NHS increases spend of private ambulances and taxis to more than £92M

By Jane Kirby, Health Editor27th August 2019News EnglandAccident and Emergency, Hospitals, News England, NHS

Major ambulance trusts are increasingly relying on private ambulances to attend 999 calls, an investigation has found.

Research by PA news agency shows England’s ambulance trusts spent more than £92 million in the last year on private ambulances and taxis to transport patients.

Some trusts told PA they rely on private ambulances due to a chronic shortage of NHS staff and ongoing problems with recruitment.

In some parts of the South, almost one in five emergency calls result in a private ambulance being sent to the scene.

Earlier this year, the Care Quality Commission (CQC) published a damning report warning that patients were being put at risk by private ambulances.

It found that some firms were failing to obtain references or carry out criminal records checks while a lack of staff training was leading to serious patient harm.

For the latest study, PA obtained data from the 10 ambulance trusts in England via the Freedom of Information Act.

It detailed how much they spent on private ambulances and taxis, and whether these were used for 999 calls or non-emergency patient transfers.

The data showed the East of England Ambulance Service NHS Trust spent £9,535,027 on private ambulances for 999 and non-urgent work in 2018/19, double the £4,791,155 the year before.

Its reliance on private ambulances to attend 999 calls rose, with more than double the number of 999 incidents resulting in a private ambulance being sent to the scene.

Some 26,428 incidents in 2018/19 involved a private ambulance being required, up from 12,947 the year before.

Private ambulances were sent to 5.21% of all 999 incidents in 2018/19, up from 2.59% the year before.

The East of England Ambulance Service NHS Trust said it had hired hundreds of new staff but used private ambulances for overtime and spikes in demand, such as in winter.

It added: “It takes three years to qualify as a paramedic and we use private services to fill gaps in budgeted capacity whilst student paramedics complete their university studies and whilst we fill vacancies.

“Recruiting trained staff, particularly registered paramedics, is extremely challenging and whilst we continue to recruit and train a significant number of patient-facing staff, we continue to use private ambulance services so that we can respond to patients as quickly as possible and give them the best possible service.”

The data also showed that South Central Ambulance Service increased its spend on private ambulances for 999 calls.

In 2018/19, it spent £15,382,218, up from £12,994,544 the year before.

The number of 999 incidents attended to by private ambulances also rose, to 989,811 in 2018/19 from 917,521 the year before.

Private ambulances attended 17.69% of incidents following a 999 call in 2018/19, up from 16.19% the year before.

South Central said: “Private providers ensure that despite vacancies in our frontline workforce (due to national shortage of paramedics and exacerbated in our region by operating in a high-cost living area and the need to maintain salary levels that are agreed at a national level) we can ensure that the expected level of demand for our 999 service can be met.”

The FoI data also showed East Midlands Ambulance Service increased its spend on private ambulances for 999 and non-urgent patient work.

In 2018/19, it spent £6,969,000, up on the £3,974,000 in 2017/18.

In 2017/18, 4.6% of all its 999 work was carried out by private ambulances (29,681 incidents).

But this rose in 2018/19 to 7.2% (48,686 incidents).

A statement from East Midlands said private ambulances helped it “bridge the vacancy gap while we recruit and train people to work on our frontline.

“Ambulance crews are highly-skilled clinicians and it is not possible to recruit and train staff within a short period of time.

“However, since May 2018, EMAS has recruited over 200 additional frontline colleagues, with the majority completing their training and starting to join our ambulance crews out on the road.”

Meanwhile, the Yorkshire Ambulance Service increased its spend on private ambulances, to £4,906,384 in 2018/19, up from £3,343,771 the year before.

Private ambulances were used to respond to 3,606 calls to 999 in 2018/19 (0.48%), up from 2,511 the year before (0.35%).

West Midlands Ambulance Service, which recently lost its contract to supply non-emergency patient transport after the bid went to a private firm, spent nothing on private ambulances in 2018/19.

However, it doubled its spend on taxis to transport patients for non-urgent work, spending £4,082,556 in 2018/19, up from £2,028,745 the year before.

Shadow health secretary Jonathan Ashworth said: “Labour have longed warned against the risky, wasteful practice of privatising patient transport services.

