Challenges and Solutions for London Ambulance Service NHS Trust

This report analyzes the main challenges faced by London Ambulance Service NHS Trust and proposes viable solutions to address them. It focuses on the increasing patient demand for services and recommends strategies to manage it effectively.

London Ambulance
Service NHS Trust

The London Ambulance Service NHS Trust is a NHS trust service that is responsible for
answering and responding to emergency or urgent medical situations and operating various
ambulances within the capital London region of England. The London Ambulance Service NHS
Trust is designed to respond to two major phone numbers the 999 and the 111 phone calls, with
the intention to provide the callers with triage and advice in order to respond back to the grieved
caller in an appropriate manner. The London Ambulance Service NHS Trust is one of the most
busiest ambulance services around the whole world, and is in fact the busiest ambulance service
in the entire UK, as it provides emergence care to more than 8.6 million different individuals
who make their living and work in London. In order to effectively be able to conduct its daily
operations, the London Ambulance Service NHS Trust employs more than 5,300 distinct
individuals within its hierarchical chain of command at various different roles and positions. As
the London Ambulance Service NHS Trust is a part or component of the National Health
Services of UK, it receives direct funding from the UK government for its roles and
responsibilities (Nunan and et.al., 2020). The London Ambulance Service NHS Trust does not
charge any individual of UK for procuring the ambulance services provided by them and every
citizen of the UK has a right to avail the ambulance provided by London Ambulance Service
NHS Trust in cases of urgency or emergencies. In 2016/17, The London Ambulance Service
NHS Trust responded to over 1.8 million emergency calls from grieved individuals from all over
the London region and also responded to over 1.1 million incidents. The main roles of London
Ambulance Service NHS Trust are as follows:
 Handling and responding to all 999 calls taking and prioritising emergency cases of
grieved individuals.
 Responding to 999 emergencies and urgent cases from individuals all over the London
region.
 Providing clinical telephone advice to aggrieved citizens within the London region who
are suffering from less serious illness and injuries, that do not require the immediate
response of London Ambulance Service NHS Trust.
 Providing and dispatching paramedics for the london’s air ambulance service in cases of
extreme emergencies.
 Planning for being able to effectively respond to large scale emergencies or serious
events that occur in the capital region of London.

 Running the NHS 111 service for the south-eastern part of London.
Through its vital roles and responsibilities, the London Ambulance Service NHS Trust
performs critical services for maintaining the health and safety of a large number of the London
population and hence any issues or challenges that the London Ambulance Service NHS Trust
faces during its daily operations has the potential to risk and endanger the lives of the London
citizens. This is because such challenges and issues can keep the emergency response services
from being able to effectively reach the aggrieved citizens, within critical timing restriction,
which endangers the health and safety of the injured, ill or aggrieved citizen of London
(Tollinton, Metcalf and Velupillai, 2020). This report analyses the main issue or challenge that
London Ambulance Service NHS Trust faces during its daily operations, evaluates a viable
solution to the proposed challenge faced by London Ambulance Service NHS Trust and assesses
how London Ambulance Service NHS Trust can effectively implement the proposed solution in
order to address the challenges and issues that they face daily for their operations, enhancing the
ability of the London Ambulance Service NHS Trust to provide critical healthcare to the
individuals who are suffering from an emergency situation.
TASK 1
One of the most critical and major issues or challenges that the London Ambulance
Service NHS Trust faces during its daily operations towards providing the London citizens with
emergency response and ambulance services relates to the steadily increasing patient demand for
the services of London Ambulance Service NHS Trust in the last five years. Since 2015, the
London Ambulance Service NHS Trust has observed an average increase of over 6% per year in
the number of London patients demanding for the services provided by the London Ambulance
Service NHS Trust. As this trend has been going on for the last five years, experts assess that
there exist no external reasons for the trend to slow down or stop. This is a major challenge or
issue for the London Ambulance Service NHS Trust as it increases the overall pressure on the
public trust to keep servicing an ever greater number of London patients while financial
resources allocated to the London Ambulance Service NHS Trust by the UK government stay
constant (Shaw, Murphy-Jones and Fothergill, 2018). After conducting long term forecasting of
the impact and effect of this trend on the operations of London Ambulance Service NHS Trust,
experts UK are of the opinion that if no alternative solution or strategy is implemented towards

