The next item on our agenda is the statement by the Cabinet Secretary for Health, Well-being and Sport on the independent evaluation of the emergency ambulance services clinical response model. I call on the Cabinet Secretary to make the statement—Vaughan Gething.

Thank you, Presiding Officer. I’m pleased to update Members on the outcome of the independent evaluation of the clinical response model for emergency ambulance services.

Members will know that the clinical response model pilot commenced on 1 October 2015. There was widespread agreement that the previous model was not supported by clinical evidence and made poor use of the emergency ambulance service. The new clinical response model set out to make the best use of our ambulance service and ensure that it prioritised people with the greatest clinical need.

I received clear clinical evidence from a review conducted by Dr Brendan Lloyd, the medical director of the Welsh ambulance services trust, to undertake this pilot. His advice was explicitly endorsed and supported by every other medical director in Wales.

When making the decision to approve the pilot for the new clinical response model, I directed the chair of the emergency ambulance services committee, which I’ll now refer to as EASC, to commission a robust independent evaluation. I’ve now received that evaluation report. Having considered the report’s findings and advice from EASC, the Welsh ambulance service and my own officials, I have decided to approve the substantive implementation of the new model with immediate effect.

In my written statement yesterday, I set out some of the key findings from the evaluation report. The report was supportive of the introduction of the new model and identifies a range of benefits from its introduction. It found that the new model has helped to deliver a service that is more focused on the quality of care that patients received and it has improved efficiency in the use of ambulance resources. The new model has provided additional time for call handlers to better assess patients and ensure that they get a response from the right type of clinician and vehicle in the first instance. It’s allowed the Welsh ambulance service to explore alternative ways of responding to calls, either over the telephone, known as ‘hear and treat’, or at the scene, which is known as ‘see and treat’. The number of calls ended through hear and treat has significantly increased since the beginning of the pilot. In December 2016 alone, the Welsh ambulance service was able to avoid 1,700 ambulance journeys through hear and treat. This was the highest monthly rate since the beginning of the pilot, and is a 70 per cent increase compared to October 2015. Similarly, there’s been a 9 per cent increase in the number of incidents that ended following a face-to-face intervention from paramedics at scene, without the need for that patient to be taken to hospital. In December 2016, over 3,000 patients were discharged through see and treat. So, those patients remained at home, and ambulance resources were released into the community without an unnecessary journey to hospital.

The Welsh ambulance service enhanced its clinical desk in November last year so that more calls can be resolved without patients going to hospital. It also provides improved clinical support to ambulance staff making on-scene treatment decisions.

Whilst these results are promising, there is, of course, scope to increase hear-and-treat and see-and-treat rates in Wales as we do remain behind other parts of the UK on these measures. I expect the Welsh ambulance service and health board partners to work with the chief ambulance services commissioner to take this matter forward.

One of the report’s recommendations was to keep call categories under constant review to ensure that patient experience and expectation is considered as part of our evidence-based approach. A year of operation now means more robust and real-time information for EASC to carry out this work in collaboration with the Welsh ambulance service to support improvements for patients. I know that accurate and easily accessible data is fundamental to understanding demand, and there is a clear need to improve data across the patient journey. So, the new model introduced a new suite of ambulance quality indicators. These provide a much broader view of the quality of care that is being provided by ambulance clinicians. I’ve been particularly encouraged by high performance levels against the seven clinical indicators being measured. This demonstrates that paramedics are delivering care that will make a real difference to patient outcomes. EASC is now working with the world-renowned Picker Institute Europe to improve measures relating to patient experience. And work is already under way to establish routine linking of data across the patient journey. This will allow us to analyse the impact on patient outcomes of interventions at each step of patient care.

Together, this work will help Welsh ambulance service AST and EASC to understand emergency ambulance services in ever greater detail and place interventions in the wider context of the patient’s journey through the unscheduled care system. This work will also inform the refresh of the AQIs later this year to include additional measures of clinical and operational performance.

