Up for the challenge?

In an age of such overwhelming change across the entire NHS, it seems there is rarely time to pause, take stock of the road we travel along, and appreciate the significance of the journey ahead. In December 2010, the Department of Health published ‘The Operating Framework for the NHS in England 2011/12’, which became operable on the 1 April 2011. Although many ambulance trusts are still wrestling to interpret the finer details of what is now required of us, there is little doubt that these new measures of performance are one of the most significant developments in the way ambulance services are measured since the inception of ORCON in the mid 1970s.

Many of us have heard and often echoed the complaint that 8 minutes is no measure of clinical performance; and it is clinical performance that should be the yardstick used to benchmark a clinical service. It is worrying that in an era of evidence based care, UK ambulance services have been mostly measured by how fast their clinicians can get to a patient, even though no robust evidence shows either an 8 or 19 minute response has any impact upon outcome for most patients (Pons et al, 2005). Interestingly however, when asked ‘what is the most important role of an ambulance service?’, roughly one third of Londoners felt it was ‘speed of response’ while only 5% felt that it was ‘treating injuries’ (Ipsos MORI, 2006). A balance must therefore be struck between the need to demonstrate high standards of clinical care, and the need to meet public expectation through a timely, yet appropriate response. Arguably, the 11 indicators relevant to ambulance trusts proposed in the new NHS Operating Framework do just this. They require ambulance services to demonstrate a portfolio of measures which focus interest upon clinical quality, while at the same time demonstrating efficient call handling, dispatch and emergency response.