LA PESTAÑA DISEÑO DE INFORME

Demand

The increasing demand for ambulance service resources was perceived as a risk to patients, as articulated by one of the participants:

Surely a major risk factor for all potential patients is a mismatch between an ever-growing demand and the resources.

SUFG20 The increasing demand for 999/ambulance service care was attributed in part to difficulties in accessing urgent care. Specific barriers identified included limited opening hours for GP surgeries, the perceived difficulty of accessing appointments and a lack of home visits, combined with limited awareness of and confusion over the various alternative options for urgent care. It was also suggested that the ambulance service was‘filling the gap for home visits’.

In the community in which I live there is a consensus that with the GPs’surgeries, there’s no faith whatsoever with them and other services are too far away. There is a large part of the community that don’t have access to vehicles and sometimes even relatives to give them lifts anywhere and the safest bet would be 999. I am not just talking about seniors I am talking about across the board.

SUFG23 It was also suggested that primary care and other services are contributing directly to the increase in 999 calls. Participants shared experiences of relatives being advised by GPs and NHS Direct to call 999 when they did not feel that it was necessary. Some participants expressed optimism that GPs’involvement in commissioning services will improve awareness of the ambulance service.

She fell down and hit her head, about 6 months ago. Phoned the doctor up at 6 o’clock at night. He says phone the ambulance. All she had was some bruises to her face and he said phone the ambulance. Whereas 20 odd years ago the GP would have come out.

SUFG1 Service users also discussed with apparent frustration the impact on limited ambulance service resources of having to deal with social problems such as alcohol abuse. Some innovative examples were cited across the groups of attempts to address alcohol-related demand at weekends, including buses and tents that focus on treating people at the scene and keeping them out of A&E.

Educating people to be more proactive in taking responsibility for managing their health was proposed as a way of managing the demand for care. This includes expanding patient education programmes to enable those with a chronic condition to better manage their condition and reduce the need for urgent or

emergency care.

That then goes into the realm of expanding and ensuring the expert patient programme is

incorporating everybody who has chronic conditions because both they and their carer should know what that condition is, what the treatments are, what the risks are and what the response is that they should seek.

SUFG21 Education of the general public in relation to calling 999 and highlighting the role of the ambulance service was also suggested. It was felt that the latter option would be harder to achieve but that focusing on the education of young people in schools could be desirable.

The difficulty there is that mostly until they need it, information, whether it was leaflets or whatever, they wouldn’t read it. But it is really more when they need it. That’s when they will start taking notice and that is a difficulty with getting the message out to people.

SUFG19 Resources

Accommodating the specific needs of patient groups such as wheelchair users and bariatric patients, including carers, was a concern. Participants were aware that the limited availability of vehicles and increasing need may result in delays. Wheelchair users felt that there was a lack of clarity over whether they should wait for a special vehicle or be transferred to a stretcher for transport.

I am coming across lots of different scenarios with wheelchair users and conveyance policies and whether they are in keeping with what the needs of the patient might be. For example, in an emergency context my understanding is that patients have to be transferred onto a stretcher, no questions asked, because the vehicles can’t accommodate wheelchair users in their own wheelchairs. So I would flag that up as a possible risk to patients because sometimes there can be a delay there in the debate about whether someone can transfer, or if they are fit to transfer or not, and whether the vehicle is actually suitable for conveying them to the emergency department or maybe centre of excellence. Likewise the issue about the carer. Sometimes the carer wants to go with the person, who might be in the wheelchair, or the carer might be a wheelchair user and their spouse or partner might be another wheelchair user. Sometimes the lack of clarity about whether the two parties can go in the same vehicle when someone has to go separately. And what happens to the individual who needs the care of the person who is ill. So I would really like to suggest that something is done around that.

SUFG8 Participants discussed the issue of receiving a fast response that is not necessarily the most appropriate response, and which in some instances may give the impression that specific requirements were not communicated. Participants in one of the groups were asked,‘What is most important to a patient, is it the speed of a response or the most appropriate person turning up with perhaps a bit of a delay?’ The group indicated a preference for‘speed of the response’, but then added‘the outcome’.

It doesn’t matter if the first responder isn’t a specialist or qualified in that area as long as they can give assistance. And then the proper, that sounds wrong doesn’t it? The qualified response turns

up afterwards.

SUFG18

When Make Ready ambulances were used they were perceived to be safer on the basis that all of the equipment was available. Participants were less in favour of voluntary and private ambulances. The scope for community pharmacists to play a greater role in providing unscheduled care to reduce the burden on the ambulance service was also mentioned in one of the groups, with a view to freeing the ambulance service to deal with emergencies and reducing the risk of not getting emergency care to the people who need it most.

The goal has to be that the emergency services deal with emergencies otherwise that is piling more demand onto the ambulance service. If you are overstretched that puts some patients at risk of not getting emergency help as quickly as they need. A hidden risk factor.

SUFG20 Concerns were expressed that expectations of ambulance service crews are too high. Participants questioned whether it was reasonable to increase the training of one individual to deal with the full range of 999 calls and whether specialism is preferable (e.g. a paramedic specialising in strokes being sent to stroke calls). Service users at one of the sites were particularly knowledgeable about staff issues such as training and feedback. The lack of time for staff training, because of high service demands, was regarded as a significant risk in terms of safe decision-making and patient care.

Now as a patient, if two guys turn up in an ambulance I expect them to be up to date on all their training techniques and practices and to find that there are that many hours that had to be made up and the consequence of having to make that up and the cost of it because it’s an accumulative cost because if two people turn up who are not able to deal with it, they have got to seek back-up. That delays it whilst someone else arrives and so you have got two vehicles, four people and possibly a line manager turning up as well for the one call.

SUFG21 Service users queried the potential impact of work demands (e.g. long hours, solo working) on the

well-being and performance of staff in terms of patient care, particularly if they do not have adequate support.

You work individually, there is no support there and it just concerns me that there is not enough back-up for crew or for individuals working. They could be under a lot of pressure all the time. Can they carry on working like that or is this just a short space model and they are finding it can’t work?

SUFG18