Dear Mr Gruffydd Re: Mr Peter Parker I write in response to the Prevention of Future Deaths Report issued to this Trust on 22 October 2025, following the inquest in relation to Mr Peter Parker. The matters of concern that you have asked the Trust to consider are: “There was a significant delay in getting an ambulance to Peter which resulted in him dying from his injuries before assistance arrived. The time for survival of such injuries was 30-45 minutes, however the time taken to respond was in excess of 9 hours. Whilst there is no specific target for Amber 1 calls it was envisaged that when the system was introduced such calls would be responded to in 20 minutes”

Additionally, you have stated:

“The inquest heard evidence that when the MPDS system was introduced in 2015 it was envisaged that an Amber 1 priority call would be responded to in 20 minutes from the time of the call and that a person with a transected radial artery could expect to survive 30-45 minutes. Given that it was not

feasible for Peter to transport himself to hospital, and Peter had not contacted his family for their assistance.”

I would like to start by explaining that the Medical Prioritisation and Dispatch System (MPDS) is used by the Trust to prioritise the calls it receives and was adopted during the 1990’s. Your reference to 2015, we believe refers to the trial of a new Clinical Response Model (CRM) which commenced in October 2015. The CRM guides the way in which the Trust utilises its resources. An initial trial was undertaken for 12 months and extended by a further 6 months. In February 2017, the CRM was approved by Welsh Government and has remained in place since that time. During the trial of the Trust did have in place an internal only target to attend Amber 1 calls in 20 minutes. For clarity this was purely an internal, non-official target, which ceased when the CRM was fully adopted in 2017. Since 15 October 2015, the Trust has had only one official time based target, and that is in relation to an 8 minute response to 65% of ‘Red’ cases. You may now be aware that on 26 November 2024, the Cabinet Secretary for Health and Social Care, Jeremy Miles, announced the establishment of a task and finish group to review our current “red” target and associated metrics. This comes after the Senedd’s Health and Social Care Committee published a series of recommendations in August following its general scrutiny of the Welsh Ambulance Services University NHS Trust in May 2024. The scrutiny report has been included as an appendix to this letter (Appendix 1). The emergency ambulance response measures task and finish group will comprise of senior civil servants and policy leads, representatives of the Joint Commissioning Committee (JCC), clinicians and members of our leadership team. This group will work at pace and is due to report to the Cabinet Secretary early next year with a view to updating Committee, and Senedd members, by the end of February 2025. The Trust does not propose to take any additional, or new, actions specifically in relation to this Preventing Future Deaths report because of existing plans already being enacted. Whilst we recognise that this may appear insensitive given the loss Mr Parker’s family have experienced and in light of the risks you raise with us, we hope to provide assurance that the Trust already recognised the risks and pressures within Urgent and Emergency care pathways and is taking all possible steps within its control to ensure availability of resources to respond to Red and Amber calls. The Trust also seeks to secure full support from its commissioners through it commissioning body, the JCC, Welsh Government, the wider NHS and Local Government to ensure appropriate clinical risk management across the urgent and emergency care pathway to release resources with the Trust. In addition to the Governmental task and finish group referenced above, and aligned to our 2024- 27 IMTP, the Trust has commenced work to evolve its Clinical Services Model. We have provided an overview of our current position and planned incremental changes under the headings below. Current Situation ▪ We fully understand and acknowledge the long standing and entrenched problems facing health and social care services. ▪ The challenges facing the system are complex, and not easily solved by a single organisation unilaterally.

▪ This is no consolation for families who have been caught up in the challenges of the current system. ▪ It is our view that the traditional ambulance model of care needs updating to reflect both increasing clinical skills of staff and increasing opportunities presented by technology. We need to think differently. ▪ As a result, we recognise that there is more we need to do ourselves to improve patient care and experience for patients calling 999. ▪ We are looking to potentially do things differently in the future and are working closely with commissioners on the art of the possible in terms of ‘evolving’ our clinical services model. What are we looking to achieve? ▪ Protect our ambulance resources for patients most in need of an ambulance response ▪ We only want to convey patients to hospital whose needs cannot be met by the Trust or in another part of the system. ▪ Enhance our ability to resolve more care through the Trust led interventions without needing an emergency ambulance response. Including: o Enhancing our ability to manage more patients’ needs remotely following a remote clinical assessment. o Patients’ needs are met in their own home following a face to face clinical assessment through an enhanced community response services (e.g., Advanced Paramedic Practitioners, Falls Response, Mental Health Vehicle). o Improve access to signpost / refer patients whose needs are best met by another service. Core foundations of the model ▪ The core foundations of the model are set out below:

