Gwent ambulance services 'among worst in Wales'

A claim by staff of a management culture based upon blame and bullying is among the factors contributing to poor performance highlighted in a highly critical report from the Assembly's audit committee.

The South East Wales region is described as the "most problematic" of the three Welsh Ambulance Services NHS Trust regions, which in addition to its own difficulties suffers from those afflicting the service as a whole.

Earlier this month the Argus highlighted two incidents in which young rugby players - James Pearce, 16, from New Panteg RFC, and Sam Allaway, who plays for Talywain under-13s - had to wait for 70 and 110 minutes respectively after ambulances were called. James suffered a broken back and Sam a fractured and dislocated knee.

Published ahead of trust chief executive Alan Murray's appearance before the Assembly's health, well-being and local government committee tomorrow, the report emphasises that progress has been made against the aims of the trust's Time To Make A Difference modernisation plan unveiled two years ago.

Its 29 pages are peppered with the words "disappointing" and "unacceptable" in relation to a number of problems including handover times for patients at the Royal Gwent Hospital, and poor response times in Monmouthshire.

Of the former the report says: "These delays are having a direct impact on performance in this region.

"We (the audit committee) were shocked by the apparent impact of problems at two major hospitals which we would have expected to be examples of best practice, the University Hospital of Wales, Cardiff, and the Royal Gwent Hospital, Newport, which between them accounted for the loss of 14,800 unit hours of ambulance cover between February 2007 and February 2008."

A lack of trust in managers, and poor communication, particularly in respect of the changes to the way services are run, are big contributors to low staff morale, says the report, resulting in some staff being "alienated" by the change process. Other issues highlighted in the report include:

• The slow pace of change, with over-ambitious modernisation plans having to be scaled down;
• Inefficient deployment of ambulances because of lack of control room technology to pinpoint precise ambulance locations;
• A huge repairs backlog to ambulance stations and lack of progress toward new methods of crew deployment.

Gwent worst performer

GWENT ambulances lost the most hours in Wales during April-July this year waiting to offload patients at hospitals.

Problems with handover and turnaround times at A&E departments, particularly in South East Wales, is highlighted in the audit committee report as a major hindrance in the battle to improve response times.

But the report says NHS trusts must work with the ambulance service and that the latter cannot be solely responsible for solving such problems.

"There is no excuse for the current problems at A&E units which cause long delays in ambulance staff handing over patients," states the report.

"The problem of excessive hospital handover and turnaround times is probably the most prominent example of poor interaction between unscheduled care services, to the detriment of the patient."

The handover times problems has been particularly acute at the Royal Gwent Hospital. In recent weeks Gwent Healthcare Trust has used a computer screening system in partnership with the ambulance trust, to provide more accurate data in relation to handover times.

"Where there have been delays at the "front" of the hospital, ie admission areas, it has been because of high numbers of very poorly patients presenting at the same time," said a Gwent trust spokseman.

"The difficulty is then that we cannot compromise the clinical assessment of patients, so this can cause delays.

"But the new system is giving much better information so that we do know that recent delays have not been due to any problems with handover but simply volume of patients at certain times."