New response times

Four of England's ambulance services have begun the roll out of new response times announced earlier this year.

Explaining the next steps in the delivery of the Ambulance Response Programme, Professor Jonathan Wenger, NHS England's National Clinical Director for Urgent Care, and NHS England's lead paramedic, Richard Webber, told delegates at this year's Health and Care Innovation Expo that a further four ambulance trusts would be switching to the new target times before the winter begins.

"Giving call handlers more time for triage doesn't impede the response to the sickest patients and the ambulance service becomes more efficient as a result," explained Professor Benger.

"We already have the North West, Yorkshire, West Midlands and South West services working to the new response targets and more will be moving to the new standards in October.

"Rather than sending multiple vehicles to one call and having to stand crews down, we are now sending one vehicle and giving the patient the right response. This is freeing up paramedics and ambulances to attend other calls.
"There is now a response standard for every patient and this will focus services on the less urgent calls while not affecting responses to the most serious calls. From now on the bar will set at 90 per cent of calls to be reached in the target times rather than 75 per cent under the old system."

Richard Webber added: "We think we will see further improvement in performance as things bed down."

The Ambulance Response Programme (ARP) was approved by Health Secretary Jeremy Hunt in July.

England's 11 ambulance trusts immediately began planning for the crucial delivery phase of the programme with the aim of most of them going live by the end of October as part of a series of Urgent and Emergency Care initiatives aimed at taking pressure off busy A&Es this winter.

Professor Benger explained ambulance trusts would begin to change their vehicle fleets and response models to deliver the overall objectives of the 'Keogh Review' of urgent and emergency care, with an emphasis on reduced conveyance to hospital through greater use of 'hear and treat' and 'see and treat' where it is safe and appropriate to do so.

These changes to the way services operate follow the largest study of an ambulance system ever completed. Over the course of almost two years more than 14 million calls were included, with no adverse or safety incidents identified.

The ARP trials have shown the new system could:
* Bring faster treatment for those needing it and save 250 lives a year
* Mean up to 750,000 more calls a year get an immediate response
* Drive improved care for stroke and heart attack patients

Professor Benger added: "The new targets will 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. 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."

Professor Jonathan Benger and Richard Webber presented on "the way ambulance services work to support change at the frontline" at last month’s Expo Pop Up University sessions.