) Received in 2009/10 18 Grievances carried over from 2008/09 10 Total Active Grievances 2009/10 28

Grievances resolved informally 6 Grievances withdrawn 2 Excluded under procedure 0 Cases being examined under Informal Stage/Pending Stage 1 Hearing 4 Stage 1 Grievance Hearings (heard) 16

Stage 1 Hearings Upheld/Partially Upheld 1 Stage 2 Grievance Hearings (heard) 3

Stage 2 Hearings Upheld/Partially Upheld 1 Total Formal (Stage 1 & Stage 2) Hearings Processed 19 Formal Disciplinary Procedures enacted in 2009/10 21 Disciplinary cases carried over from 2008/09 12 Formal Disciplinary Investigations which did not proceed to S1 Hearings 3 Stage 1 Disciplinary Hearings 13 Stage 2 Disciplinary Appeals Hearings 2 Total Formal Disciplinary Hearings Processed 15 Disciplinary Hearings/Investigations Ongoing 16 Total Complaints of Harassment 10 Complaints requiring further instruction (from Complainant) 2 Informal Complaints of Harassment 2 Formal Complaints of Harassment (current) 6

Complaints closed (following no further instruction received) 2 Complaints Resolved informally 2 Formal Complaints Upheld 1 Formal Complaints not Upheld 5 Investigations ongoing 0

Industrial Tribunal Cases 4 JCNC Meetings 4 Legal Cases 2


SECTION 2: PERSONNEL SERVICES DEPARTMENT A)

EMPLOYEE RESOURCING

i. The total number of current employees at 31 March 2010 is 1126. This figure represents a 93.52% complement of staff against the current funded establishment figures.

CURRENT EMPLOYEES

ii.

During the reporting period, a total of 34 employees exited the organisation, representing a 3.01% turnover of staff. Of these 34 employees, 17 were Operational, 9 Control, 5 Administrative & Clerical, 2 Managers and 1 Non-Executive Director. Reasons for the exit of these employees are attributed to “ill health”, “other employment” and “resigned”.

EMPLOYEES EXITING NIAS

iii.

A total of 22 Recruitments were completed during the year generating the processing of 4,040 Application Forms: 22 Shortlisting Panels and 658 interviews. As a result of this, 47 appointments (internal and external) were made (this equates to 1.16% of applications). Key recruitments were as follows: -

RECRUITMENTS

Paramedic-in-Training Ambulance Care Attendant Clinical Support Officer Asst. Director of Operations – Performance Management Station Officer

In addition to the 22 completed recruitments, a further 6 campaigns were ongoing as at 31 March 2010.

iv.

During the reporting period, a total of 47 new employees were appointed to NIAS, the majority of whom were appointed to operational positions.

NEW APPOINTMENTS


v. CONTRACTS OF EMPLOYMENT

A new Contract of Employment has been developed in line with Agenda for Change Terms and Conditions of Employment and is currently being issued to all new employees. To date, 164 staff have been issued with the new contract (this includes the 47 new appointees). A rolling programme has been developed to ensure the issue of new Contracts of Employment to all existing staff and is due for completion in 2010/11.

vi. TRANSFERS During the reporting period, 65 transfers took place within divisions and across divisions. These requests were processed by the Employee Resourcing Section, in conjunction with Divisional Officers/Area Managers.

vii. ATTENDANCE MANAGEMENT The average total percentage time lost due to sickness until 31 March 2010 was 6.93%. This figure represents a 0.86% reduction in absence from the year 2008/09. The table below details average monthly absence figures for the reporting year, with figures for the previous year (Apr 08/Mar 09) provided for comparison purposes: -

MONTH % TIME

LOST TO SICKNESS

MONTH % TIME LOST TO SICKNESS

APR 08 7.51 APR 09 5.84 MAY 08 6.51 MAY 09 6.67 JUN 08 6.65 JUN 09 6.70 JUL 08 6.23 JUL 09 7.38 AUG 08 5.98 AUG 09 6.51 SEP 08 6.84 SEP 09 6.48 OCT 08 7.59 OCT 09 6.54 NOV 08 7.00 NOV 09 6.64 DEC 08 8.50 DEC 09 6.76 JAN 09 8.10 JAN 10 9.24 FEB 09 6.20 FEB 10 7.63 MAR 09 6.77 MAR 10 6.72

YEAR TOTAL

6.99% YEAR TOTAL

6.72%

The Employee Resourcing Manager meets with all Senior Managers/Officers of the Trust on a monthly basis to review absence over the previous month, agree actions and develop employee rehabilitation plans. Home visits are conducted by managers (together with an HR Representative) for employees on long-term absence, particularly when an employee reaches the half-pay and no-pay stages.


27 home visits were carried during the year. In addition, employees on long-term absence are routinely referred by their Line Manager, via HR, to Occupational Health. An average of 16 Occupational Health Referrals and follow up recommendations are actioned by the Employee Resourcing Section each month. Quarterly performance and accountability meetings are also held with managers and relevant directors to review absence.

viii. ILL HEALTH RETIREMENTS A total of 7 (20.58% of turnover) applications were processed for ill health retirement.

ix. MATERNITY LEAVE APPLICATIONS

A total of 13 applications for maternity leave were processed during the reporting period. Personal meetings were held with the employee and a representative from Employee Resourcing, to discuss entitlements, etc. A new Information pack has been developed and is currently being issued to staff who are pregnant.

x. LIGHTER DUTIES The Lighter Duties Policy is currently under review, with only one member of staff carrying out lighter duties during the reporting period.

xi. WORK LIFE BALANCE POLICY APPLICATIONS Applications for a variety of the work/life balance policies were processed during the period. All applications from employees are submitted to their Line Manager for approval. HR Staff provide advice to Managers on the decision-making process to ensure that due consideration has been given to each request: - CAREER BREAKS

There were 7 staff on Career Breaks during the reporting period. JOB SHARING

No member of staff was working in a job sharing capacity during the reporting period.

10/11 MONTH WORKING 11 staff requested 10/11 month working during the reporting period. All requests were considered and granted.

REDUCED HOURS There were 9 female and 8 male members of staff working reduced hours during the reporting period, the majority of whom were operational staff.


CARER’S LEAVE During the reporting year, a total of 180 applications for Carer’s Leave were requested.

xii. USE OF RECRUITMENT AGENCIES The use of recruitment agencies remains under scrutiny and the Trust aims to minimise the use of Agency Staff. Agency Staff are being used to cover posts which are either in the process of being advertised or are waiting to be recruited. A total of 26 Agency Staff were used by the Trust as at 31 March 2010. The majority of Agency Staff, who worked during the reporting period, were working on a short term basis.


B) EEMMPPLLOOYYEEEE RREELLAATTIIOONNSS

i. STAFF GRIEVANCES During the reporting year, a total of 18 grievances were submitted by employees. 10 grievances were carried over from the previous year (2008/09), bringing the total number of grievances dealt with by the Employee Relations Section to 28. 6 grievances were resolved informally, 2 were withdrawn and 4 remain pending a stage 1 hearing or seeking an informal resolution. 16 formal Stage 1 Hearings were heard. 3 Stage II Appeal Hearings were heard, 1 of which was partially upheld. The Grievances all related to the application of Trust Policies and Procedures or the management of these procedures (for example, staff transfer, travel expenses, recruitment).

ii. DISCIPLINARY CASES During the reporting year, there were a total of 33 disciplinary cases in operation within the Trust. Examples of the types of alleged misconduct included criminal conduct (ie failure to notify the Trust of a criminal offence outside of work), bringing the Trust into disrepute, and failure to comply with Trust Policies and Procedures.

