Part of the debate – in the Senedd at 2:56 pm on 6 November 2018.
Thank you, Cabinet Secretary, for your statement. There are obviously things to welcome in the report, as Angela Burns has already said, and in your statement. I'll be particularly interested to see how the falls response project with St John Ambulance progresses, and I hope you'll come back to us to tell us. I'm very optimistic that that will have some positive outcomes.
The financial investment that you mention in your statement is also welcome. Can you confirm to us today that that is new money for the ambulance service? And can you also, perhaps not today—. If it is new money, it will clearly have come from another part of the health budget and I'd be very grateful if you could write to Members to confirm out of which part of the healthcare budget the new money for the ambulance service—if it is new money—has come.
The report makes a number of recommendations, and I'm struggling a little bit to see quite how your statement reflects the recommendations, but I would accept that it does, broadly, in spirit. I'd like to draw your attention to one particular recommendation where the report recommends a programme of engagement to ensure clarity on the role of emergency ambulance services and how calls are prioritised and categorised. Do you accept that specific recommendation and, if so, can you tell us whether this programme of engagement will provide opportunities for concerns to be raised again about the breadth of calls that are included within the amber category? Your statement says that prioritisation, as it stands,
'should improve clinical outcomes for people with conditions like stroke, heart complaints and fractured hips.'
But would you accept, Cabinet Secretary, that these are actually quite different conditions and that, for some of them, they are much more time sensitive than others? I would suggest, for example, that stroke is much more time sensitive, in terms of the ultimate outcome for the patient, than fractures. In fact, of course, the report shows that internally the service does effectively use an amber 1 and an amber 2 code, as well as protocols to prioritise based on the information of what's happening for the patient. And it also states that the relationship between time and care has been established for a number of conditions, such as acute heart myocardial infarctions and stroke. So, therefore, wouldn't you accept that this shows that time actually does matter for patients and that this internal categorisation reflects that? Would you be prepared to consider, as you work with the ambulance trust to move this forward, whether it is time to look again at formalising a target, particularly for those amber 1 calls? I understand the reluctance to overburden the system with targets—none of us would wish to do that—but where those calls are time sensitive for patients like patients with stroke, I'm a bit bemused by your reluctance to be prepared at least to consider setting a target.
In terms of categorisation, the report also identifies that, sometimes, calls are initially regarded as amber and then get upgraded to red calls because of additional information becoming available. The report also states that there are times when the staff felt that there was an inability for call handlers to deviate from the system because the system was restrictive, and I wonder if you would take another look at that to see whether it needs to become a little bit easier for staff to use clinical judgment to move calls up a category to red or perhaps from amber 2 to amber 1, if necessary.
And finally, can I just ask you again a little bit more—? You did respond to Angela Burns's question about the sickness rates and the stress that I think we can accept is probably at the root of those sickness rates. You mentioned in your response to Angela Burns that you will be expecting the local health boards and the ambulance trust to work on that and to work with the trade unions on that issue. But can you give us a little bit more detail about what exactly that work will consist of and the time frame for it? Because you know very well, of course, Cabinet Secretary, that our health and care services—and none more than our ambulance service—depend entirely on our staff, and, if there's a question about the well-being of the staff, I think that we would all like to be further reassured about how those questions with regard to their well-being are being addressed.