Categorisation in the Ambulance Service

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2014 Health Care Service Group Conference
7 December 2013

National guidelines state that at least 75% of the most serious Category ‘A’ 999 calls should be responded to within eight minutes (Red 1 target). But less than half of trusts are able to meet their target to reach the most critically ill patients within this time.

These delays are caused by a range of reasons and most fall under the heading of government cuts or efficiency savings. For example, cuts or reductions in the levels of staff within A&E have led to a shortage of staff to hand patients over to. Handover times cover the point at which ambulance crews arrive at hospitals to when the patient and their medical notes have been handed over to hospital staff.

The target for handovers is set at 15 minutes of an ambulance’s arrival at A&E but in many cases, handover times have become unacceptably long and we believe that such delays have an adverse impact on patients’ experience of the service, can increase risks for patient safety, and affect the morale of staff.

Another factor causing delays is the number of rural ambulance stations that have been closed and replaced by a lesser number of hubs which have resulted in ambulances that are needed in rural areas having to travel long distances from city bases with staff having to travel further to pick up their ambulances before starting or ending work.

Increase and surges in demand for the service is no doubt an additional factor forcing some trusts to look for creative ways of meeting their target. These have included sending a car as a first response despite the fact that the majority of the most serious Category ‘A’ patients cannot be transported by car to hospital. This policy of despatching cars to some incidents is of particular concern as the necessity for back up (by fully crewed vehicles) can often be delayed and claiming a transportable target with a vehicle that in most cases is unable to transport that patient, is at best dishonest and at worst a deliberate attempt to put targets ahead of patient safety and to hide ambulance delays.

This is also a major issue across the devolved nation where overruns and a failure to meet targets are a major concern to UNISON members. For example, the targets were recently raised in a report calling for major changes to the running of the Welsh Ambulance Service and whilst no specific recommendations was made on how response times should be managed, the report called for a revamp of performance targets.

Seeking to meet these targets is having a detrimental effect on staff morale and has led to an increase in stress related ill health, low morale and feelings of helplessness especially when the media’s focus is often on the workforce rather than the employers actions.

Conference, it is clear that the ambulance service is coming under extreme pressure as finances are so tight and the service undergoes a fundamental re-organisation. The way calls are coded must be looked at again and the toll that the regime is having on both staff and patients needs to be taken into account.

Conference calls on the Health Service Group Executive to:

1)work with the National Ambulance Strategic Partnership Forum (NASPF) and relevant bodies across the devolved nations to assess how well the Category A target is working and develop guidance to encourage a nationally consistent approach to achieving the target;

2)gather further information on the impact of late or delayed handovers on both staff working in the service and members of the public;

3)use evidence gained to suggest recommendations that can improve the health, wellbeing and morale of staff by reducing overruns.