To receive
a presentation from Jason Killens, Chief Executive of
the Welsh Ambulance Service and Estelle Hitchon, Director of Partnerships and
Engagement.
Minutes:
Jason Killens, Chief
Executive of the Welsh Ambulance Service and Estelle Hitchon,
Director of Partnerships and Engagement, were welcomed to the meeting. Members
were given a presentation which reported on the performance of the Welsh
Ambulance Service.
Details were given on statistics such as the response
times to red calls (risk to life calls) at Betsi Cadwaladr, noting that the
percentage response to these emergency calls within 8 minutes had dropped since
October 2022 from 62% to 47% by October 2021 and had now stabilised at
approximately
45% by September 2022. It was acknowledged that this meant that some patients
were waiting much too long for an ambulance.
It was noted that the main reason for the drop in the
response
times was the substantial increase in lost hours when transferring to hospital,
which affected the ability to respond to emergency calls promptly. It was noted
that this delay when transferring had increased over time and had
been
at
its worst in September 2022. Details were also given of other challenges such
as increasing staff sickness and absences leading to capacity
problems and challenges relating to attracting staff and filling posts.
Reference was made to patient safety and civil
reportable incidents, which detailed the deaths and serious harm that could
have been avoided, and comparison was drawn between the situation of Betsi
Cadwaladr and the rest of Wales. The numbers were lower compared with the whole
of Wales, but on average, 2 patient safety issues were recorded every month as
a result of very long
delays, clinical errors and patients waiting in ambulances
outside the hospitals.
Information was received on the current review being
undertaken of demand and capacity
within the service, and details were given on what was being done in
an attempt to improve the situation, such as
recruiting and training more staff, reviewing the list of duties and changes to
arrangements such as rapid response vehicles, e.g., staffed by senior
paramedics. It was believed that these measures would help with the response
time problems.
To close, they ran through a future response model
which focused on transforming the emergency medical services by placing more
emphasis on consultation, treatment
and referrals, instead of transporting patients to hospitals.
During the discussion, the following observations were
submitted
by members:-
·
Members
expressed gratitude for the presentation and commented that it conveyed a bleak
image of the ambulance service and for the people who lived in North Wales,
particularly in the rural areas.
·
A
request was made for an explanation of
the role of the first responders, noting that their service was essential to
rural areas in the County such as Tywyn,
particularly considering the current situation and discussions about the air
ambulance service.
·
Reference
was made to the lack of locum staff,
and it was asked whether it was possible to increase staff numbers in the Tywyn
area. Members expressed their admiration towards the existing staff who worked
under strain. Reference was made to staff who had recently joined Tywyn
but there was a tendency for them to be transferred to other locations, leaving
Tywyn
without adequate staff. It was added that the ambulance service was very
important to the area, considering that there
were not
many
doctors in the area and no minor injuries unit in Ysbyty Tywyn.
It was noted that a number of
first responders who were volunteers had stopped because they
often had to wait with patients for 4-6 hours before an ambulance arrived and a
number of them had other jobs to go to.
·
Reference
was made to examples of older people falling and fracturing bones in the
community and no first responders being available to assist
them, therefore they faced hours waiting for an ambulance. It was believed that
the risk to patients was increasing due to the unacceptable waiting time for
ambulances.
·
Concern
was expressed about the ambulance service transporting patients to hospitals in
Bangor, Wrexham and Glan Clwyd and then being held back in these locations or
being sent to calls in nearby locations, therefore there was no supply to
respond to calls in the local community. It was also noted that the transfer
time should take 15 minutes but now it took on average more than 2 hours and in
some cases
patients could be waiting in the back of the ambulance for 12 hours, which was
a concerning situation and meant that the fleet was not available in local
stations. It was added that it was not uncommon nowadays to see over 10
ambulances waiting outside Ysbyty Gwynedd.
·
It
was asked how many lives were being lost as
a result of ambulances not arriving or long
delays
when they were needed
and concern was expressed that the national health service appeared
to be
broken.
·
It
was agreed and emphasised that collaboration was needed across the Health and
Social Care sector and that the current situation of patients and ambulance
workers waiting outside accident and emergency departments for up to 12 hours,
sometimes more, was unacceptable.
·
It
was asked how much pressure was being put on the Government in
an attempt to improve the waiting times outside
hospitals. It was also noted that there were 100 fewer beds in Ysbyty Gwynedd
today compared to when the Hospital was built.
·
The
service received directly by the paramedics was praised.
·
Disappointment
was expressed in the previous
comments received from the Chief Executive of the Welsh Ambulance Service regarding
the air ambulance and his support to the recent proposals on moving the
location of the air ambulance in Gwynedd. It was believed that insufficient
consideration was being afforded to rural needs.
