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

BRAVE NEW WORLD –

WHERE DOES THE

AMBULANCE SERVICE FIT IN?

KGMM AlbertiNational 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» Sickest patients seen by

most junior doctors» Poor relation

EMERGENCY CAREThe Past 2•Ambulance service

» “Scoop and run”» Focus on blue light» Separate from NHS

•General practice» Patchy» A&E focused

•Fragmented services

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

WHY HAS IT CHANGED?

•Unsustainable

•Patients and clinical need

•NHS Plan 2000

•REC 2001

•Ambulance targets

•New GMS

•TARGETS

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

WHERE ARE WE NOW?

96.2% A & E

76.4% Cat A

But …there are still

problems

CURRENT PROBLEMS

•Rising demand

•Too much focus on EDs

•Beds – use, place, number

•Staff – too few

•Buildings, gear

•Silos, fragmentation

A & E ATTENDANCES All types (millions)

1962 5.01992 13.12002/03 14.42003/04 16.52004/05 8.9 (6 months only)

NB Interpret with caution

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)

STAFF

•Too few Paramedics

•Too few ECPs

•Too few ENPs

•Too few AHPs

•Too few Radiographers

•Too few Consultants

SO WHAT NEXT?

Have we got the

right targets?

THE STARTING POINT

THE PATIENT

WHAT CARE DO PATIENTS WANT - AND NEED?

•Convenient

•High quality

•Rapid

•Simple access

•Friendly

•Choice

KEY FACTORS

•ECN SHA-wide

•ECN

•ECN tasks

EMERGENCY CARE NETWORKS

Partners

• Mental health

• Acute

• OOH

• Social Services

• Children’s

services

• Ambulance

• PCT

• Pharmacies

• Public/patients

• Etc.

EMERGENCY CARE NETWORKS

What will make them work?

»Commitment by all partners

»TEETH

KEY ROLE FOR

AMBULANCE

SERVICE?

KEY FACTOR

The Pathway

THE EMERGENCY CARE AND URGENT CARE PATHWAY - FUTURE

PATIENTA&E GP

SIMPLE LOCAL

ACCESS

Acute Alcohol Team

Voluntary

Sector

Mental Health Service

s

Emergency Social

Services

NHSD

OOH

UCC

Pharmacy

GP Appt

RRTs

Acute Trust

s

Paramedic

999

WHO SHOULD PROVIDE THE SIMPLE LOCAL ACCESS? THE NAVIGATOR

ROLE

•NHSD?

•OOH Services?

•Ambulance Service?

•AN AMALGAM OF ALL 3?

THE WHOLE SYSTEM

Components» Home» Community» Urgent Care Centres» Emergency

Department» Rest of hospital» Intermediate Care

HOME CARE

•CDM Teams

•Care of the elderly teams

•ECPs

•Social services, etc.

COMMUNITY

•Care teams

•Paramedics/ECPs based in Primary Care Centres (? wider role)

•Voluntary Sector, etc.

URGENT CARE CENTRES (1)

•WiCs and MIUs

•“Minor” injury and illness

•ENP/ECP led

•GPSI supported

•Diagnostics available

•24/7

URGENT CARE CENTRES (2)

•Location?•Co-location with

OOH/social services•Primary care AND

Secondary care skills•Children??•Mental health??•Co-location CDM

URGENT CARE CENTRES

Problems

» Ownership

» Numbers

» Staffing

» Location

ALL SOLUBLE

COMMUNITY ROLE FOR

THE AMBULANCE SERVICE

•First contact practitioners (ECPs)

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

OTHER ROLES FOR ECPs

•UCCs

•Primary care

•A & E

NUMBERS OF ECPs

Now 600 +

Needed 11,000 !

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

PROBLEMS

•Attitudes

•Habit

•Other parts of the service

•Training / education

•Resources

THE FUTURE

Exciting

Get on with it!