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No To Longer Ambulance Response Times

Monday, December 22, 2014

More Patients Deaths Will Arise If Leaked Proposals To Extend Ambulance Response Times In England Are Accepted By Government

These proposals from Association of Ambulance Chief Executives are ridiculous and they will only serve to bring worse outcomes for patients says GMB.

GMB, the union for ambulance staff, commented on the leaked report on BBC that about 40% of Red 2 calls, that is all other life-threatening emergencies, such as stroke and fits, which now have a response target of eight minutes would have a 19-minute response target, as well as three minutes before the clock must start. See notes to editors 1 for copy of report on BBC website on 21st December on proposals drawn up by the Association of Ambulance Chief Executives.

Tony Hughes, GMB regional officer for Ambulance service in London and East of England, said "These proposals from Association of Ambulance Chief Executives are ridiculous. They will only serve to bring worse outcomes for patients. The proposals are clearly motivated by the run up to the general election so that the Tories can show that Ambulance Services are meeting their targets. This is so far from the truth. See notes to editors 2 for changes between Oct 2013 and Oct 2014 for ambulance response times by region.

If these plans go ahead we will see people die more often that we see at the moment from conditions that can be treated if the right resource is got to them in good time.

The whole of the Accident and Emergency structures are at breaking point due the changes this government has already made. There are a number of issues why there are slow responses in the service such as no beds at hospitals, the new Clinical Commissioning Groups funding fewer opportunities to access other medical assistance, the closing of A&E departments and walk in centres and the new 111 service. All these issues have led to Accident and Emergency Services to be at breaking point.

There are unfilled vacancies in ambulance services. Yet government are not prepared to keep pay up with inflation. That is why GMB ambulance staff are looking at 48 hours continuous strike from noon on 29 January to noon on 31st January.

In 2011 GMB warned that the Government’s scrapping of the category B target for ambulances to arrive at the scene of an incident within 19 minutes of the call being received and replacing it with a set of 11 new clinical quality indicators would open the door to cuts being made and we have now been proven right. (See notes to editors 3 for the indicators that replaced this target)."

Notes to editors.

Story on BBC website 21st December 2014:

Ambulance targets: Plan for longer times in England revealed

Labour has said Health Secretary Jeremy Hunt has questions to answer over the plans

Target times for ambulances to reach some seriously ill patients could be lengthened, the BBC has learned.

A leaked NHS document includes plans to change the response time for some Red 2 patients - those with "serious but not the most life-threatening" conditions - from eight to 19 minutes in England.

It said the plans had been backed by Health Secretary Jeremy Hunt, subject to approval by ambulance trust bosses.

The government said no decisions had been made. Labour has demanded answers.

And the party has rejected suggestions from ambulance chiefs that it was told about the plan to change response times and raised no objections.

Ambulance Doc

"We have never given any support for this plan. When raised in passing, [Shadow health secretary Andy] Burnham explicitly warned of the need for caution and consultation as he repeated today, " a Labour spokesperson told BBC political correspondent Carole Walker.

"The evidence needed to be produced first and it hasn't been. Instead, ministers are forcing it through from January, in the middle of a crisis, without proper planning," the spokesperson added.

Mr Burnham has written to Mr Hunt asking him to explain why the measures - proposed to be brought in within weeks - were not disclosed to Parliament days after he signed them off.

The leaked document, drawn up for the Association of Ambulance Chief Executives and dated 16 December, said NHS England had "explicitly stressed" the plans were confidential and "should not be disseminated beyond the group" involved in the discussions.

The document said there were existing plans for changes "after the general election" in May.

But it said Prof Keith Willett, head of acute care at NHS England, had made an "urgent request" for discussions due to "unprecedented demand" on health services - and the "target for implementing these changes was the first week of January 2015".

In an interview with the BBC, Prof Willett stressed nothing had been agreed but the proposals must be taken "very seriously".

He said the plans would be scrutinised, and only implemented if proved safe and following testing.

Analysis

By BBC home affairs correspondent Sally Chidzoy

A whistleblower leaked the memo to the BBC because of serious concerns over patient safety, fears the plans were rushed at the height of winter when the service is under unprecedented pressure and anger over the secrecy involved.

To many in the service, the general ideas are good - but there this concern it should have been a more thoughtful exercise where time was taken to consult widely and the public was involved in the process.

Paramedics say response times distort their ability to treat patients because they have to chase the clock.

They say some illnesses such as strokes, should be moved up a category.

The target for these changes was early January, according to the document, but it seems unlikely the proposals will now go ahead by then.

One ambulance service director, who asked not to be named, told the BBC: "This is being done for political expediency rather than patient safety and it's being done with the full blessing of Jeremy Hunt.

"This is being pushed through with limited consultation with the chief executives and the health service as a whole."

Professor Keith Willett, head of acute care at NHS England: ''We may well be able to give individual patients a better response''

Martin Berry, executive officer of the College of Paramedics, said he was not opposed to change but it could not be done "behind closed doors".

"There's been no effort to engage with the paramedic profession. We're just very concerned about the way this has been kept in the dark."

