"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.
"It is welcome that the Department has now introduced
new measures and a new broader performance regime but improvements
to the whole urgent and emergency care system will depend on its
working more coherently."
Amyas Morse, head of the National Audit Office, 10
June 2011
The Department of Health has until recently been focusing on
speed of response as a measure of performance of the ambulance
service, rather than on clinical outcomes for patients, the
National Audit Office reports today. The ambulance service achieves
high levels of public satisfaction but there are wide variations in
ambulance trusts’ efficiency and the NAO concludes that the system
has not delivered the best value for money to date.
Over the last ten years, until the beginning of April 2011, the
Department has focused on response time targets, rather than taking
a more rounded view of whether cost-effective clinical outcomes
have been achieved. The 8-minute response target, intended for the
most seriously ill patients, is one of the most demanding in the
world. However, without more direct measures of patient outcomes,
its application has skewed ambulance trusts’ approach to
performance measurement and management. This has led to such
practices as sending more vehicles than necessary to meet the
target, leaving extra vehicles to be stood down. The target is also
applied to a much wider group of patients than intended.
The report identifies various inefficiencies in the system. For
example, the cost per incident varies between trusts: from £176 to
£251. There is scope across the urgent and emergency care system to
make more of different ways of responding to patients, such as
clinical advice to callers over the phone and taking patients to
minor injuries units rather than A&E departments. The NAO
estimates that if all 11 trusts adopted the best practice currently
being used in at least one trust, this could save the NHS £165
million a year.
The elements of the emergency care system are not yet fully
integrated and this leads to delays in turnaround times at hospital
A&Es. Over one-fifth of patient handovers take longer than the
recommended 15 minutes. This can lead to ambulances having to queue
outside hospitals, reducing their availability to respond to other
calls.
Improving ambulance trusts’ performance has been hampered by a
lack of data on patient outcomes and a lack of comparative
information that can be used to benchmark performance. The new
clinical quality indicators introduced from April offer the
potential for a fuller measurement of performance based on
outcomes.
Publication details:
HC: 1086, 2010-2012
ISBN: 9780102969719