MEMORANDUM SUBMITTED BY THE

WELSH AMBULANCE SERVICES NHS TRUST (CBPS 68)

EXECUTIVE SUMMARY

1. The information set out below has been compiled for the Welsh Affairs Committee within the limited time available, in response to their request to submit written evidence for Members to consider on cross-border issues in the field of health and social care, particularly as they relate to the ambulance service in Wales.

2. Information included relates to:

· Out of area EMS activity

· Clinical governance arrangements

· Partnership working

· Patient Care Services contractual arrangements

· Divergence issues

INTRODUCTION TO SUBMITTER

3. The Welsh Ambulance Services NHS Trust (WAST) was established in 1998 and from 1 April 2007 also incorporates NHS Direct Wales. The Trust serves a population of 2.9 million and operates across the whole of Wales (some 20,640 kilometres).

4. The Trust is divided into three Regions (North; Central and West; and South East) and:-

· employs 2,576 people - 76% are operational - 1,310 on emergency duties, 693 on non emergency ambulance and health courier services

· operates from 90 ambulance stations, four control centres, three regional offices, five vehicle workshops

· has a National Training College with regional training centres

5. In 2006/7 the Service responded to 287,594 emergency incidents, 56,282 urgent journeys and transported 1,360,445 non-emergency patients to over 200 treatment centres throughout England and Wales. The increasing number of emergency calls continues to represent a considerable challenge to the Trust.

6. The Trust embarked on a five year modernisation programme in 2006.

FACTUAL INFORMATION

THE EXTENT TO WHICH CROSS-BORDER HEALTH AND SOCIAL CARE SERVICES ARE CURRENTLY PROVIDED FOR AND ACCESSED BY THE WELSH POPULATION

General

7. The Trust is probably unique within the United Kingdom in terms of the length of the border and the number of NHS Trusts that it has a reciprocal arrangement with.

Out of Area activity

8. Out of Area responses are the result of requests either from bordering Ambulance Services/Hospitals for assistance or direct requests from the Police to assist with Road Traffic Accidents.

9. The North Region in particular, undertakes many out of area transfers across the Welsh/English border, for example:-

· cardiac case are transferred to Liverpool or Manchester

· neurological case are transferred to the Walton Centre, Liverpool

· paediatric cases are transferred to Alder Hey in Liverpool

· patients who have suffered burns are transferred to Whiston, Merseyside

10. In addition to the above, routinely, crews who are dealing with patients from the Queensferry, Hawarden, Broughton, Saltney and Northop Hall area will convey to the Countess of Chester.

11. The Trust's Adverse Incident Reporting processes allow for the flagging up of any issues, either clinically or operationally.

12. The table below depicts the geography of WAST resource utilisation outside of Wales for all category types. The Trust's vehicles attended a total of 40 out of area incidents during February, of which 39 were within the Cheshire area.

Summary of monthly resource utilised outside WAST's area

13. Attached separately is a PDF file containing relating to the number of conveyances to English hospitals, ie. Hereford, Shrewsbury and Countess of Chester over a 12-month period. Please note that Evacuation time/Job Cycle time is the whole job cycle up until the vehicle books clear at Hospital. The drive time back to Wales is not included.

THE ARRANGEMENTS CURRENTLY IN PLACE TO CO-ORDINATE CROSS-BORDER SERVICE PROVISION

14. In terms of clinical governance policy and procedure, WAST crews use the Trust's guidance and are expected to utilise the recognised reporting arrangements in place. For example, crews would complete a WAST adverse incident form to report an incident internally. This adverse incident would then be investigated by contacting the receiving hospital in England.

15. Another mechanism for co-ordinating services is by liaising with the Local Health Board (LHB). A good example of this is WAST's involvement in the Powys Unscheduled Partnership Board, where the LHB is coordinating plans to reduce the number of incidents of patients being transported/ attending hospitals outside of the County (on many occasions into England)

THE COMMISSIONING, FUNDING AND QUALITY OF CROSS-BORDER SERVICES

Patient Care Services

North Region

16. Set out below are the proposed contracts that the North Region have for taking patients to treatment centres across the border. The contract is on weighted patients, this means an allowance is made for the condition of the patient, eg. walker, wheelchair bound, stretcher, so it is not the actual number of patients transported which will be a lot smaller.

Contracts with

17. Also the Trust transfers patients from the main DGH's to these establishments. These are not included in these figures and are usually done by an emergency crew, and can amount to as many as four a day across the Region.

18. In addition, the Trust does have extra contractual referrals to other treatment centres in England: these can be anywhere and are paid for by the centre providing the treatment.

Central and West Region

19. Central and West have PCS Contracts with the Royal Shrewsbury Hospitals valued at £132K for 7900 patients and with Hereford valued at £90K for 3400 patients. The Trust also conveys patients on an out of area basis to many trusts in England.

South East Region

20. South East have PCS contracts for East Gloucester valued at £55K and for 1600 patients and United Bristol valued at £84K and for 1000 patients.

21. Wales now has its own eligibility criterion providing equity of access to all Welsh patients attending Welsh hospitals. One of the challenges in PCS is that often the patient meeting the Welsh criteria does not meet the English criteria for their journey. This can result in Welsh patients not receiving transport to treatment centres in England. This can be evidenced by the number of English hospitals asking for authorisation by Hospital Managers before transport can be granted.

THE EXTENT TO WHICH HEALTH AND SOCIAL CARE POLICY HAS DIVERGED ACROSS THE UK SINCE THE INTRODUCTION OF DEVOLUTION, AND THE IMPACT THAT THIS HAS HAD

22. Although NHS Wales and the Department of Health (DoH) have a similar commitment to patients in terms of providing access to services, a good example of divergence is in the terminology used to describe approach for delivering such services.

23. The release of the Delivering Emergency Care Services (DECS) strategy by NHS Wales refers to development of unscheduled care services. The key element to this strategy is that no matter how or when a patient contacts any unscheduled care health and social services, they will be assessed and seen by the most appropriate health or social care professional at the most appropriate time.

24. Similar proposals were put forward by the DoH in its discussion document called Direction of Travel for Urgent Care (2007). The difference is in terminology. This document states in the past both patients and staff have been confused as to what the term urgent care refers to and what services are available locally. The document says 'urgent care' should replace other terms such as unscheduled, emergency or unplanned care. Urgent care should also include social care needs and should apply in-hours as well as out of hours.

25. Another example of differences that directly affect the provision of

ambulance services is how it is commissioned in Wales.

THE EXTENT TO WHICH MECHANISMS ARE IN PLACE FOR IDENTIFYING AND RESOLVING CROSS-BORDER DEFICIENCIES

26. WAST is involved in the unscheduled care partnership boards of the various health communities in Wales. This includes work with health communities that are most affected by cross-border services (e.g. Powys). As stated above, in paragraph 14, WAST is working with these partnership boards to reduce the number of incidents where patients are transported unnecessarily to accident and emergency departments. Work is continuing to enable all patients to easily access a service - either by phone, or face-to-face - and have their problem dealt with straight away by the most appropriate professional.

7 April 2008