Audit Committee Ambulance Services in Wales Inquiry

216 Pages·2009·2.32 MB·English

Audit Committee
Ambulance Services in Wales Inquiry
July 2009
The National Assembly for Wales is the democratically
elected body that represents the interests of Wales and
its people, makes laws for Wales and holds the Welsh
Government to account.
An electronic copy of this report can be found on the National Assembly’s website
www.assemblywales.org
Further hard copies of this document can be obtained from:
Audit Committee
National Assembly for Wales
Cardiff Bay
CF99 1NA
Tel: [phone]
Fax: [phone]
Email: [email protected]
National Assembly for Wales
Audit Committee
Ambulance Services in Wales Inquiry
July 2009

Ambulance Services in Wales Inquiry
Contents
Chair’s Foreword
4
Introduction
5
The eight minute standard
8
Rapid Response Vehicles
9
Transport of patients by other emergency services
11
Intelligent targets
12
Advanced Paramedic Practitioners
13
Handovers
15
Data terminals
16
Handover targets
17
Making best use of resources
18
Ambulance officers
19
Restocking
21
Sharing best practice
21
Addressing geographical variations
22
Staffing levels at emergency departments
23
The staff experience
24
WAST financial position
25
Re-organisation of the NHS
26
1
Annexes
Audit Committee Record of Proceedings 21 January Annex 1
2009
Audit Committee Record of Proceedings 11 March Annex 2
2009
Audit Committee Record of Proceedings 30 April 2009 Annex 3
Audit Committee Record of Proceedings 4 June 2009 Annex 4
Audit Committee Record of Proceedings 18 June Annex 5
2009
AC(3) 08-09 (p1) Unison – Ambulance Services in Annex 6
Wales
AC(3) 08-09 (p2) British Paramedics Association – Annex 7
Ambulance Services in Wales
2
Committee Membership
Jonathan Morgan
Chair
Cardiff North
Welsh Conservative
Lorraine Barrett Mike German Janice Gregory
Cardiff South and Penarth South Wales East Ogmore
Labour Welsh Liberal Democrats Labour
Lesley Griffiths Irene James Bethan Jenkins
Wrexham Islwyn South Wales West
Labour Labour Plaid Cymru
Huw Lewis Nick Ramsay Janet Ryder
Merthyr Tydfil and Rhymney Monmouth North Wales
Labour Welsh Conservative Plaid Cymru
3
Chair’s Foreword

Since the National Assembly for Wales voted in favour of an inquiry into the
Welsh Ambulance Services NHS Trust in July 2006, the Audit Committee has
taken a keen interest in the performance of the Ambulance service. But
despite two Committee reports on the underperformance of the Trust, the
Committee is not convinced that progress is being made and remains
unhappy with unscheduled care provision.

The Trust has undergone a transformational change in recent years that has
gone some way to modernising the delivery of pre-hospital care in Wales but
further improvement is still needed.

The Committee is concerned that targets designed to ensure a prompt
response to emergency 999 calls are not being met consistently and at times,
performance falls well below the required level. The Committee is also
concerned that performance has been adversely affected by the Trust’s
efforts to make efficiency savings. Further concerns relate to the bullying
culture evident in the Trust which is undermining the achievements of staff
and must be addressed as a priority.

But the Ambulance service does not work in isolation. Lengthy delays to
handovers at accident and emergency units can mean that paramedics are
queuing with patients in corridors and unavailable to answer 999 calls. For
the patient in an A&E Department a lengthy wait is unacceptable. For the
patient in the community awaiting a response to a 999 call, the situation could
be fatal. It is of the utmost importance that the NHS in Wales works to
improve the process from the ‘front door’ to the ‘back’, with joined up working
and intelligent systems that have both the capacity and the tenacity to enable
staff to provide first class care.

This report examines the pre-hospital care provided by the Welsh Ambulance
Services NHS Trust and the handover process when paramedics transfer the
care of a patient to hospital staff. The Committee has previously made
recommendations about delayed transfers of care which occur when patients
are discharged from hospital, and will be examining other aspects of the
patient journey in future reports. It is hoped that the Welsh Assembly
Government will take the opportunity of the forthcoming re-organisation of the
NHS to modernise the delivery of care across the whole system. However,
the re-organisation should not be seen as the solution in itself and work on
improving the performance of the Wales Ambulance Service NHS Trust must
be carried out in earnest.

