999 staff could be allowed to take four times longer to send ambulances
AMBULANCES are likely to be given far longer to reach 999 calls in a controversial bid to ease spiralling pressures on emergency services.
Handlers could be given four times as long to assess calls after a study of 10million calls found too many cases being counted as hitting official targets, without patients getting the help they need. Current rules state that 75 per cent of calls classed as lifethreatening are supposed to receive a response within eight minutes. Before the clock starts, handlers have just 60 seconds to gather information – meaning they often send a response before crucial details have been established.
The targets, introduced by Labour, can be hit if a “first responder” on a bike gets to the scene quickly – even if the patient is a stroke victim in need of an urgent ambulance to convey them to hospital. And trusts are routinely sending multiple responses out in the hope that one will beat the clock.
Under new plans, handlers are likely to be given up to four minutes to assess calls – four times as long as the existing rules. Government sources said there was a growing clinical consensus that giving call handlers longer to make assessments meant the most urgent cases received the right help quicker.
Professor Keith Willett, NHS England director of acute care, said six NHS pilot schemes, evaluated by the University of Sheffield, provided “very compelling” evidence that changing the system would boost patient safety.
Ministers are expected to discuss the findings shortly, with reforms of the 999 system likely by next year. Cases involving patients who are unconscious or not breathing would still be sent an immediate response.
The study by NHS trusts is the largest research into urgent and emergency care in the world.
“Once every two decades, we get a real opportunity to modernise the
ambulance service. We have an evidence base now,” Prof Willett told a meeting of NHS managers.
“We have something we know is safe and evidence of improved efficiency.
“From my point of view, it is very compelling.”
While current targets say 75 per cent of calls classed as “life-threatening” should receive a response in eight minutes, just three per cent of patients turned out to need such an urgent response, Prof Willett said.
On average, one in four “blue light” ambulances sent out are stood down before they arrive, often because multiple vehicles have been sent out, or because the case turned out not to be so serious. Prof Willett said the system was “outdated” and in need of a major overhaul.
A Government source said the evidence appeared persuasive, although the final draft of the review has yet to be sent to ministers. “There seems to
be a clear clinical consensus on this,” he said. “At the moment we have a system where the clock stops when a responder on a bike reaches the patient, even if it turns out to be a stroke victim who will need an ambulance.”
The review comes after a major strain across ambulance and A& E services, with a 6,000 per cent rise in the number of patients left on trolleys for more than 12 hours in the past seven years.
Record occupancy levels in hospitals mean increasing numbers are being forced to wait longer in A& E, with ambulances queuing outside and paramedics waiting with patients.
In 2016-17, ambulance services in England received 9.8 million calls – a 20 per cent rise from the 8.2 million in 2011-12. Just 69 per cent of Red 1 calls – the most urgent category – received a response within eight minutes in 201617, compared with a 74 per cent performance in 2011-12.
Some ambulance services have been accused of tweaking response times. In the winter of 2014-15, up to 20,000 patients were subject to deliberate delays under a secret policy authorised by the head of South East Coast Ambulance Trust, which forced high-risk cases to wait up to twice as long if their call was referred from the 111 helpline.