The Inquiry found that the Trust has consistently failed to achieve response time targets which are less ambitious than those in England. It has also failed to provide adequate response time performance across Wales, with significant regional variations. Compliance with response time performance targets was found to be highest in north Wales and lowest in south-east Wales.

Other problems identified include a longstanding absence of strategic direction; weaknesses in internal governance at board level; weak leadership and problems of management capacity. Also, although overall staff and revenue resources appear adequate, the supply of ambulance and patient care services does not adequately match peaks of demand, particularly because of inflexible shift patterns and deployment.

There is also evidence of weak systems and infrastructure which suggests that further capital investment is required. For example, the Trust’s fleet of ambulances is inadequate, partly because of problems arising from the procurement of 46 ambulances that were not fully fit for purpose. The trust has also not invested in key ICT systems such as satellite navigation, automatic vehicle location software and other systems. 

Despite all this, the report points to some key strengths of the service. With the required capital investment and improved processes it has adequate people and revenue for day to day operations; it is supported by significant public goodwill and possesses highly-skilled frontline staff. Other ambulance services in Britain have been in a similar position and have been able to turn the position around over time. This leads the Auditor General to conclude that the Welsh Ambulance Service has the potential to do the same if it addresses a series of key internal and external challenges raised in this report.

The report contains 28 recommendations for improvement that cover the key weaknesses identified and will help the Trust to address the key challenges it faces. The report also contains an appendix in which the Trust sets out how its modernisation plan addresses each of the Auditor General’s recommendations.

Auditor General for Wales, Jeremy Colman, said today:
“My Inquiry has confirmed that there are longstanding problems in all areas of ambulance services in Wales. It will take time to deliver sustained improvement but I am hopeful that the service can turn itself around as long as it addresses key challenges. For that reason, I am able to reach an optimistic conclusion about the ultimate prospects for the success of the ambulance service in meeting the needs of the people it serves.”

Notes to Editors:
• In July 2006, following public concern about the Welsh Ambulance Services NHS Trust, the National Assembly invited Jeremy Colman, Auditor General for Wales, to lead an inquiry into ambulance services in Wales.

• The Inquiry sought to confirm the nature and extent of the perceived problems with the ambulance service. The inquiry also focused strongly on the future and the plans being developed by the new Chief Executive to improve ambulance services for the people of Wales.

• The Inquiry team worked closely with, and drew upon the initial findings of colleagues from Healthcare Inspectorate Wales, who undertook a review of clinical governance, patient care services and specific investigative work to assess the claim that 500 lives are avoidably lost because of the way the service operates. The 500 lives claim is still being tested by HIW who will report separately on their findings in due course.

• This report took evidence from a wide range of people and organisations. Information was obtained in a variety of ways including public hearings, interviews, focus groups surveys and on-site visits.

• The Welsh Ambulance Services NHS Trust (the Trust) was set up in 1998 through the merger of five predecessor ambulance services. The Trust employs nearly 2,500 staff and had an annual turnover of £115 million in 2005/2006.

• The Wales Audit Office is independent of government and is responsible for the annual audit of some £19 billion of annual public expenditure. Its mission is to promote improvement, so that people in Wales benefit from accountable, well-managed public services that offer the best possible value for money. It is also committed to identify and spreading good practice across the Welsh public sector.

• The Wales Audit Office was created in April 2005 through the Public Audit (Wales) Act, 2004, which expanded the functions of the Auditor General for Wales and enabled the transfer of staffs from the Audit Commission in Wales and National Audit Office in Wales to his employment.

For more information please contact Rachel Harries on 02920 262 675 or email rachel.harries@wao.gov.uk