Passing the mantle: a parting farewell

Adobe SparkThis issue of the Journal of Paramedic Practice will be my last as editor. It has been an honour and privilege to edit a publication aimed at one of the most exciting healthcare professions, and I am grateful for being given this fantastic opportunity. I took over the journal in 2013, having previously worked on a nursing title, and in those few short years have witnessed a notable change within the paramedic profession.

The publication of the Francis report marked the beginning of my time as editor, and although not directly concerned with paramedics, it highlighted a need for cultural change within the NHS, with an emphasis on patient-focused care. This was followed by the long overdue update to the UK Ambulance Services Clinical Practice Guidelines, which was welcomed by the profession. The latest update was published earlier this year.

The publication of the end of study report for the Paramedic Evidence Based Project (PEEP), which called for the introduction of a national education and training framework for paramedics, marked a turning point for the profession and highlighted how its needs were changing. This was cemented in Sir Bruce Keogh’s Urgent and Emergency Care Review, which called for the development of 999 ambulance services so that they become mobile urgent treatment services. Illustrating an appreciation of the skill set of paramedics, their potential in the delivery of pre-hospital care was finally being recognised.

The Five Year Forward View expanded on these ideas and proposed a broadened role for ambulance services. It was becoming apparent that out-of-hospital care was becoming an increasingly important part of the work the NHS undertakes.

One of the most significant changes within the profession over the last few years has been the growth of its professional body. As of January 2016 there were 6 458 full members of the College of Paramedics. This represents 29.7% of all paramedic registrants of the Health and Care Professions Council, the regulatory body for the paramedic profession. The increase in members show the College is one step closer to its aim of becoming a Royal College, which requires that 50% of the profession are members of the professional body.

However, this evolution has not been without its difficulties. Reports of staff facing burnout, time taken off work due to stress-related illnesses, problems with staff retention, disputes over pay, and the fundamental problem of how ambulance services can cope with year-on-year increases in demand, mean the workforce is facing all manner of pressures.

Despite this, I believe these are exciting times for paramedics. As we gradually see a move to an all-graduate profession and changes to the paramedic scope of practice, the opportunities for work outside of the ambulance service are growing.

As I pass the mantle, I look forward to seeing the journal reach new heights following my departure under a new editor. It only remains for me to personally thank my consultant editors, the editorial board, and of course, you the readers, who have ensured the publication could continue.

Taken from Journal of Paramedic Practice, published 5 August 2016.

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Working together to improve efficiencies

Adobe Spark (4)It was recently announced that the North East Ambulance Service NHS Foundation Trust, North West Ambulance Service NHS Trust and Yorkshire Ambulance Service NHS Trust will be coming together to form an alliance across the North of England (Association of Ambulance Chief Executives (AACE), 2016). The services have said the launch of the Northern Ambulance Alliance will help to improve the efficiency of ambulance services in the areas covered by all three Trusts.

It is important to stress that it is not a merger but an attempt by all three organisations to work closer together to improve patient care. Additionally, it is felt the alliance should help identify savings through collaborative procurement and offer improved resilience. So, in effect, the boards of each of the individual Trusts will still have responsibility for their individual service, but will also consider the work and objectives of the Northern Ambulance Alliance when making decisions.

One of the key driving forces behind the inception of the alliance was the Lord Carter Review (2015)into productivity in NHS hospitals, which supports identification of efficiencies and reduction of unwarranted variances. Some of the areas already identified where the Trusts can work together include looking at ‘efficiency through joint procurement exercises, major changes to IT, assessing specialist expertise and learning from each other’s achievements’ (AACE, 2016).

This alliance should be commended and highlights the overall commitment from each of the Trust’s to improve patient care. While demand for each service will inevitably differ due to considerations such as population and community, their strategic priorities are inextricably linked. It therefore makes sense that they should be considered together. More than anything, the alliance offers an excellent opportunity for the sharing of best practice and to tackle mutual difficulties. An example was highlighted by Rod Barnes, chief executive officer of Yorkshire Ambulance Service NHS Trust, of how the Trusts could come together to deliver on a single issue: ‘This might mean the procurement of a single agreed vehicle specification for all three services, identifying savings through the standardisation of maintenance and equipment contracts, which is something that has proved elusive at a national level’ (AACE, 2016).

It has been assured that there will be no direct staff consequences as a result of the alliance. However, it may mean in the future that the three organisations consider joint appointments or shared working for new roles and replacements.

It is hoped that other services will follow and create their own alliances. Who knows, it may even be one step closer to a single national ambulance service.

