In an age of such overwhelming change across the entire NHS, it seems there is rarely time to pause, take stock of the road we travel along, and appreciate the significance of the journey ahead. In December 2010, the Department of Health published ‘The Operating Framework for the NHS in England 2011/12’, which became operable on the 1 April 2011. Although many ambulance trusts are still wrestling to interpret the finer details of what is now required of us, there is little doubt that these new measures of performance are one of the most significant developments in the way ambulance services are measured since the inception of ORCON in the mid 1970s.
Many of us have heard and often echoed the complaint that 8 minutes is no measure of clinical performance; and it is clinical performance that should be the yardstick used to benchmark a clinical service. It is worrying that in an era of evidence based care, UK ambulance services have been mostly measured by how fast their clinicians can get to a patient, even though no robust evidence shows either an 8 or 19 minute response has any impact upon outcome for most patients (Pons et al, 2005). Interestingly however, when asked ‘what is the most important role of an ambulance service?’, roughly one third of Londoners felt it was ‘speed of response’ while only 5% felt that it was ‘treating injuries’ (Ipsos MORI, 2006). A balance must therefore be struck between the need to demonstrate high standards of clinical care, and the need to meet public expectation through a timely, yet appropriate response. Arguably, the 11 indicators relevant to ambulance trusts proposed in the new NHS Operating Framework do just this. They require ambulance services to demonstrate a portfolio of measures which focus interest upon clinical quality, while at the same time demonstrating efficient call handling, dispatch and emergency response.
This fundamental change in the way in which we are assessed is underpinned by the need to place less emphasis on process measures, and more on patient outcomes (DH, 2010), which is precisely the model that we as practicing ambulance clinicians have demanded for many years. Importantly however, along with the change in measurement, there will inevitably be a consequential shift in focus of equal intensity, meaning frontline clinicians can now expect that pressure to prove our clinical worth will be transmitted all the way from the commissioning bodies at the top (in whatever guise they may take) to each and every one of us; and what we really need to ask, is ‘are we up for the challenge?.’ For the first time ever, the clinical care that we provide to a number of patient groups will be scrutinised and reported to a national arena. Therefore, we must now step up to the plate and ensure that our practice remains evidence based, justifiable and appropriate.
Whether we feel that these new ‘clinical quality indicators’ are a sufficiently articulate proxy measure of our overall clinical acumen, is probably a debate for another day. Now, we need to actively engage with clinical performance measurement at a local level; support and nurture those amongst us who have yet to appreciate the magnitude of the challenge that lies ahead; and perhaps most importantly seize this opportunity to demonstrate that evidence and quality are as central to our practice as to that of any other clinician working in the NHS.
Paramedics in the UK are well underway with their transition from a trade to a profession, and prehospital clinical care in the country is among the best in the world. Now is the perfect opportunity for us to individually and collectively evidence the effect that our actions have on the prognosis of patients whom we encounter, and to demonstrate our capability to the wider healthcare community as the UK's core providers of emergency prehospital care. This will be a challenge but we should be confident that it is well within our capacity.