Going behind the scenes of the emergency operations centre

Have you ever wondered what happens when you dial 999 or 111? We were keen to dig into the practicalities of operations at busy ambulance operations centres, so found the perfect person for Catherine Levin to talk to for the latest episode of our For Every Response podcast.

Dan Ainsworth, who started his career at North West Ambulance Service 18 years ago as a call handler, is now Director of Operations. He’s responsible for a wide portfolio including 111, NHS 999 call handling, patient transport and resilience services, and his operational remit covers around 7,000 staff. 

“I progressed through all the leadership roles in 111,” he explained. “Then around eight years ago I moved to run our emergency operation centres, moved into a director’s role, and then about two years ago moved into the executive director of operations role.” 

Notably, he is the first person in the organisation to hold the role without a paramedic background.  

A shared identity across the service 

Despite that difference in background, Dan says the ambulance service identity remains a strong unifying force across the organisation. 

All operational staff, whether they are responding on the road or answering calls, wear uniform. “We feel it’s a really important sign that there is no role that is more or less important within the organisation,” he said. The approach helps reinforce a shared sense of purpose. 

Understanding the demand behind 111 and 999 

While the emergency line attracts the most public attention, Dan says the reality of demand tells a different story.  “111 is the busiest service of the two from a core volume perspective,” he explained. 

The trust runs a full regional 111 service, due to the sheer scale of calls they deal with. “On a daily basis, the average call volume for the North West for 111 is about 5,300 calls a day, and 999 is about 4,000 calls a day.” 

However, 111 demand is far less predictable and can spike dramatically. On Boxing Day, traditionally the busiest day of the year, the service can reach 12,000 calls in a single day. The pattern is often driven by the availability of primary care, with GPs being closed over the festive period. 

Scaling the workforce to meet demand 

Managing those fluctuations requires careful workforce planning inside emergency operations centres. Across both services, the organisation employs around 900 call handlers. Staffing levels vary significantly across the day depending on predicted demand. 

“In the early hours of the morning, we may have 30 or 40 call handlers working,” Dan explained. “And we can scale that up to almost nearly 200 at a peak period.” 

Workforce management systems play a crucial role in forecasting call volumes and scheduling staff accordingly.  “Mapping how many calls we think we’re going to receive in a given hour or day, how long we’ll think it’ll take to manage each call, is all done through technology,” he said. 

A changing model of emergency care 

Rising demand has also reshaped how ambulance services respond to patients. “If you went back 15 or 20 years, and you called 999 there’s a good chance that an ambulance arrived and took you to hospital, whether that was the best thing for you, or not,” Dan said. 

Today the system relies far more on clinical assessment and referral to alternative services. 

“These days, less than 50% of patients who ring 999 will attend an emergency department in an ambulance.” 

A major factor behind that change is the number of clinicians now working within control rooms. “We’ve got really good referral pathways out into the wider NHS,” Dan explained. “And of the patients we go and see, around a quarter will be referred to a service on scene.” 

Technology speeding up response 

Technology is also playing a growing role in improving efficiency. One example within the 111 service is the introduction of voice systems that collect key information while patients are waiting to be connected. 

“While the patient is waiting, they will tell the system their demographics – their name, their doctor, their address, their date of birth – and that will be immediately available on screen for the call handler when the patient’s connected,” Dan said. 

Another innovation focuses on speeding up the response to the most serious emergencies. “Currently if a patient rings 999 and we predict and automatically dispatch, we can have a vehicle physically moving to them in about 35 seconds from the point they dialled 999,” he said. 

Looking ahead, Dan believes future improvements will come from closer collaboration between operational leaders and digital specialists. 

“What we’ve got to get a lot better at doing is describing the problem we’re trying to solve and allowing those clever digital folk to actually help us solve those problems.” 

Dan will continue to work through these operational stumbling blocks in his upcoming role as chair of the National Directors of Operations Group, one of AACE’s workstreams. The team will be focusing on maximising alternate pathways for patients and scaling up digital innovation, as well as harnessing data to help diversify leadership roles that have typically been quite male dominated.  

As he looks to the national stage, his focus remains on practical solutions, utilising technology, and building teams capable of meeting the unpredictable demands of modern emergency care.

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Listen to the full episode below.