Urgent and emergency services
Responding to a 999 call involves our call handlers answering the call and then triaging to determine the urgency of need. Not all calls to the ambulance service are dealt with as emergencies.
Our dispatch team allocate life threatening cases straight to a response, either an ambulance crew, community first responder, critical care team or rapid response vehicle.
To ensure that the sickest patients get the fastest response, and that all patients got the right response first time, our experienced clinicians complete a clinical assessment, or refer cases directly to other healthcare providers, depending on the patients’ need following assessment. This ensures everyone receives the right level of care for their presenting condition.
All 999 calls are answered by our dedicated call handling colleagues in any one of our three emergency operations centres (EOCs). We have built in resilience and flexibility, which means if all all the call handlers in one centre are already on 999 calls, the next call will automatically divert to an available call handler in another one of our centres.
This level of automation is then expanded nationally to allow alternative ambulance trusts to also answer our calls when there is a particularly high call volume, in order to minimise patient safety incidents, risk or delay.
The volume of calls presented to the 999 emergency operations centres depends on several factors. These include time of year and seasonal variations We received more calls on bank holidays and at weekends, some months had more weekends than others. Events occurring in any area like a concert or football match, health care condition prevalence in an area, like an outbreak of diarrhoea and vomiting or availability of other unscheduled services in an area.
The below chart demonstrates this fluctuation of calls throughout the year.
All ambulance trusts in England are measured against ambulance quality indicators, including standards on how quickly patients receive a response following their 999 call. The national standard for responding to the sickest patients is an average of seven minutes and we aim to attend to nine out of 10 of them within 15 minutes.
The table (right) provides detail on each of the main response categories along with the national standard, as well as our performance over the year.
In our region we responded to our sickest patient in an average of nine minutes and 50 seconds, and to nine out of 10 in under 18 minutes and 22 seconds.
| Category | Response | Target Average Time | EEAST response |
|---|---|---|---|
| 1 | An immediate response to life threatening condition, such as cardiac or respiratory arrest | 7 minutes | 10 minutes 46 seconds |
| 2 | A serious condition, such as stroke or chest pain, which may require rapid assessment and/or transport | 18 minutes | 1 hour 9 minutes |
| 3 | An urgent problem, such as an uncomplicated diabetic issue, which requires treatment and transport to an acute setting | 2 hours | 8 hours 23 minutes |
| 4 | A non-urgent problem such as stable clinical cases, which requires transportation to a hospital ward or clinic | 3 hours | 12 hours 7 minutes |
EEAST covers 750,000 square miles, that incorporates some of the most rural areas in England. As a result, the road network is challenged at some points of the year, as thousands of people head to the coastline which is a hugely popular holiday destination.
We must use our resources wisely and it is not always possible to reach some destinations as quickly as we would like. That is why the emergency operation centres have experienced clinicians to thoroughly assess patients, to ensure the right level of care is provided by the right service.
Sometimes, this means that patients will be passed onto the local unscheduled care services which have access to a wider choice of services to meet patient needs. It may mean that one of the dedicated community first responders, living locally, will attend to the patient first and sometimes it may be a paramedic on a bicycle.
The emergency operations centres play a fundamental part in ensuring the safety of patients through numerous processes to ensure the right care is delivered. All emergency life threatening patient calls are responded to immediately, so that even before the call has finished with the patient, the crew can be on the way.
Clinical assessment service
A number of people who call 999 do not need an ambulance, but need advice, guidance or signposting to other services. On average, around 10% of all 999 calls can be managed safely through our clinical assessment service, this is called ‘hear and treat’.
We were able to find alternative care pathways for approximately 8% of cases through our ‘hear and treat’ service. This team of senior, experienced clinicians are based in our emergency operations centres. Their role is to review the case, speak to the patient, and find them an alternative solution to help them. This could be a pharmacist, a GP or another alternative patient pathway available in the community.