• 15 employees were suspended from all duties as a precautionary measure, pending the outcome of a formal investigation and subsequent disciplinary proceedings.

• 6 employees remained on suspension as at 31 March 2010.

• 3 cases of alleged misconduct were formally investigated but did not proceed the a Stage 1 Hearing

• 13 cases proceeded to Stage 1 Hearing,

• 4 employees were issued with formal written warnings,

• 6 employees were issued with final written warnings and

• 1 employee was dismissed and 1 employee resigned before the disciplinary process was exhausted.

• 1 Stage II Appeal Hearing was heard with the decision, made by the Stage 1 Disciplinary Panel, being amended.

• 16 cases were still ongoing, or were pending Hearing stage as at 31 March 2010.


iii. COMPLAINTS OF HARASSMENT During the reporting year, a total of 10 written complaints of harassment were received from employees. 2 complaints were addressed via the Trust’s Informal Procedure and 6 are being investigated via the Formal Procedure. 2 complaints required further instruction from the complainants however these instructions were not provided. Of the 6 confirmed formal/informal complaints, 1 complaint was upheld and transferred to the Disciplinary Procedure, whilst 5 complaints were not upheld.

iv. INDUSTRIAL TRIBUNAL CASES During the reporting period, the Trust has been involved in 4 Industrial Tribunal Applications. 1 case claimed discrimination on the grounds of disability and unlawful deduction of wages. This case was still ongoing as at 31 March 2010. 3 cases claimed discrimination on the grounds of race and sex, with settlements being reached and 1 case being withdrawn.

v. LEGAL CASES During the year, the Trust has been involved in 2 legal cases. 1 of these cases is in the initial stages of proceedings and 1 is pending further instruction from the Claimant.

vi. INDUSTRIAL RELATIONS ISSUES

The Trade Union Recognition Agreement remained under review during the period 2009/10. In the absence of the Trade Union Recognition Agreement being finalised, Management continued to meet with recognised Trade Unions and their Representatives via its Joint Consultative and Negotiating Committee (JCNC) to consult on strategic issues affecting the Trust, thereby enabling the corporate agenda to be progressed. In addition to meetings of JCNC, significant and important work was undertaken with Trade Unions within the sub structures of JCNC. 2009/2010 was a challenging year for the Trust particularly in relation to the implementation of CSR/Efficiency savings, which was made possible through the work undertaken with Trade Unions via the CSR Joint Consultative Group. The CSR Joint Consultative Group was supplemented by local consultation between local management and Trade Unions, with both management and Trade Unions demonstrating a commitment to implementing, and achieving the efficiencies with the least possible impact on staff. Significant work was undertaken with Trade Unions relating to employment Policies/Procedures/Practices via the Human Resources Joint Consultative Group. Policies and Procedures that were consulted/negotiated on and agreed during the period were as follows:


• Freedom Of Information Act 2000 Policy

• Data Protection 1998 Policy

• Records Management policy

• Gifts and Hospitality Policy

• Fraud Policy

• Policy for the Safeguarding, Movement and Transportation of Patient/Clients/Staff/Trust Records, Files and other Media Between Facilities

• Data Quality Policy

• Email Policy

• ICT Security Policy

• Internet Security Policy

• Operational Overtime Procedure 2010

• Overtime Policy 2010

• Policy on Use and Management of Passwords

• Policy on the Use of the Internet

• Data Quality Policy In addition NIAS is represented at regional consultative/negotiating forums e.g. Regional Joint Negotiating Forum, Regional Partnership Forum and Agenda for Change Joint Working Group and therefore following agreement at regional level, the following Policies/Procedures were tabled via the NIAS HR JCG for implementation within NIAS. These include:

• Grievance Procedure

• Disciplinary Procedure

• Capability Procedure

• Redeployment and Redundancy Policy Furthermore, meetings of the Control Joint Working Group and the Zero Tolerance Joint Working Group continued to take place.


CC)) EEQQUUAALL OOPPPPOORRTTUUNNIITTIIEESS:: AANNNNUUAALL FFAAIIRR EEMMPPLLOOYYMMEENNTT MMOONNIITTOORRIINNGG RREETTUURRNN

ii.. EEMMPPLLOOYYEEEESS

The annual Fair Employment Monitoring Return was submitted to the Equality Commission for Northern Ireland (ECNI) on 28 April 2010 for the period 01 January 2009 to 31 December 2009. The total number of employees recorded at 31 December 2009 was 1,139. The percentage make-up of employees recorded for 2009 was 56.1% Protestants, 39.9% Roman Catholics and 4% non-determined. This was an increase of 0.7% on figures recorded for 2008. This figure also reflected a marginal increase of 2% from the previous year, in the number of female employees within the workforce. However the total number of females within the Trust represents 26.25% of the workforce, which is a slight increase from the figure reported in 2008 (this being 25.9%) The percentage make-up of Catholics and Protestants showed marginal fluctuations from 2008: the percentage of Roman Catholics increased by 0.2% with the percentage of Protestants decreasing by 0.6%. The religious affiliation of 4% employees could not be determined.

iiii.. AAPPPPLLIICCAANNTTSS For the purposes of monitoring, the Equality Commission for Northern Ireland (ECNI) defines an Applicant as a person who applied to fill a vacancy for employment in the 12 month period which runs between the anniversary date of your registration [in this case 01 January – 31 December], and is still in employment in your concern on that date [ie, at 31 December]. There was a substantial increase in the number of applications received for the year 2009 from the previous year, due to 4 large recruitment campaigns (Ambulance Care Attendant, Student Paramedic, internal Paramedic-in-Training, Non-Emergency Call Taker). The total number of applicants for 2009 was 2,390, which was up from the previous year (1,097 applications received in 2008) thus showing an increase of 54.1% The 2009 applicant pool was made up of 62.2% males and 37.8% females. It should be noted that the Non-Emergency Call Taker recruitment was withdrawn prior to appointments being made.

iiiiii.. AAPPPPOOIINNTTEEEESS For the purposes of monitoring, the ECNI defines an Appointee as those persons who filled a vacancy for employment in the 12 month period ending on the date which runs between the anniversary date of your registration [in this case 01 January – 31 December], and are still in employment in your concern on that date [ie, at 31 December].


The Trust made a total of 33 appointments during the year 2009. This was a 49.2% decrease on the preceding year (65 appointments made in 2008). Of the 33 appointments made, 51.5% were male and 48.9% female. 42.4% of appointments made were from the Protestant section of the community and 24.3% were from the Roman Catholic community. The religious affiliation of 33.3% of appointees could not be determined. It should be noted that only the Ambulance Care Attendant recruitment was advertised externally, which resulted in 12 appointments.

iivv.. PPRROOMMOOTTEEEESS For the purposes of monitoring, the ECNI states that an Employee is considered to be a Promotee if all 4 conditions listed below are met: a) The employee has moved from one job to another within the concern;

and b) in doing so, the employee fills a job which was restricted to persons

already employed in the concern; and c) the employee remained in the new job or was notified in writing that he

would so remain, for a continuous period of not less than 6 months; and

d) as a direct result of the move, the employee received an increase in pay (excluding expenses).

A total of 23 employees gained a substantive promotion during the year 2009. Of these 23 employees, 82.6% were male (which is an increase from 76.2% in the previous year) and 17.4% were female (which is a decrease from 33.3% in the previous year). 43.5% were from the Protestant community and 52.2% from the Catholic community. The religious affiliation of 4.3% of those promoted could not be determined. It should be noted that the Student Paramedic and internal Paramedic-in-Training recruitments were advertised internally only.

vv.. LLEEAAVVEERRSS A total of 27 employees left the employment of NIAS during 2009: the same number of employees left in 2008. A total of 70.4% were male employees (which is an increase from 66.7% in the previous year) and 29.6% were female (which is a decrease from 33.3% in the previous year). 51.9% of employees leaving employment were from the Protestant community and 29.6% were from the Catholic community. The religious affiliation of 18.5% of those who left the organisation could not be determined.


