ࡱ> -  !"#$%&'()*+,Root Entry( JrMatOSTMMMN0QND ( JrMicrosoft Works MSWorksWPDoc9quS??$cFQN"N@NNNNA}.dNFtHPNNTBritish Ambulance Services (Foresight) Panel (BASP) "A Resume and Review of Nine C.H.I. Reports" During 2002 The Commission for Health Improvement (CHI) published the first nine reports on Ambulance Services. The CHI published what was the overall impression of the Trust, and what the CHI concluded, based up on that review, together with area's of notable practice that were identified. BASP is about identifying threats and opportunities, it is not about politics, it is about presenting new visions and a fresh agenda for action. From discussions around our mutual industry, very few individuals seem to have read these CHI reports at ground level. We have no doubts that the services involved have digested the individual reports, taking note of the critical items, and well publishing the "better items" of practice. But has it provided New Vision or indeed a fresh agenda for Action ? Are all the NHS services looking at ALL the reports and learning from both the critical elements, as well as from the better practice elements ? or are they again just having a meeting about a meeting, with very little positive action ? The BASP Panel have restricted this review to just nine individual CHI reports, mainly for ease of convenience and example, but it is hoped that NHS services will expand on this to include all the CHI reports and action plans. This report is an attempt to encourage Best Practice, identify Threats for elimination, and provide expansion of opportunities, through lessons that can be learnt by all Ambulance sectors in the NHS, Private and Voluntary sectors. From these reports, some services have very few good items, and all have critical elements, much of which is common criticism. What we have attempted to do is list both, to highlight common area's that can be learnt, by all who wish to progress to service improvements on a National Basis. The good points are less than the criticism, and whilst we all realise that this process of having an outside organisation inspection, will be critical, much of the criticism has a valid and common point, highlighted through the positive in-action of the services themselves. Ten of the good main points identified (1) Some Paramedics are issued with sign language cards. BASP. This is good practice, but all services should undertake this, it should be expanded to A&E, PTS and others. Ambulance Services all deal with deaf people, Costs are minimal compared to overall NHS Ambulance Budgets (2) 'Some' Paramedics 'discuss' how to communicate with ethnic minority groups. BASP Survey discussion should be on a National Basis, and proper training and appropriate materials devised again at minimal National cost. There is a very good phase book and Guide to Holiday Health (ISBN 0951133403) published by the manufactures of T.C.P. some years ago. This type of booklet could be updated with additional language's other than English, French, Italian, Greek & Spanish. It would also be useful for other Public Health Surgeries, Hospitals, Doctors and Nurses called upon to deal with ailments and injuries and perhaps sponsored by Industry reducing Costs for the NHS. (3) Staff can be honest and open about mistakes. BASP A more open culture is to be encouraged, it is about identifying mistakes, rectifying situations, and being pro-active to ensure that they do not occur again. (4) Forms are available on how to make a complaint or say thank you. BASP Many services have a complaints procedure, not all publicise it, many have just a complaints form, which is reluctantly given on request. Better practice is to give each patient or relative a simple form, which not only tells them how to complain, but also how to say thank you, when the job has gone right. BASP believe that this is something that every body should be given at the point of inception, the patient may well find that the Ambulance Service did a good job, but the GP did not, or that the Hospital let them down, or that others did a good job and the Ambulance service let them down. A common simple format to encompass all involved, given to the patient at inception by which ever service first meets with the patient, that is returnable to the PCT. The opportunity is there to provide documented evidence of the patients experience of all involved within the chain of recovery. Complaints should be resolved at local level within 48 hours. The earlier a complaint is resolved the quicker it goes away. (5) Investing Staff and Time in Teaching First Aid & CPR in Local Schools BASP The UK Has Hundreds of Thousands of secondary School students, all of whom are potential 'First Responders'. In emergency situations all of these are best placed, or about to be placed in a working, recreational, or residential environment. Employers need vocational qualifications in the workplace, such as First Aiders. In Scandinavia all students leave school with First Aid Training, this is good practice and Educational Authorities should bring first aid in to the curriculum of all 5th year students. The Health Department have a budget for Health Education, which could be met by equal contributions from both Education & Health budgets. "It not only saves lives when someone is doing something, but it also makes economic sense", and will provide a far better outcome, than the current First/Fast Responder Schemes. Treatment is on a humanitarian basis, this reduces possible clinical claims. It will release more staff to provide the core service, of Ambulance Attendance and transportation to an appropriate facility, it will also provide in the first few years some two million First Responders, who will be far better placed in the residential, industrial, and recreational community, and it would provide for a faster response than any other system and at far less cost to the Nation. "Clinical Practitioners realise, that there is very little you can do, when the victims Blue, and that earlier starts produce better