Oral - Ambulance Service Assurance Review

In November 2007, I announced that I had asked Stuart Fletcher, Chair of the Welsh Ambulance Services NHS Trust, to lead a review of the Welsh ambulance service. I asked that the review consider the progress the trust had made against the recommendations of the Auditor General for Wales's report, published in December 2006, whether the Trust's plans for further modernisation are robust and deliverable, and the effectiveness of infection control and cleanliness in ambulance vehicles.

My decision to request a review was based on my concerns at the continued poor response-time performance of the emergency ambulance service in some areas of Wales, and on the concerns raised with me by Assembly Members and members of the public about the delivery and performance of ambulance services in their areas.

Many of you have continued to raise issues with me since I announced the review, and you will be aware of my disappointment at the poor performance in some local health board areas and the unacceptable variation in performance across Wales. I am determined to see improvements achieved in the responsiveness of ambulance services in Wales, and I expect to see significant improvement in the next six months.

I am grateful to Stuart Fletcher, David Galligan of Unison, Professor Morton Warner of the Welsh Institute for Health and Social Care, Dr Nick Looker of the National Public Health Service, and the Wales Audit Office, for the work that they have done in carrying out the review. I also thank the staff of the Welsh Ambulance Service NHS Trust and other organisations whose contributions have been invaluable in informing their work.

The report makes 16 recommendations for improvements across the service and provides further recommendations on the robustness of the trust's modernisation plan and infection control procedures.

On the issue of the progress that the trust has made against the recommendations of the Auditor General's report, the review found that the trust is in a stronger position than it was when the report was published. Overall performance has improved and the trust has made some progress in the first year of its modernisation programme.

While I am satisfied with the findings that the trust has made progress against the Auditor General's recommendations and that some improvements in performance have been achieved, response times in many areas of Wales are far from acceptable. I expect to see demonstrable improvement within the next six months, particularly in rural Wales, where too many people are still waiting too long for a response from the emergency ambulance service. I am particularly concerned about services in Powys. Performance is unacceptable and there is considerable public concern at the resources available in the region and the number of staff vacancies that have remained unfilled for many months. While we all recognise that there are different demands in delivering emergency services in sparsely populated areas, the people of Powys must be assured that when they have an emergency, the service will be there for them, and that they will receive the same of level of care as other residents in Wales.

The solution to delivering high-quality responsive emergency services in Powys goes wider than the Welsh Ambulance Service NHS Trust. I know that Powys Local Health Board and the Welsh Ambulance Services NHS Trust are working with partner organisations to develop new models of care and I have asked officials to ensure that this work is progressed and to report back to me in six months' time.

A number of questions have also been raised with me about the role of rapid response vehicles in delivering improved performance. The review found that, in most cases, the use of rapid response vehicles has not been at the expense of ambulances being available to transport patients to hospital, and that it is for a small minority of calls, mainly in south-east Wales, where excessive delays are experienced. However, it is not acceptable for patients who need to be taken to hospital to experience long delays waiting for ambulance transport. I expect the trust to work in partnership with hospital trusts to address the issues that are impacting on emergency ambulance resources and to ensure that the incidence of long delays is reduced.

One issue impacting on ambulance resources is prolonged delays in handing over patients from ambulance crews to hospital staff. It is unacceptable for patients to wait in ambulances for admission to accident and emergency departments and for paramedics to be delayed in hospital car parks when there are patients in the community who need their services. Therefore, I have introduced a priority target this year to measure the time taken to hand over patients at major accident and emergency departments. NHS organisations should be clear that I will be taking a particular interest in performance against this target and will take action against organisations that fail to improve their service.

My concern about response-time performance does not reflect on ambulance crews, who work hard every day to provide the best service that they can for their communities. I am well aware of the dedication and professionalism shown by ambulance staff and of the difficult and demanding circumstances in which they often have to work. I want to see an ambulance service in Wales that supports its staff and provides them with the means to make the best use of their skills. I was therefore extremely concerned with the review's findings that there are significant problems with the culture of the organisation, leadership and management of staff. The report highlights that the number and speed of changes has had a serious adverse effect on staff morale, and that there are issues of poor people management and perceptions of a bullying culture. These findings are consistent with the trust's staff survey and with views expressed directly to me by some staff in the service.
The Welsh Ambulance Services NHS Trust must focus on the needs of its staff if it is to continue to improve and deliver a modernised ambulance service that meets the needs and expectations of the people of Wales. I expect the trust to address these serious issues urgently and I will be discussing with Stuart Fletcher how this will be taken forward.

On the issue of whether the trust's modernisation plan is fit for purpose, the review found that the plan was robust, but that improvements should be made to the trust's programme management arrangements to ensure that the plan is effective in delivering change.

On the question of the effectiveness of infection control and cleanliness in ambulance vehicles, the review found that there is a strong and positive commitment to infection control in the trust and that there is a culture that supports improvement at the highest levels within the organisation. I am pleased that the review concluded that there is a clear commitment by staff on the ground to high standards of hygiene and that the design of the new ambulance vehicles, funded by the Welsh Assembly Government, supports infection control requirements.

I have supported the trust in taking forward its modernisation plans through the provision of additional capital and revenue funding. I want to satisfy myself that I am getting the most value out of the investment that I have made in the service, and I have therefore asked my finance director to work with the trust to assess the organisation's efficiency and spending plans.
I can assure Members today that I remain committed to improving ambulance services in Wales. It is essential that the trust takes on board the recommendations of this review and addresses the needs of its staff, the NHS community and the public it serves. I have told Stuart Fletcher that I expect to see substantial improvements in performance within six months. The recommendations set out the issues that must be tackled and I expect the board to provide strong leadership to ensure that the trust delivers a more responsive and effective service.

The Welsh Assembly Government has given the Welsh Ambulance Services NHS Trust its support. I now expect the trust to take on the challenge before it and to deliver to the people of Wales an ambulance service of which we can all be proud.