I think it is important for us to understand that the Welsh ambulance service trust has reported a significant increase in calls of between about 20 to 30 per cent compared to this time last year, and I think it's worth noting that 18 per cent of 999 ambulance calls are COVID-related. So, it's not just about the pressures in the system—COVID is still a major issue here. And it's also worth pointing out that this is not an issue that is unique to Wales. We've seen recent announcements in England, in Scotland, and there is a need to explore all of the possible avenues of support to maintain safe delivery of care and health services. 

Now, these system-wide flow challenges manifest in different ways across all parts of the system. Of particular concern is the significant impact on ambulance capacity caused by ambulance patient handover delays that so many people have talked about this afternoon. And that is compounded by increasing demand on services as well as workforce, and resource constraints due to the continued impact of the pandemic. So, we do need a genuinely system-wide response to address these system-wide challenges which, by their very nature, can't be viewed in isolation or solved by any single part of the system.

So, we need cohesive actions to take place at local, regional and national level, and despite significant investment and accelerated recruitment to the Welsh ambulance services, staff resourcing has continued to be significantly impacted, as some have pointed out, by staff absence, and that's through a combination of staff sickness, which grew by 10 per cent [Correction: to 10 per cent] FootnoteLink in June 2021, self-isolation—they are affected of course by COVID as well—shielding, annual leave—which was delayed, of course, for so many staff as a result of the emergency response to the pandemic. We've got to accept the fact that a lot of these people are reaching burnout and they need a break. 

Welsh ambulance staff have been working to their limit, and often going beyond what could be reasonably expected of them over the course of the pandemic. And of course, that is impacting on staff morale and well-being. There's also been a reduced uptake of overtime, which has prompted the trust to consider options to incentivise overtime in order to make it more appealing to staff to fill gaps, and increase capacity over the forthcoming months.

Now, practical requirements, including the need to don personal protective equipment and deep cleaning of equipment and vehicles for each ambulance response. Don't forget, we're working in a COVID environment; it changes what they do usually to something more difficult and more sophisticated. And that also impacts therefore on ambulance availability and responsiveness at times of peak demand. 

Now, these capacity-limiting factors have been accentuated by difficulties in timely discharge of patients from hospital, which, again, so many Members alluded to, and this reduces available hospital beds and causes delays for the transfer of patients from ambulance crews to the emergency department staff. Despite all of these challenges, almost 60 per cent of immediately life-threatened patients received a response within eight minutes in July. Almost a third of these patients received a response within five minutes.

Now, over recent weeks there have been a number of occasions when the Welsh ambulance service trust has experienced pressures that have forced it to escalate, through its demand management plan, to a level at which it has not been possible to send an ambulance for certain categories of calls. Now, the demand management plan enables the trust to dynamically react to situations where the demand for services is greater than the available resources, and it's designed to optimise the safety and outcomes of all patients, and to prioritise those patients in the greatest need of an immediate response based on the resources available.

Now, I don't think it would be appropriate for the Welsh Government to declare an emergency in the Welsh ambulance service, but of course we accept there is a problem here that needs to be resolved. The trust is taking actions to transition from the recovery phase of its COVID-19 effort back to the response phase, the monitoring position, in response to the current and anticipated pressures. Now, this places the trust on a similar footing to when we were at the height of the pandemic, so I'm underlining the point that the problem now is as great as it was at the point of the greatest risk in terms of the pandemic. That gives a stark perspective on the level of the pressure the service continues to experience.

The Welsh ambulance service has been considering a number of options to supplement existing capacity, including exploring options with a number of national agencies. So, the trust has already contracted St John Ambulance Cymru to support additional support over the busy winter months, and the trust has also been working with military planners as part of the MACA, or the military aid to the civil authorities process, which the First Minister explained in the Chamber yesterday. The Welsh Government received the MACA from the trust earlier today, and both the First Minister and I have now agreed that that should now be passed on as a formal request.

We haven't been waiting for things to happen. In fact, in July, I called an extraordinary meeting of the emergency ambulance services committee, because we saw that there might be a problem. I requested the development of a delivery plan. I think somebody was asking for a delivery plan; we've got one and that sets out a range of time-bound actions to be delivered between now and the end of March 2022. The key actions in that plan—as Janet-Finch Saunders, I think, wanted me to tell her what was in the delivery plan—were: improved forecasting to better understand and plan for actual demand and match resourcing accordingly; continued implementation of recommendations from independent demand and capacity review; ensuring we're able to control the demand on our services whilst ensuring patients are safe and receive the care they need in the place that they need it; health board clinicians directly managing ambulance patients and redirecting them to clinically safe alternatives; and using ambulance staff to safely cohort multiple patients, allowing ambulances to return to community response.