Welsh Ambulance Services NHS Trust

Noted (AI summary) The Welsh Government outlines its role in setting the strategic context for health services and holding NHS organisations accountable, noting that all health boards are in escalation for urgent and emergency care. They mention providing additional funding to Betsi Cadwaladr University Health Board and supporting improvement programs, but do not commit to specific changes in response to the report.

Noted (AI summary) The Welsh Ambulance Services University NHS Trust acknowledges concerns about ambulance delays and the MPDS system but states it is not the primary authority to take action, offering to meet to discuss the response in more detail and welcomes suggestions for actions they might take with partners.

Noted (AI summary) The Trust details existing processes for prioritising calls and rapid handover of patients, and offers a meeting to discuss their response and commitment to improvement. Swansea Bay University Health Board outlined existing plans to reduce delays within acute unscheduled care pathways, including reducing bed numbers and improving flow, implementation of a frailty assessment unit and SDEC, and providing alternative pathways for patients presenting to the Emergency Department. The Welsh Government notes that the Health Board and Ambulance Service will respond separately and summarises pressures on urgent and emergency care services in Wales, as well as the actions being taken to address them including '50 day challenge' and escalation of Swansea Bay University Health Board to level 4.

Noted (AI summary) The Welsh Ambulance Service explains why it carries naloxone but not flumazenil, stating that flumazenil is not safe for widespread use and that ambulance personnel are trained in more appropriate techniques for benzodiazepine overdose.

Noted (AI summary) Welsh Ambulance Services NHS Trust does not propose further action directly, but is working with Aneurin Bevan University Health Board to implement additional measures in January 2024 to reduce conveyances to The Grange Hospital through direct admission to alternative sites, and the introduction of a new temporary facility. They also offer to meet to discuss the response in more detail. The Health Board acknowledges handover delays and that an ACA2 crewed ambulance could have attended. It states that reducing patient handovers is a focus and that the Chief Operating Officer and Clinical Executives are providing leadership to address the issue. NICE acknowledges the concerns but states that existing guidelines on fever, sepsis, and sore throat cover the diagnosis and early management of relevant symptoms, and they have not been asked to produce specific guidance on Group A streptococcus.

Noted (AI summary) Cardiff and Vale University Health Board reviewed the patient's triage and management by the Out of Hours GP Service, sharing their initial findings. The board acknowledges that there was poor communication at the inquest hearing which may have led to some of the recommendations. The Welsh Ambulance Services NHS Trust acknowledges the concerns raised regarding triage and response times and the impact of system pressures. The Trust says it will continue to press for real systemic change at every opportunity.

Noted (AI summary) The Welsh Ambulance Services NHS Trust acknowledges the coroner's concerns regarding the effect of long lies and systemic pressures. The Trust highlights collaborative work and limitations in insisting on discrete actions beyond lobbying and emphasizing patient safety concerns, while also recognizing the need for systemic change and support from the Welsh Government.