SSUUMMMMAARRYY TTAABBLLEE:: CCOOMMPPAARRIISSOONN OOFF RREELLIIGGIIOONN BBEETTWWEEEENN 22000088 AANNDD 22000099

22000088 22000099

%%PP %%RRCC %%NNKK %%PP %%RRCC %%NNKK

EEMMPPLLOOYYEEEESS 56.7% 40.1% 3.2% 56.1% 39.9% 4.0%

AAPPPPLLIICCAANNTTSS 46.6% 45.2% 8.2% 43.4% 46.0% 10.6%

AAPPPPOOIINNTTEEEESS 50.8% 41.5% 7.7% 42.4% 24.2% 33.4%

PPRROOMMOOTTEEEESS 48.4% 49.2% 2.4% 43.5% 52.2% 4.3%

LLEEAAVVEERRSS 44.4% 44.4% 11.2% 51.9% 29.6% 18.5%

SSUUMMMMAARRYY TTAABBLLEE:: CCOOMMPPAARRIISSOONN OOFF GGEENNDDEERR BBEETTWWEEEENN 22000088 AANNDD 22000099

22000088 22000099

%% MMAALLEE %% FFEEMMAALLEE %% MMAALLEE %% FFEEMMAALLEE

EEMMPPLLOOYYEEEESS 74.1% 25.9% 73.7% 26.3%

AAPPPPLLIICCAANNTTSS 45.5% 54.5% 62.2% 37.8%

AAPPPPOOIINNTTEEEESS 63.1% 36.9% 51.5% 48.5%

PPRROOMMOOTTEEEESS 76.2% 23.8% 82.6% 17.4%

LLEEAAVVEERRSS 66.7% 33.3% 70.4% 29.6%


DD.. AAGGEENNDDAA FFOORR CCHHAANNGGEE

ii.. TTEERRMMSS AANNDD CCOONNDDIITTIIOONNSS OOFF SSEERRVVIICCEE The Agenda for Change (AFC) Terms and Conditions of Service apply in full to all Staff directly employed by NHS organisations, except very senior managers and Staff within the remit of the Doctors’ and Dentists’ Review Body, with effect from 1 October 2004. The vast majority of Terms and Conditions have been introduced and mainstreamed within NIAS in accordance with the AFC’s overriding principle of partnership. Any residual and/or new areas pertaining to AFC will be considered and subsequently mainstreamed within the Trust via the Human Resources Joint Consultative Group (HRJCG).

iiii.. AAFFCC PPAAYY BBAANNDDIINNGG The AFC Terms and Conditions of Service require all Staff directly employed by NHS organisations, except very senior managers and staff within the remit of the Doctors’ and Dentists’ Review Body, to move to AFC pay banding with retrospective effect from 1 October 2004.

aa)) JJOOBB MMAATTCCHHIINNGG // DDEESSKK TTOOPP EEVVAALLUUAATTIIOONN The Trust achieved the Minister for Health’s target date to complete the job matching/desk-top evaluation process by 30 June 2008.

bb)) RREEVVIIEEWWSS The Trust has received 8 requests for review of Job Matching outcomes and 8 requests for review of Desktop Evaluation outcomes. The NIAS partnership Job Evaluation (JE) Leads will progress this work in accordance with the AFC Regional Joint Working Group (JWG) protocols and timescales. This will include the setting up of review panels, internal consistency checking and regional quality assurance processes, prior to final outcomes being notified to post holders.

cc)) JJOOBB EEVVAALLUUAATTIIOONN Despite the Trust’s full adherence to the JWGs protocols and procedures in relation to the matching process for all jobs, there has been failure to agree outcomes for 3 jobs to date, i.e. Emergency Medical Technicians, Paramedics and Rapid Response Paramedics. These jobs have therefore been earmarked for full Job Evaluation. This will take place at the earliest opportunity following due process. In the interim, all 3 jobs are being paid on account, subject to the outcome of the evaluation process, Emergency Medical Technicians at Band 4, and Paramedics and RRV Paramedics at Band 5. If the evaluation outcome is other than Band 4 and Band 5, assimilation will be required.


dd)) AASSSSIIMMIILLAATTIIOONN // PPAAYYMMEENNTT OOFF AARRRREEAARRSS All jobs with final agreed outcomes throughout the Trust have been assimilated to the AFC pay scales and arrears paid.

iiiiii.. KKNNOOWWLLEEDDGGEE AANNDD SSKKIILLLLSS FFRRAAMMEEWWOORRKK The NHS Knowledge & Skills Framework (KSF) and Development Review process is one of the three strands of AFC. As such, it is a mandatory element of the Terms and Conditions of Service for Staff employed in Health & Social Care (HSC) in Northern Ireland. In recent times, the main AFC focus of HSC Trusts has been to complete the pay banding process which includes matching and assimilation, payment of arrears and managing review requests. As the above activities near completion, the regional JWG agreed to set up a sub-group (KSF Joint Leads Group) in late 2008-2009 to focus on the implementation of KSF on a regional basis. In April 2009, the DHSSPSNI, in partnership with Trade Unions, re-launched the implementation of KSF in parallel with the launch of the Regional Learning and Development Strategy through an event entitled ‘KSF Re-Energise’. The event focused on promoting KSF as the central tool for developing individuals within the HSC Trusts. In addition to the above, the DHSSPSNI have appointed a temporary regional KSF Project Manager, Mrs Frances Douglas, to support the HSC implementation of KSF. Both NIAS JE Leads are members of the KSF Joint Leads Group and will therefore focus on the full implementation of KSF within NIAS in line with agreed DHSSPSNI and JWG regional action plans, guidelines and timescales.


SECTION 3: REGIONAL AMBULANCE TRAINING CENTRE

ii.. SSUUMMMMAARRYY OOFF KKEEYY AACCHHIIEEVVEEMMEENNTTSS This report details progress against the Training Plan for 2009-2010. The key achievements to date have been:

iiii.. PPRROOGGRREESSSS AAGGAAIINNSSTT TTHHEE TTRRAAIINNIINNGG PPLLAANN aa)) SSTTAANNDDAARRDDIISSEEDD CCOORREE TTRRAAIINNIINNGG

Achieved – See Table Paramedic-In-Training Programmes Cohort 1 x 25: 25 completed – all registered with HPC Cohort 2 x 16: 15 completed – all registered with HPC Cohort 3 x 20: 16 completed – in process of registering with HPC ACA (BTEC) Cohort 1 x 14: 12 completed - BTEC certificates received.

bb)) PPOOSSTT PPRROOFFIICCIIEENNCCYY // CCOONNTTIINNUUOOUUSS PPRROOFFEESSSSIIOONNAALL DDEEVVEELLOOPPMMEENNTT

The Post Proficiency / CPD Programme is reviewed on an annual basis to ensure it meets current needs. The programme during 2009-2010 contained the following elements:

PPAARRAAMMEEDDIICC//EEMMTT Health & Safety Fire Code Infection Control Spinal Clearance Consent Child Protection Awareness New MRX Defibrillator ALS/BLS Pegasus Trolley New A&E Vehicle Organisation Visions and Values Complaints/Patient Experience Good Relations/Equality Harassment Records Management Fraud

AAMMBBUULLAANNCCEE CCAARREE AATTTTEENNDDAANNTT Health & Safety Fire Code Infection Control


