NHS Blackpool CCG is the lead commissioner of ambulance and NHS111 services on behalf of the 31 North West CCGs.
There are two distinct types of provision:
- Paramedic Emergency Service (PES) – this is the 999 service which responds to life threatening and other urgent clinical need
- Patient Transport service (PTS) – this is the non-emergency transport service to take patients to and from healthcare services
- Patient Transport Services (PTS)
- Patient Transport Services (PTS) are commissioned for patients with a medical need (defined by national eligibility criteria) to and from NHS funded healthcare facilities. This can include transport for outpatient appointments or discharge from hospital. The North West has five separate PTS contracts for each of its county areas; NWAS is the provider in Cumbria, Lancashire, Merseyside and Greater Manchester and West Midlands Ambulance Service (WMAS) is the provider in Cheshire.
- Paramedic Emergency Service (PES)
Paramedic Emergency Services are provided across the North West of England by the North West Ambulance Service (NWAS). NWAS covers an area of 5400 square miles with over seven million people. Each year, there are over one million calls to NWAS.
As with all other ambulance services, calls to NWAS are assessed using a clinical decision support system to understand the urgency of the response required. In August 2017, new national standards were introduced. There are four categories, each with different response time standards:
Category 1 -Time critical and life threatening events requiring immediate intervention, such as cardiac arrest (heart stops) or respiratory arrest (the patient stops breathing); airway obstructions and ineffective breathing. Around 10% of 999 calls are category 1 and the target is to respond to these calls within an average time of 7 minutes and at least 9 out of 10 times within 15 minutes.
Category 2 – Potentially serious conditions that may require rapid assessment, urgent on-scene clinical intervention/treatment and / or urgent transport. These conditions include probable heart attacks, strokes, and major burns. Around 50% of 999 calls are category 2 and the target is to respond to these calls within an average time of 18 minutes and at least 9 out of 10 times within 40 minutes.
Category 3 – Urgent problem (not immediately life-threatening) that requires treatment to relieve suffering (e.g. pain control) and transport or assessment and management at scene with referral where needed within a clinically appropriate timeframe. Around 30% of 999 calls are category 3 and the target is to respond to these calls within an average of 60 minutes and at least 9 out of 10 times in 120 minutes.
Category 4- Non urgent problem (not life-threatening) that requires assessment (by face to face or telephone) and possibly transport within a clinically appropriate timeframe. Around 10% of 999 calls are category 4 and the target is to respond to these calls within 180 minutes in 9 out of 10 cases.
The way ambulance services work is changing; although all calls will be assessed, not every call will result in an emergency ambulance being dispatched, particularly those which are a lower response category. Patients may undergo further assessment over the telephone by a clinician (including paramedics, nurses, doctors, pharmacists and mental health practitioners). Following such clinical assessment, patients may require no further treatment or could be seen by another service, such as their own GP.
Similarly, if an ambulance is dispatched, following assessment by the ambulance crew not all patients will be conveyed to A&E; they may be referred to a local service providing care at home or conveyed to another service such as an urgent treatment centre.
- Hazardous Area Response Teams (HART)
As part of the emergency response provision, NWAS also have two Hazardous Area Response Teams (HART). These teams form part of the NHS response to support the National Capabilities Programme being led by the Home Office. This programme aims to ensure that fewer lives would be risked or lost in the event of a terrorist CBRN (Chemical, Biological, Radiological or Nuclear) incident or an accidental release of hazardous materials.
NWAS HART teams account for two of the 15 teams across England. The teams are based in Manchester and Merseyside working alongside teams across the rest of the country. The locations of the teams were selected to support the resilience and capability requirements identified by the Home Office to ensure a comprehensive coverage of the country with rapid response times whilst taking account of areas of high population density.
The national HART strategy is overseen by the National Ambulance Resilience Unit (NARU) on behalf of the Department of Health.