The replacement of the existing computer-aided dispatch system later this year will put WAST in a much stronger position to manage all calls more effectively through the better identification and allocation of the most appropriate resource. The new system will be supported by a £4.5 million of Welsh Government investment and is expected to be online later this year.

Our pilot has attracted global interest. The Welsh ambulance service have been invited to provide advice to a number of international ambulance services, including Canada, New Zealand, Australia, USA, Chile and England. In fact, the Scottish Ambulance Services NHS trust is currently piloting a very similar model, directly referring to the work undertaken here in Wales. There is a significant opportunity here to build upon the success of the model to date to further evidence this successful innovation and step forward.

I recognise that it takes time for new ways of working to become established. The clinical model has proven to be effective in enabling the Welsh ambulance service to prioritise a response to the greatest level of need. However, the model itself is not a panacea. There is a clear acknowledgement from the Welsh ambulance service and from EASC that there are opportunities to improve care for patients in the greatest need, and to ensure patients with less serious need continue to receive a safe and timely response. I have, therefore, written to Professor Siobhan McClelland, directing EASC, to develop a way forward in response to the evaluation report’s recommendations to support the work that is already under way to deliver high-quality ambulance services for the people of Wales.

The new model has proven to be a positive step forward. However, it has only been possible because of the commitment and skill of our staff who deliver the ambulance service, and I am truly grateful to them, both in making the case for change and in then delivering that change. I will of course continue to monitor performance and the implementation of the new model.

Thank you very much for your statement this afternoon, Cabinet Secretary, and there’s much to commend, or to be commended in the report from the Welsh Ambulance Services Trust. And, like you, I would like to particularly commend the paramedics who have made enormous strides forward in delivering and being able to deliver timely care, and I think that they are making a real different to patient outcomes, and I have absolutely no quarrels with the assertions you make along those lines.

I do have three key areas of questioning I would like to go through with you. The first is about increasing resources to the ambulance service. There’s been an awful lot of discussion by the staff within the report, in the report itself, and in the discussions that you facilitated, most kindly, with the Welsh ambulance service only a couple of weeks ago about not having enough clinicians, either in a hub or within their particular specialities in a hospital, that will enable patients who have been brought by paramedics to the right door of the hospital to be processed more quickly and thoroughly, and that there’s been some real concerns by the staff that they feel that there’s a blockage there—. And I’d like to have your view on what you think we can do to improve, or you will be doing to improve, and adding to the resources in the ambulance service, so that having had these amazing paramedics get them to that door, they’re through that door and in the right place, at the right time, and being treated well. Staff have also raised concerns that they need more training, and I wonder how much of the recent funding package for medical staff training will you be allocating to this particular staff group in order to enhance and give added depth to the ambulance service.

The second area I’d like to ask you about is the amber calls and waiting times. The report has highlighted that there’s concern that the amber category group is way too large, and is not sufficiently discriminatory. The staff themselves talk about this as a real issue, because, of course, there are only a few calls now that are being put into the red category. And I’d just like to read one quick excerpt from a member of staff, who says:

‘Amber response targets not being met due to demand and resourcing’.

And

‘I feel as there are so many calls in this category, the triage queue doesn't work well. For example, an unconscious stroke patient categorised below a person who is drunk and not alert.’

And I’d be really interested in hearing your take on the very valid staff concerns that they’re raising about amber calls and waiting times.

The previous model called for almost 50 per cent of calls to be categorised as life threatening, and we all recognise that that was counter-productive, given the true proportion of life-threatening calls is nearer to 10 per cent. So why is it, Cabinet Secretary, that only 5 per cent of life-threatening calls are being held against targets in Wales, and will you intend to review that, as you move forward?

