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58-480: The South East Coast Ambulance Service NHS Foundation Trust ( SECAmb ) is the NHS ambulance services trust for south-eastern England , covering Kent (including Medway ), Surrey , West Sussex and East Sussex (including Brighton and Hove ). It also covers a part of north-eastern Hampshire around Aldershot , Farnborough , Fleet and Yateley . The service was made an NHS foundation trust on 1 March 2011. It

116-424: A 999 call. For other emergencies the target is for 90% to be seen in 40 minutes. Urgent or non-urgent calls should expect an average response time of 120 and 180 minutes respectively. Extensive trials have shown that fewer patients are classed as life-threatening and fewer vehicles are dispatched, but responses for the most urgent calls improved. Trusts asked for more resources to meet these targets, in particular

174-466: A 999 video calling service, in order to be able to visually assess patients whilst crews are en route. The work of ambulance services included responsibility for patient transport , but in England this is now often covered by separate contractual arrangements, and often delivered by private providers. The National Health Service Act 1946 gave county (and county borough) councils in England and Wales

232-618: A clinical commissioning group. The area of the CCG had to all be within one top-tier local authority . As originally established, CCGs did not have any responsibility for primary care which was commissioned and managed by NHS England , but in November 2014 they were invited to become co-commissioners of primary care in their area, responsible for the performance management and budgets of their member GP practices, including managing complaints about practices and GPs. A delegated commissioning model

290-443: A contract worth up to £30m for “auxiliary ambulance services”. This is worth £7.5m annually and is initially an eight-month contract. It covers both emergency and non-emergency ambulance crews “with the capacity to respond to callouts across categories one to four”. Currently, England's ambulance auxiliary is provided by St John Ambulance . NHS England sets targets for response times to 999 calls, which were first established in

348-561: A culture of bullying, harassment and sexual predation. SECAmb is under severe financial pressure and faces a £7.1   million deficit. Ambulance crews in the area will no longer be paid to interrupt meal breaks and attend to some types of emergencies. Patients with breathing problems , car crash victims, patients with chest pains , seizures or strokes , among others, face delayed response times. Critics fear this will put lives at risk and worsen outcomes for some surviving patients. Jon Ashworth blamed government financial pressure on

406-567: A doctor who was a secondary care specialist from an area not covered by the CCG's boundaries. The aim of this was to give GPs and other clinicians the power to influence commissioning decisions for their patients. The Health and Social Care Act 2012 provided that the areas specified in the constitutions of clinical commissioning groups together cover the whole of England, and did not coincide or overlap. CCGs were overseen by NHS England including its Regional Offices and Area Teams. These structures managed primary care commissioning, including holding

464-425: A good way of saving money. For 2020, 86 mergers were planned; 45% of the existing 191 groups. As of April 2020 there were 135 CCGs. On 1 April 2021, 38 CCGs merged to form 9 new CCGs. In October 2017, it was announced that Brighton and Hove Clinical Commissioning Group were to merge some services with those provided by Brighton and Hove City Council , via a Health and Social Care Integration Board. The board

522-406: A new set of performance targets for the ambulance service were announced after a trial across four different ambulance trusts, looking at more than 1 million patients overseen by Sheffield University. These are to apply to all 999 calls for the first time. Call handlers will be given four minutes to assess the urgency of the call before the clock starts. The target for the most seriously ill patients

580-482: A notable increase to risk for patients in the emergency department". In November 2015, it emerged that the trust had set up a project which ran from December 2014 to February 2015, where calls were transferred from the NHS 111 system and an additional ten minutes was allocated to the response time, which is part of the nationally agreed operating standards. This delayed the dispatch of ambulances to up to 20,000 patients. It

638-450: A statutory responsibility to provide an emergency ambulance service, although they could contract a voluntary ambulance service to provide this. In 1977/78 ambulance services in the UK cost about £138m. At that time about 90% of the work was transporting patients to and from hospitals. The Regional Ambulance Officers' Committee reported in 1979 that: There was considerable local variation in

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696-701: A variety of support functions, largely staffed by former employees of the primary care trusts . All CCGs were told that they must procure support services by a tender process by April 2015. The first tender, by South Lincolnshire and South West Lincolnshire CCGs was won by OptumHealth with a value of £3 million a year for three years. By 2017 the number of commissioning support lists had been reduced to eight. In September 2015 at least 9 CCGs had set up "ethically questionable" incentive schemes to persuade GPs to reduce referrals for new outpatient attendances, follow-ups, A&E attendances and emergency admissions with payments per practice of up to £11,000. Chaand Nagpaul , of

