News Roundup [abridged Versions Appear In The Paper Journal]

Government unveils new approach to emergency care

BMJ 2005; 331 doi: (Published 07 July 2005) Cite this as: BMJ 2005;331:69
  1. Rebecca Coombes
  1. London

    Fewer people calling 999 in the United Kingdom will be taken to emergency departments for treatment in future, under government plans announced last week.

    A review of the ambulance service recommends instead that more patients be treated at home by new “super paramedics” who will be trained to the same level as nurses. More patients should also be dealt with over the phone and referred to appropriate services such as GP services, both in and out of hours, or an emergency nurse service.

    The health minister Norman Warner said the changes could prevent at least one million attendances at emergency departments each year: “People, by and large, would prefer to avoid a hospital visit; most would prefer to receive treatment at home. We now want ambulances to play their full part in that process. We are spending £1.2bn [$2.1bn; £1.8bn] a year on ambulance services, and there is scope for efficiency savings to be made,” he said.

    The plans also mean that, from April 2007, all trusts must “start the clock” for calculating the response time for the most serious “category A” 999 calls from when the calls are actually received. The aim is to end discrepancies that meant that up to 14 different starting points for measuring response times were used in 31 ambulance trusts in England. The government's target response time for category A calls is eight minutes.

    The number of the new breed of paramedics—emergency care practitioners—will be significantly higher than the present number of paramedics of 600, said Lord Warner. They will be trained and equipped to carry out and interpret a greater range of diagnostic tests and do basic procedures. They will also refer patients to social care services, directly admit them to specialist units, and prescribe a wider range of medicines. The changes will especially help elderly people who have fallen and sustained cuts, bruises, or other minor injuries, said Lord Warner.

    The changes were recommended in a strategic review of NHS ambulance services led by Peter Bradley, the national ambulance adviser and chief executive of the London Ambulance Service NHS Trust.

    He also recommended that the number of ambulance trusts be cut by 50%, subject to consultation, while retaining the same number of staff and vehicles.

    Frances Blunden, the principal policy adviser at Which?, part of the Consumer's Association, welcomed the move to standardise the starting point for response times for category A calls.

    “We have been calling for this since 2002. Ambulance times are being fiddled, and people's lives are being put needlessly at risk.” She said that questions remained about the extension of the diagnostic and treatment role of paramedics. “Are paramedics properly trained for their extended roles? For example, will they be able to stitch cuts and wounds?”

    Ms Blunden also questioned how many patients paramedics would be able to assess safely without taking them to emergency departments, as they won't have access to important diagnostic tools such as radiography.

    The shadow health minister, Andrew Murrison, said the report was “patchy” concerning how the ambulance service would cover the diminished provision of GP out-of-hours services, especially in rural areas.

    Taking Healthcare to the Patient: Transforming NHS Ambulance Services is available at

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