Health CommitteeSupplementary written evidence from the Association of Ambulance Chief Executives (ES 19A)

It was a pleasure to be able to provide you with my oral evidence at the Health Select Committee of 4 June 2013, and I hope you find the information of help to you and other MPs. As promised, please find attached three pieces of information which Mark Docherty and I agreed to share with the Committee:

Impact of Serious Incident upon conveyance rates of patients to hospital by ambulance crews following media coverage.

Workforce skill mix in Ambulance Services.

Evidence of multiple services working together.

I feel it is really important to also reinforce that the Ambulance Service nationally sees itself as part of the solution to the difficulties currently being experienced within the Urgent Health care system and would very much like to progress some of the good work being undertaken in certain areas across England. However the ability to be able to provide such solutions would be greatly improved with some new innovations to assist progress, for example:

Access to the NHS Information spine to assist Paramedic clinical decision making.

Further advanced training for Paramedics.

Wider access and integration with Out of Hours Services and NHS 111.

The ambulance service is fortunate to be held in such high regard by the general public, and as such this will provide public confidence to the communities we serve with developments as we move forward.

There are already large scale initiatives taking place to drive efficiencies within ambulance services, some of which may be better appreciated when viewed personally.

Anthony C Marsh
Chair, Association of Ambulance Chief Executives

14 June 2013

Annex

IMPACT OF SERIOUS INCIDENT REPORTED BY THE MEDIA (A LONDON EXAMPLE)

28 January 2011 Last updated at 20:06

Ambulance crew suspended over Sarah Mulenga death1

Two London Ambulance Service (LAS) Staff have been suspended following the death of a 21-year-old woman they were sent to treat in east London.

Sarah Mulenga, who suffered from sickle cell anaemia, fell ill at her home in Barking on 9 January.

Her landlady said an ambulance crew refused to take her to hospital and other paramedics had to be called.

Miss Mulenga died after her condition deteriorated.

Conveyance rates prior to incident average at 77%.

Incident happens on 9 January 2011—In the month of the incident, conveyance rates increase to 79.7%.

Conveyance rates peak two months later at 82% (at this point it goes out of the Statistical control limit, so is a significant variation).

After three months, the conveyance rates come back within normal variance.

Evidence of Multiple Services Working Together—Birmingham Mental Health Services

The Birmingham and Solihull Mental Health Foundation Trust Rapid Assessment, Interface and Discharge (RAID) model was the first of its kind in the UK and ensures patients get help for mental and physical health at the same time—delivering all the care that people need, when they need it in Birmingham’s acute hospitals.

The government’s mental health strategy, No Health Without Mental Health, recognises that mental wellbeing is closely linked to physical health—and the need for mental health awareness to be raised in primary care and acute hospital settings.

Recent research and guidance highlights how important it is for acute hospitals to address the needs of patients who self-harm or misuse substances, recognise the impact of conditions like depression and dementia, and those who present as complex cases with both physical and mental illness, which often result in repeat admissions to acute care.

RAID is a great example of how this new strategy works in Birmingham. The RAID team assesses and treats patients aged over 16, who present at A&E or are already inpatients; getting them the help they need, regardless of age, locality, complaint, severity or time of presentation.

The key to RAID’s model is to see everyone referred from A&E within an hour, and all others within 24 hours. This means care for people with mental health problems is initiated early and problems are dealt with swiftly. Staff in the RAID team provide tailored interventions, signposting, follow-up clinic appointments and onward referrals to GPs, and third sector organisations that have been set up to provide on-going help in the community.

Ambulance and hospital staff also receive training on mental health awareness and interventions. This leads to improvements in their practice, in turn improving patient experience, with better detection, diagnosis and therefore earlier treatment.

Now when a patient arrives at the hospital, the RAID team is alerted to provide an assessment prior to admission. The model has shown clear benefits in service delivery, increasing staff and patient satisfaction, rapid response times, delivering high cost savings while improving overall quality.

RAID’s primary aim was to streamline the patient journey. In achieving this, RAID has had a positive effect on traditional winter pressures, by reducing length of stay and the number of readmissions.

The number of older adults seen by RAID, who had come from their own home and returned there, almost doubled with 80% returning home compared to 47% pre-RAID.

The team specialises in working with older people with mental health problems, who are embedded in the acute hospital through RAID, can support other professionals to jointly manage the potential risks of discharge and facilitate rapid access to specialist community support.

The close working relationship between the Ambulance service, staff in A&E, the RAID team and the trust’s community-based teams, ensures the patient’s journey from assessment to treatment is a smooth, straight-forward one.