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.

Ambulance staff contemplate suicide due to poor mental health

Project M (1)‘It started to manifest itself after a failed resuscitation attempt on a child several years ago. While there were low-level symptoms over the years, and there were certain calls that would affect me more than others, there was much more severe recurrence after witnessing the aftermath of a plane crash over a year ago.’

Aryeh Myers, 39, is a paramedic for Magen David Adom, Israel’s national ambulance service. Before that he worked for London Ambulance Service NHS Trust for almost 10 years, as both an emergency medical technician (EMT) and paramedic. He was diagnosed with post-traumatic stress disorder (PTSD) just over a year ago.

Myers is one of an alarming number of paramedics whose mental health has suffered directly as a result of working for the ambulance service.

Recent figures published by mental health charity Mind revealed a third of ambulance staff surveyed contemplated taking their own lives due to stress and poor mental health. The results, taken from the responses of 1 600 emergency services staff and volunteers, including 308 in the ambulance service, also showed that 67% of ambulance staff contemplated leaving their job or voluntary role because of stress or poor mental health. A huge 93% reported experiencing stress, low mood and poor mental health at some point while working for the emergency services.

The figures also highlighted how 57% of ambulance staff took time off due to stress, low mood or poor mental health. These results reaffirm those published by The Observer that revealed over 40 000 days were lost by ambulance staff in 2014 due to mental health problems.

For Myers, he recalls how he took a month off work to begin treatment, including several sessions with a counsellor who taught him how to recognise triggers, how to partially ward them off, and particularly how to deal with the thoughts and reactions that those triggers bring.

‘It helped to a certain degree,’ he says. ‘At least I was able to go back to work. But there is, from what I’ve experienced, no way to completely get rid of PTSD, and certainly not if you continue working in the field where it was caused in the first place.’

Blue Light Programme

In October 2014, Mind was awarded LIBOR funding to deliver a programme to provide mental health support for emergency services staff and volunteers from police, fire, ambulance and search and rescue services across England up until 31 March 2016.

The Blue Light Programme focused on five main areas: tackling stigma and discrimination, embedding workplace wellbeing, building resilience of staff, providing information and support, and improving support pathways.

So far the programme has seen 250 000 information resources disseminated, 5 000 managers participate in line manager training, over 400 emergency services staff register to be ‘Blue Light Champions’, and 54 blue light employers and 9 national associations sign the Blue Light Time to Change pledge—a commitment to raising awareness of mental health, tackling stigma and helping enable staff and volunteers to talk more openly about their mental health at work. Currently, all ambulance services in England except East of England Ambulance Service NHS Trust have signed the pledge.

Funds have been allocated for Mind to continue to deliver the programme on a smaller scale throughout 2016/17.

Esmail Rifai, 50, is a clinical safety officer for North West Ambulance Service NHS Trust, who recently returned to work following a long period of work-related anxiety and depression. He lost a work colleague and friend to suicide.

‘My colleague taking his own life had a devastating effect on me at a time when I was coming to terms with my own mental health,’ he says.

‘At work I often take on more than time permits, which inevitably takes its toll and ultimately ends up with my own mental health deteriorating.’

Rifai is a ‘Blue Light Champion’ and has found the experience helpful in coming to terms with his own mental health issues. ‘Being involved with the Blue Light Programme has also given me some solace,’ he says. ‘Knowing that I’m helping others in itself makes me feel good—a sense of achievement.’

Exposure to shocking events

Project M (3)Dan Farnworth is an EMT for North West Ambulance Service NHS Trust who has also suffered from PTSD.

‘My mental health issues started about a year and a half ago,’ he says. ‘We went to a job that involved child abuse. It was awful. We did everything that we could, but unfortunately we weren’t able to save the child.’

While Farnworth understandably felt low after the job, it wasn’t until 24 hours later that he found himself unable to shake the image of the child from his head.

‘At work I wasn’t acting like myself anymore; I wasn’t socialising as much with colleagues, and generally not interacting with people.’

