Lord Carter’s review into unwarranted variation in NHS ambulance trusts

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Lord Carter’s review identifies unwarranted variation in the delivery of ambulance services, as well as the potential savings of £500 million that could be made in efficiencies by 2020/21.

What is the review about?

Following Lord Carter’s 2016 review into the operational productivity of acute non-specialists trusts, the ambulance sector requested a similar review into its services to help them understand what good looks like. As well as what improvements could be made to deliver good quality, better value services for their patients.

What do some of the findings tell us?

Lord Carter has produced the report into ambulance productivity in England with nine recommendations to improve patient care, efficiency and support for frontline staff who have responded to a significant rise in demand for ambulance services in recent years.

The report found that if more patients were treated at the scene by paramedics or were better assessed over the phone when dialling 999 — avoiding the need for an ambulance when it is safe to do so — the NHS could treat patients closer to home and reduce unnecessary pressure on emergency departments (EDs) and hospital beds. Offering safe and quicker care could save the NHS £300m a year by 2021, with a further £200m of savings through improvements in ambulance trusts infrastructure and staff productivity.

‘Too many patients are being unnecessarily taken to ED by ambulances, putting further pressure on hospital services that are already on the back foot. Not only is this financially costly, but it takes up staff’s time and means patients are having to spend time waiting in ED when they should be recovering at home.

An ambulance is not a taxi to ED. Modern technology means that patients can often be treated at the scene. But an ageing ambulance fleet means that this is not always possible.

Paramedics and other staff have worked incredibly hard as demand for ambulances has soared. It is now vital that improvements are made in the infrastructure of the wider NHS to help frontline staff work as efficiently as possible.’

Lord Carter, a non-executive director at NHS Improvement and author of the report


‘We welcome Lord Carter’s report, which emphasises the adoption of new technology and innovation within the ambulance service as a key driver for reducing conveyance rates to hospitals. Whilst we accept there are variabilities in the numbers of patients conveyed to EDs in each region, this is often driven by local geography, patient demographics and the availability of clinically appropriate referral pathways.’

Martin Flaherty OBE, Managing Director of the Association of Ambulance Chief Executives

Double-crewed ambulance specification


This document gives the national ambulance vehicle specification for English NHS ambulance trusts that is mandated through the NHS Standard Contract for ambulance services.

Published October 2021.