References

Association of Ambulance Chief Executives (2016) Three Northern Ambulance Trusts Form Alliance “That Will Improve Efficiencies”. http://aace.org.uk/ambulance-alliance-will-improve-efficiencies/ (accessed 27 June 2016)

Carter PR (2015) Operational productivity and performance in English NHS acute hospitals: Unwarranted variations. An independent report for the Department of Health by Lord Carter of Coles. The Stationery Office, London

Taken from Journal of Paramedic Practice, published 1 July 2016.

It takes a system to save a life

Adobe Spark (3)Last month saw pre-hospital and emergency care professionals from around the globe gather for the first European Emergency Medical Services (EMS) Congress in Copenhagen. Opened by Her Royal Highness Crown Princess Mary of Denmark, the 3-day event aimed to set new standards for research and treatment, as well as to establish an EMS Leadership Network in Europe, targeted at strengthening cross-national collaboration. Running under the theme of ‘It takes a system to save a life’, presentations emphasised the need for cooperation between the dispatch centre, ambulance services and the emergency departments for lives to be saved.

Denmark has made an impressive contribution to the field of resuscitation medicine. The congress was used as a platform to highlight the latest figures from the Danish Cardiac Arrest Registry, which collects nationwide data relating to out-of-hospital cardiac arrest. They revealed that in Denmark nearly one in four survive sudden cardiac arrest in public spaces. This is due, in part, because of the remarkable increase in the number of bystanders performing CPR before the arrival of EMS (19.4%–65.8% from 2001–2014). This is worth taking note, as approximately 1 in 8 out-of-hospital cardiac arrest patients survive if bystander CPR is initiated, compared to 1 in 30 when it is not. This provides a valid argument for implementing CPR training in schools, as well as illustrating how involvement of the community should be an integral part of any EMS.

The congress was also used to launch the Global Resuscitation Alliance, a network focused on collaborating to increase survival from sudden cardiac arrest. This agreement, signed in Copenhagen at an Utstein meeting prior to the congress, constitutes the culmination of three decades of international work, and is a major and decisive step in global efforts to save more lives from sudden cardiac arrest. Participants of the alliance have committed themselves to the ambitious target of increasing survival rates by 50%.

Alongside the scientific programme, sponsored symposia and workshops offered delegates the opportunity to expand their knowledge on areas such as managing the everyday critically ill patient, and improve their competence with a hands-on procedural cadaver lab.

Additionally, 13 teams from around the world competed in the European EMS Championship. The competition consisted of scenario-based events that tested each team’s ability to manage patients in various circumstances with common critical medical conditions and trauma. London Ambulance Service NHS Trust (LAS) walked away with the top prize, fighting off stiff competition from Turkey and Denmark in the final. Judges praised LAS for their extraordinary skills and team work in the final scenario: a canoe accident on a Copenhagen beach.

This would easily have been enough to satisfy those attending the congress, yet a number of excellent social events were also added to the mix. From morning runs and swims to an emergency management scenario at Copenhagen City Hall Square and a Gala Dinner, organisers went to every effort to ensure the event was a success. Delegates will undoubtedly be itching to return in 2017.

Taken from International Paramedic Practice, published 22 June 2016.

Ambulance service at creaking point

Adobe SparkRecent figures published by NHS England reveal the ambulance service is continuing to fail to meet Government standards for responding to Category A (Red 1 and Red 2) calls. The figures for March 2016 showed only 66.5% of Red 1 calls were responded to within 8 minutes, while 72.3% of Red 2 calls received a response within the same timeframe (NHS England, 2016). This is compared to 73.4% and 69.6%, respectively for the same period in 2015. It marks 10 months that services in England as a whole have failed to meet the Government target of 75% for Red 1 Calls. The response to Red 2 calls is the lowest proportion recorded since the data collection began in June 2012. However, it must be highlighted that Red 2 data from February 2015 onwards are not completely comparable across England due to the introduction of Dispatch on Disposition, allowing up to two additional minutes for triage to identify the clinical situation and take appropriate action.

It has been a tough year for ambulance services, with London Ambulance Service NHS Trust being placed under special measures by the Care Quality Commission (CQC) in November 2015 and East Midlands Ambulance Service NHS Trust being recently rated inadequate by the CQC for safety due to insufficient staff numbers and a consensus that the skill mix of staff deployed was not always safe (CQC, 2016).

The fact of the matter is that demand for ambulance services continues to rise and services are struggling to keep up. The ambulance service in England received 861 853 phone calls in March 2016, compared to 694 188 in March 2015 (NHS England, 2015; 2016), a rise of 24%. However, Trusts have not been able to increase their numbers of staff to meet this demand. This creates greater work pressures and stress for existing employees, brought on by longer working hours and missed meal breaks. The result? High staff attrition within Trusts. Those that remain will no doubt be questioning whether this is sustainable. With staff currently being balloted by unions over industrial action on pay, the possibility of a crisis within the ambulance service cannot be dismissed as hearsay.

