3. 3. Statement: The Independent Evaluation of the Emergency Ambulance Services Clinical Response Model

Part of the debate – in the Senedd at 2:46 pm on 28 February 2017.

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Photo of Vaughan Gething Vaughan Gething Labour 2:46, 28 February 2017

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.