Under-pressure ambulance services are accelerating transformation

Daren Mochrie profile picture

12 August 2021

Daren Mochrie
Chair
Association of Ambulance Chief Executives


The health and care sector is facing the long term impact of COVID-19 while undergoing a period of significant change to embed system working. The ambulance sector can and must have a key role in pulling through the pandemic, bearing down on the care backlog and transforming services for patients.

The consequences of the pandemic will be with us for a long time. An effective long-term response that meets the needs of patients and the public will rely on system partners, including ambulance services, working collaboratively to share best practice and make the best use of NHS resources. These efforts also need to be underpinned by investment to build on learning from the pandemic and to address historic underfunding.

The ambulance sector's role in ensuring that people are treated in the right place at the right time, and preventing avoidable hospital admissions, is sometimes less well understood than its direct and very visible profile as a 'blue-light' service.

   

The ambulance sector's role in ensuring that people are treated in the right place at the right time, and preventing avoidable hospital admissions, is sometimes less well understood than its direct and very visible profile as a 'blue-light' service. This is shown by a new report from the Association of Ambulance Chief Executives (AACE) and NHS Providers – Rapid response: the role of the ambulance sector in transforming services and coping with the long-term impact of COVID-19. The report sets out how the skills, scale and reach of ambulance services mean they can be key to planning, coordinating and delivering high quality care as close to home as possible: a central ambition of the NHS Long Term Plan.

The report highlights three areas where the ambulance sector is driving initiatives that align with the priorities set out in the long term plan and the task of recovering the care backlog as rapidly as possible across all services: integrated care, innovative workforce models and digital transformation.

With a focus on integrated care, ambulance trusts are working with their system partners to maximise the use of 'hear and treat' and 'see and treat' response models, which have been particularly important during the pandemic in keeping people out of hospital wherever possible. Key to this is the clinical assessment service (CAS) model, which is designed around having a single point of access for urgent and emergency care, through which a patient can then access the appropriate service. This avoids waste and duplication and improves patient flow, leading to a better patient experience.

Examples in the report include South Central Ambulance Service NHS Foundation Trust's use of the app-based support tool, SCAS Connect, and the trust's provider partnership in Hampshire and Surrey Heath, where the public can access a 24/7 multi-disciplinary CAS.

Trusts are also adopting innovative workforce models so that paramedics can develop and learn alongside other types of healthcare professionals and therefore be deployed differently.

   

Trusts are also adopting innovative workforce models so that paramedics can develop and learn alongside other types of healthcare professionals and therefore be deployed differently, leading to a reduction in unnecessary hospital conveyances. This includes work by North West Ambulance Service NHS Trust to develop its team of community specialist paramedics and to extend social prescribing in partnership with primary care networks and other providers. This is particularly helpful for patients who struggle with anxiety, loneliness and a lack of support with daily living.

It's clear that digital transformation has been accelerated by the pandemic, including greater use of video consultation, to enable paramedics to provide care remotely, and 111 First, to ensure seamless clinical handover for patients who need to visit emergency departments (ED). All ambulance trusts providing NHS 111 now have the 111 First option. London Ambulance Service NHS Trust has implemented a 111/999 and Barts Emergency Access Coordination Hub (BEACH) integration programme. This helps to coordinate care for patients who do not require immediate conveyance or referral to an emergency department. As of May 2021, 27% of 111 patient referrals to BEACH were managed without requiring attendance at ED.

These successes have come in the face of extraordinary pressures for the ambulance sector. Although the vaccination programme has helped to reduce the direct impact of COVID-19, urgent and emergency care services as a whole are under enormous strain. For example, in June 2021 category one incidents, requiring an immediate response to a life threatening condition, were up 8.1% on the previous month, and by 27.2% compared to two years ago, before the pandemic.

It should be remembered that ambulance service provision has historically been under-funded, with financial settlements lagging behind ever-increasing activity.

   

It should be remembered that ambulance service provision has historically been under-funded, with financial settlements lagging behind ever-increasing activity. Prior to the pandemic we established  that the ambulance sector needed £250m additional funding to deal with increasing demand. This has had an inevitable negative impact on patient experience and clinical outcomes, as well as the mental health and wellbeing of ambulance service staff.


AACE and NHS Providers are therefore calling for:

  • policy alignment, ensuring the ambulance sector is closely involved in strategic decision-making at national, regional, ICS and place level
  • greater recognition of the ambulance sector’s role as providers of urgent and emergency care, with many patients being treated on-scene or over the phone without the need for onward referral, ensuring people are treated in the right place at the right time.
  • whole system investment to build on learning from the pandemic, to match the ambition set out in the long term plan, and to address historic underfunding.


With the right measures and investment in place, the ambulance sector can play a leading role in transforming services and dealing with the long term legacy of COVID-19. This is a rare opportunity that must not be missed.

This blog was first published by HSJ.

About the author

Daren Mochrie profile picture

Daren Mochrie
Chair

Daren Mochrie took up his role as Association of Ambulance Chief Executives chair in August 2020, having previously served as the chief executive of North West Ambulance Service NHS Trust (NWAS) since May 2019.

Having worked for the NHS since the age of 17 he has extensive experience of managing ambulance services in both rural and urban settings. Daren is a registered paramedic, holds a master's degree in business administration from Napier University, Edinburgh and was one of the first paramedics to gain a diploma in immediate medical care, Royal College of Surgeons, Edinburgh.

In 2013 Queen's Birthday Honours, he was awarded the Queen's Ambulance Medal for distinguished service to the UK NHS Ambulance Service. Prior to joining NWAS, Daren was chief executive of South East Coast Ambulance Service. Previously he had been director of operations for the Scottish Ambulance Service and the lead for ambulance provision in the 2014 Commonwealth Games in Glasgow. Daren has also held the position of specialist advisor with Care Quality Commission (CQC), leading several CQC inspections of ambulance trusts in England.

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