If this is to be avoided, a number of things have to change. Trusts must ensure front-line vacancies are filled and staff do not leave. This can only be done by fostering a work environment in which staff are happy to remain. The over triage of patients must be minimised so that appropriate resources are dispatched. And, where possible, patients’ needs must be addressed at the point of contact and unnecessary transfers to hospital must be avoided. If the ambulance service carries on as it is, it is difficult to see how it will continue to operate in 10 years’ time. By focusing on employee welfare, this crisis may be averted.

References

Care Quality Commission (2015) London Ambulance Service NHS Trust Quality Report, 27 November 2015. http://tinyurl.com/hxdhwpr (accessed 26 May 2016)

Care Quality Commission (2016) East Midlands Ambulance Service NHS Trust Quality Report, 10 May 2016. http://tinyurl.com/h5r4wfv (accessed 26 May 2016)

NHS England (2015) Ambulance Quality Indicators Data 2014–15. http://tinyurl.com/zf2p5jf (accessed 26 May 2016)

NHS England (2016) Ambulance Quality Indicators Data 2015–16. http://tinyurl.com/jyls6rt (accessed 26 May 2016)

Taken from Journal of Paramedic Practice, published 27 May 2016.

Delivering a promise over pay

Project M (2)

The junior doctor dispute over pay has taken up a lot of space in the news in recent months, yet they are not the only health professionals who are displeased with Government plans.

In 2014, paramedics were among the thousands of health professionals who took to the picket line in the first NHS strike over pay in 32 years. In a desperate effort to resolve the pay dispute of 2014/15, the Secretary of State for Health, Jeremy Hunt, agreed to a number of commitments to ambulance staff, including a review of the banding system to recognise the skill set of paramedics (Hunt, 2015). Roll on 2016 and there is still no suggestion that Mr Hunt will deliver on his promise. Understandably this has angered many ambulance staff.

As a result, the unions UNISON, Unite and GMB have announced they will be balloting their ambulance service members to see if they are willing to take industrial action over the Government’s failure to keep its promise.

The numbers of paramedics leaving the profession has been increasing year-on-year (UNISON et al, 2015). This has resulted in the addition of paramedics to the shortage occupation list (SOL), with vacancy rates running at approximately 10% of the total 12 500 paramedic workforce in England (Migration Advisory Committee, 2015). One of the key reasons people cited leaving, or considering leaving, the ambulance service was pay (UNISON et al, 2015).

The proposal set out in the Urgent and Emergency Care Review (NHS England, 2013) to extend paramedic training and skills, and develop 999 ambulances into mobile treatment centres, emphasises how the current scope of practice of paramedics is changing. As paramedics take on increasing responsibilities, it is only fair their pay is amended to reflect this shift. The short supply and high demand of paramedics means that ambulance services are facing a conceivable recruitment and retention crisis. However, while the National Ambulance Strategic Partnership Forum have made a formal request to the National Job Evaluation Group to look at the National Job Evaluation paramedic profile, only a handful of ambulance services have agreed to pay paramedics Agenda for Change band 6 in the hope of recruiting and retaining paramedics.

The Journal of Paramedic Practice would like to find out how its readers feel about their current pay and conditions. I therefore urge you to take 3 minutes to complete our online survey.

References

Hunt J (2015) Letter from the Rt Hon Jeremy Hunt MP, Secretary of State for Health, to Christina McAnea on Agenda for Change Proposal, 27 January 2015. http://tinyurl.com/hcwlk7g (accessed 29 April 2016)

Migration Advisory Committee (2015) Partial review of the Shortage Occupation Lists for the UK and for Scotland. MAC, London. http://tinyurl.com/qdaqbbl (accessed 29 April 2016)

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, Leeds

UNISON, Unite, GMB (2015) NHS Pay Review Body Evidence: Recruitment and retention of ambulance staff. http://tinyurl.com/grd59l2 (accessed 29 April 2016)

Taken from Journal of Paramedic Practice, published 6 May 2016.

Caring for Calais

Photo Credit: Rose Oloumi

Photo Credit: Rose Oloumi

Earlier this month I accompanied a group of student paramedics who were spending their weekend providing first aid at the refugee and migrant camp on the outskirts of Calais, France. Situated adjacent to a motorway and in the vicinity of a chemical factory, the camp is colloquially referred to as the ‘Jungle’ by outsiders, as well as those who have been forced to call it home. While semi-permanent structures made of converted shipping containers were introduced by the French Government at the beginning of the year, the vast majority of people live in makeshift shelters and tents in squalid, overcrowded conditions. Current figures estimate the number of refugees and migrants living in the area as anything between 6000 and 8000, with many more arriving each day.

