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.
In January 2019, the NHS revealed its Long Term Plan for how the Service plans to address the issues that plague health care in the UK, over the next 10 years (NHS, 2019a). It prioritises chronic conditions such as respiratory disease, diabetes, stroke, cardiovascular disease and mental illness. It promises not only training and equipment for ambulance staff to respond effectively to people in a crisis—but also mental health transport vehicles to reduce inappropriate conveyance to A&E, and plans to bring mental health nurses into ambulance control rooms to increase staff competency through education and training, and improve triage and response to mental health calls.
It also highlights how respiratory conditions contribute to winter pressures and how inappropriate admissions to hospital can be reduced through an improved response, consistent use and application of risk scoring, and support for the provision of safe out-of-hospital care. The main proposals related to respiratory disease are to improve diagnosis, provide better training for those delivering respiratory care, increase the uptake and availability of pulmonary rehabilitation and, importantly, to provide more appropriately-resourced respiratory care closer to home for patients (Baxter, 2019).
The Plan importantly favours multidisciplinary collaboration and joined-up working to increase efficiency of resources and taxpayer money, and reduce pressure on hospital beds while providing quality care to people as close to home as possible. An emphasis on patient self-care and self-management also features in the Plan, with an intention to support patient empowerment and convenience by maximising use of digital technology, which should begin the much-needed process of modernising the Service.
A case study on the dispatch of community first responders to patient falls without injury demonstrates a reduced impact on ambulance capacity while getting help to patients faster and allowing them to remain at home. South Central Ambulance Service receives in excess of 65 000 falls calls a year; making use of community first responders has meant that 75% of these patients have not had to be taken to hospital, and that ambulance crews have been freed up to attend more emergencies (NHS, 2019b).
The Plan also devotes a section to prehospital urgent care and in addition to plans for a multidisciplinary Clinical Assessment Service (CAS) and full implementation of the Urgent Treatment Centre model by autumn 2020, it offers support to eliminate hospital handover delay and increase ambulance capability to respond to terrorism. Encouragingly, urgent treatment centres are now growing far faster than A&E attendances (NHS, 2019a)—so perhaps there is light at the end of the tunnel?