To receive a verbal presentation by the Chief Executive of the Welsh Ambulance Services University NHS Trust :-
· Current service provision on the Isle of Anglesey;
· Resilience, challenges and affordability of the current service delivery model on Anglesey
· Joint working between the Welsh Ambulance Services and the Isle of Anglesey County Council
Minutes:
The Chair welcomed Mr Jason Killens, Chief Executive of the Welsh Ambulance Services, and Ms Estelle Hitchon, Director of Partnerships and Engagement, to the meeting.
The following were points of discussion by the Committee:-
· Questions were raised as to how long patients on Anglesey wait for an ambulance to respond following an emergency call and what plans are in place to improve the respond times. The Chief Executive of the Welsh Ambulance Services responded that it is dependent as to the category of the emergency call and from where the ambulance is responding to the call. He noted that on average the ambulances will not respond from the Ambulance Station but from an Emergency Department when they have concluded an emergency response to another patient. The respond time for patients who are categorised as requiring emergency assistance (category red) i.e. heart attack, seizures, and unconscious patients, is 8 minutes in 65% of calls. The target, at present, nationally and locally is currently not been achieved with a response time up to 10 minutes, which does vary, during the day and evenings. The Chief Executive further said that funding from Welsh Government has seen the Ambulance Services investing considerably over the last 4 years in the recruitment of over 400 front line clinicians to the service. However, emergency calls categorised as life-threating, have doubled and there have been significant delays in handing over patients to Emergency Department across the Betsi Cadwaladr Health Board. Whilst the Ambulance Service has invested to improve the service to increase efficiency, with Paramedics and Clinicians within communities that do not need an ambulance to take patients into hospital, the pressure on the Ambulance Service continues. The Director of Partnerships and Engagement said that development of staff is taking place on the Island with Emergency Medical Technicians training to become Paramedics. 2 Paramedics have also joined the team on Anglesey which will allow for patients to have fully qualified staff to attend and to be able to prevent people from going into hospital. Further questions were raised that some patients are having to wait for hours for an ambulance to attend. The Chief Executive agreed that some patients who have no life-threating illnesses are having to wait long periods of time for an ambulance to attend and waiting outside A+E departments. However, this is the reflection of the situation that exists across the emergency care and adult social care services.
· Questions were raised as to what the arrangements for prioritising requests are when there is significant demand on the Ambulance Service. The Chief Executive responded that all emergency 999 calls are categorised on the time that the emergency service will respond. There are long delays in the transfer of patients into A+E departments with queues of ambulances waiting outside which results in further delays to respond to additional emergencies that the ambulance service receives. The delays in transferring patients are a result of problems with the flow within the hospitals, with patients who are medically fit to be discharge taking up beds. This is due to problems within the adult social care system which is under pressure to provide care packages for patients to return home.
· Questions were raised as to the average waiting times in an ambulance outside A+E at Ysbyty Gwynedd and how do waiting times compare with other area. Further questions were raised as to what degree could joint working with social care alleviate or decrease waiting times. The Chief Executive responded that the target time for the transfer of patients into A+E’s is 15 minutes and an expectation that the ambulance crew would have 15 minutes to clean and prepare for their next patient. However, the transfer and preparedness for the next patients is on average 2 hours across Wales but North Wales is a challenge area for transfer of patients into hospital. He further said that there are, on average, 1,500 patients every day, across Wales that should be cared for safely within the local communities. The Director of Partnerships and Engagement said that both the Health Board and Social Services Departments are facing increased demands for social care and the need for patient safety within their home environment. Reference was made by the Committee as regards to other patient alterative transport providers i.e. Môn Medics and Medic 1. Questions were raised whether these providers could alleviate the waiting time for the Ambulance Service to attend patients. The Chief Executive responded that whilst the Ambulance Service responds to emergency 999 calls it also provides services to transfer patients and non-emergency patient care. The Ambulance Service also provides the urgent care system NHS 111. Volunteers are used extensively across North and West Wales with regards to the non-emergency transfer system for patients to attend out-patients planned appointments. Volunteers who are trained and equipped by the Ambulance Service as First Responders and Welfare Responders within local communities are available for life threating emergencies whilst waiting for the ambulance to arrive. He referred to the non-NHS providers which has a limited capacity. The Ambulance Services does not routinely use non-NHS providers for emergency activity due to the quality and safety of the services provided compared to the standard that is required. He highlighted that having additional ambulances to take patients to A+E departments is not the solution to alleviate the problems encountered in waiting times.
· Questions were raised as to the percentage of Ambulance Services’ staff working with patients on Anglesey who can speak Welsh. The Chief Executive responded that staff are encouraged and supported to speak and learn Welsh across the region. The Director of Partnerships and Engagement said that the Ambulance Service has recently been incorporated within the Well-being and Generations Act and the priorities will be as to how to develop staff locally and encouraging young people into the Ambulance Service as a career across the service.
The representatives from the Wales Ambulance Service needed to attend another meeting and they agreed that they would send written response to the remaining questions the Committee wished them to respond.
It was RESOLVED to thank the representatives from the Wales Ambulance Service for attending the meeting.
ACTION : That the remaining questions by the Committee be forwarded to the Chief Executive of the Welsh Ambulance Service for a written response.