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The Scottish Ambulance Service: A Service for Life

Sir John Bourn, the head of the National Audit Office, reported to the Scottish Parliament today that there is scope to improve the responsiveness of accident and emergency ambulance services in Scotland and the impact they have on the healthcare of patients.

The Scottish Ambulance Service are responsible for ambulance services across Scotland. Their emergency services provide pre-hospital clinical care, in some cases advanced life support, whilst transporting patients to hospital.

The National Audit Office examined the speed and responsiveness of the emergency ambulance service, their economic and efficient use of resources and their provision of effective pre-hospital emergency healthcare.

The National Audit Office found that:

  • there is a wide range of response time performance across Scotland, though in most areas Scotland compares favourably with elsewhere in Britain. Nevertheless ambulances miss response time targets not only in the more remote, sparsely populated areas of Scotland, where ambulance stations are necessarily fewer, but also in busy populous areas such as Glasgow and Lothian;
  • ambulance response times for the most seriously ill patients are not significantly better than those for other patients which raises important questions about how quickly ambulances should respond to patients’ varying needs;
  • the greatest scope for improvement in response times is in Glasgow where ambulance crews are already amongst the busiest of any ambulance service in Britain. Only about one in three Glasgow ambulances reach the scene of a 999 incident within seven minutes, against a target of one in two;
  • the costs of the Ambulance Service have risen as they have dealt with an increasing volume of incidents. However, unit costs are static and in line with other ambulance services. In the last five years emergency ambulance responses have grown 15 per cent across Scotland, including 28 per cent more 999 calls;
  • there is scope for the Service to manage more systematically the complex balance between demand, responsiveness and ambulance resources. Emergency ambulance operations need to respond to incidents by matching ambulance resources to varying and difficult to predict demand levels. It is not simply a question of increasing resources to improve responsiveness; and
  • ambulance crews provide professional quality of service and are the first link in the NHS’s chain of patient care. The Service could do more to monitor clinical quality and participate in formal clinical audit to provide sound evidence that patient care procedures are as effective as possible.

The National Audit Office considers that the Service should take the lead in involving their health partners in necessary decisions regarding the ambulance service and recommends that:

  • the Service should improve how they address the clinical and health issues underlying their work. In this crucial area the Service need clearer objectives to direct their work to the greatest possible healthcare impact;
  • the Service and the Scottish Executive should act urgently to consider whether and how far to introduce ambulance deployment systems which give greater priority to life threatening emergencies. The Service are not achieving all response time targets. Deploying emergency ambulances according to the urgency of calls could improve response times to the more seriously ill patients and help save more lives, but would present complex challenges;
  • the Service should target improved responsiveness to provide the greatest benefit and impact. In order to maximise their impact the Service should set goals and targets that correspond to real and specific needs that they should aim to satisfy through improved responsiveness;
  • the Service should improve the planning and deployment of operational ambulance resources. The Service should review existing practice regarding the disposition and deployment of emergency ambulances and review the existing eight separate control centres; and
  • the Service and the Scottish Executive should set and monitor new performance measures to focus the development of the Service including resource efficiency and healthcare impact. New performance measures could be helpful to indicate the Service’s contribution to healthcare improvements, for response times for vehicle and crew deployment and productivity and for control room performance.

Notes for Editors

The Scottish Ambulance Service cost some £86 million in 1998-99. The accident and emergency service represent nearly four-fifths of the Service's total costs (£67 million) and some 1,720 front line staff and 451 emergency ambulances. 487,000 emergency and urgent ambulance responses were made in 1998-1999.

999 ambulance response time targets measure the proportion of ambulances getting to incidents within specified times from receipt of a 999 call. Different targets apply to different parts of Scotland dependent on population density. In urban areas like Glasgow and Edinburgh the targets are: 50 per cent of ambulances should arrive within 7 minutes, 95 per cent within 14 minutes.

The Comptroller and Auditor General, Sir John Bourn, is the head of the National Audit Office employing some 750 staff. He and the NAO are totally independent of Government. He certifies the accounts of all Government departments and a wide range of other public sector bodies; and he has statutory authority to report to Parliament on the economy, efficiency and effectiveness with which departments and other bodies have used their resources.

Future auditing arrangements in Scotland will be changing following the Scotland Act 1998. The Act provides for the appointment of an Auditor General for Scotland who will become responsible for financial and value for money audits across much of the public sector in Scotland, and reporting the results to the Scottish Parliament. This report has been prepared and presented to the Scottish Parliament under arrangements for the transitional financial year for the Scottish Parliament ending 31 March 2000.

PN: 72/99