The monthly release of the Ambulance Service performance data usually means a busy time for the College of Paramedics in terms of press and media enquiries. One look at our Press Engagement webpage shows that we have been commenting on ambulance pressure for many months now. July 2022 has been no exception to this. In the days following the release our team of Comms Spokespeople responded to over 15 media requests, which included live interviews on BBC Breakfast, Channel 5 News, BBC News Channel, Sky News and a range of live radio broadcast around the UK. Tracy Nicholls, our Chief Executive also appeared on Newsnight, speaking about the BBC investigation into concerns ambulance services in some areas are on 'the fringe of collapse' amidst rising hospital delays. This is available to watch on BBC iPlayer here.  


The College of Paramedics would like to take this moment to acknowledge the unabating and relentless challenge that is being seen and felt within the Emergency and Urgent Care system associated with the delays in Ambulance to Emergency Department patient handover. We would also like to acknowledge the detrimental effect that this can have on the wellbeing of paramedics and our ambulance colleagues. Arriving at patients who have deteriorated, and people who have died because of the delay in the time it’s taken an ambulance to get there can bring about feelings of guilt and the burden of this can build over time. We will continue to offer a range of psychological support offerings to our members, a short mental health work update video can be watched here, and we will continue to support The Ambulance Staff Charity.   


The College of Paramedics will continue to push hard and lobby alongside our professional body and healthcare colleagues in the hope that the emotive words and appalling truths in the headlines will instigate some real change that makes a positive difference to paramedics working lives, the care that they can provide to the public and the ambulance sectors capacity to deliver a safe and effective service to those in the most need.   


We have recently offered our membership an opportunity to write to their local MPs using a template provided, to raise with them the concerning ambulance delay issues prior to a House of Commons, Westminster Hall debate on the subject on the 6th July. Read more here. 

 
In June 2022 our Chief Executive, Tracy Nicholls wrote to the (past) Secretary of State for Health and Social Care, Sajid Javid MP to clearly outline the crisis, the grave consequences of not responding adequately and to offer our support to work towards solutions to strengthen the NHS and our profession to support patients, and to resolve the untenable situation we currently face in urgent and emergency care.  As Sajid Javid then resigned his position, a further letter was sent to Steve Barclay MP, the new Secretary of State for Health and Social Care. Tracy also wrote to Amanda Pritchard, Chief Executive of NHS England to outline that paramedics have much to offer in terms of solutions for releasing some of the pressure on the NHS, and that these solutions do not depend on working for the ambulance sector. 

Tracy Nicholls also joined with Professor Martin Marshall, Chair of Council, Royal College of General Practitioners to write again to the Home Office and the Secretary of State for Health and Social to press for urgent action regarding the intolerably long delay to the request that the legislation to allow paramedic independent prescribing of controlled drugs be laid before parliament as a matter of priority. We await a response but were delighted to have had the support of the RCGP in this matter. Since the recent resignation of the Secretary of State for Health and Social Care, we have resent the letter to the new SoSHSC, Steve Barclay MP. Read the letter here.  
  

Blogs

We have published two new blogs relating to the subject of ambulance delays, Ambulance Pressures Today and Everyday by Liz Harris, our Head of Professional Standards and Retention in the world of Frontline Ambulance Staff, by Carl Betts, Paramedic, Yorkshire Ambulance Service. Our Blog page can be found here.  

Letters to the College

The College of Paramedics always welcomes communication from members and so we have decided to try a new feature in our INSIGHT magazine, called ‘Letters to the College’. This will allow us the opportunity to share with all our members the communications that we receive, particularly the ones where we feel there is a strength of opinion amongst the membership. The aim of this feature is to give our members a voice, and to give the College an opportunity to outline work that is ongoing or actions that are being taken in relation to the specific subjects raised by members.     

The first letter in this feature is from Andy Greenaway, a newly qualified paramedic and Community Responder Liaison Officer with South Western Ambulance Service. His letter, A Paramedics View on the horrendous situation outside ED departments, is included in full here also.  

A Paramedics View on the horrendous situation outside ED departments.  

Over the last several months we have seen holding times at emergency departments here in Plymouth and Truro gradually increase. It’s not unusual for ambulance to hold for many hours. The impact this is having on crews seems to be going unnoticed by Ambulance Service Management, Government, The HCPC, The College of Paramedic and Unions with no one prepared to address the situation or offer a solution. 

