Almost all ambulance trusts miss response target, NAO finds

26 Jan 17

Nine out of ten ambulance trusts in England failed to meet all three of their response time targets in 2015-16 amid rising demand for services, the National Audit Office has found.

Also, half a million ambulance hours were lost due to slow turnaround at A&E departments – the equivalent of 41,000 12-hour ambulance shifts.

In a review published today, the NAO concluded that ambulance services were struggling to cope with an increase in the number of elderly patients with multiple conditions, issues related to alcohol and mental health, and the availability of primary health services in the community.

Auditors noted that funding has not increased in line with this demand, and that future settlements were likely to be harsher. The situation was also leading to difficulties recruiting and retaining staff, they said. 

Several new care models have helped to allay pressures on the service, such as moves to try and resolve calls over the phone, and taking patients to non-hospital destinations. However, between 2009-10 and 2015-16, the number of ambulance calls and NHS 111 transfers increased from 7.9 million to 10.7 million. This represents an increase of 5.2% year on year.

English ambulance trusts have three national response time targets: Red 1 calls should result in emergency response arriving at a scene within eight minutes in 75% of cases (the clock starts as soon as the call is connected); Red 2 calls have the same requirement, except the clock starts up to 60 seconds after the call is connected. The third target – Green – are for non life-threatening cases and locally agreed targets are applied.

According to the NAO review, only 72.5% of Red 1 calls were responded to within eight minutes in 2015-16. Moreover, there was a difference of 10.4 percentage points between the best and worst-performing trusts in England on keeping to the Red 1 target.

Auditors reported widespread consensus that commissioners, regulators and providers place too much focus on response times. An internal assessment, the Ambulance Response Programme, is being conducted with a view to re-coding incidents.   

The NAO also found that 500,000 ambulance hours were lost in 2015-16 due to turnaround at A&E departments taking longer than half an hour. Transfer of patients is expected to take no longer than 15 minutes with the vehicle made ready again for the next incident in 15 minutes.

The fact that each ambulance trust has developed its own operating framework, with significant variations in the mix of vehicles, staff and estate, has further contributed to inefficiencies and variations in performance. As such, auditors noted significant differences in the speed with which ambulances responded to incidents between trusts.

Moreover, ambulance services are increasingly struggling to engage with the wider health sector, auditors found, due to the expanding range of stakeholders with which trusts are expected to work. Also, the wider system does not always make good use of the services’ experience or recognise how changes to other services can impact ambulances services.  

Commenting on the report, NAO head Amyas Morse said: “Ambulance services are a vital part of the health service but much of their ability to work better greatly depends on other parts of the health system.

“Until clinical commissioning groups see ambulance services as an integral part of that system it is difficult to see how they will become sustainable and secure consistent value for money across the country.”

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