The following amendment has been selected: amendment 1 in the name of Lesley Griffiths.

The next item 9 is the Welsh Conservatives debate on stroke. I call on Mark Isherwood to move the motion. Mark Isherwood.

Motion NDM8113 Darren Millar

To propose that the Senedd:

1. Notes that World Stroke Day is 29 October 2022.

2. Recognises the urgent response required to prevent danger to life for people suffering a stroke.

3. In accordance with Standing Order 17.2, instructs the Health and Social Care Committee to conduct a review into the benefits and challenges of recategorising strokes as 'red: immediately life-threatening calls' under the Clinical Response Model.

Motion moved.

Diolch, Llywydd. Our motion today proposes that this Senedd notes that World Stroke Day is 29 October 2022, recognises the urgent response required to prevent danger to life for people suffering a stroke, and instructs the Senedd's Health and Social Care Committee to conduct a review into the benefits and challenges of recategorising strokes as red calls, immediately life-threatening, under the clinical response model.

World Stroke Day takes place on 29 October every year. It provides an opportunity to raise awareness of the serious nature and high rates of stroke, and to talk about ways in which we can reduce the burden of stroke through better public awareness of the risk factors and signs of stroke. It is also an opportunity to advocate for actions by decision makers at global, regional and national levels, which are essential to improve stroke prevention, access to acute treatment and support for survivors and care givers. For 2021 and 2022, the campaign is focused on raising awareness of the signs of stroke and the need for timely access to quality stroke treatment.

Across the UK, a stroke happens every five minutes. An estimated 7,400 people a year in Wales experience a stroke—the fourth leading cause of death in Wales. A further 70,000 stroke survivors live in Wales and, without early intervention and diagnosis, significant harm to the patient, or chance of death, subsequentially increases—this is substantially.

According to the Stroke Association, there are three different types of stroke: ischaemic, the most common type of stroke, found in about 85 per cent of cases, caused by a blockage cutting off the blood supply to the brain; haemorrhagic, caused by bleeding in or around the brain and apparent in 15 per cent of cases—this is the most severe type of stroke; and the transient ischaemic attack, also known as a mini stroke, where the symptoms only last for a short amount of time. 

Strokes are a conditions where the golden hour is vital. Certain acute conditions, including stroke, have 60 minutes to receive definitive care. Any later, and harm, including brain damage, physical disability and mortality, can increase significantly. Quality standards for strokes in adults, published by the National Institute for Health and Care Excellence, also highlight that patients with acute stroke should receive brain imaging within one hour of arrival at hospital should they meet any indicators for immediate imaging. NICE and the Stroke Association recommend the use of thrombolysis, or clot-busting medicine, within four and a half hours of an ischaemic stroke. According to NHS advice, alteplase, the medication used for treatment, is most effective if started as soon as possible after the stroke occurs, and certainly within four and a half hours. The NHS further notes that medication is not generally recommended if more than four and a half hours have passed, as it's not clear how beneficial it is when used after this time, and that it is vital that a brain scan is done to confirm diagnosis of an ischaemic stroke, as the medicine can make bleeding that occurs in haemorrhagic strokes worse.

Latest Sentinel Stroke National Audit Programme data, or SSNAP data, showing hospital performance on stroke management across England and Wales, highlights a decline in appropriate care for stroke patients. Once arrived in hospital, stroke patients must be scanned within an hour, according to NICE, yet three hospitals in Wales took longer than this target time to scan a patient.

The SSNAP data, which scores Welsh NHS responses to key indicators, such as time to scan, time to treatment and time to admission to stroke units, highlights some concerning trends in Welsh hospitals. Their scores range from A, or hospital meets the highest standards for almost all patients, to E, or hospital does not meet the highest standards for almost all patients. The latest overall scores for Welsh hospitals were D for all hospitals apart from Withybush, which scored a C, with, for example, all three district hospitals in north Wales scoring E for admission to stroke units in their latest disclosed figures.

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.

I have selected the amendment to the motion, and I call the Minister for health to formally move amendment 1.