754-483: A vote of no confidence in their local CCGs in protest against a proposed merger. The merger between Liverpool , South Sefton and Southport and Formby CCGs was stopped while an investigation into Liverpool CCG's governance and management of conflicts of interest was carried out, leading to the resignation of several of its leaders. There were similar investigations in Hackney, London and Crawley . As of April 2018,

812-603: Is now seven minutes. The 'clock' stops when the most appropriate response, not necessarily the first, arrives. There are condition-specific measures which will track time from 999 call to hospital treatment for heart attacks and strokes. 90% of eligible heart attack patients should receive definitive treatment (balloon inflation during angioplasty at a specialist heart attack centre) within 150 minutes by 2022. 90% of stroke patients should also receive appropriate management (thrombolysis for those who require it, and first CT scan for all other stroke patients) within 180 minutes of making

870-732: Is one of ten ambulance services trusts providing England with emergency medical services , and is part of the National Health Service , receiving direct government funding for its role. The service came into being on 1 July 2006, with the merger of the former Kent Ambulance Service , Surrey Ambulance Service and Sussex Ambulance Service . The trust responds to 999 calls from the public and urgent calls from health professionals: in Kent and Sussex, it also provides non-emergency patient transport services (pre-booked patient journeys to and from health care facilities). In addition,

928-466: Is performing well and meeting our expectations), requires improvement (the service isn't performing as well as it should) and inadequate (the service is performing badly): Ambulance services trust NHS ambulance services are classed as an emergency service, the public normally access emergency medical services through one of the valid emergency telephone numbers (either 999 or 112 ). Additionally, some ambulance services are considering trialing

986-478: Is required a suitable vehicle should arrive on the scene within 19 minutes. The number of these rose from 2.5 million in 2011/12 to just under 3.4 million in 2015/16, but response times fell steadily and the 75% target was not met after 2013. Green 1 required a vehicle within 20 minutes, Green 2 within 30 minutes. Green 3 required telephone assessment within 20 minutes and Green 4 telephone assessment within 60 minutes. These targets are only recommended. In July 2017

1044-493: The Health Service Journal found that more than a third were planning to save money by restricting access to services, i.e. health care rationing , particularly on "procedures of limited effectiveness", podiatry, in vitro fertilisation, and limiting access to procedures based on aspects of a patient's health, for example whether they smoke or are obese, which can affect outcomes. A similar July 2015 survey by

1102-599: The British Medical Association , condemned them as "a financial contaminant" to patient-doctor trust. The General Medical Council guidance, Financial and commercial arrangements and conflicts of interest provides that a doctor should "not allow any interests you have to affect the way you prescribe for, treat, refer or commission services for patients" but the council accepted that "Finance and other incentives can be an effective way of driving improvements in healthcare." An April 2015 survey of CCGs by

1160-503: The Health and Social Care Act 2012 to replace strategic health authorities and primary care trusts to organise the delivery of NHS services in each of their local areas in England. On 1 July 2022, they were abolished and replaced by integrated care systems as a result of the Health and Care Act 2022 . The announcement that GPs would take over this commissioning role was made in the 2010 white paper "Equity and Excellence: Liberating

1218-658: The London Borough of Tower Hamlets Clinical Commissioning Group, chaired by Sam Everington , was awarded Clinical Commissioning Group of the year by the Health Service Journal for "strong leadership, especially around clinical leadership, while retaining patient focus." In May 2015, a study conducted by the Open University and University College London found that clinical leaders "seemed to be more willing to challenge or ignore diktats and messages from above, and to encourage their managerial colleagues to do

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1276-599: The National Health Service Reorganisation Act 1973 from local authority to central government control in 1974, and consolidated into 53 services under regional or area health authorities . In Northern Ireland the service was the responsibility of the Northern Ireland Hospitals Authority before 1974, and was then transferred to the four health and social services boards. Under the provisions of

1334-476: The National Health Service and Community Care Act 1990 England was covered by 31 ambulance trusts, which were structured as below. In July 2006 the number of ambulance service trusts was reduced to thirteen. Following consultation, on 1 July 2006 the number of ambulance trusts fell from 29 to 13. The reduction can be seen as part of a trend dating back to 1974, when English local authorities ceased to be providers of ambulance services. This round of reductions in

1392-487: The continuing healthcare costs for a patient with learning disabilities, Mr Justice Garnham ruled that a CCG could not pay for treatment of a patient registered with a general practitioner outside their area. In 2018/19, £74.2 billion was distributed among the 195 CCGs in England, equivalent to £1,254 per registered patient. The funding formula allocates more money to CCGs with elderly populations, in urban areas, or in more deprived areas. The highest allocation per patient

