Westminster Column - Improving ambulance response

21st July 2017

Last month marked the 80th anniversary of the introduction of the 999 emergency telephone number. When the 999 emergency service was launched, ambulances were little more than vehicles transporting patients to hospitals, often staffed by volunteers. Now they are almost 'mobile hospitals'. Nearly half of all emergency ambulance calls today are resolved by paramedics, rather than taking a patient to hospital.

Given the improved skills of today's crews, especially in Shropshire where every ambulance has a trained paramedic, the way in which ambulances are dispatched and patients triaged has not kept pace. So last week NHS England took forward steps nationally to ensure ambulance services continue to adapt to the needs of patients.

Currently half of all emergency calls nationally are deemed 'urgent' and have a corresponding response time, while the other 50% are deemed non urgent and have no national response target. When an emergency responder is dispatched, the clock against which their response time is measured is stopped by the arrival of the first vehicle - but not necessarily the first vehicle the patient needs. This can mean a stroke victim being attended by a first responder or a paramedic on a motorbike - bikes often being first on the scene, but unable to transport them anywhere.

It is also the case that too often multiple vehicles are dispatched to the same incident in a race to 'stop the clock' - clearly wasteful and illogical. Correcting this anachronism is expected nationally to free up to 15,000 ambulance responses every week.

These concerns are not new, so over the past 18 months West Midlands and two other ambulance services have been testing a new operating model and new set of targets on over 14 million calls. The new system would give staff slightly more time to identify patients' needs, other than for the most urgent cases, and introduce a new response target for non-urgent cases. It will also ensure that only doing the right thing for the patient "stops the clock" on a response time.

So far the results have been impressive, including improving early recognition of life-threatening conditions; increasing those patients who receive an immediate ambulance response, rather than joining a queue; and reducing the time difference between responses to patients in rural areas like South Shropshire and urban areas.

Given the success of the tests, this new system will now be rolled out across the country. I met the Chief Executive of WMAS on Monday to discuss what these changes mean for Shropshire.

The changes have been welcomed by the Stroke Association and British Heart Foundation. They focus on getting the right response to the patient at the heart of ambulance response times, and end the practice of hitting the target but missing the point.


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