Ambulance targets overhaul to 'save more lives'

Ambulance response time targets in Wales will be overhauled, the health secretary has announced.

The current target of responding to 65% of red calls - the most serious - within eight minutes has not been met for more than four years.

But now two new categories of calls are to be introduced to cover cardiac and respiratory arrests and major trauma incidents.

For both new categories, it is expected crews would arrive in a median average time of between six and eight minutes.

"We want to save more lives and improve the chances of people surviving cardiac arrests," said Wales' health secretary Jeremy Miles.

The new categories will be purple - for cardiac and respiratory arrest where somebody's heart has stopped beating unexpectedly or where someone has stopped breathing - as well as a red emergency category for major trauma or other incidents which could lead to cardiac or respiratory arrests.

Changes to the questions asked at call centres are also being made, with the aim of improving the triaging of patients so that fewer are inappropriately classed as "life-threatening".

Currently, about a third of calls for respiratory problems alone are later de-escalated from the most urgent category, with the patient discharged by paramedics on the scene.

Miles said the changes would put more emphasis on the outcomes for patients rather than just speed of response, adding it was a move away from judging ambulance response performance only by how long it takes for a crew to arrive.

For example, currently if an ambulance arrives after eight minutes and the individual survives, then this is regarded as failure, but if an ambulance arrives within eight minutes and the person dies, the target has been met.

For purple calls, the percentage of people who have their heartbeat restarted after cardiac arrest will be measured - with an expectation that this figure will increase over time.

Published figures will include the time taken to start CPR, defibrillation and the arrival of paramedics, putting a greater emphasis on the role bystanders play.

Currently, the survival rates for out-of-hospital cardiac arrests in Wales are 5%, compared to 9% in Scotland, 10% in England and as high as 25% in some European countries.

But the change comes against the backdrop of deteriorating performance since response times targets were last overhauled in 2015 - when a range of targets were replaced by a single target for the most urgent red calls.

That target, which states that 65% of red calls should receive a response within eight minutes, has not been met since the summer of 2020.

There has also been a significant deterioration in response times to amber calls - from 11 minutes in 2015 to almost two hours - which include patients having a stroke or suffering chest pains.

Many delays experienced by the ambulance service are beyond its control and occur as a result of ambulances queuing outside hospital A&E departments, with more than four times as many hours lost in this way in the past twelve months, compared with 2017.

In January this year alone, about 27,000 hours were "lost" while ambulances and crews were stuck outside A&E waiting to hand their patients over.

A task force will now be established by the Welsh government to address this problem, which differs significantly across Wales - for example, Cardiff and Vale health board has dramatically reduced the waits, while all other health boards have seen numbers stagnate or even increase, despite Welsh government initiatives to improve that flow.

The goal is for patients to be handed over to hospital staff within 15 minutes, but the most recent figures show just 13% of more than 11,000 patients taken to A&E were handed over within that time frame.

According to the Welsh government, the changes are in response to a recommendation by the cross-party Senedd health committee which concluded current targets were no longer fit for purpose.

It said the new approach mirrored those already used in Ireland, Scotland and Australia where survival rates have improved.

The new system will be piloted for a year, from July this year, and permanently introduced from August 2026 if successful.

Health Secretary Jeremy Miles said: "The current system treats someone in cardiac arrest the same as someone with generalised breathing difficulties who can often be treated safely at home.

"These changes will ensure ambulance clinicians reach those with the greatest need first, while making sure everyone gets the right care based on their clinical needs."

Jason Killens, chief executive of the Welsh Ambulance Service, added: "We welcome today's announcement that the way Welsh Government will measure ambulance service performance is changing.

"Since 1974, our ambulance service has been measured by the time it takes to reach emergency calls.

"The ambulance service of today provides much more sophisticated care, so shifting the focus to how many people survive a life-or-death emergency because of our interventions, rather than how many minutes it takes us to get there, is an important step to reflect that."

Plaid Cymru's spokesperson for health and social care, Mabon ap Gwynfor, said the party had regularly called for changes to Labour's "meaningless" targets, adding it was "clear that we need to strengthen primary and community care services alongside such changes in order to address fundamental issues around transfer delays and patient flow".