A New Era For NHS Ambulance Services

Main Category: Public Health
Article Date: 05 Jul 2005 - 6:00 PDT

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Health Minister Lord Warner today announced sweeping improvements to England's ambulance service. The changes will revolutionise the way in which ambulances deliver care across the country and build on the significant advances already made over recent years.

A number of changes that patients can expect to see over the next five years were outlined:

Faster response times to save more lives - Improved technology and information, re-organisation of ambulance trusts and call-centres, and streamlining of response time targets and call categories will mean that ambulances can concentrate on reaching the most urgent cases where every second counts. This will save more lives. The Category A response time for life threatening conditions will be measured from when the call is connected to avoid differences in measurement.

Better advice over the phone - non-urgent callers to 999 will be offered more advice over the phone and provided with the most appropriate local service that best meets their needs. This could be a referral to GP services, in or out of hours, or an emergency nurse service. This will give patients the best care for their condition and help them avoid an unnecessary visit to A&E. Ambulance services will work with other NHS services to ensure the right action in the right time.

More care in the home - Ambulance staff will be trained and equipped to carry out and interpret more diagnostic tests and undertake basic procedures in the home. They will also be able to refer patients to social care services, directly admit patients to specialist units, and prescribe a wider range of medications. This will be of particular benefit to patients in rural areas or with mobility problems.

More treatment at the scene - More patients with urgent, but not life-threatening, conditions will be treated at home rather than being taken to hospital. This could benefit, for example, older people who have had a fall and suffered cuts, bruises or other minor injuries and would prefer not to leave their home for treatment. At least one million people currently taken to A&E every year could be treated at the scene.

Home visits for better health - Ambulance staff will undertake routine assessments of patients with long-term conditions in their homes, in partnership with GP and nursing teams. This will help people with such conditions better manage their own health and avoid unnecessary visits to hospital.

Assisting all of these changes is an increase in the number of Emergency Care Practitioners (ECPs) across the country. ECPs are a new type of health professional, largely but not exclusively paramedics with extended training. They have greater assessment and examination skills and more training for the treatment of minor injuries and illnesses. ECPs are also trained in the management of long-term conditions.

There are currently more than 600 ECPs working in England. The Department of Health will work with Strategic Health Authorities and ambulance trusts to significantly increase the number of ECPs to help deliver these changes. It will also ensure that the training and education of other ambulance clinicians is reviewed to ensure that they can best meet patient needs.

The review outlines the potential for efficiency savings that could be made to free-up resources for greater investment in the training and recruitment of front-line and control room staff.

Lord Warner said:

"Following a year long review we are announcing today a fundamental change in the way ambulance services provide care. We are going to develop and enhance the care that is available in our communities from the NHS by using ambulance services to take healthcare to the patient, to become a mobile healthcare system.

"We will make sure that the ambulance services are able to respond to life-threatening emergencies as quickly as possible. But at the same time we are going to extend the role of ambulances and ambulance staff, so that they can not only be there in an emergency, but be there at other times to help people maintain their health. We believe that more than a million patients a year could avoid being taken to A&E by this new approach.

"People, by and large, would prefer to avoid a hospital visit, most would prefer to receive treatment at home. Across the NHS we are trying to give patients the chance to access care and treatment closer to their homes. We now want ambulances to play their full part in that process.

"The ambulance service has made excellent progress over the last ten years. The people most at risk are being reached quicker and more lives are being saved. We must now build on that success and will measure the response time for the life-threatening conditions from the time the call is answered.

"We will also streamline the number of ambulance trusts and improve efficiency, for example, through better procurement. This will mean we can save resources and channel them into frontline services."

The changes announced by Lord Warner have been recommended in a strategic review of NHS ambulance services led by Peter Bradley CBE, National Ambulance Adviser and Chief Executive of London Ambulance Service NHS trust. Peter was supported by a stakeholder reference group consisting of ambulance trust chief executives, representatives of other NHS organisations and clinicians. These recommendations have been published today and are endorsed by the Department of Health.

Peter Bradley said:

"We have an excellent ambulance service in England and there have been significant improvements already. During the course of this review we have seen many examples of good practice and excellence in patient care. But the service must secure further improvements.

"The recommendations set out in this review identify the key priorities for the service over the next five years. The successful implementation of these recommendations will result in a more advanced, efficient, and dynamic service delivering more personalised, high quality care to the people they serve."

Nigel Edwards, Director of Policy at the NHS Confederation which represents more than 90% of the organisations that make up the NHS throughout the UK, said:

"Peter Bradley's strategic review of NHS ambulance services has taken a visionary approach to the future development of these services.

