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A&E ambulance diverts almost double average of previous three winters

Urgent response time targets met in only six out of past 49 months

Caroline White

Friday, 07 April 2017

Hospital A&E units have had to turn ambulances away and divert them elsewhere almost 500 times this winter, nearly double the average of the previous three, shows a new analysis* of ambulance trusts’ performance against targets from health think-tank the Nuffield Trust.

The extra time paramedic crews are on the road as a result is hindering the ambulance service’s ability to meet its response time targets, suggest the report authors.

The efficient performance and smooth running of the ambulance service are vital to the operation of every part of the health service, from care homes to general practice to hospital care, they emphasise.  

But the service has missed urgent response time targets in most of the past 49 months, the analysis shows.

The pressures facing the ambulance service are growing at an even faster rate than those facing hospitals, says the report.  

Over the past five years, the number of category A calls (the most serious) resulting in an ambulance arriving at the scene of an incident has increased by 7.4% year on year—from 2.5 million in 2011-12 to 3.3 million in 2015-16— whereas over the same period the number of emergency admissions to hospital has risen by an annual average of 2.1% and the number of attendances at A&E by 1.6%.

As a result, the three main urgent response time targets have been met in only six out of the last 49 months, and none has been met since May 2015.  

The most recent figures covering January this year, show that just 67% of ‘Red 1’ calls, which include those for cardiac arrest patients who are not breathing and do not have a pulse, and only 58% of Red 2 calls (serious, but less immediately time-critical), received a response within eight minutes, which is  significantly off the target of 75%.

Of the 233,472 Category A calls received in January this year, at least 95% should have had a response within 19 minutes, but 29,000 calls did not receive a response within this time, meaning only 88% of responses met the target.

Although organisations such as the National Audit Office have provided extensive evidence of the long waits ambulances face before being able to hand over their patients at A&E departments, there has been little focus to date on what is often the ultimate outcome of these delays.

This is the decision by a hospital in “exceptional circumstances” to implement a ‘divert’ from its A&E and instruct ambulance trusts to take patients to other hospitals instead.

While these diverts were implemented an average of 249 times over the winters 2013-14, 2014-15 and 2015-16, 478 were instigated over the same period this winter—almost double, the analysis shows. 

Five hospital trusts accounted for over half of all the 478 diverts reported this winter: Pennine Acute Hospitals, Northumbria Healthcare, County Durham and Darlington, South Tyneside and Worcestershire Acute Hospitals.

In non-urban areas in particular the extra time taken to reach more distant A&E departments creates a ‘double whammy’ in that not only do crews have to drive further away once a divert is implemented but will then also need to travel further to get back to their own area to respond to the next emergency call, says the report.

And the continually increasing pressure on the ambulance service is having a worrying impact on its staff, it says. Analysis of responses to the most recent annual NHS Staff Survey, published last month, shows that the morale of ambulance staff appears to be much poorer than staff in other parts of the health service. 

“There’s rightly been a lot of focus recently on the delays ambulance crews face in being able to hand over their most seriously ill patients at A&E – but what our research today has uncovered is the huge increase in the number of times this winter ambulance trusts have been told that they must take patients to another hospital altogether, because an A&E unit simply doesn’t have the capacity to accept any more patients. The extra time crews are having to spend on the road is not helping the ambulance service’s ability to meet its response time targets,” commented lead report author Professor John Appleby, chief economist and director of research at Nuffield Trust.

“Managers in the NHS and politicians need to make improving the ambulance service’s poor morale and its ability to meet targets an urgent priority,” he said.

Dr Tony O’Sullivan, chair of campaign group Keep Our NHS Public, said: “These pressures will undoubtedly cause avoidable deaths, adding to the devastating picture of 30,000 unexplained deaths in 2015, largely in the elderly, noted by researchers. The government has to be called to account.”

* Appleby J, Dayan D. Nuffield Winter Insight - Briefing 3: the ambulance service. Nuffield Trust, April 2017

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