Ambulance leaders call for a ‘fresh approach’ to ease pressure on hospitals

A recent report from ambulance chiefs and trust leaders is prompting discussion at national, regional and system level about the potential for the ambulance service to take a greater role in leading and co-designing urgent and emergency care provision (UEC).

A vision for the NHS ambulance sector in co-designing urgent and emergency care provision published by the Association of Ambulance Chief Executives (AACE), NHS Providers and NHS Confederation, highlights the pivotal part NHS ambulance trusts currently play in delivering UEC while setting out a long-term vision for a significantly enhanced role they could take in co-designing this care. This will enable the transformation of care for patients, improvement in the working lives of the ambulance workforce (alongside the much-needed retention of staff) and the rebalancing of risk in local NHS systems.

One key point of our report is that while ambulance services’ core remit will always be to provide fast emergency responses to those who have a life-threatening health need (and also to attend major incidents) this is a relatively small proportion of what ambulance services actually do on a day-to-day basis (around 10-11 per cent). This highlights that there is significant potential in extending and formalising a wider remit in UEC which could help solve some of the key system pressures, reduce the risks for patients and offer a more positive, supportive and productive environment for staff.

This is why NHS ambulance leaders are now calling for a fresh approach to designing and delivering urgent and emergency care, including an expanded role for paramedics in helping to treat people at home and ease pressure on hospitals.

Our report also calls for a stronger focus on prevention and a shift in the balance of investment to out-of-hospital services when designing urgent and emergency care. Within this, we believe there is greater potential for ambulance services to develop with two clear remits, as the lead coordinators and navigators for access to UEC and support agencies (making efficient use of multi-professional, integrated clinical hubs and assessment services at system level) and as responders to patients needing out-of-hospital care, with more direct referral pathways to other parts of the system, and advanced skill sets and paramedicine models to safely keep more patients at home.

We already know that for most people, being treated at (or as close to) home as possible is what is best for their health and is how they want to be cared for. We also know that rapid developments in technology can be harnessed and implemented quickly to aid with the kind of connectivity and applications that are needed to keep more people safely at home (such as diagnostics, monitoring, telemedicine, access to health and social care records etc).

There can be no doubt that NHS ambulance services are already perfectly placed to become system leaders in this change because they already have the following in place:

• 24/7 regional/national infrastructure enabling them to see issues, gaps, and connections that others cannot

• Highly skilled, increasingly multi-professional workforces, with a range of skill sets able to triage and operate autonomously in all environments

• The trust of the public and interaction with patients in their own environments, and the ability to engage with ‘hard to reach’ patients

• Interoperable telephony and connectivity infrastructure, supporting the interface with all parts of UEC across primary, secondary, community and mental health care

• Data insight in real time that can provide early warning intelligence across local systems.

To get to the point where the vision can be realised, we have set out a case for change and investment in the ambulance sector. By investing in the ambulance workforce, infrastructure, and digital innovation there is a major opportunity to address inefficiencies and make significant progress in meeting the ambitions set out in NHS England’s UEC recovery plan, as well as those detailed in the NHS Long Term Plan.

‘We cannot continue to do more of the same and hope that things will get better. We owe it to patients, as health and care systems, to work together, and we have a moral duty to our people to improve on their current working conditions so they have fulfilled careers and can provide the best possible care. By doing things differently there is the opportunity to fix for tomorrow many of the things that are not working well today.’

A vision for the NHS ambulance sector in co-designing urgent and emergency care provision

The report includes several current case studies setting out the benefits of this approach, which while hugely beneficial in their own right and within the confines of their own regional systems, are currently only being implemented in small pockets across the country and often not part of an overall UEC system strategy, so many opportunities are being missed.

‘Ambulance services can reduce pressures on these sectors so they can focus on their non-urgent provision. By safely closing more episodes of care in our communities we can shift the balance away from secondary care, releasing capacity for elective work.

‘This in turn will remove the experience of ambulances being held for long periods outside hospitals, with all the adverse effects for both patients and staff. By having ambulance resources available where and when they need to be we can improve not only emergency responses, but also the out-of-hospital responses from all providers and join up the wrap-around care that patients expect and will benefit from.’

A vision for the NHS ambulance sector in co-designing urgent and emergency care provision

We are confident that the ambulance sector has much more to offer the rest of the NHS in improving urgent and emergency care provision in the UK. We would like to continue to engage with national, regional and system leaders, and our partner providers, to explore the possibilities of enhancing the ambulance role within urgent and emergency care and promote collaborative cross-sector planning and implementation of a long-term strategy to deliver meaningful change for patients and our people.

Contributions are welcome via our website, where we will also be continuing the conversation and adding to our vision through 2024/25.