o Clinically led – there will be increased clinical input, earlier in the call cycle and throughout the patient journey. Clinicians will be actively involved in decision-making on the right pathway for each patient as part of a care planning process. o Connectivity – systems, processes and people across the Trust will be increasingly connected so that patients get the right care in the right place, irrespective of their point of access (e.g., Digital access, NHS 111, 999 or the Ambulance Care service for non-emergency patient transport). o Care Planning: We will adopt a personalised care planning approach for all patients, providing robust clinical oversight of the patient throughout their episode of care until their needs are resolved and case closed with the ambulance service. o Choice: A greater range of response options will be created for those patients who need a face-to-face assessment, designed to enable more patients to be treated safely at home and to avoid conveyance to an Emergency Department. o Collaboration: Increased effort will be put into working with commissioners and system partners at national and local level to identify and develop appropriate care

pathways for the Trust clinicians to safely and appropriately refer patients to meet their care needs. What are our current priorities? ▪ We are in close collaboration with Welsh Government, our commissioners and health boards to focus on opportunities for improvement, including improving access to local pathways of care to provide more options to safely avoid patients being conveyed to hospital. ▪ As part of our plans for winter we are embedding new clinical roles in our control rooms to proactively triage 999 calls earlier in the call cycle. By using clinical expertise, it enables more effective clinical decisions regarding the best care to meet the patient’s needs. What will be the impact? ▪ We will be monitoring the impact of these developments and working with commissioners and partners to work through opportunities for further development and collaboration. When will we see changes? ▪ Our aim in the short term is to make the service ‘safer’ over this winter. ▪ Implementation of an evolved model of care (pending commissioner endorsement) will be delivered in a phased approach, and the programme is likely to run for period of circa 2/3 years. ▪ We expect to see incremental improvement as different interventions are implemented and embedded throughout the programme timescales. ▪ We recognise that no single intervention can fix the problem. ▪ The level of improvement is dependent upon how well the wider system is functioning. Ongoing Engagement ▪ We continue to work with partners across the system, commissioners and Welsh Government on collective support and action so that we can make further improvement. ▪ We will be undertaking more targeted engagement with key stakeholders, including coronial services, to support our emerging plans in the near future. We hope that this information supports our position that we are doing everything within our sphere of control and influence to deliver more timely, safer care however we are acutely aware of the limitations of our actions within the wider health and care landscape of extreme pressures across Urgent and Emergency Care systems. The number of hours' worth of Trust emergency ambulance production lost per month due to long waits at emergency departments is consistently reaching the 25,000 to 30,000 hours mark. This equates to approximately 20 per cent to 25 per cent of our entire fleet capacity every month as a result of the pressure right across the urgent and emergency care system. This issue remains the highest influencing factor on our ability to provide timely responses, far above and beyond the incremental improvement measures being taken internally by the Trust. To this end, Welsh Government released a revised Welsh Health Circular (WHC-2024-041) on ‘Ambulance patient handover guidance’ shortly following the conclusion of Mr Parker’s inquest. This document replaces the existing 2016 WHC on the same subject and reinforces the expectation that

“robust arrangements are in place to ensure rapid handover, within 15 minutes of arrival”. (Appendices 3 and 4) While the Trust fully supports the need to issue a report under paragraph 7, Schedule 5, of the Coroners and Justice Act 2009 and regulations 28 and 29 of the Coroners (Investigations) Regulations 2013, we do not believe that we are the primary authority with the “power to take such action”. Therefore, I respectfully request your consideration as to any further actions you feel the Trust could take, over and above those that we have already shared with you. Equally, I would genuinely welcome any suggestion you may have regarding actions we might take or seek to take with our partners. We continue to work tirelessly at internal mechanisms to reconfigure and improve resource allocation, regularly reporting to our Trust Board on the steps taken to mitigate patient harm. However, we recognise that we are not an organisation with a full solution in the broader context. I am therefore extending an offer to meet with you to discuss our response in more detail, and to provide you with any further assurances you may require regarding our commitment to continual improvement to proactively prevent harm and future deaths. I would like to again offer my sincere condolences to Mr. Parker’s family on their sad loss. Any reference to the systemic nature of the root causes for delays are in no way intended to be dismissive of the unacceptable and tragic loss of life and the grief his family are experiencing. If you wish to take up the offer of a meeting with myself or a member of my Executive team, please contact , Legal Services Manager, who will be happy to arrange this. Her contact email is and her telephone number is: .

