NHS Confederation calls for a sustainable and high-quality urgent and emergency care system

A response by the NHS Confederation to Sir Bruce Keogh’s review of urgent and emergency care has called for an end to ‘sticking plaster solutions’ and the need for a sustainable and high-quality urgent and emergency care system that can meet the needs of patients.

The report, entitled Ripping off the Sticking Plaster, urges joint work between primary care, acute, ambulance, mental health, social care and community services.

One of the key recommendations from the report calls for getting the best from the urgent and emergency care system and workforce. This would involve improving the education, information, engagement and support available to staff.

Sir Bruce Keogh’s report said fewer patients attended by ambulance crews should be taken to hospital in order that pressures on A&E departments are reduced. The NHS must therefore improve training and investment in its staff, such as the development of more community-based ambulance services, through enhancing paramedic practitioner roles.

This would enable paramedics to take more responsibility for decisions to treat patients on scene and not feel the need to err on the side of caution and transfer patients to hospital.

Chief of the NHS Confederation, Rob Webster, said: ‘We know patients will go “where the lights are on” and instead of blaming patients for going to the wrong place, we need to build a system around patients and to give them the care they need, when they need it.

‘Looking at emergency care in isolation, or just as a hospital problem, without an appreciation or understanding of what is going on across the rest of the NHS and social care will not solve the long-term issues.

‘This will require primary care, acute, ambulance, mental health, social care and community services to work together in networks

‘We need to build on the existing good practice which is out there, but change needs to happen, and fast.’

Taken from Journal of Paramedic Practice, published 26 March 2014.

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2013: the year in review

As paramedics across the country are recovering from the busiest shift of the year, the Journal of Paramedic Practice thought it would look back over 2013 and consider some of the notable events that occurred, both good and bad.

The beginning of 2013 will be remembered by most for the tragic loss of Roland Furber, President of the College of Paramedics, who passed away on 4 February. Roland and his late wife Carol were known for the huge contribution they made to the paramedic profession and the establishment of the professional body, which was then the British Paramedic Association (BPA). As the inaugural chief executive of the BPA, Roland made an enormous impact on the founding of the profession.

February also saw the release of the final report of the Mid Staffordshire NHS Foundation Trust Inquiry chaired by Robert Francis QC, which though not directly affecting paramedics, raised a number of important questions concerning the care of those who are older and more vulnerable. Perhaps more than anything it highlighted the need for a cultural change within the NHS, where patients are placed at the centre.

One of the most notable events of the past year was the long-awaited publication of the UK Ambulance Services Clinical Practice Guidelines 2013, which was issued following lengthy development with JRCALC and National Ambulance Service Medical Directors. The first major re-write since 2006, it features a number of significant changes in terms of guidance for clinical care. Work is already underway scoping future editions and updates, as can be seen in the obstetrics and gynaecology update published in this issue.

April saw the new health and care system in England become fully operational, with its ambitious aims to deliver the content laid out in the Health and Social Care Act 2012.

August saw the publication of the end of study report for the Paramedic Evidence Based Project (PEEP). Commissioned as a result of the growing interest in the delivery of paramedic education and training, the project called for the introduction of a national education and training framework for paramedics.

Perhaps the biggest piece of news came with Sir Bruce Keogh’s report on the first stage of his review into urgent and emergency care, published 13 November, which presented a significant step in the progression of the paramedic profession. Sir Bruce’s call for the development of 999 ambulance services so that they become mobile urgent treatment services, illustrated an appreciation of the skillset of paramedics and their potential in the delivery of pre-hospital care.

Finally, 2013 marked the five-year anniversary of the Journal of Paramedic Practice, which was launched in October 2008. On behalf of the journal I would like to thank the editorial board, the consultant editors, all those who have contributed to the journal, helping to make it an informative learning resource, and most of all, you the readers, without which this publication would not be possible. I look forward to another exciting year and wish you all the best for 2014.

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

The significance of the Keogh Review

Sir Bruce Keogh’s report on the first stage of his review into urgent and emergency care (NHS England, 2013), published 13 November 2013, presents a significant step in the progression of the paramedic profession.