The College, which represents paramedics across the UK, said it would be discussing the proposals with AACE and NHS England and seeking to be involved in negotiations.

President of the College of Emergency Medicine, Dr Clifford Mann, said the proposals appeared "sensible" but they needed to be trialled to provide evidence to prove it was not a "cosmetic exercise".

Call types:

·      Red 1: Respiratory or cardiac arrest - response in eight minutes

·      Red 2: All other life-threatening emergencies, such as stroke and fits - response in eight minutes

·      Other response times are agreed locally

Ambulance trusts dealt with almost 8.5 million emergency calls in 2013-14 in England, an average of 16.1 calls per minute.

The national target is for ambulance trusts to reach 75% of Red 1 patients within eight minutes, and 95% within 19 minutes. The time starts as soon as an emergency call is connected.

Red 2 targets are currently the same, except that the "clock start" can be up to 60 seconds after a call is connected.

The changes proposed to Red 2 are:

·      A "small number" moved to Red 1 - those where a short extra wait "could have a potentially serious detrimental impact"

·      Just under half to keep the 75% within eight minutes target, but trusts will have up to three minutes from receiving a call before the clock starts

·      About 40% to have a 19-minute response target, as well as three minutes before the clock must start

The Red 2 category includes strokes and fits, but the document does not say which conditions would be put in each of the new categories.

It said the proposed changes could bring "substantial improvements".

The document also said trusts would be able to cut the number of fast-response cars being used in favour of deploying more double-crewed ambulances.

But it acknowledged the plans have not had the "breadth of exposure that would normally be expected".

'Full apology'

Mr Burnham said: "Jeremy Hunt was dragged before Parliament last Thursday to answer questions on NHS winter planning but treated [it] with contempt. It is outrageous that he decided to keep MPs and the public in the dark about a decision he had already taken and one which will have far-reaching implications across the NHS...

"This leak leaves Jeremy Hunt with extremely serious questions to answer. He must do so today."

He said if the health secretary did not have an "acceptable reason for withholding information" he should make a full apology to MPs.

Mr Hunt has not commented but the Department of Health said the health secretary "would only agree to proposed changes that improve response times for urgent cases".

The leak comes after it emerged on Friday that pressures in England's A&E units had hit record levels, with the lowest percentage of patients seen within four hours since monitoring began in 2010.

2

Ambulance Quality Indicators: Systems Indicators October 2013 - October 2014

 

 

 

 

 

 

 

 

 

 

Oct-13

Oct-14

 

 

 

 

Proportion of Red 1 calls responded

to within 8 minutes

change

 

 

England

74.6%

72.1%

-2.5

 

 

 

 

 

 

 

1

North East Ambulance Service NHS Foundation Trust

80.1%

65.9%

-14.2

 

2

London Ambulance Service NHS Trust

75.1%

64.1%

-10.9

 

3

South Central Ambulance Service NHS Foundation Trust

79.1%

70.4%

-8.7

 

4

Yorkshire Ambulance Service NHS Trust

79.3%

73.1%

-6.1

 

5

North West Ambulance Service NHS Trust

74.2%

71.2%

-3.0

 

6

Isle of Wight NHS Trust

83.3%

80.5%

-2.8

 

7

West Midlands Ambulance Service NHS Foundation Trust

77.6%

76.7%

-0.9

 

8

East of England Ambulance Service NHS Trust

74.3%

73.5%

-0.8

 

9

South East Coast Ambulance Service NHS Foundation Trust

75.9%

75.1%

-0.8

 

10

East Midlands Ambulance Service NHS Trust

69.0%

72.6%

3.5

 

11

South Western Ambulance Service NHS Foundation Trust

67.9%

75.1%

7.3

 

 

 

 

 

 

 

 

 

Oct-13

Oct-14

 

 

 

 

Proportion of Red 2 calls responded

to within 8 minutes

change

 

 

England

73.7%

69.8%

-3.9

 

 

 

 

 

 

 

1

London Ambulance Service NHS Trust

70.1%

57.5%

-12.6

 

2

North East Ambulance Service NHS Foundation Trust

79.8%

71.3%

-8.5

 

3

East of England Ambulance Service NHS Trust

68.2%

62.6%

-5.6

 

4

South Western Ambulance Service NHS Foundation Trust

77.2%

73.6%

-3.6

 

5

North West Ambulance Service NHS Trust

76.5%

73.7%

-2.9

 

6

South Central Ambulance Service NHS Foundation Trust

76.3%

74.4%

-1.9

 

7

South East Coast Ambulance Service NHS Foundation Trust

76.8%

75.1%

-1.7

 

8

Yorkshire Ambulance Service NHS Trust

74.0%

73.9%

-0.1

 

9

Isle of Wight NHS Trust

75.5%

75.9%

0.4

 

10

West Midlands Ambulance Service NHS Foundation Trust

72.7%

73.1%

0.4

 

11

East Midlands Ambulance Service NHS Trust

69.2%

72.2%

3.1

 

 

3  Clinical Quality Indicators replaced the 19 minute ambulance response time as follows: 

Service Experience Indicator – most, if not all, ambulance trusts already undertake patient satisfaction surveys. We are now asking them to go beyond simply reporting the results of such surveys, and ambulance trusts will be required to demonstrate and publish how they find out what people think of the service they offer (including the results of focus groups, interviews and patient forums, rather than simply patient surveys) and how they are acting on that information to continuously improve patient care.

