Millions of wasted ambulance journeys made to hit targets

9 Jun 11
Government targets have resulted in 'skewed approaches' being taken by the ambulance service in England for more than a decade, auditors say today.

By Richard Johnstone | 10 June 2011

Government targets have resulted in ‘skewed approaches’ being taken by the ambulance service in England for more than a decade, auditors say today.


A National Audit Office report concludes that the service is not providing value for money. It says that ambulance trusts often send more vehicles than necessary to incidents to meet the eight-minute emergency response time set by the previous government for the most seriously ill patients. This resulted in millions of unnecessary ambulance journeys until it was revised this year.

The NAO also finds that ambulances have been forced to queue at hospitals due to delays in patients being moved inside. This reduced their ability to respond to other calls.

Today’s report, Transforming NHS ambulance services, states that although the ambulance service enjoys a high level of public satisfaction, it has not provided value for money due to wide variations in efficiency between England’s ambulance trusts. For example, the cost to a trust of attending an incident varies from as low as £176 to £251.

The ambulance service has to make a minimum of 4% efficiency savings by the end of 2014/15, around £75m per year. The report finds that £165m could be saved annually if inefficiencies were eradicated.

NAO head Amyas Morse said: ‘The time taken to respond to calls has until recently been the be-all and end-all of measuring the performance of ambulance services. Illustrating the principle that what gets measured gets done, the result has been a rapid response to urgent and emergency calls.

‘However, this led to an increase in the number of multiple responses to incidents, equating to millions of unnecessary ambulance journeys.’

Jo Webber, the NHS Confederation’s Ambulance Service Network director, said that ambulance services recognised that the variation in costs highlighed by the NAO needed to be addressed.

She said: ‘Getting this right will require co-ordination across different parts of the NHS from community walk-in centres to large “hyper acute” stroke and trauma centres. New services such as the NHS 111 number are already showing promise to link up services and improve care for patients.’

In April 2011 the eight-minute target was modified to include a set of clinical quality indicators, and a 19-minute target for non life-threatening incidents was scrapped. Morse said it was ‘welcome’ that the Department of Health had introduced a broader performance regime.

The NAO also highlights the potential impact of the health service changes being proposed by the government, warning that as the NHS moves towards GP-led commissioning,  accumulated knowledge could be lost.

Public Accounts Committee chair Margaret Hodge said: ‘Will it be more difficult to deliver the required efficiency savings under the new NHS structure?

‘We will want to understand how a reconfigured NHS will be able to secure economies of scale and incentivise greater co-operation between trusts.’

The PAC will be following up the NAO’s findings in an inquiry of its own.

Health minister Simon Burns argued the report endorsed the government’s move to focus on patient outcomes rather than targets.

Confirming that the government would examine all the NAO's recommendations, he said: ‘This report is clear evidence that Labour’s perverse fixation with bureaucratic targets distorted clinical priorities and undermined patient care. During their 13 years in power, Labour never bothered to consider the outcomes of NHS treatment for patients – instead, they left the NHS with a bloated bureaucracy and doctors and nurses tied up in red tape.’


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