Amendment 1—Lesley Griffiths

Delete point 3 and replace with:

Notes the recent establishment of the Stroke Programme Board to drive service improvement and deliver improved stroke outcomes for people in Wales.

Amendment 1 moved.

Formally.

Jenny Rathbone. No, Rhun ap Iorwerth.

Sorry, Jenny. I caught you slightly by surprise there. I caught myself by surprise as well. Rhun ap Iorwerth.

Thank you very much, Llywydd, and I thank the Conservatives for bringing this subject before us today. I'm not sure about the motion in its entirety. We'll come to that in due course, but in terms of the central point, what we have in clauses 1 and 2 in the motion, yes, it is World Stroke Day on Saturday 29 October, and it's important to take every possible opportunity to remind ourselves of the impact that strokes have within our families, within our communities, and what we can do and what the Government can do to ensure that our response is as strong and as effective as it can be.

Clause 2, of course, we recognise that we need an urgent response when somebody has a stroke in order to try to influence the best outcomes for that person. Stroke is the fourth main cause of death in Wales. The survival rates have improved, and that is to be welcomed as technologies worldwide improve. It is important to note, however, that your chance of survival is much greater if you don't live in poverty, and this is another one of those areas where health inequality has a genuine impact on your chance of survival if the worst happens.

But we do know that there is much more that we need to do to improve the service that is provided in Wales after a stroke. We need to ensure that survivors do receive better support, receive their six-monthly reviews, and receive services to rebuild their lives in some ways. There is a need for physiotherapists, occupational therapists, and so on, to ensure that people have the necessary support after suffering a stroke. 

Now, there is also the element that we see in the motion of urgency—the need for a response as soon as possible when a stroke happens. We see the statistics that show us that, on average, it takes six and a half hours between the start of a stroke and reaching hospital in Wales, and that is significantly longer than what we see in other parts of these isles. I do hope that the Minister, in her comments, will recognise that that's not good enough and that we need to improve that performance significantly.

I will draw attention here, in terms of a swift response, to the fact that the Wales air ambulance notes on their website that stroke response is one of the services that they offer. That is noted very clearly on their website. I draw attention to that, of course, because of the concerns in parts of Wales—in mid Wales and the north-west in particular—that the ideas on the table in terms of reorganising air ambulance services mean that people in the hardest-to-reach areas are going to have to wait longer for A&E to reach them, because, of course, that's what the air ambulance is. 

I'll turn now to clause 3. I do see this, I have to say, as a strange clause. I can see that the Conservative spokesperson on health and care is not in his seat this afternoon, for whatever reason, but what we have is a proposal by his party ordering the health committee to look at issues relating to stroke and the response to stroke. As a member of the health committee, I see that as a strange thing. I'm perfectly happy for the health committee—if we can make time for it; maybe we can have a conversation with the Chair about that—to look at that area, but I do see it as an odd process that that is being presented in this way. 

I'll turn quickly to the amendment from the Government. I have had an interesting experience in preparing for this session today, because I can't find any information at all in terms of what the stroke programme board that the Government refers to here is, which it says is going to make a great contribution to the response to stroke in Wales. There is no information available anywhere as to whether it exists and who is a member of that board, so I'm looking forward greatly to the Minister educating us on that. But it does say to us that where action is being taken, the Welsh Government should explain that. Even charities couldn't tell us what that board was. I'll listen very carefully. But we can all be in agreement that we need to do more to ensure that people who do suffer from stroke in Wales have urgent support, and the best possible support.

I'm grateful to my colleagues for tabling this motion, especially given that this Saturday marks World Stroke Day 2022. As Mark Isherwood mentioned in his opening remarks, on average, 7,400 people a year in Wales will experience a stroke, the fourth leading cause of death in this country. Therefore, the importance of fast-acting, excellent-quality stroke services cannot and should not be underestimated, not just in supporting and treating patients, but within the wider context of pressures within the health and social care system.