Dear Mr Gruffydd,

Re: Inquest Hearing in respect of Mr Peter Parker (Ref: 13893868)

Thank you for providing Swansea Bay University Health Board with an opportunity to address concerns raised at the conclusion of the Inquest of Mr Peter Parker, on 16th October
2024.

As you are aware the Health Board was not directly involved in clinical decision-making or care delivery immediately prior to Mr Parker’s death in September 2021 and as such were not a party to your Inquest hearing. The Health Board’s last known contact with Mr Parker was in April 2021 in relation to Type II Diabetes Self-Management Clinic, which was a telephone contact.

It is noted that in evidence submission made to your Inquest by the Welsh Ambulance Service NHS Trust (WAST), it was put forward that delay in releasing emergency response vehicles from the Emergency Department at Morriston Hospital was a factor in WAST being unable to respond to Mr Parker within an appropriate clinical timescale.

The Health Board accepts that routinely there are substantive delays within acute unscheduled care pathways, as a local, national and UK wide level. These pathways can include extended waiting times for emergency vehicle response and clinical handover delays on arrival within acute secondary care.

At any point in time (24/7), the Health Board and specifically the Hospital Management Team at Morriston Hospital is aware of the number of open calls being managed by WAST, the clinical priority assigned to each of these calls, by WAST, and a very general comment on clinical presentation; universally referred to as the “stack”. The extent of information available, at this point is very limited and the Health Board has no role in determining clinical priority and resource allocation.

Sadly, as described in your Inquest papers, WAST emergency vehicle attendance at the home address of Mr Parker was too late and he was declared deceased and therefore was not conveyed to Morriston Hospital, for emergency care. Bwrdd Iechyd Prifysgol Bae Abertawe Swansea Bay University Health Board Un Porthfa Talbot | One Talbot Gateway Parc Ynni, Baglan | Baglan Energy Park Port Talbot SA12 7BR Ffôn Phone:

Rydym yn croesawu gohebiaeth yn y Gymraeg neu'r Saesneg. Atebir gohebiaeth Gymraeg yn y Gymraeg, ac ni fydd hyn yn arwain at oedi. We welcome correspondence in Welsh or English. Welsh language correspondence will be replied to in Welsh, and this will not lead to a delay.

Pencadlys BIP Bae Abertawe, Un Porthfa Talbot, Port Talbot, SA12 7BR Bwrdd Iechyd Prifysgol Bae Abertawe yw enw gweithredu Bwrdd Iechyd Lleol Prifysgol Bae Abertawe Swansea Bay UHB Headquarters, One Talbot Gateway, Port Talbot, SA12 7BR Swansea Bay University Health Board is the operational name of Swansea Bay University Local Health Board At this point I would like to take an opportunity to offer my heartfelt condolences to the family of Mr Parker.

On occasions when such events have occurred, WAST have notified the Health Board of a potential Serious Incident and afforded the Health Board time to reflect on the case and look for learning opportunities, this process has been in place since circa 2019 and continues to date with outcomes shared at joint meetings between the Health Board and WAST. We have not been able to identify such a notification from WAST in relation to Mr. Parker.

The agenda for the Health Board and WAST meetings is driven by exceptional cases, where severe/catastrophic harm has been identified. The meetings are held monthly and are chaired by a Health Board Associate Nurse Director. (Outcomes from these meetings are available).

In lieu of a case review not being undertaken in 2021, the Health Board has taken the opportunity to apply its established review methodology to Mr. Parker’s case.

