Agenda item

To receive a presentation and discuss with representatives from the Welsh Ambulance Service Trust matters relating to ambulance response times in Denbighshire.

 

10.05am – 11am

 

The Chief Executive of the Welsh Ambulance Service NHS Trust (WAST), alongside the Director of Partnerships and Engagement of the Welsh Ambulance Services NHS Trust, provided members with a presentation highlighting matters relating to ambulance response times, including various emergency response data for callouts in Denbighshire.

 

During the presentation WAST representatives highlighted Emergency Medical Services Performance.  It was only ‘red calls’ that had a set performance indicator (PI) target, which was that 69% of calls should be responded to within 8 to 10 minutes.  The graph for this PI indicated that performance had generally declined since November 2020.

 

The Service’s main aim was to ensure patient safety.  With a view to securing patient safety in the face of increase demand on WAST’s services a collaborative independent demand and capacity review, focussing on Amber level calls and patient safety concerns had been instigated.  This review predicated on the level of hospital handover lost hours of 6,038 (December 2018), considered high at the time.  By October 2022, the Trust lost 28,937 hours due to waiting for hospital handover - 36% of its capacity or 65 shifts a day. This situation was likely to worsen in the winter significantly. It was emphasised that the concern about patient demand data was not the fundamental issue concerning patient safety; the fundamental problem was capacity, particularly the number of hours lost waiting to handover patients at hospitals and to a lesser extent sickness absence levels amongst WAST personnel.

 

In October-22, due to a number of factors e.g. sickness absence, CoVID-19, annual leave, training etc. the number of staff available on WAST rosters was down 40%.  The roster review used a benchmark of 30%. Pre-CoVID-19 WAST had started to deliver the 30% benchmark. Unfortunately, although sickness absence was coming down training commitments were high currently due to internal movements linked to recruitment and this had an adverse effect on roster availability.

 

In relation to data on National Reportable Incidents (NRI) (avoidable deaths/serious avoidable harm) WAST was considered a “high reporting” organisation.  This was regarded as a good approach because it meant a culture of openness and transparency, an essential aspect of a patient safety culture. WAST referred patient safety incidents to health boards where the primary cause was considered to be hospital handover lost hours. It was a health board responsibility to review and report these incidents, where appropriate, as NRIs.

 

An independent strategic review had been undertaken by Operational Research in Health on behalf of the Emergency Ambulance Services Committee (EASC). EASC was made up of the seven health boards, which have a responsibility for commissioning ambulances. The basis of the Review was Amber patient incidents (serious, but not immediately life-threatening).  This represented the largest patient incident category accounting for 70% of patient incidents, compared to Red (immediately life-threatening) which accounts for 10% of patient incidents.  It was felt that Amber waiting times were too long, and there was some concern about the number of serious adverse incidents for patients (SAIs) in the Amber category.

 

The findings of this Review identified that the WAST had a gap between the number of full-time equivalent (FTE) staff budgeted to fill its Response rosters and the FTEs required to fill the rosters of 263 FTEs.  As a result of this review EASC agreed to invest in WAST and close this gap, known as the “relief gap”.  Consequently, WAST delivered an uplift in FTEs of 136 FTEs in 2020/21 and was on target to deliver a further uplift of 127 FTEs in 2021/22, which would close the “relief gap”. This has been achieved despite the pandemic.

 

The Response Roster Review had twin objectives:

1) to improve patient safety (by delivering rosters aligned to patient demand); and

2) to improve staff well-being (by delivering good workable shift patterns). 

 

There had been a high level of engagement with the Review and positive feedback received in relation to the approach taken.

 

In addition, the Review had identified a range of efficiencies for WAST, particularly re-rostering ambulance resources around the daily patient demand pattern. Re-rostering would see the introduction of Cymru High Acuity Response Unit (CHARUs) and more emergency ambulances. The CHARUs would focus on resuscitation (clinical outcomes) and emergency ambulances on the Amber 1 tail (patient safety). Re-rostering was complex and emotive area of work, but the new Rosters were currently going live.

 

The CHARUs would be replacing the RRV as WAST’s rapid response vehicle. CHARU would provide increased clinical skills and leadership in responding to very high acuity calls.  Betsi Cadwaladr University Health Board (BCUHB) would see less rapid response resources, as WAST increased the number of emergency ambulances available.

 

Responding to Members’ questions WAST officials –

 

·         advised that as a direct result of the EMS Roster Review 263 more personnel had been recruited nationally, 73 of whom were located within the BCUHB area

·         agreed to facilitate discussions between senior officials of Denbighshire County Council and WAST to explore potential options for enhancing local authority and Third Sector links that could help support the Ambulance Service, as well as utilising Denbighshire’s communications platforms to share messages and to promote the use of volunteers in local communities to lessen the strain on the ambulance services.

·         advised that co-working between the fire and rescue and ambulance services did take place, but to various degrees across Wales’ three Fire and Rescue Service areas.  In some FRS areas a co-responders service existed.  Officers clarified the matter was the subject of industrial negotiations, and was continually kept under review.

·         confirmed that local defibrillators were crucial to saving lives from cardiac arrests.  They were easy to use, would not cause any harm to a patient experiencing a cardiac arrest, and WAST were in possession of up to date location maps of all registered defibrillators and could direct emergency callers to the nearest one for use whilst waiting for an ambulance/RRV.

·         stated that in their view the amalgamation of WAST with the Health Board would not provide a solution to the extended hand-over period for patients from the Ambulance Service to hospitals.  The issue was the lack of flow of patients from health service settings to social care establishments or back to their own homes.  This problem was not unique to North Wales, it was happening across Wales, the UK and internationally.

·         advised that the use of ambulances as ‘extensions’ to Emergency Departments was not good for either the patient or the Ambulance Service.  They were undignified places for patients to be waiting for a long time, and until WAST personnel could handover their patients to hospital staff a valuable ambulance resource was tied-up and unavailable to attend another emergency elsewhere.

·         outlined the three different types of ambulance services provided by WAST – the emergency 999 ambulances, urgent care ambulances (for conveying less serious cases to hospital) and the non-emergency patient transport (used for conveying people to and from hospital appointments and home from hospital).  Whilst WAST did utilise ambulance services provided by charities, such as the Red Cross and St. John’s Ambulance, along with private ambulances at times, it could not however be over reliant on the voluntary sector.

·         confirmed that first responders did visit people in their homes to assess if an emergency vehicle was required in order to reduce the pressure on ambulance services.  WAST now employed a vast range of medical staff such as advanced paramedic practitioners, pharmacists, occupational therapists etc. and dependent upon the nature of the ailment these personnel may be able to deal with the medical emergency without the need to convey to hospital.  This in turn would help relieve the pressure on the 999 emergency ambulances.

 

At the conclusion of an in-depth discussion, the Committee thanked the officers for their presentation, and all WAST personnel for their hard work and efforts which, they carried out under extremely difficult conditions at times.  It:

 

Resolved:  subject to the observations made –

(i)   to receive the presentation and information provided by the Welsh Ambulance Services NHS Trust (WAST), and acknowledge the measures being developed and implemented in a bid to respond and effectively manage emergency call-outs going forward;

(ii)  having regard to the pressures currently experienced by WAST that the Corporate Director: Environment and Economy convene a discussion between senior officials of Denbighshire County Council and WAST with a view to exploring potential options for enhancing local authority and Third Sector links that could possibly help support the Ambulance Service to focus its resources on dealing with emergency calls; and

(iii) recommend that links be established with the Council’s Communications and Marketing Service with a view to facilitating the sharing of WAST public information messages with residents via the Council’s communications channels and social media platforms.