There are some things in life which you hope and trust will be outstanding, while also hoping you will never need to find out. The 999 emergency ambulance service, for example.
Even though we all hope we will never need to dial 999 for an ambulance, it’s good to know there is a high quality service in place should we need to call on it. To give that welcome reassurance, NHS England has just announced a new set of performance targets for the ambulance service, which for the first time applies to all 999 calls.
The new targets are designed to save lives and remove ‘hidden’ and long waits suffered by millions of patients, including the frail and elderly. 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 more quickly 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’ at the point an emergency vehicle arrives. Currently one-in-four patients who need hospital treatment – more than a million each year – undergo a ‘hidden wait’ after the existing eight-minute target is met, because the vehicle despatched, a motorbike 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 vehicle 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 eight-minute target, meaning that 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 999 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 six hours or more. It will also help to make patients in rural areas less disadvantaged.
To ensure these changes improve care for seriously ill patients, ‘condition-specific measures’ are being introduced. These will track time from a 999 call to hospital treatment for heart attacks and strokes, where a prompt and appropriate response is particularly critical. It is expected that by 2022 90% of eligible heart attack patients will receive definitive treatment within 150 minutes.
Nine out of 10 stroke patients should also receive appropriate management 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.
Martin Flaherty, Managing Director of the Association of Ambulance Chief Executives, said: “The introduction of the new ambulance response standards is positive for patients and ambulance services alike. Our control room staff and paramedics out on the road have welcomed the new system, which has been developed with significant input from senior ambulance clinicians. We know it is safe because it has been rigorously tested using over 14million 999 calls, with no safety concerns.”