In June, annual performance data for ambulance services in England were published by the Health and Social Care Information Centre (Workforce and Facilities Team, Health and Social Care Information Centre, 2015). It revealed that the number of emergency 999 calls presented to ambulance switchboards over the past year was 9 million. This represents an increase of 515 506 (6.1%) over last year's 8.49 million calls. To break this down, this is an average of 24 661 calls per day or 17.1 calls per minute.
Of these calls, 3.14 million (48.5%) were classified as category A (most urgent) and resulted in a response from an emergency vehicle. Of these, 5.2% (164 478) were classed as Red 1 (most serious) and 94.8% (2.98 million) were classed as Red 2 (serious but less urgent). The response rates within 8 minutes were as follows: Red 1—71.9% nationally with 5 of the 11 ambulance Trusts achieving 75% or more (compared to 75.6% for 2013–14); Red 2—69.1% nationally with 1 of the 11 ambulance Trusts achieving 75% or more.
It is worth noting that the national Red 2 data needs to be treated with caution, as a result of the Secretary of State for Health introducing the Dispatch on Disposition (DoD) pilot in February 2015 (Hunt, 2015), rolled out within London Ambulance Service NHS Trust and South Western Ambulance Service NHS Foundation Trust. The pilot increased the time call handlers have to assess patients before the ‘clock starts’ from 60 seconds to a maximum of 180 seconds for all 999 calls, except those categorised as Red 1. The aim was to allow more time to triage and therefore improve the overall outcomes for ambulance patients.
However, the pilot caused notable sensationalism within the media when the proposed recommendations for change were leaked by a whistleblower in December 2014 (BBC, 2014). Although the clinical advice claimed a change to response times would improve overall outcomes for ambulance patients, concerns were raised as to whether this would in fact be the case.
Factors thought to have affected response times for 2014–15 included the increase in demand for ambulance services, which in turn has put pressure on resources; the location of incidents; patient handover and turnaround time; and staffing numbers.
Perhaps one of the most interesting findings was that the proportion of incidents managed without need for transport to A&E has risen slightly from 36% last year to 37% this year (two years ago this was 35.1%). This figure concerns patients discharged after treatment at the scene or onward referral to an alternative care pathway, and those with a patient journey to a destination other than Type 1 or 2 A&E.
Given the introduction of the DoD pilot, it is difficult to gain an accurate gauge of how Red 2 response times have changed over the last year. However, what is evident is that the number of emergency calls to ambulance services has increased. Assuming this will continue to rise, new initiatives will be required to meet this demand.