ESTCOLLABORATION | 15 management structure and its evolution into its current 10-service structure has been, in part, driven by increasing efficiencies and gaining cost savings, which have been realised. Demand for ambulance services increase on an annual basis and they are delivered in the context of tight financial constraints.
“There is clearly more work that can be undertaken by both ambulance service and fire and rescue services within the context of efficiency and public satisfaction, however what needs to be achieved is an evidence base to support the change to ensure sustainability into the future.” Clinical context The ambulance service is both an emergency service and a fundamental NHS service provider. Road traffic collisions and life threatening emergency incidents represent a very small proportion of the ambulance service’s workload. Closer working with the fire and rescue service would therefore not be relevant for the majority of calls. The focus is increasingly on urgent care and the development of more appropriate patient pathways, a focus which can only be achieved through close collaboration and partnershipworking with other elements of the NHS. The patient’s NHS journey commonly starts with a 999 call answered by ambulance service Emergency Medical Dispatcher (EMD) operating a sophisticated telephone clinical triage system, which determines the medical priority for the patient and assigns an appropriate response within an appropriate time frame.
Facts & Figures • Overall costs for the English fire and rescue services are in the region of £2.3bn annually compared to £1.6bn for the ambulance sector • The ambulance service deals with over 25,000 calls a day, the fire and rescue service handles circa 1700 calls (2013) • The ambulance service’s utilisation rate is running at circa 60 percent. (Meaning that 60 percent of the available hours worked by an ambulance professional they are actively engaged on dealing with emergency calls).
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England has been an excellent example of close working and cooperation between the fire and rescue services and ambulance services. It has brought the ability for ambulance paramedics to bring definitive care to patients inside contaminated and dangerous areas and has saved many lives since its introduction. HART train in collaboration with fire and rescue services, as they do with other emergency services and agencies, for some parts of their education, and in the main this training has been led by the ambulance service. It is vital to recognise that being part of the NHS facilitates joint training and exercising while encouraging cross-fertilisation of ideas by different NHS clinicians meeting and sharing best practice. Mutual aid arrangements exist between ambulance services and fire and rescue services, both of which were tested in 2013 at a national major incident exercise.
Professional ambulance clinicians are able to ensure the best possible treatment and advice is given to patients, ensuring continuity of care is started and facilitated throughout the NHS system. Fracturing this system by separating out components of it to different providers would undoubtedly lead to a worse service for patients as well as undermine the flexibility of the current system. Ambulance services are responsible for managing the demands placed upon them by the 999 system, general practitioner (GP) admissions and interhospital transfers together with a Patient Transport Service (PTS) component in most trusts. All of these services are backed by public satisfaction surveys, which have always shown that circa 95 percent of the public are very satisfied with ambulance service provision. High level clinical oversight is maintained and Ambulance Foundation Trust Boards are required in statute to have a Medical Director and a Nursing Director to lead on these issues. NARU and HART The recent introduction of a National Ambulance Resilience Unit (NARU) and Hazardous Area Response Teams (HART) capability across
Summary There is clearly more work that can be undertaken by both ambulance service and fire and rescue services within the context of efficiency and public satisfaction, however what needs to be achieved is an evidence base to support the change to ensure sustainability into the future. CFOA and AACE already have strong engagement at a national level to exploring opportunities for increasing the already good work being undertaken in most areas of the country. The ambulance sector supports the need for efficiencies in public sector organisations and is therefore committed to assisting others in realising efficiencies as ambulance services have already. http://aace.org.uk
Emergency Services Times August 2013