There’s also real concern that the data on patient outcomes are very poor, and I wonder what can be done to improve this. When we had our meeting with the WAST officials, and we talked about why stroke patients, for example, are not in red category—which is something we, the Welsh Conservatives, absolutely believe in—the officials were talking about the fact that they were getting them to the door in time, and what we needed to do was talk to the health boards, to be reassured that, going further, those stroke patients, at the door, would be moved through to the appropriate place for their correct treatment, whether they needed a CT scan, or some kind of thrombolytic treatment. And yet, when I FOI’d all the health boards, none of them—none of them—were able to come back with the information that says that stroke patients are being moved through appropriately.

So, we still have an issue where we have an illness that requires a certain amount of treatment within a certain amount of time, and, although the health board, because of the way you’ve now run this system—although the ambulance service no longer has to get to that patient, and get them to the front door within a very short period of time, the worry we have is that too much of the amount of time is being used up by the ambulance service before they go and get to that patient, or getting the patient to the door, because there is absolutely no guarantee yet that the patient, once they get to the door of the hospital, is getting to the appropriate treatment within that hospital. In the old days, if you had to get them there by eight minutes, or 10 minutes, or whatever it was, you knew then you had a couple of hours to play with if there were problems within the hospital in terms of resources. We’ve now flipped that over on its head. And this is not me saying it, it’s actually the report highlighting it, and it’s the staff concerns about what is happening to these stroke patients.

And, as I say, I would reiterate this, Cabinet Secretary: when I did an FOI on every single health board, none of them were able to tell me, with any degree of data, that they had stroke patients entering their door, and getting to the treatment, still within the golden hours that those patients need. And I find that very concerning, and I’d really like to have a good, clear answer as to why people with strokes and hearts are not in the red category. There are a number of other questions, but I appreciate that I’m probably taking too much time.

Thank you for the series of questions and comments. I’ll start with some of your points about clinicians in other parts of the health service and the point about delays in treatment, or otherwise. There is, of course, a challenge about seeing the ambulance service as part of the whole system, and not just that whole patient—[Inaudible.]—partly about the ambulance service. And that’s why we do have a real focus on hospital delays, regularly publishing information about delays in individual sites and in health boards. It’s why it’s part of the accountability that takes place with health boards about their whole population responsibility.

There’s also something about making sure—and the report also highlights this as well—there are alternative places for people to go for their treatment, because, sometimes, somebody will need treatment, but it won’t be in a hospital. So, it’s about referring them on to a different setting, that’s in the community, or in another part of the whole healthcare system. That absolutely is part of what we are looking at, as a whole system. And that also is informed by one of the recommendations in the review.

On your point about staff training, both the internal training, within the service, so that the staff are appropriately equipped and skilled, but also on the future workforce, and my recent announcement of the £95 million we’re investing in the NHS workforce of the future—the numbers of paramedics we’re training for the future, we think they’re in line with what we need, but we do think that there is a need for a different skill mix, in how people will be deployed. So, that actually is part of what we’re doing. There are a range of different models, looking forward. For example, on my recent series of visits to see paramedics at their stations, I’ve met with a number of people undertaking some of those pilots. In the Vale of Glamorgan, I met with a paramedic who was undertaking a community pilot. I also met with advance practitioners undertaking a similar pilot in Aberdare, with the Member for the Cynon Valley. So, they’re looking at different models to evaluate and understand where the place is then to make the biggest and best impact on improving patient outcomes. So, that work is already being undertaken and that will help to enforce the sort of workforce we need for the future.

On your broader point about patient outcomes—and then I’ll come back to your point about the amber category—we’re, of course, interested in the whole patient journey, so looking at outcomes isn’t just about what the ambulance service do. That’s why linking data through different parts of the health service is really important. So, the investment that we’ve made in digipens, for example, means that it’s much easier to transfer those data on. We will have an opportunity, because of the way we organise this, to look at someone’s journey through the whole system and to understand how interventions, both in the ambulance service and on the five steps we’ve set out for them, but also the rest of our healthcare system, which interventions are having an impact on that ultimate patient outcome? The Picker Institute work is telling us about patient experience, because often the complaints that are made about the health service are about the experience people have in that healthcare, as opposed to the ultimate clinical outcome. So, that linking of data is hugely important.

