Wales Considers Revising Ambulance Response Targets Following Persistent Failures

Wales is considering adjustments to its ambulance response targets in 2025, following a four-year period during which the service consistently failed to achieve its primary performance indicator. The current expectation is for 65% of the most critical, life-threatening calls to reach patients within an eight-minute timeframe; however, this benchmark has not been met for the last 51 months. In response, Health Secretary Jeremy Miles has commissioned experts to evaluate the “appropriateness” of this target. Jason Killens, chief executive of the Welsh Ambulance Services NHS Trust, stated that “avoidable harm” was occurring among Welsh patients, especially within the second-most severe call category. Since 2015, calls have been classified into red, amber, and green priorities, with an eight-minute response expectation for emergencies in place for the past 50 years. The volume of “red” calls has shown a consistent increase since the implementation of this colour-coding system. In October, over 25% of the 21,000 emergencies requiring an ambulance were designated as “red”. Response durations for “amber” calls, encompassing conditions such as chest pains and strokes, have been adversely affected by hundreds of ambulances experiencing prolonged waits of several hours outside hospitals monthly, pending patient handovers. Health officials attributed the failure to meet targets partly to an increasingly older and less healthy population, while also noting that the ambulance service is refining its patient categorization system. Furthermore, there is recognition that patients’ conditions have deteriorated during the wait for ambulance arrival. Current statistics indicate that only 50.4% of red calls were responded to within the eight-minute timeframe. Conversely, a significantly larger volume of green calls involve minor conditions that can be managed via telephone or without hospital admission. Response times for amber calls have escalated from 11 minutes in 2015 to nearly two hours, representing 70% of all ambulance responses. Ambulance service management reported that even with the recruitment of 500 additional personnel in recent years, extended waits of multiple hours outside emergency departments have prolonged the time required to reach a greater number of individuals. An analysis by BBC Wales concerning handover times revealed an average of almost 52 minutes spent outside hospitals. Additionally, 1,863 vehicles per month were observed spending four hours or longer per visit outside Accident and Emergency departments. Mr. Killens stated: “Avoidable harm is happening to patients, sadly across Wales, and that happens predominantly in the amber category.” He clarified that this encompasses both patients whose lives are threatened and those not immediately life-threatened. He added: “What we’ve seen over the last few years is is a growing trend of extended response times for patients in that category.” During the summer, a cross-party committee comprising Senedd members examined these concerns. Jeremy Miles informed Senedd members that an expert group, consisting of clinical and health service leaders, would now “focus on measuring the quality and safety of the service.” The objective is to establish “realistic” and “achievable” targets. Sam Rowlands, Conservative health spokesman, acknowledged widespread accounts of lengthy waiting times and expressed support for the announcement, while hoping for “clear targets in place so there was proper accountability and transparency.” Mabon ap Gwynfor, Plaid Cymru health spokesman, emphasized the necessity of addressing fundamental issues within care services that fall outside the ambulance service’s purview, asserting that a holistic approach was “desperately needed.” The ultimate fate of the current eight-minute red target—whether it remains, is abolished, or modified—is presently unknown, awaiting the review’s determination. However, it is anticipated that any new targets will likely place greater emphasis not solely on response time, but also on the quality of care ultimately received by patients. This includes considerations such as whether patients receive appropriate care and assessments over the phone, if stroke and heart problem patients are directed to the correct facility initially, and if 999 callers are provided with effective CPR instructions. Consequently, an increase in such quality-focused metrics is expected. Nevertheless, a significant challenge for the ambulance service involves the frequent situation where numerous crews become delayed outside overcrowded A&E departments. Staff members have expressed profound frustration over spending entire shifts unable to respond to new 999 calls within the community due to these delays. It has been indicated that this review will not establish specific targets for hospitals and health boards aimed at mitigating these handover delays. Some observers contend that enhancing ambulance performance will be nearly impossible without addressing this particular issue.