Wales Ambulance Service: 'Big changes needed,' review says

Ambulances queue outside Wrexham Maelor hospital The review proposals three models for the way the ambulance service can be run

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Major changes are needed in the running of the Welsh Ambulance Service, according to a review commissioned by the Welsh government.

The review also calls for paramedics to be given more training to make decisions about patient care and calls for a revamp of performance targets.

The service failed to meet targets for life-threatening call responses in every local authority area last month.

The ambulance service said it had faced extra pressures with adverse weather.

All-Wales figures for March show 53.3% of emergency responses arrived within eight minutes. The Welsh Ambulance Service target was 65%.

The review ordered by the former Health Minister Lesley Griffiths last year calls for a new "clear vision" for the ambulance service and big changes in the way it works.

'Lacking in clarity'

It says the ambulance service should concentrate on emergency patients, leaving routine transfers to hospitals as the responsibility of local health boards.

Health correspondent Owain Clarke says the report identifies 'fundamental flaws'

Led by health academic Prof Siobhan McClelland, the review also found a "fundamental problem" with accountability and governance arrangements of the ambulance service which it describes as "complex and lacking in clarity".

It proposes three models for the way the ambulance service could be run in the future:

  • One option would be to run the ambulance service as a separate health board directly funded by the Welsh government with the same budget, performance and accountability.
  • A second option would see ambulance services commissioned directly by health boards but with clearer aims and procedures.
  • The third option would see individual health boards taking charge of the ambulance service in its area which would see its dissolution as an all-Wales service.
'Food for thought'

The review says each option has advantages and disadvantages but the third option could be legally fraught and would neither be "quick or straight forward to implement".

ANALYSIS by Prof Ceri Phillips, health economist, Swansea University

The model which is most attractive is the one where the current health boards would commission the ambulance service to provide emergency and patient transport.

Local authorities can help provide transport through bus services as well as ambulance services.

It's the emergency service which needs to be looked at very closely so that we don't get patients being picked up and taken to hospital and having to wait.

We need to go back to look at why patients are actually being conveyed to hospital if they don't necessarily need to be there.

The review makes the valid point that more training of paramedics needs to take place.

Patients need to get the treatment they need at the right time.

Prof Phillips was talking to BBC Radio Wales

Opposition parties called for urgent action from the Welsh government to improve the ambulance service.

Conservative health spokesman Darren Millar said "swift action" was needed by ministers.

He said: "Scores of ambulances are stacked up outside our emergency departments, response times have fallen to a disgraceful low, and unwanted hospital closures and downgrading are set to increase ambulance travelling times and make the situation worse. Patient care and safety is being put at risk.

"The report's recommendations give significant food for thought but it is important that these are considered alongside other challenges facing our NHS and the way in which it delivers emergency care."

"This is the latest in a long line of ambulance service reviews and we now need to see some swift action from the Welsh government to address the problems it identifies."

Welsh Liberal Democrat leader Kirsty Williams said it was important to "see action" from the Welsh government.

She said: "This is the ninth review we have seen into the ambulance service in Wales in the last six years.

"Let us hope this is the last review because what we need now is action not more empty words and futile strategies."

Plaid Cymru health spokesman Elin Jones welcomed some of the findings.

She said: "Some recommendations are really useful, such as the recommendation to give more resources to enable the training of paramedics and a more workable relationship between [local health boards] and the ambulance service."

The Welsh government and the ambulance service both declined to comment before the matter was discussed in the assembly next week.

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