Mr. Robert Morton:

I thank the Deputy for the question. Absolutely, it is probably the single biggest clinical risk we face at the moment. Working closely with all of our colleagues across the acute hospital sector we collectively realise the implications of offload delays and the clinical risk this presents, which is the patient lying on the ground waiting for an ambulance because it is parked at a hospital somewhere. The solutions are complex. Some of it is down to capacity in the hospitals and in the ambulance service. We are focused on working with our acute hospital colleagues to try to streamline the process of handing over patients, and looking at measures we can take in extremis. Part of that is how we prepare for the forthcoming winter period. For example, Professor O'Donnell is involved in a high-level group along with other clinicians looking at what are some of the process solutions we can put in place. From our perspective, we are looking at measures around improving the local escalation arrangements between local National Ambulance Service, NAS, managers and local hospital managers. We are looking at models such as fit to sit, where we must take a deep look at ourselves and ask ourselves whether every patient who attends an emergency department needs to go in on a stretcher or are some patients clinically suitable to sit in a chair, which would release the ambulance to get out back out to another patient. We are also looking at cohort arrangements whereby we can have one crew looking after more than one patient, to release another ambulance. These are the kind of in extremismeasures we need to look at as part of our own contingency planning. It is very high on our radar but the solution will not lie in the acute hospital or the National Ambulance Service looking at it in isolation. We must look at it together.