Story by HSJ full story can be viewed here - Expert review concludes NHS ‘got winter it prepared for’ | News | Health Service Journal

A new plan authored by six leading expert groups and shared exclusively with HSJ has concluded the NHS “got the winter it prepared for” and warned poor standards of urgent and emergency care has been “normalised and accepted”.

The plan, which calls for major reform of urgent and emergency care, has been jointly produced by leaders from the Royal College of Emergency Medicine, the Royal College of GPs and the Association of Ambulance Chief Executives, among others.
The proposals are being published ahead of the government’s anticipated UEC “improvement plan” for the sector which is due imminently and also comes with the NHS in the midst of yet another winter capacity crisis.

The groups conclude in the review, titled Our Urgent and Emergency Care Improvement Proposals, that poor care is being “normalised and accepted as inevitable as part of the expected annual ‘winter crisis,’” which has left staff “exhausted and demoralised” by their working conditions.

The expert groups, which also include The Patients Association, College of Paramedics and the National Association of Primary Care, say the urgent and emergency care system “remains fragmented and disjointed” and hard for patients to navigate. A joint statement on the proposed reforms adds that primary care “does not have the capacity to meet its patient demand,” the NHS is not “pro-actively” looking after the most frequent users of urgent and emergency care, and emergency departments have become “hugely congested” due to a lack of patient flow.

The centrepiece of the proposed reforms is the establishment of a “single ED service” but they also call on the government to put extra resource into primary care, by ensuring the uplift in funding it promised in 2025-26 “does translate into the ability of practices to employ more GPs”.

Other proposals include making flu vaccinations available “to a much broader group than currently defined”, subject to approval by the Joint Committee on Vaccination and Immunisation. They also include providing every older person in a high-risk group with a “full health MOT” every year, conducted by integrated neighbourhood health teams. This proposal would mark a more pro-active, community-based approach to risk assessing elderly patients – which are at greater risk of harm from long A&E waits.

The groups also say care and nursing home residents “should have the NHS delivered to them,” an approach led by GP and community teams as their first point of contacts for “most urgent care episodes,” rather than 999. They have also called for an OPEL-style national alert system for GP services to flag unsafe levels of workload.

The government’s UEC improvement plan is expected to be released by early March.

Kamila Hawthorne, chair of RCGP, said: “When general practice is properly resourced, our service can alleviate pressure across the whole of the NHS and provide cost-effective care closer to home, where patients want it. “With the right time and support we can work with patients to prevent health conditions reaching the point where emergency care is needed. This is why the college has supported the government’s aspirations to shift more care into the community – but this must be resourced appropriately.”

NHS England said: “We agree with many of these proposals to help improve care, which is precisely why, in preparing for this winter, we have focused on providing more care in the community and integrating urgent and emergency care services, alongside primary care, as well as making the most of tools like same day emergency care and care transfer hubs to boost patient flow.”
NHSE added it will “soon publish” its UEC improvement plan, which along with the awaited 10-Year Health Plan, would “deliver much-needed shifts from hospital to community and from treatment to prevention.”

We are honoured and extremely proud to announce today that His Royal Highness The Prince of Wales has become Patron of the College of Paramedics.

The patronage reflects His Royal Highness’s continued admiration and respect for the UK’s medical and emergency services community. As a former Air Ambulance Pilot who worked for East Anglian Air Ambulance from March 2015 until July 2017, the Prince has seen first-hand the unique clinical expertise, decision-making skills and versatility paramedics possess and the enormous contribution they make to our healthcare system.

During his time with East Anglian Air Ambulance, His Royal Highness piloted operational missions out of Cambridge Airport, as part of a team including specialist doctors, critical care paramedics and pilots providing emergency medical services across Bedfordshire, Cambridgeshire, Norfolk and Suffolk.

Tracy Nicholls OBE, Chief Executive of the College of Paramedics said: “We are absolutely delighted to welcome His Royal Highness The Prince of Wales as our new Patron. His remarkable achievements and unwavering commitment to the health and wellbeing of our members and all emergency service personnel align perfectly with our mission to shape the future of the paramedic profession. His unique understanding of the role paramedics play in benefiting society will be instrumental in this partnership. Having his support will undoubtedly raise the profile of our work, and that of our members, and inspire others to join us in making a difference. This is a transformative moment for the College of Paramedics, and we look forward to the exciting opportunities ahead under his patronage."