The following key aspects, with regards to the Health Board’s response to unscheduled care pressures experienced across the 10th and 11th September 2021 are as follows:

• At the time Mr. Parker contacted WAST (21:21, 10/09/2021), there were 3 emergency response vehicles outside the Emergency Department at Morriston Hospital, awaiting clinical handover.

• During the period between the initial 999 call and the arrival of a WAST response vehicle at Mr. Parker’s address, a further 10 emergency vehicles arrived at the Emergency Department at Morriston Hospital and 10 emergency vehicles were clinically handed-over; with an average handover time of 192minutes (range 784 minutes to 13minutes). This includes the 3 vehicles outside Morriston Emergency Department at the time of the initial contact.

• This case occurred when enhanced infection prevention protocols related to COVID- 19 were still in place, within the Emergency Department and across the hospital site, which could have impacted on the speed of clinical handover for some patients in order that appropriate risk assessment was undertaken to ensure patient and staff safety. A high-level review of the cases arriving by ambulance on 10th and 11th September 2021, supports this, with a number patients presenting with breathing problems.

• It is apparent from evidence provided by WAST, that there was a significant increase in WAST demand during the period Mr. Parker was awaiting a response, with the number of Amber1 calls increasing from 11 (at 22:28 with a longest waiting time of 7hours 24minutes) to 21 (at 02:19 with a longest waiting time of 9hours 40minutes).

It is noted that the Serious Incident Review undertaken by WAST concluded that due to the number of Amber1 calls polling ahead of Mr Parker, they could not have responded to his call any sooner.

A multi-faceted risk to delivery of unscheduled care is recognised on the Health Board’s Risk Register and is scored at 25.

Rydym yn croesawu gohebiaeth yn y Gymraeg neu'r Saesneg. Atebir gohebiaeth Gymraeg yn y Gymraeg, ac ni fydd hyn yn arwain at oedi. We welcome correspondence in Welsh or English. Welsh language correspondence will be replied to in Welsh, and this will not lead to a delay. Pencadlys BIP Bae Abertawe, Un Porthfa Talbot, Port Talbot, SA12 7BR Bwrdd Iechyd Prifysgol Bae Abertawe yw enw gweithredu Bwrdd Iechyd Lleol Prifysgol Bae Abertawe Swansea Bay UHB Headquarters, One Talbot Gateway, Port Talbot, SA12 7BR Swansea Bay University Health Board is the operational name of Swansea Bay University Local Health Board Since Mr Parker’s death the All-Wales National Immediate Release Protocol (July 2022) has been introduced (a copy is attached for reference). The objective of this protocol is to provide an escalation process, across NHS Wales, that ensures WAST resources are released when required to mitigate, in real-time, serious cases of potential harm from occurring because of an avoidable delayed response in the community.

The protocol is designed to work alongside, and not replace, organisational management/ clinical safety plans. It is designed to complement joint working to reduce harm and improve patient safety.

The protocol sets out a clear process for request/escalation and requires Health Board’s to investigate all occasions when an immediate release is declined.

In summary the steps (S.5) are set out below: -

Step 1 – WAST will contact ED staff via the “red phone” and direct an immediate release of an ambulance delayed outside the ED when no other appropriate resource is available to respond to a Red or Amber1 patient and/or when the resource has an extended travel time and nearer appropriate resources could attend that patient. The direction made by WAST will share the incident priority, patient age and chief complaint, identify the number of resources that are required to be released and the callsigns of the resources to be released (those that are immediately able to respond to the incident).

Step 2 – Health Board colleagues on receipt of an immediate release direction will ensure compliance and facilitate the release of the resources identified without delay.

Step 3 – Should an immediate release direction be declined by the ED staff, WAST will act in accordance with the WAST Resource Deployment SOP and record and escalate the refusal to the Operational Delivery Unit. If a Health Board does decline an immediate release direction, they will be required to provide the reasons for this and the name or identifying detail (e.g., employee number) of the declining staff member.

The reason for handover delays is solely related to a lack of capacity to bring the conveyed patient into the hospital; both in terms of safe physical space including access to essential clinical support and staffing to take care of the patient. All patient’s waiting on the back of ambulances will have been clinically assessed and all opportunities explored as to how best to deliver a safe, timely, clinical management plan. The Emergency Department at Morriston Hospital routinely functions with additional patients across its template including within the acute resuscitation area, with “Major” patients overflowing into the “Minors” area and “Minors” patients sitting in the “Waiting Room”.

