Created a rigorous evidence-base to guide future decision-making through detailed analysis of millions of calls to the ambulance service
Highlighted key opportunities to improve resource efficiency by identifying that ~40% of care home incidents involved conditions suitable for alternative pathways
Supported the design of coordinated improvement initiatives across five Integrated Care Boards to reduce unnecessary ambulance attendances and build patient-centred pathways
Ambulance demand from care homes across an ambulance service’s geography had been rising steadily and there was significant variation in ambulance utilisation between similar care homes. There was limited understanding of the drivers of the increased demand and variation, limiting efforts to design targeted interventions to safely reduce 999 calls and hospital conveyances from care homes. NHS England region identified care home ambulance utilisation as a priority area to address under its winter plans, highlighting that a large proportion of care home call-outs could be safely managed through alternative community-based pathways.
To address this, NHS England commissioned TN to conduct a detailed diagnostic to establish a consistent evidence base, uncover the drivers of unwarranted variation (e.g., staff capability, service availability, or provider practices), and identify practical, system-level opportunities to use ambulance resources more effectively across the region.
- Creating care home archetypes: Segmented care homes into seven ‘archetypes’ based on the incident per bed rate, size of care home, specialisations and service offering
- Distilling drivers of variation within archetypes: Evaluated ambulance utilisation by analysing call reasons, the availability of alternative community services, and the number of frequent callers
- Co-developed initiatives: Engaged with community, social care and ambulance service colleagues to refine insights and co-develop best practice initiatives that could be implemented to resolve the challenges, such as:
- Developing robust training and induction processes for care home staff on care provision and available pathways, including when and how to utilise them
- Establish closer links between primary care and care home providers, for instance hold weekly multidisciplinary team meetings in care homes to identify the appropriate response to patient needs and update resident care plans
- Developing a single, accessible and comprehensive care plan for all residents, thereby streamlining access to patient history and care plan updates
