Paramedics treating more patients at the scene or referring them to services other than A&E could help towards £500m of efficiency savings, improve patient care and experience, and support paramedics doing difficult jobs according to a new report.
Non-executive director at NHS Improvement and NHS productivity champion Lord Carter, has produced a report on the productivity of ambulance trusts in England with 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.
It has 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 A&Es and hospital beds. Offering safe and quicker care in this way could save the NHS £300m a year by 2021, with a further £200m of savings through improvements in ambulance trusts infrastructure and staff productivity.
The report found that as long as it is clinically appropriate to do so, it is always quicker and just as safe for patients to be treated on the scene by paramedics, rather than being transferred to A&E. It found that delays at hospital cost ambulance trusts nearly £50m last winter.
In one ambulance trust, as many as 64% of patients are taken to A&E after being seen by an ambulance, compared to 52% at the best performing trust. The NHS should work together to ensure there are suitable, alternative patient services with the aim that all ambulance trusts should reduce the average rate of ambulance transfers to A&E from 58% to 50% to help reduce the strain on A&E services. Moving towards the best performers will be particularly important as the NHS continues to prepare for increased demand of its services this winter.
The report identified a need to give paramedics access to patient information digitally, as this will help them to treat more patients at the scene. Most paramedics cannot access patient records while attending an incident, which significantly limits their ability to make informed decisions on the scene and results in more patients being taken to hospital. Some ambulance trusts have introduced mobile devices for frontline staff which is an encouraging first step but more needs to be done to ensure full utilisation.
Lord Carter also identified the need for improved assessment of 999 calls to ensure that there is more consistency in how different ambulance services respond to the same types of calls and improve the number of patients being cared for over the phone. Every patient who can be advised over the phone without needing an ambulance saves the service £190, and means more ambulances are available to respond to emergencies.
The report also says that the NHS may need to invest in up to 3,300 new ambulances within the next five years to replace and expand the existing fleet. In June, the Department for Health and Social Care announced a £36.3m investment to support trusts which included funding for 256 new ambulances. Ambulance trusts have already planned to purchase or lease 2,600 vehicles over the next five years.
Lord Carter, a non-executive director at NHS Improvement and author of the report, said:
“Too many patients are being unnecessarily taken to A&E by ambulances, putting further pressure on hospital services that are already on the back foot. Not only is this financially costly, but it takes up staff’s time and means patients are having to spend time waiting in A&E when they should be recovering at home.
“An ambulance is not a taxi to A&E. Modern technology means that patients can often be treated at the scene. But an ageing ambulance fleet means that this is not always possible.
“Paramedics and other staff have worked incredibly hard as demand for ambulances has soared. It is now vital that improvements are made in the infrastructure of the wider NHS to help frontline staff work as efficiently as possible.”
The Managing Director of the Association of Ambulance Chief Executives, Martin Flaherty OBE said:
“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 emergency departments in each region, this is often driven by local geography, patient demographics and the availability of clinically appropriate referral pathways.”