It is important to note that patients can and do self-present at the Emergency Department with significant clinical presentations that require immediate clinical intervention and this is a feature when WAST waiting times for an emergency vehicle are long. This represents a secondary route for very unwell patients to present at hospital that needs to be considered in assessing safety within the Emergency Department. These patients can be more clinically urgent than patients arriving by emergency response vehicle.

I can confirm that all Red release requests are actioned by the Health Board. Amber1 release requests are managed on a case-by-case basis and the Health Board may have to decline requests when there is a significant/severe clinical safety risk to the Emergency

Rydym yn croesawu gohebiaeth yn y Gymraeg neu'r Saesneg. Atebir gohebiaeth Gymraeg yn y Gymraeg, ac ni fydd hyn yn arwain at oedi. We welcome correspondence in Welsh or English. Welsh language correspondence will be replied to in Welsh, and this will not lead to a delay.

Pencadlys BIP Bae Abertawe, Un Porthfa Talbot, Port Talbot, SA12 7BR Bwrdd Iechyd Prifysgol Bae Abertawe yw enw gweithredu Bwrdd Iechyd Lleol Prifysgol Bae Abertawe Swansea Bay UHB Headquarters, One Talbot Gateway, Port Talbot, SA12 7BR Swansea Bay University Health Board is the operational name of Swansea Bay University Local Health Board Department, in accepting additional patients into the Department. This risk is assessed at a point in time, by the senior clinical staff in-charge of the Emergency Department (medical & nursing) and would be consistent with the nationally reported emergency care status or SAPhTE score (Staffing, Acuity, Physical Capacity, Transfer, Environment). The decision is documented and notified to the Hospital Site Management Team who record it as part of the situation reporting throughout any 24hour period.

The Health Board actively monitors ambulance handover performance against the following two performance measures, on a daily basis:
• Number of ambulance handovers greater than 1hour
• Number of lost hours as a result of delayed ambulance handovers (greater than 15minutes)

Diagram1: Ambulance Handover Performance covering the period 1st November 2022 to 30th November 2024:

(Source: Health Board Performance Scorecard – weekly update 03/12/2024)

The above graphical representation demonstrates the number of delayed WAST handovers (>1hour) has reduced by 15% (744 in November 2022, to 632 in November 2024) and the number of lost hours (>15mins) as a result of handover delays has significantly reduced by 32% (4456 hours in November 2022 to 3028 hours in November 2024).

The Health Board has commenced a programme of targeted intervention in conjunction with the National Strategy for Right Care, Right Place, First Time: Six Goals for Urgent & Emergency Care, supported by Welsh Government, to address risks associated with urgent and emergency patient pathways, including the ability to release emergency response vehicles, following arrival at Morriston Hospital. The aim of this programme of work is to critically review and redesign across community access, service delivery, staffing models and infrastructure in order to reduce risk of patient harm and service failure.

Right Care, Right Place, First Time: Six Goals for Urgent & Emergency Care The above strategy focuses on strengthening signposting to clinically safe alternatives to admission, rapid emergency care response, good discharge practice and preventing readmission.

Rydym yn croesawu gohebiaeth yn y Gymraeg neu'r Saesneg. Atebir gohebiaeth Gymraeg yn y Gymraeg, ac ni fydd hyn yn arwain at oedi. We welcome correspondence in Welsh or English. Welsh language correspondence will be replied to in Welsh, and this will not lead to a delay.

Pencadlys BIP Bae Abertawe, Un Porthfa Talbot, Port Talbot, SA12 7BR Bwrdd Iechyd Prifysgol Bae Abertawe yw enw gweithredu Bwrdd Iechyd Lleol Prifysgol Bae Abertawe Swansea Bay UHB Headquarters, One Talbot Gateway, Port Talbot, SA12 7BR Swansea Bay University Health Board is the operational name of Swansea Bay University Local Health Board

I have attached a copy of the Policy Document, for your information.

In support of delivery of this programme of work the Health Board has an Urgent and Emergency Care Project in place, which is led by the Morriston Service Group.

