Evidence submitted by the London Ambulance
Service NHS Trust (WP 85)
Taking Health Care the Patient: Transforming
NHS Ambulance Services, published by the Department of Health
in June 2005, outlined a vision of where NHS ambulance services
should be within the next five years:
— Providing significantly more clinical
advice to callers and work in a more integrated way with partner
organisations;
— Providing and coordinating an increasing
range of mobile healthcare services for patients who need urgent
care;
— Continuing to improve the quality
of services to patients with emergency care needs;
— Providing an increasing range of
other services in primary care, diagnostics and healthcare promotion.
This has huge implications for the ambulance
service workforce and in order to achieve this vision, a new approach
is needed to how we assess, treat, transport and refer patients.
Education and development needs to be designed more closely around
the needs of the 800,000 patients attended each year by the London
Ambulance Service. We have already started this by redesigning
all our training courses.
Safe assessment and where possible diagnosis
is vital given the need not only to decide what is wrong with
the patient but also to decide where the patient should receive
their definitive health care. Ambulance staff work unsupervised
and do not have medical advice routinely available, so the provision
of underpinning medical knowledge is vital to enhance clinical
decision making in the pre hospital environment. If this is done,
it will over time, improve patients care, job satisfaction for
staff and reduce costs to the NHS. This is particularly the case
if we are to achieve our aim of transporting up to 200,000 fewer
patients each year to A&E departments in London in five years
time.
A great start has been made, the London Ambulance
Service has a number of highly trained Emergency Care Practitioners
(ECPs). These staff, working in the community are providing primary
care alongside (and in some cases instead of) GPs and other health
professionals. A high percentage of the patients they attend do
not require transport to hospital and can be successfully treated
in the home.
The ambulance workforce, in contrast to medicine,
nursing and other Allied Health Professionals has not been designed
within a formal external education framework. However over the
past few years, we have, working with Higher Education Institutions,
developed new qualifications for ambulance clinicians that are
fit for purpose and regulation in the 21st Century.
We are working towards developing a much more
sophisticated, integrated and forward thinking approach to workforce
planning. As the range of responses to patients widens, skill
mix and workforce diversity needs planning for. Traditionally
we have had difficulties in attracting staff from ethnic minorities
to work in the ambulance service. We have to make the jobs more
attractive in local communities and show that the ambulance service
offers excellent career opportunities.
Although much of the work undertaken by ambulance
staff is urgent care (not requiring an immediate response), a
critical part of the work is the 24/7, emergency 999 service which
deals with life threatening and serious conditions. Although this
represents only a small percentage of calls in terms of volume,
these are also potentially catastrophic for patients, their families
and their community. As the vision states, we must continue to
improve the quality of services to patients with emergency care
needs.
Over the next few years we have a unique opportunity
to really create an ambulance service workforce that has the right
skills and knowledge to have major impact on patient care, job
satisfaction and the wider NHS in London. We look forward to working
with the new London Strategic Health Authority in making this
vision a reality.
Peter Bradley CBE
Chief Executive Officer, London Ambulance Service
NHS Trust
May 2006
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