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NHS England to change ‘inefficient’ ambulance response targets

Current ambulance targets that require call handlers to assess and dispatch an ambulance crew to the scene within 60 seconds are causing major inefficiencies to a stretched system, NHS England’s director for acute care Professor Keith Willet told MPs at a Public Accounts Committee (PAC) hearing into Ambulances.

In addition, Prof Willett announced that NHS England will publish a report next month detailing changes to these targets, by giving call handlers an additional 180 seconds, up to four minutes, to assess and diagnose patients ringing 999.

During the hearing, he identified that inefficiencies were coming about from the current target as staff were unable to properly assess patients, but due to emergency departments having to hit targets of responding to patients within eight minutes, crews had no choice but to be dispatched within 60 seconds of receiving a call.

The revelation came on the same day that NHS Providers sent a similar message out about hospital trusts, saying that achieving targets for 2017-18 was currently “mission impossible” in the NHS’s current state.

Speaking to the committee, Prof Willett said that though targets could be “very beneficial”, they can be “blunt instruments” used to make trusts fall into line, risking poor practices to be incentivised.

“The call handler is taking the information from the patient—perhaps an old lady downstairs and a poorly husband upstairs—and in 60 seconds you have to get an awful lot of information across to come up with something that says, ‘This is what we think is wrong with the patient and this is what they need’,” he explained.

“At the end of 60 seconds while the call handler is still taking that call, the dispatch desk has no choice but to discharge an ambulance on blue lights and sirens.”

This can lead to ambulances wasting valuable time and money as they are recalled when it is established that the patient is not in critical need of medical attention.

“Many of you will have experienced driving along the road and pulling over to allow an ambulance to pass you with blue lights on, only to find 400 yards down the road that it has pulled over and stopped and you think, ‘What was all that about?’” Prof Willett said.

This is something that is both “inefficient and frustrating” for ambulance crews, and something that the NHS simply cannot afford to carry on doing in a system with little “headroom” for error.

For targets to be effective in pushing better practices in NHS trusts, said Prof Willett, they had to be “clinically credible and they need to be sensitive”.

“They need to be doing what you want for—in the ambulances’ case—the sickest patients, but not at the expense of those patients who clearly have a need, but which may not be of the same priority,” he added.

Prof Willett stated that next month an NHS England report, which has been formulated following industry involvement and a series of pilots over the last 18 months, will confirm the news that ambulance targets are to be changed, something that deputy chair of the committee MP Richard Bacon described as “moving the goalposts”.

In response, Prof Willett said: “The whole concept of the ambulance response programme has come from the ambulance clinicians. It did not come from us.

“It came from Anthony Marsh, who is the chief executive of the Association of Ambulance Chief Executives, who came from the medical directors of the ambulance services. Those are the people who gave us the advice that we initially took, and we then took that advice to the secretary of state.”