The Professionals: Service can only deal with challenges if it has level playing field

Jul 7 2008 by Mike Ponton, Western Mail

THE Welsh Ambulance Service Trust has been in the public eye a lot lately, with the focus rather more on the negative than the positive.

The phrase “chwarae teg” comes to mind – are we being fair?

Since the current chief executive Alan Murray was appointed, real progress has been made.

After years of annual reductions, in 2007/08, ambulances reached 7,500 more patients with life- threatening emergencies within the eight-minute target than the previous year.

These improvements are happening across the whole of Wales – the trust has improved performance in all 22 LHB areas. When the new management team first started, only four LHB areas met the standard – now it is 15.

The Welsh Ambulance Service Trust is currently demonstrating both leadership and direction in trying to radically change the way ambulance services are delivered in Wales.

It has already made huge strides and is continuing to make real improvements for the patients it serves.

Ambulance staff have been under pressure for some time – the trust had three chief executives in the space of four months, less than two years ago.

Add the further pressure of large-scale modernisation plans, and it is inevitable that the morale of employees, both staff and management, is suffering.

As playwright Arnold Bennett once said: “Any change, even a change for the better, is always accompanied by drawbacks and discomforts.”

But is the trust being given a level playing field on which to face these challenges? It is a favourite game of pundits and politicians to try to compare the trust’s performance with that of English trusts.

However, it is important to understand that targets in Wales are unique to the Welsh Ambulance Service, and they are extremely challenging given the demographic, financial and systemic problems it is facing.

The trust fully supports the principle of high standards across Wales – Welsh citizens deserve high-quality services and good response times, wherever they live – but we have to accept it is more difficult to reach emergencies in some areas such as rural communities than in more populated and accessible areas.

Even more surprising then is that the Welsh Ambulance Service is also the only one in the UK without sophisticated vehicle location technology – a system that shows the exact position of all crews automatically.

The trust has applied for the funding for this crucial equipment, but is currently still waiting for a response from the Assembly Government.

In addition to this, the trust has one of the largest efficiency programmes of any NHS Trust in Wales. Last year, it had to save more than £12m; this year, the trust is on target to save £17m, against a turnover of £136m.

To be able to achieve this level of savings and improve performance at the same time is a remarkable feat and shows the skill and dedication of all trust staff – whether it be the chief executive, middle managers, frontline or backroom staff.

The trust is the first to admit that it is not satisfied with the improvements made so far, and it is determined to continue working until it has reached the point where it wants to be.

Change always takes time, especially after a period of organisational turmoil. It was always going to be a long-term process for the ambulance service to get to the level of service that we all want and expect.

As the recent Audit Office report said, the trust is precisely where it would expect to be at this stage of a huge change programme.

Management and organisational stability is crucial at times like these.

What the ambulance trust needs now is support from the Government – whether it is through additional resources such as those needed for the vehicle location system, or through the space and time it needs to reach the very challenging targets it has been set.

It will take much more work and investment to resolve fully the trust’s legacy of problems from the past. Stability is key and the last thing the trust needs is changes to its management structure, which is doing an excellent job in improving services in very difficult circumstances. Chwarae teg.

Mike Ponton is director of the Welsh NHS Confederation