References
Which factors most influence demand for ambulances in South West England?
Abstract
Ambulance demand in South West England is increasing year-on-year, but the driving forces behind such increases are poorly understood. We developed a system dynamics model to simulate the factors that influence a call being made for an ambulance. We used data from the South West Ambulance Service NHS Foundation Trust (SWAST), the Office of National Statistics (ONS) and quantitative relationship data in both national and international literature to parameterise the model. We compared predicted ambulance demand over 12 months in the base case model with scenarios in which each influencing factor was removed in turn.
The model predicts that the prevalence of regular falls among older people most influences the level of demand for ambulances. The model also predicts that the number of users of adult mental health services could be a significant contributor to ambulance demand.
Additional focus on, and investment in, falls prevention strategies could help to significantly alleviate increasing levels of demand for ambulance services in South West England. Additionally, efforts to understand why those with mental health needs tend to use ambulances more than those without such needs could also be beneficial.
Demand for ambulance services is prone to within-day, within-week and within-year fluctuations (Cantwell et al, 2013) that are well understood. However, increasing year-on-year demand has also been widely reported in the literature (Cadigan and Bugarin, 1989; Wrigley et al, 2002; Lowthian et al, 2011) demonstrating a national pattern, but has received only limited research attention (Clark and FitzGerald, 1999; Lowthian et al, 2011). In South West England, the ambulance service has seen a rolling growth in the activity of its A&E service line of between 4–5%. This increased growth has occurred over the last 6 years, and includes all incidents originating both from members of the public and healthcare professionals calling 999.
The reasons behind this escalating overall demand are less clear, and while it has been postulated that broad factors such as an ageing society (Clark and FitzGerald, 1999) and increasing alcohol-related incidents (Brokaw et al, 1998) might be responsible, it is difficult to determine the predominant drivers of ambulance demand without quantifying and comparing the impact of these factors on ambulance demand.
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