A TARGET for ambulances to respond to the most urgent 999 calls in eight minutes could be changed after services missed the mark for more than four years.

Jeremy Miles, who was appointed Wales’ health secretary in September, announced a clinician-led review of the appropriateness of emergency ambulance response targets.

The target of responding to 65% of immediately life-threatening “red” calls within eight minutes has not been met since July 2020, with latest performance standing at 50%.

In a statement on November 26, Mr Miles raised concerns about “unstainable” levels of demand, with 36,700 emergency calls in October, an average of 1,183 a day.

He told the Senedd the proportion of red category calls has soared from 4% to 5% when the target was introduced in 2015, to nearer 15% today.

Mr Miles said the ambulance service received 177 “red” calls a day in October, warning: “This was the second highest number of daily red calls to the ambulance service on record – a level of demand that is, frankly, becoming unsustainable.”

The health secretary added: “Despite the fact that the category of red calls is now approximately three times the size since the target was set in 2015, in October just over half of red calls were responded to within the target time of eight minutes.

“The ambulance service is still off target but this equates to the highest number of red calls responded to within eight minutes on record.”

He announced an expert group will review the target in the context of the Welsh Ambulance Services University NHS Trust’s evolving model of rapid clinical screening for most 999 calls.

Mr Miles said the group will consider whether new measures are required, with no response time targets currently in place for the amber nor green categories.

Sam Rowlands, the Conservatives’ shadow health secretary, suggested any change to the target could be seen as the Welsh Government trying to move the goalposts.

Mr Rowlands expressed concerns about handover delays at emergency departments, recognising a big part of the challenge remains outside the ambulance service’s control.

Mr Miles stressed the review was launched on the back of a recommendation from the Senedd’s health committee, rejecting any suggestion of seeking to swerve accountability.

“That way lies madness,” he said. “The health service is hedged around with dozens of targets. There is not a shortage of targets in the system.

“But if we are to have an honest discussion about performance in the health and care systems, we have to apply that rigour to how we look at the priorities that we set and the targets against which we measure performance.”

Plaid Cymru’s Mabon ap Gwynfor warned of grave problems in Wales’ care service, with patients unable to leave hospital to return to the community.

He told the Senedd that response time delays are a symptom of a far wider problem and the entire machinery of the health care system is in fundamental gridlock.

Mr ap Gwynfor said: “These missed targets are of course a reflection of chronic handover delays; whereas the average handover period is supposed to be 15 minutes, the current average is in excess of two hours.

“The cumulative impact was 260,000 hours being lost to handover delays at emergency departments last year.”

Mr Miles accepted that patient handover times remain “far too long” as he stressed that reducing delays is a key priority for the health service.

Labour’s Lesley Griffiths welcomed more rapid clinical screening of 999 calls after meeting Jason Killens, the chief executive of the Welsh Ambulance Services NHS Trust, last week.

The Wrexham Senedd Member said: “Having clinicians inside control rooms I think is absolutely right to target reducing harm and make sure people who are genuinely a red call receive the correct service.”

Conservative Laura Anne Jones said: “This isn’t just about statistics, it’s about lives at stake – families left waiting in fear while precious seconds tick by.

“Instead of improvement, we’re witnessing decline.”

Plaid Cymru’s Peredur Owen Griffiths welcomed the statement but argued it “stops short of the major surgery and investment that’s needed within the ambulance service”.

MID AND SOUTH PEMBROKESHIRE MP Henry Tufnell has launched a survey to address growing concerns about access to healthcare and GP services in the county.

The survey aims to gather feedback from residents, which will be presented to the Health Board in the new year.

Mr Tufnell told The Herald: “I urge constituents to complete my survey and share their experiences with healthcare and GP access. I have been meeting with local GP practices and Health Board executives to discuss the challenges facing our community.

“Each response will be taken forward to the Health Board. My aim is to ensure patients’ concerns are heard, leading to better services for everyone. Pembrokeshire deserves and needs improved healthcare outcomes.”

The survey is live on the MP’s website and can also be accessed via his social media channels.

Survey link: Click here to participate

Contact details:
Joshua Beynon, 07802 761520, [email protected]

Henry Tufnell is the MP for Mid and South Pembrokeshire.

ALTHOUGH the latest batch of NHS performance data contained some good news for the Welsh government, chronic problems with meeting targets remain the headline.

The Welsh Government announced further funding to reduce waiting lists earlier this week. Following that announcement, the Health Minister, Jeremy Miles, led a Welsh Parliament debate on waiting times on Tuesday, November 19.

