Although it has only been six months since the commencement of the programme, I'm encouraged to note improvement in the typical response time to patients in the amber category. The latest available data shows an improvement in the typical response time during every month between December last year and March of this year when compared with the same period in the previous winter.

There has been a reduction in excessively long waits found by the review team, but there is still much work to be done to eradicate unacceptably long waits for some patients. This is the source of considerable focus through this programme. I expect to see an agreed plan for improvement by the programme board by the end of this month to address the remaining long tail of waits.

Typical response times to amber calls in some health board areas are extremely positive and conducive to a good patient experience and clinical outcome. For instance, the typical response time to amber calls in March 2019—at the height of winter pressures this winter—in Powys was just 18 minutes, and 20 minutes in north Wales. However, there does remain local variation, and whilst amber responsiveness in the Swansea Bay area has improved when compared to last year, there are continued challenges caused by ambulance patient handover delays at the Morriston site.

In recognition of this challenge, I have directed the chief ambulance services commissioner to place immediate and targeted focus on achieving improvements at this site. A series of new actions have now been agreed with local clinical teams. These innovations are being delivered alongside broader whole-system actions in the area to improve community care and enable people to leave hospital when they are ready. We will, of course, monitor the situation closely.

Members will recall that a central tenet of the amber review was the need to focus on certain groups of patients to improve experience. This included people who reside in care homes, who are more vulnerable to falling because they are frail or as a result of the complexity of their conditions. The Welsh Government has provided £1 million for the purchase of modern lifting equipment in almost every care home in Wales, which is proven to support patient experience and, if possible, enable people to stay within their own home. We understand there are now only four care homes in Wales that do not have the up-to-date lifting equipment. 

We've also provided funding for the Welsh Ambulance Services NHS Trust’s falls assistant response service. The primary objective of this project is to enhance patient experience for people who have fallen, but who are uninjured or have minor injuries, ensuring they receive a timely response and to prevent the need for avoidable hospital admission. Falls assistant units have been utilised to attend a variety of calls within the amber and green categories involving people who have fallen or other welfare-related issues. Since 1 December 2018, falls assistant units have responded to almost 1,800 people, with an average response time of just 24 minutes.

Since November 2018, I have made available extra funding to the Welsh ambulance service that has allowed it to recruit 16 additional clinicians to work on its clinical-support desk. Over 80 per cent of these additional healthcare professionals are nurses. They bring their experience and expertise to enhance the skill mix and capacity of the service. More senior clinicians were also recruited to undertake supervisory roles. 

As a result of this enhancement of the clinical support desk function, the Welsh ambulance service was able to resolve over 16,000 calls over the telephone between November 2018 and March 2019. This has meant thousands of people being treated in the community without the need to be taken to a hospital. The Welsh ambulance service is currently considering the optimum staffing levels to enable it to deal with up to 12 per cent of patients over the phone.

While the review found that the clear majority of people felt that getting the best response for their condition was more important, even if it is not the quickest response, there was recognition that waiting for an ambulance can be an anxious time for patients and their families. In order to improve patient choice and reduce patient anxieties, the Welsh ambulance service has introduced a new script for call takers at times of high demand to help provide callers with an indication of how long they can expect to receive a response.

Use of the new script will be monitored and reviewed, with a view to introducing it more widely. The Welsh ambulance service continues to engage with the public to build on its understanding of what matters to patients. The programme team is also working in partnership with community health councils, the Stroke Association and its local patient groups, and NHS Wales partners to develop measures that give greater context to ambulance response times to people who have a stroke. I'm expecting these to be available for winter 2019-20. Any measures developed will be designed for public reporting.

The amber review reinforced that the ambulance service must ensure that planned resources are sufficient to meet expected demand. The trust has commissioned a capacity and demand review to inform future configuration of resources and staffing across Wales, and to improve service resilience during periods of high demand. The review is due to be completed by the end of September this year, and will be considered at the emergency ambulance services committee meeting in October.

The Welsh ambulance service is currently undertaking a mapping exercise to show which services are available across Wales. This should help to identify where there are services that could and should be implemented to support work on admission avoidance. I expect this mapping exercise to be the catalyst for more consistency around pathways of care across Wales.

It is clear that there is still more work to be done to support delivery of the recommendations of the amber review. However, early steps have been made to reduce typical response times to amber calls, to reduce excessively long waits for patients, and to improve the experience for some of the most vulnerable members of our communities.

I will, of course, be happy to provide a further update to Members in the autumn.