Written Statement - Extension of clinical response model pilot for emergency ambulance services

I am pleased to provide an update to Assembly Members on the clinical response model pilot for emergency ambulance services to announce an extension to the pilot for a further six months.

Members will know that demands on our emergency ambulance services are growing year-on-year. It is clear that if we are to meet these demands and ensure the best outcomes for patients, we need to transform the way in which we deliver these vital services.

In July 2015, I announced that the Welsh Ambulance Services NHS Trust (WAST) would pilot a new clinical response model for a 12-month period.  The clinical response model moves away from the historic time-based target, for all but the most immediately life-threatening calls, and places a greater focus on patient experience and outcomes.  

The decision to implement the pilot was made in response to compelling evidence from leading clinicians and a clinical review of the timeliness and quality of ambulance services led by Dr Brendan Lloyd, Medical Director of the Welsh Ambulance Services NHS Trust. The clinical review indicated there was no evidence that an eight-minute target response makes a difference to around 95% or people’s outcomes.

The new model is part of a wider clinical modernisation plan for Welsh ambulance services and is based on the recommendations of Professor Siobhan McClelland’s Strategic Review of Welsh Ambulance Services. That review clearly recommended a move to a more intelligent set of indicators, which put a greater emphasis on patient outcomes and experience.  

The pilot is intended to prioritise those in most need of a response by ensuring all available resources are immediately despatched to those in danger of death and to allow clinical contact centre staff a maximum of an additional two minutes to determine the type of resource needed for all other patients. The additional time given to call handlers is intended to empower them to despatch the right type of clinician and vehicle to the patient to optimise their chances of a good outcome.

The pilot is 11 months in, following commencement on 1 October 2015, and I have been encouraged by progress.  The national target for 65% of immediately life threatening or ‘red’ calls to be responded to within eight minutes has been exceeded in every month and was achieved by every health board area in June and July. A response and clinical intervention in minutes to ‘red’ patients help to optimise chances of survival and a patient’s outcome. It is pleasing, therefore, to see the latest available data which shows 3 in 4 (75.3%) patients received a response in eight minutes with an average response time of five minutes and one second.

This time based target is supported by the Emergency Ambulance Services Committee’s (EASC) Ambulance Quality Indicators (AQIs) to provide greater context to the quality of services patients receive from ambulance clinicians. This should also provide assurance that patients no longer subject to a time target receive a timely response commensurate with improving their outcome.

The latest set of indicators was published on 27 July and included health board level information for a number of indicators for the first time.  Importantly, these figures have shown that the average response time to patients who would have previously been subject to the target, many of whom will now be categorised as ‘amber’ calls, has been between 11 minutes 4 seconds and 16 minutes 36 seconds since the commencement of the pilot. They also show a 32% increase in the number of patients who have been safely discharged over the telephone following an assessment by a clinician in the contact centre since the start of the pilot.

Additionally, ‘clinical indicators’ show the extent to which paramedics are delivering ‘best in class’ care bundles to patients with conditions like stroke, sepsis and those who have suffered a heart attack. I have been encouraged by high performance levels in these clinical areas that demonstrate paramedics are delivering care that will optimise patient outcomes in the vast majority of cases.

A robust evaluation of this pilot is fundamental to inform all stakeholders’ understanding of the effectiveness of the model and in determining whether it can be implemented substantively. Before the commencement of the pilot, I directed EASC  to commission an independent evaluation and experts in the field of emergency medical services research are in the process of conducting this crucial work.  Following consideration of the interim evaluation report by the Chair of EASC, Professor McClelland, I have agreed that the pilot should be extended by six months to allow time for consideration of the final evaluation report. This is due in December 2016.  I will make a final decision on the future of the pilot by the end of March 2017.

Finally, I acknowledge that while improvements delivered by our ambulance services have been promising, we know that more needs to be done to better utilise existing resources and partnerships to strengthen local responsiveness. It is clear, however, that WAST and its staff have made significant and encouraging strides which I hope will be recognised and supported by all Members.

This statement is being issued during recess in order to keep members informed. Should members wish me to make a further statement or to answer questions on this when the Assembly returns I would be happy to do so.