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Written - Welsh Ambulance Service Performance

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Edwina Hart, Minister for Health and Social Services

Members will be aware of the criticism of the Welsh Ambulance Service Trust’s performance in the media last week where comparisons were made with other ambulance services. The reports used historic data which failed to take account of the different service challenges faced in Wales and the different ways in which the respective services respond to certain types of calls. 


We briefly discussed this issue at the Health, Well-being and Local Government Committee on 10 June.  However, given its importance, I felt I should provide you with an update on the performance of the Trust and a number of developments that have taken place since my last statement in November 2009. 


I am pleased to note that response time performance has continued to improve since November 2009.  The national target of 65% of first responses to Category A calls arriving within 8 minutes has been met by the Trust in 8 out of the last 12 months.  The Trust only failed to achieve the 65% target during July, August and December 2009 and January 2010, which was as a direct result of the very difficult and unique set of circumstances generated by the first wave of swine flu and the unprecedented winter weather conditions, respectively. 


Importantly, the Trust has improved the levels of performance in a number of Local Health Board areas which have previously fallen short of the 60% equity standard.  I am pleased to note the improvements made in Torfaen, RCT, and Monmouth, with the 60% target being achieved.  This is illustrated by the Trust’s reported performance in April which saw it achieve a 70.5% Category  A overall response rate and 60% in each of the 22 Local Authority areas.  This is the first time that the 60% target has been achieved across all 22 unitary areas and work is being undertaken to ensure it is sustained.  This will be challenging given the continued increase in demand.   


I am pleased to note significant improvement in Powys.  Members will be fully aware of the unique challenges facing us in Powys and whilst the Improvement Group I established earlier this year has made good progress, it is clear that a full multi-agency approach will be required to improve service standards.  The group will therefore continue its work, and receive further support from the recently established National Programme for Unscheduled Care.   


The improvements which I am now reporting are the result of the continued hard work and professionalism of the ambulance crews, paramedics and Trust staff, in what have been extremely challenging times.  This has been supported by a number of investments within the organisation in technology, buildings, vehicles, the workforce and improvements in clinical services which include:

  • The provision of £5 million by the Welsh Assembly Government for the vehicle replacement programme;
  • The full implementation of the Automatic Vehicle Location System;
  • The ongoing implementation of the Ambulance Radio Re-procurement Project and Mobile Data Terminal;
  • The continued benefits being realised from the Vantage Point House site;
  • Continued investment in the upskilling of staff such as Clinical Team Leaders and Specialist Practitioners; and
  • The introduction of a new clinical triage model to reduce inappropriate ambulance deployments.

In addition to the above, the Trust, in partnership with the former Health Commission Wales, sought an independent view on where further improvements could be made and what actions were required to achieve them.  The Independent Review, ‘Efficiency Review of the Welsh Ambulance Services NHS Trust’, was accepted by both parties and published in December 2009.


It concluded that:

  • The demand for emergency ambulances in Wales will continue to rise if the current model of care is continued;
  • A significant proportion of patients are being transferred inappropriately to A&E departments, when their care could be better provided in an alternative setting;
  • The continued delays in the handover of patients from the ambulance service to A & E departments is a major barrier to improving ambulance response times;
  • The existing national response standards were acting as a barrier to change, as they served to reinforce the current system, behaviours and cultures;
  • Wales should adopt the principles of the response standards utilised in England; and
  • The Trust could expect to achieve the national response standards in a sustainable manner and improve patient outcomes, if a more clinically focused service model was fully implemented.

I have considered the recommendations of the review, and particularly those relating to the revision of the national response standards policy.   I have also taken clinical advice on this issue and I am now  convinced that their revision will support the continued transformation of the Trust into a modern clinical service which makes effective and informed clinical decisions, based on clinical need and priority -  and not simply based on a computer generated algorithm. 


The revisions I have made to the national response standards are relatively minor, with Category A calls continuing to receive a response within 8 minutes and Category B calls continuing to receive a response within 14/18/21 minutes.  Some Category A and B calls will be attended initially by one ambulance resource, either an emergency ambulance or a rapid response vehicle (RRV), based on clinical need.   If the patient cannot be treated at the scene by the attending clinician and requires transport to hospital, this will be undertaken within 14/18/21 minutes of the clinicians’ request.  On occasions where an RRV is the initial response vehicle, and the clinician deems it to be an inappropriate method of transport for the patient, an additional emergency ambulance or high dependency vehicle will be provided to transport the patient.  These changes bring the standards into line with those used in England and will support a significant reduction in the deployment of two vehicles to most Category B calls, which is the current operating practice.


With regard to A&E Departments Handover Times, I have made it clear to the Chairs of all Local Health Boards that the responsibility for resolving the issues affecting patient handover performance lies predominantly with them.  I have asked them to focus on improving the process with the A&E Departments and the development of the whole unscheduled care pathway, ensuring that it provides a range of services that meets the needs of patients and offers a real alternative to hospital settings. 


I expect these changes to deliver a number of significant benefits.  Principally, it should further support the Trust and LHBs to work in partnership to treat more patients in their homes, at the scene and in a range of settings alternative to hospitals, and result in a reduction in the number of patients being transferred to A & E departments.  It will also free up resources within both the ambulance and A & E services to deal more effectively with patients who do have an emergency care need; and ensure that patients suffering from cardiac arrests receive an ambulance before patients with minor injuries which are not immediately life threatening.  Finally, it will ensure that the full skills and professionalism of the ambulance Trust staff are maximised and enable them to work in close partnership with patients and the Local Health Boards to ensure that effective clinical decisions are made, which deliver the best possible outcomes for patients.


I expect the Trust to implement these proposals in full and to work with the Health Boards in developing a comprehensive response to Unscheduled Care, as part of the 5-Year Strategic Framework.