Written Statement: Further Changes to the Emergency Ambulance Performance Framework

This statement updates Members about the second phase of the review of the emergency ambulance performance framework. 

Following the review of the red eight-minute response target, undertaken in response to recommendations from the Senedd’s Health and Social Care Committee, I asked the task group to examine the timeliness and quality of care for people not in the new purple: arrest or red: emergency categories. 

This looked at the amber category, which includes the way the Welsh Ambulance Service responds to chest pain, stroke, and limb fractures which are classified as serious but not immediately life-threatening. The amber category makes up about 70% of 999 calls and some conditions require transport to hospital for diagnosis and treatment. 

The review also looked at green category calls, which are neither serious nor immediately life-threatening, which can be managed in the community or need to go to hospital using scheduled, non-emergency transport services. 

It found the current categorisation system is not sophisticated enough to provide a nuanced response to genuinely time-sensitive complaints and the system can flag healthy individuals as sick resulting in an ambulance being dispatched. For example, symptoms of indigestion can lead to an emergency ambulance response, staffed by two skilled paramedics, and a person being transported to hospital, when self-care or signposting to a community service may have been a more appropriate option.

The task group also highlighted that clinical screening of calls by a paramedic or nurse to identify those people who are experiencing clear symptoms of a stroke, STEMI (a type of heart attack) and other time-sensitive conditions would ensure these calls get the right 999 response, direct transport to specialist centres with the right treatments for stroke and STEMI, which will improve outcomes. 

To better identify and address the response to 999 callers with time-sensitive health complaints, I am adding three more new categories to the emergency ambulance performance framework, which will replace the current amber and green categories:

• Orange – time-sensitive category. This will cover calls which need a prompt response and include the delivery of evidence-based clinical care protocols by ambulance clinicians and rapid transport to hospital or a specialist centre for further treatment.
• Yellow – assess-and-respond. This will apply to calls which need a clinical assessment, which may need transport to an NHS service or referral to a community-based service or can be discharged on-scene.
• Green – planned response. This is for calls which can be seen and discharged at scene or use scheduled services to access the right support for their clinical needs.

These changes will be introduced before this winter.

Measurements for the new orange-time sensitive category will include the delivery of clinical care bundles by ambulance clinicians and the median call-to-door times for people experiencing stroke and STEMI. Additional clinical indicators will be developed as needed.

We will also measure both the median and 90th percentile (longest wait) response times of the most appropriate resource in each category. For example, in acute stroke cases, performance monitoring will focus on how quickly an ambulance clinician arrives in a vehicle capable of transporting the individual to hospital, as transport to the right clinician for the right intervention is crucial for positive outcomes.

For yellow and green categories, the median and 90th percentile response times by the most appropriate resource and data on individuals’ outcomes after ambulance service assessment or response will be measured.

These measures will be assessed as part of the broader emergency ambulance performance framework over the next 12 to 18 months. 

To support people with time-sensitive health emergencies like stroke, we are trialling the use of pre-hospital video triage (PHVT) at five hospitals across Wales. This is a system which helps clinical teams assess and diagnose a stroke, so patients receive the most appropriate care quickly. It allows real time communication between pre-hospital clinicians, such as ambulance crews, and hospital stroke specialists, to improve the assessment and diagnosis of stroke. 

The early feedback from the trial shows PHVT is improving pre-arrival information for hospital teams. The service will be subject to a robust evaluation, which will and inform options to roll out the system across Wales if the results are positive. 

Health boards, supported by NHS Wales Performance and Improvement, are also developing a new model for stroke care. From 1 July, the University Hospital of Wales has been providing a day-time thrombectomy service for South Wales – thrombectomy is a procedure to remove a blood clot from a blood vessel. 

Together with PHVT and the Wales-wide roll out of AI to support the diagnosis of stroke, these are vital steps to improve stroke care, survival rates and outcomes.  

I will keep Members updated about the impact of these changes and the work of the national taskforce to reduce ambulance handover delays at emergency departments.