Carter sets out £500m emergency care efficiency opportunity

NHS productivity champion Lord Carter’s report said £300m a year could be saved by cutting unnecessary ambulance transfers to hospitals and a further £200m through more efficient operating models.

But the review also raised fundamental questions over the need for significant investment in the ambulance sector by laying bare how overstretched it was, both in terms of its staff and its fleet, and calling for digitalisation as a matter of priority.

Staff reported the highest sickness and bullying rates in the health service. And the NHS’s emergency vehicle fleet is estimated to need 3,300 new vehicles over the next five years, significantly more than planned for, the review said.

Moreover, providers warned that at least some of the savings would be offset by higher costs for other parts of the system.

The review also estimated the financial impact of ambulance handover delays. It said the delays – usually down to issues within the hospital with ambulances left queuing outside the emergency department – cost the NHS £50m last winter.

On avoidable transfers, it said by upskilling paramedics to treat more patients at the scene and by better integration with, and signposting to, other services, conveyance rates could be significantly reduced.

The report said: “The NHS should work together to ensure there are suitable, alternative patient services with the aim that all ambulance trusts should reduce the average rate of ambulance transfers to A&E from 58 per cent to 50 per cent.”

No ambulance trust is currently hitting the 50 per cent target. The best performer is not far off – South West Ambulance Services, achieved 52 per cent between January and July this year. North West Ambulance Service was the worst, recording a 64 per cent conveyance rate during the same period.

Other recommendations included:

• Digital patient records paramedics can access on scene needed across the sector
• A standard ambulance model to increase purchasing power. There were 32 different double crewed ambulance models in the NHS, the review said
• More efficient operating models could deliver £200m savings a year by 2021
• Standard lists for what ambulances should carry on board.

The Association of Ambulance Chief Executives welcomed the review, and especially its focus on the need for a major technology upgrade.

AACE managing director Martin Flaherty said in a statement: “We welcome Lord Carter’s report, which emphasises the adoption of new technology and innovation within the ambulance service as a key driver for reducing conveyance rates to hospitals.

“Whilst we accept there are variabilities in the numbers of patients conveyed to emergency departments in each region, this is often driven by local geography, patient demographics and the availability of clinically appropriate referral pathways.”

NHS Providers said rising demand was outpacing funding increases and the paramedic shortage was “unsustainable”. It welcomed the focus on driving down unavoidable conveyances.

“Reducing unnecessary trips to hospitals in ambulances could save money, but it will require investment in other areas, for example in primary care, mental health and community services or social care,” deputy director of policy and strategy at NHS Providers, Miriam Deakin, said.

She added: “Underpinning this is a workforce at full stretch. Sickness levels across ambulance staff are some of the most severe [in the NHS]. The significant shortage of paramedics is unsustainable and must be tackled if we are to address these pressures. We need to ensure staff feel valued and supported.”

The review did acknowledge that ministers had recently announced funding for the ambulance fleet. In June, the Department for Health and Social Care announced a £36.3m investment to support trusts which included funding for 256 new ambulances.

Ambulance trusts have already planned to purchase or lease 2,600 vehicles over the next five years. However, the review concluded the amount required was closer to 3,300.