The Scottish Ambulance Service has missed its target of reaching dangerously ill patients within eight minutes.

A report published today assessing the performance of NHS Scotland reveals plans to answer a greater proportion of life-threatening emergencies in time have stalled.

A huge increase in 999 calls since GP surgeries stopped working after 6pm is being blamed for the problem. The new report, by public spending watchdog Audit Scotland, also noted a sudden surge in patients attending accident and emergency departments.

Mary Scanlon, Tory health spokeswoman, said the struggle paramedics faced answering top-priority calls in eight minutes was very worrying.

She added: "I think there are unacceptable pressures on the ambulance service because it is the 24-hour open door to the NHS. When there are problems with phoneline NHS 24 and a lack of access to GPs, it falls on the ambulance service.

"Last year, the north-west division had an increase of 20% incategory A top priority calls. More is being expected of the service within existing resources."

By 2008, it was hoped that ambulances in Scotland would reach three-quarters of life-threatening emergencies within eight minutes. Incremental targets to reach this goal were set. Last year, the aim was 64%. However, the Audit Scotland report shows in 2006-07 the percentage of cases reached in time was 55.7%. This is poorer than the previous year's 58.5%.

In contrast, the English health service has almost met the same target. A 74% success rate was reported last summer.

A spokesman for the Scottish Ambulance Service said crews north of the border faced different challenges, such as Scotland's rural geography.

He said: "Since the change of out-of-hours arrangements - the introduction of the new GP contract - the rate of increase in demand for ambulances has doubled, creating an unprecedented volume of 999 calls."

The spokesman added that the latest figures held by the organisation show the service is reaching 62.9% of top- priority calls in time and the average response time across Scotland is 8.3 minutes.

GPs giving up responsib-ility for patient care outside surgery hours is also thought to be behind the rise in the number of people turning up at A&Es. Audit Scotland said in 2006-07 that the number of people attending A&E increased by 50,000 to more than 1.55 million - the highest since the millennium.

Dr David Ritchie, Scottish representative of the British Association for Emergency Medicine, said a range of factors, including the growing elderly population and a change in patients' expectations, could be behind the rise.

Dr Ritchie added that A&Es are meeting the four-hour waiting time target despite the extra work. "Everyone is doing pretty well, without extra resources," he said.

The Audit Scotland report also reflected significant improvements in the manag-ement of the NHS. The report emphasised the need to invest in community medicine to stop people becoming seriously ill and called on NHS Scotland to tell taxpayers more about what they are getting for their money.

Robert Black, Auditor General for Scotland, said: "I am pleased to report progress in performance and financial management but there is a need for more evidence that the money is making a difference to people in Scotland."



Report's key findings

  • The financial performance of all health boards improved and the NHS underspent by £98m. Only NHS Western Isles missed its financial target. It burst its budget for the past four years and has a deficit of £3.4m. Concerns were raised with the Scottish Parliament.
  • Significant management changes at some health boards, including the Scottish Ambulance Service and NHS 24. "Leadership seen as a key risk by auditors, with significant senior management changes and vacancies adding to the risk presented by complex and significant future challenges."
  • NHS boards setting aside increasing sums of money to cover potential negligence claims, rising from £134m to £208m over the past three years. However, the cost of settlements has decreased for the last four years.
  • Sickness absence rates increased, and most health boards are likely to miss the 2008 target to reduce the rate to 4%.
  • No evidence resources are shifting to help community medical services keep people out of hospital. Community health partnerships, meant to be crucial to this strategy, are making "slow progress".
  • Consultant and nurse vacancies have fallen, but stand-in nurses from the NHS bank continued to rise.
  • Patients stuck in hospital when they could be discharged dropped but more than 1000 trapped on wards of which 40% waiting more than six weeks.