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In a week that saw ambulance chiefs gather at the Ambulance Leadership Forum in Leeds, AACE Chair Jason Killens talks to Emergency Services Times about how the ambulance sector is taking on a greater role in leading and co-designing urgent and emergency care provision.
Jason is in the early part of his three-year tenure as Chair of the Association of Ambulance Chief Executives (AACE). He put himself forward for the role saying he wanted to focus on culture. Early in 2024, NHS England published the findings of an independent review and found “significant challenges related to workplace culture,” including “leadership styles that do not adequately support staff to speak up and instances where those who voiced concerns faced intimidation or inaction.”
Jason explains, “We have similar issues to other parts of the emergency services. It’s simply not right that people don’t feel safe at work.” He wants to use the convening power of AACE to make a difference.
The second focus for him is to bring the sector closer together.
“I’ve been in the ambulance service for 28 years, and if I think back to ten or fifteen years ago, the sector nationally used to work much closer than it has as of late. I do think there is strength in the sector trying to get closer to a national agreement where we can but recognising that on some things we won’t be able to do so because of local drivers and politics ”
He wants to see more national and consistent approaches across many areas of ambulance service business. It’s a refrain that is going on in policing right now as the Home Secretary seeks to create national bodies to drive efficiency and effectiveness in law enforcement. Jason adds, “I think there is a genuine desire for the ambulance services to work more closely together across the UK and AACE can galvanise that joint working.”
Health is fully devolved in Wales, Scotland and Northern Ireland. Jason leads the Welsh Ambulance Service, a single country service and now that the Welsh Government and the Westminster government are both of the same political hue, this may help with that closer working ambition.
A vision for the NHS ambulance sector
Against that backdrop, last year AACE, along with NHS Confederation and NHS Providers, published A Vision for the NHS Ambulance Sector. Over 16 pages it sets out how the ambulance sector could take on a greater role in leading and co-designing urgent and emergency care provision.
How the ambulance service – one that regularly makes the headlines for being overstretched – has the capacity to take on any more demands without falling over in the process is a theme that Jason responds to by looking first to the past.
He explains that the ambulance service has a broader offer today, and is much more than when it was set up or even in the last 20 years. It has diversified and is using different types of clinicians to respond to urgent and emergency care demands. He says that’s in part because the service has professionalised, with a paramedic now expected to pass a three-year degree course and use a wider range of drugs and equipment to deliver more complex care than before.
“The offer of care that the ambulance service provides today is very different to what you saw 20+ years ago. We were set up originally as a clinical transport organisation, moving people from their home or wherever they were to the hospital. We do that still and we do it very well but increasingly the way that the public use the service means we see more and more urgent and social care needs rather than life threatening needs – which are less than 10 per cent of what we go to.”
Expanding on this theme, Jason talks about the volume of mental health calls that ambulance staff respond to and how that has increased partly because of the introduction of a policy called Right Care Right Person, where instead of police officers responding, ambulance and other healthcare professionals step in.
“The starting point here is that these are patients and they should be dealt with in the health service, not by policing. It’s a care crisis. What ambulance services are doing is growing capacity and capability to respond using dedicated mental health resources – where they work side by side with ambulance paramedics in response vehicles. They are able to ‘close off’ those episodes of mental health crisis without transporting the patient to the emergency department, which is what historically would have happened. It is the wrong place for them to go.”
Jason says that the move to paramedics being more involved in prevention is a natural progression because they have so much contact in communities. With less 10 per cent of paramedic time spent on life threatening care, Jason says that in his service alone ambulance staff have 3 million contacts with the public per year. With a population of 3.5 million in Wales, that is a massive opportunity “to make every contact count,” as he puts it.
The language in the 2024 vision document is aligned to this move to prevention, it talks about ‘thriving systems’ where the ambulance service can help keep people out of hospital. The prevention picture is varied, he says, across the 10 ambulance services in England and Jason’s service in Wales. The Integrated Care System introduced under the last government remains in place and sees one ambulance service having to contribute to (and be commissioned by) many Integrated Care Boards and yet is not a statutory member of any. Jason’s predecessor, Daren Mochrie, talked about this problem during an interview with Emergency Services Times in August 2023.
Spotting pre-existing conditions and signposting people to the right parts of the NHS will reduce acute contact and the need for a visit to the emergency department, so whether that is ambulance service staff or others in the healthcare system, the outcome is the same. Jason says that the modern paramedic is trained to deal with the acute but also to manage urgent care cases that don’t end up at the emergency department.
“The reality is that universities educating paramedics today are training them to manage other patients and the experience on the streets is not what TV programmes would perhaps suggest.”
While the media continues to focus on handover delays and ambulances stuck outside emergency departments because hospitals cannot discharge patients due to a lack of social care, it seems that the messaging about ambulance service capability needs to change and that starts with leadership. The vision states clearly: “In thriving systems leaders view the ambulance service as doing more than responding to emergencies.” If the ambulance service does more in the prevention space, it requires the whole healthcare system to tell the public that it has the capacity to do it well.
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