Ambulance leaders release report on the role of the sector in transforming services

The Association of Ambulance Chief Executives (AACE) and NHS Providers have published a new report on the role of the ambulance sector in transforming services, supporting Integrated Care Systems (ICSs), and responding to the challenges of COVID-19.

Titled ‘Rapid Response – The Role of the Ambulance Sector in Transformation Services and Coping with the Long-Term Impact of COVID-19’, the publication covers a number of areas – including integrated care, innovative workforce models, and digital transformation.

In a foreword, Darren Mochrie, Chair of the Association of Ambulance Chief Executives, and Chris Hopson, Chief Executive of NHS Providers, spoke of the need to highlight “the pivotal role ambulance trusts are playing in managing the long-term impact of COVID-19, transforming urgent and emergency care (UEC) services and delivering the NHS long term plan [sic].”

They add that, thanks to the “skills, scale and reach of ambulance services” they are “well placed to play a leading role in the integration of services”, as well as a “key role in helping to recover care backlogs and meet rising demand.”

Despite facing the “the twin challenges of severe workforce and funding pressures”, it’s added, ambulance services have adapted to find solutions through collaboration, changing ways of working, training the workforce, and utilising digital technology – all of which the report aims to showcase via a range of case studies.

The publication highlights three areas of focus – integrated care, innovative workforce models, and digital transformation – before going on to make three requests of the UK Government and national NHS bodies.

NHS Providers and AACE explain that “high rates and lengths of ambulance handover delays” due to increased levels of demand, potential risks to patient safety due to these delays, the impact of the large geographical footprints on response times in rural areas, strain on staff wellbeing, and concern over staffing levels, as the main challenges facing services currently.

The literature also addresses further concerns, such as the “risk that attention is focused on recovery and transformation within acute settings” and that “recovery efforts are focused on elective care while not fully addressing the wider post-COVID impact of delayed treatment and long COVID”. For ambulance providers, it states, recovery will be based around improving patient flow in and out of hospitals, paramedic referral to same day emergency care initiatives, and utilising digital tools to help avoid unnecessary visits to hospital.

On the topic of the role of ambulance services in integrated care, the document cites the clinical assessment service (CAS) model – to help streamline services and avoid duplication of resources – and the role of non-emergency patient transport services (PTS) in supporting elective recovery, to help with patient flow, the backlog, and equity of access, as key.

The case study examples in this section include the South Central Ambulance Service NHS Foundation Trust’s on-scene referrals support tool, which led to 9,422 patients being directly referred to medical or surgical SDEC instead of an emergency department, as well as Yorkshire Ambulance Service NHS Foundation Trust’s regional coordination of non-emergency patient transport services.

In regard to innovative workforce models, the reports says that the pandemic “brought about rapid changes to minimise barriers” for employment of multiple professions, such as nurse practitioners and mental health nurses, across frontline roles.

Approaches such as “reducing bureaucracy related to staff movement between employing organisations and different clinical settings”, “allowing staff to work to the top of their license”, and the “wider implementation of the digital NHS staff passport” to enable staff to begin new posts more quickly and avoid repeated training, are showcased.

However, despite rotational working, the lack of a “long term, fully costed and funded, workforce plan” is cited as a barrier, alongside high vacancy rates and “patchy” mental health provision in some areas. Examples of innovative workforce models include South East Coast Ambulance Service NHS Foundation Trust’s introduction of mental health professionals into its emergency operations centres and London Ambulance Service NHS Trust’s investment in specialist and advanced paramedic practitioners for urgent care.

In the dedicated section on digital transformation, which is described as a “key enabler to service improvement”, better sharing of medical records between ambulance trusts and other organisations, collaboration between ambulance services and secondary care providers to provide remote care, and the roll-out of 111 First, supported by cloud-based digital software, are all highlighted. While specific case studies include Yorkshire Ambulance Service NHS Trust’s seven-day-a-week, 12-hours-a-day frailty response line in Hull and East Riding, and examples of trusts using NHS 111.

Concluding with ‘key asks’ of the government and NHS bodies, the authors call for policy alignment, so that the “voice of the ambulance sector is involved in strategic planning and decision-making at national, regional, ICS and place level”, as well as “greater recognition of the ambulance sector’s role as providers of UEC”. The report also asks for “whole system investment” to build on learning, match the NHS Long Term Plan, and “address historic underfunding” of services. This, it says, should include dedicated mental health funding, a long term, fully costed and funded workforce plan, and a multi-year NHS capital settlement.

To find the full report, including more about the ‘key asks’, the points raised, and the case studies outlined, click here.