Committee publishes report on transforming NHS ambulance services

• Report: Transforming NHS ambulance services
• Public Accounts Committee

Speaking on publication of the report, the Rt Hon Margaret Hodge MP, Chair of the Committee of Public Accounts, said:

"Until April this year, ambulance trusts’ performance was measured solely against response time targets and so that’s what they focused on. This contributed to the high regard in which they are held by the public, but has also led to inefficiencies, such as ambulance services all too often sending out too many vehicles and staff to one incident, potentially keeping the surplus ambulances from responding to other calls. Introducing a broader performance regime is therefore welcomed.

But there are other areas of inefficiency still to be tackled. For instance, the cost of responding to calls varies widely across different ambulance trusts, from £144 per call in the North West to £216 per call in Great Western.

Too often, ambulances are kept waiting outside A&E with one in five patients forced to wait more than the recommended 15 minutes to be accepted by the hospital. The whole of the emergency care system needs to become more integrated to prevent this happening, so that patients can get treatment faster and the ambulances can get back out to help others sooner.

Performance will not be improved, nor will unwarranted variation be eradicated, until ambulance services have consistent information so that their performance can be compared with others.

We are concerned about the accountability of ambulance services following the reform to the NHS. It is not yet clear who will commission services, who will be responsible for improving efficiency, nor which body will intervene to protect 999 services if an ambulance service gets into financial difficulty, seriously underperforms or even fails."

Margaret Hodge was speaking as the Committee published its 46th Report of this Session which, on the basis of evidence from the Department of Health (the Department), the ambulance service and ambulance service commissioners, examined the value for money ambulance services provide.

Ambulance services provide a valuable service that is held in high regard. Eleven regional ambulance services operate across England. In 2009-10, they handled 7.9 million emergency calls, and spent £1.5 billion on urgent and emergency services. Ambulance services are expected to make 4% efficiency savings year-on-year, in line with the rest of the NHS, at a time when public demand for their services continues to rise.

Until 1 April 2011, the Department measured the performance of ambulance services against three response time targets. These were introduced in 1996 to focus attention on improving basic standards and achieving consistency across the country. But the incentive to meet response time targets has led to some inefficiencies. For example, some ambulance services send more than one team to incidents, over-committing vehicles and staff. We welcome the Department's decision to introduce a wider suite of health quality indicators to create a broader performance regime in which response times remain one indicator.

There is wide variation in the cost of responding to an incident across ambulance services, which is underpinned by variation in a number of other factors, such as sickness absence, overtime and back office costs. Ambulance services need to produce more consistent performance data in order to benchmark and share best practice so that efficiency can be improved and variations reduced across the country. For example, they do not currently collect and share comparable data on the extent to which ambulance crews are utilised when on duty. Although we note the Department’s and ambulance services’ commitment to provide more reliable benchmarking data and reduce variation, we were disappointed that it has taken so long to address the variation in efficiency.

Under the NHS reforms, there is still a great deal of vagueness around who will be responsible for what in the new system. It is not clear who will be responsible for commissioning ambulance services, who will be responsible for improving efficiency across ambulance services, or who will intervene if a service runs into financial trouble or seriously underperforms. In the future, ambulance services will become foundation trusts and be directly accountable to Parliament, but it is not realistic for each ambulance service to be individually accountable to us for value for money. There needs to be greater clarity on the roles and responsibilities of the Department, commissioners and ambulance trusts, with appropriate structures for accountability to Parliament on value for money.

Other parts of the health system affect ambulance services’ performance. A more integrated emergency care system is required to ensure that ambulances are not kept waiting outside accident and emergency, can hand over patients faster and get back out to help others. The Department has plans to align the objectives of those involved in the provision of urgent and emergency care providers. There are also varying levels of collaboration between ambulance, fire and police services which should be strengthened and we look to government to investigate the scope for further co-operation to identify savings in areas such as procurement and back-office services.

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