Médecins du Monde (Doctors of the World) have provided essential medical help to refugees and migrants living in and around Calais and Dunkirk since 2003. Médecins Sans Frontières (Doctors without Borders) have provided aid more recently and run a health clinic that is open Monday to Friday within the main Calais camp. However, there is no official system in place over the weekend. As a result, health professionals offer their time and services, providing first aid from three caravans located within the ‘Jungle’. Patients are predominantly treated for minor ailments such as colds, lice and the various coughs referred to as ‘Jungle lung’, as well as bruises, cuts and broken bones sustained from attempts at crossing the border into the UK. In the case of more serious incidents, patients are transported to an emergency department in the city.

Shadowing the paramedics for two days as they wandered through the camp providing care, one was made acutely aware of how desperate circumstances for those living there are. The recent demolition of the southern part of the camp highlighted the general sentiment that the refugees and migrants are not welcome there. However, by evicting them from their homes the police are simply moving the problem, not addressing it. For the refugees and migrants, this means the Sisyphian task of constantly having to rebuild their homes.

What is most disheartening on a personal level is that the current situation in places such as Calais in France or Idomeni in Greece appears somewhat hopeless. While countless people offer their time, money and professional expertise to provide care and support for the thousands of refugees and migrants who have come to Europe seeking work or asylum, it does not get to the root of the problem. It reminded me of a line in Nigerian novelist Chinua Achebe’s book Anthills on the Savannah: ‘While we do our good works let us not forget that the real solution lies in a world in which charity will have become unnecessary.’ This dispiriting quote is notably poignant in light of what the Western media has dubbed the ‘migrant crisis’. The lack of willingness for many European countries (including Britain) to grant asylum to people, many of whom have fled their country as a result of their lives or human rights being seriously at risk, means the end result will be the continued living, for many, in conditions that no person should have to experience. Refugees have been present in Calais since 1999 and they continue to be in Calais in 2016. How long will this continue and when will this change?

Taken from International Paramedic Practice, published 30 March 2016.

Ensuring patients get the right response

Bosses at the Welsh Ambulance Service NHS Trust (WAST) will breathe a sigh of relief as the first full set of data to be published measuring clinical care, operational efficiency and patient experience for the service since the implementation of a new clinical response model, were largely positive.

The Welsh Government announced plans to implement a new clinical response model in July 2015, with a pilot trial running for 12 months from October 2015. One of the key changes to the service during this trial is the move to having only the most serious calls—categorised as Red (immediately life-threatening)—as requiring a response time target (Welsh Government, 2016). All other calls still receive an appropriate response, and this is either through face-to-face or telephone assessment, based on clinical need. For example, for Amber calls a range of clinical outcome indicators have been introduced to measure the quality, safety and timeliness of care being delivered, alongside patient experience information (Welsh Government, 2016). This data is to be published quarterly.

Between 1 October 2015 and 31 December 2015, 70.6% of Red calls received a response arriving at scene within 8 minutes or less, against the Wales national target of 65% (Emergency Ambulance Services Committee, 2016). It was also revealed that 14 489 incidents did not result in a conveyance to a hospital or another destination. However, some Ambulance Quality Indicators are still under development and will not be published until the next quarterly report on 27 April 2016. It is then that information will be provided on the reasons for not conveying patients to a hospital or another destination. Also, due to changes to the trial that came into effect from 11 November, as a result of revised technical guidance, data for December is not comparable to that for October or November.

However, it is interesting to note that results from a staff survey, which included responses from 167 EMS front-line staff, revealed an overall feeling within the service that the new clinical response model has not led to more appropriately categorised calls, improved patient safety, improved quality of service delivery or improved patient experience (WAST, 2016). While the number of respondents is low, it does paint a compelling picture of staff conception of the new model, although unfortunately we will have to wait until April before we can gain a greater understanding of its effectiveness.

The move by WAST to a new response model is a brave one, and intended to ensure the service is providing the right response for patients dependent on their clinical need. While some may complain that doing away with almost all response time targets relieves pressure from the service, it is arguable that they are outdated and do not always result in the best care for the patient. Only time will tell whether this is truly the case.

References

Emergency Ambulance Services Committee (2016) Welsh Ambulance Services NHS Trust National Collaborative Commissioning: Quality and Delivery Framework Ambulance Quality Indicators: October—December 2015. http://bit.ly/1Pj54ds (accessed 1 February 2016)

Welsh Ambulance Service NHS Trust (2016) Clinical Modernisation Programme. http://bit.ly/1P9vBq6 (accessed 1 February 2016)

Welsh Government (2016) Ambulance services in Wales, December 2015. http://bit.ly/1WXbeBH (accessed 1 February 2016)

Taken from Journal of Paramedic Practice, published 8 January 2016.