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30-Nov-2018

 

We want your views on our proposed clinical response model

The Northern Ireland Ambulance Service are currently undertaking a public consultation on the way in which they respond to emergency calls. In our blog this week Brian McNeill, Director of Operations at NIAS, tells us how these proposed changes will be the most radical development in the way they deliver services in the last 20 years – and why they need to hear your views.

At the Northern Ireland Ambulance Service we aim to provide safe, effective, high-quality, patient-focused pre-hospital care and services to improve health and wellbeing by preserving life, preventing deterioration and promoting recovery.  The proposed changes on how we respond to emergencies will be the most radical development in the way we deliver our services for 20 years.

So why do we need to change?  First of all, our current emergency response model is no longer sustainable or fit for purpose.  It was introduced in the mid-1970s, a time when healthcare was very different from today.Demand for our services significantly exceeds capacity, with the number of ambulance responses dispatched to calls increasing by 50% over the last five years.  This has resulted in many people having to wait longer for ambulances, with response times increasing year on year, and falling well below the targets set for us.

The current operating model results in the rapid dispatch of multiple resources to a large number of patients whose clinical condition may not warrant that level of response.  About 30% of our patients are categorised as requiring an 8 minute response, when emergent evidence demonstrates that fewer than 7% require a response that quickly.

The proposed new clinical response model is about making sure the best, high quality, most appropriate response is provided for each patient first time.  Patients with the most serious life-threatening conditions will get the most immediate response, while those whose condition is less urgent will benefit from a response appropriate to their needs.  This will enable us to direct our resources in the most clinically appropriate way to best meet the needs of all patients.  The outcome will be a clinical response model in which we provide an 8 minute response to the patients whose clinical condition actually requires that level of response.

It is important to point out that this is a clinically safe model that has been ‘tried and tested’ in NHS England with over 14million 999 calls having gone through this new way of working.

The Ambulance Service story has been one of constant evolution and improvement. When I joined, we were, in essence, a first aid and transport service. During my time here I have worked in a range of frontline and management roles and throughout   the service we provide has grown, adapting to advances in medical technology, an increase in demand and changes in our service users’ expectations.  We were tested to the extreme during the Troubles, introduced paramedics in the late 1980s, and became a regional service in the mid-1990s.  We have reviewed and modernised our service over the years, introducing new radio and mobile data technology in 2000 and, more recently, we have introduced a series of pathways which mean that we can refer patients to the most appropriate source of care, along with piloting paramedics working in rural communities. I very much believe that the proposed new clinical response model will build on these foundations and provide us with an Ambulance Service fit for the 21st century.

So far during the consultation, we have engaged with a range of individuals and organisations with an interest in the services we provide, including meetings with Local Commissioning Groups, but it is important that we hear your views.The consultation document and details about how you can respond are on our website at: http://www.nias.hscni.net/nias-launch-12-week-consultation-on-new-clinical-response-model/

I hope you will take the opportunity to let us know what you think about the proposals.

Brian McNeill
Director of Operations
Northern Ireland Ambulance Service Health and Social Care Trust

 
 
 

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Previous comments ...

charlie lynn 07-Dec-2018 at 19:06 hrs

Hello everyone, I have been trying to send this comment since last week but I seem to be having a problem with my laptop.
I just wanted to say that I think it's a good idea to ask some questions when someone calls a ambulance as there is probably some times people call a ambulance when they could make their own way to the hospital by taxi, bus etc.
Charlie.

