Ambulance services should be more flexible and adapt responses according to different levels of urgency, a report from the Audit Commission recommends. A life in the fast lane , questions the current practice of dispatching a fully equipped ambulance and crew in all situations however minor. It asks whether it might be more appropriate to treat some patients at home instead of transporting them to hospital. The commission calls on the government to reopen the case on whether emergency ambulance services can offer a wider range of responses to emergency 999 calls. Andrew Foster, controller of the commission said: "Ambulance services are under increasing pressure. In order to cope in future, they could have the flexibility to tailor responses to each situation." Last year over three million 999 calls were made for ambulances, a rise of 40% since 1990. On average each service receives one call every five minutes, 24 hours a day. Regardless of the nature of the incident a fully equipped ambulance is dispatched and each patient is admitted to hospital.
This leads to considerable delays in response times. In 1997/98 a quarter of ambulance services failed to meet the emergency response target (to reach a patient within nine minutes) and two thirds failed the target for urgent requests for an ambulance from a GP (to reach a patient within 20 minutes).
If ambulance services were given greater discretion in responding to emergencies then some paramedics would need extended clinical education. Ambulance crews would also need direct access to clinical advice and support. For example in Barnet, the London ambulance service is developing ways of working directly with district nurses to ensure that, where appropriate, patients receive treatment in their own homes.
Interestingly, there was no relationship between cost and ambulance response time. Over 80% of the variation in cost was explained by factors which are largely outside the management's control, such as population density, average mileage per trip, and the number of calls per resident. However, the report says that opportunities to improve performance using existing resources do exist. For example, Staffordshire Ambulance Service NHS Trust increased efficiency by predicting where ambulances should be positioned to react to expected demand. Life in the Fast Lane is available from Audit Commission Publications on 0800 502030 or the commision's website (http://www.audit-commision.gov.ukhttp://www.audit-commision.gov.uk), price £20.
