Handover guidance expected as ambulance services face challenges

What’s the problem?

Ambulance services are facing a multitude of challenges, of which delays on the handover of patients to hospitals are among the most prominent. Next week the Ambulance Service Network will issue guidance and highlight good practice on reducing delays.

‘Some areas have introduced penalties for long waits to handover patients – although there is little evidence that solves the problem’

Some areas have introduced penalties for long waits to handover patients – although there is little evidence that solves the problem. NHS Norfolk and Waveney is looking at penalties but also treating long delays as potential serious incidents, sparking investigations and, it hopes, actions.

• Read an in-depth analysis of ambulance trusts’ performance

That does not sound too serious…

On its own it’s not – not all regions are badly affected by delays and they often occur only at points in the day or week. Certain hospitals seem to have a particular problem. But the handover issue is indicative of pressure throughout the emergency care system and what Ambulance Service Network chair Heather Strawbridge calls a “relentless rise” in demand.

Dealing with that rise is the big issue for most trusts. There is concern – not universally shared – that the rollout of the NHS 111 non-emergency number will add to the pressure. Pathway changes for stroke, cardiac and major trauma patients impact on ambulance services – as will the reconfiguration of children’s, maternity and accident and emergency services. 

And there is apprehension about the coming winter: some services are already missing national targets around emergency response time on a monthly basis.

So what are ambulance services doing to ensure they hit these targets?

Plenty – but it is not always popular with public, politicians and their own staff. In the East Midlands many ambulance stations could close, with staff based at larger hubs and then using tactical deployment points in the community.

This proposal – together with other actions – will make it easier to hit the crucial A8 and A19 performance targets, it says.

In the East of England, a massive project to match supply of ambulances with demand across the region and across the week has run into difficulties, and an independent review of capacity has been ordered. In London, a demand management programme shifts resources to deal with the most urgent calls – but this can mean other people wait longer. There are concerns about clinical risks with this.

What about less urgent cases?

How patients who call an ambulance but do not need to be taken to an A&E are dealt with could have massive ramifications for the whole NHS. Ambulance services are moving towards “hear and treat” and “see and treat” for these patients which is crucial if they are to be kept away from A&E.

So what does the future hold?

In the immediate future ambulance services are keeping their fingers crossed for a mild winter to ensure A8 and A19 performance is kept up. In the medium term, the Ambulance Service Network guidance may help address some of the handover issues and some of the work being done around the country – however painful – should help them cope with the increasing pressure.

A majority of ambulance services will also have one eye on their bids for foundation trust status and the impact poor performance has on that. Longer term, emergency response will remain the core of their portfolio but what “add-ons” – NHS 111, out of hours, patient transport – they provide is likely to vary from region to region. It could be determined by what role clinical commissioning groups want them to play.