Transforming NHS ambulance services

Document type
Corporate author(s)
Great Britain. Parliament. House of Commons. Committee of Public Accounts
Date of publication
16 September 2011
House of Commons papers. Session 2010/12; HC1353
Health Services
Social welfare
Material type

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Ambulance services provide a valuable service that is held in high regard. Eleven regional ambulance services operate across England. In 2009-10, they handled 7.9 million emergency calls, and spent £1.5 billion on urgent and emergency services. Ambulance services are expected to make 4% efficiency savings year-on-year, in line with the rest of the NHS, at a time when public demand for their services continues to rise. Until 1 April 2011, the Department of Health measured the performance of ambulance services against three response time targets. These were introduced in 1996 to focus attention on improving basic standards and achieving consistency across the country. But the incentive to meet response time targets has led to some inefficiencies. For example, some ambulance services send more than one team to incidents, over-committing vehicles and staff. The report welcomes the Department’s decision to introduce a wider suite of health quality indicators to create a broader performance regime in which response times remain one indicator. There is wide variation in the cost of responding to an incident across ambulance services,which is underpinned by variation in a number of other factors, such as sickness absence,overtime and back office costs. Ambulance services need to produce more consistent performance data in order to benchmark and share best practice so that efficiency can be improved and variations reduced across the country. Under the NHS reforms, there is still a great deal of vagueness around who will be responsible for what in the new system. It is not clear who will be responsible for commissioning ambulance services, who will be responsible for improving efficiency across ambulance services, or who will intervene if a service runs into financial trouble or seriously underperforms. In the future, ambulance services will become foundation trusts and be directly accountable to Parliament, but it is not realistic for each ambulance service to be individually accountable to us for value for money. There needs to be greater clarity on the roles and responsibilities of the Department, commissioners and ambulance trusts, with appropriate structures for accountability to Parliament on value for money.

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