Dear Vaughan....

(Pic : Wales Online)

Although AMs are still on recess for another fortnight or so, and attentions are firmly-focused on the Westminster campaign, it's worth briefly returning to the National Assembly – though a bit later than I otherwise would have – and what's become a thorn in Labour's side : Welsh ambulance services.

The Assembly's Health & Social Care Committee recently undertook a short inquiry into the ambulance service, and wrote a letter (pdf) to the Deputy Health Minister, Vaughan Gething (Lab, Cardiff S. & Penarth), to outline the evidence and concerns they picked up from witnesses.

Although the Committee acknowledges that "significant work is taking place to bring about improvements", they believe progress isn't being made quickly enough, and the the ambulance service's record is, "falling short of the levels of performance that the people of Wales rightly expect".

The Committee picked out eight areas of concern :

Targets – Witnesses believe the current 8-minute target (for ambulances to respond to life threatening Category A 999 calls) needs an "evidence-based review". The Welsh Government are undertaking a review alongside clinicians based on changes made in England, but the Committee believes attention shouldn't be taken away from improving overall response times.

Accountability – The Committee welcomed some of the changes brought in as a result of the McClelland Review (Ambulance required for Wales Ambulance Trust), but there were concerns that some local health boards (LHBs) were participating in the process to greater degrees than others, resulting in uneven commitment to reforming how ambulance services are run.

Leadership & Staffing – The Committee are "encouraged" by the progress the (interim) Chief Executive of the Wales Ambulance Service Trust (WAST), Tracy Myhill, has made in her post. However, they expect cultural changes to continue. The Committee heard that there were differences in terms and conditions between ambulance staff in different parts of Wales, and there are still serious problems in staff rostering.

Non-emergency transport – Tracy Myhill doesn't expect the Ambulance Service to provide these services in future, and the Committee agrees that WAST needs to make emergency transport its priority (as recommended in the McClelland Review).

Patient handovers at A&E departments – One of the headline pieces of evidence coming out of this inquiry was that 40,000 hours were lost in delays handing over patients from ambulances to hospitals in 2014, compared to 32,000 hours in 2012 – a very clear worsening of the situation. A new handover policy has been agreed, and Cardiff & Vale LHB said the new policy has resulted in "significant improvement". The Committee said this new policy needs to be rolled out across Wales.

Ambulance deployment – At the moment the ambulance closest to an incident is the one dispatched to it. Although this has a certain logic to it, it means many ambulances are drawn away from their "home base" for long periods of time. Subsequently, if ambulances are clustered near A&E departments it takes longer to reach rural patients. WAST are trialing a system where ambulances travelling outside their home area will be considered "out of service" until they return (except for the most serious calls).

Frequent callers – It's said the number of requests from "elderly frequent callers" had risen by 253% over the last seven years. The McClelland Review, and other witnesses, believe using ambulances for such calls is not recommended, and  alternatives should instead be found which keep elderly patients out of hospital.

Coping with demand – Work is currently being undertaken by LHBs to determine future demand for ambulance services, such as evaluating demographic trends and taking those into account. Although the emphasis needs to be on improving short-term ambulance response times, the long-term demand has to be catered for too or the problems will be revisited time and time again. The public also have a responsibility to only call for an ambulance when absolutely necessary.

Many of the problems picked up by this inquiry I covered in my post from last October titled Why are Welsh ambulance response times so poor? I doubt there's very much decision-makers can do with regard those problems, though issues like A&E handovers can be worked on.

The ambulance service has shown signs of improvement over the last few months after the "worse response times on record" in December 2014 - though even with this improvement, response times remain below the levels expected of the ambulance service. Whether we like it or not there'll need to be discussion on the appropriateness of the current 8-minute target, as that's probably the single biggest issue at the moment alongside A&E transfer delays (which is a hospital-side problem).

Having said all that, it's worth giving the Welsh Government credit when they try to address the problem.

As I've also mentioned before, one solution being put forward by the Welsh Government is its Emergency Medical Retrieval & Transfer Service (EMRTS) – a collaboration between the Wales Air Ambulance and WAST which aims to "take A&E to patients" in rural areas, meaning the most seriously ill can bypass a lengthy ambulance trip/delay.

The Assembly's scheduled to debate the EMRTS in more detail when they return from recess.