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BRAVE NEW WORLD – WHERE DOES THE AMBULANCE SERVICE FIT IN?

BRAVE NEW WORLD – WHERE DOES THE AMBULANCE SERVICE FIT IN?. KGMM Alberti National Director for Emergency Access “Trolley Dolly”. THE PAST. THE PRESENT. THE FUTURE. EMERGENCY CARE. The Past 1 Major focus on A&E Demand exceeding capacity Long waits Trolleys

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BRAVE NEW WORLD – WHERE DOES THE AMBULANCE SERVICE FIT IN?

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  1. BRAVE NEW WORLD – WHERE DOES THE AMBULANCE SERVICE FIT IN? KGMM Alberti National Director for Emergency Access “Trolley Dolly”

  2. THE PAST THE PRESENT THE FUTURE

  3. EMERGENCY CARE The Past 1 • Major focus on A&E • Demand exceeding capacity • Long waits • Trolleys • Sickest patients seen by most junior doctors • Poor relation

  4. EMERGENCY CARE The Past 2 • Ambulance service • “Scoop and run” • Focus on blue light • Separate from NHS • General practice • Patchy • A&E focused • Fragmented services

  5. THE SIZE OF THE PROBLEM • 7 million OOH GP calls • 5+ million 999 (60% to A&E) • 6 million NHSD calls • 2 million WiC/MIU • 14+ million A&E • 2.5 million Admissions

  6. WHY HAS IT CHANGED? • Unsustainable • Patients and clinical need • NHS Plan 2000 • REC 2001 • Ambulance targets • New GMS • TARGETS

  7. THE TARGETS • 90% in and out of A&E within 4h (31/3/03) • 100% (now 98%) by 31/12/04 • 75% Cat A < 8 mins

  8. WHERE ARE WE NOW? 96.2% A & E 76.4% Cat A

  9. But … there are still problems

  10. CURRENT PROBLEMS • Rising demand • Too much focus on EDs • Beds – use, place, number • Staff – too few • Buildings, gear • Silos, fragmentation

  11. A & E ATTENDANCES All types (millions) 1962 5.0 1992 13.1 2002/03 14.4 2003/04 16.5 2004/05 8.9 (6 months only) NB Interpret with caution

  12. AMBULANCE SERVICE 999 CALLS No Incidents of calls attended (millions) (millions) 2001/02 4.7 3.78 2002/03 4.96 3.99 2003/04 5.34 4.27 (1993/94 2.42 2.41)

  13. STAFF • Too few Paramedics • Too few ECPs • Too few ENPs • Too few AHPs • Too few Radiographers • Too few Consultants

  14. SO WHAT NEXT? Have we got the right targets?

  15. THE STARTING POINT THE PATIENT

  16. WHAT CARE DO PATIENTS WANT - AND NEED? • Convenient • High quality • Rapid • Simple access • Friendly • Choice

  17. KEY FACTORS • ECN SHA-wide • ECN • ECN tasks

  18. EMERGENCY CARE NETWORKS Partners • Ambulance • PCT • Pharmacies • Public/patients • Etc. • Mental health • Acute • OOH • Social Services • Children’s services

  19. EMERGENCY CARE NETWORKS What will make them work? • Commitment by all partners • TEETH

  20. KEY ROLE FOR AMBULANCE SERVICE?

  21. KEY FACTOR The Pathway

  22. Paramedic 999 OOH UCC THE EMERGENCY CARE AND URGENT CARE PATHWAY - FUTURE A&E PATIENT GP NHSD Acute Trusts SIMPLE LOCAL ACCESS RRTs Pharmacy GP Appt Acute Alcohol Team Mental Health Services Emergency Social Services Voluntary Sector

  23. WHO SHOULD PROVIDE THE SIMPLE LOCAL ACCESS? THE NAVIGATOR ROLE • NHSD? • OOH Services? • Ambulance Service? • AN AMALGAM OF ALL 3?

  24. THE WHOLE SYSTEM Components • Home • Community • Urgent Care Centres • Emergency Department • Rest of hospital • Intermediate Care

  25. HOME CARE • CDM Teams • Care of the elderly teams • ECPs • Social services, etc.

  26. COMMUNITY • Care teams • Paramedics/ECPs based in Primary Care Centres (? wider role) • Voluntary Sector, etc.

  27. URGENT CARE CENTRES (1) • WiCs and MIUs • “Minor” injury and illness • ENP/ECP led • GPSI supported • Diagnostics available • 24/7

  28. URGENT CARE CENTRES (2) • Location? • Co-location with OOH/social services • Primary care AND Secondary care skills • Children?? • Mental health?? • Co-location CDM

  29. URGENT CARE CENTRES Problems • Ownership • Numbers • Staffing • Location ALL SOLUBLE

  30. COMMUNITY ROLE FOR THE AMBULANCE SERVICE • First contact practitioners (ECPs)

  31. THE ROLE OF THE FIRST CONTACT PRACTITIONER • Rapid assessment, initial treatment, education • Decision re disposition • Leave at home • Contact other agencies • Take to UCC/GP/hospital

  32. OTHER ROLES FOR ECPs • UCCs • Primary care • A & E

  33. NUMBERS OF ECPs Now 600 + Needed 11,000 !

  34. TOMORROW’S AMBULANCE SERVICE • Co-ordinating role in network • Close working with GPs, social services, mental health services, rapid response teams for CDM, A&E • Rapid transport of patients to acute hospital - but only for those who need it! • Other transport services

  35. PROBLEMS • Attitudes • Habit • Other parts of the service • Training / education • Resources

  36. THE FUTURE Exciting Get on with it!

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