Along with the introduction of a two-tier A&E system as part of a fundamental shift in the provision of urgent care, the NHS England Medical Director has called for the development of 999 ambulance services so that they become mobile urgent treatment services, noting that paramedics now have the skills that would only be done by doctors 10 years ago. The suggested change comes in a letter to Health Secretary, Jeremy Hunt, and NHS England Chair, Sir Malcolm Grant, where Sir Bruce says:

‘Our vision is simple. Firstly, for those people with urgent but non life- threatening needs we must provide highly responsive, effective and personalised services outside of hospital. These services should deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families’ (NHS England, 2013).

Both the College of Paramedics (CoP) and the Association of Ambulance Chief Executives (AACE) have welcomed the report, and emphasised that increasing demands on ambulance services highlights the need for further investment into the training and education of paramedics.

There are a number of factors said to be contributing to the growing number of A&E admissions, including an ageing population with increasingly complex needs, and people struggling to navigate and access a confusing and inconsistent array of urgent care services provided outside of hospital (NHS England, 2013). However, while the number of people attending A&E departments is on the rise, it must be stressed that those who can receive treatment at home or closer to home, should. According to the report, 40% of patients attending A&E are discharged requiring no treatment at all; there were over one million avoidable emergency hospital admissions last year; and up to 50% of 999 calls requiring an ambulance to be dispatched could be managed on scene (NHS England, 2013).

It has already been proposed that the provision of key roles in urgent and emergency care, such as specialist paramedics, has illustrated high-quality clinical outcomes and reductions in A&E admissions, but what the Keogh Review adds to the debate is confirmation of this fact.

The need to develop a larger workforce with advanced clinical decision-making skills has never been more apparent. The report also arguably offers good evidence for the need to develop prescribing for paramedics, as this will inevitably have an effect on the reduction of A&E admissions if patients feel they are able to receive sufficient out-of-hours care, which may include the chance to be issued prescriptions.

While this is a significant undertaking, that is expected to take between 3–5 years, it is undoubtedly a triumphant step in the recognition of the potential of the paramedic profession.

References:

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, London

Taken from Journal of Paramedic Practice, published 4 December 2013.

NHS medical director proposes increased role for ambulance services

The National Medical Director of NHS England, Sir Bruce Keogh, has proposed an increased role for ambulance services in the provision of emergency and urgent care in England.

Sir Bruce Keogh’s report on the first stage of his review of urgent and emergency care, published 13 November 2013, has called for the development of 999 ambulance services so that they become mobile urgent treatment services, noting that paramedics now have the skills and equipment that would only be done by doctors 10 years ago.

In a letter to Health Secretary Jeremy Hunt and NHS England Chair Sir Malcolm Grant, Sir Bruce says:

‘Our vision is simple. Firstly, for those people with urgent but non life-threatening needs we must provide highly responsive, effective and personalised services outside of hospital. These services should deliver care in or as close to people’s homes as possible, minimising disruption and inconvenience for patients and their families.’

Both the College of Paramedics (CoP) and the Association of Ambulance Chief Executives (AACE) have welcomed the report, and emphasised that increasing demands on ambulance services highlights the need for further investment into the training and education of paramedics.

Prof Andy Newton, chair of the College of Paramedics, said:

‘Key roles, like that of the specialist paramedic roles in urgent care, now urgently need support with further investment and critically the development of prescribing for paramedics, another key area highlighted in this NHS England report.’

Association of Ambulance Chief Executives managing director, Martin Flaherty OBE, said:

‘This will require further investment in the training and education of paramedics and other ambulance staff together with a review of the overall capacity of ambulance services. This will ensure that they have the resources needed to resolve the patient’s issue without taking them to hospital.’

The report also suggests that a two-tier A&E system should be introduced. The biggest 40–70 units would be called ‘Major Emergency Centres’ and designated to deal with heart attacks, strokes and other serious injury, while the remaining 70–100 A&Es would be ‘Emergency Centres’ and deal with less serious conditions.

Taken from Journal of Paramedic Practice, published 26 November 2013.