In addition to his work, he found the event had begun to affect his life at home as well.

‘It made me a grumpier person, and my patience was a lot shorter. It even started to affect my sleep, and I found myself having nightmares about it.

‘I’d often find myself just sat there, not really doing anything but thinking about the job, and thinking about whether there was anything else I could have done.’

The nature of work undertaken by ambulance services means there are times when paramedics find themselves turning up at the scene of a shocking or upsetting event.

‘As a paramedic there is no way to avoid seeing sights that are difficult,’ says Myers. ‘It may be one shocking call, or it may be a build up over time, but I believe we are all affected in some way by the things we see, by the emotion we experience but are forced to contain while dealing with our job. Showing any sign of emotion is still perceived as a weakness rather than an outlet, and this is one of the things that needs to change.’

Kevin Sibley is an EMT for East of England Ambulance Service NHS Trust who served 8 years within the army. A year of that time was spent in Northern Ireland where he witnessed a number of harrowing events. He remains unconvinced at the prevalence of mental health problems suffered by ambulance staff.

‘I have known people who have left the ambo service and have come back 6 months later after querying suffering mental problems,’ he says.

‘Unfortunately I think lots of people use the mental health card in the ambo. PTSD in the military is not an excuse, it’s because your mates who will die for you are killed in a horrible situation. Unfortunately I can’t compare this to the ambo service as we join to help people in road traffic collisions (RTC) etc. You [can] walk in to a hanging, RTC or decapitation.’

Sibley is of the opinion that some paramedics are quick to associate distressing events with potential mental health issues, with some reaching for the latest buzz word to explain how they are feeling.

‘I don’t mean to belittle people with issues but we were unwell,’ he says. ‘Not dealing with it, then stress, then depression. People looked for a new thing, a new name, and grabbed PTSD.’

Support for ambulance staff

Currently, ambulance services have internal debriefing support services, and through occupational health staff have access to professional counselling services. Additionally, support is provided to ambulance service staff and their families by The Ambulance Services Charity (TASC).

‘Most people will normally feel some levels of stress throughout their day—the fight or flight model enables us to cope with difficult situations,’ says Jean Hayes, director of support services for TASC. ‘However, prolonged levels of stress can sometimes have a negative impact on health and wellbeing. For some ambulance personnel, constant and increasing exposure to difficult situations may result in poor health.’

Hayes explains how since its launch in March 2015, TASC have been approached by a number of ambulance personnel suffering from low mood, stress-related illness and undiagnosed PTSD, many of whom remain in work providing a dedicated service to the general public.

As a result, the charity is currently developing a programme of support for individuals, working with a leading psychologist, which will enable ambulance personnel to recognise their own symptoms and develop strategies to help manage poor mental health.

‘Subject to funding, TASC aim to roll out this programme of work nationwide,’ says Hayes. ‘Along with other support services, TASC are here to support those working in the UK ambulance services, whenever they are facing unexpected difficulties, crisis or are in need.’

The College of Paramedics has been working closely with Mind over recent months, and is an active participant in the blue light mental health agenda nationally, along with the Association of Ambulance Chief Executives (AACE).

According to David Davis, paramedic and fellow of the College of Paramedics, the College has recognised the importance of the mental health and wellbeing of paramedics and other ambulance and pre-hospital professionals for a number of years. These include significant concerns around what many feel is an unachievable retirement age of 68, significant changes in working practices and increased workloads resulting in increased isolation of practitioners, as well as concerns over violence and aggression towards emergency services workers.

‘The research undertaken by Mind, as part of the Blue Light Programme, has reinforced anecdote with real meaningful data about the level of problems, and importantly revealed that many frontline staff were not keen on being open about mental ill health and stress for fear of either embarrassment or adverse consequences from employers or otherwise,’ says Davis.

‘The most recent data was very worrying indeed,’ he adds. ‘Particularly that 35% of those ambulance staff completing the online survey had contemplated taking their own lives.

