NI Ambulance Service chief executive Liam McIvor responds to our findings

Liam McIvor

Liam McIvor

A simple and straight forward message directs our actions and intentions within the Northern Ireland Ambulance Service.

“NIAS seeks to provide safe, high quality ambulance services that meet the needs and expectations of the people of Northern Ireland as effectively as possible within the resources available”.

The Northern Ireland Ambulance Service welcomes the opportunity to set the context for the information that you present and hope that it will engage the public of Northern Ireland in a debate on the use of their ambulance service and the investment necessary to deliver their expectations.

The challenge is to respond to all calls as quickly as possible. Our systems are designed to support this goal by triaging calls to distinguish and prioritising response to life threatening over non life threatening emergency calls.

Figures presented demonstrate that we are successful in this regard, consistently responding more quickly to life threatening calls despite the year in year increase in demand for our services.

The target by which our performance is measured is to respond to 72.5% of life threatening calls within 8 minutes across Northern Ireland with the associated response targets for the five local commissioning group areas (65% of Cat A calls responded to within 8 minutes). This target recognises and acknowledges the difficulties in providing response to the whole of Northern Ireland. Inclusive in the target set is a recognition that more than a quarter of potential life threatening calls will not receive a response within 8 minutes. The exercise undertaken reflects and demonstrates this.

Ambulance funding is linked to the target set and we are in regular ongoing discussion with Commissioners at Health and Social Care Board level to secure the resources we consider necessary to achieve the target and if possible exceed it.

To date most of the recent investment secured has been directed at meeting the consequences on the ambulance service of acute services changes such as closure of emergency departments rather than increases in demand. We are continuing to engage with Commissioners in an effort to secure investment to mitigate the impact of demand increases of 4 to 6% per annum.

In an environment of constrained financial resources where demand continues to rise and the ambulance service continues to respond to all calls as quickly as possible, timeliness of response will suffer as demonstrated in the data presented.

More calls are carried out with the same underlying ambulance resources resulting in less time being available to provide cover for the next call. What ambulance cover remains is spread more thinly and is less able to effectively cover the 5,500 square miles of Northern Ireland within which ambulance incidents occur.

In addition the clustering effect were significant numbers of ambulance resources are tied up for a period of time at a single incident such as a significant road traffic collision or other multi casualty incident creates specific pressure points which impact directly on response capacity for a period of hours.

The Northern Ireland Ambulance Service is keen to build on the achievements of recent years which provide a strong stable platform on which to build the Service to meet the challenges we face.

NIAS has changed greatly from the organisation of five or ten years ago. We have invested heavily in our ambulance personnel by bringing in new staff, increasing the number of paramedics we employ and training them in new clinical skills and interventions.

Ambulance vehicles are equipped with the best clinical and technology systems to improve the care we provide to patients. We continue to invest in our capacity to take 999 calls, establish the clinical urgency of the call, and quickly dispatch an appropriate ambulance resource to respond.

Operating from a single emergency Control Centre for the whole of Northern Ireland means that these benefits are felt by all equally and, the recent investments in mobile technology ensures that the location of ambulances are clearly presented to the Control Centre officers at all times.

The securing of DHSSPS capital resource funds has supported ambulance fleet upgrade, by replacing ageing vehicles on a regular basis over the years with new purpose built state of the art ambulances and rapid response cars.

We continue to highlight the financial constraints within which we operate – we spend less than ten pence per person per day on our ambulance service in Northern Ireland. Investment in ambulance services in N Ireland is less than £35 per person, which is one of the lowest in the UK.

While this clearly does not reflect the value which the Northern Ireland community place on their ambulance service, it is one indication of the priority placed on our collective health and well-being.

As we move deeper into a difficult financial environment, we will have even more cause to consider the value we place on our ambulance service and the investment we wish to make in pre-hospital care.

The speed of response is a key measure of performance for any organisation, particularly so for an emergency ambulance service and we acknowledge our inability to maintain the performance achieved in 2011/12. We are getting to more patients more quickly than ever before, but increasing demand for emergency response has impacted heavily on our capacity to respond promptly.

We averaged a sub 8 minute response to these life threatening calls in 68.3 % of cases throughout Northern Ireland in 2012/13. We are absolutely committed to seeking to improve the speed of our response to the most clinically urgent patients while providing timely and appropriate services, including alternatives to hospital attendance, to those whose need is less immediate.

The whole healthcare system has changed greatly in recent times, particularly the configuration of hospitals and acute services. The Ambulance Service has engaged directly and positively with other providers, commissioners and the Department of Health to ensure that the consequences of these changes have been recognised and taken account of.

This has resulted in investment which has increased ambulance cover in affected areas and we have also increased the number of our ambulance response bases in operation.

We have grown as an organisation over this period and this is reflected in expenditure on ambulance services which this year exceeded £63m. We have deployed our finances to support change and consolidate service delivery. We have also reduced expenditure in key areas over the period, in line with requirements set by DHSSPS and HSCB, to create greater efficiency and secure value for money.

We will continue to critically review our expenditure to drive further efficiencies which we hope will continue to be used to improve patient care. In an uncertain and volatile economic environment the need to choose wisely is greater than ever.

Looking ahead it is clear that 2014/15 and beyond offers no indication of respite from the challenges we face, particularly increasing demand, rising expectations, and less funding.

The clear signal in Transforming Your Care that the ambulance service has a continuing and pivotal role to play in future service delivery is welcomed. We are keen to play a full and influential role in both shaping and delivering healthcare in the future.

As we look to this future we recognise the necessity to address immediate pressures and challenges such as Category A response, ambulance turnaround at hospital, staff issues around meal break management and grading resolution, achieving financial balance with sound procurement processes and prompt payment.

We are absolutely committed to working with all parties and stakeholders to address these issues from a patient-centred perspective focused on the provision of safe, effective, high-quality care within available resources.

It is the ambulance personnel directly providing the Ambulance Service who have greatest influence on those who receive that service.

Our staff operate in all weathers, in all conditions, anytime day or night to provide ambulance care and transportation to the people of Northern Ireland and are highly regarded by them as a result.

I pay tribute to their commitment and dedication and their application of clinical and non-clinical skills to meet the needs and expectations of their patients.

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