The table below shows that due to the partnership collaboration with unscheduled care services across the EEAST region, the emergency operations centres do not always close calls after clinical assessment. Up to 26% of our calls are assessed by the local unscheduled care provider which can deliver care closer to home and has access to more patient information. Calls passed to unscheduled care providers are the calls where an emergency ambulance response is not required. This has created a downward trend for patients being clinically assessed within EEAST, as these patients are clinically assessed by their local service. More access to local services via the ambulance service are coming online all the time and it is anticipated that their hours of operation will improve over time.
Call pickup time
The national standard for call pickup is answering 999 emergency calls within five seconds, with nine out of 10 calls being answered within this time.
This standard is to ensure that our most unwell patients, such as those in cardiac arrest, are answered as promptly as possible, as every second counts.
The table below demonstrates the increased pressures our 999 centres have been under, with high call demand making the five second answering standard challenging over the last year.
It also shows the great improvements in call answering over the last year. This has been due to modernising the telephony systems and processes, recruiting to additional levels of call handling staff and sharing best practice with our colleagues on call handling procedures.
| Month | Mean call pickup (seconds) average | Call pickup 90th percentile (seconds) Nine out of ten times |
| April 2022 | 23 | 89 |
| May 2022 | 42 | 135 |
| June 2022 | 60 | 192 |
| July 2022 | 80 | 240 |
| August 2022 | 18 | 69 |
| September 2022 | 35 | 136 |
| October 2022 | 37 | 137 |
| November 2022 | 21 | 79 |
| December 2022 | 51 | 173 |
| January 2023 | 1 | 1 |
| February 2023 | 2 | 0 |
| March 2023 | 4 | 1 |
Single Point of Contact (SPOC)
The single point of contact (SPOC) team was established to make sure our colleagues are able to support patients to access the right care to meet their needs.
The single point of contact is a 24/7 phone line which is available to all our colleagues and includes the ability to refer patients to a range of different services, like social care or diabetic hypo education teams.
The table below shows the types of referrals made and the number of each within each type:
| Type of referral | Total number of patients referred | Percentage of patients referred |
| Social care | 29,113 | 26.60% |
| Falls service | 21,002 | 18.46% |
| GP | 55,168 | 48.50% |
| Hertfordshire admission avoidance response car | 2,158 | 1.90% |
| Diabetic hypo | 1,127 | 0.99% |
| Safe and well | 1,620 | 1.42% |
| KARMA2 study | 34 | 0.03% |
| Datix (telephone) | 3,519 | 3.09% |
Hospital Handover
An important part of our winter pressure planning action was to reduce the time it takes for an ambulance crew to hand over the patient to the care of the hospital. Any delay in this process can have an impact on the patient and increases the time before the crew can respond to another emergency in the community. This can also impact on call handling, as patients try to call back for an estimated timeframe for an ambulance, this can delay emergency calls.
Over recent years we experienced a significant loss of ‘ambulance hours’ because of delays in handing patients over to hospital care, and this created a delay in responding to other emergencies. As a result, we worked collaboratively with regulators, commissioners, and hospitals to reduce the delays, so that our patients in the community were waiting less time for an ambulance.
As a healthcare wide system, we continued to implement a handover escalation protocol which helps all organisations rapidly identify cases of concern and work together to accelerate care and reduce delays.
This graph (above) shows that handover times continued to increase, despite the partnership working with all agencies.
The Trust implemented and developed a number of contingency measures to support the ongoing delivery of services during these challenging times. This included recruiting more colleagues, greater collaboration with partners, and introducing new ways of working. These initiatives provided additional resources enabling the Trust to respond to 999 calls during the peak pressure periods.
- We invested in increasing call handling capacity to support resilience, enabling a reduction in waiting times for calls to be answered during the peak demand periods.
- We supported admissions avoidance by not taking patients to emergency departments. We utilised a robust clinical assessment process to transfer patients to other appropriate services such as 111, while maintaining patient safety and appropriate use of services.
- We worked with some providers across the region to establish referral pathways for urgent community response, for example falls services, REACT and mental health referrals.
- The ‘make ready’ teams enabled our ambulances to be ready between shifts as quickly as possible. Make ready ensures that all ambulances are fully serviced, maintained and kitted out with all the required equipment and medical devices and are infection prevention control compliant, prior to the crew starting shift.
Next page: NHS emergency preparedness, resilience and response