The Secretary of State for Health, Jeremy Hunt, has put out a call to action on reducing avoidable deaths. The aim is to reduce avoidable deaths through improvements in the fight against the five major causes of deaths. If successful, this fight against premature mortality could result in a reduction of 30 000 deaths by 2020. This is a tall order and the size of the challenge is considerable. There will need to be recourses (financial and material) made available, and this will have to be done against a backdrop of the swinging austerity measures that are in place. The government will be expected to play its part, but so too will other members of the NHS, including paramedics.
Living Well for Longer: A call to action to reduce premature mortality (Department of Health, 2013) is an initiative that has been launched by the Department of Health (DH). The introduction of the initiative suggests the government are making a concerted effort to work with all health care providers to improve the health of the nation. This is to be achieved by tackling the main causes of premature morality. The five big killer diseases are:
Front-line paramedics face these diseases day in and day out. There are many factors that will impact on the success of this initiative, both locally and nationally.
Locally (in England), there will need to be robust partnership arrangements across local councils, Clinical Commissioning Groups (CCGs), and health and social care providers, as well as their partners. Leadership will need to come from health and wellbeing boards. These requirements reflect the arrangements laid out in the Health and Social Care Act 2012. As a result of the reforms to the health and social care systems, taking place April 2013, the health system will be better placed to bring about change.
‘The performance of the UK in terms of premature mortality is persistently and significantly below the mean of other European peers’
From a national perspective, a cross government departmental approach that includes the Department of Health, NHS England (formerly the NHS Commissioning Board) and Public Health England, will be needed to ensure that there is a coordinated approach to the efforts being made. There must also be action taken to address the wider social determinants of health that impact clearly on the various health inequalities that still endure. In order to avoid premature mortality, we all need to be guided by the outcomes frameworks for public health and the NHS, where there are shared measures for premature mortality that are designed to lead to greater alignment of actions. As such, departments and individuals will be working smarter, with the intention of avoiding the duplication of effort and enhancing the nation’s health and wellbeing.
For mortality and disability, overall health has improved substantially in absolute terms in the UK from 1990 to 2010. Life expectancy in the UK increased by 4·2 years from 1990 to 2010. However, the UK performed significantly worse than other European countries for age-standardised death rates and life expectancy in 1990. By 2010, the UK’s relative position had worsened (Murray et al, 2013).
The performance of the UK in terms of premature mortality is persistently and significantly below the mean of other European peers, and as such, demands additional intensive activity to address this disparity. If there is to be progress in premature mortality from a number of major causes, e.g. cardiovascular diseases and cancers, this will require better public health, prevention, early intervention and treatment activities. There is also an increasing burden of disability, particularly from mental health disorders, substance misuse, musculoskeletal disorders and falls. These issues should also be given serious consideration, and they too deserve an integrated and strategic response.
Improvements across the three domains: prevention, early diagnosis and treatment, are needed if the challenge to tackle premature mortality is to succeed. Two thirds of deaths under the age of 75 years can be avoided, with approximately 80% of those being preventable (DH, 2013) predominantly as a result of enhanced public health. The interventions required often span more than one of the three domains. The primary care input, for example, spans prevention, diagnosis and treatment.
‘Critical care paramedics are an important strand in the fight to reduce mortality rates in the pre-hospital setting’
NHS Confederation (2011) noted that a number of reports have been critical of sub-standard hospital and pre-hospital care. For those patients who are seriously ill and injured, the reports have acknowledged that more lives could be saved. A common thread was noted in these reports of the need to reduce between 450 and 770 preventable deaths in England each year, and to improve patient survival rates.
The NHS Confederation (2011) report concludes that critical care paramedics are an important strand in the fight to reduce mortality rates in the pre-hospital environment. International evidence demonstrates they have an important contribution to make towards improving patient survival rates, and what they do does make a notable difference. Paramedics and critical care paramedics can make a significant difference to premature mortality when provided with an appropriate structure in which to practice. This involves competent leadership, along with a clear focus and the right skills and capabilities.
Improving the rates of early diagnosis must be seen as a priority. Action taken by those working in the primary care sector will ensure identification of the key risk factors, diagnosing illness and long-term conditions as early as possible, as well as ensuring appropriate case management of people’s conditions and risks with timely referral to the secondary care sector for further treatment. Here the role of the paramedic is significant, as they undertake brief interventions and make the most of the fact that people usually respond well to professional health advice. Paramedics are essential in identifying risk factors and early diagnosis of illnesses, ensuring that effective treatment and care can have the greatest benefit possible.
‘Paramedics are essential in identifying risk factors and early diagnosis of illnesses’
In the government’s call to action, which has the intention of inspiring and combining ideas and action from individuals and organisations across the health and care system, partners and stakeholders will be brought together over the coming months and years to assess performance in relation to the reduction in premature mortality. Paramedics and emergency care professionals should be a part of these meetings, they should be making known what their contribution will be in helping to reduce the numbers of people who are dying at too young an age.