1450-903: The coronavirus pandemic , on 23 and 27 March 2020 the Secretary of State for Health and Social Care directed the NHS Commissioning Board to buy services from the private sector, thereby bypassing CCGs. The directive also allowed NHS England to exercise functions normally carried out by CCGs, as the Board deemed appropriate. The directive had an initial expiry at the end of 2020, which was extended in stages to 31 March 2022. All CCGs had to go through an authorisation process. Between July and December 2012, there were four waves of authorisation . In 2014 NHS England investigated Wirral Clinical Commissioning Group after Birkenhead MP Frank Field raised concerns about it. They found that

1508-514: The 1970s. Call handlers were, until 2017, given just 60 seconds to decide on the urgency of the call. The clock stopped once a vehicle reached the patient - even if it was not the appropriate vehicle. Category A (Red 1 and Red 2) were classed as life-threatening and the national standard sets out that a vehicle should reach the scene within eight minutes for 75% of these calls . Red 1 calls are for patients who have suffered cardiac arrest or stopped breathing and require two vehicles. If onward transport

1566-680: The GP magazine Pulse , found that many CCGs were planning to restrict access to routine care in various ways. Another Health Service Journal survey in September 2015 showed that 34 of 188 CCGs who responded to the survey had restricted access to some services. Restrictions were usually introduced by a number of CCGs acting together across an area. Nottinghamshire CCGs had restricted access to surgery for sleep apnoea and hysterectomy for heavy menstrual bleeding, fat grafts, hair depilation, earlobe repair, and chin, cheek or collagen implants. In view of

1624-585: The NHS Contracts for GP practices NHS. Each CCG had a constitution and was run by its governing body. Each had to have an accountable officer responsible for the CCG's duties, functions, finance and governance. Most CCGs initially appointed former primary care trust managers to these posts. However, by October 2014, only a quarter of accountable officers were GPs, whereas 80% of CCG Chairs were GPs. By November 2014 only half of GP practices said they felt involved in CCG decision-making processes. Unite

1682-500: The NHS". This was part of the government's stated desire to create a clinically driven commissioning system that was more sensitive to the needs of patients. The 2010 white paper became law under the Health and Social Care Act 2012 in March 2012. At the end of March 2013 there were 211 CCGs, but a series of mergers had reduced the number to 135 by April 2020. To a certain extent they replaced primary care trusts (PCTs), though some of

1740-500: The UK, which are listed below: In 2019 the Care Quality Commission reported that ambulance services were relying on private providers because of lack of capacity. Some firms had failed to obtain references or carry out criminal record checks and a lack of staff training was leading to serious patient harm. More than £92 million was spent in 2018/9 on private ambulances and taxis. In May 2022 NHS England tendered

1798-543: The Union surveyed the 3,392 CCG board members in 2015 and reported that 513 were directors of private healthcare companies: 140 owned such businesses and 105 carried out external work for them. More than 400 CCG board members were shareholders in such companies. The King's Fund and the Nuffield Trust ran a survey of GPs in six areas of England in 2016 and found that more than 70% were at least "somewhat" engaged with

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1856-420: The chair and chief clinical officer "did not demonstrate the necessary close working agreement" about what needed to change within the CCG. There were also questions about the relationship senior leaders had with Arrowe Park Hospital . After the report was published Field repeated his calls for the senior officers to stand aside while a new constitution is made for the governance of the group. In October 2014 it

1914-460: The group's area and were not provided with primary medical services by a member of any clinical commissioning group. CCGs operated by commissioning (or planning, buying and monitoring) healthcare services including: Clinical commissioning groups were responsible for arranging emergency and urgent care services within their boundaries, and for commissioning services for any unregistered patients who live in their area. All GP practices had to belong to

1972-418: The health service. Critics complain money is prioritized over patient care. In September 2017, the trust reached just 50.8% of red one calls within the target of eight minutes, and 39.9% of red two calls. This was the lowest ever recorded by an ambulance service since May 2012. There was also a decline in calls being answered within five   seconds, from 72.4% in September 2016 to 48.6%. In May 2018,

2030-445: The highest ever recorded. Category one performance averaged 9 minutes 35 seconds, the same as in March 2022 and the joint lowest on record. Category two calls took an average of 59 minutes 7 seconds. Between 2011-12 and 2015-16 ambulance activity in England rose by 30%. Funding only increased by 16%. In May 2018 several trusts told commissioners that they needed to spend many millions on extra staff and ambulances if they were to meet

