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Medics say 999 calls 'coded incorrectly to hit new targets'

The way ambulances are despatched to emergencies in Wales is leading to more suffering and loss of life compared to the old system - that's the view of some paramedics.

Credit: PA

ITV Wales has been approached by a number of paramedics all expressing their concerns that the new response framework for ambulances - which changed in October 2015 - is failing patients.

Before October 2015, ambulances in Wales had to get to all 999 calls within eight minutes, 65% of the time. But that target was being missed. A new system where calls were given a red, amber or green code was introduced. Under this system, only red 'life threatening' calls have a target time of eight minutes.

This meant a significant reduction in the number of time-targeted calls. In 2016-17, according to Stats Wales, just over 290,000 calls were coded as amber, 20,000 were red. Since the system change, the target has been hit.

Speaking anonymously, the paramedics say they believe that pressure on staff to hit targets is leading to emergency calls being coded incorrectly. For example, they say that if an ambulance is close to an incident, it will get a red code, because it's known the ambulance will get there within the target time.

Somebody could be drunk in a bar and they're given a red call knowing that we could get there within the eight minutes to achieve the target. Whereas outside the city centre, that call could be coded as an amber 1, even a green. So they could stay there for [any] amount of time.

– Paramedic

When asked to clarify this assertion that drunk people in the city centre are being given red categorisation to hit targets, the paramedic said, "yes."

He added: "There's an alarming amount of people who are pressurised at the first point of contact from that treble nine call to downgrade calls and yet there's others who are pressurised to upgrade calls because it is all target driven. The only people who are suffering are the people of Wales."

Another paramedic, echoed this view. He said: "The focus obviously from the control room staff is to hit the targets. However, they're not working in a banking sector or an insurance company. These are real people, they have often serious illness or injuries and the way these calls are dealt with can have serious impacts on their outcome."

Responding to these concerns, the Health Secretary, Vaughan Gething said that he understands the model is not perfect and that he is always interested in making the system better.

I'm always interested in the concerns of what staff have to say. But I do meet representatives of paramedics, I meet the three trade unions regularly, I also meet ambulance staff on the front line.

If there are real concerns about things that are being done in a way that does not look honest and does not look right, as I say, I want to understand what they are, they'll be investigated, and they'll be taken seriously.

– Vaughan Gething, Health Secretary

The Welsh Ambulance Service says it "takes all issues raised by our staff seriously and are naturally concerned by the comments made."

We must be absolutely clear that our response times are not being manipulated in order to meet targets.

We scrutinise the integrity of our data regularly, at the end of each call, each shift, each day and each month and there is no evidence to support the allegations that have been made.

The priority of a call is not determined by the Trust but rather by the information given by the caller in response to a set of scripted questions, which is then triaged by our automated Medical Priority Dispatch system.

There are only two occasions where the priority of a call will be changed; when new information from the caller is assessed via the MPDS system, or where a nurse or paramedic has gathered further information about the patient’s condition over the phone.

In these instances calls are both upgraded and downgraded based on the clinical needs of the patient. This allows us to send resources to the sickest patient first.

We have provided regular opportunities for staff to provide honest feedback about how the model is working in practice, but if any of our colleagues have concerns or would like to understand more about this then I would encourage them to come forward.

– Richard Lee, the Welsh Ambulance Service’s Director of Operations

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