Written - Welsh Ambulance Service Performance

In December 2008, I provided a written statement to members on the response times of the Welsh Ambulance Service Trust.  In the statement I communicated my disappointment with the performance of the service, identified a number of issues which needed to be resolved and set out the actions that I would take to do so.  We are now 3 months on and I felt it was appropriate that I brought you up-to-date with the position of the Trust in the early part of 2009.

As far as response times are concerned, I am pleased to note that there has been a steady increase in performance across Wales from the low point in December when only 47.6% of Category A calls arrived within 8 minutes.  Further and steady progress has been made with performance improving to 57.8% in January, 58.8% in February and culminating in 65% for March.  I am also pleased to note that the variation in performance across Wales has reduced since December with the Trust achieving the 60% equity target in 18 out of 22 Local Health Board areas in March.  The four Local Health Board areas where the target was not achieved, Powys, RCT, Monmouth and Torfaen also showed improvement, with a response time performance of 58%, 54%, 53% and 47% respectively.  While this is still not an acceptable level of performance, the continuous improvement made in these four areas over the past months is encouraging, particularly in light of the specific challenges presented in each.

There are a number of reasons for this improvement which I will briefly outline for you.  However, I would firstly like to recognise the efforts of the ambulance crews and Trust staff who have worked incredibly hard to deliver them.  It is also important to note that this has been achieved during the winter period which was an extremely difficult time for all individuals working within the emergency services, due to the extended severe weather conditions.

Turning to the reasons for the improvement, I am pleased to tell you that I have worked closely with the Trust and have been able to take a number of issues forward which has removed a number of barriers to improved performance.  I have strengthened the Trusts leadership at Executive and Board level through a number of key executive appointments, including the Regional Directors for the South East and Central and West Regions and a HR Director.  I have also agreed to strengthen the Trust Board with the recruitment of two further Non-Executive Directors underway.  This has improved the Trust’s management capacity and capability to deliver the required changes.

I have also focused my attention on the excessive delays being experienced in the handover of patients from the ambulance service to A & E departments, particularly in Cardiff and Gwent.  The Director General wrote to all Chief Executive Officers requesting immediate improvements within the unscheduled care system and my officials have worked closely with Trusts to achieve this.  This has resulted in sustained improvement in the timely handover of patients at Cardiff and Gwent, allowing ambulances to get back on the road quickly and respond to emergency calls.

With regards to staffing, I have assisted the Trust in securing the appointment of a Senior Operational manager in the South East, who has supported the Regional Director in providing clear leadership to all staff.  I also provided an additional £2 million of funding in December which has enabled the Trust to fill vacant posts and fund overtime to cover areas of high demand, predominantly in South East Wales.  Further progress has also been made on matching staff rotas to demand on a permanent basis, with the work in North and West Wales completed.  There still remain a small number of issues to be resolved in the South East.  It is clear that further progress needs to be made with regard to levels of efficiency and productivity within the Trust and the unscheduled care system as a whole.  My officials are awaiting the outcome of an independent efficiency review commissioned by the Trust and Health Commission Wales which will provide us with a clear view of what further improvements can be achieved.  The report is expected at the end of April.

I am also pleased to tell you that that progress is being made in improving the morale within the Trust through better working relationships between management, staff and trade unions and more effective human resource management.  I have been able to support the recently appointed HR Director in improving the recruitment process, ensuring that staff and potential employees are subject to a fair and open process.  Further progress has also been made regarding the appointment of Clinical Team Leaders, who will play a crucial leadership role within the Trust at an operational level.  I will continue to assist the Trust in accelerating this work as it is vital in providing a clinically responsive service.

We have also supported the Trust in addressing a number of other important HR issues, with the reduction of sickness absence being a key priority.  This work has seen a reduction in sickness absence from 8.1% in December 2007 to 6.9% for 2008.  Much of this improvement has been driven through the closer working relationships between managers and staff.  The Trust has taken a step forward in improving the culture within the organisation through the setting up of a Equality and Human Rights Steering Group, which is supported by a working group, which has the remit to oversee equality and diversity, Welsh language and anti-bullying and harassment issues within the Trust.

I have also been able to take a number of steps which will support the Trust in sustaining this improvement.  I have approved the Trusts business cases for the purchase of the Automatic Vehicle Location System, which the Trust tells me will improve response time performance by an average of 5% across Wales.  I have also approved the Outline Business Case for the development of a Make Ready Depot at Wrexham which will improve operational service delivery.  The Director General of the Department of Health and Social Services has also focused a great deal of attention on improving the unscheduled care system.  This has culminated in organisations being required to work closely together to develop 7 Local Delivery Plans at new Local Health Board level, which set out a range of short and medium term actions for improvement.  My officials are currently analysing these plans and once they have been agreed as robust, I expect organisations to implement them with a real sense of purpose and urgency.

While much has been done over the past few months, I have made it very clear to the Trust that further sustained improvement is required across Wales, with a particular focus on areas such as Powys, RCT, Monmouth and Torfaen to ensure that it is accelerated in these areas.  Given the pace of the improvement required, I am disappointed to tell you that that the Trust has still not been able to provide me with an overarching strategic plan or a fleet strategy which I consider to be fit for purpose.  The Trust needs to improve its strategic planning capability quickly to ensure that it presents a clear way forward, which is understood by its staff and partners, and which enables the various capital investment programmes and planned operational improvements to be linked in a coherent manner.  I have also made it clear to the Trust that it must improve its operational planning and management and levels of efficiency and productivity, to ensure that has done everything within its control to improve performance.

I will ensure that the Trust does not become complacent and believe that this upward trend in performance can be improved further through more effective planning, increased efficiency levels, and the improvement of the working environment for staff.  My officials will continue to work closely with the Trust to ensure that the significant improvement seen over the past months is sustained and built upon.