Written - Update on the Review of the Welsh Ambulance Service

In June 2008, I made an oral statement to Members on the state of the Welsh Ambulance Service Trust (WAST) and I committed to give a further update after six months.

As far as response times are concerned, latest published statistics show that the level of performance has deteriorated across all areas of Wales.  I am extremely disappointed in this.  In June, performance stood at 62.7% of category A calls arriving within eight minutes.  The latest figures available for October show that performance had fallen to 58.8% of category A calls arriving within eight minutes.  I am also disappointed to note that the variation in performance across Wales remains as wide as ever, with some areas still not achieving even 50% of category A calls being responded to within eight minutes.

My officials have held regular discussions with both WAST and Health Commission Wales (HCW) on how the performance targets can be achieved.  They have been directed to consider a number of options for securing the improvement required and provide me with a plan, which should be available shortly.

I am concerned at delays in handing the care of patients over to A&E departments, which are often lengthy. This is bad for the patients, and prevents ambulances from being available for the next emergency call.  The problem is particularly acute in Cardiff and Gwent.  This is a significant governance issue for both WAST and the Hospital Trusts, and it must be addressed.

We are now collecting detailed information on ambulance handover times.  Early problems with the electronic reporting systems will be resolved by the early part of 2009. That data will be used to monitor performance, and to bring about necessary improvements.

I must state that this is not a reflection on the ambulance crews who work hard every day to deliver a vital service to the people of Wales.  I am well aware of their dedication to the job, despite the difficulties they face.

The workforce is the lifeblood of the ambulance service, and I am pleased to note a number of improvements have been made in this area by the Trust.  A permanent HR Director took up post on 1 November 2008, and over 90% of staff have an outline or agreed post description, in accordance with the Key Skills Framework.  The Trust is also working towards ensuring that all staff have a personal development plan in place.  This is vital in ensuring that staff are clear about their jobs and objectives, and are supported to develop in their roles on a daily basis.

I have been extremely concerned about staff morale, which was an area that was highlighted in the Audit Committee Report published at the beginning of November. Over the last few weeks, with the assistance of the trade unions, I have undertaken a series of visits to ambulance stations in the South East region and have had the opportunity of meeting with a large number of ambulance staff. I have listened to what they have had to tell me about some of the problems they are facing day by day.  There has been a consistent pattern to the issues and comments which have been raised relating to the filling of vacant posts, cover during the busy Christmas period, frustrations about the quality of service bring provided for patients and the need for senior management to be visible in the Region.

That feedback has now been discussed with the Chair of the Ambulance Trust. I was pleased to see that the Trust and the Trades Unions have issued a joint statement covering such issues as staffing levels for the emergency service, training and partnership working.

These measures must now be implemented, with immediate action taken urgently to fill vacancies for front line staff, particularly in the South East of Wales, in order that response times improve. With Christmas coming I have given instructions that all available staff, including managerial staff, play their full part in ensuring that there is adequate cover for the emergency ambulance service over the whole of this period.

Recent press coverage has highlighted the importance of an effective emergency ambulance service, together with ready access to hospital care. During the recent emergency pressures in North Wales all organisations, including WAST and the hospital trusts responded in this way by implementing escalation plans and working together to ensure that patients were seen and treated at the most appropriate place.

However, concerns remain about management capacity in South East Wales. The Trust must urgently cover the Deputy Chief Executive post with a senior officer who will be located in the south east and over see optional performance and improve communications.  The Ambulance Trust must raise its game and work with its staff and partner organisations to improve services for patients.

Turning to the issue of clinical governance, the Trust has developed a number of policies and procedures, which have been approved by the Board.  It is disappointing, however, that progress has been slower than expected in implementing and embedding them into the operational and professional working of frontline personnel.

I am pleased that the Trust has signed up to the 1000 Lives Campaign and is enthusiastically participating in a number of areas; Improving Leadership for Quality, Medicine Management, Reducing Healthcare Associated Infections and Improving General Medical and Surgical Care.  Changes are being introduced in each of these using the campaigns method for improvement.  This is the first time an ambulance service has been involved in such a campaign anywhere in the world.

Progress has also been made since June on strategic developments required within the Trust.  Firstly, agreement has been reached on the Automatic Vehicle Location System (AVLS) business case between the Trust and Health Commission Wales.  This will bring real benefit to patients by ensuring the most efficient deployment of ambulances.

Finally, with regard to the business case to replace the Trust’s fleet of vehicles, in August I requested that the Trust underpin this case through the development of a supporting vehicle strategy.  This, when complete, will enable me to consider a business case which is robust and which should provide a more sustainable direction for the Trust. I expect this to be ready early in the New Year.

This statement provides Members with an update on a range of issues concerning the performance of the Welsh Ambulance Trust.  I can assure you that the Trust is fully aware of my expectations, and I will hold the Chair and Board to account for performance.