outcomes. It is Basic CPR within minutes that saves lives, and 8 Minutes may be to late !" (6) Introductions of appraisals for Self Development. BASP Self Development Appraisals are not new in either Industry or the Retail Sector, they have been in existence for over 20 years. They do not cost large amounts of money and are a valuable investment, they identify Training needs to ensure efficient operation, and additional needs to develop the person who wishes to seek higher aspirations. It is about management meeting with employees on a one to one basis, it is about an open and honest culture, something that is greatly lacking in both Ambulance services and the Health Service as a whole. It however needs NHS Executive central development with a common simple system. (7) Cardiac Arrest Survival Reports. BASP With political emphasis on Cardiac Problems, a common reporting procedure including the recording of outcomes of interventions is essential in order to improve on what is already being undertaken. (See 5 Above) In many cases it may be found that simple interventions have perhaps provided better outcomes then the more complex and costly interventions of today. This will only be identified through recording outcomes. (8) 24 Hour Clinical Practice Help Line BASP The need for Ambulance Aid Practitioners to obtain clinical advice on a 24 hour basis is greater today then ever before. There is a need for development on a National Basis. NHS Direct could be the ideal avenue, if it had more Medical Practitioner involvement. Developments should be considered in this avenue for NHS Direct expansion as it would serve to maximise the services offered by this service. With the many calls now being received by NHS Direct, auditing should be undertaken on the calls received, where a GP has failed to attend or refuses to attend. These could be collated and sent to the appropriate Authority as an audit on primary care services. Likewise Ambulance Services could also report such incidents bringing failures in this field of medicine to the notice of those that matter the PCT. Likewise inappropriate referrals undertaken by ambulance services should be reported, which may result in a reduction of such calls by GPs and others, who could have attended, and who could have provided for a better line for treatment, other than direct transportation A & E. (9) Historical Data used in positioning Vehicles BASP Hot spots are not new, indeed all services should have adequate mapping systems that can provide 'Hot Spots' which is useful for positioning Ambulance vehicles. However Services also have to be pro-active in prevention, and involve other authorities who have a possible responsibility for example : Continual accidents at an Industrial Complex or on a road system should be reported to the appropriate authorities in order to reduce these calls. Hot spots for Sudden Illness, Drunkenness and the many variety of calls recorded should be collated and passed on for preventative action in order to reduce these calls. The Fire Service have a duty of Fire Prevention, and Ambulance Services must become more involved with Accident and Sudden Illness prevention, especially when the causes are through some one else's neglect or inadequacy to respond. The future of all services should not be about expansion and more vehicles, staff and money. But more about reduction and about an "In case of " not "a because of " environment due to the lack of implementing simple management controls that should be aimed at "the reduction of Ambulance calls" (10) Emergency Services action team, management of Bed Availability and Capacity Pressures. BASP A considerable number of services experience A & E Waits, and there is no sense in GPs, or Ambulance Services taking or sending patients to Hospitals, which have reached capacity. Ambulance services should be equipped to manage, collate and manage bed availability for Hospitals, they can divert vehicles to suitable units that are under less pressure, early warning of pressure build ups are imperative to the Hospitals themselves and the services directing patients to such facilities could be better co-ordinated through a central Regional Facility. Ambulance services are ideally placed for this function, however it must be on a County or regional basis with the full co-operation from all resources. With adequate National support, direction and funding, many of the existing A & E trolley waits could be reduced or eliminated, which is better for the patient and the NHS as a whole, however it must be a impartial service, operated through ambulance services for the patients, and medical consultants benefit, not just the individual service benefit, but for the eventual benefit of the NHS overall. We feel that over time this will provide considerable benefits in both manpower and costs for the whole of the NHS. The emphasis must be on replacing practice, to provide overall savings to the NHS, rather than individual savings to partial sections of the NHS as appears to be the current situation with bed management A considerable number of points still need resolving The list includes some of the items that could be rectified by adopting many of the items listed above that the CHI felt the NHS could have learnt from, in brief they are: No complaints leaflets Staff not appraised on an annual basis Ambulance Trolley delays of over one hour Trust driven by National Performance Targets Lack of Clinical Audit Programme Not Meeting with GP Targets Personal Development Plans not activated or in operation PTS Staff limited training or education appraisals BASP Personal Development Plans (PDPs) should be implemented as a priority, as it is through these that many of these critical items will be identified. It is however just as important to provide action and implementation of the plans, otherwise the justified criticism will never be managed or illuminated. A considerable number of area's of risk have been highlighted by CHI they can be grouped as follows: Education Linked to PDPs Lack of