Of the 12 ambulance trusts in England, only London, the North East, the West Midlands and the Isle of Wight trusts are reaching 75 per cent of the major emergency calls within eight minutes.
Decade-old changes to GP working hours – where most GPs do not work late shifts or at weekends – continue to have an effect, pushing patients into hospitals. Patients end up in A&Es, even though many – particularly those brought from nursing homes – could be better treated by GPs if they had been left where they were.
Evidence collected by the King’s Fund shows that fully trained paramedics help ease delays in A&Es and cut the time patients stay in hospital.
“What a skilled paramedic can do in an ambulance now is most of what we spent the first 30 minutes doing in A&E 10 or 15 years ago,” says Prof Keith Willett. Paramedics are being encouraged “to see and treat” patients, but not bring them to hospitals, unless necessary.
Since 1999-2000, the number of hospital journeys per 100 call-outs has fallen by a tenth.
In the West Midlands, 58 per cent of people who call out ambulances are actually brought by one to hospital – compared to 70 per cent 15 years ago.
However, paramedics must be given more information about patients if they are to be able properly to treat people at the scene, says Anthony Marsh, chief executive of the West Midlands Ambulance Service. Staff must be “able to pull down useful and critical information about a particular patient”.
Sometimes, the NHS Ambulance Service is short of ambulances; sometimes it is short of the paramedics needed to send them out. In Nottingham, over the last six months of figures, ambulances were left idle for up to 12 hours at a time for 4,000 shifts because of shortages. Often, the problem is not money.