But for this to be the case, the entire system needs to be overhauled. We have heard this afternoon about the importance of those first 60 minutes post stroke. In that time, treatment intervention can be the difference between a successful recovery or irreversible damage. And if you live in a rural area like Carmarthen West and South Pembrokeshire, then the attainability of this target is one of huge concern. Since 2015, stroke emergencies have had no target time, meaning that patients displaying FAST symptoms can often wait several hours for an ambulance to respond to their call. And as we've heard during the debate, stroke patients do not have hours to wait.

Not only does the Government need to review its clinical response model, but it also needs to ensure that there are quality services in place to support an individual through their stroke treatment action plan. On both fronts, unfortunately, this isn't currently happening. Over the past few weeks, I've had the pleasure of meeting with both Carmarthen Stroke Group and Stroke Association UK on the Senedd steps to discuss the effectiveness of the FAST acronym, the importance of quality stroke services, and the administration of quick and fast access to healthcare. 

However, having reviewed the most recent SSNAP data for west Wales—the sentinel stroke national audit programme—where services are rated from A to E depending on their quality, it is clear that stroke services across the country have not received the focus and funding they require. SSNAP data for Withybush Hospital categorises four of their six ratings as outside the acceptable green zone, with their 'admission to stroke unit' rating scoring an E, the lowest possible grade. At Glangwili Hospital, both 'admission to stroke unit' and thrombolysis services were rated an E. And at Prince Philip Hospital in Llanelli, three services—stroke admissions, thrombolysis and occupational therapy services—received, again, an E, Minister. I'm sure you'll agree that simply isn't good enough, and this is happening in our region as Members. 

Let us make no mistake: the situation I have described this afternoon is certainly not the fault of our committed and dedicated NHS staff; this is the responsibility of the Government. But if we are to give any stroke patient the best chance of recovery, then we must ensure that stroke services across the board are the very best that they can be. This is our opportunity to overhaul stroke services in Wales and ensure that every person, no matter what their postcode, has excellent access to top-class services, which can take the necessary interventions to prohibit the irreversible damage of severe strokes. With that, I would urge all colleagues in this Chamber to vote in favour of this motion this afternoon. Diolch.

My constituents have a challenging relationship with stroke services, unlike those in many other parts of Wales, due to us not having a district general hospital in Powys. The rural nature of Brecon and Radnorshire and the lack of stroke service provision makes treatment more difficult for my constituents, and many of them have to travel across the border into Herefordshire and Worcestershire to receive treatment. A total of 150 people in Powys were admitted to hospital in England following a stroke in 2021-22. Think of the difference that it could've made to those people if they could've been treated closer to home. For a long time, as the Minister knows, I've been calling for an acute stroke unit within Brecon and Radnorshire, to ensure that people get timely treatment in our communities. This would be a massive boost to the people in my area who are desperately in need of modern and effective stroke provision.

With strokes, the seconds and the minutes matter. People from Powys having to go across the border for treatment is an unnecessary burden in time for those people who have suffered. The lengthy travel times due to the lack of a hospital, as I've said, in Powys, make death and disability more likely, because time saves lives. I was reassured, I think it was last week, to hear, health Minister, that you had plans for regional stroke services that are being worked on, but my residents need to know how many people in those will be able to stay in Wales for treatment instead of going into England. Because the closer we can have stroke treatment to home, the better, and I think I'd like to hear more clarity from you around when we're going to see those coming to fruition.

With stroke being the fourth leading cause of death in Wales, it's essential that people in mid Wales have good, timely treatment and they are not passed over. Stroke provision must be a priority, and when we look at the Wales-wide ambulance response times, it seems to me and others that this is not currently a priority for the Welsh Government. That's why Welsh Conservatives are calling for a review into the benefits and the challenges of recategorising strokes as red calls instead of amber. That's something that I hope the health committee can look into. This would be a recognition of the huge challenges that stroke poses and a big step on the way to dealing with the problem, which will get worse before it gets better. Diolch, Llywydd.

I think this is an important debate, because, as has already been acknowledged, it is the fourth biggest killer, so it's clearly something we need to get right. But I would caution James Evans on the idea that we could have a district general hospital in Powys that would provide you with the quality of care that you need when you have a stroke. [Interruption.] If I misunderstood you, I'm happy to take an intervention.

