CQC outlines priorities for improving monitoring, inspection and regulation of ambulance services

The Care Quality Commission (CQC) has published a signposting document outlining initial thoughts on how it intends to regulate ambulance services in England.

A fresh start for the regulation of ambulance services builds on the new vision and direction set out for the CQC in its strategy for 2013–2016, Raising standards, putting people first, and the changes proposed in the way health and social care services are regulated in the consultation document, A new start.

These changes were developed through engagement with the public, CQC staff, providers and key organisations.
The document sets out the CQC’s priorities on how it monitors, inspects and regulates ambulance services.

It also sets out the conversation the CQC wants to have with all its stakeholders in the ambulance service, including the people who use services, their families and carers, in order that it can develop a new approach which places matters important to patients at its heart.

As part of the new operating model that the CQC will use, it has set out a number of principles that will help guide how the CQC will inspect and regulate all care services. These include: the way the CQC register those that apply to provide services; the standards that those services meet; how the CQC uses data, evidence and information to monitor services; the specialists used to carry out inspections; how the public are given information on judgements about poor care quality, including a rating to help people compare services; and the action to require providers to improve, making sure those responsible for poor care are held accountable.

While these principles will guide the regulation of ambulance services, the detail of how the CQC will do this will be specific to the sector.

Five key questions will be asked of all services, to establish whether patients are receiving the necessary level of care: are they safe? Are they effective? Are they caring? Are they responsive? Are they well-led?

New inspection methodologies for the ambulance sector will begin in July. This will be followed by further inspections from October, to help refine the inspection methodologies and provide a meaningful system of inspections.

Taken from Journal of Paramedic Practice, published 28 April 2014.


UNISON warns stress epidemic threatens breakdown of ambulance service

Trade union UNISON has warned that the ambulance service is on the verge of breaking down as a result of high levels of stress among its staff.

A survey of 1,332 NHS ambulance workers released on 11 April has highlighted tight targets, long hours and the physical demands of the job have led to one in five saying that they have a ‘terrible’ work-life balance.

According to the survey, a third of respondents (34%) have taken time off work due to work-related stress in the past year. While some are looking to leave the profession, there are many who continue to suffer in silence, afraid of the repercussions should they make their voice heard.

It was also revealed that 74% of staff said they suffered from mood swings and irritability, two thirds said they were sleeping too little, and more than half suffered from anxiety.

UNISON Head of Health, Christina McAnea, said:

‘The Government needs to take work-related stress in the ambulance service seriously or it will break down.

‘Our members accept that their jobs can be physically demanding and challenging. However, some now tell us they are suffering from heart palpitations, flashbacks, nightmares, migraines, depression and an overall feeling of despair. As a result, many are actively looking to leave the profession.’

Higher call-out rates, extended waiting times outside A&E departments and the recent change of expected retirement age to 68 have all contributed to the increased anxiety among ambulance staff.

‘Work-related stress is the elephant in the room’ McAnea added. ‘Employers can’t keep on ignoring it. We expect them to do all they can to manage and where possible eliminate the risks to the health and welfare of their workforce.’

Taken from Journal of Paramedic Practice, published 28 April 2014.

Health Education England chair praises WMAS staff developments

Sir Keith Pearson, chair of Health Education England and Jenni Ord, chair for Health Education West Midlands have praised the staff developments that are being undertaken by West Midlands Ambulance Service NHS Foundation Trust (WMAS).

During a visit to the WMAS headquarters on 12 March, the pair received an overview of the educational systems embedded into the Trust, such as paramedic progression and apprenticeships.

Key to the presentations were the way the Trust has invested heavily in helping staff to train to higher levels of education which ultimately allows individuals to deliver better patient care. For example, they heard about the additional skills paramedics have which means many more patients are now cared for within their own homes rather than needing to be taken to hospital as might have happened only five years ago.

The role of WMAS critical care paramedics and their role within the Medical Emergency Response Intervention Team (MERIT) was next on the agenda. MERIT has been noted as a world leading trauma initiative, which sees highly skilled paramedics and trauma doctors being dispatched to some of the most serious incidents within the region.

WMAS Chief Executive, Anthony Marsh said: ‘The visit provided the opportunity to demonstrate how we are strengthening our workforce, particularly with paramedic progression through recruitment as well as providing existing staff development opportunities. This progression will help to ensure we continue to provide patients with high quality services. We are getting ever closer to our aim of having a paramedic on every vehicle which will undoubtedly improve patient care.’

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

Report into London’s NHS demands urgent review of emergency ambulance services

A report into the service provided by the NHS in London has demanded an urgent review of emergency ambulance services, including further investment and greater clarity on pathways of care among its key recommendations.

