Agenda item

To receive a presentation from the Welsh Ambulance Service Trust and discuss with them the problems and pressures faced by the Service in Denbighshire.

11.00 a.m. – 11.45 a.m.

Welsh Ambulance Services NHS Trust (WAST) representatives David Scott (Non-Executive Director), Sonia Thompson (Interim Head of Operations Betsi Cadwaladr University Health Board (BCUHB) Area) and Claire Bevan (Executive Director for Quality, Nursing and Patient Experience) were introduced and welcomed.  WAST representatives had been invited to attend the meeting to discuss with the Committee the problems and pressures faced by the service in Denbighshire and across Wales, and how they were addressing those pressures.

 

Through a PowerPoint presentation WAST representatives illustrated to members –

 

·         data on the number of calls and website enquiries received by the service last year, which showed a substantial increase on the previous year, and the number of patient care journeys undertaken by the service and its volunteer network

·         data on the number of calls responded to by Community First Responder volunteers

·         the perverse effect of meeting ambulance response times – being able to meet the set targets, but not improving the experience or the outcomes for the patient, apart from the most critically ill

·         the measures being implemented with a view to improve call management and patient assessment to aid appropriate dispatch of emergency ambulances and other response vehicles, including the anticipated benefits of this approach to the patient and to WAST

·         the improvements realised to date from adopting the New Clinical Model, including a 38% reduction in the number of Rapid Response Vehicles (RRVs) stood down

·         work undertaken with Health Service and Police staff with a view to reducing the number of ‘frequent callers’ and the Fire and Rescue Service in relation to preventing falls

·         the increase in the number of patients who had been clinically assessed by the Clinical Telephone Assessment Team which had resulted in them not requiring an emergency ambulance

·         the pan-Wales Transition of Care Closer to Home initiative, which had led to fewer patients being conveyed to hospital in North Wales than the rest of Wales

·         work currently in progress and proposed to drive improvements with respect to managing calls for assistance which were deemed to be non-emergency calls

·         the work underway to try and improve handover times from WAST to the Health Board, currently performance in BCUHB’s area against this specific indicator was consistently the worst in Wales

·         initiatives underway across North Wales with a view to driving improvements.  These included a team of clinicians based in the Police Control Centre and at WAST’s Control Room which could assess the patient’s needs, and the development of Alternative Care Pathways – including a Community Assistance Team in partnership with the Fire and Rescue Service, District Nurse Pathway, a revised Minor Injuries Unit (MIU) Protocol, and in March 2017 a Mental Health Pathway pilot would commence at Ysbyty Glan Clwyd

·         in addition a Rapid Handover Protocol would be rolled-out pan North Wales to support the timely handover of patients who do not require a clinician to clinician discussion, the Community First Responder Service would be expanded to work in areas of North Wales which did not currently have a significant CFR presence; and work would continue with frequent service users with a view to supporting their needs without them having to call out the service.

 

WAST representatives informed the Committee that initial feedback from the public and Welsh Government (WG) Ministers to the New Clinical Model approach had been favourable, staff morale had also improved.

 

The Committee heard evidence from a member of the public in attendance on how he had called for an ambulance to an accident in Llangollen, and the delay experienced before an ambulance actually arrived as there were no ambulances available within close proximity to the town.  Despite a firefighter being nearby at the time he had not been mobilised to attend the incident to administer first aid.  WAST representatives advised that they were concerned to learn of the gentleman’s experience and asked if he could discuss the matter with them following the meeting so that they could investigate it on this behalf.  Committee members also gave examples of delayed responses to emergency calls which had been brought to their attention.  WAST representatives encouraged councillors to forward any such concerns to them because investigation of complaints was an effective way of improving services.

 

Responding to members’ questions WAST representatives –

 

·         advised that the Health Board commissioned WAST to deliver an ambulance service

·         confirmed that they were looking at potential areas where they could work collaboratively with other emergency services and public bodies across Wales to deliver co-ordinated responses or services as well as preventative services.  Part of this exploratory work included looking at the potential of co-locating WAST teams, including Control Room staff, with other emergency services.  Potential co-location plans to date could not be progressed due to premises capacity limitations

·         advised that work was taking place with the Older People’s Commissioner with a view to securing a co-ordinated approach by all agencies to health and well-being matters, including responding to emergency calls

·         reassured the Committee that any delay in responding to an emergency request was deemed as unacceptable, emphasising that a concerted effort was required across all health care services and external agencies to support people at home where possible

·         advised that with an ageing population there was a need to expand areas, such as falls prevention work.  Often these days patients conveyed to hospital by the Ambulance Service had a range of complex needs

·         confirmed that upon arrival at a general hospital if the patient could not be transferred immediately to the care of the hospital nurses would attend to the patient in the ambulance.  At that point the patient would become the joint responsibility of the hospital and the Ambulance Service

·         informed the committee that work was currently underway on modelling the anticipated demand and capacity of community hospitals for the forthcoming five years

·         advised that a new Computer Aided Despatch (CAD) system was due to be introduced during the summer of 2017.  This system, based on an internationally recognised system, would help triage emergency calls to determine the most appropriate response to them

·         explained the process for dealing with request for passenger transport for planned hospital appointments

·         confirmed that WAST did not class persistent callers as ‘nuisance callers’ as they obviously were in need of assistance.  WAST had worked closely with the other emergency services in a bid to raise awareness of the impact such calls had on the emergency services and on other residents who were in urgent need of the emergency services.  Awareness raising campaigns in relation to this would continue to be held on a regular basis

·         agreed with members and council officers that loneliness was a hidden, but growing problem, within the population.  It was one of the causes why some individuals were persistently calling the emergency services for non-emergency assistance.  It was anticipated that the triaging system introduced with the Clinical Assessment Team and the services that would be provided by the Community Assistance Team, a team consisting of Fire, Police and Single Point of Access (SPoA) staff which was currently being piloted in Denbighshire, would help ease pressures on WAST as these teams could direct the callers to the most appropriate services for their needs.  Whilst no authority or organisation had a statutory duty to address loneliness, the problem was impacting on a range of front line services

·         confirmed that the Air Ambulance was an independent charity.  The Wales Air Ambulance Service was different to its counterparts in other parts of the UK as it had a range of highly qualified clinicians attached to it who could be called upon as and when required.  A decision on whether to call on the services of the Air Ambulance would be made based on the assessed need of the patient.

 

The Chair thanked WAST representatives for attending and answering members’ questions.  He also thanked the member of the public for attending and sharing his experiences of the Ambulance Service.  Both the Chair and members emphasised to WAST representatives the importance of maintaining regular communication between the Ambulance Service and those who had called for assistance in order to reassure the patient that appropriate assistance was on its way to them.  At the conclusion of the discussion the Committee –

 

RESOLVED that subject to the above observations to receive the presentation and extend an invitation to the Welsh Ambulance Service Trust to attend another meeting at an appropriate time in the future.