Website of the Department of Health

Review launch

Perhaps I could turn now to the review itself.

Peter Bradley was appointed last year to undertake the task of reviewing the ambulance service. He has been well placed to undertake this review as both the Department's national ambulance advisor and chief executive of London Ambulance service. You - more than most - are aware of how services have transformed over the last decade. However, equally, you will be very aware that there is much more still to be done to maximise the potential of staff and to make best use of resources.

Peter's review acknowledges the good service you provide and builds on the strong foundations you as a service have established. It sets out a vision for where the ambulance service should be in the future - an internationally renowned world-class service. I have great pleasure today in formally launching this report today.

So what does the ambulance review mean for patients? The underpinning principles of the vision rightly focus upon ambulance services designed around the care they can provide and the needs of their patients. At present the Review estimates we take over 1 million people to A&E who needn't go there if we did things differently and this is featured in quite a lot of the media I have been doing. Patients deserve the chance of different improved care and consistently receiving the right response, first time, in time. Over the next few years, more and more patients will be able to be treated in the community, resulting eventually in at least one million fewer unnecessary A&E attendances. That's good news for patients and good its news for the NHS.

Why do all this? Patients tell us that they want convenient services that are easy and simple to access. That are tailored to their needs. It doesn't come much easier than dialling 999 and receiving clinical advice or treatment within minutes. We know that patients calling 999 are a mix of those with clinically urgent needs and those who view their condition as urgent. Indeed on average only about 10 per cent of 999 ambulance calls are truly life-threatening conditions. This report makes clear that ambulance trusts need to further widen the range of services that they provide so that they meet a diverse range of needs. They need to work very closely with other urgent care providers so that alternatives can be found for those patients who do not need an ambulance. Some of these can and should be delivered by the ambulance service and some should not. Making these changes is not a cut in services as some have tried to suggest, it's an improvement. Why give people a ride in an ambulance when they don't need one and someone else does? We are not seeking to cut the number of ambulances as some suggested last week but to provide a wider range of responses that are appropriate including using vehicles that are themselves appropriate.

There will be greater job satisfaction for ambulance clinicians, as they utilise their skills in full by playing a wider role

In practice this may mean equipping ambulance clinicians with the competences to undertake and interpret more diagnostic tests, to undertake basic procedures such as unblocking catheters and blood glucose measurements, as well as make referrals to other health and social care providers or directly admit patients to specialist units in line with local protocols. This can only be of benefit to the patient - ensuring appropriate healthcare is delivered in the right environment, at the right time, as well as having a positive impact on other parts of the NHS. A model of delivering people to A&E when there are more helpful things you can do for them helps nobody - it doesn't help patients and it doesn't help the NHS.

We need to ensure all ambulance staff are equipped and empowered to do so. This means building on the excellent service you already deliver, and on the dedication and skills that have made the service the one it is today. But it also means maximising the potential for ambulance staff and clinicians to utilise their skills, develop them further and to progress their own careers. This is why one of the key elements of this review focuses very strongly on developing the workforce. Continuing the development of the emergency care practitioner role, further developing the national competence framework for emergency, urgent and scheduled care, improving opportunities for career progression, aiming to improve workforce diversity are just some of the things to give you a flavour of the recommendations set out in the report. Agenda for change provides us with the framework for making these changes and for rewarding staff who develop their skills.

You will have heard and seen last week that some parts of the media were critical of so-called hidden waits. While some of their allegations fed in part from within the service were unfounded, we know that this is an issue that does have to be tackled. Indeed it was one that we specifically asked Peter and his reference group to make recommendations on. They have considered the options carefully over the last 12 months.

Patients are waiting for help, for treatment, from the moment they dial 999. Reported response times will in future capture the full interval from a 999 call being connected to an ambulance control room to an ambulance clinician arriving at the scene. This will better reflect patients experience and act as a driver for improvements in speed and quality of care. We will also - over time - look to reduce the number of targets so that we can increasingly focus on those patients for whom every minute counts.

Implementing this, whilst also investing time and resources in training and education, and service development; will I recognise be challenging. But it is the right thing to do. It is the only option if your performance is to be meaningful to patients when they compare it to their experience; and it is credible to all including those who have criticised the arrangements. Some of the criticism levelled on this issue is unfair but the best response to this is improve the service further and remove the doubt.

I accept that expenditure on ambulance services is a small part of NHS expenditure. But after all we do still spend £1.2 billion on them each year and we could get a lot smarter in the way we spend it. Why do we have 31 organisations spending time negotiating contracts to buy the same equipment to be used for the same purpose? Why do we have organisations who don't have the capacity to do as much to prepare for tomorrow as they would like because they are fully occupied dealing with today? Too often the urgent overrides the important and we have committed ourselves as a Government to improving efficiency in the NHS.

Maximising efficient use of resources in order to save money to reinvest in patient care will be a key activity for all NHS organisations over the next five years and you will have seen some of the exchanges in the not to distant past. The Government's manifesto commitment is to streamline the number of NHS organisations. The Bradley report recommends that there should be fewer, larger ambulance trusts to improve strategic capacity and efficiency. I have thought about this carefully - and I believe we need to seize this opportunity to take a decisive step forward. My view is we should reduce the number of ambulance trusts by at least 50% and be a long way down that tract by the end of 2005/6 in order to maximise the benefits that the report describes. I know this will be a significant challenge. And it is essential that we get it right. We will consult closely with you and with patients and the public and other parts of the NHS on how we go about this significant reduction, the precise number and the boundaries over the next few months.

We will also work with you to achieve more single procurements of equipment - and secure greater efficiency and quality through outsourcing of services, particularly in fleet management, or other means. Money saved from greater efficiency can be reinvested in more and better services - and in more opportunities for ambulance service staff to expand their skills and competencies. The NHS has had a huge public investment and all parts of it need to improve efficiency to justify the continuing public investment and public support for that investment. It is the search for efficiency that can fund improvements to services including investments like digital radio systems and staff education and training.

Peter Bradley's report and recommendations fairly set out the achievements of the ambulance service to date and what more the service could achieve. We want to carry on our dialogue with you, with the rest of the NHS and with patients and the public to look at how those recommendations can contribute to the development of out-of-hospital care in England.

What is important is that this vision sets out the service that will deliver the best care possible to patients who need your expertise in delivering emergency and urgent care.

But we do want to move forward to implementation as well as dialogue. This is so we can support ambulance services to deliver the transformation set out in the review achieve continuing improvements in service quality and patient experience. We need to move forward as speedily as possible in the interest of patients whilst fully recognising the achievements of the past. Thank you for your attention and thank you for all you are doing in the NHS.