Written Statement - Welsh Ambulance Services NHS Trust delivery of October 2013 eight-minute target and the introduction of the NHS Outcome Framework and development of future NHS measures

I would like to start by thanking ambulance staff and A&E staff in each Health Board area, for their efforts over the summer to improve our emergency medical service. I am pleased to announce that figures released this morning reflect these efforts with the achievement of the 65% eight-minute target in October. This now provides a solid basis for performance over the winter months.

The NHS has also focused over the summer months on reducing the number of patients waiting over 62 days for their cancer treatment. This has resulted in an increase in the number of people having their first outpatient appointment within 10 working days, and performance moving closer to the 62 day target. It is encouraging to note that the performance against the 31- day target has been achieved and sustained since July 2013.

For other unscheduled care measures: 

• there were fewer people waiting 12 hours or more in A&E departments in the combined period from August to October 2013 (2,133) than in the single month of April 2013 (2,254);
• there have been fewer patients waiting over an hour for handover from ambulance crews to A&E staff over the whole of the past six months from May to October (4,306)  than in March and April 2013 (4,333); 
• There have been fewer ‘lost ambulance hours’ accrued at A&E departments around Wales in the past five months (from June to October) than in March and April combined.

I congratulate the ambulance staff for achieving the target and for their ongoing commitment to patients and improvement in delivery. However, I must emphasise, as did the McClelland Review, that the eight-minute target itself is, only very weakly backed by clinical evidence as a measure of best outcomes for patients.

At the end of October 2013, the National Audit Office (NAO) reported again on the perverse outcomes being driven by the four hour target in A&E departments, which it identified as the most significant factor in increasing unnecessary emergency admissions, at a time of high winter pressures.  It also noted  that nearly a quarter of all admissions from A&E took place in the 10 minutes before the four-hour limit was reached, casting further doubt on the extent to which such action reflect genuinely clinical priorities.

Nor are unscheduled care targets the only ones which fail to promote the best outcomes for patients. I continue to be advised by the most senior oncologists in Wales that the distinction between 31 and 62 day cases is not one which reflects today’s highest standards of patient care.

I am concerned that there may be many other examples where existing measurement systems do not promote the best outcome for patients. Therefore in line with the commitment in ‘Together for Health’ to develop an Outcome Framework for the NHS, my Department is in the process of developing proposals for an outcome driven delivery model.

It is important that the public and the service are engaged in this development and I am clear that any new framework needs to be co-designed. To date there have been 16 patient, clinician and stakeholder events held across Wales.

These events have resulted in seven draft outcomes that stakeholders, patients and clinicians have identified as being important to support the NHS in delivering meaningful outcomes for the citizens of Wales.   Work needs to be undertaken on these draft outcomes to ensure that these really reflect the key drivers of the NHS. This work will be undertaken in the coming weeks in conjunction with stakeholders, patients and clinicians.

In that work I have asked my Department to prioritise the development of unscheduled care measures including both the ambulance service and A&E departments.  Events with clinicians and patients took place in early November to apply the seven outcomes to the unscheduled care pathway. As a priority I have asked the national clinical lead for unscheduled care to work with clinicians across Wales to come forward with any necessary proposals for change.

This will then be supported by more detailed pilot work to explore appropriate measures across the unscheduled care pathway. These will be tested with clinical leads across Wales, with the aim of piloting some new measures from April 2014 where data collection can be achieved within that timescale.

I have also asked senior clinicians to provide me with advice concerning targets for access to cancer services. That advice will focus on identifying how we can best be assured that any target regime is firmly based on achieving best clinical outcomes for patients. If there are immediate changes recommended, I will consider them rapidly. Wider work will proceed through clinical engagement between now and April 2014.

I also intend to secure advice concerning the refinement of Referral To Treatment (RTT) regime for the future. In the short term, that advice will focus upon ophthalmology services where opportunities exist to improve access by better stratification of referrals, according to clinical priority. I expect such work to inform wider engagement with clinicians on a reformed application of RTT principles in other conditions in the future.