(Title Image: Wales Online)

After the publication of a high-level review of the 999 clinical response model (pdf), the Health Secretary, Vaughan Gething (Lab, Cardiff S. & Penarth), went through the key findings this afternoon.

The model places 999 ambulances calls into three categories: red (serious/life-threatening), amber (serious but not life-threatening) and green (neither serious or life-threatening). While the new system has improved ambulance response times, concerns have been raised that amber call patients – which includes some heart attacks, strokes and falls – are waiting too long.

“Our clinical response model is safe”

The Health Secretary told AMs the review found that the clinical response model was safe and ensures patients in the greatest need receive care in the quickest time. However, he accepted there was room for improvement:

“The median response time for amber calls has increased by seven minutes during the review period (April 2016 to March 2018). That’s clearly not acceptable….Findings suggest timeliness of response has been affected by a number of capacity-limiting factors. “Ambulance handover delays and staff sickness need immediate attention through a whole-system approach and improved staff well-being. I expect health boards and the Welsh Ambulance Service….to take immediate action to address them, and we will, of course, monitor progress closely.”

– Health Secretary, Vaughan Gething

Falls were said to make up the biggest proportion of amber calls and £140,000 has been committed towards a falls project between St John Ambulance and the Ambulance Service.

Cause for Concern

Shadow Health Secretary, Angela Burns AM (Con, Carms. W. & S. Pembs.) said there were a number of findings that stood out as areas of concern: long waits to be transferred from ambulance to hospital, 15,000 people waiting longer than 3 hours for an ambulance and a rise in staff sickness rates.

Angela was also worried there was no specific sepsis protocol card for 999 call handlers; sepsis being a bigger killer than cancer – something the Health Secretary said he was willing to look at.

Helen Mary Jones AM (Plaid, Mid & West Wales) argued that some conditions that fall under the amber category were more time-sensitive than others:

“I would suggest….that stroke is much more time-sensitive, in terms of the ultimate outcome for the patient, than fractures. In fact, of course, the report shows that internally, the service does effectively use an amber 1 and an amber 2 code, as well as protocols to prioritise based on the information of what’s happening for the patient. And it also states that the relationship between time and care has been established for a number of conditions, such as heart attacks and stroke.”

– Helen Mary Jones AM

Lee Waters AM (Lab, Llanelli) later echoed this by saying patient experience was important and waiting patients still needed to feel clinically safe.

The Health Secretary didn’t think it was appropriate to introduce time targets for amber calls, but will instead focus on ensuring standards of care for amber category conditions “in the whole system”.

Non-Emergencies & Co-Responders

Caroline Jones AM (Ind, South Wales West) said cuts to beds were leading to some hospitals running at 90% capacity, around 6-7% of ambulance calls were from “frequent callers”, while a lack of NHS dentists was leading to a high proportion of 999 calls – and calls to NHS Direct – for dental problems.

The Health Secretary didn’t believe lack of beds was the problem, but the flow of patients through hospitals. The number of frequent callers has reduced – though the big problem was falls in care homes and the issue of lifting (he suggested the fire service could get involved).

Suzy Davies AM (Con, South Wales West) asked whether co-responders, like the fire service, could be utilised for amber calls? The Health Secretary said it wasn’t his place to say whether co-responders should be used or not; it’s a matter of clinical judgement.