I didn't say we needed a district general hospital in Powys; I'd like to see one, but I recognise the challenges of doing that. What I would like to see is actually more of those services being delivered, like a stroke care centre, in our little cottage hospitals or in our minor injury units, so actually we can have those services closer to home so people don't have to travel over 40 minutes in a car.

It might well be possible, in a cottage hospital, to deliver the sort of rehabilitation services that you may have in mind, but it isn't going to be possible to deliver clinical excellence unless you've got the critical mass of patients to justify it. It is really, really important that we have stroke units that are available to all our populations within a reasonable driving distance, but there's no doubt that, if you're having a stroke, you need to go to a stroke unit, end of story. That is what the ambulance should be doing—and I'm hoping that the Minister will reassure us that that is what they are doing—because it means that survival is infinitely more likely and the limitations on any disability much more likely.

This is an important debate, and I think it's a good use of World Stroke Day on Saturday to highlight this issue. But I have to say, I'm struggling a little bit in terms of the amount of information that we have been given by the Stroke Association. I was quite concerned when I got the information that my stroke unit for my population in Cardiff and the Vale has an overall score of D. But, when I asked for more information to understand exactly what was going on, I was just referred to the methodology, the alphabet soup; this is not helpful. I need a layperson's description as to what we need to do. And whilst I acknowledge that the physiotherapy services, the speech and language services, occupational therapy, are really good, and the scanning services as well, the key issue is how quickly can you get thrombolysis when you first have a stroke.

That brings us back to the amendment. I'm not convinced, I'm afraid, that recategorising strokes as red, in the same category as immediately-life-threatening calls, is the right approach at this point, because, brutally, if we add stroke to the red list, then in the context of today's stretched services, I fear that that would mean that other people on the red list would die. I don't want to be alarmist about this, but I think—. I acknowledge, however, that the Tories' motion is taking a precautionary approach by suggesting that we refer this to the Health and Social Care Committee to review the benefits of recategorising it, but there's nothing stopping the Health and Social Care Committee from doing that anyway, if they wish to.

I think more important for me is really understanding how the stroke implementation group, which was established in 2013, has been approaching its work to bring all stroke units in Wales up to the standard that is required, and how this stroke implementation board, which was announced in a written statement in September last year, is actually going to change things. Because I don't know anything further about the stroke implementation board. Like Rhun, I've had difficulty finding out about it. I think this is a really important debate, and clearly one that our constituents want us to pay attention to. But, I do think that we need to be clear that in order to have high-quality stroke units, we need to have them not in every district hospital; we need to have stroke units geographically spread out so that the whole population is able to get to one, but it has to be with the justification for the population of that area if you want the quality that everybody is going to want if it's their loved one or their constituent who is having a stroke.

I look forward to hearing the Minister's contributions. I want to hear a little bit more about what Dr Shakeel Ahmad, who is our Wales national clinical lead for stroke, has been doing. I also note that there is a UK conference in Liverpool at the end of November, which I hope some of our Welsh clinicians will be going to, because this is something that is just as important for people the other side of our border. There's been huge improvements in the way that stroke patients are cared for, but, clearly, there's always more to learn.

It has already been pointed out that an estimated 7,000 people a year in Wales experience a stroke, and that can be the equivalent of a whole town having one every year. It takes on average, as has been said, 6 hours 35 minutes between stroke onset and arrival at hospital in Wales. Compare that with 3 hours 41 minutes in England, and 2 hours 41 minutes in Northern Ireland. There's been mention of this need for that golden hour. Some years ago, a relative of mine experienced a stroke, and in those days it was almost expected that it was going to be classed as urgent.

The sentinel stroke national audit programme data, which scores Welsh NHS responses to key indicators such as time to scan, time to treatment, time to admission to stroke units, highlights some concerning trends in north Wales hospitals. With the worst possible score of E, Wrexham and Ysbyty Glan Clwyd have seen no improvement in their SSNAP scores of D since 2021. In fact, Ysbyty Glan Clwyd took longer than an hour on average to scan stroke patients. When considering that stroke is the fourth leading cause of death, it comes as no surprise that I have constituents who really have a heightened level of anxiety about whether an ambulance would turn up on time and, if it did, how, then, would they proceed to have a scan.