Call Prioritisation (Transportation of the Mental Health Patient) DNAR (Do Not Attempt Resuscitation Protocol) ALS/BLS (FR2 Defibrillator) Child Protection Awareness Organisation Visions and Values Complaints/Patient Experience Good Relations/Equality Harassment Records Management Fraud

cc)) MMAANNDDAATTOORRYY RREEFFRREESSHHEERR // CCPPDD TTRRAAIINNIINNGG Achieved - See table 1

Non-Clinical Training Day Due to operational pressures, it was agreed in February 2010 to defer remaining training until 2010-2011 Training Plan. This will now be captured within the mandatory and statutory Training Workbook to be introduced to all staff in October.

dd)) CCAARREE && RREESSPPOONNSSIIBBIILLIITTYY ((CC&&RR)) TTRRAAIINNIINNGG Achieved - See table 1 Refresher Training Programme Propose delivering a 1 day C&R refresher course on a 2-year rolling basis for all relevant NIAS staff who have completed the full 3-day C&R course. This is based on numbers of staff to undertake refresher training and capacity to deliver. This proposal equates to 4 days per month and will require the recruitment and development of an additional 5 C&R Trainers within the Trust. After recent discussions with Miss Hilary McConnell from Honestas it has been identified that this development will be commenced in October 2010 as a partnership approach between South Eastern Trust and NIAS to train C&R trainers for both organisations, 5 from each Trust.

ee)) AADDDDIITTIIOONNAALL TTRRAAIINNIINNGG RREEQQUUEESSTTSS The RATC facilitated a request from Control to deliver a 2-day First Aid at Work course to 6 RNEMDC staff.

ff)) EEQQUUIIPPMMEENNTT // NNEEWW PPOOLLIICCYY To implement stage 2 of the thrombolysis programme to remaining Paramedic Staff on introduction of new Philips MRX defibrillator was delivered to staff throughout 09 / 10


iiiiii.. HHIIGGHHEERR EEDDUUCCAATTIIOONN DDEEVVEELLOOPPMMEENNTTSS

aa)) PPOOSSTT--GGRRAADDUUAATTEE CCEERRTTIIFFIICCAATTEE IINN EEDDUUCCAATTIIOONN ((PPGGCCEE)) 10 staff successfully completed course in June 2010.

bb)) SSUUPPEERRVVIISSIIOONN IINN CCLLIINNIICCAALL PPRRAACCTTIICCEE 20 Clinical Support Officers (CSO) now in post presently completing a Level 3, 20 CAT point ‘Supervision of Clinical Practice’ module. This higher education module is delivered locally by university-accredited educators from South Western Ambulance Service Trust and accredited by Plymouth University.

cc)) MMEENNTTOORRIINNGG IINN CCLLIINNIICCAALL PPRRAACCTTIICCEE 35 students successfully completed mentorship programme at Queens University, Belfast. Evaluation from Queens and Students was very positive. A Mentorship Model is being rolled out to Mentors to facilitate next cohort of Paramedic-in-Training Students.


iivv.. TTRRAAIINNIINNGG PPLLAANN SSUUMMMMAARRYY TTAABBLLEE Training Event Course

Dates No of

Students Planned

No of Students

Actual

No of Students

Completed

Comments

CORE TRAINING

Stage 1/Cohort 04 Mar 09 –Jun 09

12 14 12 14 commenced training - 2 students on long-term suspension

Stage 2/Cohort 01 Apr 09 –Jun 09

25 25 25

Stage 2/Cohort 02 Jul 09 –Sept 09

15 16 15

Stage 2/Cohort 03 Jan 10 –Mar 10

20 20 16 1 deferred due to pregnancy 3 unsuccessful

ACA (BTEC) Oct 10-Nov 10

12 14 12 14 students commenced training 2 resignations


MANDATORY REFRESHER / CPD TRAINING

A&E Staff MRX plus Annual Resuscitation 1 day

Sep 09 - April 10

577 577 577

A&E Staff Clinical/Corporate 2 day course

Nov 09 -Jan 10

577 577 319 Remaining 258 A&E staff completed Clinical Day only during April-May 2010

A&E Staff Non-Clinical Day only

577 577 319 Remaining 258 A&E staff still to complete Non-Clinical Day – this will be scheduled into 2010-2011 Training Plan

PCS Staff Annual Resuscitation + Clinical/Corporate 2 day course

Dec 09 - Feb 10

215 215 67 Remaining 148 PCS staff completed Clinical Day only during April-May 2010

PCS Staff Non-Clinical Day only

215 215 67 Remaining 148 PCS staff still to complete Non-Clinical Day – this will be scheduled into 2010-2011 Training Plan

Paramedic Staff Pre-hospital Thrombolysis 2-day Course (Stage II)

Sep 09 -Mar 10

285 339 339 Fully achieved


SECTION 4: EQUALITY During the reporting year, a number of key programmes of work were developed under the Trust’s Equality agenda. Equality objectives are included in the Trust Delivery Plan and an Equality Action Plan was developed with specific objectives and performance indicators for the Equality function within the Trust during this time. Progress against this is monitored by the Trust’s Equality Steering Group and regular progress reports are provided to the Trust Board. Regionally, NIAS continued to contribute to the implementation of the DHSSPS Equality, Good Relations and Human Rights Strategy and continued to be represented on the DHSSPS Equality and Human Rights Steering Group. This group works to ensure consistency, sharing of good practice and a collaborative approach to the strategic implementation of Section 75 duties within Health and Social Care.

ii.. EEFFFFIICCIIEENNCCYY SSAAVVIINNGGSS AANNDD CCOOMMPPRREEHHEENNSSIIVVEE SSPPEENNDDIINNGG RREEVVIIEEWW The Equality Impact Assessment and Public Consultation in respect of Efficiency Savings and Comprehensive Spending Review (CSR) investment was a key strategic policy for NIAS during the reporting period. Following consultation, the Trust completed its decision-making process and published a final EQIA and Consultation document in July 2009. Section 75 was mainstreamed within this decision-making process and the published document provided consultees and other stakeholders with information around how EQIA responses were considered in addition to a Trust response to comments received. Work then began to develop a monitoring framework for the proposals following implementation.

ii. DDIISSAABBIILLIITTYY AACCTTIIOONN PPLLAANN

The Trust continued to implement its Disability Action Plan in compliance with its duties under the Disability Discrimination Order and began to work towards the development of a new plan effective from 01 July 2010. In order to inform an updated Plan, the Trust engaged with the Equality Commission for Northern Ireland and Disability Sector representatives. In addition the Trust engaged with other Trusts and DHSSPSNI to plan a more collaborative approach across the HSC to the implementation of these duties in the future.

iii. TTRRAAIINNIINNGG During the reporting period, Equality and Good Relations Training continued to be delivered to operational staff as part of Induction Training.


