Dorothy Jones
PFD Report
All Responded
Ref: 2023-0020Deceased
Emergency services related deaths (2019 onwards)
Wales prevention of future deaths reports (2019 onwards)
All 2 responses received
· Deadline: 17 Mar 2023
Response Status
Responses
2 of 2
56-Day Deadline
17 Mar 2023
All responses received
About PFD responses
Organisations named in PFD reports must respond within 56 days explaining what actions they are taking.
Source: Courts and Tribunals Judiciary
Coroner’s Concerns
1. The ongoing pressures faced by the ambulance service are clearly multifactorial. However, a failure to provide a resource within a reasonable timeframe has been a constant and ongoing feature of inquests within Gwent, where a patient has died at home or shortly after admission to hospital. Despite repeated reassurances over the past 12 months about remedial action being undertaken, the evidence before me at this inquest suggests there has been no appreciable improvement in the response times for Amber 1 category patients.
2. The Amber 1 category includes all life-threatening conditions except those in the Red category where the person appears to be in the throes of dying. I was informed that all the patients in the Amber 1 category are allocated an ambulance / clinical resource chronologically, without further consideration of clinical need.
3. I was informed at the inquest that on occasion a clinician within WAST will intervene to undertake a further assessment to determine whether the response should be expedited. However, this appeared to be an ad hoc arrangement not underpinned by local policy or guidelines.
4. The evidence suggested that a patient who was choking, had difficulty breathing and was drowsy would still be assessed, under the current algorithm adopted by WAST, as meeting the requirement for an Amber 1 response.
2. The Amber 1 category includes all life-threatening conditions except those in the Red category where the person appears to be in the throes of dying. I was informed that all the patients in the Amber 1 category are allocated an ambulance / clinical resource chronologically, without further consideration of clinical need.
3. I was informed at the inquest that on occasion a clinician within WAST will intervene to undertake a further assessment to determine whether the response should be expedited. However, this appeared to be an ad hoc arrangement not underpinned by local policy or guidelines.
4. The evidence suggested that a patient who was choking, had difficulty breathing and was drowsy would still be assessed, under the current algorithm adopted by WAST, as meeting the requirement for an Amber 1 response.
Responses
The Trust has implemented actions to mitigate avoidable harm, including an ambitious recruitment programme and increasing the Clinical Support Desk (CSD) size with consultant paramedic capacity for enhanced triage. They noted improvements in Amber 1 response times and detailed existing procedures for allocating resources and clinical scrutiny of waiting calls.
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Dear Ms Saunders
Re: Mrs Dorothy Anne Jones
I write in response to the Prevention of Future Deaths Report issued to this Trust on 20 January 2023, following the inquest in relation to Dorothy Anne Jones.
You have asked the Trust to consider 4 specific areas:
1. The steps being undertaken on a national and local level to address the delays in ambulance response times, particularly within the Amber 1 category.
The Trust has focused on actions to mitigate real time avoidable harm and has sustained reporting to our Trust Board on progress. Attached is a copy of the progress report, with accompanying action plan, provided at the open Trust Board in January 2023. As recognised, the pressures are multifactorial but none as significant as those connected with patient flow leading to emergency department handover delays. These delays remain elevated with more than 32 thousand hours lost to extended handover in December 2023 amounting to 37% of our conveying resource capacity. In January 2023, this will be between 23-24 thousand hours which remains extremely high.
2 Whilst too early to indicate sustained improvement, as levels of activity abate (particularly that connected to respiratory illness) there has been improvement in the Amber 1 median response time in January 2023 compared to the proceeding period. The Trust will continue to report progress against the actions to mitigate avoidable harm to its Trust Board.
2. Whether consideration can be given to undertaking a more detailed clinical assessment of the patients within Amber 1 to ensure those in the greatest need for clinical intervention are given priority. To ensure that the Welsh Ambulance Services NHS Trust (WAST) maintains a clinically safe response to patients, regular reviews are undertaken of current Medical Priority Dispatch System (MPDS) code categorisation by the Clinical Priority Assessment Software (CPAS) group.
During reviews, each individual code is considered, in terms of the types of patients who should be within that category, as well as historical data on call volume, conveyance rates, adverse incidents, and where available, data on success rates of secondary triage, etc. The codes are also compared to the categorisation within the Ambulance Response Programme (ARP). These are the categorisations used by the Ambulance Services in England.
