22.12.14
Target times for ambulances could be more than doubled for some patients
Target times for ambulances to reach some seriously ill patients could be lengthened, according to a leaked NHS document.
The document, drawn up by the Association of Ambulance Chief Executives (AACE) and dated 16 December, includes a proposal to change the response time for some Red 2 patients – those with “serious but not the most life-threatening” conditions – from eight to 19 minutes in England.
It said the plans had been backed by health secretary Jeremy Hunt, subject to approval by ambulance trust bosses.
According to the document there were existing plans for changes "after the general election" in May but it said Professor Keith Willett, head of acute care at NHS England, had made an "urgent request" for discussions due to "unprecedented demand" on health services – and the "target for implementing these changes was the first week of January 2015".
The document also said NHS England had "explicitly stressed" the plans were confidential and "should not be disseminated beyond the group" involved in the discussions.
In an interview with the BBC, Prof Willett stressed nothing had been agreed but the proposals must be taken "very seriously". In a statement he added that any decision on the proposals would now not be made until the new year.
“Any operational changes to ensure ambulances reach sickest patients even quicker would need to be proposed by the senior doctors running ambulance services and agreed by the NHS nationally. No such decisions have been taken on their proposals, nor will they be - one way or the other - until next year.”
The details of the plan would see the existing target times for ‘Red 1’ cases, which cover life-threatening incidents such as heart attacks and trauma, remain at 75% attendance within five minutes and 95% within 19 minutes.
But Red 2 cases, covering serious illnesses that are not immediately life threatening, which currently have to be answered within the same period with an extra 60 seconds, would be broken into three groups.
The most serious, covering conditions such as strokes, would be recategorised into the most urgent Red 1.
Two new categories of Red 2 would be treated on a slightly slower timetable. The first Red 2 category would be covered by the 75% eight minute target plus an extra three minutes to allow the emergency services to spend slightly more time assessing the case.
The second Red 2 category would see their ambulance response time delayed from eight minutes to 19 plus the extra three minutes “disposition” to allow for a better medical assessment.
Martin Berry, executive officer of the College of Paramedics, said he was not opposed to change but it could not be done "behind closed doors".
"There's been no effort to engage with the paramedic profession. We're just very concerned about the way this has been kept in the dark."
Other unions also raised concerns. Rachel Maskell, head of health for Unite, said: “What they are doing is highly dangerous – instead of admitting that there is a serious problem in ambulance and emergency care and putting solutions in place.”
Anthony Marsh of the AACE insisted the reforms are safe and would improve services, after research found that 40-50% of ambulance calls are categorised as life-threatening while only around 10% should fall into this category.
He said: “We firmly believe that our proposals are safe and deliver benefits for patients and for staff who have been concerned for some time that we continue to try and reach many patients in eight minutes when it is not clinically required therefore unnecessarily adding to the pressures they are working under. At this stage, these are only proposals and they will not be formally approved until NHS England and the secretary of state are convinced, as we are, that they are clinically safe and that they offer better care for our patients.”
Clifford Mann, president of the College of Emergency Medicine, said the proposals were in large measure a pragmatic response to an enormous number of responses which did not really correspond to that much of an increase in very severe illnesses and injury. However he believes the plans should be piloted before any decision is made to implement them.
“I would have thought the sensible thing to do is to pilot this either for a period of time or in a number of different areas and to be able to produce data which compares with the same area or the same period last year,” he told BBC Radio 4’s The World this Weekend.
Shadow health secretary Andy Burnham MP has used the plans as an opportunity to accuse Hunt of misleading the public.
Burnham said: “It is outrageous that he decided to keep MPs and the public in the dark about a decision he had already taken and one which will have far-reaching implications across the NHS.”
A Department of Health spokesperson said: “This government has absolutely no plans to double ambulance wait times. We have given ambulances an extra £50m this winter to ensure the service remains sustainable and the secretary of state agreed that NHS England should investigate a proposal from the ambulance services themselves to see whether the service they offer the public could be improved.
“No decisions have been made, and the secretary of state would only agree to proposed changes that improve response times for urgent cases.”
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