Agenda item

To receive a presentation from the Welsh Ambulance Service. 

(a)       That the presentation be noted;

(b)       That the Locality Manager provide the Committee with a list of reasons given for dispatching ambulances;

(c)        That the Locality Manager provide performance statistics for previous years to compare with those included in the presentation; and

(d)       That the Facilitator arrange a site visit to the Ambulance Service depot.

The Chair welcomed Jo-Ann Dyson from the Welsh Ambulance Service and invited her to deliver the presentation, copies of which were circulated.  Ms. Dyson explained that she was the Locality Manager for Flintshire and Wrexham and was based at the newly-established Area Ambulance Centre at Dobshill.  In thanking the Committee for the chance to give a brief presentation, she welcomed the opportunity for a future return visit if further information was required.

Ms. Dyson explained details of the ‘Make Ready’ system which aimed to accelerate and improve the preparation process of ambulances to benefit response times as well as improving infection control and patient experience.  In reporting vast improvements in ambulance waiting times at hospitals since April 2013 mainly due to regular liaison with three appointed hospital-based Operational Site Managers, Ms. Dyson assured the Committee that there had been a significant increase in patients being seen within 15 minutes and a decrease in numbers of those waiting over an hour.

Statistics indicated a steadily improving performance in Flintshire, resulting in 60.1% of emergency calls in June 2013 being responded to within 8 minutes.  It was acknowledged that response times during March had been affected by the extreme weather conditions experienced throughout the county.  Ms. Dyson referred to local press coverage on ambulance response times in Flintshire in comparison with those in Wrexham, and pointed out that crews from Flintshire were dispersed to Glan Clwyd, Wrexham Maelor and the Countess of Chester hospitals which impacted on turnaround times.  She added that despite the high demand for services in Flintshire, it was hoped that performance figures would continue to improve, although this was dependant on a number of other factors.

The Chair asked whether patients, particularly those from the Mold area, could opt to be taken to the Countess of Chester hospital if they wished.  Ms. Dyson confirmed this and stated that the hospital was generally chosen based on the postcode area of the patient, but was also dependent on patient choice.

In response to queries raised by Councillor H.J. McGuill, Ms. Dyson confirmed that equipment and stretchers etc in ambulance vehicles were thoroughly cleaned in-between patient use.  Staff based at the Dobshill depot were employed by the Ambulance Service and undertook a rigorous three week training programme to gain an understanding of the equipment used, including driving of the vehicles and safety checks.  Councillor McGuill referred to a range of systems and additional resources put in place for hospitals to cope with emergency situations and said it was difficult to understand why these measures could not be utilised on a daily basis to ensure that demand was met.  Ms. Dyson agreed that this was a fair observation and commented that patients were triaged on arrival at hospitals however internal hospital organisations were responsible for moving patients out of the emergency department.

In response to further queries, it was explained that ambulances were unable to discharge patients to out-of-hours clinics as once the patient was on board the vehicle and documentation initiated, there was a responsibility to discharge the patient to a hospital unless the patient chose to discharge themselves.  Explanation was provided on the process of dealing with 999 calls from receiving the call at the control centre within a set time to the dispatching of an ambulance vehicle at the same time as seeking responses from the caller to set questions.  Emergency ‘red’ calls were to be dealt with within 8 minutes whereas other calls were deemed ‘green’.  Councillor McGuill referred to a previous incident at County Hall where an ambulance had failed to respond to an emergency call with no notification given as to why.  Ms. Dyson explained that a callback system was now in place to report any follow-up information.

Issues raised by Councillor H.T. Isherwood were in relation to the increasing pressure on the NHS due to the ageing population and ambulances being able to access individuals in rural areas.  In addition, she felt that more education should be available on basic first aid/CPR procedures in schools and referred to drivers with hearing impairments who may not be able to hear ambulance sirens.  Ms. Dyson said that rapid response vehicles could be used to access rural areas which, apart from stretchers, were fully equipped.  Staff knowledge of areas was helpful in identifying any access issues and was also aided by advance notification, for example in a recent case of a home birth where a prior risk assessment had been carried out.  The intensive training course undertaken by ambulance drivers included awareness raising and consideration of other road users such as those with hearing impairments.  Whilst the suggestion for training at schools would be beneficial, there were insufficient resources to put this into practice, however representatives from the Ambulance Service made every effort to attend schools and associated events to raise awareness, when requested.  In response to a request, she agreed to provide the Committee with a breakdown of the reasons for calling out ambulances.

Following a query raised by Councillor M. Bateman, Ms. Dyson said that a doctor calling an ambulance from a patient’s home would request the type of vehicle required to transport the patient to hospital.  Councillor Bateman would discuss this further outside the meeting.  As requested, Ms. Dyson agreed to provide performance figures from previous years to compare with the current statistics included in the presentation.

In response to a query raised by Councillor V. Gay, it was confirmed that Operational Site Managers were located at BCUHB hospital sites including Ysbyty Gwynedd.  A similar, less robust, arrangement was in place at the Countess of Chester hospital where issues could be raised with another contact.

Councillor D.E. Wisinger commented on the effectiveness of service arrangements and waiting times in previous years, despite the improvements currently being made, however acknowledged that some delays could be due to increased traffic on roads.  He referred to the case at County Hall mentioned earlier and similar incidents across the UK in relation to ambulance waiting times.  Ms. Dyson pointed out that demand on the Ambulance Service had significantly increased which was partly due to individuals not registered with a GP choosing to call for an ambulance and impacted by the closure of some community hospitals.  She gave assurances that work was ongoing to look at ways of resolving this issue.

The Chair said it was recognised that the closure of community hospitals was an increased risk and would lead to further pressure on hospital beds and ambulance waiting times.  Ms. Dyson agreed and said that there would be an increased pressure on ambulance waiting times due to visits made to patients’ homes who could have been in community hospital beds.

Councillor McGuill referred to the first responder on the scene of an incident and asked if there was potential for future training in the Ambulance Service and the Fire Service to be linked.  Whilst Ms. Dyson was not aware of any intention to do this, she commented on the system in place at Airbus where co-responders were in place to deal with emergencies on site with the option to call in the Ambulance Service if required.

Following comments made by Councillor C. Hinds on demand for services in December and January, Ms. Dyson said that traditionally there was an increase in calls received during this period of the year and that the service aimed to deal with at least 58% of those calls within the target time of 8 minutes.

Councillor D.I. Mackie expressed his disappointment that information on the use of Operational Site Managers had not been mentioned by BCUHB representatives at a recent meeting and asked if the high demand for services in Flintshire was based on population size or volume of calls.  Ms. Dyson said that this related to population size and also took into account the number of employees from other areas who worked at the number of large industries in the county.  In relation to the example cited on prior knowledge of an incident gained through a risk assessment, she said that such information would not be retained in the log after the incident had been resolved.  On access to rural areas, staff in the Control Centre had an awareness of locations and could opt for a rapid response vehicle to attend an incident in addition to an ambulance.  Ms. Dyson went on to speak of her involvement in two working groups to address improved flow of working in partnership with BCUHB.

The Chair thanked Ms. Dyson for her detailed presentation and full responses to queries raised.

Following the item, Councillor Hinds said that Ms. Dyson had extended an invitation for the Committee to visit the Ambulance Service.  The Facilitator agreed to arrange this.

RESOLVED:

(a)       That the presentation be noted;

(b)       That the Locality Manager provide the Committee with a list of reasons given for dispatching ambulances;

(c)        That the Locality Manager provide performance statistics for previous years to compare with those included in the presentation; and

(d)       That the Facilitator arrange a site visit to the Ambulance Service depot.