 
 

Anthony Brady 05-Dec-2018 at 10:08 hrs

This is a truly excellent Public Consultation Document on the Northern Ireland Ambulance Service (NIAS). I have read all 93 pages and compliment the authors on every aspect of it. The analysis of the available historical service material and the planned forward radical strategic is phenomenal.
I have been a regular contributor to the local Health Trusts Public Consultation Documents, during the 20 years I lived in Fermanagh. The result was most input, provided among that of other members of the public, was ignored and public hopes dashed. So long as the poison of cuts, savings, efficiencies, exponential under resourcing, huge bonuses to Principal Trust executives continues to infect the credibility of users, I see little chance of any informed user taking Public Consultation seriously. Even so, this Service is so essential and crucial, I can only support it wholeheartedly and offer encouragement to its range and breadth and those that will take it forward into practice..
In August 2016, when I suggested that my impaired walking ability was caused by years of statin’s use, the Consultant Cardiologist, merely by looking said: “You have progressive deteriorating disease of the spinal cord”. Adding that “No neurological treatment is available.” My GP soon confirmed that, by informing me my condition was due to old age.
In N.I. At 77, I was written off as aged, diabetic, with suspected Parkinson’s Disease and very low priority against neurological help for the N.I. priorities are: road accidents, work related injuries and people involved in external and internal conflict zones. Fair enough.

I was forced to take drastic action to obtain better life chances that living in N. I. denied me. I moved to Germany in November 2017. I could no longer tolerate the deceptions visited on, not just me, but others, by the providers of health and social services services in rural areas. As one doctor put it: “If you want the wealthy, quiet, peaceful rural life and a reliable health service – this is not for you.” I will not attempt to compare and contrast the health services of the two European States. It would be unfair as (like-for-like) is not possible.
Now, in December 2018, my Diabetes Type 2 is almost reversed: the lowest cholesterol and sugar parameters ever. I have been comprehensively assessed by a Consultant Neurologist who eliminated Parkinson’s as significant. A ten year-long growth of rogue bone on a lumbar verterbra, impeding the main leg nerve, was identified.. I am currently recovery from the micro surgery after 9 days in hospital less than a mile from my accommodation. Physiotherapy? 10 sessions @ 2 per week are prescribed in a suite just yards away. The service is free and there is no public concern about the health service funding.
There are 3 ambulance services in Germany: The Red Cross, St. John of Malta and private - but not exclusively so, ambulance services, which supplement the other two in major incidents. I have had published over 50 letters on topical local health concerns in The Fermanagh Herald & The Impartial Reporter since 2000.
With an extensive background in Nursing and Social work in London before N.I. - I offered my service to all the 4 health boards: was shortlisted but refused to sign up to their cuts etc, culture.
I have practical experience of the emergency ambulance service on average about once a year over the past 20 years: my multi disabled and mentally ill son mainly, who lives in permanent residential care. My wife of over 50 years married to me, has Dementia and is currently in the Enniskillen SWAH for a suspected brain tumour. She was a user of NIAS on this occasion for the first time.
AJMB
December,2018

 
 

charlie lynn 03-Dec-2018 at 19:01 hrs

Hello, I think asking a few questions when someone calls a ambulance is a good idea as there is probably a percentage of people that call for a ambulance that need the service at all.
Charlie.

 
 

Barbara Midrash 01-Dec-2018 at 12:02 hrs

My very real concerns in todays climate of criminalising chronically ill, disabled, deaf and older people:
As a disabled wheelchair user it is already difficult on the few occasions when an ambulance has had to be called for a GENUINE emergency. They were not permitted to take my powered chair. My suffering was extended when the hard hearted folk at the depot would not be reasonable. Thankfully the dedicated ambulance men found a solution. It put my life at risk as i had to wait an extra couple of hours in chronic pain and discomfort. These new rules will mean that £5,000 chair would be discarded at the side of the road leaving me with no way to get about. Or I will be triaged as not worth the hassle and deleted or kept at the bottom of the list. let me die. Also what if someone is a certain age eg over 70 they may be triaged as not urgent even if in heart failure...

 
 

Robert HEDLEY 01-Dec-2018 at 06:52 hrs

8 minute priority emergency call - 10/10
Do you have a well tested procedure for prioritizing your calls?
Would you consider a compulsory charge for all ambulance calls? Refundable to genuine calls and chargeable to all others? Cuts out the scroungers and time wasters.

