So…

“Da Boss”, Peter Bradley CBE, Chief Executive of the London Ambulance Service also moonlights as the governments ambulance advisor.  As part of this new role he has created a report on the future of the ambulance service.  This report will be published on Thursday, although a couple of his ideas have already been released to the public (the use of ECPs and the changing balance of vehicles).

ECPs are ‘Emergency Care Practitioners’, paramedics specially trained in treating minor injuries.

Mr Bradley is strangely respected by the road crews of the LAS – and I say ‘strangely’ because we tend to be dismissive of anyone who works in an office.  Middle management tends to be disliked by everyone, and upper management is seen as having lost touch with the job as it is today.  But Mr Bradley commands a great deal of respect amongst the troops.  From people who have spoken to him I hear that he is indeed a fair, and forward thinking boss, something that I think we need.

Once I get my hands on the report I’ll do a full breakdown of it, but until then, here are my thoughts on what the media has been reporting.

First off, there is no way the ambulance service can continue in the current way of working.  The number of people using the service are rising, and while the ambulance service was originally for emergency calls, our area of expertise has had to be expanded in order to fulfil the wishes of our clients.

In plain language, we deal with a lot more ‘crap’ jobs.  Because of all these crap jobs, we soon won’t be able to cope.

We have tried to educate the public about the correct use of ambulances, and the NHS has provided other sources of patient information and treatment, like pushing for pharmacists to provide more advice, the creation of NHS Direct, and more ‘Walk-in centres’.  Unfortunately, this hasn’t helped much, and the change in the working hours of GPs has only increased the workload for ambulance services countrywide.

In other words, no matter how many times we tell people we aren’t a taxi service, and give them other ways to get treatment, they still want a ride to A&E in a big white taxi.  GPs refusing to work during the hours of darkness (or hours when the golf course is open) hasn’t helped us much either.

So, the ambulance service needs to think smarter, rather than throw resources at the problem.

We surrender.  The public are too daft to be told.

The plan is simple, we bring treatment to the patient, rather than bringing the patient to the treatment.  A&Es are busy places, and there are a lot of patients who can safely and effectively be treated at home.  Other patients will be advised of other, more appropriate, avenues of treatment.

Taking everyone to A&E only increases hospital waiting times, which are no good for anyone (let alone government targets), so why can’t we treat things like minor wounds at home?  We should also be able to tell people with a runny nose that they need tissues, not an A&E department. (We do at the moment, but the service doesn’t currently support us doing this).

The ambulance personnel that will undertake these roles will have to have extra training.

Here is the problem, it’s all good until someone gets left at home and then dies.  Training will have to be pretty intense, and that will cost money, and take time – there will also have to be some serious support for people acting in this extended role.  When every job could ‘go bent’, I imagine the stress will be pretty big.

The salaries of those trained will have to increase.

Because a majority of calls to ambulance services are not life-threatening emergencies (my opinion only), the balance of solo responders (like myself) will increase, while the number of ‘proper’ double crewed ambulances will drop.  Of course, if these extended role practitioners feel the need for a patient to go to hospital, if appropriate they may transport the patient themselves.  (This is why all new ‘Rapid Response Units’ are going to be people carriers).

This is really brave.  With enough ECPs I think that this will work.  But I wouldn’t like to work in the PR department the first time the Daily Mail has the headline “Ambulance chiefs send car to dying wife”.  Also with more people turning up alone to calls, I suspect that there will be more and more risk of ambulance personnel being assaulted.

The plan is to send these rapid responders to more calls, so as to filter out and treat those people who do not warrent an ambulance.  Then ‘proper’ ambulances will be reserved for the most serious cases.

My personal opinion of what I’ve heard?  I think it’s a bold, yet very clever idea – and I hope that it will work.  I think that success will depend on the details, like what the training is like, and I hope that the government doesn’t water down the ideas.  We will also need some serious thought going into treatment guidelines and protocols in order to protect the registration of paramedics.

At the end of the day – we are cheaper than GPs, we work 24/7, unlike district nurses, community psychiatric nurses and GPs.  It is up to the ambulance service to pick up the shortfall in care that this leads to, and ‘Da Boss’ is thinking ‘outside the box’ to solve this situation.

I’ll write more once I’ve read the report.