addressing the increased patient demand that London Ambulance Service NHS Trust has been
observing for the past 5 years, then in the future the London Ambulance Service NHS Trust can
observe close to 14000 distinct emergency calls every week, which would be a 30% increase
from the number of calls received by London Ambulance Service NHS Trust for 2016/17 year.
Figure 1: Increase in the number of patients demanding for services of London Ambulance
Service NHS Trust over years
There exist numerous reasons for the overall average increase of patient demand for the
services provided by London Ambulance Service NHS Trust over the years such as:
 As the London’s population grows and ages, the London Ambulance Service NHS Trust
naturally observes increased number of patients demanding for their services, with the
cases also increasing in terms of emergencies and complexities. This increases the overall
patient demand for services of London Ambulance Service NHS Trust within London
and also lengthens the treatment times (Nunan and et.al., 2019). As the population of
London grows, injuries that might not be considered as emergency situations are now
also being considered as emergency due to the increased age of the patient such as falls
which are highly common but require emergency response from London Ambulance
Service NHS Trust, account to over 11% of the total calls received by the London
Ambulance Service NHS Trust.

 Rise of various physical and mental health conditions within the London population such
as obesity or blood pressure or depression or respiratory problems or the Coronavirus
(COVID 19) etc., also may lead to increasing number of patients demanding for the
emergency services provided by London Ambulance Service NHS Trust.
 Increasing difficulties for the London citizens to access social care and primary care,
particularly for support during out of service hours. There are numerous publicised
journals and reports detailing of the long waiting queues and lines for making
appointments with professional healthcare practitioners and doctors which also makes it
harder to persuade the London population to only call for ambulance services from the
London Ambulance Service NHS Trust when in critical, urgent or emergency situations.
 Changes to the public perception relating to the way through which patients access and
expect to access healthcare and emergency services (Lazarus, Iyer and Fothergill, 2019).
 Another major reason for the increased patient demand for the services provided by
London Ambulance Service NHS Trust pertains to London being a major tourist
attraction, attracting over millions of foreign individuals to the metropolitan city who also
require ambulance and healthcare response services from London Ambulance Service
NHS Trust.
Through such numerous factors, the problem of increased demand for the services
provided by London Ambulance Service NHS Trust has surfaced to be one of the most
significant challenges for the successful operations of London Ambulance Service NHS Trust in
their objective to provide healthcare services to the London population. This is one of the major
challenges faced by London Ambulance Service NHS Trust, as due to the increased demand,
they are not able to provide required response and healthcare services to many emergency and
critical cases, as their hands are already full owing to the increased number of patients already
demanding for the services of London Ambulance Service NHS Trust.
TASK 2
In order to address the issue of increased patient demand for the services of London
Ambulance Service NHS Trust, the trust is recommended to implement the following strategy as
part of its operations and functions within London. This new strategy would allow for London

Ambulance Service NHS Trust to address the problem of increased patient demand by focusing
on three main themes, which are as follows:
 Providing comprehensive emergency and urgent access, triage, care and treatment to the
patients of London, with multichannel access being provided to patients.
 Providing critical, emergency and urgent response to patients with healthcare treatment
being provided to patients on scene and focusing on faster conveyance to hospital for
patients who cannot be provided necessary and required healthcare treatment on scene
(Shaw, Whitbread and Fothergill, 2016).
 Collaborating with the emergency services, NHS and London partners to provide
increasingly consistent, equitable and effective healthcare services to the population of
London.
The solution strategy aims to implement the following procedures at London Ambulance Service
NHS Trust, in order to address their problem relating to the increased number of patients
demanding for services of London Ambulance Service NHS Trust:
 Decreasing the overall number of patients who are transferred to the ‘Accidents and
Emergency’ departments within healthcare hospitals as a default without first assessing
whether the patient is required to be transferred to the A&E department in the first place.
 Providing care to increased number of patients within London based on the ‘Hear and
Treat’ strategy. The hear and treat strategy allows for the emergency response services of
London Ambulance Service NHS Trust to provide advice to patients over the telephone,
who are not in any kind of emergency or life threatening situation after they have called
for emergency response over 999 (Lee and Titchener, 2017). The advice relates to how
they can care for themselves or where they can receive required healthcare assistance.
 Providing care to increased number of patients within London based on the ‘See and
Treat’ Strategy. Through this strategy, the healthcare staff in ambulance conduct clinical
assessment of the patient at their location, providing them with immediate treatment and
discharging them or referring them to come back on a later date. This can allow for
London Ambulance Service NHS Trust to refer the patient to services that are much more
appropriate to their needs.

