Dear Friends,

Over the past few days you will have seen headlines about our operation at Welshpool. We would like to share with you the full story and circumstances.

Firstly, we would like to explain the reason that this information has come out the way it has. There is an extensive ongoing analysis looking at whether we are delivering our lifesaving care in the most effective and equitable way with the resources that we have. More information on that is below. We intended to release the information in the near future once the analysis was fully complete. However, the media had received information specifically about Welshpool and asked the question.

We pride ourselves on our communications and place a high value on our relationship with our supporters, volunteers and employees. We had planned, and still do plan, an extensive period of engagement with you all, however, we always knew that, at some point, information could reach a media outlet. This means that we have had to bring forward the communication of our research and not follow the route we had planned – talking to you all first and letting the full data and evidence make the case. And I can only apologise that we have not been able to do that.  Despite being several weeks away from being ready to go public, we decided to answer the media question honestly with the headline figures we have been presented with rather than giving just a holding statement. 

The Analysis

Why are we considering any changes?

As part of our wide-reaching strategic review, we are conducting a detailed analysis of our service delivery data, current demand and base utilisation, to understand whether we are delivering the most effective service for the people of Wales. You have entrusted us with your vital donations and we owe it to you to identify the best service delivery model to achieve our mission and vision.

Mission - To deliver lifesaving, advanced medical care to people across Wales, whenever and wherever they need it.​

Vision - To improve the lives of patients and their families by being a world leader in advanced, time-critical care. ​

We have a commitment to our supporters to maximise the impact of donations, ensuring that as many people as possible across Wales benefit from our advanced critical care. Improving the lives of patients and their families is, and always has been, at the forefront of everything we do, and every decision made. Wales Air Ambulance has grown to be one of the most advanced air ambulance services in the world. Each development we have strived for, we have delivered. Thanks to your trust and support, we are saving more lives than ever. But we know we can do more.

In 2015, we became a consultant-led service. That means we now deliver the highest-level emergency department care at the scene of an incident. This includes the ability to undertake minor operations, administer anaesthesia and deliver blood transfusions. We are taking the hospital to the patient. Therefore, the ‘golden hour’ clock stops when we arrive on scene and not on arrival at hospital as it was previously – dramatically reducing the time it takes for patients to receive the lifesaving treatment they need.

Not only that, our ability to diagnose the often complex medical requirements of a patient means that we can take them directly to the medical facility that has the specialist care they need – reducing specialist treatment time even further. This improves the chances of survival and recovery.

We are the largest air ambulance charity in the UK, and arguably a world leader in terms of our advanced care. In addition to our four helicopters, we have added eight Rapid Response Vehicles to our fleet. This means that even when aircraft are grounded (for technical or weather-related reasons) we can still get our medics to patients to administer that lifesaving care.

Our existing base structure is rooted in historical logic and practice. Air Ambulances used to prefer airports as locations, but the sector has increasingly seen a shift towards purpose-built heliports/airbases which can better serve their communities. The change from “taking patients to hospital quickly to receive critical care” to our new model of getting critical care experts directly to patients has changed everything.

However, as our medical provision and transportation have become some of the most advanced offered by any air ambulance, some of our base infrastructure remains the same as when it was introduced over 15 years ago.

The question we asked ourselves as part of our recent strategic review was, are enough people benefiting from our services? As a result, we embarked on probably the most rigorous and ambitious piece of work attempted by an Air Ambulance, which was to see how we could best configure our operations to match most closely the needs of every county in Wales.

Our objectives are shared by our clinical partners, the Emergency Medical Retrieval and Transport Service (EMRTS Cymru), who provide our medics. EMRTS has been commissioned by NHS Wales to continually evaluate the service and identify opportunities for improvements – in particular, expanding equity of access to our advanced critical care. 

Together, Wales Air Ambulance and EMRTS aim to identify the most effective operational model for our lifesaving service.

 

Our Research Findings

To understand the current demand for our service and whether we are effectively meeting that demand, a large volume of mission data has been gathered from EMRTS databases, as well as from other NHS Wales sources. The analysis is one of the most comprehensive conducted by any air ambulance in the world. This was supplemented by the significant five-year service evaluation, published in March 2022

The analysis included looking at all those 999 calls where we might have attended but weren’t able to because we didn’t have resource available. This data, which was broken down into periods of time, geography and seasonality, has been fed into external analytics software that presented a series of projections based on a number of operational models, such as different medical shift patterns and base locations. 

The analysis revealed that the most effective operational models available with our current resources would allow us to attend approximately 583 additional lifesaving missions across Wales every year.

 

What is the most effective operational model identified by the research?

The results of the analysis are telling us that there are more effective locations for some of our resources and that we are not always working at the right times to meet patient needs. The answer that came up time and time again, by any method of analysis, was to co-locate the resources we currently have on the edges of the country (Caernarfon and Welshpool) and combine them at a single base location and, crucially, use those combined medical teams to provide an extended hours service more able to respond both by air and by road, with two helicopters and two road vehicles at their disposal. The data and analysis process is rigorous and solid.

 

What does this mean for Powys?

The analysis is telling us that for Powys:

• Wales Air Ambulance could attend up to 26 more missions in the county every year.
  
  
• The service can increase its responses in the county by 11%. This is the highest improvement increase per 1000 population of any county in Wales.
  
  
• Wales Air Ambulance could meet 85% of the demand for its service in the county (currently we are meeting 79%).

 

It’s important to point out that 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, through regular conversations and surveys with our supporters.s

 

How is the analysis coming to this conclusion?

We completely understand why people in Powys would see the headlines and ask questions as to how it was possible to deliver an improved service by moving away from the county.

However, it's a very complex analysis and when you add in the specifics of an air ambulance operation, it needs an extensive narrative to paint the full picture and for it to make sense. This is why we are keen to complete the analysis and then offer you a full overview of the data and what it means. As we had originally planned, we will do this in a public forum where we will present the information to you and answer your questions.

Some of our most senior medics, those who lead the way in critical care not just in the UK but globally, believe these analysis results are significant and could bring benefits across Wales. This is also the feeling of our Trustees based on the information that they have seen and it meets our key aim of delivering the best outcomes for patients and our communities. 

We will continue, as we always have done, to try to do the best thing for the people of Wales.

We represent all the communities of our nation and our mission duty is to try and find the right operational model to benefit everyone equitably and save more lives.  

Our message is clear and heartfelt - please trust us. We have always had your best interests as our primary motive. We would ensure that any changes that may be implemented are open to scrutiny and judgement, as is always the case. Every time we have introduced a change, that change has been based on evidence and we have delivered. Again, for those who may have concerns, we encourage you to please get in touch via [email protected].

We will endeavour to answer messages as quickly as possible but please bear in mind that we are a charitable organisation with limited resources.

Our only ask of you is that before you make a judgement, please allow us to share and explain the analysis and its finding in full, which we will do when the analysis is complete.

We fully understand and appreciate the strength of feeling and we encourage constructive questions, which we hope to answer in full very soon. However, we very kindly ask that this conversation is not personalised against individuals within the organisation. Please remember that we all want the same thing. The Charity is simply responding to findings that it has been presented with and, as part of the Trustees’ robust governance, is examining rigorously.

The analysis is indicating that we can save more lives, in Powys and across Wales. This is not something we can ignore and we must explore it further.

With very best wishes

Dave Gilbert, Chair of Trustees

Sue Barnes, Chief Executive