The Scottish Ambulance Service deals with 2.2 million patient contacts every year but it is with some pride that its chief executive Pauline Howie tells me they are managing to get to the most acutely ill patients “quicker than ever before.”
“Our average time of response to the most seriously ill people is six and a half minutes in Scotland, which is a world class response time. But more than that, our ambulance crews are higher skilled than they have ever been before and they are able to get definitive care to patients at the scene of incidents. In fact, you could say now that because we’ve invested in clinical paramedic advisers within our control rooms that, actually, care starts as soon as the person phones 999.”
However, on the day we meet the Daily Record is running a highly critical article quoting GMB union organiser Michael Conroy as saying that ambulance staff are “demoralised” after working long hours without breaks, and warned that if reassurances aren’t provided quickly to address “poor” working conditions and concerns over patient safety then he will have “no hesitation in balloting members about industrial action.”
Howie admits she was “surprised” by the story as they have had no indication from staff directly that industrial action is planned.
“The Daily Record highlighted that there hasn’t been a strike for 25 years so I wouldn’t be expecting a strike. We have got robust processes in place for staff engagement and we will work through this,” she says determinedly.
The article follows “ongoing” communications with staff confirming what the service believes its budget will be for the next year, she explains. In common with other parts of the NHS the Scottish Ambulance Service will be required to find efficiency savings of around 4 per cent again next year to reinvest in new ways of working. However, she insists that patient safety “is right at the heart” of everything they do and will not be compromised.
“We work with our staff in terms of how to we square the financial reality with where we are trying to get to in terms of those new ways of working. We go through a process of coming up with areas where we might look to drive out waste and variation, which can be inefficient, and where we need to move resources into other areas in order to take more care to the patient...
“Our local intelligence would suggest that whilst that is going to be really challenging, our staff side has committed to working with us in terms of trying to find a way through,” she added.
The service is already a very different one than it was a decade ago, when it was mainly about response times, she explains.
“Now it is about the quality of the care that we provide. So, for example, out of hospital cardiac arrest, which is a traditional illness that people might phone 999 services with, the chances of survival are actually very small across the world but we have been doing some groundbreaking work with the University of Edinburgh and clinicians at the Edinburgh Royal Infirmary to provide more rapid resuscitation response. We’ve almost doubled the chance of survival in terms of cardiac arrest out of hospital in Edinburgh and we are now launching that in Glasgow and want to roll it out to the whole country.”
With such incidents, every minute counts, so they have also been collaborating more closely with the Scottish Fire and Rescue Service as potential first responders to provide support whilst an ambulance is on its way – many of the engines already carry defibrillators and Howie says that the British Heart Foundation is also funding all ambulance services across the UK to map all available public defibrillators so that those additional resources are known to control room staff and can be put to use if required.
However, the service has also been working to alleviate pressure on acute services by working in a more preventative way, Howie says. In partnership with the Scottish Government’s Joint Improvement Team and the emerging integrated health and social care partnerships, the service has been working to develop a falls pathway.
One of the most common reasons why someone might call 999 is when an elderly person falls, Howie explains.
“We know that probably about 30 per cent of people that have fallen aren’t injured at all, and they are elderly and they don’t want to go to hospital. But often if our crews don’t have anywhere else to refer them to they will be concerned about the vulnerability of that person having another episode, because it is typically during the night at a weekend, and maybe take them to hospital as a default because they think that is safest for them. What we’ve been doing is developing this alternative pathway where if we do get activated to someone who has fallen our crews will go out and diagnose whether they have injured themselves. If they have, then they take them to an appropriate facility. If they’ve not then activate a rapid response team from the falls service can come in and make sure that person is safe for the immediate period, and then for the longer term put in place an anticipatory care plan that is appropriate for their needs. That might involve housing adaptations, changes to medication, or they might need a bit more homecare support. And it means that for that person, the future prevalence of falls is reducing as well. So we have got many examples across the country now where we have actually managed to prevent future falls happening.”
Looking ahead, Howie also believes the service has a “huge contribution” to make in supporting the integration of health and social care and achieving the Scottish Government’s ambition for people to be able to live longer healthier lives at home, or in a homely setting.
“Part of the Scottish Government’s 2020 vision is about how we can prevent more ill health, and where people might be at risk of ill health how we can anticipate their care needs in advance and see how we can design services. And the Scottish Ambulance service is a mobile healthcare provider. The modern ambulance is like a mobile health clinic. In some cases it is like a high dependency clinic.
“So some of the equipment that we’ve got on it, and the diagnostic capability and skills of our staff that we’ve now got really provide tremendous opportunities in terms of new ways of working and new care delivery models for patients in Scotland.”
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