On the day briefing: NHS operational productivity: unwarranted variations in ambulance trusts
This briefing provides a summary of the key findings and recommendations of Operational productivity and performance in NHS Ambulance Trusts: unwarranted variations. The review, led by Lord Carter, has been produced following engagement with all 10 ambulance trusts in England. It focuses on ambulance services, which account for £2.3bn of NHS spending each year. The report also considers other services such as 111 and patient transport services, which are often run by ambulance trusts, in the context of their impact on urgent care services.
- The focus of the report is on reducing the numbers of patients being taken by ambulance to accident and emergency (A&E) departments. The Carter team has found variations in the rates of conveyance between trusts which it describes as unwarranted.
- Reducing avoidable conveyances to hospital could release capacity worth £300m in the acute sector, the report states. However it also acknowledges that in order to make those savings, alternative services that better meet patients’ needs will need to be put in place. It does not calculate the cost of establishing these additional services.
- There are three structural problems with tacking to reduce conveyance rates and improve patient experience: access to GP and community services; establishing urgent treatment centres in all sustainability and transformation partnership (STP) areas; and reducing ambulance handover delays.
- The report states that demand for ambulance services has risen in the past five years, and that the service’s overall productivity has increased in response. However, trusts have improved at different rates, and there are significant differences in productivity between providers. Eliminating these could yield £200m in savings, it estimates.
- Productivity opportunities exist in three main areas: staffing, particularly improving engagement and reducing sickness rates; better use of technology; improved fleet management, including nationally-coordinated procurement for vehicles and equipment.
- Although questions were raised over whether ten ambulance trusts is the right configuration, the review concludes “now is not the time” to attempt to address this issue. Trusts should instead focus on moving towards a common infrastructure and operating model.