THIS WEEK, The Herald is investigating ambulance response times in Wales after a local member of parliament raised concerns after receiving comments from paramedics who have said the ambulance service is ‘not fit for purpose’.
A new ambulance system was implemented in October 2015, after requests had been made to create a system that places calls into different categories; ‘red, amber, or green’, with red calls considered life-threatening. This new system is a step away from the original ‘Category A, B, C’ calls, and the Welsh Government continue to set a target that would see 65% of Red calls receiving a response within eight minutes.
Red calls refer to immediate lifethreatening calls where someone is in imminent danger of dying, such as a cardiac arrest. Amber calls are for patients who may need treatment at the scene or fast blue light transportation to a hospital. Green calls are calls of a non-serious nature, which can be managed by other services, including healthcare advice.
The Welsh Ambulance website tells readers that they are moving away from time-based targets, and looking more closely at the quality of what they do once they arrive.
The site says the new changes place the patient at the very centre, explaining: “The changes will clearly identify those patients who require an immediate life-saving response, and these patients will receive the highest priority response in the fastest time possible.
“All other patients will receive a bespoke clinical response based on their condition rather than a generic response based solely on a time standard.”
MP’S CONCERN
Plaid Cymru MP Jonathan Edwards expressed concerns on the changes to ambulance response times, explaining: “In theory, the new system introduced by the Labour government could mean a pensioner falling and breaking their hip but unless there is a risk of heart attack or stroke then an ambulance has no time target to arrive. This could lead to a whole host of problems… and could have serious consequences.”
With this new system, targets are only set for urgent red calls, so performance data subject to targeting is unavailable for less urgent amber and green calls.
Leader of the Welsh Liberal Democrats, Kirsty Williams AM, told the Herald: “This new targeting regime may make life easier for Labour Ministers but in reality people are being left in the dark as to how well their ambulance service is actually performing.”
Although the Welsh government continue to set a target that 65% of all red calls will receive a response within 8 minutes, the public have no way to find out how fast ambulances reach other, less urgent calls.
Kirsty Williams continued: “A rugby player with a broken leg, or an older person fallen down the stairs, could be waiting for hours upon hours, and we would have no idea.
“Even if targets aren’t applied to these less urgent calls, at the very least we should be able to see how quickly they’re responded to. People have the right to hold their Ministers to account, but this new regime amounts to a backwards step for transparency by Labour.”
Jonathan Edwards felt worried that the Welsh government were changing targets as they could not be met, claiming there was ‘more to the changing of targets than meets the eye.’
Over the last three years the target has been met only once.
Mr Edwards also questioned why the Welsh government’s target of 65% was lower than targets of 75% set in England and Scotland, feeling there was a ‘lack of ambition’ from the Welsh government.
Speaking of ambulance response changes in October 2015, Jonathan Edwards said: “Any observer would reasonably expect a government – irrespective of political hue – to want to raise standards and targets. With the Labour party, however, we have a Welsh Government that is scrapping targets – which were already less ambitious than the rest of the UK – when it can’t meet them.”
TARGETS NOT MET
Since the new system has been implemented, response time data has been made available on the Hywel Dda University Health Board, and the statistics show that the 65% target has still not been met.
The Herald contacted both the Hywel Dda Health Board, as well as the Welsh Ambulance Service, to see if they could enlighten us with their insight on the current issue.
A spokesperson for the Welsh Government explained to the Herald: “We totally reject these allegations.
“The new model, which was devised by clinicians, is designed to provide the best care and results for people in life-threatening situations and to improve outcomes for patients. The latest figures suggest it is making a difference to patients.
In December, there was a 15% increase in the proportion of people with an immediately life-threatening condition who received a response in eight minutes, compared with the same month in 2014 in a similar category, under the old system.
“In December, the average response time to patients in the new amber category – people who do not need immediate life-saving care – was just 11 minutes and four seconds, including for stroke patients. Evidence suggests that transporting these patients to the right healthcare facility within one to four hours will improve their outcomes. There has been no change in category under the new model for the level of response required for patients who have broken their hip.”
Jonathan Edwards’ concerns have been reinforced by ambulance workers, with one paramedic speaking out to state the new system only exists to appease the Welsh government.
Speaking anonymously, one paramedic spoke of the new system explaining: “The new clinical model is nothing more than yet another way to fraudulently manipulate responsetime performance figures in an attempt to pacify the Welsh Government and Welsh media.
“It makes no difference to the staff on the road other than an apparent tendency to code calls in the highest ‘red’ category based on proximity of a resource rather than clinical need.”
CALL CONCERNS
One of the main concerns is that prioritising calls based on the seriousness of the incident can prove difficult, with some incidents being categorised as not urgent enough; therefore not suggesting that a quick response time must be met by the ambulance service.
A second paramedic said: “The amber calls are too broad and don’t come across urgent enough for us to respond to quickly.”
With only the red category having a response time target of 8 minutes, the amber and green categories of calls do not have a target time, and implications are made this will affect how quickly patients receive emergency healthcare.
Jonathan Edwards MP continued to show his concerns saying: “I am gravely concerned by these comments, not least because the new target has still not been met for patients within the Hywel Dda area. If a government moves the goalposts and still can’t hit a target then there is a deeprooted problem that needs prompt investigation and remedy.”
A Welsh Ambulance Service spokesperson told the Herald they are trying to build a culture of integrity and partnership in the Welsh Ambulance Service, explaining: “This feedback is very disappointing especially when we are working very hard developing positive relationships with staff and their trade union representatives.
“While we strongly refute the suggestion that the clinical model is an attempt to manipulate performance data, we recognise that staff continue to face day-to-day challenges which, while frustrating, are not linked to the model, which is evidence-based and which is delivering positive benefits for our patients.
“We are absolutely committed to working in partnership with our staff and trade unions to resolve some of the operational challenges our teams face, and this includes further developing our mechanisms for listening to, and addressing staff concerns.”
The decision for the change in the new ambulance system came after a clinical review which was led by Dr Brendan Lloyd, medical director of the Welsh Ambulance Services NHS Trust.
The review found that there is no evidence to support that the eight minute response time, which was originally established in 1974 and has not been changed since, makes a positive difference to the outcomes of around 95% of patients accessing the ambulance service.
HERALD MEETS GETHING
The Herald met with The Deputy Health Minister for Wales, Vaughan Gething, to discuss his thoughts on the matter. Vaughan Gething explained: “The demands placed on our emergency ambulance service are more complex than ever before and are growing year-on-year. It is clear if we are to meet these demands and ensure the best outcomes for patients, we need to transform the way in which we deliver emergency ambulance services.
“The new clinical response model, which we will pilot in Wales, has been designed by Wales’ top ambulance service clinical leaders and is based on firm evidence. It is a move away from the system based solely on the eightminute response time target, which was introduced 42-years ago, to one which measures how successful our ambulance clinicians are in ensuring they have the most positive impact on clinical outcomes and people’s quality of life.
“We take very seriously the responsibility to have appropriate response times for those who need it, that’s why we changed the model, it is about people who need a fast response. The health board is in a better place than it was under the old model.
“I am confident these changes will improve patient experience. They will also make emergency ambulance services in Wales among the most progressive and transparent in the world.”
Add Comment