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Ambulance Trusts could save £500m says Lord Carter

Lord Carter’s report into unwarranted variations in NHS Ambulance Trusts has been published and identifies potential savings of £500 million that could be made in efficiencies by 2020/21.


‘Operational productivity and performance in English NHS ambulance trusts: unwarranted variations’ lists nine recommendations to improve patient care, efficiency and support for frontline staff who have responded to a significant rise in demand for ambulance services in recent years. 


Ambulance Trusts answered 10 million 999 calls last year and responded to over seven million separate incidents last year. Nine out of 10 of these calls were not life-threatening, but were lower acuity calls, often involving elderly patients. Nearly 60% of responses resulted in a patient being conveyed to A&E.


The report found that if more patients were treated at the scene by paramedics or were better assessed over the phone when dialling 999 — avoiding the need for an ambulance when it is safe to do so — the NHS could treat patients closer to home and reduce unnecessary pressure on emergency departments (EDs) and hospital beds. Offering safe and quicker care could save the NHS £300m a year by 2021, with a further £200m of savings through improvements in the infrastructure of ambulance Trusts and staff productivity.


In his introduction to the report, Lord Carter identifies three important areas where he says operational improvement must be made: staff, digital ambulance service and effective fleet management.



Giving staff the level of support they require is critical, Carter says, revealing that levels of sickness and engagement across ambulance staff are some of the most problematic in the NHS and should be addressed culturally. “Staff need greater clinical and managerial support to ensure they feel confident in treating a patient over the phone or on scene and are supported by effective rotas which match supply to patient demand.”


The digital ambulance service

Renewed emphasis on technological innovation is necessary. Lord Carter highlights that auto dispatch technology was proven 12 years ago to shave valuable seconds from response time to patients who suffered cardiac arrest, but it has yet to be fully implemented across all ambulance Trusts in England. “New technology is not adopted rapidly across the service and this, plus the weakness identified in the control centre infrastructure, must be addressed.”


Effective fleet management

It is, Carter says, “simply unacceptable that Trusts purchase different ambulances and stock them with different equipment and medicines.” He argues there is a case for a common specification across England and a move to centralised procurement for the ambulance fleet. “Technology like black boxes and CCTV must become standard issue and make ready systems must be put in place across the country to drive productivity.”


The Chief Executive of South Western Ambulance Service, Ken Wenman, says: “We welcome Lord Carter’s report on the productivity of Ambulance Trusts in England. As the best performing Ambulance Trust in the UK for not taking patients to hospital, South Western Ambulance Service (SWASFT) continues to treat a high number of patients on scene or at home, with only 52% of patients being taken onto hospital Emergency Departments for further treatment.  


“This is a much better experience for patients and saves the health system as a whole across the South West millions of pounds each year. For this calendar year that’s over 1,000 patients a day who did not need to go to hospital. 


 “The report also mentions how ambulance services need to move to the use of electronic systems - our crews across the South West already use a digital method called an Electronic Patient Care Record (EPCR) throughout the region which is a fully linked to the patient’s own NHS records and improves clinical decisions on scene.”


The report has also been welcomed by the Association of Ambulance Chief Executives. Martin Flaherty OBE, Managing Director, says: “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 EDs in each region, this is often driven by local geography, patient demographics and the availability of clinically appropriate referral pathways.”


This latest report follows the 2016 Carter review ‘Operational productivity and performance in English NHS acute hospitals: unwarranted variations’, which concluded that £5bn efficiency savings were achievable by 2020. The (ERIC) data on which this report was based has since been found to be significantly flawed, but it nevertheless kick-started the process of examining operational efficiencies, identifying and understanding unwarranted variations as well as what ‘good’ looks like. It also underlined the need for the data returns submitted by Trusts to be more consistent and robust to enable accurate benchmarking. 


Click here to download the full report