Role of Ambulance in Transforming Urgent & Emergency Care

33 Pages·2017·1.9 MB·English

by  Hilary Pillin

Ambulance Services
Working Collaboratively
with Community Partners
John Black
Medical Director, South Central Ambulance Service FT
on behalf of the Association of Ambulance Chief Executives
October 2017
National picture
2016/17
 10 English NHS Ambulance
Services
 999 calls increased by 21% since
13/14
 11.2 million 999 calls
 Includes 1.46 million transfers
111 > 999
 Led to 6.9 million face-to-face
attendances
 52% conveyed to ED
 38% treated at home &
discharged or referred
 10% telephone advice and/or
referral
 700,000 hours lost waiting to
transfer care in ED
South Central Ambulance Service (SCAS)
Our services An integrated approach
> Enabling people to access right care, first time
Patient
> Saving lives and improving outcomes
Transport
> Supporting people in their own homes
SCAS
NHS111 Emergency
Service 999
Past Future
Ambulance Services have visibility of the whole care system
225 patients taken to hospital
Daily average per million 105 people treated at scene
population
60 calls resolved with telephone
advice
270 999 calls
435 referred to primary care
55 referred to other
550 111 calls on weekdays /nights
services/agencies
(more than double at
weekends)
60 advised to take themselves to
ED
30 GP requests for urgent
8 transported between care
transport
settings
320 journeys to and from
370 bookings for non-emergency outpatients
patient transport
40 taken home after hospital
discharge
With data on demand trends, patient flow,
Based on SCAS 2016-17
pathways, processes and local variation
The Emergency / Urgent Picture
10% Life threatening 90% Urgent care
 Advances in cardiac care,  Mix of acute / chronic, LTCs /
complex and multiple health issues
stroke, major trauma, cardiac
arrest
 Increasing care closer to home
 Alternative destinations –  Alternative destinations - UCCs
Trauma Centres, PPCIs, Stroke
 Ambulance clinicians working
Units
alongside community, primary care,
 Acute service reconfigurations- social care, mental health in MDTs
maternity, paediatrics, surgery
 Advanced and specialist paramedic
roles - expanded clinical decision
 Clinical performance measures
making, advanced clinical
(AQIs)
assessment, diagnostic & treatment
skills
 Public health promotion/prevention
role
Plus, Resilience for major incidents & mass casualties - working with
other emergency services and specialist response agencies
Five Year Forward View & UEC Review
 “Helping patients get the right care, at the right time, in the right
place…” (FYFV)
 “Ambulance services empowered to make more decisions, treating
patients and making referrals in a more flexible way…” (FYFV)
 “Ambulance Services should maintain clinical hubs in their EOCs to
ensure appropriateness and timeliness of responses...staffed by
range of clinicians” (SFB)
 “Ambulance Service & CCGs should develop mobile urgent treatment
service capable of dealing with more people at scene and avoiding
unnecessary journeys to hospital” (SFB)
 “Clinicians working in the 999 system – through ‘H&T’ or ‘S&T’
models - should have unrestricted referral rights to all other
services in the UECN, including social care services, with free flow
of information and feedback” (CMAS)
 “Effective urgent care services will be supported by the immediate
availability of relevant patient information” (CMAS)
 “We cannot deliver the necessary change without investing in our
current and future workforce” (FYFV)
NHS England publications
Health and Social Care Transformation
Emergency 999
As an example, SCAS has a role in 6 STPs
Bedfordshire, Luton and Milton Keynes
Thames Valley
PTS Frimley (part)
Hampshire
Frimley (part) (excl IoW)
NHS111
Surrey
Heartlands
Sussex &
East Surrey
Tendency to overlook Ambulance Services in STPs
Support to
NHS
infrastructur doctors,
e
nurses and
Nurses,
midwives
midwives and
health visitors
Scientific,
therapeutic,
C
M
technical
staff and G Doctors
P
hospital /
support
communit
y
Mobile clinicians / Paramedics
Coordination Centre / support staff
Indicative workforce Tiny but essential cogs in a very big machine
based on FTE in
England
SCAS strategic themes
Care coordination and integrated urgent
care
Mobile care and emergency
responses
Expanded patient transport and
logistics
SCAS as a partner in local care systems
NHS Ambulance Service 2020 & Beyond
www.aace.org.uk