The People’s Inquiry, commissioned by the Unite union, has said that the present trajectory of financial constraint and fragmentation within the NHS in London, if unchanged could lead to increasing strains on frontline services and commissioning budgets, primary care, mental health and community health sectors.

Malcolm Alexander, chair of the Patients’ Forum for the London Ambulance Service NHS Trust (LAS), spoke of the increasingly long delays in responding to calls from category C1 and C2 patients. This seems to suggest that frontline staffing levels and resources of the ambulance service are not keeping pace with the rise in urgent and emergency calls across London.

The report raised concerns over the lack of transparency over the issue, recommending that there should be an obligation on ambulance control to notify callers well in advance in cases where it is clear that delays are inevitable in the dispatch or arrival of an emergency ambulance, so that they know the situation, and in some cases may be able to make other arrangements.

The report also raised concerns over the misleading rhetoric of pathways of care, which conceals the fact that none of these pathways appears to have been clearly established or are viably operating. A recommendation was made for the clarification of pathways of care to ensure local services are viable and clearly understood by all health professionals involved.

Finally, the re-establishing of a reliable and accessible Patient Transport Service (PTS) is discussed, recommending an appraisal of the costs, benefits and viability of the expanded network of PTS that would be required for LAS to provide reliable services that could enable less mobile patients to travel further for outpatient treatment in the event of hospital organisation.

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

Government rejects proposed 1% NHS pay rise

Around 600,000 NHS staff will receive a lower pay rise than expected following the government’s rejection of proposals to increase staff pay by 1%.

The independent NHS Pay Review Body recommended a 1% rise across all pay scales but ministers have claimed this as an ‘unaffordable’ cost.

Staff eligible for incremental ‘progression pay’ increases on the Agenda for Change framework, which usually average at 3.4%, will not receive a 1% rise on top of this. However, staff due to receive incremental rise of less than 1% will have them lifted to 1%.

Danny Alexander, the chief secretary to the Treasury, said: ‘We need to continue with public sector pay restraint in order to put the nation’s finances back on a sustainable footing.

‘We are delivering on our commitment to a 1% pay rise for all except some of the most senior public sector workers.’

NHS Employers has defended the decision to curb NHS pay. Chief executive, Dean Royles, said:

‘These are really tough calls for the government to make. We know staff have worked incredibly hard in some very challenging circumstances when the NHS has been subject to exceptional scrutiny. For many staff a pay increase would of course help ease some financial pressures and for others a pay award would be a welcome recognition in a difficult year. We know how tough this decision will feel and how disappointed staff will be.

‘The evidence we gave to the review body said any rise would add to already significant cost pressures. Employers are recruiting more front line staff with no additional money and this is not sustainable. The simple fact is that the decision to have no annual pay increase for those already eligible for increments will help ensure more that staff remain in employment than would otherwise be the case.

‘More than two-thirds of NHS spending is on staff and increasing all staff pay by 1% cent would have cost about half a billion pounds, equivalent to around 14,000 nurses. Even with limiting the increase to staff at the top of their pay scales, employers still face a £150 million pay bill pressure this year. This is bound to have an impact.’

Health unions have reacted furiously to the announcement, with Rachel Maskell, head of health at the union Unite, saying that it will ask its members to consider industrial action over the pay award.

She added: ‘[Jeremy Hunt] is deliberately muddying the waters by trying to imply that the annual increment that staff receive, as they gain more skills to benefit patients throughout their careers, is part of the annual pay increase—it is not. It is despicable that Hunt has adopted such an underhand tactic.

‘The [pay review body’s] role is defunct, if ministers continue to steam roller its copious evidence gathering process which leads to its considered recommendations on pay.

‘Hunt has created a parallel pay universe where 2,400 top NHS bosses are earning more than David Cameron—this is a gravy train for the elite, while nurses, health visitors, paramedics and speech and language therapists are treated with contempt.’

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

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.

South Central Ambulance Service HART celebrates its 3rd anniversary

The South Central Ambulance Service NHS Foundation Trust (SCAS) Hazardous Area Response Team (HART) is celebrating its third year of operation.

The HART has attended over 680 incidents since 1 April 2013, while continuing to train and strengthen its staff.

HARTs are groups of paramedics and technicians who have been trained to deal with a wider range of possible scenarios than normal. The programme was started to allow ambulance workers to perform their duties in ‘hot zones’ (areas where danger is still present, e.g. a building collapse or a natural disaster) and bring patients into safe areas where they can be more effectively treated.

John Dyer, head of resilience and specialist operations at the SCAS HART, said:

‘Taking care to patients, wherever they might be is very important. SCAS HART have proved that a close knit team working in partnership with other emergency services can ensure high quality care is given to patients as soon as possible.’

Taken from Journal of Paramedic Practice, published 17 February 2014.