This training and the Equality Awareness Sessions delivered at Post Proficiency Training promote a positive attitude to diversity and outline the legal duties placed upon the organisation and its staff under Equality legislation. The Trust began to develop a system to evaluate its Equality and Good Relations Training Programme. In addition, NIAS was represented on a Regional Working Group, which was established to develop a disability e-learning module for use across HSC Trusts. This group includes representatives from other Trusts and individuals with a disability and their representatives. Through the DHSSPSNI Equality and Human Rights Steering Group, planning began for an Information Session for Trust Board Members from all HSC organisations in respect of revised Section 75 Guidance. This event took place in April 2009 and NIAS was represented by its Chairman, Chief Executive and Executive and Non-Executive Directors.

iv. EEMMEERRGGEENNCCYY SSEERRVVIICCEESS DDIISSAABBIILLIITTYY TTRRAAIINNIINNGG EEVVEENNTT

NIAS has continued to contribute to the Emergency Services Disability Forum with colleagues from NIFRS, PSNI and Employers for Disability. This group works to share good practice and explore opportunities for collaborative working, in discharging duties under disability legislation in the context of an emergency service. In December 2009, an Emergency Services Disability Training event took place. This was the result of a collaborative approach by the emergency services to management training in respect of disability. The emergency services worked with Employers for Disability to develop the training and commissioned Michael Rubenstein, an expert in Equality Legislation and the author of the Equal Opportunities Review, to deliver this. The training was delivered to approximately 100 Managers and Officers from across the three emergency services. In addition, the emergency services engaged with disability sector organisations to obtain literature about disability and the management of disability in the workplace and this information was made available to the Managers from the emergency services organisations at the event.

v. PPRROOVVIISSIIOONN OOFF AACCCCEESSSSIIBBLLEE IINNFFOORRMMAATTIIOONN

NIAS is a member of the Regional HSC Regional Accessible Information Group. Within this group, NIAS is contributing to the development of a regional approach to the provision of accessible information across the sector. The purpose of this group is to support individuals in making informed choices about their health and social care through the provision of accessible information. Five specific target groups have been defined to date: people not fluent in the English language, children and young people, people with a learning disability, people with sensory impairments, and older people.


The initiative attempts to progress the mainstreaming of equality of access to information, by linking the work to the delivery of key sectoral standards and policy initiatives, including the Quality Standards for Health and Social Care and improving the patient and client experience and personal and public involvement. By March 2010 preliminary terms of references were agreed and Chief Executives were briefed. During the reporting year, a key priority for this group was planning for a stakeholder workshop to be undertaken during the Financial Year 2010/11.

vi. CCOOMMPPLLAAIINNTTSS

During the reporting year, the Trust did not receive any formal Section 75 complaints, however, as with previous years, the Trust continued to identify equality related elements of any complaints and the Trust’s Equality Manager was involved as appropriate.


SECTION 5: COMMUNICATIONS

ii.. CCOOMMMMUUNNIITTYY EEDDUUCCAATTIIOONN

a) Funding for the Community Education Programme, in this period, remained non-recurrent.

b) Throughout the year NIAS staff participated in excess of 200 events including visits to nursery and primary schools, community fun days and a number of career days for year 12 – 14 students. NIAS introduced, this year an “Ambulance Awareness Course”, for delivery over a 6 week period to students in Years 11-14. It was delivered by Paramedics in two educational establishments and was well received by students and teachers alike. NIAS staff also participated on a regular basis in inter agency events in relation to road safety and alcohol use among young people. The Community Education Programme performs a pivotal role in forging links with the communities we serve. Engagement with local communities enables NIAS to showcase the services we provide and educate the public on matters such as improvements/changes in service delivery.

c) The non-recurrent funding of the Community Education Programme continued to make it difficult to deliver a coherent strategy. However efforts continue to secure some recurrent funding for the programme in order to improve value for money by targeting a wide range of age groups and community groups.

TB/11/23/09/10


TRUST BOARD MEETING

23 SEPTEMBER 2010

Title:

STESS MANAGEMENT PROCEDURE

Purpose:

TO PROVIDE NIAS WITH A STRESS MANAGEMENT PROCEDURE WHICH LINKS IN WITH THE HEALTH & WELLBEING STRATEGY 2010-15

Content:

PROCEDURE

Recommendation:

FOR NOTING

Previous Forum:

HEALTH & SAFETY COMMITTEE

Prepared by:

MRS MARIE MULLAN

Presented by:

MS ROISIN O’HARA

STRESS MANAGEMENT PROCEDURE

2

CONTENTS

1 BACKGROUND

2 DEFINITION OF STRESS

3 SYMPTOMS AND CAUSES

4 AIMS

5 NIAS RESPONSIBILITIES

6 MANAGEMENT RESPONSIBILITIES

7 EMPLOYEE RESPONSIBILITIES

8 TYPES OF SUPPORT/HELP AVAILABLE

9 HANDLING INDIVIDUAL CASES

10 EQUALITY STATEMENT

3

STRESS MANAGEMENT PROCEDURE

1. Background

In its Mental Health and Wellbeing Policy the Northern Ireland Ambulance Service (NIAS) has committed to providing a supportive working environment that maintains and promotes the health and wellbeing of staff. The Trust acknowledges that due to the emergency nature of providing an ambulance service staff are expected to deal with potentially stressful situations in carrying out their professional role. The policy highlights that staff will receive the appropriate education, training and support in order to fulfil their duty successfully. This Stress Management Procedure operates under the remit of the Mental Health and Wellbeing Policy and supplements other related NIAS policies and procedures.

1.1 The Northern Ireland Ambulance Service Health and Social Care Trust (NIAS) acknowledge that stress can exist in the workplace and that a psychologically healthy workforce when combined with a supportive work environment will benefit staff and employers alike.

1.2 NIAS is required, under the Health and Safety at Work (NI) Order 1978 to take whatever steps are reasonably practical to prevent employees becoming ill because of work. Whilst the scope of this procedure is to cover workplace stress, the Trust recognises that sources external to the workplace may be significant in causing stress for people. When identifying and dealing with stress, the Trust will endeavour, if the individual is willing, to discuss these issues.

1.3 Employees have a responsibility to co-operate with the implementation of the Stress Management Procedure.

2. Definition of Stress at Work Stress is defined by Health and Safety Executive as “the reaction people have to excessive pressures or other types of demand placed upon them”. NIAS recognises that while providing an effective Ambulance Service to patients and providing a motivating environment for staff it must so far as is reasonably practicable avoid harmful levels of stress.

4

Stress as well as affecting the health of the employee, can also result in an increase in unhealthy behaviour (i.e. smoking and drinking), increased levels of sickness, reduction in performance, a lack of communication, high staff turnover, high levels of grievance cases, an increase in accident rates and an increase in workload/pressure for the remaining workforce and a reduction in staff morale.

3. Possible symptoms and causes of stress

It must be realised that stress is not a sign of weakness. It can affect anyone, at any stage in their life. No one is immune to stress. It is important however that you are able to recognise the causes of excessive stress so that they can be minimised or avoided completely. There will be occasions where the source of the problem is wholly unavoidable and it is in these circumstances that careful management will be necessary to avoid staff becoming unwell. A list of possible symptoms (stress indicators) as well as causes (stressors) are listed in Appendix I.

It must be emphasized that maintaining a healthy workforce is not only the responsibility of the Trust; it also lies with the individual to take appropriate steps to alleviate the causes of stress, if they are within their control. Individual members of staff have a duty to take responsible care both of their own health and general fitness and of the health and welfare of others who could be affected by their actions. Ways of dealing with everyday stress are highlighted in Appendix II.

NIAS will ensure the risk assessment process will be used, as appropriate, to identify workplace stressors and control and mitigate against the risks associated with stress. 4. Aims This procedure aims to:

• Increase general awareness that stress exists in the workplace and is an issue which requires openness and understanding of both the employee and the organisation as a whole

• Create and highlight the methods available to manage stress • Provide a clear framework within which unreasonable workplace stressors can

be identified, managed, mitigated against or potentially eliminated • Protect employees ensuring that they are not discriminated against because of

their difficulties and are given the necessary support available.

5. NIAS Responsibilities

5

The Chief Executive has overall responsibility to ensure that issues involving stress are managed and dealt with appropriately. This duty is delegated to the Director of Human Resources, however, each individual manager retains a duty of care and responsibility for each of their members of staff.

