To receive a presentation on plans for the Trust to become an NHS Foundation Trust and consider the Committee’s response.

The Committee received a presentation on plans for the Trust to become an NHS Foundation Trust and considered points it would wish to include in its response to the Trust’s consultation exercise on its proposals.

Mr C Harris, Foundation Trust Project Manager, gave the presentation on the plans.  The principal areas covered were: the fact that the Government had announced that all NHS Trusts would become Foundation Trusts by 2013 either by moving through the process themselves, joining with an existing Trust, or being dismantled and incorporated within other Trusts; the background to the Trust and the challenges it faced as the second largest Ambulance Trust in terms of area; current performance levels and the Trust’s focus on training its staff; the background to how Foundation Trusts operate and the proposed governance arrangements for the Trust. 

The Trust considered that as a Foundation Trust it could deliver more benefits, more choice, better facilities and improved quality.  The way it intended to achieve this was by workforce development including reaching  a 70% paramedic skill mix; increasing efficiency and maximising ambulance availability including the introduction of  the Make Ready system across the Region; implementing a single triage system giving access to emergency and primary care pathways; using the ethnically representative Membership to inform developments; supporting implementation of NHS reform agenda; and becoming an integrated emergency healthcare provider and developing a wider range of services.

In discussion the following principal points were made:

·         The wording of the Trust’s proposed vision was questioned, noting in particular that it made no reference to the provision of emergency care and was very general.

·         In terms of service improvements Members considered that there was scope for improved integration of frontline emergency services.

·         The Committee was well aware, through the review it had undertaken of the ambulance service and the regular updates to the Committee, of the challenges posed by the geographical area covered by the Trust, consisting as it did of large conurbations and extremely rural sparsely populated areas.  It was recognised that the Trust had to meet a performance target for the Trust’s area as a whole and that this could be achieved by focusing resources on the conurbations. It was essential that as pressures on resources increased the needs of the rural areas were recognised and response targets in those areas were met.

Mr N Henry, the Locality Manager, commented that although the Government had yet to finalise its position on targets for the ambulance service the expectation was that there would be a requirement to achieve a minimum uniform standard of performance across the Trust’s area to avoid the possibility of underachievement in any one section of it.

·         Part of the plans to increase efficiency and maximise ambulance availability included the introduction of the Make Ready system.  Mr Harris stated that the intention was that different models would be applied across the Trust’s area recognising the different circumstances in the urban and rural areas.

·         Members noted that in many ways the ambulance service, like the Accident and Emergency Service, was resorted to by the public almost by default because it could be relied upon to provide treatment.  Part of the proposed efficiency savings were therefore based on a revised triage system that directed the public to the most appropriate provider of treatment.

·         The continued investment in training including increasing the number of paramedics was a further way in which improved services and efficiencies would be delivered.

·         It was observed that the governance arrangements were different for each of the three emergency services.  The aim should be to keep the governance provisions as simple and straightforward as possible. It would be easier for the public to understand if governance arrangements were standardised.

·         The proposal that young people should be admitted as members of the Foundation Trust from the age of 16 was considered acceptable.  However, Members agreed that established mechanisms for engaging with young people, such as via Children’s Trusts, might provide a more effective voice than individual membership and should be incorporated into the Foundation Trust’s Governance arrangements alongside the provisions for individual membership.

·         The consultation document proposed 15 public governors elected by the public members from the five constitutional groups into which the Trust’s area was proposed to be divided.  This meant 3 public governors for the West Mercia Region comprising Herefordshire, Shropshire and Worcestershire.

It also provided for nine appointed governors from key partner agencies to include two governors from local authorities, one urban and one rural.

The Committee was concerned that this did not guarantee representation from Herefordshire.

It was noted that the Trust was seeking to achieve a representative public membership across the Trust’s area proportionate to populations.  However, the Committee did not consider that this was a satisfactory substitute for direct representation for the County on the Members Council.

·         It was suggested that given the increasing importance of the voluntary sector in service delivery one appointed governor was insufficient.

·         The Committee acknowledged the cost to the Trust of each public Member and its intention to have two levels of public membership, developing engagement with an active membership of a few thousand, rather than a membership of 100,000 as developed by one current Foundation Trust.

RESOLVED:  That a draft response be circulated to Members of the Committee for comment and authority granted for a response then to be submitted to the West Midlands Ambulance Service NHS Trust after consultation with the Chairman.