knowledge or understanding of principles of good practice Updating programmes to include new materials Risks in Infection Control Procedures Duty of Care issues on hand over at Hospitals No formal education, training or continual Professional Development Lack of clarity and understanding of clinical training rolls Lack of Infection Control Patient Confidentiality breaches No Paramedic Training for 2-3 years 999 call categorising problems Trust Direction and Management Difficulties in communications with staff. Problems in recording of suspensions and grievances. Directors with extensive portfolios Part-time or No Medical advisor Medical Advisors roll lacks clarity and accountancy Staff sickness levels require management Lack of awareness on key decisions and job responsibilities Failure to develop, safeguard or evaluate clinical quality outcomes No protocols on deployment of helicopter No PALS or PALS combined with complaints Risk of Serious consequence requiring immediate action Probationary students make up crews with no mentor The use of V.A.S. Staff and others for Doctors Urgent Calls (see above) Fast/First Responders & PTS Lack training and skills CRB Enhanced checks not undertaken on all operational staff (Care & protection) Paramedics seconded to Hospitals and Doctors Surgeries creating Service shortage Lack of protocols or guidelines for drug administration, documentation or storage. Duty of Care issues on hand over at Hospitals Risks in Infection Control Procedures Lack of Infection Control BASP A further 20 reports have been issued since these original nine, all but one bring forward the same type of concerns. It is evident that despite attempted National Direction, Ambulance Trusts continue to act as individual units, and many have still not addressed even the risks of serious consequence, nor have they learned from the critical CHI reports of other Trusts. BASP have identified other area's of serious risk that we feel should be responded to as potential threats to NHS Ambulance Services: Recruitment the main age groups are between 21 & 28 years, there is a severe threat that these persons may not be licensed to drive the Ambulances being designed and purchased as they require additional groups of C1 and D1. It restricts suitable recruitment. The continued use of V.A.S. staff for Doctors and other Emergency calls place's patients at extreme risk, and contravenes Charity law and the very constitution of these charity Organisations. There is immanent danger of incompatibility of Vehicles, Stretchers, Equipment and Training at a major incident, last highlighted in 1966, and fragmented since 1990 due to Individual Ambulance Trusts being allowed liberal freedoms to act outside of a National imposed Ambulance framework. Peter A. Littledyke Chairman British Ambulance Services (Foresight) Panel. PRESS RELEASE. The British Ambulance Services (Foresight) Panel (BASP) have recently concluded a Resume and Review of nine original Commission for Health Improvement (C.H.I.) reports that were published in 2000. Peter Littledyke BASP Chairman states: "Since the publication of the initial nine original CHI reports, a further 20 reports have been concluded, NHS Ambulance Trusts have followed these by publishing 'CHI Action Reports'. However it would appear that these very same NHS Ambulance Services, have not acted on either the Good points that were highlighted on a National Basis, or taken action on the Items raised as a risk of serious consequence requiring immediate action on a National Basis" "This report is a warning for the Government to instigate an immediate agenda for change, BASP is about "Action" it is shameful that we are finding that NHS Ambulance Trusts are still taking today risks of serious consequence, Risks that in 2000 required immediate action. Yet these very same Ambulance Trusts continue today to undertake the very same practice which is placing patients and the Public at considered serious risk. The Government must act now, otherwise they will be seen as just paying lip service to this continued bad practice and be open to a charge of 'Failure to Care & Protect'." Editors Note: The Government's 'Foresight Programme was launched in 1994, this was expanded in 1998 and further developed through the Office of Science and Technology. In 1998 the British Ambulance Services (Foresight) Panel (BASP) was formed. The Panel consists of six individuals with over 200 years of Ambulance Experience, the panel also maintain a web-site with over 200 individual members (the Knowledge Pool) drawn from all sectors, all of whom have an interest in Ambulance Services. Foresight is about visions of the future to guide today's decision makers' It is about anticipating the future, identifying potential needs, identifying potential threats and opportunities, and about taking Action now to ensure that people and Organisations in the UK are better placed to respond effectively. Foresight is clearly about Action. Where in-action prevails the Foresight Panel may have to kick-start the process, Foresight is not about politics, it is however about providing guidance to the decision makers in all sectors concerned with Ambulance Services. Links to the BASP Web-site may be found at : www.ambulanceservices.co.uk All those interested in Ambulance Services are invited to join, there is no fee or commitment. ng potential needs, identifying potential threats and opportunities, and about taking Action now to ensure that peop  } Yysymygygygygygyay8 8 8 ="F"""&4',,-G000ysmsmsmsmsmsmsmgsgs8 8 0022449 9:':::9<K<o<x<=>?ysysysmsmsmsysgsga8 8 ?o?x?@M@AAABBCC.D]DDDE#ENEWEysysymymymymgmymymy8 8 WEFy5ce!DFy{`HJm ooa :u :u   w y SUysssss;="D"F""$&&2'4',,-y-----.2.`.... //G0yyyggggggggUU h G0I0K0M0O0Q0S000001H1o1mmmmmmmm[[III h o111!2<2^2222222)3N3o333 4mmmmmmm[[[mmmmmmm h 4P4z444445]5556666666y8mmm[[[mmmmmmmmm[[ hy89::;;7<9<;<=<M<O<<<m[[[mmmIIImmm h <==D=G=== > >f>h>>>#?,?.?0?????P@mmmmmmmmmmmmmmmmmmmmmP@R@@@ A AoAqAAAACDDE*FFFmmmmmmmmmmmmmm[[0?WEF -G0o1 4y8<P@FTimes New Roman ceA}.A}.dCompObjU