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New ambulance service standards announced

NHS England has announced a new set of performance targets for the ambulance service which will apply to all 999 calls for the first time.

The new targets will save lives and remove “hidden” and long waits suffered by millions of patients, including reducing lengthy waits for the frail and elderly. The new system is backed by the Association of Ambulance Chief Executives, the Royal College of Emergency Medicine, the Stroke Association and the British Heart Foundation amongst others.

Call handlers will change the way they assess cases and will have slightly more time to decide the most appropriate clinical response. As a result cardiac arrest patients can be identified quicker than ever before, with evidence showing this could save up to 250 lives every year.

The redesigned system will focus on ensuring patients get rapid life-changing care for conditions such as stroke rather than simply “stopping the clock”. Currently one in four patients who need hospital treatment – more than a million people each year – undergo a “hidden wait” after the existing 8 minute target is met because the vehicle despatched, a bike or a car, cannot transport them to A&E.

Ambulances will now be expected to reach the most seriously ill patients in an average time of seven minutes. The ‘clock’ will only stop when the most appropriate response arrives on scene, rather than the first.

This will free up more vehicles and staff to respond to emergencies. Currently, three or even four vehicles may be sent to the same 999 call to be sure of meeting the 8 minute target, meaning that across the country one in four are stood down before reaching their destination.

According to independent analysis of what has been the world’s largest clinical ambulance trial, the new standards mean that up to 750,000 calls a year that currently go into a queue will get an immediate response. Academics at Sheffield University found that the changes are safe, with no safety issues identified in more than 14 million 999 calls handled over the 18 month trials.

The changes also introduce mandatory response time targets for all patients who dial 999. Currently half of all ambulance calls, around five million a year, are classed as “green” and not covered by any national target. Response times for these patients, who are often frail and elderly, have been under pressure, with some patients waiting 6 hours or more. It will also help to make patients in rural areas less disadvantaged than they can currently be.

To ensure these changes improve care for seriously ill patients, we are introducing condition-specific measures which will track time from 999 call to hospital treatment for heart attacks and strokes, where a prompt and appropriate response is particularly critical. By 2022, we will expect that 90% of eligible heart attack patients will receive definitive treatment (balloon inflation during angioplasty at a specialist heart attack centre) within 150 minutes. Nine out of 10 stroke patients should also receive appropriate management (thrombolysis for those who require it, and first CT scan for all other stroke patients) within 180 minutes of making a 999 call. That currently happens for less than 75% of stroke patients. Data collection will begin immediately so the new targets are achieved in the coming years.

The overhaul follows calls from paramedics for the modernisation of a service developed and introduced in 1974, as well as criticism of the current system from the National Audit Office and Health Select Committee.

Sir Bruce Keogh, NHS England’s National Medical Director, who commissioned the Ambulance Response Programme in 2015, says: “Patients across the country deserve to benefit from the significant improvements seen in the trial areas, from ambulances reaching cardiac arrests in London 30 seconds faster to the one minute improvement on stroke responses in the West Midlands. These changes, together with ambitious new clinical standards for heart attack and stroke patients, will end the culture of ‘hitting the target but missing the point.’ They will refocus the service on what actually counts: outcomes for patients.”

Professor Keith Willett, NHS England’s Medical Director for Acute Care, says: “Our core priority will always be patient safety, but paramedics are rightly frustrated that under the current ‘stop the clock’ system they are frequently dispatched to simply hit targets. This has led to the inefficient use of ambulances, with the knock-on effect of ‘hidden waits’.

“This is not about relaxing standards but updating a decades old system to respond to modern needs. In most 999 calls we know the best clinical outcome for patients is not about the fastest response by the nearest vehicle, but the most appropriate one. These are changes which have been called for by paramedics, and the evidence shows that they will save lives.”

Independent researchers from Sheffield University studying the pilot sites have shown patient care has been maintained with no safety concerns or adverse patient outcomes identified. Elements of the new ambulance programme are already being trialled within England’s ten ambulance trusts, and will now be introduced as a permanent change during Autumn this year.