The must-read stories and debate in health policy and leadership

Seen on scene

London Ambulance Service Trust has pledged to treat more patients at the scene to cut the capital’s high conveyance rates under ambitious plans which include a significant increase in senior paramedics.

The trust, removed from special measures and rated good by the Care Quality Commission last month, plans to more than quadruple its advanced paramedic practitioner for urgent care workforce, from 16 to 75, medical director Fenella Wrigley told HSJ.

The move follows a pilot in Croydon where APPs treated 63 per cent of patients without conveyance to hospital, compared to a London average of 36.6 per cent. The new measures could reduce emergency admissions by 95,000 saving up to £13m per annum, the trust said.

Any safe procedural changes to take the heat off overcrowded emergency departments must surely be welcomed. The results of the Croydon pilot were welcomed by the Association of Ambulance Chief Executives.

Trust chiefs will hope that offering paramedics the chance to develop their skills further – and earn more – will prove an incentive for sticking around in what is a hugely stressful and challenging job offering modest remuneration.

But filling the vacancies will likely prove challenging. A survey by the Observer published in March found seven out of the English NHS’s 10 ambulance trusts were struggling to recruit, and London had the highest number of unfilled posts – more than 350. 


Health minister Lord O’Shaughnessy has spoken to HSJ about his innovation and life sciences brief - themes sure to have finance directors’ cheque books itching at the thought of whizzy drugs and devices proliferating at a rate of knots.

His comments contain the perennial balancing act between the desire for more clever stuff (also thus keeping industry happy); and the taxpayer having to pay for it (via the NHS), when there might be better value elsewhere.

The minister indicates some stuff should be taken up quicker, giving the example of the prominent new Hepatitis C drug whose introduction NHS England has phased.

But he also seems to buy the oft-held view in the NHS that the most urgent thing in the “innovation” sphere is to spread uptake of existing good practice; rather than generating new techniques.

Scaling up innovation projects “has been our Achilles’ heel”, he said, and revealed academic health science networks would become the “overseeing authority” to do something about it.

There’s a parallel with the prime minister’s current interest in variation in practice and standards across the health and care systems, perhaps.