“Matt Hancock promised ‘no privatisation on his watch’ and yet just in the last few weeks another patient transport service in Worcestershire was privatised, leaving staff in tears and fearing for their jobs.

“Patients are utterly fed up of profiteering companies like this taking our NHS for a ride.

“Labour will end the Tory privatisation racket and put patients, not profit, first.”

Unison national ambulance officer Colm Porter said: “Spiralling costs for private ambulance hire are siphoning tens of millions from squeezed NHS budgets that would be better spent elsewhere.

“Research suggests private firms are cutting corners and failing to provide the level of care needed for patients.

“The NHS sorely needs investment to address staff shortages and stem the flow of departures from the ambulance service, rather than papering over the cracks.”

PA’s data showed that NHS ambulance trusts in England spent £92,476,915 on private ambulances and taxis in 2018/19.

This was up on the £90,862,230 the year before.

While some individual ambulance services increased their spend on private ambulances and taxis, others spent less than the year before.

Among those spending less were the North West Ambulance Service and South Western Ambulance Service NHS Foundation Trust.

The CQC report in March warned that patients were being put at risk from private ambulances.

The regulator found “ongoing issues with poor recruitment, training and safeguarding processes, with evidence of incidents of serious harm to people from staff that had not been properly recruited and vetted.”

It added: “Many providers had no, or very limited, training for their staff.”

In one example, inspectors heard how a driver believed he could drive the wrong way down a one-way street if he had a blue light on.

In another, “an extremely confused dialysis patient was found wandering in the street” after crews failed to make sure he got into his home safely.

A statement from the Independent Ambulance Association (IAA) said: “The support provided by independent ambulance providers to NHS ambulance trusts is vital in ensuring that the emergency needs of patients are met, particularly where there are peaks in demand.”

It said private providers must be registered with the CQC and are “subject to additional and rigorous checks by NHS trusts.

“Our view is that monies spent on independent ambulance providers by NHS ambulance trusts are an investment to ensure the highest standard of care is provided; it’s also very cost-effective.”

The IAA said it was consulting on a quality framework for its members “that will provide greater assurance for those commissioning services in areas not currently covered by the CQC”.

A Department of Health and Social Care spokesman said: “We are committed to a world-class NHS free at the point of use and the proportion of spend on the independent sector in the last financial year is at the same level as 2014/15.

“With record numbers of paramedics in the ambulance service, we are supporting them to deliver the response patients need in an emergency, including investing more than £36 million for trusts to buy 256 new vehicles and introducing improved performance standards.”

How much does the NHS spend on private ambulances and taxis?

Here is a breakdown of how much ambulance trusts in England spend on private ambulances and taxis.

Overall, trusts spent £92,476, 915 in 2018/19, up from £90,862,230 the year before.

East Midlands Ambulance Service NHS Trust:

Private ambulances:
- £6,969,000 in 2018/19
- £3,974,000 in 2017/18
Taxis:
- £1,103,000 in 2018/19
- £1,180,000 in 2017/18

A statement from the trust said: “Private ambulance service colleagues are helping us to bridge the vacancy gap while we recruit and train people to work on our frontline.

“Ambulance crews are highly skilled clinicians and it is not possible to recruit and train staff within a short period of time.

“However, since May 2018, EMAS has recruited over 200 additional frontline colleagues, with the majority completing their training and starting to join our ambulance crews out on the road.”

West Midlands Ambulance Service NHS Foundation Trust:

Private ambulances:
- Zero spend in 2018/19
- £308,143 in 2017/18
Taxis:
- £4,082,556 in 2018/19
- £2,028,745 in 2017/18

A statement from the trust said: “We are the only ambulance service in the country that has a paramedic on every ambulance vehicle and have no paramedic vacancies.

“We believe that recruiting and training our own staff provides the highest standards of patient care and is more cost effective.

“The trust has also stopped using private providers and charitable organisations in its non-emergency patient transport service. The trust does use some taxis as part of its PTS (patient transport service) operation, usually because it is mandated within such contracts, but we are actively reducing this figure as much as possible.”

