Supporting an ambulance service's Covid response

East of England Ambulance Service


At the end of March 2020, national modelling predicted a 200% increase in both call demand and face-to-face incidents in a regional ambulance service as a result of Covid.

To meet this challenge, it was clear that the ambulance service would need to prepare at an unprecedented scale and pace. Demand increase of this magnitude required the rapid expansion of all functions across the organisation that affect a patient’s journey, from call pickup to their safe discharge. It involved the ambitious coordination of all teams across the organisation and would require overcoming challenges and taking action instantly.

However, meeting the national standards for patient response time was already a challenge for the trust, consistently ranking 10th out of 10 for both C1 and C2 among mainland ambulance services.

Compared to other ambulance services, the service experienced significantly higher staffing gaps across all frontline units and higher rates of sickness. Furthermore, the addition of long-standing systemic cultural issues, including poor ambition and capability to deliver rapid change, lack of accountability, siloed working, etc. created a unique challenge for the service.


We developed a programme to address the challenge consisting of 4 approaches:

Clear governance framework

Introduced weekly Transformation Cell and working groups, and co-developed live Power BI dashboards

Increased workforce capacity

Set clear workforce targets and approach to achieve them. Streamlined management of hiring processes

Upgraded operational command and control

Introduced Delivery Commander position and daily command battle rhythm. The battle rhythm responded to the critical need of managing demand and resources, and patients risk

Career development

Developed framework to improve skill mix and provide staff with a roadmap for career development


Road resources
clinical on the ground hours

Bolstered resources including 25% increase in clinical on-the-ground hours within 2 months

Response time
C1 national ranking

Reduced response times including decreasing Category 1 response times by ~2 minutes (20%) and decreasing Category 2 by >5 minutes (>20%). Improving national ranking for C1 from 10th to 4th


Achieved an important cultural shift in the level of ambition. Notably the narrative has changed and teams are using ambitious, performance focused terminology: stretch targets, daily battle rhythm and piloting new actions

Morale & Satisfaction

Improved staff morale and satisfaction with the Trust response to COVID pressures

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