In the live environment, WAST regularly undertakes more detailed clinical assessments of waiting patients, in all categories, including Amber 1; to reassess and/or confirm the correct priority for patients. This process, known as secondary triage or consultation is led by the Clinical Support Desk (CSD) which is a pan Wales team that comprise of control room nurses, paramedics, advanced paramedics, and mental health practitioners.
The process of secondary triage or consultation involves clinicians assessing patients remotely using clinical decision support software over the phone or through video
3 consultation. WAST has recently invested in the CSD by near doubling its establishment, employing mental health practitioners, and by implementing a new innovative clinical decision support system to support the more detailed clinical assessment of patients.
WAST has also invested in new versions of its Computer Aided Dispatch (CAD) tool, which allows health board Doctors to log in (remotely from the control rooms) to the waiting ambulance stack and undertake more detailed clinical assessments of patients in their health board. The Physician Triage Assessment and Streaming (PTAS) model is now operating across three of the health boards with plans to roll out further.
3. The process for reassessment of the patient’s clinical condition during the time they are waiting for an ambulance.
The Clinical Safety Plan (CSP) provides a framework for the Trust to respond to situations where the demand for services is greater than the available resources. It recognises that causes can be multifaceted impacting either demand for services, the capacity to respond to demand, or both.
The CSP provides a set of tactical options that are flexible and immediate so that the Trust can dynamically react to situations to ensure those patients with the most serious conditions or in greatest need according to their presentation remain prioritised to receive services.
A copy of the CSP is attached for your reference and as you will see this provides details of when welfare calls should be made. These calls are made to reassess the patient’s clinical condition, if any changes are reported.
Additionally, the CSP provides details of the actions to be undertaken by the clinicians working on the Clinical Support Desk.
The CSP operates alongside the Clinical Support Desk Standard Operating Procedure (SOP), which also documents the actions to be taken by clinicians when there are long waits for patients. The SOP provides details of the action’s clinicians on the CSD can take with regard to upgrading the call.
4. Confirm whether the national algorithm adopted by WAST is fit for purpose and that there is provision to identify life-threatening scenarios, where a patient may quickly deteriorate from an Amber 1 into a Red. The Trust uses 5 priority categories for emergency calls. As per the evidence provided at the inquest, these are known as Red, Amber-1, Amber-2, Green-2, and Green-3. Whilst the terminology is different to other UK ambulance services (For example, English services use 5 priority categories, known as Category 1 through to Category 5), but the principles of prioritisation, and the vast majority of calls within each category are similar across other UK services.
The utilisation of the Trust’s resources is undertaken in line with our Clinical Response Model. Within that model calls are generally responded to chronologically, within their priority category. So, it is broadly accurate to say that, for example, Amber-1 calls waiting for a response are generally responded to in chronological order within the priority, as
4 based on available information from the 999 calls. Again, this is in keeping with the principles used by all other UK ambulance services.
The staff responsible for the allocation of the resources can allocate resources out of chronological order and this is documented in the attached Standard Operating Procedure - Action Cards for Emergency Medical Dispatch.
However, when the Trust is unable to respond as quickly as we would like to be able to, waiting 999 calls (in all priorities/categories) are subject to clinical scrutiny by the Clinical Support Desk (CSD).
Clinicians from the Clinical Support Desk review waiting calls and will speak directly to 999 callers and/or the patient to establish if other methods of response might be suitable, and to ensure the priority assigned to the call does not need to be adjusted. These clinicians can change the priority of any 999 call, increasing it or decreasing it, according to the outcome of their more detailed clinical triage.
Whilst writing I would like to extend my sincere condolences to Mrs Jones’ family on their sad loss. I would also like to extend the 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 support the prevention of future deaths.
Re: Mrs Dorothy Anne Jones
I write in response to the Prevention of Future Deaths Report issued to this Trust on 20 January 2023, following the inquest in relation to Dorothy Anne Jones.
You have asked the Trust to consider 4 specific areas:
1. The steps being undertaken on a national and local level to address the delays in ambulance response times, particularly within the Amber 1 category.
The Trust has focused on actions to mitigate real time avoidable harm and has sustained reporting to our Trust Board on progress. Attached is a copy of the progress report, with accompanying action plan, provided at the open Trust Board in January 2023. As recognised, the pressures are multifactorial but none as significant as those connected with patient flow leading to emergency department handover delays. These delays remain elevated with more than 32 thousand hours lost to extended handover in December 2023 amounting to 37% of our conveying resource capacity. In January 2023, this will be between 23-24 thousand hours which remains extremely high.
