1. Will the Cabinet Secretary make a statement on ambulance response times in South Wales West? OAQ51478

Ambulance performance in the Abertawe Bro Morgannwg health board area has exceeded the eight minute target for red calls in each of the last 19 months. In October, the typical response time for a red call was just over five minutes, and for amber calls the typical response time was less than 20 minutes.

Thank you, Cabinet Secretary. We have made great progress in dealing with immediately life-threatening calls, but not so well for amber calls. Last month saw over 35 per cent of amber calls taking more than half an hour for a response in ABMU. The longest wait across Wales was a staggering 23 hours. When you consider that suspected strokes are categorised as amber, and these patients can wait up to 10 hours, this could hamper their recovery. The new response model was supposed to filter out calls that did not need a blue-light response in order to free up resources to respond to those calls that did. Cabinet Secretary, what more can your Government do to ensure that Welsh patients are not waiting up to a day for an ambulance?

Well, this is an issue of obvious concern, not just to the wider public but to myself as well. I have seen and identified in the independent evaluation of the new clinical response model some concern about the boundaries of categorisation, between red and amber, as one issue that is being addressed by the emergency ambulance services committee and the Welsh ambulance services trust, in addition to the longer tail. Because whilst our average times are reasonable, there are too many people waiting too long. There are examples of people waiting significant amounts of time, so I have already asked the chief ambulance services commissioner to undertake a piece of work to understand why that is happening, and then also for our whole system to look at what needs to change to resolve that. Because overall, we actually provide a good service, and we should be proud of the improvements that we have chosen to make. Ninety-six per cent of people with suspected strokes received the appropriate care bundle—a significant improvement in the quality of care being provided. The average response to a stroke call is less than 14 minutes. But for some people, they wait too long. We should be honest about that, recognise that, and look to improve that. That's exactly what I've tasked the health service with doing.

Cabinet Secretary, co-responders are an essential part of the ambulance service provision, not least in rural areas. Their role is also being increasingly felt as, when attending amber or even green calls, what they discover is a person whose status was red, or whose status had become red due to the delay, which they can either deal with themselves or escalate. Can you confirm that you've been asked by the ambulance service to transfer the responsibility for funding this essential service to health boards, who are, bar one, already overspent, and that you've been asked that co-responders should only be sent out to red calls, thereby jeopardising the safety of those whose calls have been wrongly categorised, or which have become more serious due to delay? If you have, will your response to both those questions be 'no'?

I haven't been asked to make those choices. Those are operational choices for the service to make about the right way to deploy services. If there's a choice to be made about what's a clinically appropriate thing to do, then again, that isn't something that I think I should try and step into as the Cabinet Secretary for health. We instituted a new model based on clinical evidence and advice to try and get away from the interference of politicians and targets that didn't necessarily make sense. That must also apply to how we make the best use of our staff to deliver the right response. Co-responders and community first responders are part of what makes a difference for people, in particular for those people who require an eight-minute response. So, there's something about understanding how they're properly deployed, how we use them effectively, and actually there's a piece of work again about trying to make the best use of those people and understanding where they come from—whether they're there from other public services or from the community first responders team. So, it's an area that I take an interest in, in terms of asking questions about what could and should happen, but I won't step into the space of giving direction about operational matters, or indeed matters where clinical judgment should lead the way the service uses its resources appropriately.

I've been made aware of recent examples in Swansea where patients—well, one patient had to wait three and a half hours with an urgent situation for an ambulance, and another patient waited four hours having suffered a myocardial infarction. Still at home, they waited four hours for an ambulance to attend the scene. Another patient waited five hours for an ambulance to attend the scene in the community. On top of that, I'm aware of people having to wait on trolleys for over 20 hours in accident and emergency, having had a heart attack as well. Now, I take on board all that's been said so far, that this is obviously about improving patient flows through hospitals, and naturally I'm aware that much good work is being done, and in all these cases that I've outlined, there is nothing but the highest praise for the nurses and doctors involved in the cases. But those waits remain. So, what in addition can you do to address matters?

I think you neatly highlight the point that I was trying to address in response to Caroline Jones's supplementary, that overall our service is good. The great majority of people receive a timely response that properly meets the care need, and actually we now have a better prospect of getting to people with the highest level of care need because of the changes we have made. But, there is a recognition that some people do wait too long. You've highlighted four instances where I wouldn't try to tell you that everything is fine. I'd be very interested, if you wanted to write to me with more detail on those, so that I can have them properly investigated, but there's something about not standing up here and saying everything is awful, and then equally not trying to stand up here and saying, 'Everything is fine, so don't criticise.' It's important for us to understand what doesn't work as well, and then to honestly look to address it. So, if you want to give me the individual instances you've raised, I'll look at whether they're individual matters or part of the system-wide challenge that I've already tasked the chief ambulance services commissioner with actually looking to address for us.