‘There is increasing awareness of the risk of suicide among paramedics and other emergency ambulance service personnel that simply cannot be ignored, and the recent data from the Mind survey tells us that actions must be taken now to support and protect this important group of public servants.’

Davis, who is spokesperson on mental health for the College of Paramedics, goes on to highlight that the recent College of Paramedics conference revealed a clearly expressed mandate to make mental health of the membership a priority and to support the Mind programme.

‘A single suicide of one of the brave men or women who I am proud to call my colleagues is a tragedy too many,’ says Davis. ‘We must work together to tackle the issues of mental ill health, whether they be stress, depression, anxiety or post-traumatic stress disorder.’

The AACE is one of the national associations signed up to the Mind Blue Light Time to Change pledge and were fully engaged in the Blue Light Programme throughout its initial duration. According to Anna Parry, national programme manager for the AACE, the association is continuing to benefit from the work undertaken by Mind, with the Time to Change Programme Manager contributing to ongoing work the AACE is overseeing to promote and enhance the mental health and wellbeing of staff. At the national level, the AACE is collating information and data in this area to better understand what more can be done to support ambulance service staff.

‘The sector feels that there is more that could and should be done to fight mental health stigma and discrimination and to enhance the supports that are available to staff in this area,’ says Parry.

‘The mental health and wellbeing of staff subsequently features in the AACEs 2016–17 strategic priorities; these are identified and progressed by ambulance services nationally,’ she adds.

Removing the stigma

Project M (4)Farnworth believes that with ever increasing demand on the ambulance service, there is not as much opportunity for discussion and reflection between jobs anymore.

‘When staff attend a particularly traumatic job, they are offered some “time out” but many staff don’t take this up when they know there are patients out there waiting for our help,’ he says.

‘As much as we look out for each other, there is still a bravado or “stigma” attached with this job; we all like to think we are infallible. We are there to support the public in [their] time of need, but we tend to not ask for help ourselves.’

‘Talking to my peers has also been a massive help,’ says Farnworth. ‘It helps me realise that what I’m going through is normal, and that many people experience things like this from time to time.’

This sentiment is something that Myers finds he can also relate to:

‘The first piece of advice I would give would be “do not be ashamed”. It took me a long time to admit both to myself and to those around me that there was something wrong. There is still a stigma attached to mental health issues, particularly PTSD, in a field where it is expected that you just get on with the job, that prevents people from seeking help. A first-line defence must be to talk, be it to a colleague, a friend or a relative, or, if the need arises, to a medical professional who will be able to give guidance with reference to the right course of treatment if required.

‘Don’t be afraid to seek help. Because the subject up until very recently was taboo, it was not well known how and where to seek help, but I believe that it’s slowly improving.’

Rifai also believes that stigma surrounding mental health should be removed: ‘There is no shame or stigma attached to experiencing mental health problems, it’s just the same as breaking a bone, except no one can see that you are suffering. We are not super humans and we are just as prone to illness as anyone else, if not more.’

Blue Light Walk

To help raise awareness of mental health problems within the blue light community and get emergency service personnel talking, Farnworth has teamed up with Richard Morton, paramedic; Philip Baggaley, senior paramedic; and Gill Despard, paramedic lecturer practitioner, to walk from Scarborough RNLI to Blackpool RNLI stopping at fire, police and ambulance stations along the way. They will be raising money for the Blue Light Programme.

The walk will take place from 26–30 September and they are inviting all emergency services, as well as the general public, to join them on the ‘last leg’ from Broughton ambulance station to Blackpool RNLI. Additionally, they are putting on a Blue Light Walk Charity Ball to celebrate the success of the walk on 1 October. If you would like to support their cause or join them then visit http://www.bluelightwalk.com.

Has your mental health been affected as a result of working for the ambulance service? If so, Journal of Paramedic Practice would like to hear from you. Email jpp@markallengroup.com

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

The need for optimism at a challenging time for the NHS emerges as key theme of Ambulance Leadership Forum

The Association of Ambulance Chief Executives’ (AACE) annual Ambulance Leadership Forum (ALF) took place this year on 9–10 February at the Hinckley Island Hotel in Leicestershire. Designed to stimulate debate and ideas about the on-going development of emergency and urgent care, delegates were encouraged to share best practice and discuss issues pertinent to the sector.

