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 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.