The ambulance service: the past, present and future

The second challenge has been recognised for some time and was the subject of a detailed study Life in the Fast Lane, published by the Audit Commission in 1998 (Audit Commission, 1998) and considered again in 2011 in the National Audit Offce's report Transforming Ambulance Services I (NAO, 2011). Both reports skirted the issues of what real transformation in terms of the concept of operation might look like, but they did make useful observations and suggestions. In some respects these findings paralleled an earlier American Ambulance Report authored by the legendary Jack Stout who set out the primary goals that all emergency ambulance services should strive for; response time reliability, clinical sophistication, customer satisfaction and economic efficiency (Stout, 1983; 2004).

These principles would fall into what are often termed ‘lean’ management methods and derived from quality management theory (Ryan, 2002). Stout also provided a useful metric, ‘termed unit hour utilisation’, to determine the productivity of an ambulance service by simply dividing the number of patients transported, or patient contacts, by the availability of ambulance time expressed in hours (Stout, 1983). For example, an ambulance service producing four unit hours of ambulance time and moving one patient would be operating at a 0.25 level of utilisation/productivity. This simple system has yet to be widely adopted in the UK, although discussion regarding a standardised approach is now underway. However, a continuing quest for higher productivity and stronger response time performance will no longer be sufficient as the following points will illustrate.