With reference to Goal 2&3: Signposting people with urgent care needs to the right place, at the right time and providing clinically safe alternatives to admission to hospital

It is anticipated that in ensuring that there are robust alternatives to presenting at an Emergency Department, there will be a reduction in demand. This in turn will enable Emergency Departments to better manage patient flow and capacity.

In developing this model, a Same Day Emergency Care (SDEC) service is available on the Morriston Hospital site. Providing an alternative to presentation at the Emergency Department. This service can sign-post and facilitate urgent review into specialist “hot” clinics and represents a tangible link between primary and secondary care services.

In addition, the Health Board have developed an Acute Medical Unit and recently opened an Older Person’s Assessment and Short Stay Unit (June 2024) on the Morriston Hospital site, which again provides alternative pathways for patient’s presenting to the Emergency Department and funnels into appropriate care delivery settings, including being supported at home by services such as the “Virtual” Ward and Acute Care Team.

With reference to Goal 4: Rapid response to physical or mental health crisis.

This goal focuses specifically on safe alternatives to ambulance conveyance into secondary care, thus enabling a more responsive service to patients who are in danger of losing their life or require access to time-sensitive treatment; such as that for Stroke or life-threatening injury.

There is an inherent expectation that the number of people waiting over 60minutes between arriving by ambulance and being handed over to a clinician, reduces year on year (as per Diagram1).

I would like to offer my sincere condolences to Mr Parker’s family on behalf of the Health Board. Whilst it is fully appreciated that these developments will not change the outcome for Mr. Parker and his family, I hope that you are assured that the Health Board has a clear focus on improvement in access times for unscheduled care with an aim of preventing events, such as those identified in Mr. Parker’s case, from occurring today and in the future.

Dear Mr Gruffydd

INQUEST INTO THE DEATH OF PETER PARKER

Thank you for your correspondence dated 22 October received in my office on 7th November, in which you enclose a copy of a Regulation 28 Prevention of Future Deaths report (‘the report’) following the conclusion of the inquest into the death of Peter Parker. I should like to offer my sincere condolences to Mr Parker’s family on their sad loss.

In the report you ask for details of action taken or proposed by the Welsh Government to improve timeliness of ambulance response to aid prevention of future deaths.

I note you have also written to the Chief Executive of Swansea Bay University Health Board (which is responsible for planning and delivering services based on an assessment of local population need), and the Chief Executive of the Welsh Ambulance Services University NHS Trust (which is responsible for delivering emergency ambulance services in line with commissioning intentions set of it by the NHS Wales Joint Commissioning Committee). The independent responses of the health board and the trust should detail the respective actions taken by each organisation to address your concerns.

A summary of urgent and emergency care system pressures

You are likely to be aware that urgent and emergency care services in Wales, as with other parts of the United Kingdom, have been under often unrelenting pressure for a number of

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years. In summary, this is as a consequence of challenges presented by changing demographics, increasing prevalence of people with multiple chronic conditions and difficulties in supporting the timely discharge of patients to local communities caused by a range of factors. These factors include high hospital bed occupancy, delayed discharges caused by inefficient hospital processes and staffing shortages in key parts of the health and social care system.

Delayed patient discharge is a key contributing factor to long ambulance patient handover delays. This is because poor patient flow causes bed occupancy levels to increase, resulting in patients waiting lengthy periods for admission to hospital from emergency departments which, consequently, limits available space for patients arriving by ambulance to be transferred to the emergency department itself.

This can result in long ambulance patient handover delays, impacting negatively on patient experience and crucially limiting available ambulance capacity to respond to other patients in the community.

Expectations and monitoring of urgent and emergency care improvements

These issues are all connected and require whole system strategic change and leadership to overcome them. The overarching Welsh Government strategy towards improvement is set out in A Healthier Wales. Aligned to this strategy, to enable better outcomes and experience for people who need to access urgent or emergency care services, the Welsh Government published the Six Goals for Urgent and Emergency Care Policy Handbook in February 2022.

This handbook describes our expectations for health boards and partners to support people in their local communities who are at greater risk of needing an ambulance response, transport to an emergency department and admission to hospital, and coordinating their care through clear care plans and support from local community teams.

The handbook sets out the intention to safely manage people who do not need to access the services of an acute hospital in their local communities, thus freeing up ambulance response and emergency department capacity for those who have an absolute clinical need for them.

