National Assembly for Wales / Cynulliad Cenedlaethol Cymru
Health and Social Care Committee / Y Pwyllgor Iechyd a Gofal Cymdeithasol


Inquiry into the performance of Ambulance Services in Wales/ Ymchwiliad i berfformiad Gwasanaethau Ambiwlans Cymru

Evidence from Cardiff and Vale University Health Board – PAS(AI) 03 / Tystiolaeth gan Bwrdd Iechyd Prifysgol Caerdydd a’r Fro – PAS(AI) 03


Professor Adam Cairns

Chief Executive

18 March 2015


David Rees AM

Chair, Health and Social Care Committee

National Assembly for Wales

Cardiff Bay


CF99 1NA



Dear Mr Rees


I am writing in response to your letter dated 6 March 2015 and following my attendance at the Health and Social Care Committee on Thursday 5 March 2015 regarding performance of the ambulance service in Wales.  This letter details the additional information I agreed to provide.


Number of ambulances and patients experiencing delays


The following table summarises the numbers of ambulances that arrived at each accident and emergency department and also the number of patient handovers delayed over 15 minutes for the month of February 2015.



February 2015


No of ambulance arrivals

No of handover delays > 15 mins

University Hospital of Wales



Llandough Hospital



Total Cardiff & Vale UHB




With regards to the ambulance arrivals, you also requested information on the ambulance station at which each of those ambulances was based. The Information Reporting and Standards Team at Welsh Ambulance Services NHS Trust (WAST) have been able to provide a report of all vehicle types that attended the accident and emergency departments (attachment 1) at each hospital. As the report provided is a total of all WAST vehicles that arrived at each hospital by ambulance station base, i.e. is a total of the number of vehicles that both conveyed patients and also the vehicles that did not convey patients but provided back up, the total numbers differ to the number of ambulance arrivals above. However, it should provide you with a good indication of the ambulance station bases.


Actions the Health Board is taking to reduce patient handover delays


The Health Board recognises that Ambulance handover and Emergency Department performance is a barometer for the Unscheduled Care system as a whole. For this reason the Health Board has initiated improvement measures in the pre-hospital, emergency department, inpatient flow and discharge elements of the Unscheduled Care pathway.


Upstream Measures (Pre-hospital)


The focus here is around managing Ambulance conveyance demand. Cardiff and Vale UHB works closely with WAST colleagues on a range of initiatives aimed at avoiding conveyance to hospital. To examples include the development of alternate pathways and the introduction of a non-emergency taxi service. In terms of pathways, alternatives for a number of conditions have now been introduced. They include a falls pathway, a post epileptic fit pathway and a post hypo-glycaemic (diabetic patient) pathway. In addition the Health Board has put arrangements in place to avoid the conveyance of some patients with mental health needs to the department; instead these are now conveyed directly to a service provided at Whitchurch Hospital. The second area of conveyance avoidance has been implemented by WAST colleagues and involves the implementation of protocols which stand down the need for an Ambulance conveyance to a taxi for defined and clinically appropriate patients.


Emergency Department


A number of initiatives are being put in place to improve handover processes at the emergency department. In addition to the traditional 'majors', 'minors' and 'paediatrics' Emergency Unit streams, we have now developed a 'minor illness' stream to accommodate the increasing numbers of ambulatory care sensitive presentations. This has freed up some of our majors trolley capacity to help off-load ambulances. In addition we have initiated procedures to protect Ambulance response capacity through our escalation process (zero code red) which will release Ambulance when capacity to respond is limited. In addition we have now provided an experienced nurse to act a Majors Assessment Nurse at the front ambulance entrance of the Emergency Unit. The role of this nurse includes expediting offloading processes.


Inpatient Flow


It is recognised that patient flow out of the Emergency Unit into hospital inpatient beds is a key driver for off-ambulance handover performance. It is also recognised that the increased volume of elderly complex discharges is a constrictive factor. The Health Board has now developed a complex discharge process to manage and expedite complex discharge needs. In addition, we have recently strengthened our patient access and Standard Operating Procedure for inpatient flow.








To complement the improved complex discharge management process, the Health Board has been deploying new models for convalescent care. Over the winter months we have initiated a 'discharge to assess' model for patients with complex discharge needs, as opposed to the tradition of assessing patients completely before they leave hospital. Our Primary, Community and Intermediate Care Clinical Board is actively pursuing discharge improvement initiatives through investing in Community Resource Teams and other virtual bed capacity such as End of Life care support. For many of these initiatives we are working closely with our Local Authority partners. We have already developed a joint contact centre with the Vale Local Authority and we are in discussions with Cardiff Local Authority to join this approach through a single contact centre.


I hope committee members will find this information helpful. You will note that the Health Board is working collaboratively to pursue integrated improvement initiatives extending throughout the Unscheduled Care pathway. If you would like any further information please do not hesitate to contact me.


Yours sincerely







Professor Adam Cairns

Chief Executive




Attachment 1


Cardiff & Vale UHB - Ambulance arrivals (all vehicles) by station and hospital site



Source: WAST Information Reporting and Standards Team