Outcome from acute ST-elevation myocardial infarction (STEMI) indicator - STEMI is an acronym meaning "ST segment elevation myocardial infarction," which is a type of heart attack. This is determined by an electrocardiogram (ECG) test. We know that, for many conditions, your recovery will be more likely and quicker if you receive early treatment. Early access to reperfusion (i.e. where blocked arteries are opened to re-establish blood flow) and other assessment and care interventions are associated with reductions in STEMI mortality and morbidity. Measuring patient outcomes in this way will allow services to place performance in context and stimulate discussion on how to continually improve. 

Outcome from cardiac arrest: return of spontaneous circulation indicator – This indicator will measure how many patients who are in cardiac arrest (i.e. no pulse and not breathing) but following resuscitation have a pulse/ heartbeat on arrival at hospital. We recognise that providing resuscitation as early as possible to those in cardiac arrest is likely to improve the chances of recovery. Clearly, the higher the survival rate the better.

Outcome from cardiac arrest to discharge indicator – We know that the ambulance service play a vital role in saving patient’s lives, but it is important to understand the effectiveness of the whole system in managing those patients who are in cardiac arrest. We will know from the indicator above how effective the ambulance service was in responding to and treating patients in cardiac arrest when the ambulance arrives at the hospital – but what about after the patient is in the care of the hospital? That is why this indicator measures the rate of those who recover from cardiac arrest and are subsequently discharged from hospital as a patient outcome.  

Outcome following stroke for ambulance patients indicator – The Stroke: Act F.A.S.T campaign has been very successful in raising awareness to the public on the signs of a stroke (as well as TIA’s, Transient Ischaemic Attacks (or “mini-strokes”)), and we know that prompt emergency treatment can reduce the risk of death and disability. The campaign promotes that when a stroke strikes act F.A.S.T:

?        Facial weakness - can the person smile? Has their mouth or eye drooped?

?        Arm weakness - can the person raise both arms?

?        Speech problems - can the person speak clearly and understand what you say?

?        Time to call 999 for an ambulance if you spot any one of these signs.

This indicator will require ambulance services to measure the time it takes from that all important 999 call to the time it takes those F.A.S.T-positive stroke patients to arrive at a specialist stroke centre. We know that patients should be arriving at specialist stroke centres as soon as possible so that they can be rapidly assessed for thrombolysis, delivered following a CT scan in a short but safe time frame; this has been demonstrated to reduce mortality and improve patient recovery.

Proportion of calls closed with telephone advice or managed without transport to A&E indicator -  Ambulance trusts are exceptionally good at handling and responding to 999 calls. But calling 999 does not necessarily mean that a ‘blue light’ emergency response is the best one. Similarly, with ambulance staff becoming increasing skilled in treating patients at the scene even if an ambulance is sent, the front-line crew may be able to treat the patient then and there without the need to take them to an A&E department. On the other hand, alternative healthcare options, other than A&E, may be more appropriate for the patient.

This indicator should reflect how the whole urgent care system is operating, rather than simply the ambulance service or A&E, because it would reflect the availability and provision of alternative urgent care destinations and treatment of patients in the home. Knowing this will help improve urgent and emergency care services so that they offer the right treatment to patients in the right location at the right time.

Re-contact rate following discharge of care Indicator – if patients have to go back and call 999 a second time it is usually because they are anxious about receiving an ambulance response or have not got better as expected. Occasionally it may be due to an unexpected or a new problem.  To ensure that ambulance trusts are providing safe and effective care the first time, every time this indicator will measure how many callers or patients call the ambulance service back with 24 hours of the initial call being made. 

Call abandonment rate – the vast majority of people who phone 999 do so because they need to access emergency healthcare. If people do not get to speak to the ambulance service quickly they may hang up or try to receive the care they need elsewhere, for example turning up at A&E. This indicator will ensure that ambulance trusts are not having problems with people phoning 999 and not being able to get through so that 999. 

Time to answer calls – It equally important that if people/patients dial 999 that they get call answered quickly. This indicator will therefore measure how quickly all 999 calls that are received by the ambulance service get answered. The quicker the ambulance service answer the call, the quicker they can establish what is wrong with the patient so that the best type of response can be given. Answering the call quickly also provides reassurance to often very anxious and scared callers, who have called 999 because it is a real emergency. 

Time to treatment by an ambulance-dispatched health professional – it is important that if patients need an emergency ambulance response that the wait from when the 999 call is made to when an ambulance-trained healthcare professional arrives is as short as possible, because urgent treatment may be needed. 

Category A, 8-minute response time – In truly life-threatening situations, the speed of an ambulance arriving could help to make the difference between life and death. This indicator measures the speed of all ambulance responses to the scene of potentially life-threatening incidents and importantly measures that those patients who are most in need of an emergency ambulance gets one quickly.

 

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