Agenda item

To receive a presentation from Jason Killens, Chief Executive of the Welsh Ambulance Service and Estelle Hitchon, Director of Partnerships and Engagement.

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.