Now, on your point about stroke and the amber category, I go back to the fact that the review that we’ve had that actually recommended the pilot that we’ve just had an evaluation undertaken on has been based on clinical evidence about the right thing to do. I don’t recognize your assertion that there are 10 per cent of life-threatening calls made to the ambulance service rather than the 5 per cent that are categorised by the red category. We acted on the very best available clinical evidence and advice in undertaking the new pilot, and are moving forward with the new model. The review that’s been undertaken following the evaluation is to look at whether we have got appropriate boundaries drawn between red and amber and amber and green for the different categorisation that exists. So, I will continue to be guided by the clinical evidence and advice from that review about whether each condition is in the right category. I recognise that Welsh Conservatives say they want particular conditions moved, but, frankly, if it’s just the view of Welsh Conservative politicians that they want conditions moved around, that won’t persuade me. What would persuade me that there is a change needed is if there is real clinical evidence and advice that this is the right way to use precious ambulance resources to improve outcomes for patients, and that work is being carried out following the direction I’ve given to the chair of the emergency ambulance services committee.

I look forward, on stroke performance, and in dealing with your other point Angela Burns—in the near future, I’ll be making a statement in this Chamber on stroke performance across the whole pathway, on the way in which we objectively and overtly measure stroke performance within the system. I think, actually, that we’ve got a good story to tell in Wales about improving performance in stroke, and I look forward to making further progress in the future.

May I thank the Cabinet Secretary for the update and, of course, thank the paramedics and those working behind the scenes in the ambulance service for all their hard work? Of course, I look forward to seeing ongoing monitoring of this programme. Certainly, the outcomes are the most important thing here, and therefore it’s difficult to disagree with a programme that prioritises the most urgent cases. But what we need to guard against, of course, is that we don’t put all our focus on those most urgent cases and that that doesn’t lead us to miss problems in other parts of the performance of the ambulance service. For example, the median waiting time for amber calls has deteriorate. Are you comfortable with that as a Government? Following on from what was raised by the Member for Carmarthen west, we hear that the categorisation is under review, but how likely is it that we will see the need for a new subcategory—a dark amber, perhaps—to deal with certain cases such as stroke that don’t need an immediate response like the 5 per cent, but where there would be a benefit, perhaps, of setting a specific target? And if that is a consideration, what assessment has been made of the impact of that, then, on the response to the red calls?

I spent an interesting few hours, and a very valuable few hours, in the north Wales ambulance response centre, having a look for myself at the problems being faced there, and a few things were encapsulated in my own thoughts, and I have two questions emerging from my own experience there. What steps are being taken to ensure that there is less demand for ambulances in relation to calls from other health professionals where there is in fact no emergency?

Secondly, we know that these delays in hospitals are a huge problem. It has become clearer to me, having seen it for myself and the impact that has on the operation of the ambulance service. The problem, of course, is these vehicles lined up outside hospitals, vehicles that could be responding to emergency calls. Now, as I understand it, in Stoke hospital, which is used as a trauma centre for the north, there is a service where a paramedic or a paramedic team actually takes patients immediately before they are transferred to the trauma team, and what that means, of course, is that the vehicle and the team of paramedics manning that vehicle are ready to go immediately. So, what work has been done or is being done to introduce similar systems in hospitals across Wales in order to speed up that transfer process and ensure that the vehicles and the teams are back on the road as soon as possible?

