Health Business

The NHS has come a long way over the last 60 years. As the service celebrated its diamond birthday, it also waited to learn the results of Lord Darzi’s NHS Next Stage Review.
    
There has been no better time to reflect on the progress made by the NHS and consider how it can make the leap from good in many places to world class in all, to save more lives, improve health and tackle inequalities. In the modern NHS, services must be specialised where necessary, and localised where possible, with the overall focus shifting more towards prevention.
 
Transforming services
The Darzi review made transforming services for trauma, heart disease and stroke a top priority. Although no one model of care will be right for the whole country, the evidence shows that early treatment for critically ill patients and those suffering from trauma saves lives and increases the chance of recovery, with better outcomes in specialist centres.

Ambulance services have a vital role to play in developing the right care pathways for patients. No one goes to hospital to have a heart attack or a stroke: they have them at home, in their local neighbourhood or in the workplace. Ambulance services need to get to the patient and start treatment as quickly as possible, as well as taking them to the best place for their care.
     
Many parts of the NHS understand how the ambulance service can help ‘add years to life’ by improving emergency care. There is much less awareness, however, about the ambulance service’s role in ‘adding life to years’ by improving other types of services.
 
Gateway to healthcare
The ambulance service is one of the most important gateways into the health and social care system. Some 7.2 million urgent and emergency calls were made last year and 5.9 million of these calls were attended by ambulance services.
    
Around one in ten patients seen by the ambulance service are critically ill or suffering from major trauma. The vast majority have non-life threatening conditions. Many are older people who have had a fall, patients who have mental health problems or other chronic conditions, and people with minor illnesses and injuries.

It is this latter group – those with urgent rather than life threatening conditions – that is driving the increase in demand for ambulance services, by on average, five to seven per cent each year.
     
Ambulance services are already improving their ability to assess and diagnose patients, so they get the best care for their needs rather than always sending a frontline ambulance. Ambulance services are also delivering more care for patients in the local community so they don’t have to go into hospital unnecessarily, for example running minor injuries units and using emergency care practitioners to assess, diagnose and treat minor illnesses in patients’ homes.
 
Radical change
More radical changes are, however, needed if we are going to genuinely transform urgent or ‘unscheduled’ care, as outlined in the Ambulance Service Network’s vision for urgent and emergency care, published in June. The network believes that the first and most important step is to develop a single point of access for urgent and emergency care so that all patients are assessed and prioritised in the same way whichever number they call: 999, NHS Direct or out-of-hours, which should be co-ordinated regionally and linked to the appropriate service response.
    
This would require a directory of services with real time information showing where urgent as well as emergency services are available near to the patient, including walk in and urgent care centres, GPs (in and out of hours), district and other community nursing, mental health crisis intervention teams and social care services. This model is already being developed in the North East through a new system called NHS Pathways.
     
A single point of access, supported by a local directory of services, would in turn help identify where patients health and social care needs aren’t being met. Primary care and practice based commissioners could then use this information to develop a range of primary, community and other urgent care services available 24 hours a day, seven days a week.
     
To better improve access a new national telephone number for urgent care, to sit alongside 999, should be piloted to assess the potential to further simplify access for patients and improve the co-ordination of care.
     
This model of care could play a major role in tackling health inequalities. Recent research shows that ambulances are four times more likely to be called out to deprived areas than to affluent ones, and poor access to primary and community care is likely to be a crucial factor.

Costs involved
It could also help deliver more cost-effective care. Around 70 per cent of incidents attended by the ambulance service result in a patient being taken elsewhere to continue their treatment, usually to hospital. Whilst this figure fell slightly in 2007/08, there were still 4.26 million ‘patient journeys’.
    
The cost of sending an ambulance to someone who calls 999 is around £200. The total cost to the NHS will be far greater if patients are then taken to Accident and Emergency and admitted into hospital overnight or for longer.
     
Delivering the best care for patients, and the best value for money for taxpayers, will require important changes to the way urgent and emergency services are measured and funded. We need a system of funding that incentivises services to give patients the most appropriate care, in the most appropriate place, rather than resorting to taking them to the closest A&E. Ambulance services should be assessed according to patients’ outcomes and experiences, as well as response times.
     
Shifting the focus to outcomes means ending the practice of keeping data within individual providers – for example hospitals or mental health services keeping their data, ambulance services keeping ambulance service data – so that data is shared across the health and social care system.
     
These changes are ambitious, but these are challenges the ambulance service is keen to meet. I believe the ambulance service is well placed to help improve the quality and access to NHS care in so many ways, and ensure that all our patients get the care they need, when they need it.
 
For more information
Please visit http://www.nhsconfed.org/ambulance-trusts