Today’s announcement comes at an exciting time for the College of Paramedics. Last February, the charity was granted the Charter of Incorporation by His Majesty King Charles III and next year the organisation will celebrate its 25^th anniversary; two key milestones in the College’s history which help reflect the rapid growth, development and value of our modern paramedic profession.

The College of Paramedics began life as the British Paramedic Association on December 14, 2001, when it was established as the professional body for paramedics in the UK. Three years later, the organisation rebranded itself the College of Paramedics and within 15 years of its inception, the College had 10,000 members. This figure has continued to grow over the years and now stands at more than 20,000 members.

Since its early days, the College has been instrumental in developing the paramedic profession and was responsible for writing the first standards of proficiency for paramedics in 2004, introducing the British Paramedic Journal, presenting the first paramedic curriculum framework in 2006, raising the threshold for entry to the Health and Care Professions Council’s register to degree status and achieving independent prescribing for paramedics. The College of Paramedics continues to work with governments and stakeholders across the UK, making sure the profession is represented and that our members have a strong voice.

Jon Price, President of the College of Paramedics said: “On behalf of all our members, it is such a privilege that HRH The Prince of Wales has agreed to serve as our Royal Patron. Given his experience as an Air Ambulance Pilot, The Prince has an in-depth knowledge and understanding of the work paramedics do and the difference they make to their patients’ lives on a daily basis. We know that his patronage will be a real moment of pride for our members, and I look forward to working together to further strengthen and support our profession.”  

Allied Health Professionals (AHPs) play a critical role in improving the health and well-being of individuals across the country. Their contributions to public health are increasingly recognised, as they embed prevention and health promotion into their daily practice. The below article is from the Allied Health Professions Federation to update on the progress and impact of the UK Allied Health Professionals (AHP) Public Health Strategic Framework (2019-2024).

The impact report of the UK Allied Health Professionals (AHP) Public Health Strategic Framework (2019-2024) was published in January and demonstrates the significant progress made by the AHP community to embed public health into practice.

The 2019-24 UK AHP Public Health Strategic Framework was the first example of a collaborative four nation professional approach to public health for allied health professionals.  It was developed by the UK nations and the AHP professional bodies to provide a vision and plan to develop the AHP role in public health, build on the evidence base, and embed the principles of public health across the AHP workforce. 

Our vision for the 2019-2024 strategy was for AHPs to improve population health; public health to be a core element of all AHP roles; and the impact of AHPs on the population’s health and reducing health inequalities to be increasingly recognised. 

Our goals were:
1. The AHP workforce will have the skills, knowledge, and behaviours to promote, improve, and protect the health and well-being of individuals, communities, and populations.
2. AHPs will be able to demonstrate their contribution to improving population-level health outcomes through robust evaluation and research. 
3. AHPs will be recognised as valuable public health experts through ongoing profile raising of the AHP contribution to public health. 
4. Effective relationships will exist between AHPs and system leaders at local and national levels to make the best use of AHPs to improve public health and reduce health inequalities. 
5. The expertise of AHPs will be used to protect and improve the health and wellbeing of the health and care workforce.

The impact report describes progress against each of these goals with some notable examples outlined below. 
● Public health pre-registration curricula guidance for AHPs published by the Council of Deans for Health
● 100% of HEIs now include public health in AHP pre-registration education.
● 31 AHPs have undertaken population health fellowships, and 12 are part of the specialist public health training programme.
● The Health and Care Professions Council (HCPC) has introduced standards relating to public health.
● Increased access to public health placements in pre-registration education
● 4 evidence reviews have been published demonstrating the impact of AHPs in public health.
● More than 80 AHP public health case studies have been published.
● Profession-specific descriptors of public health have been developed with the Royal Society for Public Health to support clinicians to understand how to embed public health in the context of their role.
● Over 25 high-impact examples of AHPs leading or contributing to public health priorities, e.g. vision screening, environmental sustainability, health inequalities, falls prevention, work, and health.

These successes are a direct result of the independent and collaborative approaches taken by AHP teams, their professional bodies, and partner organisations.

