Supporting ambulance service development

Following mounting pressures on England’s emergency care services, the NHS Confederation’s Urgent and Emergency Care Forum has brought together organisations from across the whole health and care system to debate, develop and share ideas for improving urgent and emergency care. The resulting briefing published by the NHS Confederation, which incorporated findings from a survey of 125 senior NHS leaders and an analysis of national data, highlighted a concern that only ‘sticking plaster’ solutions were being offered to overcome pressures placed on A&E departments, rather than solutions which focus on the long-term challenges ahead (NHS Confederation, 2013).

This was followed by a report published on 10 March, which proposed the fundamental changes required to create a sustainable and high-quality urgent and emergency care system that can meet the needs of patients (NHS Confederation, 2014).

One of the key recommendations from the report is the importance of getting the best from the urgent and emergency care system and workforce. Ways in which this could be achieved include improving the education, information, engagement and support available to staff.

In Sir Bruce Keogh’s report on the first stage of his review into urgent and emergency care, he emphasised that fewer patients attended by ambulance crews should be taken to hospital so that pressures on A&E departments are reduced (NHS England, 2013). In order for this to be made possible, the NHS must improve training and investment in its staff. The development of more community-based ambulance services, through enhancing paramedic practitioner roles, is just one of the ways this could be achieved.

This would enable paramedics to take more responsibility for decisions to treat patients on scene and therefore equip them with the necessary skills to establish when it is appropriate to convey patients to emergency departments.

Given that life-threatening emergencies represent approximately 10% of the overall workload for paramedics (Turner et al, 2006), the expectations, behaviours and skills of the workforce need to change. Confidence is dependent on good training and the availability of services to enable efficient referrals where necessary. The development of ambulance services as out-of-hospital providers, in combination with a whole-system approach to urgent and emergency care, will help reduce pressures placed on A&E departments and ensure the needs of patients now and in the future are met.


NHS Confederation (2013) Emergency care: an accident waiting to happen? NHS Confederation, London

NHS Confederation (2014) Ripping off the sticking plaster: Whole-systems solutions for urgent and emergency care. NHS Confederation, London

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

Turner J, O’Keeffe C, Dixon S, Warren K, Nicholl J (2006) The costs and benefits of changing ambulance service response time performance standards: Final report to the Department of Health. Medical Care Research Unit, University of Sheffield

Taken from Journal of Paramedic Practice, published 4 April 2014.

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