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.
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Ali Quaile 
Government’s additional £1.3 billion for mental health services is misleading
November 20, 2017 Leave a comment
Other policies include giving an extra 1 million patients access to mental health services at an earlier stage, round-the-clock services and the integration of mental and physical health services for the first time.
Examining the plan
The scale of these proposals is commendable and reflects the additional staff required to deliver the transformation set out in The Five Year Forward View for Mental Health (Mental Health Taskforce, 2016). Mental health provision has consistently been underfunded, therefore an update to place it more in line with physical health provision is long overdue.
For this reason, the announcement has been welcomed by many mental health campaigners and professionals. The Royal College of Psychiatrists (RCP) led the way in commending the Government’s plans, with Professor Wendy Burn, President of the RCP, saying the 570 extra consultants promised in the strategy will be ‘crucial to delivering the high-quality, robust mental health services of the future’ (RCP, 2017). NHS Employers said service providers will welcome national support, particularly for ‘improved access to funding for continuing professional development for the mental health workforce, and facilitating increased use of international staff where required’ (NHS Employers, 2017).
However, despite the will to welcome these proposals it would be wise to take them with a pinch of salt. While the Royal College of Nursing (RCN) encouraged the investment, it said the Government’s proposals ‘appear not to add up’ (RCN, 2017). RCN chief executive, Janet Davies, stressed that in order for the nurses to be ready in time, they would have to start training straight away. Additionally, she cites how the scrapping of nursing bursaries has led to a ‘sharp fall in university applications’.
Attrition rates on the rise
Attrition rates for all mental health staff are rising. From 2012/13 to 2015/16, the number of people leaving mental health trusts has risen from 10.5% to 13.6% (HEE, 2017). The NHS currently funds over 214 000 posts to provide specialist mental health services in England. However, over 20 000 of these vacancies are predominantly filled by bank and agency staff (HEE, 2017). It is clear the sheer scale of growth cannot be met via the traditional training routes within this timescale, as in some cases this would mean doubling or trebling the workforce. While investment is needed in the development and reskilling of existing staff, or looking to the global market for recruitment, this is an unrealistic aim.
The Royal College of Occupational Therapists (RCOT) is one of the groups who have raised concerns over vacancy rates. Julia Scott, CEO of the RCOT, said health and care services across the country are experiencing real difficulties in filling existing vacancies, with vacancy rates for occupational therapists of up to 50% (RCOT, 2017). She stressed that rapid action is needed to address this crisis if commitment is to be delivered.
The British Medical Association (BMA) echoed worries over recruitment, stressing insufficient psychiatry trainees across England and a high percentage of trainees not completing training in the specialty. BMA consultants committee deputy chair and consultant child and adolescent psychiatrist, Dr Gary Wannan, said: ‘In 2014, one in five doctors undertaking core psychiatry training did not progress into the final part of their training’ (BMA, 2017).
Government pledge still insufficient
Currently, 15.8% of people with common mental conditions access psychological therapies each year. However, even with the Government’s proposals this will only increase to 25% by 2020/21 (HEE, 2017). This is still an unacceptable figure
and one that is emphasised by the UK Council for Psychotherapy (UKCP), who said the announcement falls far short of what is needed to offset the growing demand for NHS mental health services.
According to UKCP Chair Martin Pollecoff: ‘To meet even existing demand, the Government should take advantage of the vast existing workforce of therapists. UKCP alone has more than 8000 highly qualified trained psychotherapists from different backgrounds, and many of them have medical experience’ (UKCP, 2017).
Origin of investment misleading
This is not the first time the introduction of £1 billion for mental health services has been proposed. In 2016, then Prime Minister David Cameron announced almost £1 billion of investment as part of a ‘revolution’ of mental health treatment (Prime Minister’s Office et al, 2016). This commitment from the Government sounds impressive, but has to be considered in the context of cash terms rise in the NHS budget generally. The Government has pledged to increase NHS spending in England to £120 billion by 2020/21
(HM Treasury, 2015). For mental health spending to grow at the same rate as the rest of the NHS, around 11.9% of the extra funding given to NHS England needs to be spent on mental health (Full Fact, 2016). This works out at roughly £2.2 billion. This figure far exceeds the £1.4 billion pledged in the most recent announcement and clearly represents a slower rise in spending than other parts of the NHS.
Simply not good enough
At first glance, the Government’s proposals appear to be the desperately needed boost to mental health services, which should be welcomed. However, the explanations of how additional posts will be funded or the recruitment issues overcome does not add up and are simply not good enough.
The Government has sugar-coated the amount of investment pledged and the figure still falls far below what is needed for mental health. It therefore comes as no surprise that Labour’s Shadow Minister for Mental Health, Barbara Keeley MP, said the workforce plan: ‘offers little hope to those working in the sector faced with mounting workloads, low pay and poor morale’ (The Labour Party, 2017).
References
British Medical Association (2017) BMA responds to Department of Health mental health workforce plans. BMA, London. https://tinyurl.com/ybtgxye8 (accessed 29 August 2017)
Department of Health (2017) Thousands of new roles to be created in mental health workforce plan. DH, London. https://tinyurl.com/y9akdjdr (accessed 31 August 2017)
Full Fact (2016) Unanswered questions on “extra £1 billion” for mental health. Full Fact, London. https://tinyurl.com/y7oyy8qc (accessed 1 September 2017)
Health Education England (2017) Stepping forward to 2020/21: The mental health workforce plan for England. HEE, Leeds. https://tinyurl.com/ycebebna (accessed 25 August 2017)
HM Treasury (2015) Spending Review and Autumn Statement 2015. The Stationery Office, London
The Labour Party (2017) Tory Government promising jam tomorrow when action is needed today to tackle the staffing crisis in mental health – Keeley. The Labour Party, Newcastle upon Tyne. https://tinyurl.com/y7db35pf (accessed 29 August 2017)
Mental Health Taskforce (2016) The Five Year Forward View for Mental Health. NHS England, Leeds. https://tinyurl.com/gvc4or3 (accessed 25 August 2017)
NHS Employers (2017) NHS Employers welcomes plan to prioritise mental health services. https://tinyurl. com/ydg8h3ca (accessed 29 August 2017)
Prime Minister’s Office, 10 Down-ing Street, Department of Health, NHS England, The Rt Hon David Cameron, The Rt Hon Jeremy Hunt MP (2016) Prime Minister pledges a revolution in mental health treatment. Department of Health, London. https://tinyurl.com/z69jcpc (accessed 1 September 2017)
Royal College of Psychiatrists (2017) RCPsych response to HEE’s Mental Health Workforce Plan. RCPsych, London. https://tinyurl.com/yc2p93k8 (accessed 25 August 2017)
Royal College of Nursing (2017) RCN responds to Mental Health Workforce Plan. RCN, London. https://tinyurl.com/yavm3ulq (accessed 25 August 2017)
Royal College of Occupational Therapists (2017) Royal College of Occupational Therapists welcomes an expansion in the mental health workforce. RCOT, London. https://tinyurl.com/ycl9bss2 (accessed 25 August 2017)
UK Council for Psychotherapy (2017) We urge the Government to use existing therapist workforce to plug treatment gap. UKCP, London. https://tinyurl.com/ydfojrpk (accessed 29 August 2017)
Taken from British Journal of Mental Health Nursing, published September 2017.
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