Key areas of interest for paramedics in 2018

My Post (11)The most substantial development concerning paramedics this year is prescribing. Proposals to introduce independent paramedic prescribing were made to the Commission on Human Medicines (CHM) in 2015. However, the CHM did not support the proposals at that time. The College of Paramedics and NHS England went back to the CHM in July 2017 with case studies and an implementation plan to try and get further discussion. The following December the CHM decided to support independent prescribing by paramedics. It will now recommend implementation by making a submission to government ministers.

There is still a lot of work to be done and this is likely to be the key area for development of the profession in 2018. Legislation changes need to be made to enact the recommendation. Universities will have to develop their prescribing programmes and the Health and Care Professions Council (HCPC) will need to update its Standards for Prescribing. While it is unlikely there will be any paramedic prescribers until 2019 at the earliest, this marks a key progression in the development of the profession.

In September 2017, the HCPC began consulting on the threshold level of qualification for entry to the register for paramedics. The current level is outlined in the HCPC Standards of Education and Training at ‘equivalent to Certificate of Higher Education for paramedics’. However, the Paramedic Evidence Based Education Project (PEEP) report recommended the level to the paramedic register be raised to BSc (Hons) degree by 2019.
The consultation document proposes the level of qualification should be amended, due to the changing nature and complexity of the role of paramedics, and it illustrates the ongoing diversity in current qualifications across the UK. Any resultant change would not affect existing registered paramedics or students who are part way through pre-registration education and training programmes. The consultation closed on 15 December, with the outcome expected early this year.

Clinical practice

The UK Ambulance Services Clinical Practice Guidelines, last published in 2016, published supplementary guidelines last year. Although there will not be a new version of the guidelines this year, ongoing updates continue to be published online.

The National Institute for Health and Care Excellence (NICE) is updating its Quality Standard on Trauma. This quality standard covers assessment and management of trauma (complex fractures, non-complex fractures, major trauma and spinal injury) in adults, young people and children. It does not cover hip fracture or head injury as these topics are covered in a separate Quality Standard. The draft quality standard was open for consultation from 7 November to 5 December. The final Quality Standard is expected to be published on 29 March 2018.

Initial results from the AIRWAYS-2 trial are likely to be seen in spring 2018. This randomised trial is comparing the clinical and cost effectiveness of the i-gel supraglottic airway device with tracheal intubation in the initial airway management of patients suffering an out of hospital cardiac arrest.

At the time of writing, the final publication of the College of Paramedics’ position statement on paramedic intubation is still impending. Work began in May 2017 on the statement, with a group meeting in July to discuss and develop a first draft. This statement was reviewed and amended by several key clinical groups before being released to the membership and wider stakeholder organisations for comment. Consultation ran in September 2017, with final publication imminent.

Service delivery

NHS England and NHS Improvement have called on all A&E Delivery Boards to implement measures to reduce the impact of ambulance handover delays. They have outlined key principles concerning actions to be embedded as part of normal working practice, and actions to be taken should ambulances begin to queue.

Among the principles, they state acute trusts must always accept the handover of patients within 15 minutes of an ambulance arriving at the emergency department; that leaving patients waiting in ambulances or in corridors supervised by ambulance personnel is inappropriate; and that the patient is the responsibility of the emergency department from the moment that the ambulance arrives, regardless of the exact location of the patient. It will be interesting to see if the implementation of these measures will have an impact on reducing ambulance handover delays in 2018.

Ongoing feedback on the roll out of the Ambulance Response Programme (ARP) will continue throughout the year. The ARP saw changes to the triage of calls, known as dispatch on disposition, to allow more time for call handlers in cases that are not deemed as immediately life-threatening. Additionally, new call categories were introduced to better reflect the wide range of needs patients have when they dial 999. It is likely there will be national updates on the effectiveness of the ARP, hopefully with benefits of the change being seen, in 2018.

The NHS was promised £1.6 billion for 2018/19 and £900 million for 2019/20 in the autumn budget. While this is certainly welcome relief, it is still a far cry from the £4 billion health experts said the NHS needed. It is believed £1 billion of the cash pot for 2018/19 will be used to improve performance against the 18-week target for elective treatment and £600 million to help hospitals meet the 4-hour target in A&E.