·
It
was agreed that better collaboration was needed between the Government, the
Health and Care Service and the ambulance service. It was noted that the lack
of beds in the hospitals and in the community was a problem and that the problem
of recruiting carers contributed to the shortcomings in terms of being able to
discharge patients from the hospitals. It was added that the Government should provide
better support, it was believed that the salary levels of carers were not
sufficient, and this was a matter for the Government.
In response to the observations and questions from
members above, it was noted:-
·
That
the role of the community first responders was essential and the value that
they offered was acknowledged. It was added that many volunteers had been lost
since the pandemic period, it was assumed that the numbers had halved across
north Wales. An aspiration was expressed to increase the voluntary workforce
and reference was made to recent efforts to invest in additional capacity
to train and recruit more volunteers.
·
That
the air ambulance was not a part of the Welsh ambulance service. It was noted
that they responded to 999 calls with the ambulance service and not instead of
the ambulance service. Nevertheless, the Chief Executive of the Welsh Ambulance
Service noted that he was aware of the proposals relating to the air ambulance service
and that he was supportive of them. He believed that the proposals would ensure
that more patients who required
urgent critical care obtained better access to the service, therefore the
proposals appeared to be
sensible.
·
That
73 additional
staff had been allocated
to the workforce across North Wales as well as a number who
were currently in training and would be ready to take up jobs
after Christmas. It was
reported that there had been a substantial growth in the front-line
service over the past 2-3 years.
·
That
the ambulance service's fleet in Wales was used or assigned to a call 80% of
the time. Considering the losses to the fleet such as the delay when
transferring to the hospitals, this explained why the response time to calls
had increased. It was acknowledged that the waiting time was unacceptable but
that the ambulance service was trying to be efficient. It was added that the
collaboration of the Health Service and Local Authorities was essential as
these authorities had a role to deliver
such
as discharging patients who were medically fit from the hospitals.
It was noted that the challenges that existed across the Health and Social Care
system had led to the pressures on the ambulance service.
·
That
they were aware of pressures in the social care field for Local Authorities and
were identifying
what
needed to be resolved across the system. It was reported that the ambulance
service was seeking
to collaborate to improve situations. It was noted that as
a result of the increasing and ageing population
that this had contributed to the demand on a variety of services relating to
the Health and Care field.
·
That
the hospitals had a role to play. It was elaborated that the responsibility of
the ambulance service was to transport the patients who genuinely needed to go
to hospital A&E departments so they could not do much in relation to lack
of capacity,
staff
and space within the hospitals. It was added that the health field's
responsibility was to enable patients to move quicker through the hospitals and
then the Local Authorities to help with hospital discharges. It was noted that
there was a need to improve the shortcomings in the system.
·
That
they were attempting
to improve the service in the calls control rooms in
order to avoid sending an ambulance if it was
not necessary and were then attempting
to improve the care available in the community to avoid transporting patients unnecessarily
to the hospitals.
·
That
the Wales ambulance service was providing
information, statistics
and feedback to stakeholders, including the Government, weekly and monthly. It
was noted that they were emphasising the harm that could be
avoided
as
a result of the current situation and that they
were firmly of the view that change was needed. It was added that 36% of the
fleet was
currently
unable to respond to calls and they would not be able to respond unless something
changed,
which was a matter for the Government. It was noted that the ambulance service
was focusing on what was within its
control
and was
using
the resources available in terms of staff and money as efficiently as possible.
·
That
they were proud that the excellent work of the paramedics under difficult
circumstances was acknowledged by Councillors and in the community. It was
reiterated that the paramedics or call handlers were not to blame, but that
they unfortunately continued to receive verbal abuse from some members of the
public.
·
He
was unable to comment on individual cases regarding
the ambulance service's response time, but assurance was given that the
ambulance service's system targeted the patients where there was an immediate
risk to life first, e.g.
cardiac arrest, and they were prioritised over calls where there was no direct
threat to life, e.g.
fractures following a fall. It was noted that these were not easy decisions to make,
but they had to make the choice when only one fleet was available,
and two calls were received.
·
It
was acknowledged that the waiting time and the service received in the
community was unacceptable and was cause for concern; however, assurance was
given that the ambulance service was doing everything within its ability to
improve the provision. It was noted that the situation was affecting staff
morale and leading to
more sickness amongst staff, which led to further problems in terms of staff
recruitment and retention. It was noted that there was too much pressure across
the system.
The Ambulance Service's staff were thanked for
answering the Members' questions and it was hoped that the situation would
improve. To close, it was asked whether the strikes of the nurses and ambulance
service would affect rural areas. The Chief Executive of the Wales Ambulance
Service confirmed that the ambulance service would have substantial problems
when attempting
to respond to calls in the community, should the strikes go ahead. Members were
thanked for their questions.
RESOLVED:
There was no vote since
this item was to provide information
only.