Factsheet - NHS Confed
factsheetJune 2010Seeing ambulance servicesin a different lightMore than a patient transport serviceKey points NHS ambulance services facesome of the most demandingperformance targets in the world. Ambulance services answerapproximately 7.5 million callsper year, 6 million of whichreceive an emergency response. 999 calls are increasing by 6.5per cent every year. This equatesto about 300,000 extra calls andan additional cost of 60 millioneach year. Ambulance services are taking awide range of steps to managethis increasing demand. This ishelping to ensure more patientsget the right care from the rightservice at the right time and tobring about efficiency savingsthroughout the NHS.NHS ambulance services are seeingmore people, faster, and offeringbetter quality care than ever before.1. Helping patientsto access the mostappropriate NHS servicesIt is understandable that ambulanceservices are known for how quicklythey respond to emergency calls.At present they are required toreach more than 75 per cent ofimmediately life-threatenedpatients within eight minutes andthey are constantly striving toimprove their service further.Patients find the current systemfor accessing NHS servicesconfusing and frustrating. Manydo not know when to see or how toaccess their GP, phone NHS Direct,access out-of-hours services, go toa walk-in centre or dial 999.However, ambulance services areso much more than a transportservice that simply takes patientsfrom A to B. They have moved froma service that transports patientsfor treatment to one that now bringshigh-quality care to the patient.Ambulance services play a vitalrole in ensuring patients are caredfor in the most appropriate setting,preventing accidents, promotingpublic health and working inpartnership to make NHS servicesmore efficient.This factsheet illustrates siximportant roles ambulance servicesplay and how they are helping toensure patients receive better care.Many people therefore dial 999 fornon-emergencies because they knowthat they will receive advice or aresponse. At present, this is leadingto some patients not receiving themost appropriate response and isplacing huge demands on ambulanceservices and A&E departments.Ambulance services want to workwith the rest of the NHS to helpavoid these problems. The startingpoint for achieving this change isto put in place a robust directory ofservices that ambulance servicescan access and use to referpatients to the most appropriatehealthcare professional.Ambulance services thereforesupport a new NHS-owned clinicalassessment tool called NHS
factsheet Seeing ambulance services in a different lightPathways that helps call handlersconsistently and appropriatelyassess 999 calls as well as thosefor GP out-of-hours and otherurgent care calls.The Ambulance Service Network(ASN) has also called for a singleurgent care number which willhelp people access care fornon-emergencies andthereby reduce the number ofinappropriate 999 calls. Thisis being piloted in 2010 andambulance services are takingthe lead in ensuring that it isimplemented efficiently.Case study: NHS PathwaysNHS Pathways provides a morein-depth clinical assessment ofnon-emergency cases and thenrefers the caller to the right healthprofessional who can best treatthem. This frees ambulances forlife-threatening cases and ensuresthat patients get the right care.North East Ambulance ServiceNHS Trust has been using NHSPathways to assess urgent callssince October 2009. The singlepoint of telephone access initiativein County Durham & Darlingtonbuilds upon five years of hardwork in developing the systemfrom which the 111 number will bepiloted in July 2010. This will makeit easier for patients to accessurgent care services provided bylocal NHS and independentorganisations.A survey of patients in the NorthEast who dialled 999 but did notneed an ambulance found that93 per cent were happy with theresponse they received.022. Taking care to thepatient, not always takingthe patient to hospitalAt present, about 70 per cent ofpatients treated by the ambulanceservice are taken to hospital.Further reducing the number ofinappropriate ambulance call-outsand A&E visits can play animportant part in improving care,particularly for elderly peoplewho have had a fall and for peoplewith dementia.Considering it costs approximately 200 to send an ambulance tosomeone who calls 999, and thetotal cost to the NHS is far greaterif patients are then taken to A&E,reducing the number of inappropriateconveyances to hospital can alsobring about significant cost savingsfor the NHS.Ambulance services are thereforeworking hard to ensure that fewerpatients need to be taken to A&E andmore patients are treated in theirown home.Of course, there are still manycases when ambulance servicesneed to take patients away fromtheir home for treatment, but evenin these cases ambulance servicesare working to ensure that patientsare taken to the most appropriatesetting – not necessarily to A&E.Case study: Treating patients in their own homeWhen South East Coast Ambulance Service NHS Trust is called to an elderlyperson who has fallen at home, rather than taking the patient to hospital thecrew at the scene often contact a paramedic practitioner, such as Andy Collen.On Andy’s arrival he finishes the work done by his crew, checking thecause of the fall, injecting a local anaesthetic, applying stitches andensuring that the patient has both some pain killers and advice cards.Andy then visits the patient’s GP surgery, providing them with a copy ofthe patient clinical record, and books a follow-up appointment with thedistrict nurse to remove the stitches.Not only does this service deliver better care for patients, it also greatlyreduces costs for the local NHS.Local statistics show that paramedic practitioners convey just 58 per centof patients to hospitals, compared with 70 per cent for other paramedics.It is estimated that reducing conveyance to hospitals in the south eastby just 1 per cent would save at least 400,000 per annum for the localhealth economy. It is therefore clear that paramedic practitioners have animportant role to play in making NHS services much more efficient.South East Coast Ambulance Service has developed the paramedicpractitioner programme with higher education institutes, and the servicehas been commissioned by four out of eight primary care trusts in thelocal area, with others due to support the service moving forwards.
