Ambulance response times: the NHS’s falling house of cards

[摘要] The NHS is clear on how the health service should respond to an emergency: ‘... for life-threatening injuries and illnesses, specifically cardiac arrest. These will need to be responded to in an average time of seven minutes.’ 1 In an emergency that needs rapid assessment and treatment ‘such as stroke patients’, (what the ambulance services calls a Category 2 incident), the average ambulance response time should be 18 minutes.Unfortunately, as a recent report from the Nuffield Trust describes, ambulance response rates have deteriorated significantly since May 2021.2 Instead of 18 minutes for a Category 2 incident, the average response rate in June 2022 was 51 minutes.3 That is a long time to wait for an ambulance in stroke, heart attack, or sepsis where time is of the essence, especially when the best outcomes come from rapid interventional procedures to limit ischaemic damage.The wait times for Category 3 calls, which are classified as urgent but not life-threatening (such as an elderly person falling over at home) have suffered even further with an average wait time of over 2 hours and 50 minutes, with a 90th centile response standard of over 7 hours, substantially over the 2 hour target.2WHY IT MATTERS Ambulance wait times matter. Data from a German registry analysis demonstrated that each extra minute of ambulance wait time was associated with a 5% reduction in the probability of survival following an out of hospital cardiac arrest, results that have been replicated in a Swedish study that found shortening ambulance wait times was associated with a reduction in 30-day mortality.4,5The causes of these increased waits are complex and are a symptom of pressures within the NHS and social care system. Waits for social care mean it is difficult to discharge patients from hospital, which means there is a lack of hospital beds, which means that accident and emergency (A&E) staff can’t get patients out of their department, and, ultimately, paramedics queuing outside hospitals can’t hand their patients over to A&E staff.There is a strong correlation between ambulance handover delays and increasing ambulance response times.6 In the face of system pressures, staff on the ground have limited influence over social and community care, and alone are ‘unable to resolve the challenges relating to the discharge of patients to the right place of care’.

[学科分类] 卫生学