I would like to thank the witnesses who gave evidence to this inquiry. The
passion and dedication of those individuals was apparent throughout and the
Committee is grateful for their time and efforts.

Jonathan Morgan,
Chair, Audit Committee
4
Introduction

1. The Welsh Ambulance Service NHS Trust is the frontline provider of pre-
hospital unscheduled care in Wales. The all Wales service responds to
emergency 999 calls in order to save lives and provide emergency care to
patients. The Audit Committee commends the dedication and hard work
of all staff of the ambulance service who strive each day to ensure that the
patients they see receive the care they need.
2. However, concerns regarding the Welsh Ambulance Service NHS Trust
have been ongoing for sometime. Accusations of bullying and poor
morale were coupled with poor performance against the Trusts
performance targets. In times of particular pressure, the already
overstretched service was brought close to breaking point with reports of
ambulances queuing outside emergency departments and patients waiting
for unacceptably long periods for an emergency response.
3. In July 2006, the National Assembly for Wales voted for an inquiry into
ambulance services in Wales, to be led by the Auditor General for Wales.
The Auditor General for Wales published his report on the inquiry in
December 2006. The inquiry concluded that there were longstanding and
severe problems throughout the Welsh Ambulance Service NHS Trust. In
March 2007, the predecessor Audit Committee reported on its own
investigation into the issues.
4. In June 2008, the Auditor General for Wales reported on his follow up
review into the Ambulance Services in Wales. That review found that
although there was evidence of positive improvements in the Trust since
December 2006, some difficult problems remained. These problems were
judged by the Wales Audit Office as symptomatic of the process of
transformational change. The Audit Committee report of October 2008
reflected this view and recognised that although there was a need to make
rapid and sustained progress, it would take time to deal with some of the
organisational and systemic challenges that faced the Trust.
5. In December 2008, the Welsh Assembly Government responded to the
Audit Committee report. The Audit Committee considered the response in
January 2009 and sought advice from the Auditor General for Wales.1
The Committee was concerned that progress was not being made quickly
enough with regard to the issues highlighted in its earlier reports. It
decided to seek further evidence from Paul Williams, Director-General of
Health and Social Services and Accounting Officer in the Welsh
government, and Alan Murray, Chief Executive of the Welsh Ambulance
Services NHS Trust.
6. The Auditor General for Wales issued his report ‘Ambulance Services in
Wales – further update to the National Assembly for Wales’ Audit

1 AC(3)-01-09 (p2), (p3)
5
Committee’ ahead of the Audit Committee meeting on 11 March 2009, in
which Paul Williams and Alan Murray gave evidence to the Committee.
7. On 23 April, the Auditor General for Wales published his report
‘Unscheduled Care – patient handovers at hospital emergency
departments’.
8. Following consideration of the report on handovers,2 the Audit Committee
launched an inquiry into ambulance services in Wales in order to examine
the wider issues effecting performance of the trust.
9. The Committee took oral evidence from:
16 March 2009
• Alan Murray, Chief Executive, Welsh Ambulance Service NHS
Trust
• Tim Woodhead, Director of Finance, Welsh Ambulance Service
NHS Trust
• Paul Williams, Director-General of Health and Social Services,
Welsh Assembly Government
• Simon Dean, Director of Service Delivery and Performance
Management, Welsh Assembly Government
4 June 2009
• Dave Galligan, Head of Health, Unison Wales
• Tina Donnelly, Director, Royal College of Nursing
• Andrew Evans, Professional Officer, Royal College of Nursing
• Professor Malcolm Woollard, Chair of the College of Paramedics
18 June 2008
• Jon Falcus, Directorate General Manager, Wrexham Maelor
Hospital
• Judith Rees, Deputy Directorate General Manager, Wrexham
Maelor Hospital
• Meredith Gardner, Directorate Manager, University Hospital of
Wales
• Jennie Palmer, Senior Team Leader Nurse, Emergency Unit,
University Hospital of Wales
• Alan Murray, Chief Executive, Welsh Ambulance Service NHS
Trust
• Tim Woodhead, Director of Finance, Welsh Ambulance Service
NHS Trust

2 AC(3)-06-09 (p2)
6