Rescue remedies

Published: 28/02/2002, Volume II2, No. 5794 Page 24 25 26 27 28

John Burnside, chief executive, Greater Manchester Ambulance Service trust I think the ambulance service has been a bit of a Cinderella service, both in terms of the NHS and of the other emergency services, for some years.We are all waking up a bit now, and I think working hand-in-hand with NHS Direct has involved us in a strong partnership in some parts of the country, including Manchester.

There is great added value for all concerned in the ambulance service, getting ourselves more involved with the wider NHS, especially as an honest broker facilitating exchange of information about capacity and particular bed pressures in different hospitals.

In the past, this kind of knowledge was identified and passed through the system simply through guesswork and whatever local relationships happened to exist.Especially now that the strategic health authority boundary is coterminous with ours, We are able to develop information systems that work across the whole patch.

The ambulance service did have a stiff and starchy image in the past, but these sorts of barriers are already breaking down, and the profile of the profession is changing enormously.When I joined the ambulance service in the late 1980s, I was the first NHS manager from outside the service to do so.

I am keen to see the role of 'emergency care practitioner'develop, whereby paramedics get more involved with diagnosing, treating and referring, rather than just taking everyone automatically through the doors of A&E.

Dr Judith Fisher, medical director, Essex Ambulance Service trust Having become a profession in their own right, paramedics have gained quite a lot of clout, but at the same time this can give rise to anxiety because they used to be protocol-driven and now they take a lot more personal responsibility.

About 20 ambulance trusts now have medical directors, and we network quite effectively so we can share ideas.The joint royal colleges' ambulance liaison committee issues evidence-based clinical guidelines so that from a clinical governance point of view we can ensure We are all on track.

It is noticeable that the ambulance service is being managed much more dynamically these days, and There is much more medical input.That is partly driven by central government, who are pushing ahead on things like the eight-minute response target, and paramedics doing thrombolysis, which is being introduced by 2004.

The range of drugs and techniques paramedics can use now is much wider than ever before, and that trend is increasing, with the move towards paramedic emergency practitioners.

Training-wise, sharing degree courses with nurses and even, in the future, medical students, helps these staff gain a much better understanding of anatomy and physiology, for example.This can give them the confidence to make those immediate decisions about whether a case is time-critical in terms of needing to be dealt with there and then; or in the sense of not needing paramedic input at all.

From the point of view of an A&E doctor, the better the service a paramedic provides, the easier your life is - so It is vital that doctors value the profession and integrate them.On a practical level, That is about working as a team and not just grabbing the trolley, chucking the ECGs the paramedic has brought in and starting all over again. It is great if things can be organised so that paramedics see what happens to their patients after admission, for example, though clearly That is not always possible.

'Barry Johns, chief executive, West Midlands Ambulance Service trust I've been in the ambulance service for 33 years now. I joined when I was 18, having first gained some experience as a volunteer with St John Ambulance.

I believe the ambulance service has a lot of strength in its traditions.At the same time, I also think it has a strong history of embracing change - just look at how much paramedics do these days.

A lot of ambulance services these days involve much more than that name suggests. If you look at the West Midlands service, for example, It is not just an ambulance service - it also acts as a host body for NHS Direct, offers capacity management and a bed bureau for Birmingham and Solihull, and co-ordinates organ donation for the whole country, among other things.

I think there is a challenge for some trusts to get to the position We are in, and also for the rest of the NHS to recognise the benefits we can bring to the service by acting as a real-time 'glue', keeping the whole health economy together.

Here We have always recognised that the ambulance service has a dual role - we probably see ourselves as 95 per cent part of the NHS culture and 5 per cent part of a public safety ethos that runs through us and the other emergency services, like police and fire.

As for the future, our challenge, like the rest of the NHS, is to match resources to the delivery of highstandard patient care.That is never easy, but we have just had a pretty positive settlement for next year, so we just need to get on with delivering.

'Richard Diment, chief executive, the Ambulance Service Association As a relative newcomer to the service - I've been at the ASA for less than two years, after a long career in public affairs - I have to say I have no doubt that the ambulance service wants to be an integral part of the NHS.The bigger problem is getting the rest of the NHS to accept us, not the other way round.

I arrived at the association at the mid-way point of work on our 2001 report The Future of Ambulance Services in the UK , and everyone was saying there was a big debate going on about whether or not we should be integrating more with the NHS.

I think That is more about other people's perceptions of the service than about the service's own view.There is a lack of understanding about what we do among the wider community, and there can be a superior attitude about us. I do not think the NHS has picked up on how skilled and committed ambulance workers are.

Greater rotation of staff between ambulances and the rest of the service would probably help to bridge the divide, but of course an awful lot of ambulance jobs just are not transferable.

There is also the fact that, while many ambulance staff are keen to develop ways of doing more training and work in the wider health service, most also like the idea of being out on the road.

On a general note, I do think that in terms of other people's perceptions, It is significant that of all the allied health professions, We are now the only nongraduate profession.We need to move towards a higher proportion being graduates, and we need to get the medical profession to respect the work we do.

As for the uniform, I just think That is something the ambulance service does differently.From what I've seen, It is no more hierarchical than other parts of the NHS - people just wear different clothes. In fact, some of the very people most likely to defend the wearing of uniforms are also the people right at the forefront of bringing in new approaches.Most importantly, I've certainly never seen any evidence that uniforms have an effect - good or bad - on patient care.

'Janet Davies, chief executive, Mersey Regional Ambulance Service trust I started as chief executive here on 1 January, and I must say the prospect of modernisation is what brought me here.Before taking on this role I was director of nursing at the Royal Liverpool Children's Hospital trust, so it was quite a jump, and It is a challenge. I am also joining an organisation that, managerially at least, is rather male-dominated. And there is this sense that entering the ambulance service is a bit like joining the army - where the style of management has perhaps been less than conducive to innovation.

I did think long and hard, but in fact I think the reputation is more about perceptions of what it must be like than about the reality.People from outside do laugh a bit, expecting to see me with pips and braid on my shoulders, and all that.

I think you have to cut through that and get on with the job. I am finding that a lot of what's going on in the ambulance service is similar to other parts of the service.There is a focus on the expansion of ambulance staff 's practice, for example, which in some ways is just like what happened with nurse practitioners.

There is also an incredible amount of commitment among staff - probably more than in any other group I've worked with.And as a former director of nursing at a fantastic hospital, That is saying something. Initiatives are coming from staff, and to my mind That is the only way modernisation can ever really occur.