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Radical plans to ease NHS 999 targets amid mounting pressures

Health officials said the current system of targets is
Health officials said the current system of targets is

Ambulances are set to be given far longer to reach 999 calls in a controversial bid to ease increasing pressures on emergency services.

Handlers could be given four times as long to assess calls after a study of 10 million calls found too many cases being counted as hitting official targets, without patients getting the help they need.

Current rules state that 75 per cent of calls classed as life-threatening are supposed to receive a response within eight minutes. Before the clock starts, handlers have just 60 seconds to gather information - meaning they often send a response before crucial details have been established.

The targets, introduced by Labour, can be hit if a “first responder” on a bike gets to the scene quickly - even if the patient is a stroke victim in need of an ambulance to convey them to hospital.

And trusts are routinely sending multiple responses out, in the hope one will beat the clock.

Under new plans, handlers are likely to be given up to four minutes to assess calls - four times as long as the existing rules.

Government sources said there was a growing clinical consensus that giving call handlers longer to assess calls meant the most urgent cases actually got the right help quicker.

Prof Keith Willett, NHS England director of acute care, said six NHS pilot schemes, evaluated by the University of Sheffield, provided “very compelling” evidence that changing the system would improve patient safety.

Ministers are expected to discuss the findings shortly, with reforms of the 999 system likely by next year. The most urgent cases - those involving patients who are unconscious or not breathing - would still be sent an immediate response.

The study by NHS trusts is the largest research into urgent and emergency care in the world, and assessed 10 million calls.

“Once every two decades, we get a real opportunity to modernise the ambulance service. We have an evidence base now,” Prof Willett told a meeting of NHS managers.

“We have something we know is safe and evidence of improved efficiency. From my point of view, it is very compelling”.

While current targets say 75 per cent of calls classed as “life threatening” should receive a response in eight minutes, just three per cent of patients turned out to need such an urgent response, Prof Willett said.

On average, on in four “blue light” ambulances sent out are stood down before they arrive, often because multiple vehicles have been sent out, or because the case turned out not to be so serious.

Prof Willett said the current system was “outdated” and in need of a major overhaul.

Ambulances - Credit: Dinendra Haria/REX/Shutterstock
The number of calls received by ambulance services in England has risen by 20 per cent since 2011/12 Credit: Dinendra Haria/REX/Shutterstock

A Government source said the evidence appeared persuasive, though the final draft of the review has yet to be sent to ministers.

“There seems to be a clear clinical consensus on this,” he said. “At the moment we have a system where the clock stops when a responder on a bike reaches the patient - even it if turns out to be a stroke victim who will obviously need an ambulance.”

The review follows major strain across ambulance and Accident & Emergency services, with a 6000 per cent rise in the numbers stuck on trolleys for more than 12 hours in the last seven years.

Record occupancy levels in hospitals mean increasing numbers are being forced to wait longer in A&E, leaving ambulances queueing outside, and teams of paramedics spending hours waiting with patients.

Jeremy Hunt  - Credit: PA
Jeremy Hunt, the Health Secretary. Decisions on reforms of ambulance targets will be discussed by health ministers Credit: PA

In 2016/17, ambulance services in England received 9.8m calls - a 20 per cent rise from the 8.2m received in 2011/12.

Just 69 per cent of Red 1 calls (the most urgent category) received a response within eight minutes in 2016/17, compared with 74 per cent performance in 2011/12.

In recent years, ambulance services have been beset by a number of scandals, with some accused of fiddling their response times, in an attempt to claim targets have been hit.

In the winter of 2014/15, up to 20,000 patients were subject to deliberate delays under a secret policy authorised by the head of South East Coast Ambulance trust, which forced high risk cases to wait up to twice as long if their call was referred from the 111 helpline.