2 Improving the efficiency of ambulance
8. There is wide variation in the cost of responding
to an incident across ambulance services. Costs per call vary
across ambulance services - between £144 in the North East
and £216 in Great Western.
This is underpinned by variations in a number of other factors,
such as sickness absence, overtime and back office costs. The
skills mix varies across the ambulance services, with some ambulance
services employing more paramedics and advanced practitioners
than others. There
are also variations in the back office costs of ambulance services,
which have increased recently in some services compared to front
line costs. The ambulance services attributed part of this to
increased management support to front line staff.
Sickness absence also varies between 5% and 7.9% across the ambulance
services, which is partly due to differences in the degree to
which management in each ambulance service hold staff to account
for their sickness. However, we note that sickness absence levels
have been reducing recently.
9. Ambulance services accepted there is room to reduce
this variation and make efficiencies.
Ambulance services plan to decrease the variation in costs by
introducing a 'national tariff system' from 2012. This will have
prescribed national standards for certain treatments, but the
tariffs for the standards will be set locally, so cost variations
will remain to some degree.
10. Each ambulance service has an efficiency plan
to achieve savings through actions such as reduced sickness absence,
changes in skills mix, headcount reductions, national procurement
and lowering back office costs.
We are concerned that the efficiency savings will come from a
reduction of non-core services (such as paramedics in GP surgeries),
rather than making efficiencies in the core services (such as
reducing sickness absence and overtime).
11. Until April 2011, there were national response
time targets for category A (immediately life-threatening) and
category B (serious, but not immediately life-threatening) calls.
The Department introduced them in 1996, to improve basic standards
and achieve consistency across the country.
It also introduced, in April 2008, 'call connect' to standardise
the way performance against the target was measured. From 2008,
the clock for the response time targets started when the call
was connected by BT. Before this, it started once key information
about the patient had been obtained.
12. The national response time targets and 'call
connect' led to phone calls being answered faster but also meant
that ambulance services often sent more than one team to incidents
in order that one arrived in time to meet the target.
We heard there is wide variation across the ambulance services
in the percentage of incidents where more than one response is
sent (between 28% and 62% of incidents).
In April 2011, the Government decided to maintain the category
targets but replaced category B with a suite of clinical quality
indicators. Ambulance services told us that this will lead to
a reduction in double responses being sent and give ambulance
services more flexibility to find the most appropriate response
for these calls, not the quickest one. Witnesses also spoke of
the need to review the clock start time for responses to increase
22 Q 138; C&AG's Report, para 2.4 Back
Qq 46-47 Back
Qq 75, 83-84 Back
Qq 88, 104-105 Back
Qq 34-35 Back
Qq 29, 31-32 Back
Q 34; C&AG's Report, para 3.20 Back
Q 60; C&AG's Report, para 3 Back
Q 45 Back
Qq 54-55 Back
Qq 43, 45, 51, 55 Back
Q 49; C&AG's Report, figure 19 Back
Qq 48, 51 Back