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Commissioners too focused on hitting ambulance targets, says NAO


27 January 2017

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The National Audit Office has said that commissioners, regulators and providers 'place too much focus on response times' causing systemic inefficiencies.

In a NAO report, it was found that the pressure to hit the eight-minute response time target is leading to bad practice in dispatching ambulances.

The report said some services sent out ambulances before it has been determined whether an ambulance is necessary.

The National Audit Office has said that commissioners, regulators and providers 'place too much focus on response times' causing systemic inefficiencies.

In a NAO report, it was found that the pressure to hit the eight-minute response time target is leading to bad practice in dispatching ambulances.

The report said some services sent out ambulances before it has been determined whether an ambulance is necessary.

Other services were said to have dispatched multiple ambulances to the same patient and then standing down vehicles, which are least likely to arrive first.

The NAO’s comments come as demand for ambulances grows with the number of ambulance calls and NHS 111 transfers increased from 7.9m in 2009/10 to 10.7m in 2015/16.

In the statement the NAO said that introducing new models of care, such as providing advice over the phone, ‘has helped but there are signs of stress’.

In 2015-16, for example, only one ambulance trust met the three response time targets.

In the same year, around 500,000 ambulance hours were lost becuase turnaround at A&E took more than 30 minutes, equating to 41,000 12-hour ambulance shifts.

Transferring the care of a patient from an ambulance into A&E is expected to take no longer than 15 minutes, with a further 15 minutes to prepare the ambulance for the next call. 

The NAO said that ambulance services are running into difficulties because of problems engaging with the wider health service as the number of stakeholders increases.

Sir Amyas Morse, head of NAO, said: ‘Ambulance services are a vital part of the health service but much of their ability to work better greatly depends on other parts of the health system.

‘Until clinical commissioning groups see ambulance services as an integral part of that system it is difficult to see how they will become sustainable and secure consistent value for money across the country.’

Yvonne Rispin, chair of the NHS Clinical Commissioners National Ambulance Commissioners Network (NACN) said: ‘Clinical commissioners do see ambulance services as an integral part of the health system and we agree that they are a vital component of the whole health service.

‘CCGs are working hard to make the changes needed to ensure we have an ambulance service that remains sustainable and safe, and gives our patients the best possible care.’

She added: ‘Issues such as handover and turnaround delays inevitably have a huge knock on effect on the service’s performance and clinical commissioners are working with colleagues across the urgent care system to find solutions to help manage these.’

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