“Journey of change” to improve patient outcomes and ambulance response times welcomed by councillors

The “journey of change” to remodel and improve response times by the Wales Ambulance Service Trust (WAST) has been welcomed by councillors.

Members of Wrexham Council’s safeguarding, communities and wellbeing scrutiny committee met with representatives from WAST yesterday afternoon for an update on its performance in Wrexham over the past 12 months and its overall plans to improve outcomes for patients via a “clinically appropriate response”.

In October 2015 a piloted clinical trial was launched across Wales, with ambulance response time targets for all 999 calls scrapped. Instead it was announced that calls to the service would be categorised into a traffic light system – with ‘red’ calls classed as immediately life-threatening.

This model was formally adopted in 2016, with amber and green calls also introduced.

In Wrexham the number of red calls responded to within eight minutes was above the 65 per cent target throughout 2018, with an overall average of 82.8 per cent.

Speaking at yesterday’s meeting, Duncan Robertson from Wales Ambulance Service Trust (WAST), explained that it had been on a “journey of change” over the past five years and that a “significant amount of work has been done” to alter its response model to meet demand.

One method which has been adopted by WAST is ‘hear and treat’, which can involve a clinician offering telephone an assessment or advice to patients.This is typically for calls which are classed as category green, meaning patients who require further treatment could be transported ‘planned non-emergency transport’, such as an ambulance or a taxi.

The committee was also told that the service have been utilising an training advanced paramedic practitioners – who are paramedics who return to university and undertake the same training as advanced nurse practitioners. This means that the individual can be sent to patients who are more “complex” and can deploy different drugs and assessment skills.

Cllr Trevor Bates offered his thanks for improvements made with response times in his ward of the Ceiriog Valley and questioned why the advanced primary paramedic practitioners were not being deployed in Wrexham often.

Mr Robertson explained: “The advanced primary practitioners was a short pilot to determine deployment and one of the considerations that we had was where our advanced primary practitioners actually live. We were in a position where our advanced primary practitioners for the pilot predominately lived in the west part of north Wales

“Since then we’ve been able to baseline 10 of our positions and we are spreading them more equally. We’ll be establishing a team of three at the depot on Dobbs Hill and that will be our team in the east.

“We’re anticipating that will be the nucleus of a bigger a team, but we’re still on the say so from Welsh Government for funding. If we can get funding then we can recruit some more.”

Cllr I David Bithell praised the ambulance service in Wrexham for exceeding the the response targets set by the Welsh Government.

He added: “The most frequent annoyance of paramedics is sitting outside A&E waiting to move in with a patient. I think it’s aftercare you have to look and social care afterwards, so you get those patients back out in the community and they are releasing a bed.

Liz Hughes from WAST, said: “In Wrexham is has improved significantly. Something called reverse boarding has happened in recent months and we are rarely queuing outside Wrexham Maelor due to flow issues.

“Yes you’re moving patients inside the hospital, in my opinions that is safer for that patient and it is an improvement.

“I no longer have Wrexham on my speed dial in relation to escalation, which is good. But that is the real good work that is happening there.”

It was also noted that although the average waiting times in the Wrexham Maelor Emergency Department last month was nine and a half hours, there has been a “seismic shift” in the ambulance transfer times compared to this time last year.

Meinir Williams, from Betsi Cadwaladr University Health Board, explained: “Over the past six weeks at the Wrexham Maelor we have seen a big, big shift around both culture and the way patients are being processed through the emergency department.

“This time last year we were seeing large number of patients being held for a significant number of hours in ambulances outside the department. That caused harm to community in the Wrexham area.

“The health board has taken that seriously and the work that has really reaped benefit. Over the last six weeks where the Wrexham Maelor is in terms of handover is a sea apart.

“We were losing 2000 hours per month in December last year compared to December this year. As of today I can tell you that we are looking at month end – if we continue on the trend this month has shown – we will have had less than 200 hours outside the emergency department.”

You can read our report on the work being carried out by Betsi Cadwaladr University Health Board to recruit more GPs and develop primary care in the Wrexham area here.

The WAST slideshow outlining its plans to improve the quality of ambulance responses can be viewed here.