factsheet Seeing ambulance services in a different lightCase study: Improving emergency care for dementia patientsDementia patients are sometimes taken to hospital when local care homes do not have the capacity to make aproper assessment. This can happen even at times when the patient does not have urgent or emergency needsthat are unrelated to their dementia.Great Western Ambulance Service NHS Trust is taking the lead in looking at how ambulance services can play arole in providing a much more sophisticated response to dementia.Clinical Development Manager Vicky O’Leary has developed a national strategy for ambulance services based onher own experiences of dealing with dementia patients. This strategy helps raise awareness of symptoms andspecific medications and advice for communicating with patients who have the condition. Importantly, it alsoinvolves developing alternative ways of providing care that will stop a patient with dementia from automaticallybeing transported to hospital unless they need emergency care.Case study: Treating heart attack patients in the most appropriate settingLondon Ambulance Service NHS Trust was the first in the UK to train its entire staff in the acquisition andinterpretation of 12-lead ECGs. This means that they can diagnose a myocardial infarction (MI or heart attack).Now all patients with serious heart attacks are taken directly to the few specialist centres that are able to provideemergency treatments, such as angioplasty, 24 hours a day.As a result, only 4 per cent of London Ambulance Service’s patients in 2008–09 did not survive their heartattack. This compares with a normally reported death rate of 12 per cent for patients treated with the previousgold-standard intervention of thrombolysis.3. Promoting publichealthAmbulance services have theskills and expertise to educatedifferent groups of people withinsociety about their health.Public health initiatives deliveredby ambulance trusts include theprovision of first aid training tolocal industry and campaigns thatraise awareness of the symptomsof serious illnesses.Case study: Raising awareness of the signs of strokeIn April 2009, South Western Ambulance Service NHS Trust worked with theStroke Association to pilot the ‘Know Your Blood Pressure’ campaign.The campaign aimed to find people who have high blood pressure (thesingle biggest risk factor for experiencing a stroke) and atrial fibrillation(a disturbance in a person’s heart rhythm that increases the risk of stroke).It also aimed to teach people about the FAST (Face, Arm, Speech, Time tocall 999), a simple examination to help anyone recognise the symptoms ofa stroke.A total of 25 events were held in supermarkets throughout the South West,with almost 2,000 members of the public being screened and taught theFAST test during a single Saturday.Since then, ambulance services throughout the country came together toensure the national event in April 2010 reaches as many people as possible.03
factsheet Seeing ambulance services in a different light4. PreventingaccidentsAmbulance services have shownthat prevention strategies canbe very effective in helping peopleavoid accidents and reducingthe number of 999 calls. Inparticular, joint working acrosstraditional boundaries hasshown dramatic results inreducing the number of fallssuffered by older people.Case study: Reducing hospital admissions for fallsFalls are a leading reason for people to call for an ambulance, accounting for 8–10 per cent of all 999 calls. Olderpeople are most at risk, with 30 per cent of people aged over 65 years likely to fall each year.In 2006, North East Ambulance Service NHS Trust introduced a screening questionnaire for all ambulance crewsto use when an older person calls after having a fall.Any individual with two or more risk factors for future falls identified by the tool is offered referral for fallsassessment and their GP informed by letter of the referral. Patients with a history of loss of consciousness areassessed at a specialist unit, whereas those with less complex falls are taken to the day hospital services providedin Newcastle. Those with recurrent falls are supplied with telecare and a fall alarm.Since implementation, the number of 999 ambulance calls for falls in Newcastle has fallen from 200 per month to 20per month. In total, the trust has referred more than 600 patients to falls services in Newcastle since December 2006.The scheme has required minimal costs to implement and has resulted in fewer patients being admitted to A&Eby ambulance after a fall. The effectiveness of this scheme has been enhanced by integrated services and strong localpartnership working with the NHS and other organisations.5. Safeguarding vulnerablechildren and adultsAll vulnerable children and adultshave the right to be protectedfrom harm, and NHS organisationshave a responsibility to report anyincident where there are groundsto suggest that a vulnerable adultor child is at risk of suffering abuse.This is particularly relevant forambulance services, who, morethan any other NHS service, are onthe front line and in people’s homes.Ambulance services throughoutEngland have therefore developedprocesses to ensure that the rightagencies receive the right referraland that all information is treatedconfidentially and sensitively.04Case study: Protecting vulnerable children and adultsWest Midlands Ambulance Service NHS Trust introduced a single point ofcontact for safeguarding referrals in July 2009, which is staffed by trainedpersonnel in the expertise of safeguarding and protecting the public.All West Midlands Ambulance Service staff carry a keyring with the 24hour number. They can therefore easily ring the dedicated line with anysafeguarding concern that they have and are taken through an auditedand approved set of questions aimed at receiving all relevant informationthat partner agencies such as social services departments will need.The initial results are very positive, with a consistent increase in thenumber or referrals month on month.In one recent example, an ambulance crew called the dedicated numberafter they were called to confirm the death of an elderly woman and areferral was made to social services. During the investigation it came tolight that staff at the home did not meet the minimum standard requiredfor first aid training and it also highlighted that the home did not havean end of life policy. Social services and the PCT are now working with thehome to improve standards and prevent this happening to other residents.
