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Ambulances target times for some patients could be lengthened
Ambulances target times for some patients could be lengthened
(about 1 hour later)
Labour has stepped up attacks on the health secretary, Jeremy Hunt, after it emerged that target times for ambulances to reach some seriously-ill patients could be lengthened.
Labour has accused the government of panic measures after a leaked NHS document revealed plans to lengthen ambulance response times for seriously ill patients.
A leaked document includes plans to change the response time for some Red 2 patients – those with “serious but not the most life-threatening” conditions – from eight to 19 minutes in England.
The leaked document, drawn up by the Association of Ambulance Chief Executives and dated 16 December, includes a proposal to change the response time for some “Red 2” patients – those with “serious but not the most life-threatening” conditions – from eight to 19 minutes in England.
It said the proposals have been approved by Hunt, subject to confirmation from the medical directors of 10 ambulance trusts.
The plans come as ambulance services struggle to cope with increased demand, reflecting pressures across the whole NHS in general, but particularly now in winter with illnesses such as flu and norovirus on the rise.
The Department of Health said “no decisions have been made” and Hunt would only agree to plans that improve response times for the most urgent cases.
“This looks like a panic measure,” Andy Burnham, the shadow health secretary, told Sky News. “The government is rewriting the rules and moving the goal posts during the winter… without proper debate or proper consultation.”
The current target is for an emergency vehicle to reach those in life-threatening situations within eight minutes.
Unions were also quick to raise concerns, demanding to see the clinical evidence for changes, which they said could put lives at risk.
According to the leaked memo, drawn up by the Association of Ambulance Chief Executives, NHS England has agreed in principle to relax the maximum ambulance wait for some Red 2 incidents, which include a range of serious problems including strokes and seizures.
“What they are doing is highly dangerous – instead of admitting that there is a serious problem in ambulance and emergency care and putting solutions in place,” said Rachael Maskell, head of health at the Unite union, who argued that cuts in social care and other parts of the NHS, along with fragmentation and privatisation have put increased pressure on emergency services.
The only higher category is Red 1 – immediately life-threatening incidents such as cardiac arrest, choking and major bleeding.
The NHS says pressures on ambulance service reflect pressures across the whole system.
The changes would see about 40% of Red 2 incidents move to a 19-minute response target while the proposed date for implementing the plans is the first week of January, the report states.
“Staff at ambulance trusts are already working at a high level of intensity treating a greater number of urgent and emergency patients year on year, providing high quality and safe care. We know the number of people visiting A&E is increasing as there have been 550,000 more A&E attendances overall so far in 2014 compared to the same number of weeks in 2013,” said Heather Strawbridge, chair of the south western ambulance service.
Andy Burnham, Labour’s shadow health secretary, wrote to Hunt on Sunday to demand immediate answers on the plans and ask why parliament was “treated with contempt” three days after he signed them.
She pointed out that pressures on ambulance services are growing each year – 25% over past five years – and ambulance trusts are working differently, together with other NHS providers, to maintain high quality care.
He said: “Jeremy Hunt was dragged before parliament last Thursday to answer questions on NHS winter planning but treated it with contempt. It is outrageous that he decided to keep MPs and the public in the dark about a decision he had already taken and one which will have far-reaching implications across the NHS.
Clifford Mann, president of the College of Emergency Medicine, said the proposals were in large measure a pragmatic response to an enormous number of responses which did not really correspond to that much of an increase in very severe illnesses and injury. But he criticised the way the proposals had emerged.
“Patients are already waiting hours on end for ambulances to arrive. People will struggle to understand how, in the middle of a crisis, it makes sense for the government to make a panic decision to relax 999 standards and leave patients waiting even longer.
“The first I have heard of them is today. I think that any change, for it to be credible, needs to be tested,” he told BBC Radio 4’s The World this Weekend. “I would have thought the sensible thing to do is to pilot this either for a period of time or in a number of different areas and to be able to produce data which compares with the same area or the same period last year.”
“This leak leaves Jeremy Hunt with extremely serious questions to answer. He must do so today.
In an indication of the pressure on ambulances, London Ambulance Service last week asked for help from paramedic teams from the rest of the country because of increased demand. The appeal followed its busiest ever week with 11,008 call outs for the most seriously ill and injured. Despite increased demand, LAS has more than 400 vacancies as it struggles to recruit people. As demand surges, LAS is missing response targets.
