Patients ‘waiting in queues outside hospitals’

It can take more than 15 minutes for patients to be transferred between teams during an emergency, meaning ambulances are unable to attend other calls.

The study, from the National Audit Office (NAO), does praise a move by Health Secretary Andrew Lansley to cut the focus on ambulance response times.

While ambulances still have to respond to calls about immediately life-threatening conditions within eight minutes, a target introduced by Labour to respond to less immediate calls within 19 minutes was scrapped in April.

Yesterday’s report said: “Performance over the last decade has been driven by response time targets and not outcomes.

“The category A eight-minute response time target, which is one of the most demanding in the world, has served to focus action on improved outcomes for some immediately life-threatening conditions, and meet public expectations for a consistently fast response.

“Its existence in isolation from more direct measures of patient outcomes has, however, created a narrow view of what constitutes ‘good’ performance, and skewed the ambulance services’ approach to performance measurement and management.”

The study said services have been unable to track most patients after they arrive at hospital as ambulance and hospital information systems are not linked.

“Better measurement of outcomes will drive up clinical quality,” it said.

The report criticised the fact ambulance services and emergency care organisations have no clear set of common goals and are not well integrated.

It said: “Work remains to achieve cost-effective integrated emergency care.

“Over one fifth of patient handovers at hospital accident and emergency departments (the time taken from arrival at a hospital to handing over the responsibility for care to a hospital healthcare professional) take longer than the 15 minutes recommended in guidance.

“If ambulances are queuing outside hospitals they are not available to respond to other calls. There is also scope to reduce the time taken by ambulance crews from patient handover at the hospital to being available for their next job.”

The report identifies other inefficiencies in the system – for example, the cost per incident varies between trusts from £176 to £251.

There is also scope for some patients to be taken to minor injury units rather than A&E, it said.

If the 11 trusts adopted the best practice currently being used in at least one trust, this could save the NHS £165m a year, the study said.

Amyas Morse, head of the NAO, said: “The time taken to respond to calls has until recently been the be all and end all of measuring the performance of ambulance services.

“Illustrating the principle that what gets measured, gets done, the result has been a rapid response to urgent and emergency calls. However, this led to an increase in the number of multiple responses to incidents equating to millions of unnecessary ambulance journeys.

“It is welcome that the Department has now introduced new measures and a new broader performance regime but improvements to the whole urgent and emergency care system will depend on its working more coherently.”