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.

The road to better patient care

The Francis report (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013) published earlier this year emphasised the need for a cultural change within the NHS. Highlighting the failure of the Mid Stafforshire NHS Foundation Trust to detect poor quality care and to ensure that its services met the standards that the public expects, the 3-volume, 1782-page report called for a patient-centred culture, which has a commitment to serve and protect patients.

Though the Francis report focused on a single NHS Trust, its recommendation for the need of a structure of fundamental standards, which identify the basic principles of care a patient can expect, and stronger healthcare leadership, are applicable to the NHS as a whole.

The provision of safe and effective care often starts with the paramedic, and so it is imperative that the highest quality services possible are delivered. As a profession that is rapidly taking on increasing responsibilities within the NHS, the paramedic profession has to ensure it is able to keep up with its broadening demands. One of the ways it can ensure this is done is by getting the simple things right. The importance of thorough patient assessment and accurate history taking cannot be undervalued, as it is this that informs the clinician of the appropriate action and treatment to carry out. This issue of the Journal of Paramedic Practice goes back to basics by exploring the fundamentals of paramedicine that are often overlooked, with articles on integrated care, patient assessment and history taking.

In response to the Francis report, Health Secretary Jeremy Hunt has announced a new £260 million fund for hospitals (Department of Health, 2013) that will be put towards increasing the use of technology for patient records. Outdated paper- based systems for patient notes will be replaced by computer systems, making history taking and prescribing easier. This marks a critical step in the NHS’ plan to go digital by 2018. Organisations such as St Helens and Knowlsley NHS Trust have had their patient records accessible online for health professionals to access when needed, while at New Queen Elizabeth Hospital in Birmingham, an online ‘portal’ allows patients to view and update their own medical records so that health professionals can get instant real-time updates should they need them.

History taking forms a notable part of the paramedic’s overall patient assessment, and so the ability to have more accurate details on a patient as a result of up-to-date technology systems means that better and faster care can be delivered. Not only this, but it will mean transferal to specialist departments will also be easier due to the ability to send patient records electronically.

If a truly patient-centred culture within the NHS is to be made a reality, the needs of the patient have to be properly understood and assessed. Getting the basics right is surely a step in the right direction.

References:

Department of Health (2013) £269 million invested in patient safety plans. Available at: https://www.gov.uk/government/news/260- million-invested-in-patient-safety-plans (accessed 30 May 2013)

The Mid Staffordshire NHS Foundation Trust Public Inquiry (2013) Report of the of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Chaired by Robert Francis QC. 3 vols. The Stationery Office, London

Taken from Journal of Paramedic Practice, published 10 June 2013.

Francis calls for cultural change

The public enquiry report chaired by Robert Francis QC concerning the standards of hospital care provided at the Mid Staffordshire NHS Foundation Trust has emphasized a need for cultural change within the NHS.

The 3-volume, 1782-page report highlighted the failure of the NHS system to detect poor quality care and to ensure that services meet the standards that the public expects. This failure to communicate concerns illustrates a betrayal of the trust that members of the public should be able to place in the NHS.

Francis called for a patient-centred culture, which has a commitment to serve and protect patients. His recommendations for achieving this include: a structure of fundamental standards, which identify the basic standards of care a patient can expect; an openness and statutory duty of doctors and nurses to be truthful with patients; compassionate, caring and committed nursing; and stronger healthcare leadership.

The report includes a number of recommendations for changing nursing training, regulation and professional support that, if implemented, will have an impact on nurses in all sectors of the NHS, including practice nurses. Francis identified that nurses are at the heart of patient-centred care, and stressed that training standards need to be strenghthened to ensure that qualified nurses are competent to deliver compassionate care to a consistent standard. These principles apply to nurses working in all sectors of the NHS.

‘Nurses throughout the NHS will feel devastated at the picture of poor and unsafe care that took place at Mid Staffordshire,’ said RCN president Andrea Spyropoulos. ‘What commentators often forget is that no one is more saddened or frustrated by stories of poor care than nursing staff themselves.’

The report has important implications for nursing leaders, particularly for the Royal College of Nursing (RCN). Francis found that nursing needs a stronger voice. According to the report, this can be achieved through strengthening nursing representation in the leadership of all provider organizations, enhancing the links with their professional regulators, and introducing a better appraisal system. It was also recommended that the RCN consider splitting its trade union and professional functions.

Taken from Practice Nursing, published 18 Feb 2013.