• Just over a quarter of CCG areas hitting 18-minute target for category two calls
  • Many poorly performing areas in rural STPs but some more urban STPs also did poorly
  • HSJ also finds high levels of variation within STPs

There is significant variation in ambulance response times to patients with serious conditions such as suspected strokes or heart attacks, which is not fully explained by how rural an area is, an HSJ analysis has revealed.

The exclusive analysis represents the first time ambulance performance for category two calls, which have an 18-minute response time target, have been broken down to clinical commissioning group level.

The findings — described as “alarming” by the Stroke Association — lay bare the incredibly long waits which are usually hidden, because average waiting time data is usually published for ambulance trusts, which cover far larger areas than CCGs.

The analysis, which looked at data from April and September last year, found, for example, that 10 per cent of callers in one area — Lincolnshire East — had to wait nearly an hour and a half for a category two call.

Category two, known as emergency calls, covers a wide range of conditions, including suspected stroke and heart attacks (except cardiac arrests), major burns and epileptic seizures. They account for well over half of ambulance responses.

Overall, just over a quarter of CCG areas were hitting the 18-minute target between April and September last year. The shortest average response time was 10:13 minutes in Walsall CCG and the longest was 42:33 minutes in Lincolnshire East.

The analysis also reveals one in 10 patients waited more than an hour for an ambulance in 27 CCG areas.

STP level performance varies

Performance also significantly varies at sustainability and transformation partnership level. While many poorly performing areas were in rural STPs — such as those covering Lincolnshire — some more urban STPs did poorly as well.

In Mid and South Essex STP, all five CCGs had average times of more than 26 minutes, placing them in the bottom quartile of all CCGs. Mid Essex CCG, which is based in Chelmsford, had an average wait time of 33:24 minutes, putting it in 186th place out of 192 commissioning groups.

Other poorly performing urban or semi-urban CCG areas included East and North East Hertfordshire (176th), Sunderland (172nd), Newcastle Gateshead (171st), Bolton (168th) and Darlington (167th).

Variation within STPs was also noticeable, with patients in some CCG areas facing waits twice as long as others in the same regions.

Patients in Hull waited an average of 14:52 minutes for a category two ambulance while those in North East Lincolnshire, also part of Humber, Coast and Vale STP, waited 33:02 minutes.

In Sussex, patients in Brighton and Hove waited an average of just 11:07 minutes while those in neighbouring High Weald Lewes Havens waited 23:52 minutes.

90th percentile exposes long waits and variation

The main average response time target for category two calls is 18 minutes, but there is a secondary part of the standard which is for 90 per cent being responded to within 40 minutes.

Performance at the 90th percentile — the point at which 90 per cent of callers will have been reached — shows even greater variation between areas and within STPs.

Ten CCG areas covered by East Midlands Ambulance Service Trust had 90th percentile times of more than an hour, while six served by the East of England Ambulance Service Trust had similar times.

In contrast, four ambulance services had no CCG areas with 90th percentile response times of over an hour — London Ambulance Service Trust, West Midlands Ambulance Service Foundation Trust, South Central Ambulance Service FT, and South East Coast Ambulance Service FT.

In Lincolnshire, five CCG areas were in the top 10 of longest waits and none of the county’s CCG areas had a response time of less than an hour at the 90th percentile.

Once again, there were some surprising results with some relatively urban areas with poor performance such as Mid Essex (90th percentile performance at 1:06:41), Leicester City (1:04:28) and Thurrock (1:01:34). Areas such as Newcastle and Gateshead, and Sunderland also had performance of more than an hour.

South East Coast Ambulance Service FT — which struggled in some areas with average category one response times — generally did well against the 90th percentile for category two, with no CCG areas hitting 50 minutes.

Category two calls include suspected strokes, where many patients are now taken to hyperacute stroke units.

Mark MacDonald, deputy director of policy at the Stroke Association, said: “It is alarming to hear that in some cases ambulance staff are taking over an hour to reach patients because when it comes to stroke, being assessed quickly and then, if necessary, transferred to hospital, is really important.”

Challenges, staff shortages and handover delays

In a statement, Humber, Coast and Vale STP said: “Partners across Humber, Coast and Vale are working together to improve performance against these targets across our diverse mix of rural and urban areas. This includes looking at changes to the whole system that will support continued improvements in the future. We are committed to working together to improve the health and wellbeing of the whole population of Humber, Coast and Vale.”