I thank the Member for the series of questions that he’s asked. I accept that Members will, of course, be interested not just in the red category, where we’re meeting and sustaining our performance targets, and where there is a time measure, but also in the amber category as well, because we recognise that those people require a response, and it is a blue light response to all those people in the amber category. The great majority of people in the amber category receive a response and have an experience that is not problematic at all. The challenge is that some people do wait longer than we would wish them to wait, so that’s partly understanding both the experience and what that means for their outcomes as well. That will be covered in the review measures that are being taken forward, so I would not wish any Member to leave here with the impression that, somehow, people in the amber core category are being forgotten. They’re very much part of the evaluation and the recommendations that are directed at the Welsh ambulance service and the Emergency Ambulance Services Committee to take forward. Of course, I look forward to coming back with the recommendations they make for further improvement.

As I say, if there is a requirement based on the best available clinical evidence and advice that outcomes can be improved by being moved or dealt with in a different way, then of course I’ll have to properly consider that and respond to it. But it must be that there is a positive step forward that can be taken, and there is real evidence that outcomes can be improved if we take a different approach. This is the point about having a time target where it’s appropriate.

I’m actually really pleased that this place has moved on quite a long way since where we were with the initial announcement. At that point, people in a range of parties were sceptical about whether it was the right thing to do to remove a time-based target—whether, actually, we would risk patient outcomes. Actually, the evaluation report gives us some comfort that not only are we meeting the red category, but there is no evidence at all that patient safety has been compromised. That’s an important point for all of us to take on board, and it certainly doesn’t take away from the point about further improvement in the future.

I recognise the point you make about health professionals, of course, and how they’re managed. It is part of the support that is supposed to be provided, not just within this part of the way in which care is delivered, but also support for those health professionals where there is a need and how and where they get it, and also the level of confidence that I think is being generated, within primary care in particular, that if a response is needed, it will happen in a timely way. So, this is about building confidence within a whole system, and actually each health profession taking its share of responsibility for the consequence of their own choices that impact on another part of the healthcare system and, of course, on the journey through care that each individual patient takes.

That goes into the point abut hospital delays, because decisions made within an emergency department about whether to take people out of an ambulance and to put them into a department have an impact on that individual, but they also have an impact in the community as well. If we can’t see an appropriate number of ambulances released properly and rapidly, then actually there’s a risk that isn’t being managed appropriately within the community as well. This is why we’re reiterating again to emergency departments, going through the national unscheduled care programme that we have—to make sure that we get more hospitals to do what Cwm Taf health board does successfully, in making sure that people are accepted from ambulances and brought into an emergency department quickly. Actually, if we saw that practice rolled out in a much more consistent and demanding way across our system, we would be in a better position. That means the risk is then managed in the emergency department. You will recall there being pictures of full departments throughout winter, but actually that’s almost certainly a better place for that person to be. They’ll be seen and triaged by medical staff within the emergency department, so those people will be under observation. But, equally, that then means the ambulance is released to go back out into the community. So, we’re very clear as a Government what we expect, the health service understands, and it’s been reiterated by the chief executive of the NHS, and, again, this is a regular point for myself in accountability meetings and conversations with chairs of health boards, to make sure they’re moving much closer to where Cwm Taf health board already are.

Can I thank you, Cabinet Secretary, for your statement? Can I also say that I very much welcome this report, which identifies, I think, the real benefits that have accrued from the new emergency services model?

I have only one question to ask, which I will come to when I’ve made a few comments that I do actually feel need to be recorded, because it wasn’t so long ago that I was a Unison official, having to defend the ambulance service in the face of torrents of criticism, particularly from the Tories and from Plaid Cymru, who sought to shamelessly use the ambulance service—[Interruption.]

The Member is not talking rubbish. If you want to contribute to the statement, then do so in an orderly manner. Dawn Bowden.

Diolch, Lywydd. They sought to shamelessly use the ambulance service as a political football and, as you indicated, Cabinet Secretary, continued to criticise when the clinical model pilot was actually proposed by Welsh Government. Working closely with those ambulance professionals, who were daily having to bat away largely unfounded criticisms, I could see that this was denting their confidence and making their attempts to run an effective emergency service even more difficult. The thanks to these staff, which always followed those criticisms, I have to tell you, clearly just did not wash—they did not wash.