Of the four-hour target for patients to be admitted to a stroke unit, just one hospital in Wales was within that timeframe, and according to the Stroke Association, the time it takes for patients to arrive at a hospital does impact on the time it takes patients to receive a scan. Patients in Wales are being scanned just over eight hours after their symptom onset. So, we've got to get patients into hospital faster and we need speedier scans.

Since 2015, this Welsh Labour Government has downgraded suspected stroke ambulance response times to amber, with no target time for arrival. England's ambulance services, which have a specific category for suspected stroke patients, had a mean response time of 47 minutes and 59 seconds. Here in Wales, amber calls are taking on average, one hour and 35 minutes to arrive with patients—that says 'on average'; I can tell you that I know of examples really recently, where, unfortunately, a constituent of mine passed away because, well, it was just too late. Any longer than 60 minutes, and harm, including brain damage, physical disability and mortality can increase significantly. By 2020, and pre pandemic, even the Welsh Ambulance Service NHS Trust stated that amber performance remains a concern. So, it's therefore reasonable to vote to instruct the Health and Social Care Committee to conduct a review into the benefits and challenges of recategorising strokes as red—immediately life-threatening calls under the clinical response model. And I speak as an elected Member where we have a greater number of old people, obviously, I'm speaking on behalf of my constituents in Aberconwy. That will provide a fair opportunity to hear from health boards and professionals, enabling this Welsh Parliament and your Government to make the best decision that is truly also the best for patients.

So, I've also got a question and an explanation, Minister, as to why there is no thrombectomy specialist in north Wales. There are only two employed, and they are both in Cardiff. Betsi Cadwaladr sends patients to Walton Hospital. As outlined by the Stroke Association's Saving Brains campaign, whilst thrombectomy could significantly reduce the chance of disabilities, like paralysis or blindness, it could save the NHS £47,000 over five years, per patient. Less than 1 per cent of stroke patients in Wales received a thrombectomy in 2021. So, it's not good enough. Surely, between us, we can agree to work with health boards to achieve better than that and establish a workforce plan so that north Wales has its own specialist too.

Yet again, we have fewer services than the south, and we're having to depend on England, but I will say that Walton is exceptionally good. Nonetheless, we've had devolution for nearly 25 years. Minister, as you can imagine, this is a debate that's very close to my colleagues on the Welsh Conservative benches, but it's also close to the hearts and minds of my constituents in Aberconwy, and many across Wales. I know that you listen to what we say here; please, on this one, really study the motion and do what you can to help our stoke victims. Thank you.

Unfortunately, it doesn't give me any grace to say that I actually know only too well just how serious a stroke can be. Not too long ago my mother actually had a stroke and, thankfully, by acting swiftly, we managed to limit the amount of damage it caused. What started off as a headache—in her words, a migraine and flu-like symptoms—quickly turned into something really sinister. And with my mum being rushed to hospital with three clots having formed on her brain, thankfully, after a two-week stay in hospital and really, really extensive physiotherapy and speech therapy, which went on for months, she made a pretty good recovery. If we hadn't acted quickly and got her to hospital on time, the outcome would have been completely different, and I'm under no illusion here that there's a chance that she would be dead today.

Everyone knows that the quicker you act when someone is having a stroke, the better. We've all heard about the acronym FAST—face, arms, speech and time—when it comes to acting upon a stroke, and it's worth remembering, and I only became aware of this after my mother had hers, that there is that golden hour, which many of my colleagues have spoken about today when it comes to having a stroke. The likelihood of having serious or irreversible harm, in fact, during a stroke hugely increases if the patient doesn't receive definitive treatment within the first 60 minutes. However, shockingly, in Wales, it takes more than six hours and 30 minutes on average between stroke onset and arrival in hospital. In comparison, it takes just over three hours and 40 minutes in England, and two hours and 41 minutes in Northern Ireland.