This framework represented a key step in a collaborative approach to improving public health across the UK—a journey that the AHP community is both leading and being recognised for. For this leadership role and the successes demonstrated, we want to thank the AHP community for the exceptional achievements displayed both locally and nationally. The time, energy, and individual contributions made by AHPs across the UK have brought us one step closer to building a stronger public health workforce.

We recognise that more work remains, and that prevention is one of many priorities for AHPs. We know from our recent survey, undertaken as part of the development of the new AHP public health strategic framework, that a focus on public health is important to AHPs. We are therefore committed to facilitating and supporting AHPS and their teams to continue the impactful work they have delivered, the work they are capable of, and the work they aspire to achieve.

The creation of the new 2025–2030 UK AHP Public Health Strategic Framework will support the AHP community in continuing the excellent work already demonstrated. It will enable AHPs to enhance public health, promote and implement a prevention-focused approach, and reduce health inequalities in their local communities and nationally as part of their day-to-day roles.

New data from the Association of Ambulance Chief Executives (AACE) has revealed a grim forecast for UK ambulance services, with over 20,000 incidents of violence, aggression, and abuse against ambulance staff expected in the 2024-25 financial year. This marks the highest rate ever recorded in the sector, equating to at least 55 ambulance workers being abused or attacked every single day.

Reported incidents include kicking, punching, slapping, head-butting, spitting, verbal abuse, and sexual assault, ranging from common assault to serious attacks involving weapons. However, many assaults remain unreported, meaning the true figure is likely even higher.

These concerning statistics come following the busy festive period, with AACE data indicating over 5,000 incidents are expected across December 2024, January, and February 2025 alone. December is a particularly challenging month due to the prevalence of alcohol during Christmas and New Year celebrations.

Jason Killens, AACE Chair and Chief Executive of the Welsh Ambulance Services NHS Trust, condemned the rising abuse:
“It is with huge regret that we see the level of violence, aggression and abuse across all UK ambulance services increasing and that frontline clinical employees as well as call handlers are affected. This unacceptable behaviour has a major long-term impact on the health and wellbeing of ambulance people who are simply trying to do their jobs and help save lives. This is why we are making a plea to the public to ensure that our staff are treated with the respect they deserve, especially during the busy festive period. We are also asking the judiciary to use their full powers under the Assaults on Emergency Workers Offences Act 2018 legislation to ensure appropriate sentences are handed out consistently to those found guilty of committing these crimes against our workforce.”
Killens urged the public to treat ambulance staff with the respect they deserve and called on the judiciary to enforce the Assaults on Emergency Workers (Offences) Act 2018 to hand down consistent, appropriate sentences to offenders.

Disturbing Trends in Abuse

AACE data highlights alarming increases in violence against ambulance workers over recent years:
• In 2021/22, 15,430 incidents were reported.
• This rose to 15,857 in 2022/23 and then surged by 23.8% to 19,633 in 2023/24.
• By the end of September 2024, midway through the current financial year, 11,817 incidents had already been recorded—61% of the previous year’s total—putting the sector on track to surpass 20,000 for the first time.

Alcohol remains the most significant factor in these assaults, followed by drug use and mental health crises. Disturbingly, there has also been an increase in assaults where race and sexuality are cited as aggravating factors.

Anna Parry, Managing Director of AACE, emphasized the personal toll on ambulance employees:
“These new figures highlight the upsetting fact that ambulance employees face the very real possibility of being subject to violence or abuse each time they start a shift. This can have a significant and lasting impact on wellbeing and sometimes even lead to people leaving the ambulance service. Our ongoing #WorkWithoutFear campaign is shining a light on this alarming issue and raising awareness of the negative impact of this behaviour on our people, while a significant amount of work is ongoing within ambulance services to help better protect our workforce.”

Steps to Protect Ambulance Staff

In response to the escalation in violence, UK ambulance services are implementing various initiatives alongside the #WorkWithoutFear campaign to reduce the frequency of assaults and support those affected. These measures include:

• Dedicated violence prevention teams established within each NHS ambulance service. 
• Body worn video cameras being piloted and evaluated in all NHS ambulance services. 
• The establishment of a centrally coordinated violence dataset that enables each ambulance service to report the type and frequency of assaults in a more consistent way, giving a greater foundation and better understanding of the prevalence and reasons behind violence and aggression directed at ambulance people. 
• A successful ‘restrictive interventions’ training programme giving ambulance people safer ways to protect themselves and patients in potentially volatile situations. 
• Counselling and other forms of talking therapy and support for employees who have been subjected to violence and aggression; the sector continues to work hard to find new and innovative ways to provide better post-incident support for its people. 

