Thank you, Presiding Officer.  In my statement on 15 May 2018, I informed Members that I had commissioned a clinically led, independent review of the Welsh ambulance service’s amber category. I'm pleased to be able to provide Members with an update following the completion of that review. Members will recall that an independent evaluation of the clinical response model, undertaken in 2017, found a universal acknowledgement from within the ambulance service and external partners that moving to the new model was the right thing to do. It found that the new clinical response model had helped the Welsh ambulance service to focus on the quality of care that patients receive as well as improving efficiency in the use of ambulance resources. It also made recommendations for further improvement, including a review of the amber category. 

In light of that recommendation, the amber review that I ordered sought to establish whether patients in the amber category are waiting too long for an ambulance response, and if so whether this is resulting in poorer outcomes and experience for patients. I'm encouraged to note that the amber review has echoed the findings of the previous independent review—that our clinical response model is safe. Our model continues to ensure that those in the greatest need receive the fastest response to improve their chances of a positive outcome, whilst also providing appropriate and timely care for patients who do not have immediately life-threatening conditions.

I've previously outlined the review process in place to keep all prioritisation codes under ongoing review. This review process, undertaken by experts in the field, ensures the allocation of codes to the red, amber and green categories remains clinically appropriate. Members will be aware of my focus on evidence-based measurement. It is interesting to see that the review has advised against introducing new time-based targets for ambulance services. Instead, we will continue to pursue a whole pathway measurement for conditions like stroke, and develop further clinical indicators and measures of patient outcome and experience in line with 'A Healthier Wales'.

Incidents in the amber category will generally receive a blue light and siren response, much like those in the red category. The main difference is that for red incidents all available nearby resources are despatched, whereas in the amber category the nearest and most suitable response is sent. This should help patients to access the right specialist care sooner. The majority of ambulance staff that took part in the review said they believe the prioritisation system works well, and the number of vehicles attending amber calls has decreased. And that should give us confidence that we're getting the right resource to people first time more often. That should improve clinical outcomes for people with conditions like stroke, heart complaints and fractured hips.

The review’s findings also, of course, present opportunities for improvement. The median response time for amber calls has increased by an average of seven minutes during the review period, from April 2016 to March 2018. That's clearly not acceptable and will be addressed through focused and collaborative work. Findings suggest timeliness of response has been affected by a number of capacity-limiting factors. That's despite additional Welsh Government investment of £11 million for patient care services over the last two years, and £38 million in capital investment over the same period.

Ambulance handover delays and staff sickness need immediate attention through a whole-system approach and improved staff well-being. I expect health boards and the Welsh Ambulances Services NHS Trust to work with partners to take responsibility for these issues and to take immediate action to address them. We will of course monitor progress closely.

The review was able to use innovative techniques to track patient-level data through the system. It found no direct relationship between long waits for an ambulance response and poorer outcomes for the majority of patients. However, the experience of patients and their families will be negatively affected and that is supported by public feedback. I expect action to be taken to enable reassurance and welfare checks to be provided when people are waiting longer for an ambulance to arrive.

The review found that incidents relating to people who have fallen accounted for the largest call volume within the amber category. In view of this, I have decided to allocate £140,000 to the chief ambulance services commissioner for a collaborative falls response project involving St John Cymru Wales.  

Anecdotal evidence from operational staff suggested that there were a significant number of calls from nursing homes for patients who had fallen and that it would be beneficial for all nursing homes to have lifting cushions. The national programme for unscheduled care will, therefore, fund several hundred lifting cushions for nursing and care homes across the country. Both of these initiatives should reduce the unnecessary dispatch of emergency ambulance resources to people who have fallen but are not injured and can be safely resettled.

The review found evidence to suggest that there are opportunities to better manage people in the community, either through providing clinical advice over the telephone, referring to alternative services or discharging at scene. Public feedback to the review suggests it is important to people that they avoid going to hospital if it isn't necessary. Eighty four per cent of those surveyed said they would prefer to stay at home, and 88 per cent of people felt it was important to them that medical advice was provided over the phone. Ambulance service staff also felt that expanding the numbers and roles of clinicians in the control room was essential to manage demand effectively. Given these findings, I have agreed to fund the recruitment of more paramedics and nurses to provide clinical advice to the public over the telephone to help manage demand in the community.

Investment of around £450,000 for the remainder of the year will also include a winter pilot of mental health liaison nurses in ambulance clinical contact centres, and that is based on feedback from clinical contact centre staff, who said that they do not have the required training to support people in mental distress. They believe that having a mental health specialist in the control centre would help to relieve pressure and allow more people in distress to be treated in the community.  

We will, of course, continue to work with the Welsh Ambulance Services NHS Trust, health boards and the chief ambulance services commissioner to take forward the review’s recommendations with pace and purpose. I look forward to Members' questions.