A seat at the table
Those we spoke to described their relationship with the STPs they are involved in as positive, but felt more could be done to proactively ensure ambulance trusts have a seat at the table in conversations about service changes they would need to respond to. Becoming embedded in the culture of each STP an ambulance trust is involved in helps them to maintain involvement in critical decisions being made about new care pathways, care models and service reconfigurations.
Ambulance trusts work across the health system, from urgent and emergency care, to patient transport, and have an increasing number of clinical disciplines working within their response models, such as GPs, nurse practitioners, mental health nurses, midwives, palliative care nurses and pharmacists, particularly within their clinical assessment services (CAS), to ensure patients receive the right care when they call 999 or 111. There was a sense among trust leaders we spoke to that while their trust is well regarded in the regional STPs/ICSs, it can take a good deal of work on their part to build the level of understanding of the range of clinical services they deliver, and ensure their presence and visibility within the systems in all the relevant conversations.
We have had good engagement over the past year with four STPs, and we have managed to be more embedded in clinical work streams rather than just focusing on operational performance. This has been a huge positive change. The result of this work is that our medical director is more involved. Getting to this point has been a process of development over the past few years as the STPs have become more developed.
Often, the degree and nature of this engagement depends on the maturity of the STP/ICS, and how far conversations within the STP have progressed around transformation of care – where relationships are good, ambulance trusts find space to be involved in the clinical work taking place. Elsewhere, relationships are still emerging and conversations focus more on operational challenges. Adding to this are financial and capacity pressures which can strain relationships where individual system partners are struggling to balance the demands on their own organisation with the need to collaborate to transform care.
However, in thriving systems leaders are seen as having a more up-to-date understanding of what an ambulance trust brings to a local health economy, which deepens the engagement and offers more effective collaboration – there is headspace to look beyond day-to-day pressures. In some areas it was felt that there had been a recent increase in the engagement of ambulance trusts in STP work due to a focus from the arm’s-length bodies on improving performance against A&E targets. Those STPs/ICSs which recognised the role ambulance trusts play in reducing pressure on acute trusts, when there are more appropriate community pathways in place, so avoiding unnecessary conveyance to A&E, as well as improving patient flow out of the hospital setting, meant there was more space to contribute.
We need to consider very broadly what the role of an ambulance trust is within a system. As a trust, we can think more strategically about urgent and emergency care and this is where the STPs see us as adding value and getting them involved. We want to be involved strategically on IT, digital, workforce and the whole patient pathway.