Ambulances "shouldn't go out automatically" (From Bucks Free Press)

Ambulances "shouldn't go out automatically"

3:20pm Wednesday 29th October 2008 in

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AMBULANCES should no longer be automatically sent to patients in Buckinghamshire’s towns and volunteers will be sent to incidents in rural areas under controversial new NHS plans.

Ambulance chiefs want rapid response vehicles – which cannot transport patients to hospital – to assess patients in urban areas first and then decide if an ambulance is needed.

And they want volunteers, fire and police staff to see seriously ill patients in rural areas to again assess if they need an ambulance or other kinds of NHS care.

South Central Ambulance Service NHS Trust admits the model could make geographical variations in response times worse – but said a huge rise in calls meant something must be done to meet Government targets.

But the news has met with concern by health leaders who fear the radical proposals will not improve the poor performance of ambulance services in the county.

“Instability” in hospital A&E departments – also seeing a massive boost in numbers – was making this problem worse, it says.

But having ambulances on standby throughout the area would “not make best use of finite health resources” and these should be focused on urban areas, the report adds.

The national target is to get to 75 per cent of life-threatening calls in eight minutes with an ambulance on scene if needed within 19 minutes.

But South Central Ambulance Service NHS Trust said this is “challenging” and a “major cause of concern”.

Latest figures show just 67 per cent of calls are attended in the crucial eight minute window in Bucks. Hampshire and Oxfordshire are on 76 and 80 per cent.

To solve the “dilemma” it proposes:

• Urban areas: rapid response vehicles would be “initial response” for life-threatening calls with 85 per cent of calls attended in eight minutes. They will assess the patients and decide if they need an ambulance to go to hospital or other NHS care.

• Semi-urban areas: an “alternative healthcare professional” such as an emergency care practitioner will be at 75 per cent of life-threatening calls in eight minutes. Other healthcare professionals and volunteers will “aim to” get to 80 per cent of these calls. A decision will then be taken whether to call an ambulance.

• Rural areas: “first responders”, including volunteers. would take on 60 per cent of life-threatening calls and the ambulance service would cover 40 per cent. “First responders” would include NHS staff and “retained service people such as police and fire crews”. An assessment would be made whether an ambulance was needed – with a target of an ambulance on scene in 19 minutes for 95 per cent of calls.

But while it said workers would follow “robust clinical rules” the trust admits the new set-up could make matters worse.

Its report says: “SCAS acknowledges that the performance improvement model in its simplest form could further exacerbate inequity in access to ambulance services.”

A health watchdog boss today questioned the plans. Councillor Mike Appleyard said: “Some of this, on the surface, such as volunteers dealing with the first call, is asking for trouble.”

Cllr Appleyard, chairman of Buckinghamshire County Council’s overview and scrutiny committee for public health services, added: “It is not something I would be particularly comfortable with but it seems they are just lobbing ideas in the air.”

And the proposal was met with a frosty reception yesterday by members of Buckinghamshire NHS Primary Care Trust, which decides where the vast majority of NHS cash is spent.

The plan would take more patients off the hands of the ambulance service and onto the PCT, for example through nursing teams in the community and GP surgeries.

The ambulance trust said mental health patients and those with who have fallen but are not injured should be cared for elsewhere in the NHS instead of by paramedics.

Warning that the PCT pays more per head to the ambulance trust, chief executive Ed Macalister-Smith, said: “We are spending more and getting less. Our starting point would be that we have to have that turned on its head.”

Non-executive Murray Fraser said: “I don’t feel that reassured. I am not quite sure how this community stroke ambulance model would work.

“It looks like we are being asked to inject quite a substantial amount in and my question is for what?”