factsheet Seeing ambulance services in a different light6. Working with the localcommunityCase study: working in partnership to benefit communitiesIn rural and remote areas it isoften a challenge for ambulanceservices to respond quickly topatients who are experiencing alife-threatening emergency.North West Ambulance Service NHS Trust (NWAS) runs a number of publichealth activities throughout the year jointly with its partners, particularlyemergency service colleagues the fire service and the police.In Greater Manchester, NWAS works with the police, fire, local authorityand other public sector partners to deliver Crucial Crew, an initiativetargeted at primary school children to teach them about accidentprevention and equip them with basic first aid skills.Ambulance services therefore getinto the heart of rural communitiesand engage local people toprovide their own communityfirst responders.The police and NWAS also work together in Lancashire to deliver Be Sharp,visiting local primary and secondary schools and giving presentations toeducate children on the dangers of carrying and using knives.Community first responders aretrained to attend a wide rangeof emergency calls in their localneighbourhoods and can provideessential life saving treatment likeCPR and defibrillation whilst anambulance is en route.Ambulance services also workwith a wide range of organisations,including the other emergencyservices, to deliver public healthinitiatives. These help local peopleto avoid emergency incidents aswell as ensure good relationshipswith other local organisations.In Cheshire, emergency services and NHS partners have developed DriveSurvive, a public health initiative that educates young people (16–24 year-olds)on the dangers of driving at excessive speed or under the influence of drink.Your Choice has been launched in Merseyside, where NWAS works inpartnership with MerseyTravel, public sector and emergency colleagues toeducate young people about the effects of anti-social behaviour.In Cumbria, NWAS works in partnership with voluntary and healthpartners on a campaign called Point Taken, an initiative which providesrural communities with a means to check and be reassured that theirproperty can be located on the computer and mapping systems within theemergency control centre.These are just a selection of campaigns that have been run by NWAS toreduce emergency incidents in the region and ensure that ambulanceservices have a good working relationship with other local organisations.Case study: Community first respondersSouth Central Ambulance Service NHS Trust works with a wide range of community first responders; there areover 250 volunteers in Oxfordshire alone.In one recent example, quick-thinking community first responder Ali Smith was first on the scene to a 65 year-oldmale in Stadhampton, Oxfordshire who was in respiratory and cardiac arrest.During the short time it took an ambulance to arrive at the scene, Ali provided emergency treatment to the patientby establishing an airway, using defibrillator pads to deploy a shock to the patient and administering CPR.Ali’s intervention ensured that the patient was still alive when the ambulance reached him and improved hischances of survival. The patient has since made an excellent recovery.05
factsheet Seeing ambulance services in a different lightConclusion: More than atransport serviceThese are just a few examplesof how ambulance trusts ensurethat patients are cared for in themost appropriate setting, preventaccidents, promote public healthand contribute to an efficient NHS.Across the country there are manyother local examples of new ways todeliver urgent and emergency carewith ambulance trusts at their heart.We hope that these help to showambulance services in a differentlight, as more than a patienttransport service.Contact usFor more information about ambulance services and the work of thenetwork, visit the ASN web pages, email ASN@nhsconfed.org, or phoneDavid Buckle on 020 7074 3219The Ambulance Sevice Network (ASN)The Ambulance Service Network (ASN) was established as part of the NHSConfederation to enable the ambulance service to work more closely withother parts of the health service, while retaining a strong, independentvoice for NHS and public ambulance services in the UK.The ASN has 17 members. These include the 11 ambulance trusts inEngland; those from Northern Ireland and Wales; and the ambulanceservices of Guernsey, Jersey, Isle of Man, and the Isle of Wight.The NHS Confederation is the only independent membership body for thefull range of organisations that make up today’s NHS.Further copies or alternative formats can be requested from:Tel 0870 444 5841 Email publications@nhsconfed.orgor visit www.nhsconfed.org/publications The NHS Confederation 2010. The use of this publication is covered by theconditions of Creative Commons Attribution-Non-Commercial-No Derivative WorksLicense: u may copy or distribute this work, but you must give the author credit, you may not useit for commercial purposes, and you may not alter, transform or build upon this work.Registered Charity no: 1090329INF23101The NHS Confederation29 Bressenden Place London SW1E 5DDTel 020 7074 3200 Fax 0844 774 4319Email enquiries@nhsconfed.orgwww.nhsconfed.org
assessment tool called NHS Seeing ambulance services in a different light More than a patient transport service Key points NHS ambulance services face some of the most demanding performance targets in the world. Ambulance services answer approximately 7.5 million calls per year, 6 million of which receive an emergency response.
NHS services September 2019 About this factsheet This factsheet contains information about NHS ‘primary care’ services – services you approach in a non-emergency situation when you first have a health problem. It looks at services to help you identify: if you need to see a GP services provided by
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