The theme for this year’s event focused around the future look and feel of ambulance service provision and was largely based on AACEs document published last year, A vision for the ambulance service: 2020 and beyond. This vision presents ambulance services as mobile healthcare providers operated in an extended range of care settings, doing more diagnostic work, more treatment, more health promotion, and providing patients with more services that before.

Delegates were welcomed to the conference by AACE chair and West Midlands Ambulance Service NHS Trust CEO, Anthony Marsh, who called on attendees to embrace the new ambulance initiatives on offer and improve outcomes. He noted that ‘the challenge we are confronted with now [in the NHS] offers us a real opportunity,’ and hoped proceedings for the day would help influence national policy.

The landscape of urgent and emergency care: implementing the Five Year Forward View

The opening address was given by Chris Hopson, CEO of NHS Providers, who asked whether the provider sector had the capacity to deliver the changes outlined in NHS England’s Five Year Forward View? Hopson said that all Trusts would be under pressure to achieve their financial targets in 2016–2017 and that one of the biggest debates would be over standards and performance, especially for ambulances. He highlighted that the majority of providers have found themselves in the ‘needs improvement’ box in terms of Care Quality Commission rating, and that we cannot fix many problems found in the NHS unless we have more vertical integration of health and care and horizontal collaboration.

Prof Keith Willett, national director for acute episodes of care for NHS England, then spoke on the new landscape for urgent and emergency care. He started by mentioning he sat on a sharp fence between the clinical world of service providers and Whitehall, and noted it is a sharp fence. The current provision of urgent and emergency care services sees 24 million calls to the NHS and 7 million emergency ambulance journeys a year. Willett said for those people with urgent but non-life threatening needs we must provide ‘highly responsive, effective and personalised services outside of hospital, and deliver care in or as close to people’s homes as possible.’ For those people with more serious or life-threatening emergency needs, he said: ‘We should ensure they are treated in centres with the very best expertise and facilities in order to maximise their chances of survival and a good recovery.’ As we move into the final phase of the Urgent and Emergency Care Review, the focus is on implementing new models of care and ways of working. He stressed that the ambulance service needs to come to the fore and drive change, and that no paramedic should make a decision in isolation, but should have support from whole of the NHS.

Transforming health and social care: innovation and leadership

Following the first coffee break of the day, Bob Williams, CEO of North West Ambulance Service NHS Trust, spoke on devolution in Manchester. After providing a background to the health and social care system in Greater Manchester and the Greater Manchester Devolution Agreement, Williams outlined the principles around the Greater Manchester devolution plan, which include: radical upgrade in population health prevention, transforming care in localities, standardising acute hospital care, and standardising clinical support and back office services. Williams said Greater Manchester devolution offers an opportunity to transform health and social care, and that ambulance service has the tools, the players and the crucial elements to help make the healthcare system changes needed.

Prof Paresh Wankhade of Edge Hill University then spoke on leadership in the emergency services, focusing on interoperability and innovation. Wankhade first set the scene by outlining the leadership challenges faced by emergency services, before highlighting the key issues impacting workforce development, the need for suitable leadership for empowering and motivating staff, provided a critical overview of the state of interoperability, and closed by speaking about innovation in an era of uncertainty. For the ambulance service, he noted an increasing demand but lesser proportion of life-threatening calls, and that performance and quality are unsustainable with current levels of funding. He went on to say that there is very little evidence to suggest that enough is being done to support the workforce for new challenges and performance pressures, and that there is an important role for the College of Paramedics to prepare practitioners for the future.

