Mr. Robert Morton:

In terms of our experience in 2021, as the data indicate, in the week beginning 8 February we responded to around 3,800 calls. That figure seems low but on 6 September, which was probably our most difficult day so far this year, we responded to almost 5,000 calls. What we have seen this year in the data is about a 30% increase but, as Mr. Woods said, it is best to compare 2021 with 2019 because 2020 is very much a confounding year in terms of data. Against 2019, we are probably up about 6% to 6.8%. When we look back historically over ambulance demand, we generally tend to see an increase in demand of roughly between 4% to 6% per annum. We are seeing the expected rate of increase but we are also ahead of that expected rate of increase. Our sense of what is driving that centres on three issues. First, we are seeing a shift in acuity. When we look at the delta and echo calls that we responded to, there were more of them. Patients are sicker when we reach them and we are spending longer periods of time treating them. We also know that when they get to hospital, they are spending longer periods of time in the emergency department as well. That is not just because there is no bed availability but also because of the care they require in the emergency department. Acuity is definitely one issue.

The second issue is that we are seeing a step change in health seeking behaviour. One of the unfortunate successes of the National Ambulance Service during the pandemic is that it has been high-profiled so well. As earlier witnesses said, we have stepped up to whatever challenge has come along and have basically profiled ourselves in the public consciousness. We are up there now, front and centre, as a gateway to services. The third issue that we must reflect on is the fact that we are asking our GPs around the country to do an awful lot but they simply cannot do everything they are being asked to do. GPs are involved in vaccination programmes, a range of chronic disease programmes and so on. The number of GPs available is not necessarily growing and what we are seeing in our data is a shift in demand away from calls that would have traditionally come to us through GPs to calls that are now coming directly through the 999 system. That is what we are seeing in terms of what is driving the demand.