6. Management Responsibilities

To ensure that:

• Each member of staff is clear about their individual roles and responsibilities within their own department as well as the organisation as a whole

• Each individual member of staff is competent and supported in doing their job through the provision of adequate resources, support, education and training

• Stress risk assessments are carried out within their departments and that suitable control measures are in place, as appropriate. These stress risk assessments must be monitored continually with appropriate action being taken when new or additional stress indicators are identified

• All reports of stress are investigated promptly in conjunction with the Human Resources Department and all reasonably practicable steps required are taken to rectify the situation

• Communication between Management and staff is effective, particularly in relation to organisational or procedural change

• Workloads and working hours are monitored regularly and dealt with reasonably • Bullying and harassment is not tolerated in their jurisdiction • Support is offered to staff who are experiencing stress outside work • Support Trade Union Representatives through release for training as

appropriate and facilitating attendance at relevant NIAS training events.

7. Employee Responsibilities

• Recognise their own training and development needs and discuss with line management

• Recognise their shared responsibility to identify stress in themselves and others at an early stage

• Raise issues of concern promptly with their line mangers so that they can be addressed at an early stage. (If staff find approaching their line manager on these issues difficult for any reason, they can approach a more senior manager or the HR Department)

• Accept opportunities for counselling and other forms of NIAS support in rectifying the situation.

8. Types of support/help available

6

Counselling Service: NIAS has access to an independent confidential counselling service which can be contacted confidentially on 0500 127 079.

Occupational Health: Staff can also make a self referral to Occupational Health should they feel it is appropriate, or they can ask that their line manager refers them.

Human Resources: Human Resources staff are available for individual confidential consultation if staff wish to discuss any issues relating to the policy or their post.

Trade Union: If a member of a Trade Union, staff may wish to speak to their Trade Union representative.

9. Handling Individual Cases

When a line manager is made aware that an employee is experiencing stress within their job/organisation they should, in consultation with a Human Resources representative, initiate an investigation into the possible causes of the work related problem. The results from this investigation will be used within the risk assessment framework to identify, control, mitigate against, manage and potentially eliminate, if appropriate, workplace stressors. Where necessary and feasible, modifications will be made to the work situation taking into account Occupational health advice in order to relieve stress. Any changes will be documented in writing and will be monitored closely by the line manager over a specified period of time.

Where more significant longer term change is necessary, other changes will be considered, for example, modification to current job role, reduced working week, transfer etc. The overall aim is to provide support and give help to the individual. However, where termination of contract due to ill health is necessary, all factors will be taken into account and this will only be considered when all other rehabilitative efforts have failed. In this instance the Attendance Management Policy and Procedure will be followed.

Returning to work after a stress-related absence requires careful thought and planning by all involved. It is important that the employee is well supported by line management upon return to work, with a review of work performance carried out on a regular basis.

A return to work interview will be carried out by the employee’s manager, as is normal procedure for any employee returning after sickness absence. This interview may be useful in determining if any modifications need to be made to the employee’s job and if further action or support is required.

This procedure will be regularly monitored and reviewed and any modifications made to ensure its continued effectiveness will be communicated to all employees within a

7

reasonable period of time. Any changes/modifications will be consulted on through the Health & Safety Committee.

10. Equality Statement

The Procedure has been drawn up and reviewed in light of Section 75 of the Northern Ireland Act (1998) which requires the Trust to have due regard to the need to promote equality of opportunity.

In line with the duty of equality, this Policy has been assessed against particular criteria.

8

APPENDIX I – SYMPTOMS AND CAUSES OF STRESS

Possible Symptoms

There are various effects that stress can have on an individual, some of which can be recognised by fellow work colleagues and line managers. It is important to note, however, that recognition of any the following traits in yourself does not necessarily mean you are experiencing dangerous stress but recognition of the potential indicators may help you to avoid them.

Emotional Impact

• Increased levels of hostility, irritability, and anger leading to emotional outbursts. • Feeling down or in a depressed state • Frenetic rushing about trying to do various tasks and getting more and more

flustered resulting in lack of productivity • Lack of confidence, constantly seeking reassurance form others. • Total indifference of other’s needs/wants • The inability to relax, to feel good or to switch off • Personality traits may change completely where a normally neat and tidy person

may appear somewhat dishevelled and untidy.

Cognitive Impact

• Concentration difficulties, where your capacity for making decisions is reduced • Difficulty remembering details and items • Unable to switch off • Responses erratic and impulsive • Mistakes and errors more frequent and judgement impaired.

Physical Impact

• Might become more difficult to get to sleep at night or stay asleep for more than a few hours. Indigestion, heartburn, palpitations, dizziness, sweating, dry mouth, headaches, overeating/loss of appetite

• Might find yourself drinking more caffeine/nicotine /alcohol • May lose interest in normal hobbies and external interests.

Sometimes stress may be temporary and brought on by circumstantial reasons like starting a new job or family sickness. At other times it can be cumulative, building up over a period of time with constant work pressure and family worries of a more serious nature.

9

Possible Causes

Different causes of stress exist and can include:

Culture

• Lack of communication and consultation • A culture of blame when things go wrong • Denial of potential problems • Staff encouraged to work long hours and/or to take work home.

Demands

• Too much to do, too little time • Too little or too much training for the job • Boring or repetitive work, or too little to do • Unfair allocation of work • Unrealistic targets • Lack of supervision • Inadequate staffing levels • Risk of violence • Lack of feedback.

Control

• Low participation in decision making. • Little influence on how work is organised.

Relationships

• Conflict between departments • Poor relationships with supervisors • Poor relationships with colleagues • Harassment/bullying.

Change

• Uncertainty about what is happening • Fears about job security • Introduction of new technology • Lack of training.

10

Role

• Staff unclear about work objectives • Staff feeling that the job requires them to behave in conflicting ways at the same

time • Lack of clarity regarding role and responsibilities.

Support

• Lack of training • Lack of career progression • Colleagues not pulling their weight.

Outside work

• Moving house • Pregnancy • Retirement • Illness/injury • Working and studying • Money worries.

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APPENDIX II – INDIVIDUAL STRESS AVOIDANCE TECHNIQUES

Find out what things help you relax and try to do them regularly.

Relax

• Recognise when you are tense and try and deal with the situation you are faced with

• Make time for yourself • Laughter often relieves stress and tension • Go for a walk/take some exercise • Listen to your favourite music • Take up yoga or a similar interest • Have a bath • Borrow a relaxation tape from your local library.

Think Positively

• We all make mistakes and we don’t always get things right first • Ask for help if you need it • Try to co-operate with other colleagues, they may well be feeling the pressure

too • Listen to colleagues’ opinions and negotiate a compromise.

Plan

• Plan ahead if you can and put tasks in order of priority • Write down all the things you are worried about, they are often not quite as bad

as previously thought • Make lists and put them where you can find them • Set realistic achievable goals for yourself and reward yourself when you have

achieved them.

Diet

• A balanced diet and regular meals will help you to cope with stress.

Exercise

• Exercise regularly – the feel good factor – there is evidence that this is a major help in dealing with stress. If exercise is undertaken it can take three to four weeks before it is enjoyed so persevere.

• Also remember, if you are feeling stressors are becoming overwhelming, there is a confidential free-phone telephone number to discuss any problems you may be facing.

TB/12/23/09/10

EQUALITY AND GOOD RELATIONS TRAINING

Section 75 of the Northern Ireland Act 1998 aims to change the practices of public authorities so that equality of opportunity and good relations are central to policy making and service delivery. It goes beyond anti-discrimination legislation and is designed to improve the quality of services for all people in Northern Ireland through a statutory duty on public authorities, including NIAS, to promote equality of opportunity and good relations among certain groups.

