3The ambulance service within the wider sector
Transfer of ambulance patients to hospital care
18.When an ambulance conveys a patient to hospital, transferring the care of that patient from the ambulance to the hospital emergency department should take no longer than 15 minutes. Each failure to meet the 15-minute standard results in a poor experience for the patient waiting in the ambulance, and a delay in an ambulance crew being available for a new emergency call. However, just 58% of patient transfers were completed within 15 minutes in 2015–16, compared to 80% in 2010–11.31
19.NHS England told us that ambulances not being able to transfer patients to hospital care quickly enough is one of their most serious concerns across the urgent and emergency care system, because, unlike patients already in a hospital or in an ambulance, patients in the community waiting for an ambulance are at greater risk as they are not being cared for by medical staff. NHS England and NHS Improvement told us that, to address this issue, much firmer performance management of the system was taking place. This requires hospital trust executives, such as the medical director, to engage with the ambulance service during periods when the hospital is missing the patient transfer-time target. Another key approach in preventing delayed patient transfers is to ensure that patients can be moved from the hospital emergency department onto wards, and then out of the hospital and into appropriate social care in a timely fashion. NHS England told us local Sustainability and Transformation Plans will bring together local authorities and the healthcare system, to avoid blockages of patient movement in the system.32
20.After the patient has been handed over, ambulance crews are expected to make their vehicle ready for the next call within another 15 minutes. In 2015–16, this was achieved in just 65% of cases, with wide variation in the performance of individual ambulance trusts. Collectively, hospital delays in accepting care of the patient, and ambulance delays in preparing their vehicle, meant almost half a million ambulance hours were lost in 2015–16, NHS Improvement told us they are focussing their efforts on patient transfers as this is where most of the time is lost.33
21.In 2011, the previous Committee recommended that a quality indicator should be developed for hospital performance in meeting the transfer-time target; this has not happened. The Department and NHS Improvement told us that data was being used operationally, but that NHS Improvement was working through the detail of how this data could be incorporated into official statistics.34
Integrating ambulance services into the wider health system
22.The Urgent and Emergency Care Review sets out NHS England’s ambition to integrate urgent and emergency care systems and provide care as close to home as possible. To help deliver this ambition, NHS England established 23 urgent and emergency care networks, to provide strategic oversight at a regional level. These networks are expected to include at least one ambulance trust and are supported at an operational level by Accident and Emergency Care Delivery Boards.35 NHS England has also introduced 44 Sustainability and Transformation Plan ‘footprints’, each of these has produced a plan setting out how local services will change and improve over the next five years, to meet rising demand within the resources available.36 NHS England has produced guidance to support the development of these Sustainability and Transformation Plans, and has asked urgent and emergency care networks to provide expert advice to them on urgent and emergency care.37
23.Effective collaboration is key to ensuring that all urgent and emergency services are connected and integrated. Ambulance services find it challenging to engage effectively with all their stakeholders. The Chief Executive of Yorkshire Ambulance Service told us that his trust deals with 20 clinical commissioning groups, about 15 accident and emergency delivery boards and four Sustainability and Transformation Plans systems. It is not always there for the day-to-day planning discussions with all its stakeholders, which means it is “playing catch-up”.38
24.It remains unclear how locally driven Sustainability and Transformation Plans will fit with the national aim of connecting and integrating all urgent and emergency care services and getting a more consistent service offer across regions. Moreover, plans are being taken forward in different ways across the country, and ambulance services have been insufficiently involved with local planning, meaning it is not clear how the ambulance service will be integrated into the wider health system.39
31 C&AG’s Report, para 1.22–1.23
32 Qq86, 113–116, 121–122, 217
33 Qq117–119; C&AG’s Report, para 1.23–1.24, Figure 7
34 Qq87–88, 123; C&AG’s Report, para 1.26
35 C&AG’s Report, para 1.6, 3.12, 3.14
36 Qq116, 138; C&AG’s Report, para 3.12, 3.14
37 Q137; C&AG’s Report, para 3.14
38 Q126; C&AG’s Report, para 3.13–3.15
39 Qq126–130, 167–173; C&AG’s Report, para 3.14
25 April 2017