This report looking into the use of private crews by ambulance trusts in England was complied using responses to Freedom of Information (FOI) requests made to those trusts, and statistical information available from NHS England.
The demand for ambulance services has been rising by more than 5% for many years. In 2014-15 the number of calls to ambulance switchboards was 9 million, a 6.1% increase on the year before. Of these, 6.5 million received a face-to-face response and 3.1 million were classified as category A (most urgent). The number of seriously ill patients now take up half of all face-to-face emergency calls – compared with 27% in 2001. Since 2010/11 the ambulance service has been finding £75million a year in efficiency savings (National Audit Office). In response trusts have imposed budget cuts, kept vacant posts unfilled, reduced training and cut staff.
Using the private sector for blue light calls
The use of non-NHS ambulance providers has risen substantially. Our study found that they are now being used by all ten ambulance trusts in England to attend the most life threatening of incidents. Non-NHS ambulances responded to 139,086 life-threatening emergencies and 313,661 emergencies between January 2014 and March 2015. Private providers accounted for 89% and voluntary crews 11% of non-NHS attendances in our study.
Threats to patient care from understaffing
It is widely acknowledged that there are insufficient numbers of paramedics. Our research found that training budgets have been cut between 2012 and 2014. Overall numbers of paramedic posts have risen, but there are also a large number of unfilled vacant posts. There is strong evidence to suggest that ensuring that there is a state-registered professional on every ambulance would increase patient safety and efficiency.
Declining performance statistics
Performance data from NHS England shows a decline in response times over the last 12 months. The average response time was below target for the most serious cases (Category A) throughout 2014 and the first quarter of 2015, reaching a new low over the winter period, although the Category A target (arriving to calls 8 within minutes in 75% of cases) was met in the April and May 2015. There are large disparities in survival rates across the country. The trust with the lowest survival until discharge rate, is three times poorer in performance than the trust with highest.
Problems hidden from public view
Despite the obvious pressures on the ambulance service many of the current problems remain unseen. This is because according to figures released to us by ambulance trusts around half (51%) of all emergency or “blue light” calls are not part of the performance monitoring statistics (response time and key quality measures). These can include patients with conditions such as suspected stroke, diabetes or limb fractures. This means that both positive and negative aspects of performance for at least half the patients are not recorded.