2 Whilst too early to indicate sustained improvement, as levels of activity abate (particularly that connected to respiratory illness) there has been improvement in the Amber 1 median response time in January 2023 compared to the proceeding period. The Trust will continue to report progress against the actions to mitigate avoidable harm to its Trust Board.
2. Whether consideration can be given to undertaking a more detailed clinical assessment of the patients within Amber 1 to ensure those in the greatest need for clinical intervention are given priority. To ensure that the Welsh Ambulance Services NHS Trust (WAST) maintains a clinically safe response to patients, regular reviews are undertaken of current Medical Priority Dispatch System (MPDS) code categorisation by the Clinical Priority Assessment Software (CPAS) group.
During reviews, each individual code is considered, in terms of the types of patients who should be within that category, as well as historical data on call volume, conveyance rates, adverse incidents, and where available, data on success rates of secondary triage, etc. The codes are also compared to the categorisation within the Ambulance Response Programme (ARP). These are the categorisations used by the Ambulance Services in England.
In the live environment, WAST regularly undertakes more detailed clinical assessments of waiting patients, in all categories, including Amber 1; to reassess and/or confirm the correct priority for patients. This process, known as secondary triage or consultation is led by the Clinical Support Desk (CSD) which is a pan Wales team that comprise of control room nurses, paramedics, advanced paramedics, and mental health practitioners.
The process of secondary triage or consultation involves clinicians assessing patients remotely using clinical decision support software over the phone or through video
3 consultation. WAST has recently invested in the CSD by near doubling its establishment, employing mental health practitioners, and by implementing a new innovative clinical decision support system to support the more detailed clinical assessment of patients.
WAST has also invested in new versions of its Computer Aided Dispatch (CAD) tool, which allows health board Doctors to log in (remotely from the control rooms) to the waiting ambulance stack and undertake more detailed clinical assessments of patients in their health board. The Physician Triage Assessment and Streaming (PTAS) model is now operating across three of the health boards with plans to roll out further.
3. The process for reassessment of the patient’s clinical condition during the time they are waiting for an ambulance.
The Clinical Safety Plan (CSP) provides a framework for the Trust to respond to situations where the demand for services is greater than the available resources. It recognises that causes can be multifaceted impacting either demand for services, the capacity to respond to demand, or both.
The CSP provides a set of tactical options that are flexible and immediate so that the Trust can dynamically react to situations to ensure those patients with the most serious conditions or in greatest need according to their presentation remain prioritised to receive services.
A copy of the CSP is attached for your reference and as you will see this provides details of when welfare calls should be made. These calls are made to reassess the patient’s clinical condition, if any changes are reported.
Additionally, the CSP provides details of the actions to be undertaken by the clinicians working on the Clinical Support Desk.
The CSP operates alongside the Clinical Support Desk Standard Operating Procedure (SOP), which also documents the actions to be taken by clinicians when there are long waits for patients. The SOP provides details of the action’s clinicians on the CSD can take with regard to upgrading the call.
4. Confirm whether the national algorithm adopted by WAST is fit for purpose and that there is provision to identify life-threatening scenarios, where a patient may quickly deteriorate from an Amber 1 into a Red. The Trust uses 5 priority categories for emergency calls. As per the evidence provided at the inquest, these are known as Red, Amber-1, Amber-2, Green-2, and Green-3. Whilst the terminology is different to other UK ambulance services (For example, English services use 5 priority categories, known as Category 1 through to Category 5), but the principles of prioritisation, and the vast majority of calls within each category are similar across other UK services.
The utilisation of the Trust’s resources is undertaken in line with our Clinical Response Model. Within that model calls are generally responded to chronologically, within their priority category. So, it is broadly accurate to say that, for example, Amber-1 calls waiting for a response are generally responded to in chronological order within the priority, as
4 based on available information from the 999 calls. Again, this is in keeping with the principles used by all other UK ambulance services.
The staff responsible for the allocation of the resources can allocate resources out of chronological order and this is documented in the attached Standard Operating Procedure - Action Cards for Emergency Medical Dispatch.
However, when the Trust is unable to respond as quickly as we would like to be able to, waiting 999 calls (in all priorities/categories) are subject to clinical scrutiny by the Clinical Support Desk (CSD).
