‘A’ is for ambulances: 4 ways to support paramedics this winter

It was on a ride along with an ambulance crew when it first became clear to me that being a paramedic is one of the toughest jobs there is. It’s an incredibly rewarding job, but it’s also relentless, highly pressured and physically and emotionally draining. And that was before the pandemic. The situation now is even worse. NHS leaders need to be doing everything realistically possible to support ambulance services and staff, and consequently their patients, as we head into a difficult winter.

It’s understandable that new Secretary of State, Therese Coffey, has chosen ambulances to be one of her headline ‘ABCD’ priorities in her newly released plan for the NHS and social care. Even before the pandemic, ambulance services were consistently missing targets for response times. The disruption to the system during the pandemic has had a significant impact. Demand for 999 services has steadily increased as access to other services has been constrained, and ambulance capacity is being limited by A&E handover delays. Waiting times have now spiralled to dangerous levels – patients are now waiting nearly 5 times longer for their call just to be answered; response times for emergency ambulances has doubled (category 2 calls); and journeys to hospital for stroke patients are now 30 minutes longer (Figure 1).

These extra minutes can be the difference between life and death for patients. Ambulance staff are all too aware of this fact and many will be dreading the upcoming winter. So, what can national health leaders in government and NHS England realistically do to improve the situation for both staff and patients? The plan announced recently is a good starting point but further action is needed in four areas.

A&E handovers

Ambulances getting ‘stuck’ handing over at busy A&E departments is a notorious cause of long response time for ambulances. The consistently high handover delays seen last winter are expected to be repeated this year. National leaders sometimes default to blaming either hospitals or the ambulance service for handover delays. This can create an unhelpful blame culture that filters all the way down to frontline staff.

In reality, handover delays are a system problem and therefore need a system-wide response. National leaders should be encouraging local leaders in both the acute and ambulance sector to create cohesive joint winter plans, especially as this is the first winter with fully functional integrated care systems.

Additional capacity

One of the simplest ways to support ambulance staff this winter is to provide them with extra capacity to meet demand. It was therefore promising to see previous Secretary of State, Steve Barclay, announce extra funding to increase frontline and call handler capacity, and the new Secretary of State confirming these plans. But recruitment to the NHS is notoriously difficult so more detail on how this will be achieved is still needed. And while leaders have already secured additional capacity this winter from St John Ambulance, national leaders still need to form relationships with other voluntary, community and social enterprise (VCSE) organisations to successfully create an ‘auxiliary ambulance service’ to boost capacity.

Alternative models of care

Paramedics don’t want to spend hours in an A&E car park waiting to handover a patient, especially if there is an alternative that is better for the patient. National leaders need to be advocating for alternatives to all patients being transported to hospital by ambulance.

First, by advocating for more virtual care, in the form of ‘hear and treat’ – where ambulance clinicians treat patients over the phone rather than face-to-face. The proportion of patients being treated this way has increased over the course of the pandemic but the regional variation in the figures suggests there is still room for improvement.

Second, national leaders could be doing more to reduce admissions. Pritchard and Coffey have both already highlighted that there could be alternative options for care home residents and falls patients. But there are many more opportunities like this that national leaders could be championing. For example, more can be done to support VCSEs like the British Red Cross who help ‘high intensity’ emergency care users – who account for 29 per cent of ambulance journeys.

Acknowledge staff welfare

Among all the worrying stats, is a workforce that is under significant pressure. Ambulance services consistently score the lowest results in the NHS staff survey across several indicators, including stress and burn-out. National and local leaders need to acknowledge the reality for staff on the ground and do more on staff welfare. They need to be actively working to create the conditions required to support staff to flourish as set out in The King’s Fund framework for compassionate leadership.

Conclusion

Frontline ambulance staff are facing a tough winter ahead. It is vital staff feel properly supported by national and local leaders as they navigate this pressure. To realistically help ambulance staff this winter, ‘A’ must also stand for A&E, additional capacity, alternative care models and acknowledge staff welfare.