Leading in challenging times

After lunch, delegates heard a recorded message from Lord Prior of Brampton, parliamentary under secretary of state for NHS productivity, who commended the work that is being done by ambulance services across the country, and apologised on behalf of the secretary of state for health, Jeremy Hunt, who had to pull out the conference last minute.
This was followed by Rob Webster, CEO of NHS Confederation, who gave one of the most engaging talks of the day on leading in challenging times. He began by explaining there has been a 24% increase in activity for Category A calls for ambulance services since 2011. He went on to stress the need for values-based leadership and system leadership, and that leading should come from every seat in the NHS. If senior ambulance managers do not understand the organisation’s values, then it is difficult to expect staff to understand them. He closed by noting that the NHS is made of people, and that it is the collective commitment, drive and energy that make up an organisation, and what makes a successful future.

Janette Turner, director of the medical research unit at the University of Sheffield, then spoke on managing urgent care outside hospital. Looking at data from March 2015, 27.9–57.6% of 999 calls were not conveyed to emergency departments in England. On population utilisation of emergency ambulance services the UK receives 13 calls per 100 population, compared to Belgium, which has the highest number of calls per population in Europe at 33. Turner said that outcomes of evidence on telephone-based service involved accuracy, compliance, satisfaction, costs, service impact and access. While accuracy is high for minimising risk, inaccuracy tends to come in the form of over triage. Considering the role of management by ambulance clinicians outside hospital, Turner said a small number of high-quality studies support extended paramedic roles as they offer safe decisions, reduced emergency department transports, high satisfaction and are cost effective. However, she did note that decision-making is complex and needs to be underpinned by the right education.

Introducing new delivery models

After another coffee break, Richard Murray, director of policy at the King’s Fund, spoke on new delivery models for urgent and emergency care and NHS Planning Guidance. Murray outlined the key features of NHS Planning Guidance before discussing the implications for urgent and emergency care and ambulance providers. He said it was a game of two halves: a one-year plan for 2016/17, with existing organisations as the key building block, switching to place-based plans for 2017/2018 to 2020/2021. Taken together, Murray said they offer a radical re-drawing of the boundaries in the NHS.

The final talk of the day was delivered by Dr Phil Foster, assistant medical director for Yorkshire Ambulance Service NHS Trust, who spoke on the West Yorkshire Urgent and Emergency Care Vanguard. He explained how the service’s collective local vision was for all patients with emergency and urgent care needs within West Yorkshire to get ‘the right care in the right place—first time—every time.’ The aim was to give patients access to urgent and emergency care through 999 and 111 and given an improved experience with care provided closer to home. This would be a standard service offering across West Yorkshire.

Celebrating excellence at the AACE Outstanding Service Awards

The evening saw delegates celebrate the AACE Outstanding Service Awards. Sponsored by Ferno UK Ltd in aid of the Ambulance Services Charity, ambulance service employees form across England who have gone above and beyond the call of duty were recognised and commended for their outstanding service. The Outstanding Paramedic Award went to Abigail Evans, a cycle response unit paramedic for London Ambulance Service NHS Trust. The Outstanding Mentor or Tutor Award went to Chris Mathews, a critical care paramedic with South East Coast Ambulance Service NHS Foundation Trust. Outstanding Innovation and Change Awards went to Adam Aston, a paramedic with West Midlands Ambulance Service NHS Trust and Thomas Heywood, a clinical manager for Yorkshire Ambulance Service NHS Trust. The Outstanding Non-Paramedic Clinician Award went to Steve Wainwright, and emergency care assistant for East of England Ambulance Service NHS Trust. The Outstanding Control Services Employee Award went to Craig Foster, a call operator for North East Ambulance Service NHS Foundation Trust. The Outstanding Manager Award went to Karen Gardner, operations manager for North East Ambulance Service NHS Foundation Trust. The Outstanding Support Services Award went to Tez Westwood, Hazardous Area Response Tram support technician for East Midlands Ambulance Service NHS Trust. The Outstanding Senior Management Award went to Tracy Nicholls, head of quality governance for East of England Ambulance Service NHS Trust and the Outstanding Welfare and Wellbeing Award went to Ben Lambert, a team leader for South Central Ambulance Service NHS Foundation Trust.

