The latest SSNAP data also shows that it takes on average six hours and 35 minutes between stroke onset and arrival at hospital in Wales, compared to three hours and 41 minutes in England and two hours and 41 minutes in Northern Ireland. This impacts on the time it takes for patients to receive a scan, with patients in Wales being scanned just over eight hours after their symptom onset, compared to 4.4 hours in England and 3.3 in Northern Ireland.

Wales's current clinical response model classifies stroke as an amber response call, which is serious but not immediately life threatening. Since 2015, amber calls have had no target time, meaning that patients can often be waiting several hours for an ambulance to respond. Although the Welsh Ambulance Services NHS Trust confirmed that a differing response will be made for haemorrhagic strokes, stating in 2020 that they will often tip into the red category due to their seriousness, these types of stroke are in the minority, making up, as I said, 15 per cent of stroke cases.

Further, the Welsh Ambulance Services NHS Trust stated that although there were no target times, the ideal response times for amber 1 and 2 categories were around 20 minutes and 30 to 40 minutes respectively. Given the seriousness of ischaemic strokes, which make up the majority of cases, and the deterioration of amber response times, this should, therefore, be revisited.

The last review of amber response calls, conducted in 2018, found that the clinical response model is a valid and safe way of delivering ambulance services, and that the length of time waiting for an ambulance response in the amber category does not appear to correlate with worse outcomes. However, by 2020, and pre pandemic, the Welsh Ambulance Services NHS Trust stated that amber performance remains a concern.

Since COVID-19, amber response times have deteriorated significantly, with a median waiting time of one hour and 35 minutes in September—last month—2022. Comparing Welsh Ambulance Services NHS Trust amber 1 and 2 category ideal times, just 12.6 per cent of overall amber times arrived within 20 minutes, and 25.2 per cent within 40 minutes. A staggering 64.3 per cent—nearly two thirds—took over an hour to respond.

The English NHS recategorised ambulance emergency target calls in 2017, with stroke categorised as 'emergency', with a target time of 18 minutes and 90 per cent of calls in 40 minutes. In September 2022, the mean response time for category 2 ambulances in England was 47 minutes and 59 seconds.

Given the pandemic and subsequent pressures on both ambulance and accident and emergency departments, it is, therefore, imperative that the suitability of amber calls for stroke patients in Wales is revisited. As of April to June 2022, less than half of stroke patients in Wales—46.1 per cent—were arriving at hospital by ambulance, down from 75 per cent in January to March 2021. 

Although the Stroke Association does not support recategorisation of amber calls, stating, 

'It is better for stroke patients to get the most appropriate response vehicle'

—an ambulance that can take them to hospital, rather than simply the first one that is available, which may be unable to get them to hospital to receive the treatment they need—it supports a committee inquiry into ambulance response times for stroke in Wales, which would examine the issue in more detail. They add that the review should look into the experiences of stroke patients from call to treatment, to understand how the pathway can be improved.

The Welsh Conservatives believe that the Stroke Association should not be forced to choose between a quick response by an inappropriate vehicle and a slow response by a life-saving ambulance, and that the system should be able to be adapted to ensure that an ambulance is sent for a suspected stroke, subject to the modelling necessary. It has been suggested that a few ambulances should be attached, for example, to the stroke medicine department through a direct telephone line, and emphasised that rehabilitation should start as soon as the patient arrives in hospital.

The Stroke Association has also called for a renewed FAST campaign by Public Health Wales. The FAST campaign—face, arms, speech, time—was launched UK wide in 2009 to improve awareness of stroke symptoms and urge those experiencing these to call 999 as soon as possible. Acting fast gives the person having a stroke the best chance of survival and recovery. But although the FAST campaign was run in both England and Northern Ireland in 2021, it was last run in Wales in 2018. Analysis of the campaign in England found that, after being shown the materials from 2021, nearly two thirds of those at risk mentioned needing to act as a campaign message, and two thirds mentioned a need to call 999 or ask for help. Modelling found that the campaign is highly cost-effective, and since launch in 2009 it has delivered 4,000 additional thrombolysis treatments, providing 1,137 quality-adjusted life years, and a return on investment of £8.98 for every £1 spent.

Throughout the pandemic, Welsh Conservatives have been constructively calling on the Welsh Government for action in numerous areas to help the Welsh NHS recover from COVID-19. As Wales and the NHS seek to come out of the pandemic, it's critical that a cross-party approach is embraced to the fullest by Welsh Government. Diolch yn fawr.