2088-575: The island's primary care trust ), South East Coast Ambulance Service , and South Central Ambulance Service . There have been two ambulance services trust mergers since 2006. Since 2013, the 11 ambulance trusts in England and Wales have been: In addition, the Isle of Wight NHS Trust , provides ambulance services for the Isle of Wight . There are currently 14 NHS organisations (ambulance services trusts in England) which provide ambulance services across

2146-414: The largest CCG in England was created following the merger of NHS Birmingham Cross-City, Birmingham South Central and Solihull CCGs. The newly formed NHS Birmingham and Solihull CCG became responsible for commissioning services for over 1.3 million patients. In November 2018, NHS England announced that the administration budgets of CCGs were to be cut by 20% and that mergers, which would be approved, were

2204-668: The management, governance or structure of the CCG's responsibilities, with the potential for other CCGs or relevant bodies to take over aspects of the local commissioner's responsibilities". At that time, none had been placed in special measures. In November 2015, Shropshire Clinical Commissioning Group was put in special measures after its financial position deteriorated. It expected an in-year deficit of £10.6 million for 2015/6. In September 2017, 23 CCGs were rated inadequate by NHS England for 2016–17, five were given legal directions and two, Lewisham and Greenwich, were ordered to "cease to exercise its acute commissioning functions, including

2262-650: The number of trusts originated in the June 2005 report "Taking healthcare to the Patient", authored by Peter Bradley, Chief Executive of the London Ambulance Service , for the Department of Health . Most of the trusts followed government office regional boundaries . Exceptions included Staffordshire Ambulance Service (which had a temporary reprieve), the Isle of Wight (where provision remained with

2320-505: The previous high in December 2019. Response time performance for these calls slumped to 8 minutes 33s, against a target of 7 minutes, with a tenth taking more than 15 minutes 15s. Average response time for category two calls, still classified as emergencies and including heart attacks and strokes, was 41 minutes 4s against a target of 18 minutes. In October 2021 there were around 28,900 ambulance handovers lasting longer than an hour. This

2378-495: The quality of the service provided, particularly in relation to vehicles, staff and equipment. Most Services were administered by Local Authorities through their Medical Officer of Health and his Ambulance Officer, a few were under the aegis of the Fire Service, whilst others relied upon agency methods for the provision of part or all of their services. The 142 existing ambulance services in England and Wales were transferred by

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2436-473: The registered population to Nene CCG, but Nene refused to accept it. During 2016 it appeared that further mergers would be permitted, and in November 2016 NHS England published an official procedure. In March 2017, 83 CCGs were sharing chief officers as a precursor to merger. During 2017 mergers between CCGs began, having previously been forbidden. As of August 2017 GPs in Staffordshire submitted

2494-634: The response time targets. In November 2018 NHS Digital launched the National Record Locator Service which gives ambulance staff access to patient records of mental health trusts, initially for the North West, North East, Yorkshire and London Ambulance Services. It is planned to roll it out across England and to include other records. Clinical commissioning group Clinical commissioning groups ( CCGs ) were National Health Service (NHS) organisations set up by

2552-472: The same". Clinical leaders were more "focused on outcomes and less interested in processes. They don't really mind how they do things as long as they feel they're having an impact". Having the option of returning to full-time clinical practice meant that clinicians felt a "degree of freedom in what they say and do". In April 2018, in a dispute brought by City of Wolverhampton Council against Shropshire and South Worcestershire CCGs over their failure to meet

2610-484: The scheme was suspended because of a shortage of paramedics. In January 2015, it was reported that the trust had told paramedics to leave patients at A&E departments if they had not been admitted within 45   minutes of arrival. In March 2015, the trust's "immediate handover policy" which was invoked on 10 February 2015 for an hour (before being rescinded) was condemned by clinicians at Brighton and Sussex University Hospitals NHS Trust as "unsafe and likely to pose

2668-758: The staff and responsibilities moved to local authority public health teams when PCTs ceased to exist in April 2013. Services directly provided by PCTs were reorganised through the Transforming Community Services programme. Clinical commissioning groups (CCGs) were clinically led groups which included all of the GP groups in their geographical area. They worked with patients and healthcare professionals and in partnership with local communities and local authorities. On their governing body, each group had, in addition to GPs, at least one registered nurse and

2726-479: The standards for the top 90% of responses. Taking patients to the "right" hospital rather than the nearest, leads to longer journeys. They were supported by a benchmarking exercise undertaken by the National Audit Office . In July 2018 eight of the ten services in England missed the seven-minute target. A review conducted by Lord Carter of Coles found that the rate of sickness of ambulance staff

