How will you be able to attend certain parts of the county by moving your base further away? Surely, it would take longer to get to certain locations by air or by road? Expand This is a critical question and it can only be answered by first understanding the specifics of an air ambulance operation. With only four helicopters (and complementary Rapid Response Vehicles), and four highly skilled medical crews, we are a scarce resource. There is a complex range of factors which are taken into consideration for every single deployment of our pan-Wales fleet. Dedicated allocators and clinicians in our Critical Care Hub assess every incident on a case-by-case basis to provide the most appropriate response using our resources, in conjunction with other emergency response teams we work closely with. Therefore, even though each air ambulance crew is based in a certain region, their response can be pan-Wales. None of our crews are restricted to a certain area of Wales, they move around the country attending missions as required. It’s about sending the most appropriate available crew, regardless of where they are based. For example, if a life or limb-threatening incident were to occur in a remote rural area of Mid Wales, it could be attended from any of our current base locations (Welshpool, Dafen, Cardiff or Caernarfon). Why is this important? People have raised concerns about the increased travelling times because of the proposed service reconfiguration.The reality is that this already happens, quite regularly, as part of our service and with no detrimental effect to the patients and their outcome. Of course, helicopters can cover large distances rapidly and directly. However, some may ask how this is possible in a road vehicle when there, logically, would be increases in travelling time against the backdrop of an already difficult road network. In reality, Wales Air Ambulance/EMRTS attends very few missions in an RRV from its Welshpool and Caernarfon bases as it currently stands. A vast majority of their work is by air. Why? Because these locations do not lend themselves well to any kind of road response. They are remote locations with poor access to a suitable road infrastructure, which means availability is significantly reduced. This is in addition to environmental factors, particularly in Welshpool with recurring flooding of the airbase and the surrounding road network. To put the above into context, over the past 12 months 38% of the emergencies we attended in Mid Wales were done so by our crews in either North Wales or South Wales. Also, 74% of emergencies attended by our Welshpool crew were either in North Wales or South Wales. This clearly demonstrates that our resources are national assets that travel across the country to offer our advanced lifesaving care. Questions about response times are completely understandable but we hope this offers reassurance that distances are not an issue for patient care as we already respond to incidents in remote areas, such as Mid Wales, regularly, with resources from both South Wales and North Wales.
With the challenge faced by the Welsh Ambulance Service NHS Trust, particularly around response times, will the reconfiguration of Wales Air Ambulance/EMRTS further reduce our chances of gaining a timely ambulance response? Expand No. It’s important to point out that Wales Air Ambulance/EMRTS is not a replacement for the Welsh Ambulance Service NHS Trust (WAST). We are not part of the same organisation but we do work closely in partnership. Wales Air Ambulance/EMRTS attends the highest level of life or limb-threatening emergency calls (red and some amber). It is rare that Wales Air Ambulance/EMRTS attends an incident without a WAST presence. In the chain of survival, WAST medics are usually first on the scene of an incident or medical emergency and offer the all-important initial lifesaving interventions before our crew/s arrive and administer the emergency department-standard treatment that has been proven to increase the chances of survival (see our 2015-2020 Service Evaluation). For context, WAST receives somewhere in excess of 600,000 calls per annum and responds to around 250,000 of these as an emergency response, and 40,000 as an immediate response. Unlike the ambulance service, which covers such a broad range of services, HEMS (Helicopter Emergency Medical Services) supports the highest acuity of life or limb-threatening conditions. Our detailed analysis of need has shown that somewhere in the region of 4,670 calls per year would benefit from the attendance of our critical care teams. We currently attend 72% of these nationally and the service analysis findings indicate that we can get much closer to meeting the total need – seeing an extra 583 patients and meaning that we would see 88% of those critically ill and injured patients that could benefit from our services. Wales Air Ambulance/EMRTS is not sent to an incident or medical emergency by WAST. Within the WAST contact centre in Cwmbran is our Critical Care Hub, which is staffed 24/7 by an experienced allocator and critical care practitioner, both employed by EMRTS. They monitor the most serious 999 calls and automatically dispatch the most appropriate Wales Air Ambulance/EMRTS crews to those emergencies that we can add value to with our emergency department-standard critical care. On some occasions, emergencies can be worse than first reported, or a patient can rapidly deteriorate. When this happens, a WAST paramedic involved in the incident will contact our Critical Care Hub to ask for advice and, if required, medical backup. To learn more about our Critical Care Hub, please read this article written by Hub Manager, Greg Browning. It is not just the ambulance service we work with. We try and work flexibly as a team with a range of other emergency care services. For example, our overnight crew will often switch to a road response, particularly in winter months, and may drive over significant distances, often intercepting ambulance crews to further improve time to definitive critical care. We have even been known to drive to a scene in poor weather in the middle of the night, rendezvousing with colleagues from the Search and Rescue bases who can fly in conditions that we are currently unable to. Ours is a complex and dynamic service, serving the whole of Wales and often having to balance a whole series of complicated operational, logistical and clinical judgements. Again, it is vital to emphasise that Wales Air Ambulance/EMRTS is not a replacement for WAST. For the best patient outcomes, interventions from WAST and then Wales Air Ambulance/EMRTS are important. The proposed WAA/EMRTS reconfiguration is actually a service expansion as it will increase our operational hours in the North of the country, meaning that people in both North and Mid Wales will benefit from our lifesaving care for more hours of the day and night.
