Wales Air Ambulance Charity (WAAC) is a charitable organization dedicated to providing helicopter emergency medical services (HEMS) to Wales, a constituent country of the UK. Founded in 2001, WAAC now operates from four bases: in Caernarfon, Dafen, Welshpool, and the Welsh capital of Cardiff.

WAAC operates a fleet of four primary helicopters – previously, this comprised a set of three Airbus H145s and one Airbus H135, explained Dr Sue Barnes, WAAC’s Chief Executive. “The H135 [was] based at Dafen in southeast Wales, and the other three were at our bases in Welshpool, Cardiff, and Caernarfon,” she said. However, after changing aviation provider in January 2024 – from Babcock to Gama Aviation – this will become a unified fleet of four H145s.

Additionally, while under the previous contract, the operator held the leases of all four helicopters. This will change under the new arrangement: instead, WAAC will directly hold the leases for three of its aircraft – something that Barnes hopes will offer greater stability and continuity of services in future.

WAAC’s aviation provider also provides flight crew to accompany the helicopters as part of the arrangement. “We have agreements where we can’t influence appointments, because those are based on technical requirements,” said Barnes, “but it is very common for our aviation providers to ask us to have a chat with any potential recruits!”

Medical crew

While WAAC’s flight crew is provided by Gama Aviation, the charity’s medical crew are supplied by National Health Service Wales (NHS Wales), via an intermediary organization called the Emergency Medical Retrieval and Transfer Service (EMRTS).

We have regular ongoing discussions about our future strategy, and what operating hours we feel are the right ones to reach the most people in Wales

“The critical care paramedics (CCP) are on direct full-time contracts, and the consultants have their shift allocations as part of their job appointments,” Barnes explained.

WAAC’s partnership with EMRTS, and by extension with NHS Wales, is a close one. “In fact,” she added, “the EMRTS management team are co-located at our air base in Dafen, so we see them regularly!”

Barnes continued: “One hesitates to use the phrase because ‘collaboration’ is a bit of an overused buzzword, but it is a very collaborative process. We have regular ongoing discussions about our future strategy, and what operating hours we feel are the right ones to reach the most people in Wales.”

Introducing 24/7 air ambulance services

Other than the change of aviation supplier, one of the biggest changes to how WAAC operates services happened in 2020, when the service introduced 24/7 operations, which operate from the Cardiff base, in the south of Wales.

“Being a pan-Wales service, we felt that it was important to take the step to get night vision,” explained Barnes. “Obviously, with any new service, it takes a bit of time to bed in. We are very data driven, and we’ve spent a lot of time retrospectively looking over that period.”

She noted that while the vast majority of call-outs ‘drop off’ at around 02:00 hrs, the nature of Wales’s geography – a well-populated south, a more sparsely populated north, with challenging road connections to the north – mean that the night air ambulance service is vital. She acknowledged that there currently ‘isn’t a viable road response from Cardiff’ – something she said WAAC is looking to address. “If an incident was to happen somewhere else, they would be relying on an air response,” she concluded.

Barnes explained that Wales’s geography also poses different challenges to the provision of air ambulance services that would not apply in more urban environments.

“We have a relatively small population base, and what that means is that in order to maintain the kind of coverage that we have, we need more vehicles per population than our counterparts in more urban areas,” she said. “So we have quite a demanding set of requirements in terms of being able to cover the population – a relatively small population base of just over three million people.”

Cost of living and fundraising

As a charitable organization, WAAC is dependent on donations and other support from members of the public. Consequently, it might be assumed that in light of the ongoing cost of living crisis, WAAC could find it challenging to raise funds. However, Barnes states, ‘at the minute, we’re holding our own’.

One reason why we’ve been successful in terms of managing our finances is that we don’t rely too much on any one revenue stream

She explained: “One reason why we’ve been successful in terms of managing our finances is that we don’t rely too much on any one revenue stream – we have retail operations, we have a lottery, we have community fundraisers – and in that way we’ve been able to spread the risk.

“As you can imagine, it’s something that we keep a very close eye on,” Barnes continued, “because in situations like this … you have to be much more reactive and real-time in how things are changing.”

One particular challenge was the increased costs incurred due to the new aviation contract – with increased costs partially driven by the poor economic situation. “Our contract costs … have gone up about 30 per cent,” said Barnes. “So a service that was costing about £8.5 million, by the time you take everything into account, is going to be about £11 million.”

However, Barnes commented that ultimately ‘that is half-expected’. She explained: “Every time you come out of a long-term contract, you expect to see prices rise. It’s just unfortunate that factors outside of our control have contributed to that as well.”

Improving efficiency and looking to the future

In August 2022, WAAC published an efficiency analysis, which proposed a series of possible changes that it said could, if implemented, allow them to operate up to an additional 583 missions per year.

“The thing that was obvious quite early on is that there was quite significant unmet need across Wales,” Barnes said. “This is where the collaboration with EMRTS, and them being part of NHS Wales, means that they’ve got access to really good patient data. So we were able to analyze need at a very local level by hour, by day, by season, or by locality.”

By using this data, WAAC and EMRTS discovered that with our existing base locations and current patterns of operation, there was a significant amount of unmet need

Barnes said that by using this data, WAAC and EMRTS discovered that ‘with our existing base locations and current patterns of operation, there was a significant amount of unmet need’.

This aligned with the experiences of WAAC staff: “What we also knew at the start was that not all of our operations were equally busy – some of the utilization rates, particularly at Caernarfon and Welshpool, were quite low. Depending on how you measure it, only somewhere between 25 and 27 per cent of the time was actually spent doing patient-related work, and that includes travelling.”

A key proposal of the resulting analysis was to close the base in Welshpool – located in Powys, the rural center of Wales, and relocate its crew to a new location in the north – with the aim of serving a wider and more populous area.

Barnes explained that while the initial analysis produced valuable results, the process is still ongoing – with a public engagement process currently underway, alongside the re-analyzing and updating of the data to include additional features such as weather modeling. The new results will then be published again, prior to ‘more public engagement’.