Workshops allow delegates to discuss emerging themes

The second day, co-hosted by NHS Confederation, featured a morning of facilitated workshops, concluding with a conference summary and forward view. Delegates were given a choice to attend workshops on the themes of ‘our workforce’, ‘technological and digital enablement’, and ‘vanguards and innovation’.

A summary of the main themes discussed in the workforce workshop include the need to engage with staff meaningfully, understanding culture but also taking change, collaboration, and a recognition of whether or not we are doing as much as we can on mental health and race equality.

The technology workshop had a key theme around innovation, and an emphasis that ambulance services are much more than a transportation service. There was a strong feeling that there needs to be better capture and use of data in technological advancements, that procurement needs to be looked at as a whole-systems approach, and that ambulance services should embrace social media.

Within the vanguard workshop there was a clear sense of the great work that is being done across the country. It was recognised that a lot of the components of a really good system are in place, but that we have to learn from each other’s organisations. There was also an emphasis on ensuring that the right culture is in place within services.

With difficulty comes opportunity

The conference came to a close with Anthony Marsh commending the optimism shared by delegates during what is a challenging time for the NHS. He quoted the BBC programme Inside Out, saying there is ‘no need to be miserable, we are winning the war.’ Martin Flaherty, managing director of AACE, then remarked on how sobering it was to hear about the challenging times ahead, particularly around finance. However, he said with difficulty comes opportunity and that as a sector we are always doing our best when in difficulty.

Delegates left with much food for thought and plenty of ideas for implementing change within their own services. Feedback has been positive, with one delegate saying: ‘Excellent conference, completely relevant to our practice in emergency medicine,’ while another remarked: ‘I think the organisation was superb and the quality of speakers and breadth of subject matter was really relevant.’ Congratulations must be extended to AACE for an engaging two days, and delegates can look forward to returning for another year.

Taken from Journal of Paramedic Practice, published 4 March 2016.

AACE outlines future vision for the ambulance service

The Association of Ambulance Chief Executives (AACE) has published a report outlining the English ambulance sector’s vision for 2020 and beyond, and the steps that are required to ensure that it is realised.

It presents a vision of the ambulance service as a mobile healthcare provider with roles including navigation, coordination, diagnostics, treatment and transport. It also describes an extended range of settings within which care is offered and the range of services available.

It offers a new model of care—enabled by technological development—increasing the use of tele-healthcare, and sees an increased number of advanced paramedics working alongside paramedics fully integrated into a multi-disciplinary urgent care team.

The report proposes an enhanced clinical decision-making role for paramedics, supporting the delivery of care closer to home and within the community. This is in line with NHS England’s Five Year Forward View, which outlined areas where imminent change within the NHS is imperative, specifically in respect of demand, efficiency and funding.

It goes on to argue that the Urgent and Emergency Care Review has presented the ambulance sector with an ideal opportunity to reposition itself as a pivotal urgent and emergency care provider, calling for the sector to broaden its prevention role and urgent care focus, becoming the gateway to urgent care provision via 999 and 111.

In order to realise this vision, the report says that technology must be embraced to facilitate improvements across emergency and urgent care wherever reliable, sound solutions are available that stand to benefit patients. Also, it outlines that the paramedic workforce must be developed and equipped with high-quality urgent care skills to ensure its integral role within the multi-disciplinary team.

AACE has called on staff as a key enabler in nurturing the perception of the ambulance service as a mobile healthcare provider and a key partner in designing new services.

According to AACE, the document has been informed by extensive consultation within the sector and with key stakeholders, and in response to the current healthcare policy and economic contexts.

Taken from Journal of Paramedic Practice, published 22 October 2015.

Association of Ambulance Chief Executives outlines strategic priorities for 2015/16

Paramedic prescribing and reform of paramedic education and training with Health Education England are among the key strategic priorities of the Association of Ambulance Chief Executives (AACE) for 2015/16.

The AACE National Programme, which is comprised of nine national groups and their respective 2015/16 work plans, as well as a number of other projects that are being progressed by the AACE with input from the national groups as required, is informed by its four strategic objectives: Ambulance Service: 2020 and beyond; Workforce, education and development; Operating model and efficiency; Clinical and patient safety.