BACKGROUND

Trademark is a not-for-profit social justice organisation delivering training, research and evaluation on equality and good relations, human rights and peace and reconciliation. As part of its ongoing work to tackle sectarianism and racism, Trademark identified the workplace as a key area where work was needed to encourage good relations, mutual respect and tolerance of diversity. Trademark was commissioned by NIAS, through an open tender process in 2006, to deliver a programme of Equality and Good Relations training to staff.

NIAS EQUALITY AND GOOD RELATIONS TRAINING PROGRAMME

The aim of this programme was to deliver training to staff to include:

• statutory obligations under Section 75 • legal obligations under other anti-discrimination legislation • issues around harassment and discrimination in the workplace.

The training was subsequently delivered to over 800 members of staff during the period 2006 to 2009. Sessions were held in NIAS Headquarters and the Rural College and Derrynoid Centre. This innovative training was designed to promote good relations between people of different religious belief, political opinion and racial group, but also touched on issues around discrimination and harassment generally, including in respect of sexual orientation and gender. It encouraged discussion and debate on issues such as the promotion of good relations, harmonious working environments, sectarianism, racism, flags and emblems and harassment in order to improve staff relations and service delivery.

2

The Office of the First Minister and Deputy First Minister (OFMDFM) issued for consultation in August 2010, their “Programme for Cohesion, Sharing and Integration”

OFFICE OF THE FIRST AND DEPUTY FIRST MINISTER STRATEGY

This programme, endorsed by the Northern Ireland Executive and signed by the First Minister and Deputy First Minister, sets out OFMDFM’s vision for good relations in Northern Ireland:

“We want to build a society where everyone shares in and enjoys the benefits of a more peaceful society.

..We want the Programme for Cohesion, Sharing and Integration to bring about real changes for people and places across our society.”

The document goes on to explain:

“This Programme sets out goals that we believe are crucial to achieving a shared and better future for all”.

The NIAS Equality and Good Relations Training Programme is referred to within this OFMDFM document as follows:

“The Northern Ireland Ambulance Service – one of our core public institutions – commissioned Trademark to develop a comprehensive good relations training programme which was delivered to over 800 members of staff between 2006 and 2009. The programme directly challenged sectarian and racist mindsets and helped to develop an organisational culture in which promoting good relations became something that was reflected in all training, communication and leadership roles. The training has been evaluated in overwhelmingly positive terms by the participants.” “Having an environment where you could discuss topics normally considered off limits was good; understanding what constitutes harassment and flags and emblems was enlightening.” (Paramedic)

EVALUATION OF THE TRAINING PROGRAMME

A formal evaluation of Equality and Good Relations training is being undertaken by Trademark and involves an audit of evaluation forms completed immediately following Equality and Good Relations training, interviews with Trade Union Representatives, Senior Managers Executive Directors and the Chief Executive. In addition staff have been provided with an opportunity to complete an online survey sometime after their training in order to evaluate long term impacts, particularly around how attitudes may have changed following the training. The programme of Equality and Good Relations training continues to be mainstreamed as part of the Trust’s induction programme for new staff.

The consultation on the Programme for Cohesion, Sharing and Integration ends on 29th October 2010 and copies of the document are available at www.nidirect.gov.uk/featured-consultations.

http://www.nidirect.gov.uk/featured-consultations�

http://www.nidirect.gov.uk/featured-consultations�

TB/13/23/09/10

1


M inutes of a Meeting of the Audit Committee held on Wednesday 16 June 2010, at 9.30am in the Boardroom, Site

30, Ambulance Headquarters, Saintfield Road, Belfast, BT8 8SG

PRESENT: Mr S Mullan Mr N McKinley Mr S Shields Prof M Hanratty

Non Executive Director (Chair) Non Executive Director Non Executive Director Non Executive Director

IN ATTENDANCE: Mrs S McCue Mr P Nicholson Mr N Gray Mrs J McCaw Mrs C McKeown Mrs S McMullan

Director of Finance & ICT Assistant Director of Finance NIAO External Audit BSO Internal Audit BSO Internal Audit Personal Assistant

Welcome and introduction to the meeting

Mr Mullan welcomed everyone to the meeting. Mr Shields and Mr McKinley advised the Committee that they would have to leave the meeting at 11am – therefore the Committee would only be quorate until that time.

1.0 Apologies

Apologies were received from Mr Dean Sullivan, DHSSPS, Miss Paula Maitland, KPMG and Mr John Poole, KPMG.

2.0 Declaration of Potential Conflict of Interest There were none.

3.0 Minutes of Previous Meeting of the Audit Committee held on 20 May 2010 (for noting) Minutes were approved and signed by Mr Mullan.

4.0 Matters Arising 4.1

Final Accounts 2009/10 Mr Nicholson noted that the final accounts have been updated and were approved by Trust Board on 27 May 2010. He continued that Friday 18 June 2010 is the planned date for certification of the accounts by the Comptroller and Auditor general.

4.2 NIAS Audit Risk Analysis Mr Mullan suggested that this item be brought forward to the next audit committee meeting.

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5.0 Chairman’s Business

Mr Mullan advised that his tenure as Non Executive Director will finish on 21 July 2010. He extended his appreciation to everyone for their hard work and support during his term of appointment and wished everyone the best for the future. Professor Hanratty expressed her concern that Mr Mullan’s vacancy has not yet been filled and expressed her concern as the committee require an appointment with an appropriate financial background. Mrs McCue advised that the Chair of the Trust has raised this matter with the DHSSPS who, in conjunction with the Commissioner for Public Appointments Northern Ireland, have responsibility for non executive appointments. Mr Mullan advised that he had also raised the matter and that it would need to be considered by Trust Board.

6.0 Internal Audit

6.1 Internal Audit Plan 2010/11

Mrs McCue advised the Committee that this plan highlights where the key risks are within the Trust.

Mrs McKeown advised the Committee that the Internal Audit Plan was in the third year of a three year plan which is reviewed and refreshed annually. She continued that Internal Audit had met with the Trust’s senior management team to discuss the content of this plan. Mrs McKeown gave an overview of the Plan. She added that the overtime audit would be covered in payroll and fuel would be covered in the fleet and transport audit to leave time for station visits. Mr Mullan requested that appropriate audit resources were applied to the area of fuel usage. Mrs McKeown replied that the planned audit days for fleet management, which would include fuel usage, had been increased from six to twelve days.

Mr McKinley informed the Committee he had attended a workshop on the role of internal audit which he had found very interesting. He feels that station visits would prove very useful as a means of forming a view on softer, cultural aspects that exist within an organisation and would complement the visits by Trust Board to ambulance facilities.

Mr Gray advised that there was an established audit tool which could be used to assess the culture of an organisation. He would be happy to discuss the matter further if it was felt that such a tool may be of use to NIAS. Mrs McCue referred to an HSC-wide staff survey which is being compiled at present. This survey should help to assess cultural issue. Mrs McCue was asked to follow up on the appropriateness of the NIAO’s cultural assessment at this time.

Mr Shields highlighted the importance of the culture within an organisation and the role of internal audit to alert non executive directors to areas of risk. Professor Hanratty highlighted the need to address all areas of risk, including clinical risk.

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Mrs McKeown highlighted the significant increase from 65 to 96 planned audit days. Mrs McCue advised that this would also mean a financial pressure for the Trust in a difficult economic environment. There followed a detailed discussion on various elements within the plan and the days allocated to it. The Committee recognised the financial impact of the plan and also the demands it would place on the organisation. The need to ensure that sufficient resources are made available during the reminder of the year so that audit areas had sufficient focus and that findings were meaningful.

