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27.09.18

Carter: ‘Vital’ improvements to tech, fleets needed to save £500m

New technology is “not adopted rapidly” across the ambulance service and there should be an increase in patients treated at the scene to create savings and reduce pressures on A&E wards, a new report into the service has claimed.

Paramedics treating more patients at the scene, or referring them to services other than A&E, could lead to upwards of £500m of efficiency savings and improve patient care and experience, according to the report conducted by NHS Improvement non-executive director Lord Carter.

The year-long report into the 10 ambulance trusts across the country, which currently spend a combined £2.3bn every year, found that if more patients were treated at the scene by paramedics or were better assessed over the phone, the NHS could treat patients closer to home and away from A&E, saving the NHS £300m a year by 2021.

“Overall, for every 10% reduction in the number of incidents conveyed [transferred], there is an increase in on scene time of two minutes and 20 seconds,” the report wrote.

“In simple terms, this means that as trusts reduce avoidable conveyance, on scene times are likely to increase. This will be important for trusts and commissioners to include in service planning, but it is highly unlikely to outweigh the overall benefit of reducing avoidable conveyance for patients, the ambulance service and the wider health system.”

In July, the government announced £36m for a new fleet of ambulances to be brought in to support frontline forces of the NHS this winter.

Lord Carter noted that reducing avoidable transfers from home-to-hospital requires “significant improvements” in the availability and accessibility of the emergency care system.

For patient care at the scene to be improved, Lord Carter identified the need for improved assessment of 999 calls to ensure for greater consistency in how different ambulance services respond to the same type of calls; every patient being advised over the phone can save the service £190, and free up extra vehicles to be used elsewhere.

Lord Carter also highlighted the need for ambulance services to take advantage of digital innovation and technology when providing care: ambulance crews should be given access to patient information digitally, expanding their ability to make informed decisions on the scene and potentially allowing them to reduce the number of patients taken to hospital.

'Renewed emphasis'

“Ambulance services have been at the forefront of technological innovation for many years, but there needs to be renewed emphasis in this area,” the report said.

“New technology is not adopted rapidly across the service and this, plus the weakness identified in the control centre infrastructure, must be addressed. Ambulance services need to plan for tomorrow’s service today and develop robust plans to rapidly improve the resilience of the infrastructure.”

Lord Carter also noted “substantial differences” in the average age of ambulance fleets between trusts and different fuel methods are used: fleet management can be strengthened through improvements in the information systems and greater focus by trust boards, the report wrote.

Additionally, innovation and technology was a key factor for driving improvement across fleets for Lord Carter. “Black box technology and CCTV in ambulances has enabled significant savings in fuel and accident reductions but less than half of them have this fitted,” the report wrote.

Commenting on the report, its author Lord Carter said an ambulance “is not a taxi to A&E.”

He added: “Modern technology means that patients can often be treated at the scene. But an ageing ambulance fleet means that this is not always possible.

“Paramedics and other staff have worked incredibly hard as demand for ambulances has soared. It is now vital that improvements are made in the infrastructure of the wider NHS to help frontline staff work as efficiently as possible.”  

Managing director of the Association of Ambulance Chief Executives Martin Flaherty OBE said: “We welcome Lord Carter’s report, which emphasises the adoption of new technology and innovation within the ambulance service as a key driver for reducing conveyance rates to hospitals.

“Whilst 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.”

Deputy director of policy and strategy at NHS Providers Miriam Deakin said: “Ambulance trusts are feeling the effects of rising demand for emergency services outpacing funding increases, difficulties in recruiting and retaining staff, and the need to adapt the way they meet the changing care needs of patients.

“To be able realise the levels of savings identified, we must address pressures in other parts of the health and care system. Reducing unnecessary trips to hospitals in ambulances could save money, but it will require investment in other areas, for example in primary care, mental health and community services or social care.”

Earlier this year, Lord Carter, who has released a string of reviews since 2016, said that the provision and efficiency of community health services need to be “significantly strengthened,” alongside a greater and stronger workforce to meet the growing demand for mental health services after finding “critical variations” between the two.

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Image credit: Peter Byrne, PA Images

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