Burnham added: “The NHS is in a dangerous position and crying out for leadership. Jeremy Hunt must start providing it or make way for someone else who will.
Under the current system, calls are categorised as Red 1 or Red 2. Red 1 covers life threatening illnesses such as heart attack, trauma, serious bleeding. The national target is 75% of all Red 1 patients must be reached in eight minutes and 95% must be reached within 19 minutes. Red 2 targets are currently the same, except that the “clock start” can be up to 60 seconds after a call is connected.
“Labour has been warning the government all year about the growing crisis in A&E but it failed to act.”
The changes proposed in the leaked document are to move a “small number” of Red 2 categories - those where a short extra wait “could have a potentially serious detrimental impact” - to Red 1. The other proposal – and this is where concerns have arisen – is to give ambulance services more time to assess Red 2 calls.
A Department of Health spokesman said: “We have given ambulances an extra £50m this winter to ensure the service remains sustainable and the secretary of state agreed that NHS England should investigate a proposal from the ambulance services themselves to see whether the service they offer the public could be improved.
Under the proposed changes, just under half of Red 2 calls will keep the 75% within the eight-minute target, but trusts will have up to three minutes from receiving a call before the clock starts. It means ambulances will have a total of 11 minutes to reach a Red 2 patient rather than nine. It is also proposed that about 40% – instead of the current 95% – of Red 2 calls will have a 19-minute response target.
“No decisions have been made and the secretary of state would only agree to proposed changes that improve response times for urgent cases.”
A Department of Health spokesperson said: “This government has absolutely no plans to double ambulance wait times. We have given ambulances an extra £50m this winter to ensure the service remains sustainable and the secretary of state agreed that NHS England should investigate a proposal from the ambulance services themselves to see whether the service they offer the public could be improved.
Prof Keith Willett, trauma surgeon and head of NHS acute care, said: “Any operational changes to ensure ambulances reach the sickest patients even quicker would need to be proposed by the senior doctors running ambulance services and agreed by the NHS nationally.
“No decisions have been made, and the secretary of state would only agree to proposed changes that improve response times for urgent cases.”
“No such decisions have been taken on their proposals, nor will they be – one way or the other – until next year.”
Mr Hunt tweeted about the Mail on Sunday’s frontpage headline about the proposals – “Secret plan to double ambulance wait times”.
He posted: “Categorically refute scaremongering MoS headline - no plans to double ambulance waiting times, and there never have been.”
Tony Hughes, the GMB union’s regional officer for the ambulance service in London and east of England, said: “These proposals are ridiculous. They will only serve to bring worse outcomes for patients. The proposals are clearly motivated to the runup to the general election so that the Tories can show that the ambulance services are meeting their targets which is so far from the truth.
“If these plans go ahead we will see more people die from conditions that can be treated given the right resource is with them in good time.
“The whole of the A&E structure is at breaking point due the changes this government has already made.”
But Dr Clifford Mann, president of the College of Emergency Medicine, said of the plans: “I think in large measure they are a pragmatic and sensible way forward because we have seen an enormous number of increases in ambulance dispatches in the last two years which don’t really correspond to that much of an increase in very severe illness and injury.
“I don’t think the document is suggesting there should be a complete change of the Red 2 category, which is moving from eight minutes to 19 minutes, it will be dependent on the clinical assessment made by the call handler.”
However, Mann criticised the way the proposals had emerged, telling BBC Radio 4’s The World this Weekend: “The first I have heard of them is today. I think that any change, for it to be credible, needs to be tested.
“I would have thought the sensible thing to do is to pilot this either for a period of time or in a number of different areas and to be able to produce data which compares with the same area or the same period last year.
“That way you will be able to have firm evidence that reassures the public that this isn’t simply a cosmetic exercise.”
Martin Berry, executive officer for the College of Paramedics, told the programme the recommendations had come “out of the blue”.
“There has been no effort to engage with the paramedic profession, we are very concerned about the way this has been kept in the dark,” he said.
He added the targets needed to be addressed “openly, honestly and with evidence, it can’t be done behind closed doors”.