The AACE aims to report on its ‘Ambulance service: 2020 and beyond’ project in May/June with an informed vision of what the ambulance service should look like beyond 2020 and suggestions to the ambulance sector on the steps and actions required to realise this vision.

Implementation of the Urgent and Emergency Care Review (U&ECR) will be an ongoing focus for the AACE in 2015/16, and will include the enhancement of NHS 111 services and reform of paramedic education and training with Health Education England.

Continued support and input will continue to the reform of paramedic education and training, with paramedic prescribing remaining a priority for the AACE to equip the profession for the ongoing expansion and diversification of the role.

The identification and development of future ambulance leaders is also a priority of the AACE, with focus being made on leadership development and consideration of a virtual academy and its potential for multidisciplinary training.

Ambulance service response will remain a focus for the AACE in 2015/16, and will include the development of future performance and clinical measures in light of the U&ECR, and the facilitation of any required changes to response protocol nationally following the completion of pilots in early 2015/16.

Finally, the AACE plans to deliver the National Ambulance Service Medical Directors’ Group’s Future National Clinical Priorities for Ambulance Services in England. Key clinical areas of focus include: emergency care; urgent care; mental health; the frail, elderly falls and dementia; long-term conditions; end of life patients; and public health and prevention.

To view the full list of strategic priorities, visit: http://aace.org.uk/national-programme/

Taken from Journal of Paramedic Practice, published 30 April 2015.

Rise in number or paramedics leaving NHS ambulance services

The numbers of paramedics leaving NHS ambulance services is increasing, according to figures obtained from ambulance Trusts.

At least 1,015 paramedics left their job in 2013–14, compared with 593 in the same period two years earlier.

This has meant crews are under greater pressure than ever before to meet demand.

As the amount of emergency calls continues to rise each year, there has failed to be an equivalent rise in the number of qualified ambulance staff.

Anthony Marsh, chairman of the Association of Ambulance Chief Executives, says that a surge in 999 calls this year and higher numbers of paramedics leaving some services, means the remaining front-line staff are facing pressures that are ‘greater than they’ve ever been.’

He added: ‘Traditionally, ambulance services receive just over 4% more 999 calls each year, and we have done for the last 10 years—some years a little bit more than that, some a bit less—but this year we’re seeing substantially more 999 calls.’

Dr Fiona Moore, medical director for London Ambulance Service NHS Trust, said:

‘We’ve seen an increase in calls from the 21- to 30-year-old group, and I think that now reflects the sort of supermarket culture we now have, so if you can buy a loaf of bread at 04:00 in the morning, why can’t you access you healthcare when it is convenient to you?’

Taken from Journal of Paramedic Practice, published 20 October 2014.

AACE launch review into ambulance demand

A new project launched by the Association of Ambulance Chief Executives (AACE) aims to establish how the ambulance service in the UK is used.

AACE is calling for volunteers who have recently called 999 to answer questions about the occasion on which an ambulance was called and other services that may have been contacted for help prior to calling 999.

The use of ambulance services has increased by 59% over the last decade, but it is still unclear as to what the specific factors are which have contributed to this change.

‘The overall aim of the review is to investigate the underlying causes of increasing demand on the ambulance service,’ said Dr Melanie Edwards, project researcher for AACE.

‘During the review, we are examining how demand has changed nationally over the past 10 years, investigating what factors have contributed to the rise in emergency ambulance demand, exploring how demand on the emergency ambulance service relates to demand elsewhere in the urgent and emergency care system, and exploring steps that could be taken to mitigate rising demand.

She added: ‘We are using various strands of methodology, which have included a literature review, analysis of operational data from each ambulance service in England, and interviews with key stakeholders (representatives from ambulance services, representatives from organisations relevant to urgent and emergency care, and recent users of the ambulance service).’

Taken from Journal of Paramedic Practice, published 2 June 2014.