Integrating services to provide community-based care for 999 calls

Annette Davies, Community Resource Team Integrated Manager

Jeff Morris, WAST Operations Manager, ABMUHB area

Louise Thomas, Interim Acute Clinical Team Lead Nurse Practitioner

Dr Firdaus Adenwalla, Consultant Physician


Abertawe Bro Morgannwg University Health Board (ABMUHB) and Welsh Ambulance Services NHS Trust (WAST)


This Bevan Exemplar project gave a local Acute Clinical Team access to 999 calls, enabling them to provide community-based care instead of sending patients to A&E.


Requests for an emergency ambulance to Welsh Ambulance Services NHS Trust (WAST) are triaged through a robust system and are given a call status of either Red, Amber or Green. All calls are registered in a ‘Live Stack’ system, which are responded to in order of priority.

Although 999 calls are made by people as an emergency, evidence shows that only 4% of these calls are actually of Red status and do need a critical response.

The Acute Clinical Team (ACT) have been providing enhanced care in the community to residents of Neath Port Talbot since 2005, offering a safe alternative to unnecessary hospital admission.

Working collaboratively with WAST they created an innovative model to allow the ACT to access the ‘Live Stack’, ensuring governance and permissions were adhered to.


This model has allowed WAST to redirect 999 calls where patient management would be better suited to receiving community-based care from the ACT.

This was done via a two stage process where initially WAST control clinical desk contacted the ACT with suitable calls, which progressed to the ACT monitoring the ‘Live Stack’ and contacting WAST when they could see suitable calls that could effectively manage in the community.


Option 1 of the pilot was for the clinical desk to monitor the ‘Stack’ and identify suitable calls for ACT, but this was difficult due to the clinical desk capacity issues and the need to monitor the Trust wide ‘stack’.

To overcome this, the team moved to option 2 of the project which meant giving ACT access to the Live Stack so that they could identify suitable calls. The main challenge of option 2 was addressing the information governance arrangements between the two organisations.

The pilot project was undertaken with no extra resources for ACT, which resulted in the Stack not being viewed as often as hoped.


The pilot ran for a five-month period (October 2017 to March 2018). During that time 40 patient calls were taken off the stack by ACT.

Admission to an acute hospital was avoided in 92% (37/40) of the cases taken up by the ACT. None of these were admitted in the 28 days following discharge from the care of ACT.

Collaborative working between two organisations has resulted in trust and respect, enabling the implementation of truly prudent healthcare.

There was a significant cost and time saving to WAST by not transporting these 37 patients and needing to wait outside A&E.

Patient and carer satisfaction was high.

Next steps

  1. Complete the evaluation process.

2. Learn from the development process.

3. Continue with the collaborative relationships.

4. Present the evaluation internally to both organisations.

5. Showcase the pilot across Wales and beyond.

6. Lobby strategic bodies for further resources.

“It has been a developmental journey towards implementing prudent healthcare through building collaborative relationships which will improve patient care.”

Jeff Morris, WAST Operations Manager ABM

“From the minute the acute clinical team walk into my home I know that I’m in safe hands. They are so efficient, professional and very compassionate staff members, I can’t thank them enough.”

“Everyone was brilliant, I wish I had known about this service on previous illnesses, highly recommend the service.”

“The care and compassion the team gave me was incredible – it made me feel at ease and I knew I was in safe hands with these ladies. Words can’t describe how grateful I am that they kept me out of hospital. Thank you from the bottom of my heart.”


Did you know?

Staff reported that the whole experience enabled them to work dynamically and differently. They felt that they were able to offer the patient a choice: whether they were happy to be treated at home as a safe alternative to current practice.

Part of cohort Bevan Exemplar Projects 2017-18