Having celebrated 75 years of the NHS during 2023, NHS England has now published its 2022/23 annual report. It makes sobering reading as it sets out the impact of strikes and the continued pressure on its services including ambulance provision but finds innovation in technology, use of volunteers and its commitment to achieving net zero.
‘The start of 2023 marked the beginning of the health service’s 75th year. And while we cannot, and do not, ignore the fact that in too many cases patients are not currently receiving the high quality and timely care we all aspire to, it is simultaneously true that the public retain belief in the NHS, its founding principles, and those who work within, and in support of, their local services.’Amanda Pritchard, Chief Executive, NHS England.
In December 2022, there were 2.3 million A&E attendances, the highest on record. The report says this was due to the combined impact of COVID-19, influenza and Strep A. Ambulance services also saw unprecedented demand throughout 2022/23, with the number of the most serious ambulance callouts (category 1) up by one third on pre-pandemic levels at some points in the year.
The NHS Urgent and Emergency Care Plan published in January 2023 set out a two year approach to improve frontline capacity with a promise of 800 new ambulances, including 100 specialist mental health vehicles, and 5000 more sustainable hospital beds backed by a £1 billion dedicated fund. It also contained two key ambitions: to achieve A&E 4-hour performance of 76 per cent by March 2024 and improve category 2 ambulance response times to an average of 30 minutes within 12 months.
Demand for ambulance services had peaked in July 2022 for the most critical incidents, but by the end of the year, it had risen a further 18 per cent on that level. Conversely, the demand for response to category 2 incidents decreased by 10 per cent by the end of the same year.
‘Ambulance services continued to be challenged by long handover delays that impacted the flow of patients through hospitals and response times increased to 39.3 minutes in March 2023.’
The headline numbers in this report include those for call handlers working in control rooms of the 11 ambulance trusts in England. The number of emergency call handlers increased by 15 per cent compared to September 2021, with the total number of whole time equivalent staff now just below the NHS England target of 2500 call handlers.
Trials to reduce long waits for calls took place in two ambulance trusts where an ‘intelligent digital call-routing system’ was tested to see how it could work for category 2 calls.
‘Intelligent Routing Protocol uses call routing technology to automate the transfer of calls between services. IRP will enhance ambulance service infrastructure and interoperability at a national level, as well as building further 999 call handling resilience for extraordinary events such as major incidents, extreme weather events and sudden localised technology failures.’CEO report to Yorkshire Ambulance Trust, November 2022.
Yorkshire Ambulance Service was one of the pilot services to test IRP and went live with the approach in November 2022 followed by a national roll out.
The report looks at the value of volunteers to ease pressures. NHS England commissioned a multi-year ambulance auxiliary contract with St John Ambulance to provide additional emergency ambulance support at times of high demand. In addition to this, a consortium – VCS Emergencies Partnership – led by British Red Cross is now support people who are medically fit for discharge to receive support to return home from hospital.
The NHS Volunteering Taskforce was set up in 2022 and published its recommendations in June 2023, these covered data, leadership and resilience. NHS England is considering how to implement the recommendations with a view to report on this by end of March 2024.
There has been considerable development when it comes to moving the NHS to net zero. In July 2022, NHS England published Delivering a net zero National Health Service. The annual report provides some progress on how the NHS is moving towards decarbonising travel and transport, although the NHS Net zero transport and travel strategy was not published until October 2023. Ambulance services are already making great strides in reducing emissions and investing in green fleet.
Ambulance trusts are trialling 21 zero-emission vehicles, six of which are dedicated to support mental health response, cutting emergency response times, and reducing demand on traditional double-crewed ambulances. London Ambulance service has procured 35 fully electric Fast Response vehicles.
These milestones helped the NHS reduce its carbon footprint to an estimated 4.55Mt in
2022/23, and are in line with the ambitions set out in the Delivering a net zero NHS
Prior to this report being published, London Ambulance Service announced it had put its first fully electric ambulance on the roads of the capital. Its fleet manager, Rob MacIntosh, talks about the work his service has done to meet NHS net zero ambitions in this interview from last year.