"His review is grounded in common sense and his ideas are driven by the desire to save more lives - not to cut costs. We need a faster, more efficient service that gets people the right help at the right time.

"In particular, Emergency Care Practitioners are highly skilled and save lives. They can treat people at home who don't need to go to hospital and that frees up ambulances to ensure that emergency patients get to hospital as quickly as possible."

Notes to editors

1. Peter Bradley's report makes the following recommendations for improving the performance and management of the ambulance service:

- There should be fewer national targets for ambulance services, with a focus on the small number of patients with life-threatening emergencies (Category A).

- Reported response times should capture the period between a 999 call being connected to an ambulance control room and an ambulance clinician arriving at the scene to ensure consistency across the country and to bring the reported response time closer to patients' experience.

- Resources will be used more efficiently so that funding can be reinvested to improve patient care. This will be done through new national procurement processes and outsourcing of some support services where greater value for money can be achieved.

- The number of ambulance trusts should be reduced by at least 50% (subject to consultation) while retaining the same number of staff and vehicles to ensure that trusts have the capacity, leadership, clinical support and can maximise the resources available for the delivery of effective patient care.

2. The proposed reduction in the number of ambulance trusts in England announced today is consistent with the Government's manifesto commitment to streamline the number of NHS organisations. The Department of Health will consult the NHS and the public on the future number and configuration of trusts. Timing of this consultation will be announced in due course.

3. In May 2004, the Department of Health invited Peter Bradley to become National Ambulance Adviser and to lead a strategic review of NHS ambulance services is England. Today's report sets out the review's conclusions. A full version of the report is available online at www.dh.gov.uk

4. Media enquiries ONLY please contact the Department of Health press office on 020 7210 5301 or 5896.

5. History of ambulance development in England:

Roman Britain
Teams carrying bandages and water bottles ride behind fighting lines, bearing away the injured. Horse and foot soldiers earned a piece of gold for each life saved.

Anglo-Saxon period
'Invalids of rank' transported on litter, cart or hammock.

17th century
Soldiers removed from civil war battlefields in wagons. Plague sufferers carried to plague-houses by 'fever-ambulance.'

18th century
By the 18th century some hospitals, eg Staffordshire General Infirmary, had their own ambulance. A description from the era refers to ' A carriage hung upon strings, to be drawn by one or more horses for the conveyance of the sick or maimed.'

19th century
Increase in ambulances used across the country.

1882
St John Ambulance Association introduce 'Invalid Transport Corps' free of charge to the poor (Becomes St John Ambulance Brigade in 1887).

1883
Liverpool is the first town to have a regular, hospital-based, horse-drawn service equipped for first-aid and ready for immediate use.

1903
Metropolitan Asylum Board introduce a steam powered vehicle with space for 8 stretchers.

1912 onwards
Horse-drawn ambulances replaced by motor vehicles.

1912
College of Ambulance opened in Newcastle-upon-Tyne as teaching of first-aid develops through the first-world war.

1918
War-time ambulances released for civilian use and national ambulance service planned.

1920
Register of national ambulance stations printed and circulated.

1925
Public Health Act provides for transport of non-urgent cases and ambulance services spread slowly across the country until WW2. Local authorities extend services locally with help from organisations such as the Red Cross.

1937
999 telephone number introduced.

1939-1945
War-time civil defence and rescue provision consolidates ambulance services.

1946
National Health Services Act requires local authorities to provide ambulances 'where necessary'. Initially staffed by volunteers, professionals are introduced gradually.

1964
The Millar report recommends that the ambulance service should provide treatment as well as carry people to hospital. A six-week qualifying course is introduced for A&E staff and minimum standards for equipment are drawn up.

1974
Ambulance services transferred from local authorities to NHS control and performance standards set for ambulance trusts.

1970/80
- Modernisation of communications, vehicles and telephone systems e.g. introduction of helicopters and motorbikes to speed up response in difficult conditions, computerised
- Extended skills such as Intubation and Infusion introduced
- Defibrillators become portable and are introduced onto all ambulances
- Staff with extended training re-qualify as Paramedics 1990s
- State registration confirms professional status of paramedics while the Government announces that a paramedic must be on every emergency ambulance
- Ambulance services become self-governing trusts, responsible for managing their own budgets

1995/6
Prioritisation of calls piloted.

1996
Review of ambulances - focusing on performance standards. Sets out the performance standards in use today.

2001
Prioritisation of calls used by all trusts.

2003
New Emergency Care Practitioner role piloted

2004 - 2005
Peter Bradley carries out national review of ambulance services.

GNNREF: 117285-Issued by : DOH Press Office