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Update on Enhanced Road-Based Care Service Planned for Remote Rural and Coastal Parts of Wales

26 November 2025

Following the conclusion of legal proceedings in October 2025, the NHS Wales Joint Commissioning Committee (NWJCC) has confirmed that work will now resume on proposals for enhanced road-based care in remote and coastal parts of Wales…

In April 2024, the NWJCC approved six recommendations from the Emergency Medical Retrieval and Transfer Service (EMRTS) Review.

These included consolidating EMRTS bases at Welshpool and Caernarfon into a single North Wales site and exploring a bespoke road-based service for rural and remote areas (Recommendation 4).

A Task and Finish Group was established to develop Recommendation 4, involving EMRTS, the Welsh Ambulance Service, all Health Boards, and a regional representative from Llais. However, work was paused in March 2025 due to a Judicial Review challenging the NWJCC’s decision on base consolidation.

The High Court dismissed the claim in June 2025, and subsequent appeals were refused by both the trial judge and the Court of Appeal. On 15 October 2025, the Court of Appeal confirmed that none of the grounds for appeal were arguable and the case had no real prospect of success.

This means the courts have confirmed that the NWJCC acted lawfully and rationally in reaching its decision.

With the legal process complete, NWJCC and partners can now progress with implementation.

The NWJCC remains committed to Recommendation 4 with a renewed emphasis on aligning service proposals to current ambulance performance frameworks, system changes, and the NHS Wales context.

Recommendation 4 aimed to deliver a commissioning proposal for the establishment of bespoke road based enhanced and/or critical care services in rural and remote areas of Wales as part of the Welsh Ambulance Service NHS Trust. This proposal is entirely distinct from the air ambulance service and will be revisited in light of significant operational changes in ambulance service provision since April 2024, including:

  • Phase 1 and planned Phase 2 changes to the Ambulance Performance Framework
  • Major reductions in ambulance ‘lost hours’ due to hospital handovers of patients to emergency departments
  • Variability in performance across Wales
  • Financial sustainability challenges

Interim Chief Commissioner, Huw George, said:

“NWJCC's work on Recommendation 4 was paused during the Judicial Review and appeals, but will now resume, with a renewed focus on aligning service proposals to current ambulance performance frameworks, system changes, and NHS Wales context.

“Proposals will be considered alongside the development of the NWJCC Integrated Medium-Term Plan (IMTP) for 2026–29.”

“A clear plan and timeline will be considered by the Committee in early 2026, supported by transparent governance and appropriate stakeholder engagement.

Llais confirmed its advice and support to NWJCC on relevant stakeholder engagement for Recommendation 4.

NWJCC Chair, Ian Green OBE, added:

 “Now that the legal process is complete, we can focus on delivering the best possible emergency medical care for people across Wales.

“The Joint Committee confirms its ongoing commitment to Recommendation 4, which focuses on improving emergency medical response in rural areas; this commitment remains the same: safe, equitable care for all communities.

“The Committee will continue to receive progress updates on all workstreams from the Review’s recommendations through the usual governance routes.”

Details of upcoming meetings and committee papers are published on the NWJCC website: www.jcc.nhs.wales.