Representatives from West Cornwall Healthwatch recently met representatives of NHS Kernow Clinical Commissioning Group (the NHS budget holder for Cornwall) to discuss concerns about the ambulance service.

The emergency 999 ambulance service and clinical response to 999 calls in Cornwall is provided by the South Western Ambulance Services NHS Foundation Trust (SWAST), which operates under contract across the whole Southwest, from the Isles of Scilly to Gloucestershire, Wiltshire and Dorset.

We have been hearing stories about long delays in ambulances occurring some significant time after a 999 call, and particular concerns over the impact that such a delay can have in the treatment of an elderly or frail patient. SWAST is required to meet target response times set by the Government, under a system which was updated in 2017. Under this system life-threatening events,  called “Category 1”, should receive an ambulance within 7 minutes. SWAST statistics show that on average, across the region, this target is effectively being met, and performance has improved compared to previous years – but one of our concerns is that the average may disguise problems which particularly affect some people in the more remote rural parts of West Cornwall. Also, it is possible that the focus on hitting the target for “Category 1” cases may have the effect of increasing waiting times for Categories 2-4, “emergency”, “urgent” and “non-urgent” cases. Given the limited resources which are available, ambulances can be some distance away from a particular patient, having been deployed to another area.

Our discussions with KCCG were reassuring in the sense that both they and SWAST are alert to the issues and are monitoring performance carefully. We understand that for June 2019 all Cornwall performance for Category 1 is now 8 minutes and 6 seconds (we don’t know what the figure is for West Cornwall) against the standard of 7 minutes, so there is evidence that more needs to be done to meet the situation of the more rural population - however this is against a backdrop of over 12 minutes when then programme first came in, so significant strides have been made, and will continue to improve as the new recruitment takes effect over the next two years. A total of 63 ambulances are based in Cornwall, an in addition Rapid Response Vehicles are used. We understand that some of the ambulances are new, narrow vehicles specifically chosen for areas with restricted access.

As well looking at the ambulance service itself, we need to know more about how the “triage” system operating through 111 and 999 calls is actually working in West Cornwall, as operators have to decide how to prioritise the individual cases. Also we see that this is a complex network of provision the work of “First Responders” and the “Out of Hours” service is very important. We wonder if the idea of “Community First Responders” – trained local volunteers who can be on call to respond to local emergency calls and provide life saving first aid in those vital minutes before an ambulance arrives – may have to become a more significant part of the local scene.

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