With an estimated 7,400 people a year having a stroke in Wales, it's vital that we do all that we can to ensure that more patients are seen as quickly as possible, as it is a matter of life and death. Many 999 calls for a suspected stroke in Wales arrive beyond the golden hour, since the Labour Government here downgraded suspected stroke ambulance services to amber. Like I said earlier, acting fast is crucial, and I cannot emphasise how grateful I am to the paramedics who came to our aid, and those who continue to help those who experience a stroke. But with amber calls in Wales taking on average an hour and 35 minutes to arrive to patients, let's be honest, it's not that fast at all.

Education is key to improving outcomes for people who are suffering from a stroke. There needs to be a huge push to make sure that people know how important it is to seek medical attention if they are showing symptoms of a stroke. Many years ago, when I worked for the regional Member for South Wales East, he organised a stroke event for all of his constituents with the help of and in association with the Stroke Association—if that made sense—to make the public aware of the symptoms and challenges that one experiences when having a stroke. It was a huge success and really appreciated by the residents of south-east Wales, but sadly the Senedd does not allow such events to take place any more, which is a real, real shame.

A review into the benefits and challenges of making strokes red calls instead of amber is needed, Minister, and needed urgently. I really hope that Labour Ministers and colleagues here in the Senedd today will listen to what I and other Members have said today and act quickly to save lives. Thank you.

The Minister for health to contribute to the debate.

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. 

Will you give way?

I shall. 

Just to clarify, you said, I think, that I had said that there was a special category for strokes in England and there was a 47-minute—. No, what I said was that they've recategorised strokes as an emergency in category 2, and category 2 collectively had a 47 minute and 59 second response time. 

So, my point absolutely stands, which is that there is no hard-and-fast rule for strokes, neither in England nor in Wales. 

So, the McClelland review, which prompted the change to the clinical model response highlighted that the Welsh ambulance service has been subject to more reviews than any other part of the NHS in Wales and that this scrutiny contributes to the issues that the organisation faces. It concluded that a constant cycle of reviews can be disruptive, counterproductive and likely to have little chance of significant improvement for patients. 

The amber review undertaken in 2018 carried out by clinicians, found no clinical evidence to support the recategorisation of stroke calls into the red category as a whole. It would not be justified for yet another review of the ambulance service to prompt a change until there's a body of evidence to support such a change. 

I want to turn now to the other elements I mentioned. The stroke quality statement was published in September 2021. It sets out 20 quality benchmarks for stroke services. In June 2022, the chief executives of the health boards supported the establishment of a national stroke programme board, which will build on the work of the stroke action group. It will also ensure consistency in terms of the establishment of regional stroke centres, which used to be called acute stroke units, and regional stroke units. This board is now established. The first meeting was held on 13 October. It is chaired by Mark Hackett, the chief operating officer of Swansea Bay University Health Board. The members include senior representatives of health boards, the ambulance trust, the office of the commissioners of ambulance services in Wales, the Stroke Association and community health organisations and Welsh Government. The board is supported by a core team, including the national clinical lead for stroke in Wales, Dr Shakeel Ahmad. This is the mechanism that will oversee and motivate the transformation that we need to see for a sustainable stroke service in Wales, including looking into thrombectomy. It will ensure that we reach national standards and improve outcomes for patients who have suffered stroke. 

I heard Rhun ap Iorwerth and Jenny's calls that we need to improve communication with the public on this board. We all have a role to play, and the Welsh Government welcomes all opportunities to raise awareness of stroke so that people are familiar with the symptoms and can respond quickly. I had a meeting with the Stroke Association a fortnight ago, and we work closely with them to promote World Stroke Day on 29 October, and we are looking at other opportunities to raise awareness of the symptoms of stroke, including the FAST campaign. To conclude, I'd like to assure the Chamber that improving outcomes for stroke is a priority for Welsh Government, and I encourage the Chamber to support the motion, with the amendment proposed by Lesley Griffiths. Thank you.

 Gareth Davies to respond to the debate.

