Kirsty Williams AM

Ambulance Cover in Powys

As it is currently measured, by response times, ambulance performance has long been cause for concern for Members right across the Chamber. I believe that the concerns are particularly acute in Powys, two thirds of which I represent in the form of the Brecon and Radnorshire constituency.

Powys has repeatedly found itself at the bottom of the league table. In the last year, the percentage of category A calls being answered on time in Powys did not rise above 49 per cent, and never came close to meeting the all-Wales target of 65 per cent. In October of last year, the level sank to a shocking 43 per cent-again, the Welsh average was much higher.

Remember, category A calls are the most serious ones. In Powys, 81 per cent of them were reached within 21 minutes. That is 13 minutes longer than it should take to reach those patients. We cannot begin to imagine how long those 13 minutes feel to the victim of an accident or a relative standing next to a casualty. This is not a criticism of local staff, who do the best that they can, often putting themselves at huge personal risk as they tear around the Powys countryside attempting to reach their patients. I know that they are equally frustrated by this situation. They do not want to languish at the bottom of the league table; they are professionals who are committed to doing a job for the people of Powys. Undoubtedly, as a result of the position that they are in, their morale suffers greatly. However, suffering is not confined to the staff, as I am regularly contacted by constituents who have been at the sharp end of these poor response times. Each complaint highlights the unique problems faced by the residents of Powys whom I represent.

Patient B collapsed at the theatre just before Christmas. St John Ambulance personnel at the site dialled 999, but could not elicit an estimated time of arrival for the ambulance from the staff to whom they spoke. After 90 minutes, they called again for an ambulance. This time the call centre asked whether the patient was breathing and conscious. It was pointed out to that member of staff that if the patient had not been breathing for the last 90 minutes, the patient would probably have died. No estimated time of arrival could be given because no ambulance was free anywhere in the area. Instead the St John Ambulance staff found a wheelchair, put the patient in a car and drove to Nevill Hall Hospital, where the patient was immediately admitted.

The constituent who wrote to me about these events spoke for many of my constituents in saying, 'If this is the sort of delay that can take place on a Monday evening in early December, it means that effectively we do not have an emergency ambulance service.' These delays erode any confidence that the public has in the ambulance service and make people frightened of what would happen should they, or a loved one, be in need of emergency paramedic help and admission to hospital. What can be done to solve this situation?

Patient W collapsed unconscious at home in the kitchen in Llangynllo-for the uninitiated that is near Knighton. The ambulance took one and a half hours to arrive, travelling from Llanidloes in Montgomeryshire, around 30 miles away. Patient X, who lives near the Shropshire border, called for an ambulance that took over one and a half hours to arrive. When it did, the crew had come from Telford, around 50 miles away, and the patient had to direct the driver to the nearest hospital because he was so far off his usual patch that he did not know where he was going. In many respects, the patient was lucky to have an English ambulance at all. I know of at least one example when, because of a lack of cross-border co-operation, no ambulance arrived at all.

Without doubt, Powys presents difficult problems for anyone hoping to run an emergency ambulance service. The population is spread across a huge area. In many ways, there are a relatively low number of calls, but because of where the population is located, the calls are difficult to respond to. We have poor infrastructure, so getting from place to place can take a long time. We do not have a district general hospital-and rightly so, because where would you put it and what would it do? However, that means that ambulances have to travel considerable distances to take their patients to an accident and emergency department. An average job cycle time can be up to three hours, which leaves areas in Powys uncovered or to be managed by crews who are bumped out of one station to sit between two stations to provide some kind of cover. At times, it has been difficult for the trust to recruit staff in Powys.

Increasingly our ambulances are being called out of county to respond to other people's emergencies. A recent freedom of information request demonstrated that over two months last summer, the ambulance based at the Crickhowell station answered calls from Ebbw Vale on 50 occasions, while the Ystradgynlais ambulance regularly responded to calls from Brecon, some 25 miles away, and on more than 15 occasions during that period had to respond to calls in the north of Brecon and Radnorshire in towns some 50 miles away. I guess that the equivalent would be someone sitting in Cardiff and the ambulance coming from as far away as Swansea or Llanelli to pick up that patient. If that is not good enough for people in Cardiff, it is not good enough for my constituents.