2784-495: The trust provides the crews and maintains the three ambulances of the Neonatal Transfer Service for Kent, Surrey and Sussex. It serves a population of around 4.5   million. During the financial year (2005–06) the three predecessor Trusts responded to about 460,000 emergency calls. It provided paramedics to GP practices across the southeast to take on home visits for a pilot scheme until March 2017, when

2842-526: The trust said it would need 400 more paramedics to meet the new ambulance performance standards. This could cost £20M a year. In October the clinical commissioning groups (CCG) agreed to find an extra £10M a year for more ambulances and more staff, but the service still expected to need private ambulance services and staff overtime to meet its targets. It was taken out of special measures in August 2019 after favourable inspection reports, particularly that there

2900-456: The work of their CCG, though only 20% of those without a formal role in their CCG said they could influence the work of their CCG if they chose to. In 2013, 211 groups were established and there was resistance to any proposals for mergers between groups. On 1 April 2015 Gateshead CCG, Newcastle North & East CCG and Newcastle West CCG merged, yet in the same year, Lakeside Healthcare applied to move from Corby CCG where it had two-thirds of

2958-676: Was almost four times the 7,772 hour-long handovers recorded in October 2020. In April one patient waited 24 hours in an ambulance - thought to be the longest ever recorded. 11,000 patients waited more than three hours for handover, with 7,000 of them taking more than four hours and 4,000 over five hours. 11 July 2022 was said to be the worst night on record for ambulance services in England, with more than half of some trusts ambulance crews queued outside hospitals in very hot weather. There were more than 85,000 category one ambulance callouts in July -

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3016-401: Was condemned by NHS England for putting the "public at risk" because there was "no evaluation built into its design". It was put into special measures in September 2016 after the Care Quality Commission rated it inadequate because of bullying, delayed response times and putting patients at risk. A report produced by Professor Duncan Lewis from Plymouth University in August 2017 described

3074-433: Was now an open culture where patients, families and staff could raise concerns without fear, but it was banned by Ofsted from training new apprentices. The trust's region is served by Air Ambulance Kent Surrey Sussex . In its last inspection of the service in July 2022, the Care Quality Commission (CQC) gave the following ratings on a scale of outstanding (the service is performing exceptionally well), good (the service

3132-509: Was piloted from 2015: as of April 2015, 63 were to take on fully-delegated responsibility and 87 were to begin "joint commissioning", which involved less responsibility. In 2017 it was proposed that most CCGs should take responsibility for GP contracts, as the early adopters had done well and it was "critical to local sustainability and transformation planning ". As of October they were also to be able to establish new practices, approve mergers and manage discretionary payments. In November 2014,

3190-430: Was reported that NHS England were considering a special measures regime for CCGs in difficulties, of which there were said to be about a dozen. Under the assurance framework, CCGs were rated as "assured", "assured with support" or "not assured". Only Barnet CCG was rated "not assured". Guidance issued in August 2015 provided that if CCGs were in special measures for more than a year, NHS England could "trigger changes in

3248-706: Was the highest in the NHS - 20 days per person. Use of information technology was advancing very slowly. 25% of ambulances, of which there were 32 different types, were more than seven years old. There were large differences in costs and performance between the different trusts, some of which were attributable to local geography and the performance of other parts of the NHS. Responses to the most urgent calls averaged 11 minutes in rural areas in 2018 but 7 minutes in urban areas. The worst waits were around Wells-next-the-Sea . The COVID-19 pandemic in England put huge pressure on ambulance services. In July 2021 there were 81,685 category one incidents, up 32% in July 2019, and up 16% on

3306-504: Was to commence work in April 2018 and provide full service a year later, preventing duplication of health and social care within the city. In December 2017 the ten CCGs in Greater Manchester were in various stages of establishing a "single commissioning function" with their council. Each CCG was responsible for persons who were provided with primary medical services by a member of the group, and persons who usually reside in

3364-1151: Was £1,645 for Knowsley and the lowest £1,040 for Oxfordshire. Funding per head increased in real terms by 2% a year between 2013/14 and 2018/19. In 2015, the Centre for Health and the Public Interest estimated that in 2013–14 there were about 53,000 contracts between the NHS in England and the private sector, including contracts for primary care services, of which the 211 CCGs held 15,000 with an annual value of about £9.3bn. They sent Freedom of Information requests to all 211 CCGs, seeking information about how they monitor contracts with private providers and concluded that CCGs failed to manage contracts with private providers effectively. According to Christian Mazzi, head of health at Bain & Company , in September 2015 70% of CCGs had failed to monitor their private sector contracts or enforce quality standards. 12% had not carried out any visits to private providers, and 60% could not say if they had done so. In April 2013, NHS England established 25 commissioning support units to provide

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