Conclusions

These are just a few of the elements that will affect paramedics this year. Other areas not mentioned include the Assaults on Emergency Workers (Offences) Bill 2017–19, development of the nursing associate role, the national programme to support allied health professionals to return to practice, and the final report of the Asthma Audit Development Project. There are many challenges facing the NHS in the coming year, but with the upcoming developments in the profession, paramedics will find themselves in a key position to alleviate many of these pressures.

Taken from Journal of Paramedic Practice, published January 2018.

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myHCPC app delivers standards and guidance to registrants on the go

A new app developed by the Health and Care Professions Council (HCPC) delivers standards and guidance to registrants at the touch of a button.

Created specifically with health and care professionals in mind, key features include mobile-friendly access to HCPC standards; guidance on HCPC registration; resources for registrants; plus the latest social media content via YouTube, Twitter and Facebook.

The application is free to download and available for both Apple and Android smartphones and tablets.

The launch of myHCPC follows the HCPC’s first mobile app introduced in 2011. Aimed at the general public and enabling service users to learn more about how to raise a concern, this app allows instant access to the HCPC Register on the go.

Tony Glazier, web and digital manager of the HCPC, said:

‘The myHCPC app has been created especially with registrants in mind. It delivers our standards in a mobile format, as well as guidance relating to CPD and registration at the touch of a button. We want to encourage professionals to download the app to make it your HCPC.’

Taken from Journal of Paramedic Practice, published 17 February 2015.

Exercising the right to be heard

Throughout history whistleblowers have been viewed in one of two ways: as honest and brave individuals carrying out their moral responsibility, or as traitors to the organisation and people they work for. However, for health professionals, including paramedics, the act of whistleblowing should be seen as an obligation rather than a choice.

Standard 1 of the Health and Care Professions Council’s (HCPC) Standards of Conduct, Performance and Ethics states that registrants should act in the best interest of service users (HCPC, 2012). It goes on to say it is the duty of registrants to act immediately if they become aware of a situation where a service user may be put in danger, and to take appropriate action to protect the rights of children and vulnerable adults who are at risk (HCPC, 2012). In short, registrants are required to place the safety of service users before any personal or professional loyalties at all times (HCPC, 2012).

But while it may be the duty of staff to raise concerns where necessary, this will not be done if they feel whistleblowing policies are not implemented properly.

The Francis Inquiry into the scandal at Stafford Hospital illustrated what can happen when staff fail to speak out against inappropriate care. As a result, one of the key recommendations that emerged from the Inquiry was the promotion of whistleblowing. However, what the Inquiry also revealed was the ‘culture of fear’ that exists around the act. Although theoretical protection is provided to NHS staff by the Public Information Disclosure Act 1998 (c.23), this is unlikely to be of much reassurance to potential whistleblowers who know they will have to face the wrath of their colleagues (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013). Ken Lownds of CURE made the point that regardless of protective legislation and policies, it was the culture that mattered. Without a positive culture, it will never be easy to raise concerns (The Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013).

Only last month a paramedic was banned from two hospitals after he spoke out about overcrowding in A&E (BBC, 2015). Luckily the individual involved was later issued an apology and had the restrictions lifted, but this did not stop union bosses claiming the case was a clear example of victimisation.

The raising of complaints and concerns is essential in ensuring the highest quality of care is upheld in the NHS. Employees who raise concerns should be valued, respected and protected, not victimised and bullied. A recent report from the Health Committee admitted that the treatment of whistleblowers remains a ‘stain’ on the reputation of the NHS (Health Committee, 2015). It is therefore imperative that this stain is eradicated so that staff are emboldened to carry out their duty without fearing the consequences.

