Written Statement - Response to Strategic Review of Welsh Ambulance Services

I am pleased to provide this Statement to Assembly Members that sets out a first set of decisions in response to Professor Siobhan McClelland’s Strategic Review of Welsh Ambulance Services.

I should like to thank Members for their contributions concerning the Review.  These have informed my response to it. It is my belief that continuing constructive conversations about ambulance service delivery over coming weeks and months can only assist in achieving the improvements we all want to see.

Professor McClelland suggested that shaping the future of ambulance services ought to begin with an unambiguous agreement on its nature as a clinical service. It was clear from the Plenary debate on 7th of May that Members were persuaded by the Report’s preference for a clinically focused service and I formally endorse that position today.

Professor McClelland also proposed in her first recommendation that this clinical future ought to be firmly embedded within the day to day unscheduled care system. I agree and have asked Dr CDV Jones, in his capacity as lead Chair for unscheduled care, to work with his colleagues at Local Health Boards (LHBs) and the Welsh Ambulance Services NHS Trust (WAST) to ensure this happens.

Professor McClelland’s second recommendation proposed that work should begin on disaggregating Patient Care Services (PCS) from the emergency response side of ambulance services.

Clinical concerns, workforce and legal issues will need to be carefully considered before this can take place, and a timetable will need to be agreed. I have, therefore, asked LHB Chief Executives to consider the practicalities of achieving this working with the Ambulance Trust and relevant staff representatives. I will provide further detail to Members about this work in July.

The third recommendation made in the report is related to the future delivery of services by NHS Direct Wales and the future use of the 111 non-emergency number in Wales. This recommendation is fundamental and integral and will be taken forward as part of wider developments for providing telephone triage and health information and advice, learning from emerging evidence elsewhere.  

The sixth and seventh propositions recommended that robust workforce planning and modernisation should be put in place, aligned with alternative care pathway development.

I see empowering and developing frontline staff as a priority. Allowing them to make a wider range of clinically safe and effective decisions ‘at scene’ is vital because better clinical decision making skills will improve patient experience and reduce unnecessary conveyances to hospital.

Funding has already been set aside for 2013/14 to enable a number of WAST technicians to undertake additional training. Funding has also been made available to invest in advanced practitioner roles within the NHS and this will include emergency care specific roles.

Over 47,000 patients were diverted on clinical grounds away from busy A&E departments by paramedics last year alone. However, I expect Local Health Boards to work with partners to accelerate development of alternative and community care pathways for a range of conditions over the next 6 months.

Recommendation Nine of the report provides important advice about the future measurement of performance. To achieve greater transparency and to provide a more holistic view of unscheduled care delivery, I have agreed that WAST and LHBs should publish a range of additional monthly information from July 2013.

The Welsh Government will also publish data on a wider spectrum of response times and officials are working with WAST to consider how soon this can be achieved.

There was wide agreement, across the Assembly that the eight minute target should not be seen as the only measure of ambulance performance. However, I understand the importance of maintaining information relating to the eight minute response as a comparator of performance with other UK nations, while placing greater emphasis on patient handover as a key indicator of quality.

During the rest of this year, officials will work with the ambulance service and other parts of the NHS to develop a new set of indicators that provide an intelligent suite of clinically informed targets and standards.  

These will be outcome focused, aligned with the integrated unscheduled care pathway and agreed through engagement with NHS Wales. This is not necessarily easy, but I have asked that these are in place from 1 April 2014. This information will provide greater transparency and context regarding emergency ambulance quality and performance.

Finally, Professor McClelland set out three distinct options for the future structural model for ambulance services in Wales. The debate on 7 May was very helpful in shaping my thoughts and I will further consider your views before making a decision.

I want to be certain that the future system is transparent; that funding mechanisms are aligned to accountabilities; and that responsibilities for performance are clear.

I also need to be certain that we choose the right structural model to deliver the clinical vision set out in Professor McClelland’s report. An option appraisal is being developed to inform this process so that legal, workforce and financial issues can be carefully considered.

I will provide a further update to Assembly Members in July.