| Changing healthcare needs |
Page 2 of 2 The new NHS is changing the way in which it helps people with their healthcare needs. Whether the need is a sudden emergency or management of a long-term condition, the aim is trying to provide care in the most convenient location for the patient and avoid unnecessary hospital admissions and visits. A succession of recent Government policy papers including the January 2006 White Paper ‘Our health, our care, our say’ and ‘Direction of travel for urgent care’ published in October 2006 have confirmed this intention. The ambulance service is at the hub of the system that can deliver this policy. Improved response The traditional response of the ambulance service to a 999 call of always sending an ambulance and usually taking the patient to hospital is no longer appropriate. New technology is helping call takers make very fast and safe decisions on the best way to help each caller. For some an ambulance responding on blue lights may still be appropriate, but for others, probably a majority of the 5 million 999 calls received by the ambulance service in England each year, telephone advice, an ambulance clinician visiting the patient on a non-emergency basis or referral to another agency may well be far more effective. Clinical guidance for ambulance staff is provided by JRCALC. The fourth edition of the JRCALC guidelines have recently been published giving concise, best-practice advise to staff in almost every conceivable area from child protection to quick guides for drug dosages. A major task for the ambulance service over the next couple of years will be to ensure that its work is clinically focussed. Audit, although widespread in other areas of healthcare, is not so well embedded in the ambulance service. Some significant progress has been made over the last couple of years with national audits, co-ordinated by the ASA, of the response to heart attacks and cardiac arrests. Participation in these audits is not a core performance measure for ambulance services in their annual Healthcare Commission Healthcheck. Expansion of the audit capability will be a key task for all services over the next five years. Many of the other recommendations from ‘Taking healthcare to the patient’ are focussed on making sure that the services are capable of offering this much more responsive service. This will require many changes. Existing workforces will have to learn new skills, but the experience of recent years as new drugs and other interventions have been authorised for use in the pre-hospital setting have shown just how supportive staff are of change that will deliver improved patient care. Home care Helping patients with long-term conditions to manage their own health in their homes and prevent acute episodes that could require a trip to hospital is a key part of current policy. The ambulance service is taking its part in helping this objective both by identifying the wider needs of patients to whom it responds and by providing mobile clinic services visiting patients in their home to deal with issues as diverse as taking blood samples or helping patients with their longer-term following discharge from hospital after a heart attack. Services are training existing paramedics and, in some cases nurses, to take on the role of Emergency Care Practitioner. ECPs have an extended education to enable them to make judgements about the best pathway forward for patients with less obvious presenting symptoms. This is an exciting role for ambulance clinicians offering them far broader experience of patient care and it is likely that thousands of paramedics, and perhaps others, will take on these roles over the next few years. Digital radio network Ambulance services are already very sophisticated communications and logistics operations. In their new roles they will have to become even cleverer at getting this right. The new services are reviewing their control room structures. Fortuitously the reconfiguration coincides with the start of roll-out for the new ambulance digital radio network which will offer a far more effective and resilient system for both voice and data transfer than services have had in the past. The new system should be operational across the country within a couple of years. The Department of Health already demands fairly exacting performance standards from all ambulance trusts. The most widely quoted is the requirement to get clinical aid to the side of any patient assessed as having a potentially-life threatening condition within eight minutes in 75 per cent of cases. With 32-33,000 such cases each week, this target is almost being met with a typical week showing performance at between 74 and 75 per cent. However, the target is being tightened as from April 2008 the eight minutes will be measured from the point at which the 999 operator connects the call to the ambulance service. Substantial work will have to be done by all services if that new standard is to be achieved. Be prepared The ambulance service is the emergency arm of the NHS. In addition to dealing with the thousands of patients who turn to it every day, the service must always be prepared for major incidents. These could include incidents caused by severe weather, major outbreaks of illness such as the flu pandemic that the epidemiologists tell us is now overdue, industrial or transport accidents and, sadly, the terrorist threat. The 2004 Civil Contingencies Act made ambulance service Category 1 responders with considerable legal responsibilities to prepare for emergencies but with a seat at all the forums that are ensuring that the country is as prepared as possible to cope with whatever is thrown at it. The larger size of the new trusts undoubtedly means that the ambulance service is better able to undertake this role should the occasion arise. In some ways the enhanced role of the ambulance service has perhaps happened a year or two later than would have been ideal. The process may have been easier if had happened at a time when the significant year-or-year funding increases for the NHS were happening rather than now when the financial constraints are getting tighter and tighter. However, as a smaller group some economies of scale may be achievable by more intelligent procurement and this is an important stream of work over the next few years. Commissioning and payment by results are exercising all trusts and will again be a further key area of work. In the medium term most trusts see significant opportunities from becoming foundation trusts. The current rule of eligibility for applying to Monitor mean that progress is unlikely for another couple of years, but as soon as the go-ahead is given, several trusts will be pushing hard to gain that status. Ambulance services are going through a rapid period of change. Reconfiguration is just one element of that change. Looking forward just a few years they will look, feel and act very differently to how they have traditionally. As a result the care and support they give to those who call on them will be far more appropriate. Further information: www.asa.uk.net |
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