Decision on Wales Air Ambulance base closure delayed as judge reserves judgment

Mr Justice Turner said the arguments made by all legal teams required proper analysis before he would deliver a decision.

The three-day hearing at the County Court in Cardiff this week challenged the lawfulness of the NHS Wales Joint Commissioning Committee’s (JCC) decision to adopt recommendations which would see changes to the Emergency Medical Retrieval and Transfer Service (EMRTS), including the permanent closure of air ambulance bases in Welshpool and Caernarfon.

The judicial review claim has been brought by a resident of Bryncrug and has been backed by campaigners. 

The permanent closure of the Welshpool and Caernarfon Air Ambulance bases, announced last year, has faced widespread opposition from people across mid and north Wales.  

Campaigners argue that the reconfiguration will lead to slower response times for critical care in rural areas. 

The hearing on Friday resumed after two days of the claimant’s submissions last month, with Ms Fenella Morris acting as defence counsel for the NHS Wales Joint Commissioning Committee (JCC), a group made up of the seven health boards in Wales.

She said "every conceivable stone has been looked under" when investigating alternatives to closing Welshpool and Caernarfon’s bases.

Ms Morris said healthy debates took place where decision makers raised matters of concern; Llais, the public’s voice on health and social matters, was ‘tightly woven into the decision making process’ and Emergency Medical Retrieval and Transfer Service staff were consulted.

Responding to the claimants’ claims that a cost discrepancy for the selected option was never explained to or taken into account by the JCC nor provided to the public, Ms Morris said it was ‘highly likely that the decision-making would have been the same if there had been no error in the figures’.

Further, she said full information and costs only needed to be provided for preferred options and recommendation four was not such an option, as it was an additional bespoke service.

Ms Morris said: “This proposal does not involve the loss of a service, it just means it will take slightly longer. Obviously timing is important but for EMERTS patients clinical skill provision is more important than timing.

“The likelihood of a person in a rural area missing out on the service is ‘vanishingly small’."

She said the NHS heard and reflected on public concerns that ‘the air ambulance is a lifeline in rural areas’ and they devised recommendation four for the rapid response vehicles to assuage that fear and anxiety.

Ms Morris said the service had to balance national health needs with localised concerns and everyone that gets the air ambulance service now will still get it in the future - but they may have to wait a little longer.

“Reducing inequalities was key to the review, to reduce unmet need and improve health inequalities across Wales. There is an air of unreality about the claimants’ submissions,” said Ms Morris.

“The practical effect of quashing the decision and ordering a fresh consultation would increase yet more the costs of consultation and create a delay in providing the service change which is intended to meet the needs of the entire population of Wales and to turn back a change which has been welcomed by a significant group of the population.

“The importance of improving the service and of using NHS resources to their best, and not using more money for consultation when it could be used to provide health services, is uppermost.”

Mr Jonathan Moffe, counsel for Wales Air Ambulance charity, said: “If recommendation one is implemented, the air ambulance will get to more patients, particularly in mid and north Wales, and save more lives. If it is not there will be people that cannot be reached and lives will be lost.”

Mr Moffe said generally the charity did not interfere in the decision-making process but it became increasingly concerned about delays. He said there were calls to people not to donate to the charity and staff had been subject to abuse.

“The charity’s key concern was about saving lives and it was also concerned about protecting the charity and its ability to raise funds because they fund two thirds of its costs. The concern about generating funding is again a concern about providing the service that saves lives,” Mr Moffe said.

He said delaying the decision would have delayed preparatory work in establishing a new base and he said the charity is now coming very close to having to take irrevocable steps for preparing the new base and closing Welshpool and Caernarfon bases, which would be costly to reverse.

Mr Moffe said: “In essence, the delays cost lives.”

Ms Joanne Clements KC for the claimants responded to the defence’s claims, covering the timing of key decisions to close the base, that there were no statements in the documents from EMERTS staff although their mixed views of the proposals were broadly covered, there was not enough information about the bespoke rapid response service.

She said the defence’s claim that it was not available because it’s a service still being developed was irrational.

Ms Clements said: “The campaign group would be horrified that the consultation document is as flawed as it obviously was.”

She said the JCC had ‘rushed through the third consultation when it suited them but now they say a fresh consultation would take six to nine months'.

“They are months behind in deciding what recommendation four will consist of and they said they would not implement recommendation one, the closure of the bases and the move to Rhuddlan, until recommendation four was ready. They have said there will be a 12-week consultation on recommendation four anyway,” she added, saying any delays were down to the defendants themselves.