Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

Abstract

Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of 'star rating', which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries.

Fig. 1

Percentage of category A calls met within 8 minutes (2000–2005) (source: Department of Health (2002b, 2004) (for 2000–2004) and Health and Social Care Information Centre (2005) (for 2005))

Fig. 2

Percentage of category A calls met within 8 minutes, in England (▪), Wales (•) and Scotland (Δ) (sources: England, Department of Health (1999a, 2000, 2001) (for 1999–2001) and Information Centre (2007) (for 2002–2007); Wales, National Assembly for Wales (2005) (for 2000–2004), Auditor General for Wales (2006), page 37 (for 2005 and 2006), and Welsh Assembly Government (2007b) (for 2007); Scotland, Auditor General for Wales (2006), page 37, and Audit Scotland (2007), page 2 (for 2007))

Fig. 3

Example of a ‘noisy’ decline in response times to category A calls by one service (source: Commission for Health Improvement (2003c))

Fig. 4

Marginal discontinuity in frequency of response times to category A calls by one service (source: Commission for Health Improvement (2003c))

Fig. 5

Slope in frequency of response times to category A calls around 8 minutes by one service (source: Commission for Health Improvement (2003c))

Fig. 6

Bulge in frequency of response times to category A calls around 8 minutes by one service (source: Commission for Health Improvement (2003c))

Fig. 7

Spike in frequency of response times to category A calls at 8 minutes by one service (source: Commission for Health Improvement (2003c))

Fig. 8

Spikes in frequency of response times to category A calls at each minute by one service (source: Commission for Health Improvement (2003c))