27 June 2018 Ambulance services in Wales, 2017-18 SFR 52/2018
This report presents data and analysis on ambulance services in Wales for the About this release financial year 2017-18. The report focusses on call volumes, call categories, mean Following an initial trial and median response times and performance against the ‘red’ call response time starting on 1 October target. This report also provides ambulance service statistical profiles for Local 2015, a new clinical Health Boards and supplements monthly ambulance data published in the NHS response model for the Activity and Performance release. ambulance service in Wales was implemented in February 2017. Under the new model, only the most serious calls, Key points in 2017-18 Hospital admission avoidance categorised as red 479,444 emergency ambulance calls were made during 2017-18, an increase (immediately life- of 4.4% on the previous year, and 126% more than in 1991-92. threatening), have a 22,878 were red calls (immediately life-threatening), 4.8% of the total, and an response time target. All What works? for whom? and inincrease what of 11.5% on the circumstances? previous year. other calls receive an appropriate response, 74.6% of red calls received an emergency response within 8 minutes, down from 76.3% in 2016-17; performance ranged from 68.2% in Hywel Dda to either face-to-face or 81.7% in Cardiff & Vale. telephone assessment, based on clinical need. The median response time for red calls was 4 minutes and 58 seconds, three seconds slower than in 2016-17. The median response time for amber calls The Emergency was 19 minutes and 3 seconds, almost five and a half minutes slower than in Ambulance Services 2016-17. Committee also Reducing hospital admissions: Chart 1, total emergencyTotal emergency calls, 199 calls1- (Wales)92 onwards 1991 -2018 publishes Ambulance 500,000 Quality Indicators each A realist evaluation of Welsh 400,000 quarter. What? 126% increase 300,000 ambulance service’s gatekeeping • Escalating demand for 200,000 In this release stratagem. Welsh ambulance services • Budgetary constraints 100,000 Summary of the year 3
Chris Evans 0 Calls 3
Red calls 6 INTRODUCTION NOTE: Different call classifications over the years but combined to be as comparable a basisWelsh Governmentas (2018) possible: Amber calls 8 An increase in public expectations and aging population with long-term, Emergency calls and GP urgent patient journeys from 1991-92 to 1998-99 Category A, Category B and GP urgent journeys from 1999-2000 until November 2011 multiple co-morbidities, have culminated in chronic, escalating demand for LHB profiles 9 Welsh Ambulance services (McClelland, 2013). The protracted growth in Category A, Category C and Category C (HCP) from December 2011 until September 2015 Red, amber and green calls from October 2015 to date emergency call rates has led to higher levels of Emergency Department (ED) Notes 16 referrals by Welsh ambulances (Hallaran & Robertson-Steel, 2008; Welsh Ambulance Services NHS Trust, 2011), prompting the implementation of ED Hospital handover delays (Wales) 2016-2018 admission avoidance strategies. Statistician: Craig Thomas ~ 0300 025 1646 ~ [email protected] Enquiries from the press: 0300 025 8099 Public enquiries : 0300 025 5050 Twitter: @statisticswales So What? AIM • 54% increase in lost The aim of this study is to understand admission avoidance programmes within the context of Welsh Ambulance Services; to clarify how admission ambulance hours 2017-18 avoidance processes work, for whom, and under which conditions; and to • 10% reduction in conveying understand the effects of culture and organisational practises on everyday paramedic admission avoidance work. capacity over winter 2017-18
METHODOLOGY
The study utilises realist methodology, a theory-driven approach to Welsh Ambulance Service (2018) evaluating complex interventions, with the aim of extending the knowledge of policymakers, the public, programme participants and practitioners (Pawson & Tilley, 1997). Admission avoidance programmes include mechanisms of action which can be shaped by the context of each social system in which they are embedded. ED conveyance following face-to-face assessment Programme theory will be made explicit by evaluating the sequence, or chain of processes that influence the patterns of reasoning and response of Now What? (Wales) 2017-2018 programme participants; delineating enablers and barriers to change. • Emergency Department (ED) admission avoidance METHODS • 3.5% fewer patients transported Three phases of data collection are augmented by a realist review of the evidence: to ED by ambulance 2017-18 • What actually works (or not), for Phase 1 Candidate programme theories are being developed using Soft Systems whom, in what circumstances? Modelling and e-Delphi panel Welsh Ambulance Service (2018) Phase 2 Initial programme theory will guide Ethnographic Observations of paramedic work, Telephone Interviews and analysis of Institutional Discourse and Texts
Phase 3 A focus group will review and validate the refined realist programme theory References
Hallaran, F. and Robertson-Steel, I. (2008). A guide to good practice: Unscheduled and Emergency care services. National Leadership and Innovation Agency for Healthcare. Retrieved 15/07/17: http://www.nliah.wales.nhs.uk.
McClelland, S. (2013). A strategic review of Welsh Ambulance Services. Welsh Government. Retrieved 9/06/17: http://www.ambulance.wales.nhs.uk.
Pawson, R. and Tilley, N. (1997). Realistic Evaluation. London: Sage publications.
Welsh Ambulance Services NHS Trust. (2011). Working together for success 2011-2016. Wales. WAST.
Welsh Ambulance Service (2018). The performance report. http://www.ambulance.wales.nhs.uk/assets/documents/
Welsh Government (2018). Statistical first release: Ambulance services in Wales, 2017-18. https://gov.wales/statistics-and-research/ambulance-services/
@ChrisAnglesey