Transforming Nhs Ambulance Services

The Department of Health has until recently been focusing on speed of response as a measure of performance of the ambulance service, rather than on clinical outcomes for patients. The ambulance service achieves high levels of public satisfaction but there are wide variations in ambulance trusts' efficiency and the NAO concludes that the system has not delivered the best value for money to date. The 8-minute response target, intended for the most seriously ill patients, is one of the most demanding in the world. However, its application has skewed ambulance trusts' approach to performance measurement and management. The target is also applied to a much wider group of patients than intended. The report identifies various inefficiencies in the system, with cost per incident varying between £176 and £251. There is scope across the urgent and emergency care system to make more of different ways of responding to patients, such as clinical advice to callers over the phone and taking patients to minor injuries units rather than A&E departments. If all 11 trusts adopted the best practice currently being used in at least one trust, the NHS could save £165 million a year. The elements of the emergency care system are not yet fully integrated and this leads to delays in turnaround times at hospital A&Es. Over one-fifth of patient handovers take longer than the recommended 15 minutes. The new clinical quality indicators introduced from April offer the potential for a fuller measurement of performance based on outcomes.

In 2009-10 the eleven regional ambulance services in England handled 7.9 million emergency calls and spent 1.5 billion pounds on urgent and emergency services. They are expected to make 4 percent efficiency savings year on year in a time when public demand for services continues to rise. Performance was measured against three response time targets until 1 April 2011, but the incentive to meet these targets has led to some inefficiency, such as when more than one team is sent to incidents. The Committee welcomes the decision to introduce a wider suite of health quality indicators to create a broader performance regime in which response times remain one indicator. There is wide variation in the cost of responding to an incident across the services, and there is a need for more consistent performance data in order to benchmark and share best practice. Under the NHS reforms there is vagueness around who will be responsible for what: who commissions ambulance services; who is responsible for improving efficiency in ambulance services or who will intervene if a service has financial trouble or seriously under performs? There is need for greater clarity on the roles and responsibilities of the Department, commissioners and ambulance trusts with appropriate structures for accountability. Other parts of the Health service affect ambulance services and a more integrated emergency care system is needed to ensure that ambulances are utilised in the most efficient manner. Levels of collaboration between ambulance, fire and police services could be strengthened.

Critical Perspectives on the Management and Organization of Emergency Services makes an important contribution to the subject of emergency services management and to public administration and organization studies more generally. It critically assesses developments in emergency services management by examining the multi-dimensional nature of the provision of emergency services and their connectedness in advanced western democracies. The effective management of emergency services has never been more important than in today’s high-pressured and cost-conscious public sector. The authors of this volume forensically analyse the challenges of delivering emergency services within this context. This book provides an in-depth, scholarly and comprehensive analysis of the changing landscape of emergency service provision and clearly addresses a gap in the market for a critical volume on the emergency services. For anyone seeking to understand why and how the management of emergency services matters, this collection is essential reading.

This volume provides fresh insights and management understanding of the changing role of the ambulance services against the backdrop of massive cuts in health budgets around the world and the changing context of pre-hospital care within the wider healthcare networks. The challenges of funding, training and cultural transformation are now felt globally. The need to learn and adapt from suitable models of ambulance service delivery have never been greater. The book offers critical insights into the theory and practice of strategic and operational management of ambulance services and the leadership needs for the service. One of the highlight of this volume is to bring together scholarship using experts- academics, practitioners and professionals in the field, to each of the chosen topics. The chapters are based in the practical experiences of the authors and are written in a way that is accessible and suitable for a range of audiences. We are confident that this book will cater to a wider audience to inform policy and practice, both in the UK and internationally. Paresh Wankhade is Professor of Leadership and Management at Edge Hill University, UK Kevin Mackway-Jones is the Medical Director at North West Ambulance Service NHS Trust, UK Endorsements “This unique and valuable publication, charts the history and development of the ambulance service in England over the last hundred years or so. The role of this key emergency service has always been important, and arguably never more so than today. The contributing authors have not only provided the reader with great insights into where the service has come from and the leadership challenges it has, and continues to face; it also gives examples of how the future could look as our journey of transformation continues.” Peter Bradley CBE, MBA (and author of Taking Healthcare to the Patient 2005), Chief Executive Officer. St John National Headquarters, New Zealand "With a year on year increase in demand for emergency ambulances and over 9 million calls annually, the UK Ambulance Service must change from its emergency care and transport focus model. With the increase in professionalism of paramedics and an uplift in assessment and clinical skills the modern paramedic is increasingly able to treat at home, direct patients with alternative care pathways and avoid transportation to overburdened Emergency Departments. Whilst there is some historical and cultural resistance to change there is a need for further development in clinical skills and a new perspective for the future Ambulance Service. This book brings together practitioners, managers, academics and provides a broad understanding of the major management issues in the UK Ambulance Service. It includes the history of the Ambulance Service, quality and risk management issues, commissioning, leadership, intra-operability and shape of the future ambulance service. The content will be of interest to students, practitioners and academics". Sir Keith Porter, Professor of Clinical Traumatology, University Hospitals Birmingham NHS Foundation Trust, United Kingdom