You suggest that you can attend 583 more lifesaving missions a year. How did your analysis come to that figure? Expand The data which has generated the 583 figure has been derived from EMRTS’ independent data modelling. Figures indicate that there are currently 1331 patients who, according to their clinical presentation and situation as logged on the ambulance service system, are patients our clinicians believe would benefit from WAA/EMRTS attendance and who currently are not seen for a variety of reasons. Reasons for non-attendance vary but it is predominantly because crews are already committed (at night this could be because a response would be needed from the Cardiff team) or because poor road capability means that if an air response is not possible there would be an unacceptable delay. Through the simulations run by Optima (over 200 simulations and 40 scenarios), we have identified the optimum base configuration and staffing pattern which enables us to treat both our existing patient base plus an additional 583 out of those 1331 which currently make up the unmet need. We can identify the projected location of these patients and see that not only do all parts of Wales see an increase in patients attended by WAA/EMRTS, no parts of Wales see a reduction in patients attended by WAA/EMRTS – there is a net benefit in all parts of the country. A brief overview of the calculation process is as follows: Calculation of total demand from 4-year average activity, combined with prospectively identified unmet need over 2 years. Calculation of utilisation and activity by base, day, month, season, hour, including average incidents per day, and total time involved with incidents. Optima models tuned to match real life, and then 200+ simulations run, with 41 best performing scenarios continued, and tested. This includes sensitivity analysis looking at all current base options, addition of resource, base moves, changes of shift times, and poor weather as well as road access. Data extracted from Optima models, and linked back to NHS data. ‘Deep dive’ into the clinical impact of current and proposed patients. Change in patients identified from this data by locality to give headline figures.
Are the 583 additional missions in the more densely populated areas of Wales – simply because of the increased density of population as compared to a rural area? Expand No. In fact, the per 1000 population data shows that some of the most significant improvements are in Powys. (as per the table below). Locality PC change Conwy +11% Denbighshire +15% Flintshire +18% Gwynedd +7% Isle of Anglesey +1% Wrexham +2% Powys +11% Carmarthenshire +6% Ceredigion +2% Neath Port Talbot +15% Pembrokeshire +14% Swansea +13% Blaenau Gwent +23% Bridgend +9% Caerphilly +11% Cardiff +17% Merthyr Tydfil +18% Monmouthshire +14% Newport +35% Rhondda Cynon Taf +16% The Vale of Glamorgan +17% Torfaen +16% The proposed model also has the effect of distancing the rural resources from the highest area of demand (South East) to ensure that they are not drawn into those areas. An additional daytime resource which has been added to Cardiff in April 2022 further mitigates this move and protects the three other medical teams, ensuring they are available to respond to rural areas.
If the changes are implemented, what would be the impact on mission attendance at a regional level? Expand The changes would be universally positive. All regions of Wales will see an increase in mission attendance by WAA/EMRTS. Please see below county-level information showing the percentage change in incidents attended (verses 2021 baseline), according to the service analysis modelling. Locality PC change Conwy +11% Denbighshire +15% Flintshire +18% Gwynedd +7% Isle of Anglesey +1% Wrexham +2% Powys +11% Carmarthenshire +6% Ceredigion +2% Neath Port Talbot +15% Pembrokeshire +14% Swansea +13% Blaenau Gwent +23% Bridgend +9% Caerphilly +11% Cardiff +17% Merthyr Tydfil +18% Monmouthshire +14% Newport +35% Rhondda Cynon Taf +16% The Vale of Glamorgan +17% Torfaen +16%
If the changes are implemented, what would be the impact on average response time over a 24-hour period (versus 2021 data)? Expand The negatives in the following table are improvements in minutes. As the table indicates, there are no increases in average response time for any region across Wales. Locality Average reflex* time (mins) Change ) minutes Denbighshire -41 Flintshire -36 Conwy -32 Wrexham -28 Isle of Anglesey -13 Gwynedd -14 Ceredigion -15 Carmarthenshire -12 Cardiff -12 All Wales -11 Pembrokeshire -10 Torfaen -13 Neath Port Talbot -10 Swansea -8 The Vale Of Glamorgan -9 Bridgend -9 Merthyr Tydfil -10 Powys 0 Blaenau Gwent -9 Newport -8 Rhondda Cynon Taf -9 Caerphilly -7 Monmouthshire -5 *Reflex time is allocation of a resource to arriving on scene.
