The new ambulance standards
In 2017, following the largest clinical ambulance trials in the world, NHS England implemented new ambulance standards across the country. According to NHS England, this was to ensure “the sickest patients get the fastest response and that all patients get the right response first time.”
Ambulance services are measured by the time it takes from receiving a 999 call to a vehicle arriving at the patient's location. Under the new system, all calls are triaged into four categories according to the patient's condition, which are detailed below. The 'clock' only stops when the most appropriate response arrives on scene, rather than the first.
Are the new standards being met?
Category 1 - Life-threatening injuries and illnesses
Category 1 calls include immediately life-threatening injuries and illnesses, for example, cardiac arrest, respiratory arrest and airway obstruction. The targeted response time for this category of call is 7 minutes on average and 90% of category 1 calls should be responded to within 15 minutes.
According to NHS England Ambulance Quality Indicators, following the implementation of the new standards, between April 2018 and March 2020, the average response time for category 1 calls fluctuated between a high of 8 minutes 7 seconds and a low of 6 minutes 31 seconds.
In May 2021, the average response time was 7 minutes 25 seconds, this was alongside an increase in the number of Category 1 incidents, whereby 67,982 were recorded. This is 50% higher than in May 2020 (when the number fell during the coronavirus pandemic) and 17% higher than in May 2019. The 90th centile target was, however, consistently met.
But by October 2021, the average response time for category 1 calls increased to 9 minutes 20 seconds and the 90th centile was 16 minutes 23 seconds. Neither the 7-minute average nor the 90th centile standards were met.
Category 2 - Serious conditions like Strokes and Chest pain
Category 2 calls include emergencies such as strokes and chest pain. The targeted response time for this category is 18 minutes on average and 90% of category 2 calls should be responded to within 40 minutes.
Between April 2018 to March 2020, both the average and 90th centile response time targets for category 2 calls were never met.
The 90th centile target was first met in April 2020 and the average target was first met in May 2020, when the average response time fell to 13 minutes 29 seconds. This came alongside a fall in the number of Category 2 incidents following the onset of the Covid-19 pandemic.
Since then, the number of Category 2 incidents has increased and in October 2021 the average response time was 53 minutes 54 seconds, and the 90th centile was 1 hour 56 minutes, which is significantly worse than the average targets set of 18 and 40 minutes!
Category 3 - Urgent calls
Category 3 is for urgent calls such as uncomplicated diabetic issues and these calls should be responded to within 2 hours, 90% of the time.
The average response time for Category 3 calls has fluctuated since the new standards were implemented.
Following the onset of the Covid-19 pandemic, response times fluctuated considerably. Between April and July 2020, Category 3 response times improved dramatically, with the fastest average response time of 29 minutes in May. This may be due to additional staff being brought in from other services and reduced traffic during the national lockdown.
Since then, response times have worsened overall and in October 2021, the average response time was just under 3 hours and 10 minutes. The 90th centile was just over 7 hours and 47 minutes, so the two-hour standard was not met.
Category 4 - Stable clinical conditions
Category 4 is for less urgent issues such as stable clinical conditions. These patients may sometimes be advised over the phone or referred to a GP or pharmacist. 90% of these types of calls should be responded to within 3 hours.
According to NHS Ambulance Quality Indicator Data, information relating to the response time for category 4 calls isn’t available for North West Ambulance Service after May 2021.
The remaining data however shows that an average response for category 4 calls in October 2021 was 3 hours 37 minutes and 90% of calls were responded to within just over 8 hours and 1 minute, the worst performance since the dataset began.
The data, therefore, suggest that the NHS is under increased levels of pressure and subsequently, ambulance response times are taking longer as the months progress, putting patients’ lives at risk
What is the cause of the ambulance delays?
The pandemic
Ambulance leaders have described the highest level of emergency activity in history this year. It is thought that the pandemic and the disruption it has caused to health care and everyday life, has meant the health of frail and vulnerable people has deteriorated, leading to more demand on services.
Hospital handovers
There are also concerns about the time lost to hospital handover delays. It is thought that these delays are partly due to the need to maintain social distancing in emergency departments, alongside the unprecedented pressures in the whole urgent and emergency care system due to the pandemic.
Lack of social care for patients who have been discharged
Hospitals report having problems discharging patients who are medically fit to leave but cannot because there is no social care available to support them in the community. This causes significant delays in admitting patients onto wards which can lead to long waits for ambulance crews arriving with patients.
Lack of investment
An overall failure to invest in the NHS and more specifically the ambulance workforce is also likely to be a significant cause for the delays, which includes the failure to recruit new paramedics, call handlers, and support staff.
What does this mean for the patients of NHS England?
Where there are delays in an ambulance arriving or in paramedics ensuring the right treatment is given, the effects on a patient’s health can be devastating, with lifelong consequences for them and their loved ones.
For example, if someone is in cardiac arrest, for every minute that they do not receive CPR and have a defibrillator used on them, their chance of survival decreases by 10%. Whilst CPR can be provided by a bystander, often defibrillators are not available until an ambulance arrives. Rapid ambulance response times are therefore lifesaving.
Another example would be a person who has suffered a stroke. They may require so-called “clot-busting drugs” to minimise the effects of the stroke. Evidence suggests that if this drug is not administered within 4.5 hours of the first symptoms of a stroke being identified, they are unlikely to be effective. Furthermore, the earlier the drug is administered, the less debilitating the effects of the stroke will be. Therefore, the urgency of getting an ambulance to the patient, diagnosing and getting them to a hospital where the “clot-busting drug” can be administered, is of paramount importance and will make a huge difference to the patient’s recovery and future.
Bringing a claim for clinical negligence due to ambulance delay
Where an ambulance service has accepted a call-out and dispatched an ambulance to the scene of an incident, a duty of care is owed to that patient. If they suffer an injury or die as a result of an unreasonable delay in responding, they may be liable to pay compensation. They will also be liable if negligent medical care or treatment is provided by the paramedics who attend.
If you feel that you might have a claim for medical negligence due to delays in receiving ambulance treatment, the negligent treatment provided, or for any other reason, please contact our team and we will be pleased to help.
Photo by Ian Taylor on Unsplash