Agenda item

Key Issues:

Richard Lee, Executive Director of Operations, and Louise Platt, Assistant Director of Operations provided a presentation on the Wales Ambulance Services NHS Trust.

It was explained that the most popular reason to call an ambulance in the UK is related to older persons falling and requiring assistance.  Capacity is the biggest challenge. The strategic aims were explained and also the three services lines of Emergency Medical Services and Urgent Care Services (Yellow Ambulance), non-urgent Patient transfer (White Minibuses) and NHS Direct Wales.

It was explained that there is an Ambulance Five Step Model which breaks down the service starting with helping patients choose what service is most appropriate for their needs and also the availability of available alternative services.  It was confirmed that, regrettably, trivial calls still come through 999 calls. The second step involves the importance of call takers finding out as much as possible about a patient’s condition.  It was also explained that paramedics and nurses are also utilised to take calls to filter out those patients that don’t need an ambulance, and to prioritise as appropriate. 

The third step involves deciding the most appropriate health board service to visit a patient.  The fourth is to ensure that the most appropriate treatment is provided and finally the fifth option, the decision to take the patient to hospital.

The Clinical Response Model was explained and details of how priorities are drawn were provided. An example of the response to a Red category call was provided explaining that the first response at the scene will be either a paramedic in a car, the fire service, a community first responder or a Police Community Support Officer; second to arrive will be an ambulance.  The Ambulance Service Trust is working hard to ensure that defibrillators are available in every community and sought the support of the Council to secure defibrillators in hard to reach areas; the need for no specific training to operate the equipment was emphasised.  It was explained that, unlike the previously available, lengthy course and expensive machinery, a 20 minute course can now be provided for a machine costing less than £1000.

It was explained that Amber category calls (65% of call volume) are responded to by an ambulance on blue lights.  It was explained that the ideal response has been defined for every call and the example was provided of a person suffering a suspected stroke who will be sent an emergency ambulance with a two person crew of emergency medical technicians who can conduct a FAST test, and can convey the patient to the appropriate hospital.  A patient suspected of having a heart attack will be sent an ambulance with a paramedic to administer an ECG.

Green calls may not necessarily require an ambulance or for whom their GP has requested an ambulance to transport them to hospital, and will not have a blue light response.  These patients may be spoken to over the telephone and asked to make their own way to hospital for treatment to free up the availability of ambulances for emergencies.  It was reported that performance for Red life threatening calls are regularly out performing England.

In this area, a 3% increase is forecast in calls per annum over the next 5 years assuming that no changes are made to manage the current types of calls received.  This equates to the need to recruit many more staff for which there is no budget.  Consequently, actions being taken to reduce demand include:

·         Management of frequent callers using a multi-agency approach using targeted intervention plans which has reduced the number of calls made.

·         Successfully dealing with more calls over the telephone. 

·         Working with the Police to set up a joint response unit, where a police officer accompanies the paramedic, which has reduced the demand on ambulances requested by them by 75%. 

·         Placing clinicians in the Police control room in Bridgend releasing Police Officers waiting for ambulance to resume community work and free up ambulances.

It was explained, in relation to management of elderly falls that a mobile multi-disciplinary team of physiotherapists and occupational therapists with paramedics has been created to attend to elderly people who have fallen.  This has enabled more people to stay at home.  Additionally, the team carries adaptations such as armchair risers to install to prevent future falls. 

Evidence of the effect of actions to reduce demand was provided indicating that 3,349 cases were managed differently.   The priority is to ensure that the patients transported to Accident and Emergency are those for whom it will make a difference.

Members Scrutiny

Following the presentation, Members asked questions:

A Member expressed her interest that changes have been made by reorganising services instead of requiring more money, and also disagreed with the resources used dealing with people who have consumed excess alcohol and suggested that a different approach was needed.  It was also added that ambulance delays can occur in rural areas due to limited knowledge of the area.

In response, it was confirmed that about one third of callers can be reassured that they can make their way to hospital to arrive quicker for treatment e.g. broken wrist.  Additionally, crews are encouraged to assess at the scene if the patient can make their own way to hospital, or can travel by taxi to release the ambulance for emergency cases.  It was emphasised that the public should be aware that being taken to hospital will not necessarily result in being seen quicker unless the ambulance crew phones ahead to alert hospital staff.  It was explained that all ambulances are fitted with a Sat Nav but the crews will not necessarily possess local knowledge of routes.

The Chair explained that he had recently worked with the Fire and Rescue Service and all fire engines have automated defibrillators.  Firefighters with  enhanced medical training can attend some Red calls as first responders for immediately life threatening cases on behalf the ambulance service under “Fire Medical Response” - a UK wide scheme.

A Member enquired if there was a defibrillator in County Hall, Usk and suggested that there should be training for Councillors and Officers.  It was also suggested that previously available blood pressure testing should be available for staff and Members.  The offer of free defibrillator training was made from the Community Defibrillation Team.

A Member asked if there were any views on the suitability of the Abertillery model working in Monmouthshire and also questioned cross border use of ambulances. In response, it was explained that the fire station in Abertillery needed remodelling so the Police Community Support, Fire and Ambulance Services have been centralised.  It was added that the ambulance estate plan has been released for the next five years which proposes a smaller number of larger ambulance stations across Wales with deployment points (which can be fire stations).

The example of Monmouth was provided where the Fire and Ambulance stations will be combined in the Fire Station which is in better state of repair. There has also been a demand and capacity review which may result in e.g. a paramedic car being relocated to Usk to be more convenient.

Regarding cross border ambulance collaboration, it was explained that the ambulances referred to from Bristol were private ambulances due to staff shortages.  It has now been decided to stop using these companies in Wales as they are not good value for money and not under our direct control.  It was confirmed that Monmouthshire and England borders ambulances swap jobs in pre-planned cross border arrangements and further pooling of resources is under consideration.

The Member explained that there are eight defibrillators in Caldicot and training is awaited.

A Member praised the standard of the report and developments and asked what deterrent was available to deal with hoax calls.  It was explained that 700 patients have been dealt with under the frequent callers programme in a supportive way and four have received custodial sentences which could also be linked to abusive behaviour towards staff.  A Member observed that easier access to GPs could also provide some resolution of demand on ambulance services.

The Chair asked the Head of Social Care and Health if there were any communication issues with residential care homes such as a need to strengthen the message regarding when, and when not, to call an ambulance.  It was responded that a lot of work has been undertaken with the care home sector, health board, social services and individual care homes to address variations in approach, management of symptoms and end of life pathways as well as the correct times to call an ambulance.

An offer was made to provide details of the top ten care home frequent callers in Monmouthshire.  The aim for dignified deaths in the patient’s home setting was explained.  The need for advance care plans for natural end of life was emphasised.  It was added that extensive work has been carried out on falls prevention to recognise what actions are needed to reduce the risk of falling and to educate people to move safely in their environment.

It was requested that the issue of the Grassroutes buses being restricted to 50 miles radius meaning, for example that people in Monmouth can’t travel to Chepstow is raised at the forum on Friday as this will particularly affect disabled travellers.

The report regarding Usk Prison elderly inmates was deferred until the next meeting and will also be forwarded to Executive Director of Therapies and Health Science, Aneurin Bevan Health Board and to the Director of Operations, Welsh Ambulance Service NHS Trust.