The significance of the Keogh Review

Sir Bruce Keogh's report on the first stage of his review into urgent and emergency care (NHS England, 2013), published 13 November 2013, presents a significant step in the progression of the paramedic profession.

Along with the introduction of a two-tier A&E system as part of a fundamental shift in the provision of urgent care, the NHS England Medical Director has called for the development of 999 ambulance services so that they become mobile urgent treatment services, noting that paramedics now have the skills that would only be done by doctors 10 years ago. The suggested change comes in a letter to Health Secretary, Jeremy Hunt, and NHS England Chair, Sir Malcolm Grant, where Sir Bruce says:

‘Our vision is simple. Firstly, for those people with urgent but non life-threatening needs we must provide highly responsive, effective and personalised services outside of hospital. These services should deliver care in or as close to people's homes as possible, minimising disruption and inconvenience for patients and their families’ (NHS England, 2013).