Part of the debate – in the Senedd at 4:21 pm on 13 February 2018.
Thank you. And thank you, David Rees, for the series of questions, and you're right to highlight not just the professional capability and commitment of our staff, but also the fact that the service runs on the goodwill of those staff as well.
I want to try and deal with your final point about telephony issues and elective postponements and district nursing budgets as well. I think it's best, given that you've asked me for information on elective postponements from November to February, that I write to you at the end of the February period. I have a number of abilities, but being extra sensory perception-savvy is not one of them. I can't predict the future in that way, so I'll write to you at some point in March when the figures are available.
It is worth noting, though, because I've answered a written question from Angela Burns recently on this, that of the postponements in December for elective procedures, over half of them were postponed by the patient, and so there's a challenge there about working across the whole system to try and make the whole system work better. That's not about blaming people who have postponed; it's actually about how we better organise our whole system.
On your other point about care packages to help people out of hospital, that's exactly why we've tried to help direct the £10 million with the advice and support of the Welsh Local Government Association and directors of social services, again looking at it as a whole system. I think it comes back to your point about long ambulance waits, because the easy and the straightforward thing to say is that, of course, I don't want, and no person in this room wants people to wait overly long for an ambulance, whether it's a red, amber or even a green call. The challenge then is what we do about understanding the issues behind some of those long ambulance waits, and that is only possible to see if we look at the whole system. For those ambulances that are held up outside an emergency department while they're waiting to be released, while there's risk in the community that has still got to be managed, there are differences and variations in practice across the country about how quickly that happens, but not only that—it's about recognising that there's a challenge at the front door, but also then to flow through the hospital so that the rest of the hospital system sees the front door as their challenge as well, and not just an issue for the emergency department itself. As with the package of care, there is an issue about reducing the backlog to get people out of hospital when they're medically fit, so to give them the support that they will need to do so. That must be a challenge that health and social care recognise that they own jointly for that individual citizen.
And it's then also looking at the use of local healthcare as well, and how we help people to make the right choices and how we support them to do so, and how we also deal with some of the use of the ambulance service itself. There's been really groundbreaking work undertaken by Cardiff and Vale about those people who regularly misuse the service, but some of that is about understanding what health and care need they do have even it isn't an emergency ambulance. That in itself is releasing lots of extra capacity for our ambulance crews.
So, it's about all of those points and recognising again what we could and should make in each part of them to try and deal with those longer waits, and not simply say, 'This is the problem with the Welsh ambulance service trust itself', but how as a whole system do we see the opportunities to improve.