From our research, it is clear that ambulance trusts are already engaged in system working in varying degrees, and all are keen to realise the full value of their contribution within STPs/ ICSs. Here we provide a summary of the experience and expertise which ambulance trusts, and their leaders and frontline staff, can bring to system working:
- 'No wrong front door'
Ambulance trusts are often the first port of call for many patients who need support and they sit at the centre of the array of pathways a patient could ultimately follow on their journey through the health and care system, helping to identify the most appropriate one depending on the patient’s needs. This comes with an opportunity to become embedded into the health system, connecting patients with the services best suited to their needs and embodying the 'no wrong front door' philosophy that can ensure a patient reaches the right service regardless of who they see first. - Technical infrastructure and expertise
Ambulance trusts have expressed an interest in wider engagement in STPs not just around clinical pathways, but at the more strategic level on IT, digital transformation and workforce. With a need for integrated patient records and sophisticated communications systems, ambulance trusts are not only pushing the envelope in terms of what they can add to the integration landscape, they are also offering up their technical skills and infrastructure to support other providers with telephony, high-volume call handling, triage skills and multi-disciplinary workforce deployment. - Experience of operating at scale and achieving economies of scale
Ambulance trusts are used to working on a large scale, including rostering and deploying staff across a large area. One of the key challenges around integration is the question of how to scale up small initiatives to achieve efficiencies on a larger scale. With their experience of juggling numerous pathways, and an oversight of place-based practices across their patch, ambulance trusts can bring their expertise and diverse examples of innovative practice to system working. - Knowledge and experience of supporting people close to home
A key focus of integrated care is the ambition to provide patients with the care they need as close to home as possible. Ambulance trusts meet those patients in their communities and homes and, using 'hear and treat' and 'see and treat' models, have a key role to play in keeping people out of hospital wherever possible. - Close local and system-level relationships
Ambulance trusts navigate complex care pathways both at the level of systems, conveying patients across their patch to specialist centres where needed, as well as in neighbourhoods, connecting patients with primary care and community teams, such as local falls clinics, mental health services and social care services. If integration is about building relationships and clear lines of communication, ambulance trusts have much to offer in the way of leading this development.
The development of STPs/ICSs presents some unique challenges for ambulance trusts. However, we were struck by the positivity and energy of the ambulance trust leaders we spoke to who were united in their view of the opportunities at hand.
Moving to place-based decision-making and responding more proactively to communities can only be a good thing, and having empowered ambulance leaders participating directly in this decision-making lends itself to the trust being led by their front line. Patients go where the lights are on, so the ambulance service can be the glue, signposting and joining the dots for them.
Despite some of the challenges, collaborative working is seen as an opportunity by ambulance trusts to improve pathways for patients and shift the balance of care away from hospitals. Where an STP or an ICS achieves full and in-depth engagement with ambulance trusts, they play a valuable role as a 'front door' and an 'integrator', managing flow for the wider health and care system and ensuring patients get the right care in the right place.