The Public Accounts Committee (the committee) published its report, Transforming NHS ambulance services on 16 September 2011. In 2009-10, the 11 regional ambulance services in England handled 7.9 million emergency calls and spent £1.5 billion on urgent and emergency services, the report found. Ambulance services are expected to make 4 per cent efficiency savings year on year at a time when public demand for services continues to rise.

Performance was measured against three response time targets until 1 April 2011, but the incentive to meet these targets has led to some inefficiency, such as when more than one team is sent to the same incident.

This report examines the value for money that ambulance services provide within the NHS. It highlights areas of inefficiency within ambulance services and makes recommendations for quality and performance improvement. The committee comments that there is wide variation in the cost of responding to an incident across ambulance services, which is underpinned by variation in a number of other factors, such as sickness absence, overtime and back office costs. Ambulance services need to produce more consistent performance data in order to benchmark and share best practice so that efficiency can be improved and variations reduced across the country.

The committee also welcomes the decision to introduce a wider suite of health quality indicators to create a broader performance regime in which response times remain one indicator.

The report recognises that under the NHS reforms there is vagueness around:  

  • who will be responsible for ambulance services under the NHS reforms;
  • who will be responsible for commissioning ambulance services;
  • who is responsible for improving efficiency and value for money in ambulance services; and
  • who will intervene if a service has financial trouble or seriously under performs.  

Other points noted by the report include a recognition of the need:  

  • for comparable information on ambulance service performance;
  • for a review of response time targets;
  • to address delays in hospital handovers; and
  • for better collaboration with other emergency services.  

The report concludes that there is clearly a need for greater clarity on the roles and responsibilities of the DH, commissioners and ambulance trusts with appropriate structures for accountability. Other parts of the health service affect ambulance services and a more integrated emergency care system is needed to ensure that ambulances are utilised in the most efficient manner. Levels of collaboration between ambulance, fire and police services could be strengthened.