References

BBC (2015) Worcestershire hospitals ban paramedic Stuart Gardner. BBC. http://tinyurl.com/p6de2zo (accessed 2 February 2015)

Health and Care Professions Council (2012) Standards of Conduct, Performance and Ethics. HCPC, London

Health Committee (2015) Fourth Report of Session 2014–15, Complaints and Raising Concerns. HC 350. The Stationery Office, London

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. Volume 1: Analysis of evidence and lessons learned (part 1). The Stationery Office, London

Public Information Disclosure Act 1998 (c.23) The Stationery Office, London

Taken from Journal of Paramedic Practice, published 6 February 2015.

HCPC publishes new standards of proficiency for paramedics

The Health and Care Professions Council (HCPC) has published revised standards of proficiency for paramedics.

The standards of proficiency are the professional standards that every registrant must meet in order to become registered, and must continue to meet in order to remain on the HCPC Register. The standards set out what professionals should know, understand and be able to do to practise safely and effectively.

The standards of proficiency are divided into generic standards (which apply to all HCPC-regulated professions) and standards specific to each profession.

The HCPC Council approved revised generic standards in March 2011 and the HCPC is now working to update the standards that apply to each individual profession. The revised profession-specific standards for paramedics have been published as part of this process.

Michael Guthrie, Director of Policy and Standards, said:

‘We have worked with the College of Paramedics to review the standards and asked them to make recommendations. We have also considered the feedback we received from our public consultation and are grateful to all those who participated in the process.

‘The changes we have made to the profession-specific standards for paramedics ensure that they reflect current practice and include language that is appropriate to the profession.’

The HCPC will now work with education providers to implement the new standards.

Taken from Journal of Paramedic Practice, published 10 September 2014.

Paramedics and professionalisation

Since the birth of organised pre-hospital emergency care the question of its professionalisation has been met with ambiguity. From its origins in military history as a transport service to its development into the current practitioner role that has become an integral part of the health care sector, the need for its recognition as a profession has become increasingly important.

One of the main concerns regarding professionalisation is that it has no clear definition. Sociologists of professions will dispute the requirements necessary for an occupation to be seen as a profession and so it remains questionable as to how much it relies simply on perception. According to Evetts (2012), professionalisation involves the protection of practitioners of an occupation by only making it possible to practice that occupation if you are trained in that particular category of knowledge. However, surely professionalisation extends beyond mere training?

Within the UK, the Health and Care Professions Council (HCPC) was formed as a statutory regulator of health and care professionals, standardising the education and training received by members of the National Health Service (NHS) workforce and moving that training into the university sector (HCPC, 2013). The HCPC liaises with professional bodies for all the professions that the registrar is responsible for. These organisations do work which may include promoting the profession, representing members, curriculum frameworks, post-registration education and training and continuing professional development (HCPC, 2013). The College of Paramedics (then the British Paramedic Association) was set up as the professional body for the ambulance profession. According to the College of Paramedics, having a professional body has given them the opportunity to change the way that education, training and associated awards are established (College of Paramedics, 2013).

In this issue of International Paramedic Practice, Pip Lyndon James looks at the issue of professionalisation for Australian paramedics. She comments on how at present the Australian paramedic discipline is not considered a full profession by the national or state governments. Despite frequent public misassumption that paramedicine is a registered, highly-regulated industry credited with professional status, this is currently not the case.

It is clear that steps are gradually being taken to reach this ultimate aim. Moving in the direction of other health disciplines, such as medicine and nursing, the advent of paramedic degrees worldwide that are replacing the traditional older in-house training conducted by ambulance services is surely a move in the right direction. While paramedicine has not yet received the professional status it deserves, it is important to bear in mind the distinction between professionalism and professionalisation. Until paramedicine receives professionalisation, it is integral that paramedics continue to act in a professional manner, adhering to codes of conduct and striving towards ongoing professional development.

References:

College of Paramedics (2013) About us. http://www.collegeofparamedics.co.uk/about_us/ (accessed 21 August 2013)

Evetts J (2012) Similarities in Contexts and Theorizing: Professionalism and Inequality. Professions and Professionalism 2(2)

Health and Care Professions Council (2013) Aims and vision. http://www.hcpc-uk.org/aboutus/aimsandvision/ (accessed 21 August 2013)

Taken from International Paramedic Practice, published 28 August 2013.