Winter of 2016–17 saw a record number of ambulances being turned away by Accident and Emergency (A&E) departments due to overcrowding. Unsurprisingly, this had a knock-on effect on the emergency service response times. Attending to patients turned away by A&E for longer periods of time meant that other patients in need of emergency care were left waiting for an ambulance. Around 12% of the serious Category A emergency calls did not meet the response time target of 19 minutes this winter.
As rightly highlighted by the College of Paramedics, ‘diverts’ from hospitals due to rising demands and a lack of staff have a pronounced impact on emergency services in rural areas. Hospitals that ambulances are redirected to are often far away, and time that could be spent in providing advanced medical care is spent in transport – a situation unconducive to best outcome for the patient or the professionals. Paramedics may not be able, trained or authorised to provide advanced medical care if a dangerous health condition worsens during transport. Moreover, these diverts and resultant delays in responding to emergencies have put the Ambulance Service under great pressure.
The Nuffield Trust also reports that morale among paramedics is lower than in staff members working for other NHS sectors. It can be argued that pilots of community paramedicine show promise of easing the A&E burden, which could improve emergency service's response times. However, this self-surgery by paramedics will do little to lessen the burden on the profession. Taking stock of the overall scenario, it is easy to point fingers at the Government; to (perhaps correctly) demand greater investments to the service; but it is also important to stress the responsible use of emergency services.
It will be unwise to only talk of strengthening provision of care without addressing sensible use of care by its beneficiaries. Issues like unnecessary 999 calls and resources directed to deal with drunk patients frequently surface the news. We need continued efforts to make the public aware of correct services to call in a non-emergency setting. Minimising waste of emergency resources could prove as efficient a measure as more funding for paramedicine.
We often talk about the evolution of paramedicine from a transport-only profession to one providing expert emergency healthcare over the last five decades. It is key to ensure that overcrowded systems and irresponsible use do not revert the Ambulance Service into transporters or turn them into patient-sitters in the coming years.