Clinicians from the Clinical Support Desk review waiting calls and will speak directly to 999 callers and/or the patient to establish if other methods of response might be suitable, and to ensure the priority assigned to the call does not need to be adjusted. These clinicians can change the priority of any 999 call, increasing it or decreasing it, according to the outcome of their more detailed clinical triage.
Whilst writing I would like to extend my sincere condolences to Mrs Jones’ family on their sad loss. I would also like to extend the 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 support the prevention of future deaths.
The Minister defers detailed operational concerns to the Welsh Ambulance Services Trust (WAST), but notes that officials continue to monitor WAST's performance and seek assurance on improvement plans. The response acknowledges some improvements in ambulance handover and response times for Red and Amber calls, while reiterating expectations for Health Boards to collaborate for patient safety.
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Dear Caroline
Re: Mrs Dorothy Anne Jones
Thank you for your letter of 20 January, in which you enclosed a copy of a Regulation 28 Prevention of Future Deaths report following the conclusion of the inquest into the death of Mrs Dorothy Anne Jones.
Firstly, I would like to take this opportunity to offer my sincere condolences to Mrs Jones’ family on their loss.
The Welsh ambulance service exists to deliver life-saving interventions and take patients promptly to hospital, but the pandemic, recent periods of unprecedented pressures and challenges with patient flow have had a massive impact on emergency care services across all parts of the UK. We recognise that, at times, demand has outstripped capacity and that this has resulted in long delays, and poorer experiences and outcomes for some patients. However, the vast majority of patients are receiving timely access and safe care.
I note you have also written to , Chief Executive of the Welsh Ambulance Services Trust and I would expect him to respond on the detail of the concerns you raised as these relate to operational matters and are best addressed by the Trust. I can, however, outline the actions being taken by the Welsh Government to drive national and local improvement in the delivery of safe and timely ambulance services.
We have made significant investment in urgent and emergency care this year, with a dedicated budget of £25m annual funding to support local, regional and national delivery of the Six Goals for Urgent and Emergency Care, our five-year strategy published in February 2022, to drive a whole-system transformation of access to urgent and emergency care. In 2022/23 each health board in Wales received up to £2.96m to support implementation of local ‘six goals’ improvement programmes, and £4m has been used to support nationally- coordinated projects.
A national Six Goals for Urgent and Emergency Care Programme has been established to secure improvements across the patient pathway, with a specific focus on patient flow through the hospital system and out into the community, as well as significant investment in urgent primary care and same day emergency care to help reduce pressure on 999 services and emergency departments. A direct paramedic referral to same day emergency care services pathway has also been developed to enable suitable patients to by-pass the emergency department and gain direct access to the most appropriate clinical destination for their needs.
I have been encouraged by progress against a number of key urgent and emergency care indicators which has been influenced by the ‘six goals’ programme and I will provide a detailed update to Members of the Senedd on the overall urgent and emergency care programme plan a year on from its implementation on 2 May, when I will also confirm plans for 2023/2024 intended to help people access the right care, in the right place, first time.
We have also made investments in ambulance services, including £3m funding made available in June 2022, to support delivery of a national ambulance improvement plan developed by the Emergency Ambulance Services Committee and approved by health board chief executives. The plan included a range of actions for delivery by the Welsh ambulance service, health boards and actions for joint delivery, to enable better management of 999 demand in the community, increased ambulance capacity and improved timeliness of ambulance patient handovers.
Thanks to our early investment, the Welsh ambulance service has been able deliver a range of actions to increase capacity including:
• Implementation of new triage and video consultation technology, supported by £250,000 Welsh Government funding, to support more confident decision making by paramedics about whether a patient needs to be taken to hospital. This has enabled WAST to increase the number of 999 patients who can be safely managed through remote telephone assessment, enabling people to receive the support they need in the community and freeing up ambulance resources to respond to other calls. In January, 15% of patients were safely assessed and discharged over the phone.
• The Welsh Ambulance Services Trust has recruited 380 new staff in the past 9 months, which includes filling vacancies and increasing its overall headcount and will help to future-proof its workforce.
• The Trust has confirmed it has completed the implementation of new staff rosters for emergency medical services (EMS), marking the end of a two- and half-year project including 146 rosters, 80 working parties, and 1,800 staff. The efficiencies associated with the new rosters will equate to 72 whole time equivalent staff. The project will now be evaluated to support longer-term benefits realisation and learning.
