A joint report by NHS Providers and the Association of Ambulance Chief Executives (AACE) says ambulance services should play a pivotal role in helping the NHS pull through the pandemic, bear down on the care backlog and transform services for patients.

Rapid response: the role of the ambulance sector in transforming services and coping with the long-term impact of COVID-19 sets out how the skills, scale and reach of ambulance services mean they can be key to planning and delivering high quality care as close to home as possible: a central ambition of the NHS Long Term Plan.

The report sets out how services are responding to extraordinary pressures, with growing demand outpacing funding increases and the knock-on impact of very stretched primary and social care. Demand for emergency care has reached record levels, causing high rates of handover delays despite the best efforts of staff: 

• in June 2021 category one incidents, requiring an immediate response to a life threatening condition such as cardiac arrest, rose by 8.1% compared to the previous month
• compared to two years ago, before the pandemic, category one incidents have increased by 27.2%
• in the 12 months to June 2021, 115,000 patients experienced a delay in handover at emergency departments of longer than an hour
• prior to the pandemic it had been identified that the ambulance sector needed £250m additional funding to deal with increasing demand and eliminate historic underfunding.

Ambulance trusts also face severe workforce shortages, high rates of burnout and the risk of losing their most experienced paramedics as services are re-organised.

Yet the report also demonstrates how the sector has adapted and shown resilience, helping to integrate care across different settings and working to reduce avoidable hospital visits and admissions, while supporting the response to rising demand for mental health services.

Integrated care

Through detailed case studies, the report sets out how ambulance trusts across England are working with partners to coordinate and deliver integrated services, with a clinical assessment service (CAS) linking in with 999, 111 or online as a single point of access into urgent and emergency care, for patients, carers and health professionals.

It also highlights the key role of non-emergency patient transport services (PTS) – some of which are run or coordinated by ambulance trusts – in supporting steps to bear down on the care backlog, ensuring that patients arrive on time for their appointments and that, when being discharged, they can return home quickly.

Improved workforce deployment

The report shows – through practical examples – how ambulance trusts are making changes to training and working practices so that paramedics can develop and learn alongside other types of healthcare professionals and therefore be deployed differently, leading to a reduction in hospital conveyance rates.

It highlights the benefits of rotational working, with senior paramedics moving between clinical settings, using their advanced clinical assessment skills to help provide the right response the first time.

Digital ways of working

Further case studies show how the response to COVID-19 has accelerated digital ways of working, leading to better sharing of medical records and therefore faster clinical decision making. This has also improved collaboration between services to enable paramedics to provide care remotely, reducing unnecessary admissions.

New innovative ways of working, such as 111 First, have been rolled out nationally and supported by cloud-based digital software to ensure seamless clinical handover for patients who needed to visit A&E.

The report sets out the steps needed to ensure ambulance services can play their full part in helping the health service meet some of the most formidable challenges in its 73-year history:

• ensuring the ambulance sector is closely involved in strategic decision-making at national, regional, integrated care systems and place level
• greater recognition of the ambulance sector's role as providers of urgent and emergency care, with many patients being treated on-scene or over the phone without the need for onward referral, ensuring people are treated in the right place at the right time.
• wider investment to build on learning from the pandemic and to match the ambition set out in the long term plan.

The chief executive of NHS Providers, Chris Hopson, and the chair of AACE, Daren Mochrie, said:

"Ambulance trusts are operating under incredible pressure and we owe a huge debt of gratitude to the staff who have maintained services and cared for patients – operating at the sharp end of the pandemic.

"The systems in which they operate have, at times, been overstretched, impacting on care for patients and the wellbeing of staff and volunteers.

"Ambulance services have faced pent up demand due to national lockdowns, patients presenting with more severe symptoms, and the growing mental health impact of the pandemic.

"All this at a time when workforce shortages have been compounded by staff sickness and quarantine measures.

"But this report shows in practical ways how they have been adapting and, as the health and care system builds on learning and innovation from the pandemic, it highlights how the ambulance sector will play a key role in helping to reduce care backlogs and meet rising demand for services.

"This is a time of extraordinary pressure, but also a moment of opportunity to build on the strategic strengths of ambulance services – an opportunity which must not be missed."