Ambulance service in need of a health check

People living in rural areas across Buckinghamshire, Hampshire and Oxfordshire are experiencing longer waits for ambulances than people living in urban areas.

That is the main finding of a special review of the performance of the South Central Ambulance Service (SCAS) in rural areas.

The review was carried out by councillors from Hampshire, Buckinghamshire and Oxfordshire County Councils. They found evidence of a two tier system in operation with ambulances likely to attend more quickly to emergency calls in urban areas than in rural ones in order to ensure that, on average, national target response times are met.

The review also heard evidence that there is a shortage of qualified paramedics and that best use is not always being made of the most experienced staff when deploying crews to attend patients. The report questions the current dispatch system querying how effectively it matches the most appropriate skilled staff and vehicles to patient needs.
Urgent action plan called for

The four month review heard evidence from a wide range of people including members of the public and NHS managers as well as ambulance staff. The Review Group is now calling for the South Central Strategic Health Authority and Primary Care Trusts, who commission ambulance services, to join forces with SCAS to produce an urgent action plan to address the inequities in provision. Members of the Review Group want a report on this work to be brought back to them by 31 March 2010.

Anna McNair Scott, chairman of Hampshire County Council's Health Overview and Scrutiny Committee and vice chair of the Joint Review Group, said:

"Ambulance services are a vital component of the NHS. They are, quite rightly, highly valued by the public. That is why it is essential that the commissioners work with the ambulance service to ensure it is better placed to meet the needs of all residents living in the South Central area. There is evidence to suggest that the pressure on the service to meet national standards and target times - the only measure of their performance - is having an adverse impact on those living in rural areas.

"Our review has found that an emphasis on fixed standard response times, regardless of patient outcomes, encourages the ambulance service to concentrate on achieving rapid response times in urban areas that mask under performance in rural ones."

Targets to reflect entire patient experience

The Joint Review Group is calling for the Secretary of State for Health to urgently review the national targets and ensure that they reflect the entire patient experience not just the initial response times to emergency call outs.

"Performance cannot simply be measured by the achievement of a specific response time. There is also a need to demonstrate the quality of care and the overall service to all patients",

said Councillor McNair Scott.

The Joint Review Group wants the Ambulance Service to be more accountable and for commissioners to take action to address local variations in performance. The Group's report acknowledges successful aspects of the service such as the involvement of firefighters and local volunteers and says better use should be made of these people who provide immediate reassurance and help before ambulance staff reach patients. However they should complement ambulance services and not be an alternative to them.
Call for better communications between cross-border services

The Review Group would also like to see improvements to cross-divisional and cross-border communications and support to enable crews to work outside their usual geographical areas when they are best placed to meet a patient's needs. The Group wants a progress report on this work by the 31 May 2010.

"There was some evidence to suggest it is often the nearest local vehicle rather than the most appropriately qualified crew which is deployed to attend a patient,"

added Councillor McNair Scott.

The Review Group will re-examine the performance of SCAS in 12 months time to see what progress has been made.

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