Comment

Homelessness: implications for paramedic practice

  • February 2019

Key facts on homelessnessThe full extent of homelessness and rough sleeping in the UK is difficult to describe. Homelessness is recorded differently in each nation, and not all homeless people show up in official statistics. However, it is clear that homelessness and rough sleeping have been increasing substantially since a low point between 2009 and 2010.Statutory homelessness statistics reported that the local authorities in England had duty to accommodate just over 59 000 households in 2016–2017. This is a 48% increase on the 40 020 reported in 2009–2010. In addition, the estimated numbers of people who sleep rough have increased by 169% since 2010 to 4751 (Ministry of Housing, Communities and Local Government, 2018a; 2018b).

What is the long-term plan?

  • February 2019

Acash- and resource-strapped NHS, repeatedly tasked with finding tens of billions in efficiency savings, and where funding gaps and cuts (alongside a rising demand) seems to have become a norm over the last decade. Now as we approach Brexit without any sign of a deal, a whole new string of problems are on the horizon for health care, health professionals and the patients you serve.

What is your ‘normal’?

  • February 2019

I'm not convinced that a week can be normal when working in health care. The potential for an unusual or unexpected situation, outcome or presentation is ever present. In my previous column, I proffered that there is something comforting about the feeling of normality. Perhaps then, we attempt to comfort ourselves with thoughts of the mythical normal week? Is it perhaps possible that we have normalised the unusual? I suspect most of us still relish the diversity and variation associated with a role like ours. So as I settle down to write this column, I thought I'd review my past week and share some of my experiences.

Ignorance isn't bliss: behind the unequal distribution of end-of-life demand and cost

  • February 2019

Variance in deaths and pressureClearly, some areas have more deaths than others, and Figure 1 shows the distribution of deaths per 1000 population across local government areas in the UK. Data are for 2017 and are from the Office for National Statistics (ONS) (2018a). The fewest deaths per 1000 population occur in London with the 14 lowest local authorities in the UK. Slough (5.3 deaths per 1000 population) comes in at number 15. At the other end, the top five local authorities (East Lindsey, Christchurch, Inverclyde, Rother, Tendring) all have more than 14 deaths per 1000 population. Of the four countries of the UK, Northern Ireland has the youngest population with only 8.6 deaths per 1000 population compared with 10.7 in Scotland. This inherent 5-times difference in deaths per 1000 population (as per Figure 1) therefore places markedly different end-of-life pressures on NHS organisations.Figure 1.Deaths per 1000 population in 2017 for local government areas and regions throughout the United KingdomThe last year of life is characterised by functional and cognitive decline and increasing dependence on carers for the activities of daily life (Rabbit et al, 2008; Kalbarczyk-Steclik and Nicinska, 2015; Aaltonen et al, 2017). Symptoms of anorexia, dyspnoea, fatigue and pain all increase (Singer et al, 2015); hence increasing numbers of falls and accidents resulting in fractures and other injuries along with indicators of failing immune function such as respiratory and other infections (Jones and Goldeck, 2014). Any forecast of future demand therefore must take trends in deaths into account along with the usual effects of age alone (Moore et al, 2017).

Homelessness: implications for paramedic practice

  • February 2019

Key facts on homelessnessThe full extent of homelessness and rough sleeping in the UK is difficult to describe. Homelessness is recorded differently in each nation, and not all homeless people show up in official statistics. However, it is clear that homelessness and rough sleeping have been increasing substantially since a low point between 2009 and 2010.Statutory homelessness statistics reported that the local authorities in England had duty to accommodate just over 59 000 households in 2016–2017. This is a 48% increase on the 40 020 reported in 2009–2010. In addition, the estimated numbers of people who sleep rough have increased by 169% since 2010 to 4751 (Ministry of Housing, Communities and Local Government, 2018a; 2018b).

Protecting the mental health of UK paramedics

  • January 2019

It is estimated that the average member of the public within the UK will experience one or maybe two traumatic situations in a lifetime—whether that be through witnessing or being involved in an accident, natural disaster, collision, medical episode or traumatic event. Those working in frontline emergency ambulance services however are exposed to distressing and traumatic events on a much more frequent basis (Halpern et al, 2012).

Redefining the ‘news’

  • January 2019

Researching complex topics and demysifying useful information, sharing the stories of real people, writing, editing, polishing—these are some of the reasons I went into my profession. But when I carried out my master's in journalism, the drawn out United States-led war on Iraq was front-page news, while stories in health care (which had always been my area of interest) tended to focus on sensationalising research and scaring people away from just about every food (though to be fair, a large majority of our food has in fact been tampered with to a worrying degree—but that's a discussion for another day).

Building up a positive culture

  • January 2019

In an unpredictable—and sometimes frightening—world, the few events that bring some normalcy can be really comforting. Christmas was never going to be white, New Year's Eve was always going to be busy and the question, ‘what's the worst thing you have ever seen?’ will forever follow social introductions to paramedics.

Student paramedics need funding too…

  • January 2019

In 2018, a new student column shared perspectives from first, second and third year students across UK paramedicine programmes. This year, in a special quarterly feature, we will follow Eleanor Chapman, who has now graduated, on her journey as a newly qualified paramedic

Honouring inclusivity and support in paramedicine

  • January 2019

Creating a brandIn a bid to create an identity for Proud@WMAS, the committee tried to design a new logo but quickly realised that the already established design had resonance with current staff and so it remained. The rainbow star of life, used by the National Ambulance LGBT Network, of which we are a contributing member, was agreed as it was felt that it would achieve uniformity across other ambulance organisations and enable the network to be recognised more easily. The committee sourced some funding to purchase 200 star of life pin badges which were distributed to staff across the Trust—they were so well received that a waiting list for badges had to be drawn! Why was the badge important? It allowed people to identify—not only as allies but also as advocates. When asked about the badge, people can spread the good work of the network.The network knew that work needed to be done to support not only our workforce, but also the diversity of the population we serve. A key part of this is the transgender community. The team began developing a Trans Awareness Programme for the Trust to increase awareness among operational staff, availability of information, training, and development of internal policy.It was on the back of this that a member of staff approached their line manager to notify them of their intention to transition from female to male. Their manager immediately contacted the network for support, not only to assist the manager but also to offer direct support to the staff member.

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