BRAVE%20NEW%20WORLD%20

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 AE
• 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
• AE focused
• Fragmented services

5
THE SIZE OF THE PROBLEM

• 7 million OOH GP calls
• 5 million 999 (60 to AE)
• 6 million NHSD calls
• 2 million WiC/MIU
• 14 million AE
• 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 AE within 4h (31/3/03)
• 100 (now 98) by 31/12/04
• 75 Cat A lt 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
• Childrens 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
THE EMERGENCY CARE AND URGENT CARE PATHWAY -
FUTURE
PATIENT
AE
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
TOMORROWS AMBULANCE SERVICE

• Co-ordinating role in network
• Close working with GPs, social services, mental
  health services, rapid response teams for CDM,
  AE
• 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!