 
 

Patricia Mason 01-Dec-2018 at 01:28 hrs

Advocating for from a mental health perspective I truly believe that the interagency model needs to be pushed forward after the pilot scheme is introduced . This is a must for all trusts and should be driven by a Ministerial agenga to the zero suicide policy !!!!
From a personal perspective spending 6 + hours to speak to the on call Psych team for assessment in an A & E environment only adds to excel anxiety levels of a very vunerable individual who needs expert intervention to help deminish their erge to complete sucide at that moment in time .
A& E are already stretched to capacity on physical issues and trauma therefore I believe a singular mental health assessment unit should be incorporated into that environment
of all trust emergency depts . Which would involve and incorporate specialist trained interagency staff who would work torwards treating psychological needs on par with the physical needs of the rest of emergency care .

 
 

Peter Black 01-Dec-2018 at 00:17 hrs

Great way to get feedback on asking the public what they need.
Several items to consider on the new way the NIAS hope to go forward.
Why do GPs do an over the phone diagnosis on a patient they have not visited and actually seen and taken the appropriate Clinical observations but just tell either the patient or realative to call an Ambulance, based on on what the patient tells the doctor it could be a totally inaccurate clinical call sent to NIAS controller who sends either an RRV or Frontline Ambulance to a completely none Emergeny call ,thereby depriving a proper Emergency response to a patient in dire need of an Emergency response.
Why can't GPs or Distruct Nurses put in lines at nursing homes etc for simple dehydration patients? Or replace pegs etc instead of having a patient go to ED tying up an Ambulance ,ED staff,Booking in clerks ,an ED Doctor and the patient is sorted in less than 15 mins and then has to wait hours for a return Ambulance back to where they came often 50 plus miles in some cases by Private sector Ambulances!
Private sector Ambulances should ONLY do PCS PTS work and should not be used for Doctors Urgent calls, which should be undertaken solely NIAS trained EMTs.

 
 

Mr D..Clarke 30-Nov-2018 at 21:59 hrs

The proposals are good in theory. Better public education on how to use the service should be considered. This should also apply to other health professionals to ensure they do not misuse the service. This service appears to have a poor track record of failing to look after its staff ( greatest asset) who would be essential in delivering a new model. ( remember the strike of 2014. Only service in the uk to have most of its staff threatening to strike on duty). I doubt the management of this service can be trusted to deliver these changes in a fair, professional manner.

 
 

Wm Ellison 30-Nov-2018 at 20:37 hrs

I have just watched two paramedic staggered a call in a neighbouring block of flats. After 10 mins the by emerged with a male in his 30s, walking and making them wait while he finished his cigarette before getting into the ambulance. I gather from the above this is not uncommon. I can see the need for change, but please don't make it just another money saving exercise...

 
 

charlie lynn 30-Nov-2018 at 19:51 hrs

Hello, I think it's a good idea to ask the questions mentioned as it could save the NHS money. This will let the ambulance service know who is in most need. Many people could make their own way to hospital by bus, taxi etc.
Charlie.

 
 

MARIA DENVIR 30-Nov-2018 at 19:25 hrs

I believe that often advice would suffice emergency calls.It is important that the operator is from a medical background or has medical knowledge.Often if patient can speak to the Dr the incident can be sorted out right away The danger is that operators might not realise the possible seriousness of the condition and a patient is put in danger

 
 

Paul Bloomer 30-Nov-2018 at 18:56 hrs

The comparison to the English model is not encouraging as it has been shown not to always function well. I do how ever understand that there is a definite need for change. It would be important to see that call staff would be well trained as they would need to be able to give the appropriate response.

 
 

Roberta England 30-Nov-2018 at 17:33 hrs

I totally agree with proposals. Having had to call out ambulance personnel a number of times for my mother and myself, we have always received good service. I can only wish you all well as you try to deliver an excellent service, sometimes despite very trying circumstances. We just don't pay you enough!!

 
 

Ursula Mc Aleer 30-Nov-2018 at 15:36 hrs

I have experience to be in a ambulance a lot in the last few years I never meet as nicer you could meet and so caring well dine