TASK 3
In order to implement the proposed solutions, the London Ambulance Service NHS Trust
is recommended to adhere to the following recommendations.
 London Ambulance Service NHS Trust can decrease the overall number of patients being
transferred to the A&E departments of hospitals by conducting thorough clinical
assessment of the issues or illness that the patient is suffering from and then having a
professional healthcare provider assess whether the patient is actually required to be
transferred to the A&E department or not.
 London Ambulance Service NHS Trust can implement the ‘Hear and Treat’ Strategy by
having their call responders be trained in analysing whether the patient calling for
emergency response is actually in need of the emergency services or not (Baron and
Townsend, 2017). If the call responders assess the patient to not be in a critical or life
threatening or emergency situation, then the call responders of London Ambulance
Service NHS Trust can connect the patient to the appropriate healthcare providers who
are qualified to detail and advise the patients on how they can care for themselves or
training the call responder to advise the patient on where they can get the healthcare
treatment that is required by them.
 London Ambulance Service NHS Trust can also implement the ‘See and Treat’ strategy
as part of their operations by including a medically qualified general practitioner as part
of its ambulance staff, which would allow for the ambulance staff of London Ambulance
Service NHS Trust to make clinical assessments of the patient on the scene and provide
to them the medical treatment that is required to them at the ambulance. Should the
ambulance staff be unable to provide required healthcare treatment to the patients, then
the ambulance staff should be trained to convey the patient to the hospital as fast as
possible.

REFERENCES
Books and Journals
Baron, A. and Townsend, R., 2017. Live tweeting by ambulance services: a growing concern.
Journal of Paramedic Practice. 9(7). pp.282-286.
Lazarus, J., Iyer, R. and Fothergill, R.T., 2019. Paramedic attitudes and experiences of enrolling
patients into the PARAMEDIC-2 adrenaline trial: a qualitative survey within the
London Ambulance Service. BMJ open. 9(11).
Lee, G.A. and Titchener, K., 2017. The Guy’s and St Thomas’s NHS Foundation Trust@ home
service: an overview of a new service. London journal of primary care. 9(2). pp.18-22.
Nunan, J. and et.al., 2020. The timeline of information exchange: a service evaluation of London
Ambulance Service NHS Trust’s front line communication and emergency response to
Exercise Unified Response. British Paramedic Journal. 4(4). pp.40-49.
Nunan, J.H. and et.al., 2019. The timeline of information exchange: an evaluation of London
Ambulance Service NHS Trust’s front-line communication and emergency response to
Exercise Unified Response. British Paramedic Journal.
Shaw, J., Murphy-Jones, B. and Fothergill, R., 2018. 69 Pre-hospital paediatric pain management
in the london ambulance service.
Shaw, J., Whitbread, M. and Fothergill, R.T., 2016. A clinical audit examining the use of
furosemide by the London ambulance service. American Journal of Education. 4(6).
pp.491-495.
Tollinton, L., Metcalf, A.M. and Velupillai, S., 2020. Enhancing predictions of patient
conveyance using emergency call handler free text notes for unconscious and fainting
incidents reported to the London Ambulance Service. International Journal of Medical
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