Lead: Dr Carole Fogg, Senior Research Fellow, University of Southampton

Team: Dr Dianna Smith, University of Southampton, Professor Bronagh Walsh, University of Southampton.

Phil King – Senior Business Analyst, South Central Ambulance Service (SCAS)

Vivienne Parsons – Specialist Business Analyst, SCAS

Simon Mortimore – Assistant Director of Business Intelligence, SCAS

Martina Brown – Research Manager, SCAS (and additional members of the research team – Helen Pocock – Senior Research Paramedic, Chloe Lofthouse-Jones – Education Lead, Patryk Jadzinski – Paramedic/Senior Lecturer)

Nic Dunbar – Head of Community First Responder Operations, SCAS (and Operational Leads David Hamer and Jack Ansell)

Starts: 13th March 2023

Ends: 31st July 2023

What's the issue?

NHS ambulance services are under intense pressure to deliver timely and safe care. Immediately life-threatening conditions have to be prioritised. Older people with falls and symptoms related to long-term chronic conditions with lower category calls may experience long delays before an ambulance arrives. Such patients often have recurring needs for emergency care due to lack of alternative care pathways or long waits for social care assessments. These patients may also have dementia, putting them at greater risk of clinical deterioration whilst waiting for their needs to be met.

Adults aged ≥65 represent a large proportion of SCAS demand (2022: 17% of 111 calls, 48% (21,200 per month) of 999 calls), with around 14% living with dementia. Better information on the location and outcomes of these calls through applying geospatial techniques can shape service provision to meet population needs, improve patient experience and outcomes, and enable existing resources to be used to best effect.

What did we find out in this research? Making maps of who uses healthcare services and where they live is a technique previously used by emergency services to understand patterns in ambulance response times and to identify vulnerable communities. The growing older population and increased demand for emergency care presents an opportunity to use these maps to better understand how the level of patient need for ambulance services varies by geographical area, and if there are differences in what happens to patients after they are seen.

Our study involved developing an academic-healthcare collaboration which included people with the relevant skills and abilities to identify the data that was needed, extract and collate it from healthcare data systems, translate it into geographical maps, and then interpret what the maps could tell us about older people’s use of emergency services in the area. We discussed maps which included the way older patients were distributed across the South Centralregion, the number of calls, response times, falls, dementia cases and hospital conveyance rates.

We found that there are large geographical differences in the number and type of emergency calls and ambulance requirements for older adults, particularly in how many people were then taken to hospital (“conveyance rates”). The geographical distribution of falls and calls to people living with dementia corresponded with patterns of where older people live in the region. Response times varied by location. Stakeholders recommended adding more information on other available services, including community first responders, to help map interpretation,  and identified areas to be explored in more detail, particularly in addressing conveyance rate disparities for falls.

What did we do with this new Knowledge?

We are continuing discussions with stakeholders to see how the methods and results of this initial study can be incorporated into practice and into future research.

We will take on board the suggestions from the SCAS staff on how to improve the maps, and include these in our next analyses.

We will collate this information and present it to the SCAS Board to see how the methods may be used in practice now, and what further improvements could be made.

The publication from the study provides a clear framework and methods so that other organisations providing emergency care and the Integrated Care Boards that they are a part of so that they can also consider these techniques to evaluate their provision of care to older people.

What next?

We have discussed the results in two workshops at the SCAS 2025 Volunteer Conference to see what volunteers think should be done next in using this data to improve emergency care of older people. Lots of additional areas for research were raised for older people’s emergency care, which we are working on assessing for feasibility and prioritising.

We are going to share the results with external stakeholders such as those in the healthcare improvement Q Community Special Interest Group on emergency care to seek wider collaboration for further work.

We are developing further research bids (NIHR/ESRC) to explore explanatory and potentially modifiable factors for the differences in hospital conveyance rates between geographical areas for older people with non-life-threatening calls, and to investigate which geographical areas would benefit from better provision of or access to out-of-hospital services.