Vital role of ambulance services recognised in Parliament scrutiny report

A new report has found that in 2015-16, the equivalent of 41,000 12-hour ambulance shifts were lost nationally due to handover delays at hospital.

The National Audit Office (NAO), which scrutinises public spending for Parliament, published the NHS Ambulance Services report last week (26^th January). It highlights the significant challenges and pressures facing NHS ambulance services like ourselves, while recognising the vital and growing part we play within the wider health and social care system.

The Association of Ambulance Chief Executives (AACE) has welcomed the report, saying that it has helped highlight ‘several key issues’, including how:

• demand for ambulance services continues to rise rapidly with no sign of slowing: between 2009-10 and 2015-16, the number of ambulance calls and NHS 111 transfers increased from 7.9 million to 10.7 million, an average year-on-year increase of 5.2%

• increased funding for ambulance services has not matched rising demand: between 2011-12 and 2015-16, income for ambulance trusts’ urgent and emergency care activity increased by 16% from £1.53 billion to £1.78 billion, but, over the same period activity rose by 30%

• workforce planning issues and a lack of paramedics are contributing towards limiting the ambulance service’s ability to meet rising demand: in 2015, ambulance trusts had a paramedic vacancy rate of 10%, and most trusts are struggling to recruit the staff they need

• hospital handover delays are contributing heavily to keeping crews off the road where they are needed most: in 2015-16, approximately 500,000 ambulance hours were lost due to turnaround at accident and emergency departments taking more than 30 minutes

• response time targets are not the only factors that should be considered when assessing ambulance service performance – far more important are clinical outcomes and quality of care, which have been shown to improve despite increasing activity: nationally, outcomes for patients have improved for five of the eight outcomes measured (for example, the percentage of cardiac arrest patients who had a return of spontaneous circulation on arrival at hospital following treatment from the ambulance service).

The report concludes that: “Ambulance services are finding it increasingly difficult to cope with rising demand for urgent and emergency services. Introducing new models of care has helped but there are signs of stress, including worsening performance against response time targets.

“Ambulance services are a vital part of the health service but much of their ability to work better 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.”

Managing Director for AACE, Martin Flaherty OBE said: “Changes in the way ambulance services are commissioned and operate, to transform the delivery of out-of-hospital urgent care, are essential if our ever-increasing numbers of patients are to receive the right care, in the right place, at the right time – the fundamental aims of the Five Year Forward View and the Urgent and Emergency Care Review. Such changes and aspirations are being embraced and attempted by the sector, but they cannot be achieved in isolation, without the tangible support of NHS England, NHS Improvement, commissioning bodies and colleagues in other sectors.”

Read the full report on the National Audit Office website.

 Published 2nd February, 2017