Examination of Witnesses (Questions 480-499)
DR SALLY
PIDD, MR
ROB DARRACOTT
AND MR
BILL O'NEILL
15 JUNE 2006
Q480 Charlotte Atkins: It always
amazes me that within the Ambulance Service nationally there is
loads of innovation going on in particular areas and it is not
taken up by other ambulance services. What is the overall rating
of your ambulance trust in terms of stars?
Mr O'Neill: Two.
Q481 Charlotte Atkins: You are hoping
that these ECPs will help increase your overall performance.
Mr O'Neill: Yes.
Q482 Charlotte Atkins: Can you tell
me, at this stage, what sort of percentage of emergency admissions
your ECPs are enabling you not to take to hospital?
Mr O'Neill: Of the calls that
they attend, the non-conveyance rate is about 50% as opposed to
about 25% for a traditional ambulance response.
Q483 Charlotte Atkins: Michael was
asking earlier about funding, so presumably there would be an
overall saving to the Health Service because you are not taking
them to hospital because it would cost you much more per patient
to do that. Presumably that is where some of the savings will
come to develop this particular role.
Mr O'Neill: I believe it costs
about half of what it costs for a patient to go through the Emergency
Department; the range is between £24 and £29 per patient
visit by an ECP as opposed to around £55.
Q484 Charlotte Atkins: £55 seems
a bit low to me.
Mr O'Neill: Those are the figures
I have seen in the research.
Q485 Charlotte Atkins: You say in
your evidence that ambulance staff do not have medical advice
routinely available, but in some ambulance trusts they do have
medical advice routinely available, do they not?
Mr O'Neill: There are varying
forms of advice. I think every operational ambulance person would
be able to pick up a phone or radio and get medical advice. We
have someone on duty 24 hours a day who is able to pick up on
the kind of calls that crews call in and say "I need help
with this."
Q486 Charlotte Atkins: Do you have
a team centrally to which your ambulance crews can ring who are
experienced in the whole area of emergency service? They ring
in and will get the advice so there is routine medical advice
available?
Mr O'Neill: It is not used routinely
but used for those situations where the crews feel themselves
stumped and do not know how to proceed.
Q487 Charlotte Atkins: You do not
use a Telemedicine system?
Mr O'Neill: No.
Q488 Charlotte Atkins: I know some
ambulance services do use that and are able to get from the patient
the status of the patient and feed that straight back to the medical
team, so they work on that very effectively. I am surprised, given
the challenges faced by the London Ambulance Service, that that
is not routinely done in London.
Mr O'Neill: It is done for certain
conditions. For example, the new policy we have for direct admission
into cath labs for people who have confirmed heart attacks, there
is that back and forth communication going on, but for the majority
of calls, unless the crew make a decision that this is something
they need advice on, then it is not done routinely.
Q489 Charlotte Atkins: You do not
use the technology available to give information to the medical
team back at base?
Mr O'Neill: The medical team as
such is going to be one person who is an on-call medical adviser.
Q490 Charlotte Atkins: We have already
spoken about the 25% decrease in the number of people taken to
hospital, but in the meantime A&E departments are having increasing
numbers of patients going to A&E. What do you think the potential
is for this particular development to reduce A&E admissions?
Mr O'Neill: The target for our
service is to reduce the number of patients we take to A&E
by 200,000 per year within the next five years.
Q491 Charlotte Atkins: What percentage
is that of your present admissions?
Mr O'Neill: About a quarter.
Q492 Charlotte Atkins: What plans
do you have, given we have had the review of the Ambulance Service,
to learn from other innovative practices in other services?
Mr O'Neill: Now that we have got
fewer services with the amalgamation of ambulance services across
the country, that should be easier to achieve. It would be fair
to say traditionally it has been very difficult to share practice
among ambulance services. That has increased with the publication,
several years ago, of the new joint Royal Colleges' Ambulance
Liaison Committee Practice Guidelines. We saw people coming together
from ambulance services, more so than we saw before, to share
good practice and set a national standard. We have started to
do that a great deal more than we did 10 or 15 years ago and I
can see it continuing to do that.
Q493 Charlotte Atkins: I am quite
surprised by that response because you had this star rating system,
which presumably is in place to ensure that excellence is recorded
and presumably learnt from. At the moment, apart from that Committee
you are talking about, there is no way of improving on the performance
which exists in individual ambulance services.
Mr O'Neill: I think the Ambulance
Service Association is a means by which we do share some other
good practice, and certainly in terms of what we are looking at
around skill mix and what the shape of the workforce needs to
look like in the future, that kind of area is something we do
quite well. In terms of ambulance education, we have improved
a great deal in terms of sharing the way we do things amongst
ambulance services. In the past there were enormous differences
between what we do in London and what other services did, even
just around the length of the training courses. That has improved
a great deal so despite my focusing on the development of the
practice guidelines there are other areas that we have shared
good practice.
Q494 Jim Dowd: You said that with
ECPs, what you described as the non-conveyance rate went up from
25% to 50%. The savings thus indicated do not go to the LAS, do
they?
Mr O'Neill: No, not necessarily.
Q495 Jim Dowd: In fact, it might
cost you more to have that rate.
Mr O'Neill: In some respects yes,
and in some respects no. As far as it will cost us more to train
these advanced practitioners, but then we are only sending one
person as opposed to sending a double-crewed ambulance. At the
moment we are unable to say.
Q496 Jim Dowd: I readily accept it
is far better in terms of service, and far better for the tax
payer who pays the bills for all of them, but within the labyrinthian
complexities of the NHS finances you also have this target of
200,000 over five years. Was that self-imposed or was that agreed
with the acute trusts?
Mr O'Neill: It was self-imposed
to an extent in so far as it was based on us looking at outcomes
for patients who we take to A&E and being able to safely judge
that those patients could have actually got definitive care or
been as safely left at home rather than being taken to A&E.
It is based on the actual outcomes of our patients.
Q497 Jim Dowd: To follow up Charlotte's
point about why the increased non-conveyance rate has not reduced
attendances at A&E, I realise you are only speaking for London
but can you give us an indication normally what proportion of
A&E attendees are brought by ambulance?
Mr O'Neill: I do not know.
Q498 Dr Taylor: I am a bit confused
about the training of ECPs. You start with paramedics and then
you give them extra training. Is this standardised throughout
the country or does it vary from ambulance service to ambulance
service?
Mr O'Neill: It varies, in some
cases hugely.
Q499 Dr Taylor: Certainly that is
the impression. You said this was a three-year training.
Mr O'Neill: Two-year university
based training.
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