• We have also seen progress from the Trust in delivering the agreed workforce efficiencies which are helping to increase capacity, including a reduction in sickness absence, supported by an attendance management programme and 40-point plan.
• Discussions between the Trust and its trade union partners regarding further workforce efficiencies are ongoing.
The national ambulance improvement plan has also seen all health boards develop local ambulance handover improvement plans, many of which have been in place since August 2022, which include a range of actions to help increase flow, improve patient experience and outcomes, and free up ambulance capacity to respond to urgent calls in the community. Health boards have also committed to handover improvement trajectories for each of their major emergency departments with an initial focus on eradicating delays over 4 hours and reducing the average number of minutes ‘lost’ per ambulance arrival on a monthly basis.
On 28th November 2022, I hosted a national summit on improving the timeliness of ambulance patient handover, which was attended by more than 40 senior NHS Wales representatives from across the seven health boards and the ambulance service. At the summit, health boards set out the range of actions they are taking across the six goals for urgent and emergency care as well as actions targeted at reducing ambulance handover delays. They also reaffirmed their commitment to delivering urgent improvements ahead of the winter, in line with local handover improvement plans and the national ambulance improvement plan. My officials continue to track progress and impact against the commitments health boards and the ambulance service have made and I have been encouraged by the examples of improvement at a number of sites, most notably the University Hospital of Wales.
Following this summit, and building on the progress made in delivering the actions from the national ambulance improvement plan and local handover improvement plans, EASC has agreed new integrated local improvement plans with each health board and WAST. These plans started to come into place from November 2022 and contain commissioning intentions, priorities and performance improvements and the operational plan to support delivery across the breadth of local six goals for urgent and emergency care programmes.
Regular performance and monitoring meetings held by EASC with each health board will drive delivery of these improvement plans and my officials will continue to seek assurance on delivery against these plans through regular Integrated Quality, Planning and Delivery (IQPD) meetings with each health board, WAST and EASC.
I have been somewhat encouraged by the improvements in the timeliness of ambulance patient handover, and in response times for Red and Amber calls, since we saw record poor performance in December 2022. January 2023 saw a reduction of more than 25% in the number of ‘ambulance hours’ lost to handover delays across all Welsh health board areas, when compared to December, and national ambulance handover performance in January represented the best performance since August 2022. This has had a positive impact of ambulance performance nationally, including a significant improvement in the median response time for Amber calls in January, which was in fact the fastest since May 2021.
These improvements must, however, be considered in the context of a reduction in demand in January, likely in relation to a change in public behaviours instigated by media coverage of NHS pressures and industrial action. It is also evident that performance has not improved in all parts of Wales and I have been clear with all Health Boards in my expectations that they must work together, and with the Welsh ambulance service and partners to understand local, regional and national challenges and agree collaborative actions to ensure patients within their communities receive safe and timely access to assessment and treatment and ensuring ambulance crews are available to respond when needed, through a whole system approach.
I understand has extended an offer to meet with you to discuss the Trust’s response in more detail and to provide further assurances regarding the Trust’s commitment to ongoing improvement.
Re: Mrs Dorothy Anne Jones
Thank you for your letter of 20 January, in which you enclosed a copy of a Regulation 28 Prevention of Future Deaths report following the conclusion of the inquest into the death of Mrs Dorothy Anne Jones.
Firstly, I would like to take this opportunity to offer my sincere condolences to Mrs Jones’ family on their loss.
The Welsh ambulance service exists to deliver life-saving interventions and take patients promptly to hospital, but the pandemic, recent periods of unprecedented pressures and challenges with patient flow have had a massive impact on emergency care services across all parts of the UK. We recognise that, at times, demand has outstripped capacity and that this has resulted in long delays, and poorer experiences and outcomes for some patients. However, the vast majority of patients are receiving timely access and safe care.
I note you have also written to , Chief Executive of the Welsh Ambulance Services Trust and I would expect him to respond on the detail of the concerns you raised as these relate to operational matters and are best addressed by the Trust. I can, however, outline the actions being taken by the Welsh Government to drive national and local improvement in the delivery of safe and timely ambulance services.
