Ambulance response times

The Department of Health requires that the ambulance service reaches 75% of category A (life-threatening) calls within eight minutes. If onward transport is required a suitable vehicle should arrive on the scene within 19 minutes.

How has the proportion of Category A (Red 1 and 2) calls attended within 8 minutes changed?

Category A (Red 1 and Red 2) ambulance calls are those that are classed as life threatening and the national standard (A8) sets out that 75% of these calls should receive a response within eight minutes.

There has been a steady decline in the number of Category A calls attended within eight minutes over the past four years. In particular there was a substantial decrease in performance from March 2014 to December 2014, although some of the change around this period has been driven by London Ambulance Service (see the below chart 'How has the proportion of category A (red 1 and 2) calls attended within 8 minutes varied by commissioning region?'). Subsequent to this there has been some improvement but the national target of reaching 75% of Category A calls within eight minutes has been breached in 23 consecutive months, having not been met since January 2014.

How have the number of calls resulting in an emergency response changed over time?

The number of category A calls that result in an emergency response rose from 2.5 million in 2011/12 to over 3.1 million in 2014/15, an increase of 24%. Achievement of the target has declined over this period, which might indicate a link. For example, the sudden drop in performance in December 2014 is accompanied by a spike in activity during the same month. However, not all months experiencing falls in performance are associated with any sudden increase in call volumes. This suggests other factors are also influencing the ability of ambulances to meet their target of attending 75% of category A calls with 8 minutes.

Is the number of calls responsible for the standard breach in the month?

This can also be seen when you look at the national performance against the 8 minute target against the volume of calls. There does appear to be an inverse relationship between the total number of calls and the percentage that can be responded to within the eight minutes.

However, the total number of calls doesn't appear to be the sole reason for the breach of the national standard in a given month, as breaches are not always associated with increased call activity and increased call activity doesn't always result in a breach. Although there could be a tipping point where over 250,000 calls nationally leads to a national breach in the target.

Further investigation of what is happening to cause breaches would be needed, as it is not down solely to activity in response to ambulance calls that are classed as life-threatening.

How have trusts breaching the 8 minute target for Red 1 and 2 calls changed over time?

This graph shows that in most months when there is a breach of the eight minute response target nationally there is a corresponding breach in more than half of ambulance trusts. This suggests that breach of the national target is due to common factors across areas rather than just worse performance in a few outlier trusts.

How has the proportion of category A (red 1 and 2) calls attended within 8 minutes varied by commissioning region?

The proportion of category A calls attended within eight minutes varies at the regional level in a similar manner to the national level, although London has a tendency to more extreme peaks and troughs. There have only been three occasions since April 2014 where an area has achieved the target of attending 75% of Category A calls within eight minutes. London's performance encountered a particularly challenging period since April 2014, going below 50% in December 2014. In December 2015 Midlands and East became the first region to perform worse than London in any given month since April 2014.

How has the proportion of category A calls attended within 19 minutes changed?

The Government requires that when onward patient transport is required in a life threatening situation an ambulance should arrive on scene within 19 minutes.

As with the eight minute target, there has been a steady decline over the past four years in the proportion of Category A calls with an ambulance on scene by 19 minutes. In particular, there has been deterioration in performance across all regions since March 2014. London was consistently the best performing region until March 2014, followed by a substantial drop in performance, going below 85% in December 2014. Performance did recover after this month, however performance remains below the target and since June 2015 no regions has manged to reach the target.

About this data

NHS England measures response times for ambulances as patient outcomes can be improved by ensuring patients with immediately life-threatening conditions receive a defibrillator and timely response to ambulance calls.

Ambulance calls that are classed as life threatening are categorised as Category A calls. From June 2013 these were further separated into Red 1 and Red 2 calls.

  • Red 1 calls are the most time critical and cover cardiac arrest patients who are not breathing and do not have a pulse, and other severe conditions.
  • Red 2 calls are serious but less immediately time critical and cover conditions such as stroke and fits.

Response time commitments are set out in the NHS 2010/11 Operating Framework as:

  • A8: 75% of Category A (immediately life threatening) calls should receive a response within eight minutes.
  • A19: if a Category A patient requires transport, this should arrive within 19 minutes of the request for transport being made, 95% of the time.

For the purposes of the A8 standard, an emergency response may only be by:

  • An emergency ambulance; or 
  • A rapid response vehicle equipped with a defibrillator to provide treatment at the scene; or
  • An approved first responder equipped with a defibrillator, who is accountable to the ambulance service; or when a healthcare professional is at the location of the incident, equipped with a defibrillator and deemed clinically appropriate to respond by the trust.

Further guidance can be found at NHS England, Ambulance Quality Indicators.

Comments

It would be interesting to correlate these results with the number of ambulance unit hours being produced nationally and by each trust over the same time series.

Ambulance trusts, in common with all other NHS trusts, have had to build, since 2011, towards an annual CIP of 17%-20%.

Average annual growth in the NHS budget has fallen from 4% (1948-2010) to 0.7% (2011-2016). Hospital CIP and deep cuts in adult social services have led to inability to discharge vulnerable adults and, in turn, to huge growth in ambulance handover times at EDs.

The prolonged freeze on NHS staff pay has squeezed both nurses and paramedics out of the system. For the first time in my 42 year career, there is a national shortage of paramedics.

Alan Murray (not verified)
(changed )

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