In a letter published today, to
the Minister of State for Health (Secondary Care), MP, the cross-party House of Lords Public Services
Committee has told the Government that in the face of
unprecedented demand, both ambulance services and
emergency departments are failing to meet their key time targets.
In the case of ambulance services, their effectiveness is
impacted by emergency department overcrowding that results in
delays in the handover of patients, creating increased risk of
harm to people awaiting treatment.
The Committee considered the demand for, and performance of,
ambulance services and how best they could be used to support
emergency department capacity and provide improved outcomes for
patients accessing these services. Other significant findings
include:
- Ambulance services have evolved into providers of urgent
community care, both in person and remotely, as a result of an
increased demand for healthcare and insufficient out of hospital
alternative services. This means that the role and remit of
ambulance services have become unclear and a catch-all for
failures across the healthcare system.
- Fragmented and inconsistent alternatives to A&E inhibit
the ability of ambulance services to divert patients to them.
- Operational decisions such as resource allocation and
deployment of ambulance services are based to a significant
extent on government response time targets rather than an
assessment of what care is needed and where. This creates a
tension between compliance with said targets and the aspiration
to provide more community-based care.
- Limited access to patient care records prevent paramedics
from making informed decisions about the treatment patients need.
This means patients are taken to emergency departments rather
than being treated locally using out of hospital primary or
community care services.
- Broader focus on more relevant ambulance service performance
indicators, in addition to time targets, would support ambulance
services to meet aspirations around avoiding conveyance.
The Committee has asked the Government for responses to several
questions.
Key questions to the Government include:
- Who will determine the role and remit of ambulance services
as the NHS shifts towards more bespoke neighbourhood care? Will
single ambulance services be expected to deliver different models
of care across the different neighbourhoods they serve, and what
would the implications of this be?
- What evidence does the Government have on patient
satisfaction with Hear and Treat and See and Treat? - (paramedic
out of hospital services provided to patients). If the Government
does not have such evidence, when will it be commissioned?
- What assessment has the Government made of the resource
implications of increasing See and Treat rates and of See and
Treat's impacts on ambulance service response capacity and times?
How is this currently monitored, or what plans does the
Government have to monitor these impacts?
- Will a broader set of relevant indicators, including patient
outcomes and time targets, be developed for ambulance services?
- How will ambulance services' good practice and innovation be
captured and disseminated?
- Has the Government considered how bespoke local care pathways
impact how ambulance services support patients, especially frail
older people, people experiencing mental health crises, care home
residents and people receiving end-of-life care?
, Chair of the Public Services
Committee said:
The premise of this short inquiry was two-fold. Firstly, it
was intended as a follow up to previous work of the Committee
examining emergency services. Our 2022 report on emergency
healthcare identified a system that was under unprecedented
strain with patients facing substantial delays in accessing
emergency care. Secondly, our interest in this area was to
highlight any obstacles or challenges in maximising the
operational effectiveness of ambulance services, particularly in
the context of the Government's focus on improving response times
and reducing patient waiting lists.
Our findings have resulted in somewhat similar conclusions to
the Committee's 2022 report. Ambulance services have the
potential to further reduce the proportion of patients from
certain groups conveyed to A&E departments by providing more
care in the community and supporting these patients into other
services. However, that potential is not yet fully realised and
hampered by several factors. These include an overriding focus on
time targets without accompanying focus on other indicators
relevant to patient outcomes, inadequate access to patient care
records, and often inconsistent and insufficiently accessible
alternatives to A&E.
While the provision of out of hospital services is not a
complete panacea to address busy A&E departments and an
overburdened health service, if properly administered, ambulance
services could alleviate some of that pressure while avoiding
unnecessary A&E admissions for patients who could be treated
differently. The Government needs to clarify the role and remit
of ambulance services within the wider health system in order to
maximise their operational effectiveness to fully support A&E
departments and deliver better patient care.
We've highlighted our initial findings and made some
preliminary conclusions based on the evidence we heard, but we
have asked the Government for responses to more detailed
questions and look forward to receiving these as soon as
possible.