We have made significant investment in urgent and emergency care this year, with a dedicated budget of £25m annual funding to support local, regional and national delivery of the Six Goals for Urgent and Emergency Care, our five-year strategy published in February 2022, to drive a whole-system transformation of access to urgent and emergency care. In 2022/23 each health board in Wales received up to £2.96m to support implementation of local ‘six goals’ improvement programmes, and £4m has been used to support nationally- coordinated projects.
A national Six Goals for Urgent and Emergency Care Programme has been established to secure improvements across the patient pathway, with a specific focus on patient flow through the hospital system and out into the community, as well as significant investment in urgent primary care and same day emergency care to help reduce pressure on 999 services and emergency departments. A direct paramedic referral to same day emergency care services pathway has also been developed to enable suitable patients to by-pass the emergency department and gain direct access to the most appropriate clinical destination for their needs.
I have been encouraged by progress against a number of key urgent and emergency care indicators which has been influenced by the ‘six goals’ programme and I will provide a detailed update to Members of the Senedd on the overall urgent and emergency care programme plan a year on from its implementation on 2 May, when I will also confirm plans for 2023/2024 intended to help people access the right care, in the right place, first time.
We have also made investments in ambulance services, including £3m funding made available in June 2022, to support delivery of a national ambulance improvement plan developed by the Emergency Ambulance Services Committee and approved by health board chief executives. The plan included a range of actions for delivery by the Welsh ambulance service, health boards and actions for joint delivery, to enable better management of 999 demand in the community, increased ambulance capacity and improved timeliness of ambulance patient handovers.
Thanks to our early investment, the Welsh ambulance service has been able deliver a range of actions to increase capacity including:
• Implementation of new triage and video consultation technology, supported by £250,000 Welsh Government funding, to support more confident decision making by paramedics about whether a patient needs to be taken to hospital. This has enabled WAST to increase the number of 999 patients who can be safely managed through remote telephone assessment, enabling people to receive the support they need in the community and freeing up ambulance resources to respond to other calls. In January, 15% of patients were safely assessed and discharged over the phone.
• The Welsh Ambulance Services Trust has recruited 380 new staff in the past 9 months, which includes filling vacancies and increasing its overall headcount and will help to future-proof its workforce.
• The Trust has confirmed it has completed the implementation of new staff rosters for emergency medical services (EMS), marking the end of a two- and half-year project including 146 rosters, 80 working parties, and 1,800 staff. The efficiencies associated with the new rosters will equate to 72 whole time equivalent staff. The project will now be evaluated to support longer-term benefits realisation and learning.
• We have also seen progress from the Trust in delivering the agreed workforce efficiencies which are helping to increase capacity, including a reduction in sickness absence, supported by an attendance management programme and 40-point plan.
• Discussions between the Trust and its trade union partners regarding further workforce efficiencies are ongoing.
The national ambulance improvement plan has also seen all health boards develop local ambulance handover improvement plans, many of which have been in place since August 2022, which include a range of actions to help increase flow, improve patient experience and outcomes, and free up ambulance capacity to respond to urgent calls in the community. Health boards have also committed to handover improvement trajectories for each of their major emergency departments with an initial focus on eradicating delays over 4 hours and reducing the average number of minutes ‘lost’ per ambulance arrival on a monthly basis.
On 28th November 2022, I hosted a national summit on improving the timeliness of ambulance patient handover, which was attended by more than 40 senior NHS Wales representatives from across the seven health boards and the ambulance service. At the summit, health boards set out the range of actions they are taking across the six goals for urgent and emergency care as well as actions targeted at reducing ambulance handover delays. They also reaffirmed their commitment to delivering urgent improvements ahead of the winter, in line with local handover improvement plans and the national ambulance improvement plan. My officials continue to track progress and impact against the commitments health boards and the ambulance service have made and I have been encouraged by the examples of improvement at a number of sites, most notably the University Hospital of Wales.
Following this summit, and building on the progress made in delivering the actions from the national ambulance improvement plan and local handover improvement plans, EASC has agreed new integrated local improvement plans with each health board and WAST. These plans started to come into place from November 2022 and contain commissioning intentions, priorities and performance improvements and the operational plan to support delivery across the breadth of local six goals for urgent and emergency care programmes.
Regular performance and monitoring meetings held by EASC with each health board will drive delivery of these improvement plans and my officials will continue to seek assurance on delivery against these plans through regular Integrated Quality, Planning and Delivery (IQPD) meetings with each health board, WAST and EASC.