“Globally, emergency services are witnessing a period of unprecedented uncertainty and change caused by pressure on their budgets, reduced manpower and changing patterns of demand and service delivery. Such challenges are also having huge implications on the workforce health and wellbeing. This book is a timely, well-researched addition to improve our understanding of the governance and collaboration issues in the emergency services.”Steve McGuirk, Chairman, Warrington and Halton Hospitals Trust, Former Chief Fire Officer and CEO, Greater Manchester Fire and Rescue Service “Good governance, collaboration and sound leadership are easy qualities to take for granted in the Emergency Services. However, given the increasing complexity of the challenging political and operational environments these organisations work in, it is not reasonable to assume these qualities will always emerge as a natural phenomenon. This book is a welcome addition that provides invaluable, evidence-based insights for leaders who are seeking to raise the quality of their services for both the public and their workforce alike.”Andy Newton, Immediate Past Chair, College of Paramedics and Former Paramedic Director, South East Coast Ambulance Service NHS Trust (SECAmb) This unique text provides fresh insights and understanding of the governance and collaboration issues between emergency services in a dynamic policy and organisational environment in a global world. The book offers critical insights into the theory and rationale behind the interoperability and collaboration between the emergency services and examines in detail, important themes around trust, leadership, workforce wellbeing and resilience and professional culture(s), each having great significance for the success of the interoperability and governance agenda. The chapters cover new materials, including the research conducted by the authors and are written in a style that is easily accessible. This book caters to a wide audience of researchers, academics, students, emergency services staff, leaders and public managers, both in the UK and internationally.

An expert guide to contemporary research in the field of emergency services management, this short-form book will help academics, scholars, and practitioners to appreciate the important role and contribution of these services. Contemporary emergency services have been rapidly changing in response to increasing demand, reducing resources, the impact of COVID-19 and the increasingly complex threats to public safety. Academics, practitioners, the emergency services and their key stakeholders all need to have a clear understanding of the changing role and contribution of these services as well as finding ways to improve their management and performance so that policy solutions to new and emerging threats may be efficiently developed and effectively implemented. The book looks at the application of public management theories to emergency services and the development of professionalism within the police, fire and rescue, and ambulance services. It examines the increasing need for better collaboration and identifies the nature and extent of the academic and practitioner divide and the research gap between the academic and professional communities in each of the services. This book will be invaluable to researchers, scholars, practitioners, and students in the fields of governance, leadership, and management, especially those focusing on emergency services and management during crises.

Paramedic Principles and Practice in the UK is a key textbook designed to support paramedicine students in this country throughout their studies. The volume takes a practical approach, with case histories covering a broad range of clinical presentations and treatments, all incorporating a patient-centric perspective that acknowledges the longer patient journey. This must-have textbook will not only arm readers with technical knowledge and expertise, but also with the non-technical principles of the profession, developing future paramedics who are able to provide a safe and effective management plan in the out-of-hospital environment. Aligned to UK paramedicine curricula More than 40 detailed case studies covering essential pathologies most commonly seen by UK paramedics, as well as less typical scenarios Evidence-based clinical decision-making models to support paramedics in practice Essential physiological concepts to help readers bridge the gap from principles to practice Focus on the wellbeing of both the patient and the paramedic Useful appendices including medications commonly encountered in paramedic settings

Foundations for Paramedic Practice, Second Editionprovides an introduction to many of the subjects not traditionally taught in ambulance 'in-house' training, such as psychology and sociology. It addresses the theoretical elements of paramedic courses in higher education and provides clear links to practice. The second edition features four new chapters on caring for vulnerable adults, end of life issues, theories of decision making and the scope of the paramedic role. It also provides increased coverage of portfolio writing, submission to HPC, decision making and includes more case studies. Contributors Amanda Blaber, Vince Clarke, Alison Cork, Steve Cowland, John Donaghy, Rachael Donohoe, Bob Fellows, Ann French, Graham Harris, Mary Larkin, Linda Nelson, Marion Richardson, Paul Street and Jackie Whitnell.