During that time, front-line ambulance staff were telling me what was needed. What they said they needed was to get away from the random A8 target, which meant that every ambulance, regardless of the nature of the call, had to reach its destination within eight minutes. This was against all clinical evidence, which showed that only the most serious of cardiac cases actually benefited from this target. The target itself was actually acting against getting speedy responses to those most in need. This position was never accepted by the opposition here in the Assembly, despite apparent recognition now from the Conservative spokesperson today that the previous model was actually counterproductive.

The McClelland review, which was commissioned in light of the constant criticisms of the ambulance service, took evidence from a number of stakeholders, with Unison, representing the front-line ambulance staff, being one of them. Unison’s evidence was based solely on the experience of those professional, highly skilled, well-qualified, clinical, front-line staff, who stated that a change to the clinically led suite of evidence based performance indicators was needed rather than continued reliance on the eight-minute response times, which actually were totally meaningless in terms of measuring outcomes.

It would be fair to say, Cabinet Secretary, that the views of these front-line staff, as submitted by Unison, were in the minority of the evidence that was submitted to the review. However, I am pleased that the Welsh Government attached sufficient importance to the views of the front-line professionals and clinical experts, rather than its political opponents—

You do need to come to a question now. I’m being very, very lenient. Please come to questions.

[Continues.]—and had the courage to take the decision to move towards a clinically led response model.

My question to you, Cabinet Secretary—[Laughter.]—is do you agree with me that what this report highlights is the importance of ensuring that we listen to the voice of front-line staff when formulating policy, and it’s a great example of the benefits of the partnership approach between Welsh Government and the public sector trade unions?

I thank the Member for her comments and questions. I remember, when I was appointed to this department as the then Deputy Minister, it was a remarkably difficult time. Members will recall the regular occurrence of monthly figures that were debated in this Chamber. It was a very uncomfortable place to be. There was harsh criticism of the service and demands for action and improvements. Actually, to move away from saying, ‘Are we actually chasing the right target? Is this the right thing to do?’ was actually not an easy thing to do.

And you’re right to remind people that front-line staff were consistent in saying that the old target did not make sense for the service and the way that the vehicles were used to hit the target, or indeed for the patients. And actually, we now have a much more sensible way of doing this, and that’s part of the success that we’re celebrating in actually moving forward. And, actually, it’s for other parts of the UK to actually have the courage that we’ve had in Wales and to have a unified voice from front-line staff about the need for change, but also from the clinical leaders to say there is not just a problem with the old target, but a better way to do our business.

In the review of the eight-minute target and the way that vehicles were used to meet the target rather than to meet clinical need, I’m really pleased to say that, yes, we’ll continue to listen to the front-line staff and their views about what we’re doing. In fact, over the last two weeks, I think I’ve met nearly 100 paramedics in their workplaces in four different locations around Wales, and I can tell you, paramedics are still direct and robust in their views about us as a group of politicians, me as an individual, and their managers too, and it’s been a very useful exercise in hearing directly from them what they think has happened, not just in terms of the improvements made within the new model, but also what there is still to do, as well. It’s really important to focus on the need for further improvement, too. I look forward to continuing to have a constructive conversation with your successor in the role as Unison head of health, and colleagues in the other public service trade unions, to make sure that we do have a genuinely constructive way of working, where there is demand, where there is a challenge, but also where there’s an opportunity for a constructive and grown-up conversation on our shared ethos and values for the public health service, and the need for continued improvement.

