The Association of Ambulance Chief Executives (AACE) has broadly welcomed the report published today by the National Audit Office which highlights the significant challenges and pressures facing the NHS ambulance service, while recognising the vital and growing part the service plays within the wider health and social care system.
However, AACE also sounds a note of caution regarding the report’s recommendation that there should be a single national standard operating framework for all NHS ambulance trusts, which could be difficult to implement due to regional variations in the local health economy and would be better addressed by improvements in the way ambulance services are commissioned.
The report helpfully underlines several key issues that AACE has been instrumental in highlighting to Government and other key stakeholders, especially how:
- demand for ambulance services continues to rise rapidly with no sign of slowing;
- increases in funding for ambulance services have not matched rising demand;
- workforce planning issues and a lack of paramedics are contributing towards limiting the ambulance service’s ability to meet rising demand;
- delays in being able to transfer care of patients at emergency departments – that are out of the ambulance service’s control – are contributing heavily to keeping crews off the road where they are needed most.
- response time targets are not the only factors that should be considered when assessing ambulance service performance – far more important are clinical outcomes and quality of care, which have been shown to improve despite increasing activity.
AACE has consistently demonstrated how the ambulance sector has a vital role to play in the delivery of urgent and emergency care, providing a range of clinical responses to patients in their homes and community settings, while integrating seamlessly across the spectrum of providers in health and social care.
Indeed, AACE is clear that NHS ambulance services are ideally placed to shift the balance of care away from hospitals, reduce demand on emergency departments and take the pressure off general practice. There are real and genuine benefits to be gained for patients and the wider health system by greater Government investment in ambulance services.
AACE Managing Director Martin Flaherty OBE says;
We are pleased that the National Audit Office’s report echoes so many of the key issues AACE has identified that need to be tackled urgently if we are to continue to improve patient care while managing demand more effectively, and ensure the long-term sustainability and effectiveness of the NHS ambulance service.
It is increasingly clear that NHS ambulance services are key in the coordination and signposting of patients accessing the health service as well as being a valued and trusted healthcare provider and we are there when we are needed most. It is no secret that the significant challenges facing the service at present must be addressed urgently if the service is to transform, along with the rest of the NHS, in order to cope with rising demand and provide the most appropriate responses for patients through new models of care.
The National Audit Office’s report recognises the rapid and sustained increase in demand for our services, which has not been matched by proportionate increases in funding and therefore resourcing and we believe this needs to be addressed urgently. The report also highlights the slow progress being made by ambulance services in delivering new models of care, against a backdrop of systemic barriers that are hindering the rate and scale of transformation and integration required to address the challenges of increasing demand across the whole health system.
One area that we believe the report does not address fully is the issue of how ambulance services can be effectively and efficiently engaged within the multiple and complex commissioning and planning structures in their regions. We are therefore pleased to be working closely with NHS Improvement and the National Ambulance Commissioning Network to deliver the improvements that are required.
What we really believe is needed is a standard, collaborative commissioning framework, that reflects the range of services provided by the ambulance sector – whether providing clinical advice by phone, treating on scene, referring to other services or conveying to hospital. This would mean all trusts are commissioned and monitored in the same way, which does not happen at present. This framework would better inform the development of the optimal operating framework to meet local requirements across the multiple Sustainability and Transformation Plans in each ambulance region. This would level the playing field for all ambulance trusts and help the sector measure performance and outcomes in a uniform way, while improving health and care services for local people.
Changes in the way ambulance services are commissioned and operate, to transform the delivery of out-of-hospital urgent care, are essential if our ever-increasing numbers of patients are to receive the right care, in the right place, at the right time – the fundamental aims of the Five Year Forward View and the Urgent and Emergency Care Review. Such changes and aspirations are being embraced and attempted by the sector, but they cannot be achieved in isolation, without the tangible support of NHS England, NHS Improvement, commissioning bodies and colleagues in other sectors.