The public can show their support for ambulance staff by using and sharing #WorkWithoutFear on social media and learning more at www.aace.org.uk/vaa.


Richard Webber Highlights the Issue on BBC Breakfast

Richard Webber from the College of Paramedics appeared on BBC Breakfast on Sunday, 5th January 2025, to discuss these alarming figures and highlight the impact of violence on ambulance staff. During the interview, Webber urged the public to reflect on the harm such behaviour causes to those dedicated to saving lives and emphasized the importance of respecting emergency service workers – as it is “simply unacceptable”.

 

On Saturday the 4th of January, at 8:11am, Tracy Nicholls OBE, Chief Executive of the College of Paramedics, appeared on BBC Radio 4’s Today programme to discuss the immense pressures facing paramedics on the frontline.
 
The interview shed light on the challenges posed by ongoing critical incidents declared across hospitals and trusts, an incoming cold snap, and a surge in flu cases leading to increased hospital admissions. Tracy provided a candid insight into the current realities for paramedics and the impact on patient care.
 
Listeners were given an understanding of what to expect in the coming days, as Tracy emphasised the strain on emergency services during this difficult period. The College of Paramedics continues to advocate for the wellbeing of paramedics and the essential support needed for them to deliver care under such challenging conditions.
 
For those who missed the interview, it’s available to listen to on BBC Sounds - it starts at 1:11:01 into the programme.
 
https://www.bbc.co.uk/sounds/play/m0026mvz

On Monday 2nd of December, the College submitted our response to the UK Government’s 10 Year Health Plan Consultation, contributing to Change NHS: help build a health service fit for the future 

Over 230 members responded to our survey about the consultation, and we also met with members during online engagement sessions to talk in more detail about the ambition to reform the NHS in England. Thank you to everyone who shared thoughts and experiences with us, which have been used to form our response.

This is just the start of our involvement with Change NHS, we will keep up you up to date and involved along the way.

Click here to read our response

Paramedics are often required rapidly to form a team in a high stakes situation such as response to a cardiac arrest. The team may include those we have never before worked with, or even those we would rather not work with…but to achieve a good outcome for the patient, we must work through the challenges and be the best team we can be. The College of Paramedics, in collaboration with e-Learning for Healthcare and Dynamic Business services, has created a unique e-learning session which allows you to immerse yourself in the dynamics of a team coming together to manage a sudden cardiac arrest, overcoming differences and distractions to work together effectively. 
 
Human factors: Management of a Sudden Cardiac Arrest is available now at https://portal.e-lfh.org.uk/Component/Details/844116. It can be worked through on any computer or mobile device, or as a fully immersive experience, if you have access to a virtual reality headset.

If you are new to e-Learning for Healthcare, create your account here http://support.e-lfh.org.uk/get-started/registration. If you do not have one of the recognised email suffixes such as .nhs.uk or .ac.uk, please see guidance here on how College Members can create an account. If you need further support please email education@collegeofparamedics.co.uk  

The College of Paramedics has today signed the Armed Forces Covenant at the Military Paramedics Symposium, held at Defence Medical Services (DMS) Whittington, Staffordshire.
 
The event was attended by guests including Lewis Andrews, Chief Operating Officer for the College of Paramedics, Sarah Hayward, Paramedic Defence Specialist Advisor on behalf of the Armed Forces and Ben Lyon who instigated the signing in his role as the College’s Member Representative for Military and Overseas. 

The Armed Forces Covenant embodies a promise to uphold fairness and respect for those who have served in the Armed Forces, as well as their families, in all aspects of society. 

It focuses on helping members of the Armed Forces community have the same support as any other citizen, spanning education, housing, careers, access to healthcare, financial assistance and more. 

By taking the significant step of signing the Covenant, the College of Paramedics has made a commitment to providing fair treatment for veterans, serving personnel, reservists and their families and to ensure that they are treated with fairness and respect in their communities, workplace and society for which they serve with their lives. 

The Covenant’s core principles recognise the unique obligations and sacrifices made by the Armed Forces. 

At today’s signing, the College made a number of pledges, including to: 

Prioritise the mental health and well-being of Armed Forces personnel, veterans, and their families. 

