Ambulances no longer sent to all seriously ill patients

The obvious angle for comment on the recent Daily Telegraph story, ‘Ambulances no longer sent to all seriously ill patients‘ is that targets are damaging patient care and causing ambulance services to cut corners by sending paramedic cars to patients who really need an ambulance.

But this has been covered in previous posts (here, here and here) and actually the more interesting point is hidden near the end of the article.This is a hint that health care is a system.

Ambulance bosses are desperately trying to find ways to cope with rising demand for emergency services, with the number of calls increasing by more than 250,000 a year amid failings in GP out-of-hour services.

For years the UK health care has been treated as pockets of services that don’t link up. This is just another example. As general practitioners (GPs) are providing less and less out-of-hours service so the slack is being taken up by the ambulance service. The ambulance services react to this and the fact that they still have the same old targets, by changing the type of response, even though this response may not be appropriate for the patient. This isn’t the fault of the ambulance service neither are the GPs to blame. The problem is that nobody is viewing health provision as a system.

In theory the Strategic Health Authority (SHA) is supposed to do this along with the Primary Care Trusts (PCTs). But in reality, the SHAs are too far from the action and the PCTs are driven by the commissioning process to consider cost of provision before they think about linking services together to serve the health demand.

The story in the Telegraph criticises the Department of Health’s Emergency Call Prioritisation Group, but really what needs to happen is that this group is disbanded so no-one can tell local ambulance trusts how to deal with the calls in their area. Instead, ambulance trusts need to co-ordinate with their PCT, GPs and acute trusts to understand the local demand and have vehicles and staff and skills to meet that demand.

Local understanding of and responses to local demand are the answer to this problem, not better decisions by a group in central government.

Best,

Rob