The Welsh Government communicates its expectations of health boards and NHS Trusts through an annual NHS planning framework and organisations are expected to produce integrated medium-term plans annually that respond to the priorities set in the NHS planning framework.

For the past two iterations of the framework, the Welsh Government has been explicitly clear of our expectation that health boards prioritise plans to improve timeliness of ambulance patient handover to free up ambulance clinicians to respond to patients in the community. Given the relationship between both timely patient discharge and ambulance patient handover, the Welsh Government has set a priority for improvement in patient flow and the reduction of delayed discharges (pathways of care delays). To build on this, the Welsh Government has also set health boards in-year aspirations in 2024/2025 to reduce ambulance patient handovers over 1 hour by 30% by December 2024.

The Welsh Government has put in place additional performance oversight arrangements to enhance scrutiny of health boards’ delivery against these and other key ministerial targets

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through the new performance board arrangements. I am now holding monthly performance board meetings with health board chief executives.

Support via the national Six Goals for Urgent and Emergency Care programme

To enable health boards to deliver on our expectations, the Welsh Government established a national six goals for urgent and emergency care programme which is supported by £27million in funding for 2024/25. The Welsh Government also directed health boards to establish local six goals programmes to drive improvement of urgent and emergency care services and each health board has a local programme plan intended to deliver against ministerial priorities.

Successful delivery of these plans should support improvements across a range of measures, including the reduction of ambulance patient handover delays contributing to improved ambulance responsiveness. Progress in delivering these priorities is monitored through bi-monthly Integrated Quality, Planning and Delivery meetings between Welsh Government officials, representatives of the NHS Executive and health boards.

This six goals funding is part of a wider package of more than £180million in additional Welsh Government funding this year to support health boards and regional partnership boards to:

• safely manage more people in the community;
• avoid ambulance transport and admission to hospital; and
• deliver integrated solutions with social care services to improve patient flow through hospitals.

Other initiatives to support improvements in ambulance patient handover and patient flow

More recently, the Welsh Government has developed new ambulance patient handover guidance – published on 29 October 2024 which sets out expectations of the NHS Wales Joint Commissioning Committee, ambulance clinicians and health boards to support improved ambulance patient handover. The NHS Executive will undertake audits of organisations’ compliance with the guidance over the remainder of 2024/2025, and we have been clear that health boards must also undertake their own audits of compliance.

Additionally, the Welsh Government commissioned the development of a community based falls response framework which was published by the NHS Executive on 30 October 2024 and a national task group established to enable health boards to deliver. The intention is to better support people who have fallen but are not seriously ill or injured, to safely avoid the need for an ambulance response or transport to emergency departments, thus reducing ambulance patient handover delays and improving experience and outcomes.

The Welsh Government has also recently launched a 50-day integrated care winter challenge (‘the challenge’) based on learning from other parts of the UK. The Welsh Government identified ten high-impact and best practice actions for health boards, regional partnership boards and local authorities to deliver between 11 November and 31 December
2024..

The challenge is intended to accelerate and standardise delivery of safe alternatives to admission to hospital and support timely discharge home and is enabled by an additional

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£19m announced by the Cabinet Secretary for Health and Social Care on 3 December
2024.

The Welsh Government are monitoring progress very closely and will review lessons learned following completion of the initial 50 days on 31 December 2024 to support sustained implementation of the best practice actions in 2025 and onwards. The Welsh Government also continues to engage regularly with other UK nations to learn lessons about solutions to the ambulance patient handover issue and will be seeking to transfer learning to improve performance in Wales in 2025.

Wider NHS escalation and intervention arrangements

Finally, although some progress has been made by the Swansea Bay University Health Board in some areas, concerns about delivery of urgent and emergency care and other areas led to the Welsh Government escalating the organisation to level 4 (targeted intervention) status in January 2024 for performance and outcomes. This means that the Welsh Government are now scrutinising the health board’s performance extremely closely. In response, the health board is prioritising a range of actions to support better patient outcomes and experiences in the months ahead. The health board remains at level 4 as the necessary improvements have not yet been seen.

As part of this escalation, additional support has been given to the health board from the NHS Executive to support improvements in urgent and emergency care. These actions are being monitored and reviewed in monthly oversight meetings.