There has been a lot of information and commentary about North and Mid Wales. How will the proposed service model impact South Wales? Expand All counties of Wales will positively benefit from the proposed changes highlighted in the service analysis. We could see even more patients in South Wales, and get to incidents/emergencies even quicker on average than we currently do. County-level information for South Wales showing the percentage change in incidents attended (verses 2021 baseline), according to the service analysis modelling. Locality PC change Carmarthenshire +6% Neath Port Talbot +15% Pembrokeshire +14% Swansea +13% Blaenau Gwent +23% Bridgend +9% Caerphilly +11% Cardiff +17% Merthyr Tydfil +18% Monmouthshire +14% Newport +35% Rhondda Cynon Taf +16% The Vale of Glamorgan +17% Torfaen +16% County-level impact on average response time in South Wales over a 24-hour period (versus 2021 data). Locality Average reflex* time (mins) Change ) minutes Carmarthenshire -12 Cardiff -12 Pembrokeshire -10 Torfaen -13 Neath Port Talbot -10 Swansea -8 The Vale Of Glamorgan -9 Bridgend -9 Merthyr Tydfil -10 Blaenau Gwent -9 Newport -8 Rhondda Cynon Taf -9 Caerphilly -7 Monmouthshire -5 *Reflex time is allocation of a resource to arriving on scene.
Is it true to say that those in populated areas are in less need of Wales Air Ambulance/EMRTS than rural areas due to increased ambulance service provision and closer proximity to hospitals? Expand Absolutely not. Wherever you are in the country, the out-of-hospital emergency-department standard treatments only offered by Wales Air Ambulance/EMRTS, could be the difference between survival at the scene or not, even before getting to hospital, regardless of how close that hospital may be. Also, the nearest hospital may not be the most appropriate hospital for the patient’s needs. If WAA/EMRTS did not attend such an incident and a patient was conveyed to the nearest hospital, there is a possibility that a secondary transfer would be required to a more suitable healthcare facility. This could take several hours to arrange and undertake, further diminishing the chances of survival and long-term recovery. As well as the advanced critical care capabilities we bring to an incident, our medics can diagnose the underlying issues of a patient and transfer them directly to the most appropriate hospital – whether in a WAA helicopter or, if the patient is unstable or the weather is poor, in a Welsh Ambulance Service NHS Trust road ambulance. On some occasions, we may use a Search and Rescue helicopter. This ensures that the patient receives the required next level of specialist care as quickly as possible, increasing the chances of long-term survival and recovery. Therefore, Wales Air Ambulance/EMRTS attendance is equally as important in an urban setting as it is in a rural environment.
Is this just a cost-cutting exercise? Expand No. These proposals are not, and never were, designed to produce financial savings. They are solely focused on improving patient outcomes. Our service evaluation, published in March 2022, proved that we deliver an excellent standard of care for the people of Wales. More people are surviving because of our advanced lifesaving service. Now we want to know whether we are delivering this excellent care equitably, and to as many people as possible, with our current resources. The funding we receive is from you, the people of Wales, and we have a duty to you to ensure that we are using it in the most efficient and effective way. The efficiency and effectiveness of the service is particularly important now as the global economy is changing dramatically, through an increase in the cost of goods and services. The Charity is expecting a very significant increase in aviation costs, potentially increasing our bill by several million pounds per annum.
Is this just a target-driven exercise? Expand Absolutely not. We are not a target-driven organisation when it comes to missions attended. We just want to make sure that as many people are benefiting from our lifesaving service as equitably as possible – something we know you care about too. The collaboration between the Wales Air Ambulance Charity and EMRTS is founded on improving the outcomes of patients, and this has been proven in our recent service evaluation. This is the foundation of the current service analysis, in a bid to see more patients receiving the care they require, with more lives saved, and improved long-term outcomes for the people of Wales (i.e. an effective critical care response which facilitates faster recovery times and a better quality of life, long-term, for patients and their families). Continuing with the status quo would see poorer outcomes or deaths across Wales, in patients where we know we could have a positive impact. This includes rural areas, especially out of hours.
