Transforming NHS ambulance services - Public Accounts Committee Contents

2  Improving the efficiency of ambulance services

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.[22] 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.[23] 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.[24] 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.[25]

9. Ambulance services accepted there is room to reduce this variation and make efficiencies.[26] 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.[27]

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.[28] 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.[29] The Department introduced them in 1996, to improve basic standards and achieve consistency across the country.[30] 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.[31]

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.[32] 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).[33] 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 this impact.[34]

22   Q 138; C&AG's Report, para 2.4 Back

23   Qq 46-47 Back

24   Qq 75, 83-84 Back

25   Qq 88, 104-105 Back

26   Qq 34-35 Back

27   Qq 29, 31-32 Back

28   Q 34; C&AG's Report, para 3.20 Back

29   Q 60; C&AG's Report, para 3 Back

30   Q 45 Back

31   Qq 54-55 Back

32   Qq 43, 45, 51, 55 Back

33   Q 49; C&AG's Report, figure 19 Back

34   Qq 48, 51 Back

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© Parliamentary copyright 2011
Prepared 16 September 2011