Unprecedented efforts to meet tough response time targets may be diverting ambulance services from referring and treating more patients out of hospital.

Huge staff time and resources have been put into reaching 75 per cent of life-threatening emergencies within eight minutes of calls being connected, as has been required since April. Some trusts are not meeting the standard and others are still spending time and resources on it.

East of England Ambulance service trust, though meeting the response target, is still designated as under "special measures", and Yorkshire Ambulance service trust, which has not met 75 per cent recently, was last month seeking extra funding from its commissioners to help.

Suzanne Mason, reader in emergency medicine at Sheffield University, told HSJ: "Ambulance services are being restricted in terms of how they can develop their service. There is a need to have the skills that allow decisions to be made before patients are taken to hospital. [The focus on response times] is a huge problem in developing those clinical skills."

Association of Professional Ambulance Personnel spokesman Jonathan Fox said: "Everything is being driven by the eight minute target. Whatever way services want to improve, it is hampered by the focus on that response time. It takes everybody's effort to get there."

The 2005 Department of Health document Taking Healthcare to the Patient, as well recommending the introduction of call connect targets, said ambulance staff should have "competencies that enable them to assess, treat, refer or discharge an increasing number of patients".

Range of measures

Ambulance Service Network director Liz Kendall said services were not allowing response times to divert them from other work. But she added: "Response times are… not the only measure. We do want to move towards a range of measures of how we are performing."

These should include clinical and outcome standards, she said.

There are also concerns that ambulance services are not incentivised to assess and treat. North East Ambulance Service trust is developing a payment by results contract with its commissioners which it wants to implement locally in 2010-11.

Finance director Roger French said: "One thing we would like to talk about is getting an incentive for not taking a patient to hospital in appropriate cases," he said.

"If you [were paid] purely on distance, that might be in our best interest but would work against the stated aim. The tariff needs to recognise that and be constructed in such a way."