Solving the Emergency: Improving Ambulance Response Times through Strategic Planning

After what seemed to be a potential recovery of ambulance response times in November 2022, the latest data release from NHS Digital shows that response times have taken a significant downturn, hitting the highest on record.

Since 2020 there has been a large increase in mean response times across all incident categories. C2 incidents (serious conditions that are not immediately life threatening, such a strokes and chest pain) have suffered the most with mean response times reaching 93 minutes in December 2022, 5 times higher than 18 minutes pledge time. Waiting this long for transport to care will have drastic impacts on a patient’s outcome, not just for life threatening issues, but also for urgent conditions needing acute care, such as C3 incidents that have seen their pledge time exceeded by 455%.

When breaking down these figures into regions in England, significant differences emerge, with C1 calls in the South West waiting an average of 13.2 minutes, 32% higher than North West and the Midlands’ average response time of 10 minutes. Despite diverting 68% of calls out of 999 (compared to 19% in November 2022) and allocating an extra 9,000 ambulances (a 45% increase) to attend C1 calls, only 2/3 of them arrived on site, meaning the other third was stuck elsewhere.

Ambulances mean response times by region, December 2022

What is behind this huge disparity across regions?

Calls to ambulances have seen a significant increase since the start of 2021, growing by 20% nationally. And although the total number of calls resulting in an ambulance being dispatched (an “incident”) have decreased, the proportion of incidents attributed to C1 calls has grown to 18% (from 9% in 2019) the total number of C1 incidents has increased significantly, up by 23% compared to last year (Dec 2021), and the number of C1 incidents has seen a sharp rise. This is particularly significant in the South West, where C1 incidents have nearly doubled since 2021, suggesting that patients are becoming sicker, not just more willing to pick up the phone.

The situation in the South West should not be seen in isolation, but rather as a premonition of what might be coming for other regions if resources are not planned adequately. The remoteness of locations in the South West should not be the main culprit in the rising ambulance times – pre-pandemic they were performing in line with other regions -, but rather evidence of the strain that population health factors place on acute and community services, and the need to plan accordingly.

On the one hand, the population of the South West is amongst the oldest in England, which naturally leads to higher levels of demand across the entire health as well as the social care spectrum. Our recent work with NHSE/I on demand for secondary care shows that significant planning is required to deal with the demand associated with ageing.

Issues with capacity and bed utilisation are on the other side: 6 out of 8 ICBs in the South West have average G&A bed occupancy of above 92% (the recommended maximum), well above the national average of 88%. Last week, 20% of their entire G&A bed capacity was taken up by patients who are medically fit for discharge.

Being unable to shift patients out of hospital results in A&E departments too busy to take handovers from ambulances. In December, the average time lost to ambulances due to delays in handover more than doubled – in fact, time lost due to delays in handover was the equivalent of 40% of the total time spent dealing with incidents.

C2 ambulance response times and G&A bed occupancy, England

A new NHSE delivery plan for recovering urgent and emergency care sets specific funding to both increasing capacity of beds, ambulances and same-day emergency care services (£1bn), speed up discharge (£1.6bn), with further mentions for growing workforce, expanding community services and tackling unwarranted variation that did not receive specific funding mentions.

This is a step in the right direction, though it will now be up to ICBs, once the funding has been streamlined, to figure out how this can be used most effectively. Too narrow a focus risks creating bottlenecks downstream, rather than solving the issue, and solutions will need to both address patient flow while targeting the whole pathway, spanning from community care to addressing workforce.

At Edge Health we are experts in using forensic data analysis to target new capacity to solve the flow problem, not just move it. In our experience, full-spectrum capacity planning is what enables effective use and distribution of resources, and we have supported trust-wide planning and reconfigurations that have enabled trusts to recover the 4-hour A&E target. To find out how we can help you, get in touch.