The issue of ambulances being taken out of county demonstrates some of the problems with how we manage ambulance performance as it currently stands. As it is known how difficult it is to meet our targets, ambulances are routinely taken out into other areas to help their performance on targets look much better.

While not threatened with being physically removed from the town, we face the management of the Ystradgynlais ambulance being moved out of its current jurisdiction. There are real fears in Ystradgynlais that this will mean that the ambulance will, on more occasions than not, be responding to calls in the Swansea area to help that part of the division to meet its targets. I am sure that you would agree that that is unacceptable.

Of course response times are important, but we should be moving towards a patient-focused approach to performance management. Yes, getting to a call within a certain time is important, but what the crews do for a patient when they arrive is surely as important to the outcome for the patient following an incident. This move to more patient-focused outcomes was recommended in the recent Wales Audit Office report on the performance of the ambulance service.

The ambulance service also noted the need to end to the blame game that has perhaps dominated the debate in recent months. Understandably, the Minister rightly calls the trust management to account. That is her job, and she can expect high standards from them. However, it seems that she is sometimes asking the trust to do the job with one hand tied behind its back. The reason our ambulances are in Ebbw Vale is because there are not enough ambulances elsewhere. We are robbing Peter to pay Paul. There is a distinct need for more investment in the ambulance service across the board. Operational overspend in the Mid Wales region continues to be a problem, but despite that the Minister demands big savings of the ambulance trust. The extra investment that has gone in has been outstripped by rising fuel costs and the increasing costs of complying with health and safety legislation. We therefore need to examine whether our ambulance trust is being properly funded to deliver the service required of it.

We also need to deal with the issue of waiting times at accident-and-emergency departments. The Minister is currently monitoring the length of time it takes ambulances to offload patients. I know of a case in Ystradgynlais where the patient sat in the back of an ambulance for an hour before being transferred to the accident-and-emergency department of a Swansea hospital. That is an hour that that ambulance did not need to be waiting there.

In Powys, the reorganisation of a minor injuries unit has led to problems, as local people who could be treated locally now have to be taken to district general hospitals. We need to establish clear protocols on what calls can be responded to in local minor injuries units, and we need to train our rural paramedics better so that they have more skills to deal with calls appropriately and so that they take only the people who really need to go there to accident-and-emergency departments.

We need better facilities, as I said at the start. Some of our ambulance staff are working out of really shoddy buildings without the amenities that they require. In rural areas, we need to encourage more co-responders, so that they can react initially to local incidents.

My constituents are increasingly reliant on the air ambulance, and it is shocking that, in a society as rich as ours, local people are out rattling tins to find the money to pay to keep that service in the sky. We must move to a more professional form of funding for that service.

We also need better public information. Undoubtedly, people ring 999 when they do not need to do so, but I do not believe that they do so maliciously, in most cases; they simply do not know better ways of getting in touch with the health services that they need. The move to different out-of-hours arrangements has caused confusion, and that has affected the ambulance service. We need to look at a public information and education programme that directs people to the best services that they need when they need them, ensuring that as many 999 calls as possible are genuine emergency calls.

I am under no illusion that, in Powys, due to the demographics of our county and the logistics, there are particular difficulties in servicing our area. I appreciate that it will always take longer for an ambulance to reach Merthyr Cynog in the middle of Powys than it will take an ambulance to reach Whitchurch in Cardiff. However, my constituents need the assurance that when we have an emergency, the service will be there for us, and that we will receive the same level of care that other residents of Wales receive. As one of my constituents put it to me, 'We do not want to have to sit and watch our loved ones die, not knowing whether an ambulance will come or how long it will take'.