South Central Ambulance Service NHS Foundation Trust:

Private ambulances:
- £15,382,218 on 999 work plus £12,328,134 on patient transfer work in 2018/19
- £12,994,544 on 999 work plus £15,854,210 on patient transfer work in 2017/18
Taxis:
- £1,800,000 in 2018/19
- £1,700,000 in 2017/18

A statement from the trust said: “Private providers support SCAS to be able to deliver a high-quality, responsive emergency 999 service. SCAS is one of the best performing ambulance trusts in England when measured against national performance indicators under the Ambulance Response Programme, as well as being a leading trust in clinical outcomes for patients suffering cardiac arrest, stroke, major trauma and other life-threatening injuries and illnesses. “The trust has a highly accurate demand planning model that ensures we have the correct level of resources to meet predicted patient demand.

“Private providers ensure that despite vacancies in our frontline workforce (due to national shortage of paramedics and exacerbated in our region by operating in a high-cost living area and the need to maintain salary levels that are agreed at a national level) we can ensure that the expected level of demand for our 999 service can be met.

“Private providers give SCAS the flexibility to align our resources consistently within 3% of actual demand and help deliver our high levels of performance.

“Furthermore, SCAS recently became the first ambulance service to roll out an ePR system to all its private provider partners so that every patient in or region receives the exact same high-quality care and experience whether they are treated by a SCAS crew or one from one of our private providers.”

South East Coast Ambulance Service NHS Foundation Trust (SECAmb):

Private ambulances:
- £9,210,426 in 2018/19
- £10,786,329 in 2017/18
Zero spend on taxis

North East Ambulance Service NHS Foundation Trust:

Private ambulances:
- £2,694,000 in 2018/19
- £3,196,000 in 2017/18
Taxis:
- £774,665 in 2018/19
- £683,991 in 2017/18

Yorkshire Ambulance Service NHS Trust:

Private ambulances:
- £4,906,384 in 2018/19
- £3,343,771 in 2017/18
No response regarding spend on taxis

North West Ambulance Service NHS Trust:

Private ambulances:
- £6,107,242 in 2018/19
- £9,025,359 in 2017/18
Taxis:
- £6,821,664 in 2018/19
- £8,692,534 in 2017/18

East of England Ambulance Service NHS Trust

Private ambulances:
- £9,535,027 in 2018/19
- £4,791,155 in 2017/18
Taxis:
- £679,494 in 2018/19
- £885,024 in 2017/18

A statement from the trust said: “Over the last few years, the trust has hired hundreds of new staff to improve the service for our patients and to meet growing demand.

“As well as overtime, we use private ambulance services as a flexible resource to meet spikes in demand, such as winter when we see far more demand. It takes three years to qualify as a paramedic and we use private services to fill gaps in budgeted capacity whilst student paramedics complete their university studies and whilst we fill vacancies.

“Recruiting trained staff, particularly registered paramedics, is extremely challenging and whilst we continue to recruit and train a significant number of patient facing staff we continue to use private ambulance services so that we can respond to patients as quickly as possible and give them the best possible service.

“Like the vast majority of UK ambulance services, we use Care Quality Commission (CQC) registered private ambulance services so that we can respond to patients as quickly as possible. Alongside the requirement to be officially CQC accredited, each provider we use is also subject to our own internal approval processes and regular quality reviews.”

South Western Ambulance Service NHS Foundation Trust:

Private ambulances:
- £4,090,241 in 2018/19
- £4,709,520 in 2017/18
Taxis:
- £139,341 in 2018/19 (for 999 work)
- £70,383 in 217/18 (for 999 work)

A statement from the trust said: “Where patients have been clinically assessed as not needing an ambulance, but needing further assessment at a local treatment centre, and they have no means of transport then South Western Ambulance Service would consider the use of a private taxi.

“If the patient does not need an ambulance but has no other means of transport, then taxis can be used as a cost-effective alternative. By doing this, we, and indeed other ambulance services in the country, can free up valuable ambulance resources for patients who will benefit from clinical care and the specialist equipment on our operational vehicles.

“At South Western Ambulance Service we only use a private ambulance to supplement our own resources for specific events or expected peaks in demand that would otherwise put strain on our service.”

London Ambulance Service NHS Trust: