A shared understanding
Those we spoke to were positive about the benefits of integration and felt that there was much potential to improve and streamline care. Having a shared understanding of the aims and objectives of integration was felt to be key. Trust leaders cited the importance of system partners understanding what ambulance services do, beyond just traditional emergency 999 services and conveyance to A&E, as well as within specific clinical areas like mental health, frailty and end-of-life care.
Bringing together a set of disparate organisations previously operating on different footprints and working with different subsets of the population carries challenges that can be greatly facilitated by building a shared understanding and getting onto the same page. Each organisation may have different definitions and data sources and trust leaders spoke of the need to align information to ensure clarity of understanding, governance arrangements and management of risk between system partners.
Sharing learning
Trust leaders identified benefits to working across larger footprints. The opportunity to share lessons learned from one system with another could go some way towards addressing the lack of national support identified by STP leaders as inhibiting the process of integrating care. Where system partners are equipped to learn from work taking place in other systems, ambulance trusts involved in the development of new care pathways and service transformation can bring this work to the table in an area that might benefit from a similar approach.
Equally, having a regional oversight of work happening in different systems, often adjacent to each other but working within their individual boundaries, gives ambulance trusts the unique position of being able to see how a change in one system can impact on resources and patients elsewhere, particularly in terms of the change to the way the ambulance trust might have to work more broadly.
We have been getting better at flagging up the impact of changes to the system – for example a decision to change stroke services might make sense at the STP level, but as an ambulance trust we have oversight of the whole system and can see what impact that might have on a whole region, for example where another STP might also be looking to change stroke services. This is a strategic overview that only we can offer.
Adapting to new models
Interviewees cited a willingness to adapt to the needs of the STP as a key success factor in maintaining strong relationships and building resilience to change. Those we spoke to describe the flexible and pragmatic approach they had taken to adapting to the work being done around reorganising to local systems, moulding their financial and resource planning to their needs. Ambulance trusts that hold an NHS 111 contract felt that running this service gave them a head start on successfully embedding themselves in an STP/ICS because it transforms their role from being more than just a player in one part of the journey of certain patients under certain circumstances, to being a service which sits right at the heart of the system, opening doors to the rest of the patient journey. These providers felt that they were well-equipped to offer system-wide support and play a key role in streamlining care for patients.
We have the infrastructure to integrate 999 and 111 with a regional CAS. If they’re run by the same service, we can plan future services and future-proof our current development. Ambulance trusts are about far more than trauma now.
Trusts felt, however, that current commissioning arrangements were a barrier to making the transition into system working. Contributors identified issues around the repeated re-commissioning of 111, which as a service is essential to integration and a significant touchpoint for ambulance trusts when planning for system working. This means that it is harder for ambulance trusts to engage in longer term planning when the threat of losing a 111 contract needs to be taken into account. As integration progresses, trusts are preparing for being commissioned differently in the future and so are putting in place measures to future-proof their place-based management.