Urgent and Emergency Services
Across the country, we’ve seen a significant increase in demand for ambulance services over the year, which has been problematic as a result of both increased staff absence, particularly as a result of COVID-19 and rising handover delays at hospitals. This resulted in extended response times beyond our expectations. In recent months (Feb – Apr 2022) 18.78% of our ambulances had been delayed for over one hour in handing over our patients, rather than the 15 minutes national target.
We continued to deliver our services through integration with our wider health and care colleagues across the region and a strategically co-ordinated approach. This past year saw our service respond to 999 emergency service delivery as we have never seen before.
999 Emergency Calls
We received 1,040,424 calls to our Ambulance Operation Centres last year which was 253,208 more than the year before. 2021 marked the busiest year on record in the NHS for the number of 999 calls.
All 999 emergency calls are answered by our dedicated call handling colleagues in any one of our three Ambulance Operation Centres. We have automated built in resilience and flexibility where if all the call handlers in one centre are already on 999 calls, the next call will automatically divert to an available call handler in another one of our centres.
Of the 806,061 incidents we attended, 11.6% of these (93,479) were categorised as the highest priority, immediately life threatening, and the vast majority, 65.7% (529,650) were our second highest category. That was over half a million very unwell patients our front line colleagues attended last year.
The national standard for responding to the sickest patients is an average of 7 minutes and we aim to attend to 9 out of 10 of them within 15 minutes. All ambulance trusts in England are measured against ambulance quality indicators, including standards on how quickly patients receive a response following their 999 emergency call.
The table (below) provides detail on each of the main response categories along with the national standard, as well as our performance over the year.
In our region we responded to our sickest patient in an average of 9 minutes and 50 seconds, and to 9 out of 10 of them in under 18 minutes and 22 seconds.
|
Category |
Response |
Target Average Response Time |
EEAST Response Time |
|---|---|---|---|
|
1 |
An immediate response to life threatening condition, such as cardiac or respiratory arrest |
7 minutes |
9 minutes 50 seconds |
|
2 |
A serious condition, such as stroke or chest pain, which may require rapid assessment and/or transport |
18 minutes |
45 minutes 42 seconds |
|
3 |
An urgent problem, such as an uncomplicated diabetic issue, which requires treatment and transport to an acute setting |
2 hours |
2 hours 19 minutes |
|
4 |
A non-urgent problem such as stable clinical cases, which requires transportation to a hospital ward or clinic |
3 hours |
2 hours 49 minutes |
We were able to find alternative care pathways for approximately 9.69% of cases through our ‘hear and treat’ service. This team of senior, experienced clinicians are based in our Ambulance Operation Centres. Their role is to review the case, speak to the patient, and find them an alternative solution to help them. This could be a pharmacist, a GP or another alternative patient pathway available in the community.
Responding to an emergency 999 call involves our call handlers answering the call, assessing the level of urgency and dispatch sending a resource, either an ambulance crew, community first responder, critical care team or rapid response vehicle. To ensure that the sickest patients get the fastest response, and that all patients get the right response first time, we have a clinically appropriate triage process, to make sure everyone receives the right level of care for their presenting condition.
The national standard for call pickup is answering 999 emergency calls within 5 seconds, with 9 out of 10 calls being answered within this time. This standard is to ensure that our most unwell patients, such as those in cardiac arrest, are answered as promptly as possible, as every second counts. The table below demonstrates the increased pressures our 999 centres had been under, with high call demand making the 5 second answering standard challenging over the last year.
|
Mean Call Pickup (seconds) |
Call Pickup 90th percentile (seconds) |
|
|
April 2021 |
3 |
4 |
|
May 2021 |
7 |
14 |
|
June 2021 |
18 |
63 |
|
July 2021 |
24 |
81 |
|
August 2021 |
26 |
85 |
|
September 2021 |
37 |
117 |
|
October 2021 |
53 |
159 |
|
November 2021 |
111 |
308 |
|
December 2021 |
94 |
296 |
|
January 2022 |
36 |
117 |
|
February 2022 |
52 |
148 |
|
March 2022 |
69 |
219 |
999 emergency calls - SPOC (Single Point of Contact)
The single point of contact has been established to make sure our colleagues are able to support patients to access the right care to meet their needs. The single point of contact is a 24/7 phone line which is available to all our colleagues and includes the ability to refer patients to a range of different services, like diabetic or out-of-hours nursing.
We used this single point of contact call system on 125,147 occasions over the year. The table below shows the types of referrals made and the number of each within each type.
|
Type of Referral |
Total number of patients referred |
Percentage of patients referred
|
|
Social Care |
31,575 |
25.24% |
|
Falls Service |
26,717 |
21.35% |
|
GP |
57,588 |
46.02% |
|
Hertfordshire Admission Avoidance Response Car |
2,166 |
1.73% |
|
Diabetic Service |
1,359 |
1.09% |
|
Other |
5,742 |
4.57% |
Almost 27,000 patients at risk of falling had their condition notified to a Falls Team. Nearly 2,000 patients were seen by the admission avoidance team, so they could stay at home instead of going to hospital.
Hospital Handover
An important part of our winter pressure planning action was to reduce the time it takes for an ambulance crew to hand over the patient to the care of the hospital. Any delay in this process can have an impact on the patient and increases the time before the crew can respond to another emergency in the community.
Over recent years we experienced a significant loss of ‘ambulance hours’ because of delays in handing patients over to hospital care, and this created a delay in responding to other emergencies. As a result, we worked collaboratively with regulators, commissioners, and hospitals to reduce the delays, so that our patients in the community were waiting less time for an ambulance.
As a healthcare wide system, we continued to implement a handover escalation protocol which helps all organisations rapidly identify cases of concern and work together to accelerate care and reduce delays.
The was an upward trend in the time it took for the ambulance crew to handover care to the hospital.
When 999 emergency calls, colleague sickness and handover times at hospitals were at their highest, some patients had long waits for an ambulance to reach them.
The Trust implemented and developed a number of contingency measures to support the ongoing delivery of services during these challenging times. This included recruiting more colleagues, greater collaboration with partners, and introducing new ways of working. These initiatives provided additional resources enabling the Trust to respond to 999 emergency calls during the peak pressure periods.
- We invested in increasing call handling capacity to support resilience, enabling a reduction in waiting times for calls to be answered during the peak demand periods.
- As part of a planned replacement programme, the Trust invested nearly £50m in 440 new ambulances for the front line. These meet the new national specification for ambulances and the fleet department worked tirelessly to secure suitable vehicles for our crews.
- The winter of 2021-22 saw a greater number of ambulance handover delays than any of the previous years’ enabling collaborative system wide solutions to improve handover delays.
- The ‘make ready’ teams enabled our ambulances to be ready between shifts as quickly as possible. Make ready ensures that all ambulances are fully serviced maintained and kitted out with all the required equipment and medical devices and are infection prevention control compliant, prior to the crew starting shift.
- To support admissions avoidance, not taking patients to emergency departments, we utilised a robust triage process to transfer patients to other appropriate services such as 111, while maintaining patient safety and appropriate use of services.
- We worked with some providers across the region to establish referral pathways for urgent community response, for example falls services, REACT and mental health referrals.
- The delivery of our electronic patient care record programme transformed the way we provided vital information to hospitals, giving live details as we transported patients into their care but also providing information to enable crews to treat patients safely at home. This allowed the Trust to work in partnership with other healthcare providers in the region enabling access to clinical records to inform patient care and appropriate information sharing.