I have been somewhat encouraged by the improvements in the timeliness of ambulance patient handover, and in response times for Red and Amber calls, since we saw record poor performance in December 2022. January 2023 saw a reduction of more than 25% in the number of ‘ambulance hours’ lost to handover delays across all Welsh health board areas, when compared to December, and national ambulance handover performance in January represented the best performance since August 2022. This has had a positive impact of ambulance performance nationally, including a significant improvement in the median response time for Amber calls in January, which was in fact the fastest since May 2021.
These improvements must, however, be considered in the context of a reduction in demand in January, likely in relation to a change in public behaviours instigated by media coverage of NHS pressures and industrial action. It is also evident that performance has not improved in all parts of Wales and I have been clear with all Health Boards in my expectations that they must work together, and with the Welsh ambulance service and partners to understand local, regional and national challenges and agree collaborative actions to ensure patients within their communities receive safe and timely access to assessment and treatment and ensuring ambulance crews are available to respond when needed, through a whole system approach.
I understand has extended an offer to meet with you to discuss the Trust’s response in more detail and to provide further assurances regarding the Trust’s commitment to ongoing improvement.
Action Should Be Taken
I should be grateful if the following information be provided to me:
1. The steps being undertaken on a national and local level to address the delays in ambulance response times, particularly within the Amber 1 category.
2. Whether consideration can be given to undertaking a more detailed clinical assessment of the patients within Amber 1 to ensure those in the greatest need for clinical intervention are given priority.
3. The process for reassessment of the patient’s clinical condition during the time they are waiting for an ambulance.
4. Confirm whether the national algorithm adopted by WAST is fit for purpose and that there is provision to identify life-threatening scenarios, where a patient may quickly deteriorate from an Amber 1 into a Red.
1. The steps being undertaken on a national and local level to address the delays in ambulance response times, particularly within the Amber 1 category.
2. Whether consideration can be given to undertaking a more detailed clinical assessment of the patients within Amber 1 to ensure those in the greatest need for clinical intervention are given priority.
3. The process for reassessment of the patient’s clinical condition during the time they are waiting for an ambulance.
4. Confirm whether the national algorithm adopted by WAST is fit for purpose and that there is provision to identify life-threatening scenarios, where a patient may quickly deteriorate from an Amber 1 into a Red.
Report Sections
Investigation and Inquest
On 11/04/2022 an investigation was opened into the death of Dorothy Anne Jones The investigation concluded at the end of the inquest on: 17/01/2023 The conclusion of the inquest was recorded as: A narrative conclusion in the following terms: Dorothy Anne Jones died at home on 29/03/22 from the effects of bronchopneumonia. Her death was contributed to by the failure of Welsh Ambulance Services NHS Trust to convey Mrs Jones to hospital within a reasonable timescale as dictated by her poor clinical condition. The medical cause of death was: 1a Bronchopneumonia
2. Advanced multiple Sclerosis
2. Advanced multiple Sclerosis
Circumstances of the Death
On 22/03/22, Dorothy Anne Jones developed a chest infection. After failing to respond to antibiotics, she was seen at home by her GP on 29/03/22.
considered that Mrs Jones needed to be admitted immediately to hospital. Mrs Jones had low oxygen levels and was drowsy and requested that an ambulance attends within 2 to 3 hours. Following discussion with the ambulance service they informed that there was a 2-4 hour wait but that they would attempt to send an ambulance quicker. Unfortunately, the pressure on the ambulance service and a failure to identify an earlier available resource meant that paramedics did not attend until 20:28, over 9 hours later.
On arrival, paramedics confirmed that Mrs Jones had died and could not be revived. On hearing the evidence, I determined that a failure to send an ambulance within a timescale required by the severity of Mrs Jones’s illness, contributed to her death.
considered that Mrs Jones needed to be admitted immediately to hospital. Mrs Jones had low oxygen levels and was drowsy and requested that an ambulance attends within 2 to 3 hours. Following discussion with the ambulance service they informed that there was a 2-4 hour wait but that they would attempt to send an ambulance quicker. Unfortunately, the pressure on the ambulance service and a failure to identify an earlier available resource meant that paramedics did not attend until 20:28, over 9 hours later.
On arrival, paramedics confirmed that Mrs Jones had died and could not be revived. On hearing the evidence, I determined that a failure to send an ambulance within a timescale required by the severity of Mrs Jones’s illness, contributed to her death.
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Data sourced from Courts and Tribunals Judiciary under the Open Government Licence.