Support all members of the Armed Forces community and their families where appropriate with employment opportunities, signpost and offer advice to personnel who are
transitioning from full time service into the civilian sector and collaborate with Reserve organisations to aid the employability of our members. 

Provide advice and advocate for Armed Forces personnel, veterans and their familiars on how to progress within the paramedic profession and assist with helping individuals reach their career goals. 

Lewis Andrews, Chief Operating Officer for the College of Paramedics said: “We are immensely proud to have signed the Armed Forces Covenant today. As an organisation, the College recognises the sacrifices made by those in the Armed Forces and the immeasurable value military personnel, reservists, veterans, and their families bring to the healthcare profession and to the wider country. It’s the reason we are committed to ensuring their needs are recognised and met when it comes to healthcare, mental health support, employment opportunities, education and representation. We will always strive to do everything we can for our Armed Forces community, knowing this is what they do for us.” 

Speaking on behalf of the Armed Forces, Sarah Hayward, Paramedic Defence Specialist Advisor said: “The aim of both the DMS and the College of Paramedics is to deliver the highest level of healthcare to our service users. Today’s pledge from the College allows us to feel valued and recognised in the unique working environments we find ourselves in. This enables our people to feel validated as paramedics, and nurtures interoperability, shared ways of working and inclusion in the progression and development of healthcare delivery. A shared mental model allows reassurance that we are seen and supported. It will only serve to strengthen the relationship between the DMS and the College of Paramedics and will have a positive impact on the delivery of care throughout Defence and beyond.” 

Ben Lyon, College of Paramedics’ Member Representative for Military and Overseas said: “I’m delighted that the College has signed the Covenant because it shows to all serving members of the Armed Forces, paramedic or not, that the College, as an organisation proactively considers the military community in its day-to-day business. It is also a legally recognised commitment that we have to maintain.” 

Ben added: “From a personal point of view, I am really proud of my involvement in helping to make this happen. As the first Royal Marine to hold the post of Military and Overseas Rep I wanted to do something that would make a significant and lasting difference, not only for the College but for all serving and future military paramedics, and I think this commitment does that.” 

Since 2011, when the concept was enshrined into law, the Covenant has reinforced the moral obligation between nation, government and the Armed Forces and seen more than 12,000 UK businesses and organisations commit to improving the lives of service personnel and their families.

The College of Paramedics would like to offer its warmest congratulations to three of our members – Jo Mildenhall, Ashley Hanson and Vinny Romano - who each received the prestigious Churchill Fellowship medallion at an awards ceremony in London last week.



A Churchill Fellowship is a once-in-a-lifetime opportunity, open to all UK adult citizens, to lead the change they want to see. The charity funds applicants to spend between four to eight weeks meeting experts in their field anywhere in the world, in person and/or online, building international networks that promote reciprocal knowledge exchange. It then helps Fellows to make a difference in their community or professional sector in the UK, based on insights inspired by these exchanges. 

A community of over 4,000 change-makers, Churchill Fellows work on the frontline of today’s crucial issues, developing new solutions based on global research and personal expertise. From every corner of all four nations, Churchill Fellows have achieved amazing things, from becoming community leaders and charity founders to embedding new services and campaigning for action in fields from climate change to education, technology to the arts.

Jeremy Soames, grandson of the late Sir Winston Churchill and Chair of the Churchill Fellowship, said: "We were delighted to celebrate the outstanding achievements of Churchill Fellows at our 2024 Award Ceremony. The occasion marked the successful completion of 122 Fellows' international research and reports, forming an impressively substantial body of work. More importantly, it illustrates the significant impact being made in communities and sectors through the ideas, dedication, and energy that are hallmarks of every Churchill Fellow - many congratulations to all recipients. There is no doubt that the Churchill Fellowship owes its success to the remarkable work of Churchill Fellows."

Here, Jo, Ashley and Vinny tell us how they became Churchill Fellows and what it means to them. 

