Diolch yn fawr, Llywydd. Firstly, I want to thank the Conservatives for bringing this important issue to the Chamber today, and all Members who've contributed to the debate. I've listened carefully to all speakers, and there have been many important points made. Stroke, as Mark Isherwood stated, is the fourth leading cause of death in Wales, and has a significant long-term impact on the survivors, and there are 70,000 of them in Wales.

Ambulance response to stroke is one element of stroke care in Wales. Other important elements include how we transform our model for stroke services across the system, and public awareness of stroke symptoms. The Welsh ambulance service recognises stroke as a potentially life-threatening condition, and always aims to respond as quickly as possible, and I agree that the current performance is not good enough. But for stroke patients, it's not only time that's important; it's also about making sure that they get the most appropriate response and rapid access to the right specialist services.

Stroke patients might experience any combination of a range of physical and neurological symptoms. It is these symptoms that will prompt the 999 call, and it is the relative severity of these symptoms that will inform how the call is categorised by the ambulance service. The Welsh ambulance service keeps the prioritisation of calls under ongoing review through its clinical prioritisation assessment software group, which is made up of senior clinicians and operational managers. The group has a planned, regular cycle of reviews, but will also make ad hoc reviews in response to emerging clinical evidence. This is a similar process to the other UK trusts, and aims to ensure that patients continue to receive the most appropriate response to meet their clinical need, based on the latest clinical guidance. 

The clinical response model was designed by leading clinicians, and decisions on the prioritisation of calls must always be made by clinicians on the basis of the latest clinical evidence. It is not for members of the committee, nor anyone else without that expert knowledge, to determine what happens on such matters. When the clinical response model was first introduced in 2015, it was predicated on an average of 5 per cent of calls being categorised as red. Would the committee also be interested in telling the ambulance services what other conditions will be downgraded from current red? I very much doubt it. Can I be clear? The Welsh Government did not downgrade suspected stroke ambulance response times to amber. All calls were previously given the same level of priority, irrespective of the clinical severity. So, prior to the changes, theoretically, cardiac arrest was given the same response time as toothache. So, the ambulance service introduced four new categories to ensure that people who needed a faster response received a faster response. As I say, the target was for 5 per cent of all calls to be categorised as red. But recently, red calls have been as high as 10.5 per cent in recent months—more than twice what the model was designed for, and a clear indicator that the ambulance service is increasingly responding to people with more complex and acute conditions.

Mark Isherwood suggested that England's ambulance service, which has a specific category for suspected stroke patients, had a mean response time of 47 minutes, except this isn't true. There is no separate or designated category for stroke in England. Although the categories and codes within these categories do differ between the Welsh and English models, calls are prioritised in the same way in both models. That is, on relative clinical severity. They, like us, do not have a hard-and-fast rule for all strokes.

We know that we need to do more to improve the timeliness of ambulance responses to all calls, and we have a national ambulance improvement plan in place to increase ambulance capacity, improve the responsiveness to people with time-sensitive complaints, and reduce ambulance patient handover delays. We've invested £3 million to enable WAST, the Welsh Ambulance Service NHS Trust, to recruit 100 more front-line staff, and that's on top of the 263 they've recruited in the past two years. I've also been extremely clear in my expectations for health boards to address handover delays, which have a significant impact on the availability of ambulances to respond to calls in the community.