A statement from the Sussex CCGs said: “During this financial year, we have invested significant additional funding into the ambulance service to meet increased demand. Our ambulance trust is working extremely hard to respond to calls to ensure patients get the care they need as quickly as possible.

“However, we recognise there are challenges around the response times for ambulances across rural communities and we are working with the lead commissioner for the service in Surrey and SECAmb to fully understand how this can be improved.”

East of England Ambulance Services Trust said in a statement: “We are committed to improving our rural response times using a range of initiatives, including reviewing the times that ambulances are working and the number of ambulances we provide at busier times.

“We have increased our overall staffing numbers across the area, which means that more ambulances and rapid response vehicles are now on the roads, and are working with NHS partners to reduce hospital handover times.

“In some areas our recruitment need is higher and can affect our ability to respond to patients. We continue to work on closing this gap. We have also undertaken rota changes to meet patient needs and we will be evaluating this in due course.”

South Western Ambulance Service Trust said it was facing unprecedented demand which had continued for many months. It had invested in more ambulances and 150 extra frontline staff and planned further recruitment.

A spokesman said: “We are continuing to respond to our category nine patients within the national target of an average of seven minutes. This is a considerable achievement for any service, but particularly given the very rural nature of the South West.

“We are also striving to improve our performance for all other categories of calls including category two to ensure all our patients receive the right care. In the vast majority of cases where an ambulance cannot be sent as the first response to a patient, a rapid response car with a paramedic is deployed and on scene within 15 minutes, treating the patient.”

East Midlands Ambulance Service Trust stressed the impact of hospital handover delays on its performance, despite the additional staff and vehicles it had invested in.

Ben Holdaway, director of operations, said: “Every part of the local health and care system wants to tackle these issues, and is working together to do that, but it’s clear that the NHS will need more staff and beds, and a well-functioning social care service, if we’re going to meet the needs of our growing and ageing population over the coming years.”

North East Ambulance Service also said patient handovers contributed to slower response times, together with high demand and the impact of seriously ill patients. It was looking at what it could do to reduce the waits experienced by some patients and had introduced specialist teams to respond to patients with certain conditions.

CCGs with performance over one hour at 90th percentile

CCGPerformance at the 90th percentile

Lincolnshire East CCG

1:26:38

South Lincolnshire CCG

1:15:21

North East Lincolnshire CCG

1:12:38

Kernow CCG

1:10:54

East Leicestershire and Rutland CCG

1:09:45

Somerset CCG

1:09:12

North East Essex CCG

1:09:04

North Lincolnshire CCG

1:08:29

South West Lincolnshire CCG

1:08:20

Mid Essex CCG

1:06:43

Wiltshire CCG

1:06:30

West Leicestershire CCG

1:06:12

Durham Dales, Easington and Sedgefield CCG

1:06:07

West Essex CCG

1:05:45

Lincolnshire West CCG

1:05:35

North Tyneside CCG

1:04:57

Leicester City CCG

1:04:28

Bolton CCG

1:03:42

Newcastle Gateshead CCG

1:03:15

Darlington CCG

1:03:96

Dorset CCG

1:03:00

Castle Point and Rochford CCG

1:02:54

East and North Hertfordshire CCG

1:02:46

Sunderland CCG

1:02:18

Thurrock CCG

1:01:34

South Sefton CCG

1:01:28

Bassetlaw CCG

1:00:56

 STPs with the greatest variation in average category two performance between CCGs

STP and variation — slowest as multiple of fastestBest performing CCG (average)TimeWorst performing CCG (average)Time

Humber, Coast and Vale

2.17

Hull

14:52

NE Lincs

33:02

Sussex Health and Care Partnership

2.12

Brighton and Hove

11:07

High Weald Lewes Havens

23:52

Cumbria and North East

1.95

North Cumbria

16:17

Durham Dales, Easington and Sedgefield

31:46

Bedfordshire, Luton and Milton Keynes

1.87

Milton Keynes

13:55

Bedford

25:23

Hampshire and the Isle of Wight

1.80

North Hampshire

14:02

Isle of Wight

25:19

Healthier North East Lancashire and South Cumbria

1.63

Morecambe Bay

17:49

West Lancashire

28:47

Our Healthier South East London

1.59

Southwark

14:55

Bexley

23:09

Norfolk and Waveney

1.57

Norwich

17:48

North Norfolk

27:39

Staffordshire and Stoke on Trent

1.56

Stoke on Trent

11:09

North East Staffordshire

17:27

Shropshire and Telford and Wrekin

1.53

Telford and Wrekin

13:08

Shropshire

20:00

Distance not always factor in ambulance response times