Rethinking urgent care access in Wales

Jonny Sammut, Director of Digital Services at Welsh Ambulance Services University NHS Trust, explores the role of digital tools in urgent care and how they can enhance clinical decision-making and efficiency

The NHS in Wales is under sustained pressure, and accessing urgent care is becoming more difficult. Patient demand is rising, and while much of the conversation focuses on capacity, there’s a more fundamental question we need to answer: how do people access urgent and emergency care in the first place?

At the Welsh Ambulance Service, we believe the future lies in a more connected and intelligent approach to access, one that understands need, supports choice, and helps people get to the right care.

Why digital support is needed in urgent care

Urgent and emergency care has traditionally been organised around services: 999, 111, emergency departments, rather than around people and what they are actually trying to do. The result is a system that often relies on individuals navigating complexity at the point they are least able to do so. Digital gives us an opportunity to shift that, but only if we approach it differently.

Our work with NHS 111 Wales online has been a deliberate place to start. It is high-volume and high-impact, operating across multiple channels, which gave us a way to test how digital and AI could support and augment, but not replace, existing pathways.

We introduced a virtual assistant, ‘Albot’, not as a clinical decision-maker, but as a guide to trusted, clinically assured health advice and information. From the outset, we were clear about what it would and would not do. It does not diagnose. It does not replace clinicians. It provides structured support, with clear escalation to human services where needed.

Just as importantly, each step was controlled, clinically assured, and reviewed. Every interaction gave us something back, not just about the technology, but about how people seek help and where the system needs to improve.

That approach reflects the culture we are building within our digital teams. We often talk about ‘being more pirate’, not to promote recklessness, but to create space for curiosity, challenge, and progress. It means empowering people to try, test, and learn quickly, while working within clear boundaries and prioritising safety. In healthcare, that balance matters. Innovation cannot come at the expense of governance, but equally, governance cannot become a reason not to move.

What we are seeing so far is encouraging, but more importantly, organic. The service now supports thousands of conversations each month, without promotion or forcing people down a particular route. That matters. When something is useful, safe, and easy to use, people will choose it.

So, what have we learned so far? We are not trying to push people away from calling 111; we are creating more ways to access health advice, so people can get the right care in the way that works best for them, while protecting clinical capacity for those who need it most. The opportunity, however, is much bigger than a single tool.

So, where does this need to go next? The direction of travel is towards a system that meets people where they are, not where the system expects them to be, one that understands intent, brings together information, triage and pathways, and balances demand across services.

In practice, it means moving beyond static websites: better symptom checkers aligned to clinical pathways and a more seamless experience across channels, from self-service to webchat to phone.

Digital tools must support, not replace

Digital does not save lives. People do. But the right digital, in the right hands, at the right moment can make a real difference. Artificial intelligence will play a role in this, particularly around triage and navigation. Its value will not come from replacing clinical judgement, but from supporting it, helping people explain what is going on, spotting risk earlier, and ensuring a stronger starting point for clinicians.

Done well, it should also make the day job better. Tools like ambient listening and AI-supported scribing can reduce the administrative load, giving clinicians and call handlers more time to focus on the person in front of them. Alongside this, we are exploring emerging capabilities such as Automated External Defibrillator drone delivery and advanced automation, not as standalone innovations, but as part of a broader system response. For us, that means AI does not learn unchecked. Changes are deliberate, evidence-led, and clinically reviewed. It also means being clear about what digital can and cannot do, and recognising that this is not a one-off transformation; it is ongoing.

If we are serious about changing how urgent and emergency care works, we need to do it together. That means better data sharing across organisational boundaries, so people are not asked to repeat their story, creating space for safe innovation and continuing to professionalise our digital and data workforce, recognising this as a core part of care delivery. The opportunity is there, but it will only be realised if we are prepared to work differently, together. If we continue to design urgent care around organisational boundaries rather than human intent, no amount of extra capacity will be enough.