Petition Number: P-06-1274

Petition title: Stop the removal of the Rapid Response Vehicle for Monmouth

Text of petition: The Welsh Ambulance Service NHS Trust are considering cutting the Rapid Response Vehicle (RRV) based at Monmouth ambulance station, leaving just ONE ambulance for the area. This will result in an increase in response times. RRVs were introduced because they can reach critical, isolated, sick, and injured patients quickly, easing pain, suffering, and saving lives. This hasn't changed, and with an increasing population in the area, we need more resources not less.

The Census data for the area shows a year-on-year increase in population figures in the Monmouth Area.

Data under the Freedom of Information Act to find out how many times the RRV has been used each year has been requested, but we expect that it is in use daily based on community information. My own personal story is a family member suffered a spontaneous blood on the brain 3 years ago in Monmouth. The RRV was first on the scene, and there is no doubt that without it, they wouldn't be alive today.

In March 2012, Stuart Fletcher the then Chair of the Ambulance Trust said in a statement "I believe that they provide a very rapid response which allows immediate life saving first aid to be applied until the arrival of the ambulance."

With the recent downgrading of healthcare services in Monmouthshire such as the A&E services at Nevill Hall, Abergavenny now operating as a minor injuries unit only, we cannot allow any further deterioration of emergency resources in the area.


1.        Background

As part of a national roster review, there are plans in place that could result in two Rapid Response Vehicles (RRVs) being removed from Chepstow and Monmouth ambulance stations.

The letter from the Minister for Health and Social Services to the Chair of the Petitions Committee on 27 April 2022 provides the following information relating to the proposed reduction of RRVs.

The Welsh Ambulance Services NHS Trust (WAST) initiated a national roster review in April 2021. This followed the recommendations from an independent demand and capacity review, jointly commissioned with the Emergency Ambulance Services Committee, to inform future configuration of resources and staffing across Wales. The review highlighted a requirement to better match capacity to demand through a mix of additional recruitment and the delivery of a number of operational efficiencies, including a review of existing staff rosters.

The national roster review process is intended to improve the efficiency and effectiveness of rosters and ensure staff and resources are best placed geographically to deliver a responsive and equitable emergency ambulance service across all parts of Wales. It is seen as imperative to better manage the increasing demands experienced by ambulance services in Wales and align capacity to meet current and future demand as a fundamental part of planning and delivering a ‘modern, high performing service for the people of Wales’.

As part of the review, it has been recommended that the peak ambulance production (i.e. when it has most ambulances on duty) should be brought forward to align with the daily demand peak. There should be a change to the mix of ambulance resource, significantly reducing RRVs, which do not convey patients, and increasing emergency ambulances.

2.     Response to the proposals

A news article on Monmouthshire County Council’s website states that during the meeting of the full Council on 3 March 2022,  councillors ‘across the political landscape’, along with its leader Councillor Richard John, condemned WAST’s plans to remove the RRV’s from Monmouth and Chepstow ambulance stations as part of its national roster review. The Council meeting, along with the views of Councillors, was also covered by the South Wales Argus news website.

The Nation Cymru news website reported on 23 April 2022 that Councillor Richard John had recently held talks with the Chief Executive of WAST following concerns raised about the plans. The Councillor noted that although the meeting was constructive, he didn’t get the reassurances he was seeking specifically about ambulance provision at Monmouth and Chepstow stations. Councillor Richard John went on to say:

“Their justification for removing the rapid response vehicles from our stations is that there is a relatively low level of immediately life-threatening red calls and they consider money would be better spent on new emergency ambulances, which can, unlike the rapid response vehicle convey patients to hospital.

Across Gwent they have plans to recruit 53 additional ambulance staff and increase the number of vehicles, but crucially there is no commitment for these ambulances to be based in Monmouthshire. They will be based outside our county in the larger centres of population and available to travel into Monmouthshire when required.

I don’t think this is good enough given the significant travel times in a rural area.”

In the same article, the Chief Executive of WAST stated:

“The Wales-wide roster review is a complex piece of work, and while we accept there is some nervousness among communities about what this means for provision in their area, the goal ultimately is to ensure that our finite resources are aligned to demand.

This is not about reducing or downgrading services; it’s about working smarter with the resources we have to deliver a bespoke service to communities, based on the nature and number of calls the data tells us we historically receive in that community, as well as what we predict that demand will look like in the future”.

A South Wales Argus news article on 10 May 2022 reported that campaigners had received responses from Freedom of Information requests, which they say shows the review does not take into account local issues for Monmouth such as population growth, geographical terrain and the number of incidents attended by the rapid response vehicle which do not require a forward visit to hospital.

3.     Welsh Government response

The letter from the Minister for Health and Social Services to the Chair on 27 April 2022 explains that whilst the Minister has a role to set the strategic direction for health and care services in Wales and hold the NHS to account, ambulance resourcing is an operational matter and as such remains the responsibility of WAST. This is also in collaboration with local health boards and the Emergency Ambulance Services Committee, as the joint commissioners of ambulance services in Wales.

The Minister notes that WAST considers the shift from RRVs to emergency ambulances (EAs) to be a natural step forward as part of the clinical response model, introduced in 2015. The evidence shows that sending the right response, and early provision of definitive care, takes precedence over speed of response for the vast majority of incidents, particularly those outside the Red category and patients requiring direct conveyance to hospital.

RRVs are considered to be less productive than EAs on the basis that:

§    they carry less equipment,

§    the pool of incidents that they attend is smaller than EAs,

§    they often require back-up support from EAs to transport patients to hospital,

§    within the clinical model in operation in Wales, they do not provide a significant response time gain over EAs, and crucially

§    EAs can transport patients to the definitive care they need.

Specific stations may see a reduction in their planned resource following implementation of the new rosters, but the Minister states that this is set within the context of an enhanced position across an entire locality, health board and region. It is also intended that by re-setting emergency ambulance cover, the Trust will be able to reduce responses to calls “out of area” and improve overall availability.

The new rosters for all stations in Wales are being developed in partnership between WAST management teams and staff, facilitated by an external roster company. This work is ongoing and is being taken forward in partnership with staff, Trade Union colleagues and commissioners. The Minister expects the revised rosters to begin to be implemented in September 2022.

WAST’s Chief Executive recently issued a letter to stakeholders, which included a briefingon the review and what is likely to happen across Wales as the outcome of the roster review is implemented. The Chief Executive has also offered the opportunity for local elected representatives to meet with the Trust so they can be fully conversant with the facts and any local implications for their constituencies.

The Minister highlights that as part of its commitment to delivering safe and effective services, WAST will regularly assess the effectiveness of rosters moving forward, and update and adjust them in response to changing patterns of demand, changes to clinical and operating models, modernisation of the ambulance estate, patient needs and staff welfare.



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