Policy responses and statements
- Name of organisation:
- Scottish Ambulance Service
- Name of policy document:
- Draft Scottish Ambulance Service Health Plan 2007-08 to 2009-10
- Deadline for response:
- 12 January 2006
Background: The Scottish Ambulance Services wrote to consult the College about its Draft Health Plan for the coming 3 years. The aim of the plan is to continue to improve its core services - the Accident and Emergency Service and the Patient Transport Service - and to ensure the requirements of 'Delivering for Health' are realised through the redesign of the Service. The quality and appropriateness of the care provided to patients is the fundamental driving force behind the Health Plan.
The Service has been evolving in recent years and is playing a key part in supporting the Scottish Executive's 'Delivering for Health' programme around health improvement, prevention-based medicine, community-focused services, empowering self-care and the efficient use and targeting of resources.
COMMENTS ON
SCOTTISH AMBULANCE SERVICE
DRAFT SCOTTISH AMBULANCE SERVICE HEALTH PLAN
2007-08 TO 2009-10
The Royal College of Physicians of Edinburgh is pleased to respond to the Scottish Ambulance Service on its consultation on the Draft Scottish Ambulance Service Health Plan 2007-08 to 2009-10.
The College’s comments are limited to parts of the draft plan which relate to clinical issues only.
All draft health plans for the Scottish Ambulance Service must form part of the overarching strategy for the Scottish Health Service and integrate with new proposals for urgent and out-of-hours care, and also the rise in inter-hospital transfers that will result from service reconfiguration. The College appreciates that this consultation process is part of a co-operative and collaborative approach, but it is essential that the Scottish Executive Health Department ensures that all parts of the Service are co-ordinated and moving in the same direction.
The College recognises that the SAS has been evolving rapidly and this rapid rate of change has allowed no period of stability, but it is important that lessons are learned from past errors. While the reasons for no baseline figures are given, their absence undoubtedly has implications for final performance targets, and the fact that final budget allocations are not known would indicate that this draft plan may well require significant re-drafting and further consultation.
Specific comments are as follows:
HEALTH IMPROVEMENT
HI1: Save more lives – Improve survival of cardiac arrest from the current estimated xx% in 2006-07 to xx% in 2009/10
This is clearly a very laudable and obvious objective, and the thrust is to save more lives across the whole spectrum of clinical care. The plan acknowledges that the internationally recognised indicator is the return of spontaneous circulation [ROSC] on arrival in hospital, and that this alone cannot be termed survival from cardiac arrest. It is the view of the reviewers that the term ‘survival from cardiac arrest’ should be replaced by ‘return of spontaneous circulation’ throughout the document.
If, however, true figures for “survival after hospital discharge following cardiac arrest managed by the Scottish Ambulance Service” are available, this would be far preferable as a measure of health improvement. It was also felt that mention could be made of acute myocardial infarction treatment and pre-hospital thrombolysis.
ACCESS TO HEALTH SERVICES
A3: Improve response time to all emergency incidents (island NHS Board areas) – from the current xx% within target time in 2006/07 to 50% in 2009/10
This aim is laudable and central to Scottish Ambulance Service Emergency Care.
A6: Reduce hospital admissions – increase the % of emergency calls treated at scene from the current xx% in 2006/07
The stated objective here is to ‘increase the percentage of emergency calls treated at scene from the current xx% in 2006/2007.’ At the present time, the SAS are unable to quote the percent of emergency calls that are treated at scene or give any idea what their target value would be. It is accepted that a number of patients brought to hospital by ambulance do not require this service and could be dealt with appropriately at scene, but it is felt that a significant degree of caution needs to be used in trying to achieve this and certainly to setting targets.
The College welcomes the commitment to audit of these new initiatives. It is absolutely essential to ensure that any system is both safe and cost effective and equitable with the standards of care available to patients if they had presented to Primary Care. There are concerns that the changes may be being proposed solely for (unquantified) financial reasons. Paramedics have, up until now, been trained exclusively in the care of emergency conditions. Taking on the management of acute episodes of chronic conditions is an entirely different skill and knowledge base, and it is essential that training courses and clinical supervised practice ensures competencies in this role. We understand that the pilot of Emergency Care Practitioners [ECP] that took place in England raised a number of genuine concerns and critical incidents. The consultation document identifies the constraining influence of ‘risk averse’ behaviour by paramedics. It is not entirely clear how this is defined. Clearly, all clinical situations involve an element of risk and that risk needs to be managed appropriately.
At the present time, there is a miscellany of ‘extended roles’ appearing. In addition to paramedic practitioners, we have seen the evolution of Emergency Care Practitioners, Physician Assistants and slightly longer established Emergency Nurse Practitioners. It is felt there is a lack of clarity about all of these roles and a real danger that confusion will reign in the Health Service, in the minds of patients and even between each of these practitioner groups unless a more co-ordinated collaborative approach is taken. The College supports the principle of extended roles, but recommends caution with particular attention to clinical supervision and audit as these initiatives progress.
There is no mention of possible prevention of unnecessary ambulance journeys by re-direction of some non emergency calls to NHS 24. There is a lack of clarity in this area and there are undoubtedly a proportion of patients who would be perfectly safe with either home care of a minor injury or advice on making their way to a Minor Injuries Unit or Emergency Department. This may indeed be more cost effective and beneficial for many patients, and collaboration between the Scottish Ambulance Service and NHS 24 could be explored further.
A7: Interhospital transfer service – meet response time targets for each clinical category of interhospital transfer
There is discussion about inter-hospital transfers generally. The College understands that there are developments concerning inter-hospital transfers related to Intensive Care with the Scottish Intensive Care Society, but there is no mention of this in the draft document. This requires exploration and inclusion.
Copies of this response are available from:
Lesley Lockhart,
Royal College of Physicians of Edinburgh,
9 Queen Street,
Edinburgh,
EH2 1JQ.
Tel: 0131 225 7324 ext 608
Fax: 0131 220 3939
[15 January 2007] |