Diolch yn fawr iawn, Llywydd. It’s a pleasure to take part in this debate this afternoon and to, indeed, close the debate. I’m quite passionate about strokes, really, because it was what I did for a living before I was elected to the Senedd. We speak about some of the most well-known symptoms of stroke. It can include slurred speech, losing strength on one side of the body; they’re the most well-known symptoms. But if you really want to see some of the range of symptoms of strokes, then I’d urge anyone to spend a day on a stroke unit or a rehab facility to see the actual reality of some of these cases. In the worst situations, people can lose their mobility, they can lose all their freedoms and independence, they need feeding, they lose all their strength to do their own personal care, they need showering, they need bathing. They’re the worst things. And 24, 48 hours before that, they lived a normal life, like we all do now, and to go from that, to that extreme, is why I stress the importance this afternoon of this early intervention, the thrombolysis, the physiotherapy and getting those things in place as soon as possible so it can maximise the chances of success in rehabilitation. Sometimes it can’t be done, that’s the reality of it; sometimes stroke cases are just too acute to achieve any rehabilitation, but, where we can do that, we should really be investing in allied health professionals, physiotherapy, occupational therapy and thrombolysis to make sure that we’re giving people the best chance to have a full recovery and restore some independence and dignity in their lives.

Mark Isherwood opened up the debate, highlighting that it’s World Stroke Day on Saturday, the twenty-ninth, and stressed the importance of having public awareness across all levels of the health system. Rhun ap Iorwerth mentioned it’s the fourth main cause of death, and that was echoed by many other contributions this afternoon, and, again, the importance of allied health professionals in the healthcare system to maximise the potential of rehabilitation. Sam Kurtz mentioned some of the local things in his constituency, including the Carmarthen Stroke Group, and some of the local stats at Withybush and Glangwili hospitals, and then James Evans mentioned his constituency and some of the problems in Brecon and Radnorshire of his local residents having to go over the border into England, where maybe there could be some more local provision so that people in Powys can get the treatment that they deserve.

I didn’t agree with Jenny Rathbone’s statement on not being included on the red list. It just speaks for itself; it’s the fourth biggest killer, Jenny, so that speaks for itself in terms of its importance of getting this as a priority.

I think you’re trying to compare apples and pears there. It’s about the speed with which you need to get an ambulance to somebody who is choking, compared with the speed with which you need to get to somebody who is having a stroke. I don’t think we are in the business of deciding what the guidelines should be for the ambulance service. That’s done by clinicians. I think we do need to improve stroke services, but I don’t think that is going—[Inaudible.]

That was an excellent view of your back on the camera there, Jenny, but your voice was heard on Gareth's microphone, so it's all on the record. It's okay. Gareth Davies.

Diolch, Llywydd. And fair point, Jenny, and that’s why I hope that you’ll vote for our motion to take it to the Health and Social Care Committee where we can take evidence from the right people, and hopefully they’ll echo our same words. Janet Finch-Saunders mentioned some stats in north Wales, in particular on older patients in her constituency of Aberconwy, and, as a former employee of Llandudno General Hospital in the rehab units, I fully understand and appreciate the work that goes on in Llandudno and your constituency. So, I fully support the hard-working staff there who do a good job there day in, day out.

Natasha mentioned some of the personal experiences that she's had with strokes with what her mother experienced, and it's good to see she's making a good recovery and back to good health.

Minister, you said in opening your response to the debate that you think that the performance is not good enough. Well, we have the opportunity this afternoon to actually do something about it, so let's be ambitious, let's show the people of Wales that we're on the side of victims of stroke and get this on the ambulance red list, because stroke victims do deserve, from the Welsh Government, immediate action to consider their pain as a red priority if they or anybody suffers a stroke so that they're able to be treated faster, have a higher chance of surviving and be on a solid road to recovery and independence. I'd just like to close by encouraging everyone to support our motion without amendment this afternoon. Thank you.

The proposal is to agree the motion without amendment. Does any Member object? [Objection.] Yes, there is objection and, therefore, we will defer voting until voting time.

Voting deferred until voting time.