The significance of the Keogh Review

Sir Bruce Keogh’s report on the first stage of his review into urgent and emergency care (NHS England, 2013), published 13 November 2013, presents a significant step in the progression of the paramedic profession.

Along with the introduction of a two-tier A&E system as part of a fundamental shift in the provision of urgent care, the NHS England Medical Director has called for the development of 999 ambulance services so that they become mobile urgent treatment services, noting that paramedics now have the skills that would only be done by doctors 10 years ago. The suggested change comes in a letter to Health Secretary, Jeremy Hunt, and NHS England Chair, Sir Malcolm Grant, where Sir Bruce says:

‘Our vision is simple. Firstly, for those people with urgent but non life- threatening needs we must provide highly responsive, effective and personalised services outside of hospital. These services should deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families’ (NHS England, 2013).

Both the College of Paramedics (CoP) and the Association of Ambulance Chief Executives (AACE) have welcomed the report, and emphasised that increasing demands on ambulance services highlights the need for further investment into the training and education of paramedics.

There are a number of factors said to be contributing to the growing number of A&E admissions, including an ageing population with increasingly complex needs, and people struggling to navigate and access a confusing and inconsistent array of urgent care services provided outside of hospital (NHS England, 2013). However, while the number of people attending A&E departments is on the rise, it must be stressed that those who can receive treatment at home or closer to home, should. According to the report, 40% of patients attending A&E are discharged requiring no treatment at all; there were over one million avoidable emergency hospital admissions last year; and up to 50% of 999 calls requiring an ambulance to be dispatched could be managed on scene (NHS England, 2013).

It has already been proposed that the provision of key roles in urgent and emergency care, such as specialist paramedics, has illustrated high-quality clinical outcomes and reductions in A&E admissions, but what the Keogh Review adds to the debate is confirmation of this fact.

The need to develop a larger workforce with advanced clinical decision-making skills has never been more apparent. The report also arguably offers good evidence for the need to develop prescribing for paramedics, as this will inevitably have an effect on the reduction of A&E admissions if patients feel they are able to receive sufficient out-of-hours care, which may include the chance to be issued prescriptions.

While this is a significant undertaking, that is expected to take between 3–5 years, it is undoubtedly a triumphant step in the recognition of the potential of the paramedic profession.


NHS England (2013) High Quality Care for All, Now and for Future Generations: Transforming Urgent and Emergency Care Services in England – Urgent and Emergency Care Review End of Phase 1 Report. NHS England, London

Taken from Journal of Paramedic Practice, published 4 December 2013.

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