HARD FIGURES

The number of patient pathways increased from 800,163 in August to 801,307 in September, the highest figure on record, equivalent to one-quarter of the Welsh population.

There were still around 618,200 individual patients waiting for treatment in September.

Two-year waits remain at 23,701 in Wales. Eluned Morgan promised to eliminate these waits by March 2023 and again by March this year. The dial is moving slowly in the right direction, but progress is painfully small.

At the end of September, the average (median) time patient pathways had been waiting for treatment was 22.7 weeks.

In October, only 50.4% of red calls (the most serious) received an emergency/ambulance response within eight minutes. This is a tiny improvement but a long way short of the Welsh Government’s performance target for the Welsh Ambulance Service. The Ambulance Service has never hit any of its performance targets since the Welsh Government first set them.

Performance worsened against the 62-day target for patients starting cancer treatment; it is now 55% as of September.

MINISTER FINDS THE POSITIVES

Wales’s Health Minister, Jeremy Miles, responded to the data: “I’m pleased to see the number of patient pathways waiting more than a year and two years for treatment have fallen in the last month.

“This shows positive progress is being made across Wales to reduce the longest waiting times. I hope to see this continue.

“While there has been a small rise in the overall number of patient pathways waiting to start treatment, more than half are waiting less than 26 weeks, and there was a fall in the number waiting more than 36 weeks in September.

“We recognise the impact long waits for treatment can have on someone’s life, both mentally and physically, so we have a laser-like focus on reducing the longest waits and improving access to patient care.

“More than 1,800 people started cancer treatment in September, and nearly 14,000 people received the good news they didn’t have cancer.

“There were also reductions in the long waits for both diagnostics and therapies services and some reductions in the numbers of pathway of care delays.

“Urgent and emergency care services continue to be under great pressure – in October, the Welsh Ambulance Service received the second highest number and proportion of immediately life-threatening calls per day on record, but more than half of these calls received a response within eight minutes.”

NHS “AT CRISIS POINT”

Sam Rowlands MS, Welsh Conservative Shadow Health Minister, said: “I fear that we are at a crisis point as waiting list figures continue to head in the wrong direction in Labour-run Wales.

“The Labour Health Minister’s latest initiatives, even if his expectations are met, will barely scratch the surface in terms of tackling these excessive, record-breaking waits for treatment. Something needs to change fast.

“The Welsh Conservatives will stand up for the Welsh people’s priorities by eliminating restrictive guidance blocking cross-border and cross-sector working and by enacting a substantial workforce plan to boost staffing numbers, with a tuition fee refund for healthcare workers at its heart.”

LOCAL TRENDS

The month-to-month performance data provide a limited snapshot of the details. Their nature encourages politicians to exchange barbs and engage in self-praise. Specious comparisons between Welsh NHS performance and English NHS performance crumble under the gentlest scrutiny, not least as the English NHS counts waiting times and collates patient data differently from the Welsh.

Long-term trends are more revealing.

Immediately before the Covid pandemic (data released in March 2020), 1.6% of patients in the Hywel Dda UHB area waited over 36 weeks from referral to treatment. 85.7% of patients went from referral to treatment within 26 weeks.

By March 2022, 35.2% of patients in the local health board area were waiting for more than 36 weeks, and the percentage seen within 26 weeks had fallen to 56.7%. By the following March, just over 60% were seen within 26 weeks, and the proportion of patients waiting more than 36 weeks had fallen to 28.2%.

If you move forward to September 2024, Hywel Dda UHB’s performance figures have marginally slipped. There are no peaks and troughs in the performance data; they remain steadily bumping along at the same level and are far worse than they were in March 2020.

The Health Minister’s honest acknowledgement that the £50m funding injection to address waiting times is a short-term measure to boost performance and not a long-term solution highlights the scale of the problem. The question of waiting lists is not how much money it will take to tackle them but how much money will be spent before radical reform tackles systemic problems with healthcare delivery.

Placing Hywel Dda’s difficulties in a national perspective, the Welsh Government’s planned care recovery plan established a target to eliminate two-year waits in most specialities by March 2023. ‘Most’ refers to all specialities, excluding seven recognised as exceptionally challenging even prior to the pandemic.

Those specialisms, which include Orthopaedics, ENT, and Gynaecology, are large areas of surgical practice. They are excluded from targeted improvements because tackling them is too difficult. Proposals to establish surgical hubs made by the Welsh Conservatives have not attracted Welsh Government support as resources and staffing remain highly problematic. However, a quick win for the Welsh Government on the longest waiting times is potentially available.