After extensive discussion, the plan was agreed with a few minor amendments. It was noted that the Chair of Audit would advise Trust Board that Audit Committee recommended the increase in the cost of internal audit.

6.2 Internal Audit Arrangements (HSC(F) 11/2010)

Mrs McCue introduced paper AC/3/16/06/10 for noting. Mrs McKeown noted the paper highlights the relationship between the DHSSPS and the arms length bodies. She continued that the paper had no major differences from the previous guidance.

The contents of the circular were noted.

7.0 For Approval

• Standing Orders, Scheme of Delegation and Standing Financial Instructions

• Draft Audit Committee Terms of Reference

• Draft Assurance Committee Terms of Reference

Mrs McCue introduced these documents which establish the statutory and regulatory framework of the Trust, outline the functions reserved and delegated by the Trust Board and detail the financial responsibilities, policies and procedures adopted by the Trust. The terms of reference for the sub committees, which reflected the revised governance arrangements within the Trust, had been developed following on from the Trust Board governance workshops. The documents were based on best practice and had been tailored to suit the needs of NIAS after extensive discussion with the non executive chairs of each committee.

Following detailed discussion and a number of minor amendments, the documents were agreed for approval and recommendation to Trust Board.

At this point Mr McKinley and Mr Shields had to leave the meeting. In the absence of a quorum, the meeting was closed and the outstanding agenda items would be considered at the next Audit Committee meeting.

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9.0 Date, Time and Venue of Next Meetings Wednesday 22 September 2010 at 2.30pm NIAS HQ (note this meeting has changed from Thursday 2 September 2010). Thursday 2 December 2010 at 2.30pm NIAS HQ.

Signed ________________________ (Chairman) Date 21 July 2010

TB/14/23/09/10

Mr Liam McIvor Chief Executive Northern Ireland Ambulance Service Ambulance Headquarters Knockbracken Healthcare Park Saintfield Road Belfast BT8 8SG

12-22 Linenhall Street

Belfast

BT2 8BS

Tel : 028 9032 1313

12 August 2010 Dear Liam Trust Delivery Plan 2010-11 The Health and Social Care Board with the Public Health Agency have carefully considered the NIAS Trust Delivery Plan and I have now written to the Department to recommend its approval. The TDP provides a generally satisfactory response to Priorities for Action and gives an indication of deliverability and affordability in the current financial context at a time of rising demand on services. The Board will monitor progress in areas where the targets are at risk as part of the regular performance management arrangements. The Trust will continue to be held accountable for full delivery of all PfA targets and standards, including those where NIAS is supporting other organisations with delivery. Yours sincerely

Mr John Compton Chief Executive

TB/15/23/09/10

RESPONSE TO THE CONSULTATION

ON THE

“PROPOSALS FOR A SAFE & SUSTAINABLE URGENT CARE

NETWORK

IN THE SOUTH EASTERN TRUST”

25 August 2010

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Thank you for providing an opportunity for the Northern Ireland Ambulance Service to

respond to the Consultation document “Proposals for a Safe & Sustainable Urgent Care

Network in the South Eastern Trust” which includes a proposal to change the emergency

department at the Downe Hospital. To set the context the Northern Ireland Ambulance

Service (NIAS) have been involved in projects involving significant changes to acute services

within Northern Ireland over the last few years. Notable projects would be reconfiguration of

Acute Services in Tyrone County Hospital and the more recent reconfiguration of services at

Mid-Ulster and Whiteabbey. As such NIAS recognises South Eastern Trust (SET) position

and the challenges and complexity of introducing major acute service reform. SET can be

assured that NIAS are keen to support the Trust in developing safe and sustainable services

for the future.

This response will focus on the questions presented on Section 5, Page 18 “Have Your Say”

and the supplementary questions on Page 25 in relation to the Downe Hospital. NIAS

recognise that the detail in developing proposals and consequent operational implications will

be undertaken through the Urgent Care Reform Project Team and we are grateful to be

offered two places on that team.

SECTION 1

7 Have Your Say

Do you agreed with the key principles with strategic drivers outlined in paragraphs

2.1.1 - 2.1.7 above?

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NIAS accepts the evidence presented which underpins the strategic drivers for change of the

current provision of emergency services by the Trust. Two key issues are of significance.

The first, reference Page 9 – Downe Hospital – “the proposals to provide enhanced local

hospital at the Downe Hospital”, would be viewed as a positive development by NIAS as this

would ensure that continued 24 hour access to local services would not fuel demand for

ambulance transportation to other acute facilities. Secondly, in relation to the evidence

presented to support optimum and absolute minimum specification of support services in

addition to skill mix and rotas, it is felt that this clearly defines what would be appropriate, safe

and sustainable, where these services would be located and thus category of patients that

Ambulance services could bring to these facilities.

On reviewing the principles and strategic drivers, NIAS would feel strongly there would be a

need be a full assessment of the implications of resulting changes to acute services on both

Ambulance resources and operational and destination protocols.

NIAS accept and support both the key principles and reasons for change to services as

identified in Pages 14 & 15.

7 Have Your Say

Do you agree with the current service issues as identified in Paragraph 3.2 above?

NIAS does agree with the current service issues identified. These are not unique to the SET

as these seem to be recurring issues within acute services throughout Northern Ireland.

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7 Have Your Say

Have you any other comments relevant to any issues raised in this section of the

document?

This section of the consultation deals with the SET as a whole with some specific references

to the Downe Hospital. NIAS welcomes the opportunity through the Urgent Care Reform

Group to assess the impact of proposed changes throughout the SET as a whole and in

particular for the Downe and Lagan Valley catchment areas. Such changes may result in

increased demand for Ambulance transport and longer journey times for patients. The impact

of these changes may result in delays in ambulance responses unless there is consideration

given to providing additional resources. NIAS is currently facing significant challenge in

achieving its PfA response time target of 75% of Category A Life Threatening Calls being

responded to within 8 minutes by March 2011 and not less than 67.5% in any LCG area,

within a context of dealing with increase in 999 demand (6% per annum) and the need to

achieve efficiency savings targets.

It should not be underestimated, that any proposal to achieve the principles as discussed in

the consultation document can only be achieved if there is confidence in the emergency

service provision for the area as a whole. This must include both in hospital and out of

hospital services and will require an adequately resourced ambulance service which will meet

the emergency and non-emergency demands for ambulance transport within the area. The

recent media attention on NIAS as result of the changes proposed by SET within the Downe

area has clearly demonstrated how changes could be challenged if there is an inadequate

ambulance service provision to support them.

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It is therefore essential that the SET fully considers the potential impact of the proposals on

both ambulance resources and increased journey times. NIAS must therefore be fully

engaged in the process of planning and implementation.

SECTION 2: DOWNE HOSPITAL SPECIFIC ISSUES AND PROPOSED MODEL.

Initial assessment of the proposed changes as outlined in the consultation document would

suggest an increase in activity for NIAS both in terms of emergency and non emergency

requests for ambulance transport including interfacility transfers particularly when the

proposals for the Downe and Lagan Valley are considered as a whole. These journeys will

involve longer distances and by implication longer journey times for patients. As a

consequence NIAS will experience increasing pressure in maintaining emergency cover

within the area.

NIAS will assess the impact of the proposed changes on ambulance service provision and

determine any need for additional resources in order that the Ambulance Service can

continue to provide safe and sustainable services for the population of the Down Local

Government District area.

TB/16/23/09/10

TB/17/23/09/10

TB/18/23/09/10

Documents

Northern Ireland Ambulance Service€¦ · 11.1 HR & Corporate Services End of Year Activity Report 2009/10 TB/10/23/09/10 11.2 Stress Management Procedure TB/11/23/09/10 11.3 Programme