Paramedics voice concerns over ambulance targets

Ambulances parked up outside the accident and emergency department of the Norfolk and Norwich University Hospital. Photo...

Ambulances parked up outside the accident and emergency department of the Norfolk and Norwich University Hospital. Photo: Steve Adams

Ambulance bosses have been urged to 'get a grip' of delays affecting emergency responses to patients from across the region.

MPs were briefed yesterday at Westminster by Care Quality Commission (CQC) inspectors, who are said to have spoken to whistleblowers and patients during their unannounced inspection of the East of England Ambulance Service Trust (EEAST).

The CQC is expected to publish their report on the inspection, which examined delays in rural response times and turnaround times at hospitals, in early March.

Suffolk Coastal MP Therese Coffey, who arranged the meeting, said concerns were expressed and exchanged with senior CQC inspectors.

She said last night: 'This is not about criticising frontline staff or accusing the leadership of not doing their best for patients but it is important we get to the bottom of the issues.

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'The amount of MPs that attended the meeting today shows that it is a matter of huge concern and the trust needs to get a grip of performance.'

The CQC carries out unannounced inspections at all trusts each year. Ms Coffey added she will be meeting with the chairman and interim chief executive of the EEAST on March 14 to discuss the content of the CQC's report.

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Concerned paramedics have also hit out at changes to East Anglia's ambulance service, which they believe are designed to meet targets which 'hide' delays in getting to patients.

A group of concerned frontline ambulance staff have started a campaign calling for the Department of Health to change its A19 target, ensuring that rapid response vehicles (RRVs) do not count in the 95pc target for arriving at the most critically ill or injured patients within 19 minutes.

The paramedics say that the RRVs are mostly unable to transport the category A patients in a clinically-safe manner to hospital, making this target 'contradictory', and have written to nearly 450 MPs asking for backing.

They say that through Freedom of Information requests they can show the East of England Ambulance Service has transported less than 7pc of category A patients in RRVs between November 2011 and October 2012, yet all arriving first on scene were deemed as fulfilling the target, regardless of any delay on getting a backup ambulance.

One Norfolk paramedic, who wanted to remain anonymous, claimed that changes at the trust, in light of the need to make £50m efficiency savings in the next four years, were to help them meet the A19 target, but felt more RRVs, actually meant more delays.

The paramedic said: 'We believe the reason for more delays is more cars. The redesign and reduction in hours of ambulances, we believe, is just to get the A19, rather than doing the right thing for patients.'

They added: 'The A19 target is not patient-focused as front line staff are. If a car hits A19 and they wait four hours (for the ambulance) it is not recorded. It does not affect management but affects patients and front line staff. We are at the sharp end.'

'If the target is changed we can move away from cars and focus on patient care, rather than hitting a target at any cost.'

Simon Wright, Norwich South MP, has tabled an early day motion noting concern in the target and that it is routinely being claimed on the arrival of any RRV, including cars.

The motion says that it 'calls on the government to encourage ethical behaviour from ambulance trusts, including the East of England Ambulance Trust, which is manning RRVs over ambulances in order to achieve targets'.

The paramedic added: 'We believe, as stated in the early day motion, that the change will have to come from the Department of Health to stop ambulance managers from putting targets ahead of patient welfare, as they are clearly not listening to frontline staff.'

An EEAST spokesman said A19 is a national standard set for all ambulance trusts. He added interim chief executive Andrew Morgan would be 'very happy' to meet up with representatives from the ChangeA19 group to discuss any of the issues further.

Last month Mr Morgan wrote to Priti Patel, MP for Witham, in Essex, saying that he believed the target should be reviewed nationally.

He wrote: 'I would welcome a more transparent definition which equates directly to the patient's need and experience, although this would have to go hand in hand with a review of the current 95pc target and whether this is sustainable and achievable.

'This issue of ambulance back up delays is something I am determined to resolve.'

However, in a letter from Jeremy Hunt, Secretary of State for Health, to Oxford East MP Andrew Smith, earlier this month, he said it was 'the responsibility of individual ambulance trusts to determine the type of vehicle and equipment required to respond accordingly to those calls, based on the clinical needs of the patient and to ensure compliance with the standards'.

Mr Hunt added: 'The arrival of a Rapid Response Vehicle (RRV) at the scene within 19 minutes, prior to the arrival of an ambulance, is beneficial to the care of a patient. RRVs carry clinical equipment and staff, and are sometimes used to transport patients.'

Figures obtained using the Freedom of Information Act by the EDP showed that Norfolk and Suffolk's figures in October for A19 cases had fallen year-on-year by 4pc to 88pc, while Cambridgeshire was down 2pc to an 93pc. The target is 95pc within 19 minutes.

Some of the paramedics are due to meet MPs on March 6 to discuss this further, while a website, Facebook group and petition have all been set up. The website is

•The EDP would like to make it clear that the recent inspection from the CQC was a standard one. The CQC carries out unannounced inspections at all trusts each year.

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