Your model recommends that the current crews at Welshpool and Caernarfon should co-locate on one base in a North Wales location. Did you consider your current Welshpool base as a potential co-location site? Expand Yes. As part of a suite of over 200 simulations, Welshpool was included at every stage and combination of models, even when it was identified as poorly performing early on. Part of the reason that Welshpool was consistently shown to be a sub-optimal option relates to its geographical positioning and road connectivity, meaning availability is significantly reduced. This is in addition to environmental factors and operational days lost due to recurring flooding of the airbase and the surrounding road network. Putting additional resources into this location would deliver little benefit and mean that the crew would do very few missions from the base (in Powys and beyond).
What is the approximate timescale for getting all helicopters equipped for night flying, given the priority on saving more lives across the country? Expand With a year to go on our existing aviation contract, it is likely something we would make a priority for the new supplier/new contract. Essentially there are three components to being able to fly using night-vision capability: The aircraft being fitted with the right technology. The availability of night-vision goggles for each of the pilot team/crew members who need them. Pilots and crew being initially trained and then training standards maintained throughout the period of employment/tours of duty to ensure they remain current in terms of their night-flying accreditation. With our current mixed fleet and operating model, it is the last of these which adds quite a lot more complexity. By including this requirement in our new contract, the successful supplier will be able to plan and price for this from the outset. In addition, our new contract will see us move to a single airframe type and more consistent crewing model which will help achieve this. We are awaiting the evaluation/analysis of responses from our bidders in terms of timescales but the requirement we set out was for this to be part of the contract from the start. However, the rigour of the regulations in relation to night-vision flying and the oversight and conditions required by the CAA means that the reality is this will probably be some months after the start of the contract before we are fully operational. Although, it is important to remember that all our aircraft are currently able to land at lit landing sites at hospitals and that our Cardiff-based overnight aircraft is fully night-vision operational.
Can you confirm what discussions you’ve had with the Civil Aviation Authority regarding a new base and the hours that pilots will be able to fly for, especially with the new night-time flights in North Wales? Expand Discussions with the CAA are the responsibility of the Air Operations Certificate holder, and will be for the new operator in 2024 to address. We have communicated our proposals for extended hours to those companies participating in our aviation procurement process and no concerns have been raised. Likewise, our aviation consultants can see no issues.
Why does the Charity want to remain independent? Expand The Wales Air Ambulance Charity believes that it is in the best interests of Wales to have an air ambulance operation that works in medical partnership with the NHS but is independent in its income generation and decision-making. This independence, outside of the pressures and constraints of public sector funding, allows the Charity to focus on its core services, continually monitor and effectively adapt to the critical care needs of Wales in a timely manner, while maintaining a consistently high standard of care. The third sector and public sector partnership adopted in Wales is a model that has proven benefits for patients and their families, as well as for the NHS. This rationale for remaining independent is shared by all air ambulance charities across the UK.
How much has this analysis cost the Charity? Expand The Charity has not spent any money on the analysis. It has been conducted by our medical partners, the Emergency Medical Retrieval and Transfer Service (EMRTS), with independent modelling included.
If you move from Welshpool, are we more likely to get a response from Midlands Air Ambulance? Expand Not as a result of the proposed reconfiguration. Wales Air Ambulance will continue to serve Powys as we always have – but with an enhanced service that could attend more lifesaving missions in the County (+11%) and with an additional overnight resource. As is the case now, our friends and colleagues in Midlands AA would only attend an incident in Wales at our request and likewise, we would support them if they requested and we have a team available. Here is a summary of the process behind cross-border air ambulance support. All 999 calls in Wales are received and logged within Wales. Therefore, our air ambulance colleagues across the border would not see Welsh 999 calls. Wales Air Ambulance has a dedicated 24/7 Critical Care Hub in the Welsh Ambulance Service Contact Centre (where 999 calls are received). Staffed by an Allocator and Critical Care Practitioner, the Hub team monitor all calls where a life or limb is potential threatened and, if there is an emergency that we could add value to, they will send the appropriate available Wales Air Ambulance team (regardless of where in Wales they are based). On the rare occasions where we need cross-border support from another air ambulance service, it would be our Critical Care Hub who would request this directly with them. This would only happen if our crews were already allocated to other emergencies or during a significant incident where multiple emergency resources are needed. This cross-border aid is reciprocated as Wales Air Ambulance offers the same support for the same reasons in aid of our air ambulance colleagues who work alongside our border.