Jo Mildenhall, Paramedic Psychological Health & Wellbeing Manager for the College of Paramedics

Why you were given a Churchill Fellowship? My passion and advocation for ambulance staff and paramedic psychological wellbeing started 25 years ago when, after one particular incident - a rail crash – I became aware that there was little to no understanding of the psychological impact that working within the field of paramedicine can have, particularly after attending a critical incident such as this. Fast forward two decades, and we still face many challenges in terms of the psychological health of ambulance personnel. My strong passion for improving psychological welfare and support for ambulance staff has continued, however, and I applied for this Fellowship to learn from countries which are considered world-leading in this area. Considerable research has, and continues to be, undertaken within Australia and New Zealand to explore and understand our psychological being within the context of emergency occupations and I wanted to learn from their expertise and from the evidence-based strategies and policies that have been implemented and how this has translated into real-world practice, interventions and supports. Fortunately, after a tough application process, I was over the moon to be awarded a Churchill Fellowship to enable this research trip to occur. 

The work you did to achieve it: I visited Australia and New Zealand for two months, travelling around both countries to meet with colleagues from ambulance services, responder mental health charities, universities, policing, and our colleagues at the Australasian College of Paramedicine to find out more about how ambulance staff and paramedics are supported with their psychological wellbeing in terms of informal supports, peer support, clinical psychology, and wellbeing policy. I was very fortunate to be able to spend time, not only with senior leaders and academics but also experts by experience - our colleagues working on the frontline. I even undertook a few third manning shifts in Auckland and Melbourne!

What does the Churchill Fellowship mean to you? Being awarded a Churchill Fellowship is a huge privilege; a once-in-a-lifetime opportunity to travel to explore and learn from leading experts about an area that you are so passionate about. Now that this part of my fellowship is complete, I feel proud to be able to call myself a Churchill Fellow and know that I am part of a community of inspiring change-makers. 

Ashley Hanson, Senior Clinical Research Practitioner, Royal Devon University Hospitals NHS FT - Northen Services

Why were you given a Churchill Fellowship? At the time I applied for the Fellowship I was a lecturer at Canterbury Christ Church University in Medway. As my students approached graduation, they all found that there was a 'gap' between their time as a student and their role as a practising paramedic and for many, this instilled a sense of panic and anxiety. For a lot of students, this sensation has only been heightened in recent times because of the pandemic. The purpose of my Fellowship was to investigate ways to 'close' this gap, to ensure that the future paramedics we bring into the workforce are set up to achieve and excel in their chosen careers, and that our curriculum is aligned to the needs of the changing pre-hospital workforce. 

The work you did to achieve it: I travelled to Australia for eight weeks to investigate some of the work-readiness initiatives in place to support students transitioning to newly qualified paramedics and to see if some of these changes could be brought back to the UK to be implemented.

What does the Churchill Fellowship mean to you? It’s an opportunity to share something I am passionate about with like-minded individuals on the other side of the planet. The power of "chance encounters" and the doors that opened up as a result of being a Fellow were amazing.

Vinny Romano, Consultant Paramedic for Education at North West Ambulance Service and Director for TRiM Training and Consultancy

Why were you given a Churchill Fellowship? In 2016, I began to recognise the lack of mental health support available to frontline emergency workers in the ambulance service following attendance at a difficult incident. I had a number of close colleagues die due to suicide and others who had to leave the service due to the effect on their mental health. This prompted me to embark on a journey of research to seek out options available to provide mental health support. 

The work you did to achieve it: Having seen the importance of supporting emergency workers, I was keen to ensure an awareness of the different strategies used. To make the most of my Fellowship I travelled to the USA, as the way their emergency ambulance service is organised means you can visit a number of different organisations in a small area. I split my trip into two legs – East and West Coast of America - in order to visit the maximum number of areas. I worked and met with a number of private and public ambulance providers, Fire Departments, and universities to discuss how responders are supported following their attendance at critical incidents. The Churchill Fellowship allowed me to meet and work with responders who wouldn't normally be accessible and have honest conversations about their mental health and wellbeing. I also witnessed different tools being used and have since shared these ideas with UK stakeholders within the ambulance world.

What does the Churchill Fellowship mean to you? I spent a great deal of time producing my report and it is very satisfying having now completed it. I will always have the report to look back fondly on as a record of my achievement. It was such an honour being invited to the awards ceremony in London and a real moment of personal pride receiving my medallion. 

** Applications to become a Churchill Fellow are now open until November 12, 2024. To find out more please go to The application form (churchillfellowship.org) Churchill Fellowships are open to all adult UK citizens, regardless of qualifications, background or age.