First of all, can I say that it’s not often I get very angry in this Chamber with the representations made by members of all parties, but I was angered by what Dawn Bowden said? This party has never, never criticised the paramedics and the service they provide. We have been critical of the times that weren’t met under the previous iteration of this policy, and justifiably so. As you say, Cabinet Secretary, it was a difficult time, and you had to take some steps. And while I would agree with you to a certain extent that outcomes are the most important things, the one thing has come to pass that we feared, and you did not address this Dawn: that people are being missed by this new system who weren’t missed before, and, as a result of that, are not having what you would call a good experience, quality of care, or the best journey through the system. And for that, I’m going to quote a constituent of mine—an 80-year-old man—who fell at home, and despite repeated 999 calls, no-one responded to him for more than eight hours. He had a broken femur. He risked dehydration, shock and pneumonia. He was an amber call. There was no blue light in those eight hours. That man, by the time he got to hospital, was very nearly what we would now call a red call. He very nearly died.

So, there’s no point you coming to us and saying, Minister, that the amber category is not causing problems. What I would like you to do is present to us, or give me an answer today, about how many of those amber call responses have resulted in presentation at A&E in a condition that you would then call a red category. In helping you answer that question, one of the reasons, I think, why we still have a difficulty in meeting any kind of target—although there isn’t a specific target with amber, is there—is that we still have difficulties with ambulances lining up at A&E. And perhaps you can tell me how, if there is clinical evidence that it is a good idea, that this Thursday in Morriston Hospital, it took a constituent of mine eight and a half hours to get through A&E, and during that period of time, which was overnight, so not in the busy period in the day, there were six ambulances queuing up at A&E to discharge their patients. I welcome the fact that paramedics are feeling better about this. They did have difficult targets to meet before, but I’m wondering how many of them are going to be speaking to you shortly to say that those amber categories that they turned up for were in fact red. Thank you.

I thank the Member for the points that she made, but she asked a question that she knows is absolutely impossible to answer: how many amber categories could, or would, be red in the condition that they were in when they arrived at the hospital? I’ve recognised, and the evaluation recognises, and the direction I’ve given, both to the Emergency Ambulance Services Committee and to the Welsh ambulance service in responding to those recommendations is to actually look again at the categorisation of calls, but also to look at the time that it takes for some of those calls to be answered. And there is ongoing improvement where that is taking place, and, with the greatest of respect, to have individual examples and to then try and say, ‘This tells you about the whole system’, is a well-worn road, but, actually, it doesn’t really tell us a great deal about the whole-system improvement—it tells us about individual examples. There’s another issue to try and brush aside and say, ‘That doesn’t matter.’ Of course it matters to the individuals who are concerned. But, actually, across our whole system there has been real and unambiguous improvement in the performance of the Welsh ambulance service, and some of that is directly attributable to the fact that we have a model that now makes sense in the way that those precious ambulance service resources are used.

In terms of the point about the criticism of the service, you just can’t get away from the reality that the way in which the ambulance service was described on a regular basis did have an impact upon staff. If you spoke directly to the staff, they would tell you that even though people said, ‘I don’t directly criticise individual paramedics for the job they do’, they certainly felt that criticism in the performance of the job that they were doing, and that’s an unavoidable reality of how people felt at the time. [Interruption.] There’s no point trying to say that that wasn’t the position. It’s still a point that is made to me when I go to visit front-line staff within the Welsh ambulance service.

The Deputy Presiding Officer (Ann Jones) took the Chair.

I just don’t accept the point that the new model means that people are being missed. Actually, the new model ensures that people with the greatest level of need receive a response where there’s clear evidence that a fast response will make a difference to their outcomes. I will keep on saying: I will be guided by the evidence, the very best available clinical evidence and advice on what is the right thing to do with the ambulance service, with the categorisation of calls and with the response to those calls. It doesn’t matter how often Darren Millar chunters away about what he wants to see happen, my determination is to make a decision that is right for the ambulance service and the people of Wales, and I don’t really mind or care whether Darren Millar agrees with that—that’s my responsibility and that’s what I will do.

Thank you very much, Cabinet Secretary.