We have all been told its ‘’GP services, bed blocking, social services, staffing and of course the aftermath of Covid 19’’. So, while all this is being debated the impact on those on the front line seems to have been overlooked. 

I think its fair to say morel at my station is at a low point, with many paramedics leaving or looking to leave and move into the primary care sector or leave altogether. Those that are still here are at a point where they dread coming to work and except this situation as the new normal. A typical day or night shift now consists of being sent to ED at the start to relieve a crew so they can finish only a little late unless of course they still have a long drive back to their base station. Sometimes crews are split so Emergency Care Assistant are given patients to oversee without the care of a paramedic which seems wrong for many reasons. 

If your lucky you will hand the patient over quickly and get on the road, if you’re not so lucky you’ll spend the entire shift attending a patient that should be in the ED. This means developing a whole new skill set. ie constant reassurance that everything is being done to get the patient into the department, long term management of pain relief and regular medication, providing refreshments. If a consult has seen the patient in the ambulance and prescribed drugs then administering those drugs. Conveying patients to the loo or for a scan/x-ray and back to the ambulance. Regular observation and patient comfort. Ambulances and ambulance stretchers and not designed for long lies.  

The hidden impact of this on front line crews is yet to be fully recognised and manifests in different ways. There are those that take out frustrations on nursing staff, HALO and those that constantly moan and do everything they can to avoid ED to the point of perhaps making unwise decisions with patient care. Then others that except ‘’ED shifts, working in a corridor taking obs and reporting deterioration to nursing staff. Ending their shift completely deflated and depressed with the whole situation. Saying nothing just dreading the next shift. Not to mention the others off sick simply because they can’t do the job they love. 

And what of skill fade? When was the last time we attended a difficult trauma or in-depth assessment, managing that difficult airway or tricky cannulation? This is possibly even more poignant for New qualified Paramedics. Paramedic students whether full time or working are just not getting the exposure and experience they need. Where will this leave their confidence and abilities when qualifying? 

In conclusion the effects of this is impacting hugely on the mantle health of paramedics with many looking for employment elsewhere. Students already disillusioned with the ambulance service which will intern impact on out of hospital patient care in the future. 

Is this a profession in crisis and is not being address by those that can? 

Andy Greenaway. 

Stronger together

We have on several occasions in the recent past worked collaboratively with other organisations to strengthen our voice on these most challenging yet vitally important issues.  

In November 2021 we stood alongside the Royal College of Emergency Medicine and the Association of Ambulance Chief Executives to ‘Warn of the Mounting Patient Safety Crisis in Urgent and Emergency Care’ in joint statement published here.   


September 2021 we released the following joint Press Statement: ‘Increased Ambulance Handover Delays Threatening Patient Safety’ with the Royal College of Emergency Medicine, published here.  


In January 2021 we published ‘Ambulance Handover Delays’ An options appraisals to support good decision making’ jointly with the Royal College of Emergency Medicine aimed at supporting and informing senior managers within acute hospital and ambulance services to make decision regarding improving flow and reducing delay. It can be found here. 

 
We also acknowledge that members feel our communications around workstreams could be better, so plans are in place to address this and we are increasing our engagement by also inviting some members to be part of Task and Finish groups. Whilst chatter on social media can be useful for us to gauge member thought and viewpoints, and the overall mood, it is not appropriate for us to act upon some of these posts, and we would therefore encourage you to contact us by email directly.  Such contacts can be made my emailing enquiries@collegeofparamedics.co.uk  

 
We will continue to work to keep our Press Engagement webpage up to date with all our press and media responses but offer our apologies when certain links become unavailable due to changes within organisations that are beyond our control.   

 
Tracy Nicholls, Chief Executive of the College of Paramedics, said: 

 “We must not forget that behind all these mounting [Ambulance delay] figures are real people, both staff and patients, who are bearing the brunt of this continuing strain on services.   

“Reform must happen to alleviate the intolerable pressure and reduce the guilt many paramedics and Emergency Department staff feel about dealing with patients who are waiting outside Emergency Departments or, more worryingly, in the community. 

“We support any efforts to deal with the here and now, but we commit to working with stakeholders and partners to make real change happen.”