Ambulances should treat more and transport fewer patients, NHS Improvement says

NHS ambulance trusts must do more to root out inefficiencies, improve assessment of 999 calls, and better equip crews to treat more patients at the scene of emergencies, a report from NHS Improvement has said.1

The report says that the 10 ambulance trusts in England could improve patient care and save £500m (€562m; $658m) a year by 2021—£300m by reducing avoidable transfers to emergency departments and £200m by improving infrastructure and staff productivity.

Trusts had too many old ambulances, the NHS’s highest sickness levels, low technology take-up, and unnecessary variations in performance, the report said. It made nine recommendations and called on NHS England to develop a five year plan by spring 2019 to reduce avoidable conveyances to emergency departments, which puts pressure on hospitals.

The report’s author, Patrick Carter, a non-executive director with the regulator, said, “Modern technology means that patients can often be treated at the scene. But an ageing ambulance fleet means that is not always possible.

Frontline and control centre staff would also benefit from a national set of evidence based clinical protocols, he said.

Carter ruled out creating a single national service, or smaller number of regional trusts, but he recommended moving to a common operating model with greater consistency in trusts’ response to the same types of calls.

He said productivity had been improving but demand was increasing rapidly, around 6% in recent years, and could rise 38% in the next 10 years.

Patients brought into hospital in an ambulance occupy around 40% of hospital beds in England at any one time and the proportion of patients seen by ambulance trusts conveyed to emergency departments ranged from 52% to 64%.

NHS Improvement said “avoidable conveyances,” when ambulance crews take patients who could be better managed at home to hospital, occur not because of poor decision making by ambulance crews, but because most paramedics could not access patient records while attending an incident, reducing their ability to make informed decisions.

Trusts with high numbers of GP led urgent care centres had the lowest transfer rates and conveyance rates for the least acute category 4 calls varied from 3% to 53%.

Reducing avoidable transfers of patients to emergency departments to 50% could save the NHS up to £300m a year by 2020-21, the report says.

Martin Flaherty, managing director of the Association of Ambulance Chief Executives, said, “While we accept there are variabilities in the numbers of patients conveyed to emergency departments in each region, this is often driven by local geography, patient demographics, and the availability of clinically appropriate referral pathways.”

The review also found “significant and increasing disparity” between trusts in the categorisation of calls, the model of care provided to patients, the length of time taken to resolve an incident, and the overall staff time this takes.

It found 32 types of double crewed ambulance in operation across the country and no standard list of what is carried on board.

Trusts have also yet to fully implement autodispatch software to speed up responses to call-outs, 12 years after it was first deployed.

Carter said up to 3300 new ambulances were needed over the next five years, which is more than currently planned. In June this year, the government announced £36.3m investment to fund 256 new ambulances. Trusts have already planned to purchase or lease 2600 vehicles over the next five years.