“The Concordat has created a network committed to delivering national changes at a local level”
The ambulance service has traditionally been seen as a provider of emergency care for those suffering from a physical medical crisis, and the training and education of its workforce has followed this view.
Increasingly though, the ambulance service is called upon to support and care for those patients whose crisis is a mental health one, and this creates difficulties that we are striving to overcome.
South Western Ambulance Service NHS Foundation Trust covers approximately 20% of the English mainland, providing 999 emergency services as well as primary care out-of-hours urgent care services, and a number of 111 contracts.
As mentioned already, the education of paramedics generally focuses on the provision of physical health care, and as such has created a workforce who feel less able to support patients in mental health crisis. Additionally, many staff are confused about the powers and responsibilities they have when dealing with patients who are incapacitated while in a mental health crisis, or are in need of urgent assessment and management.
Ambulance services often struggle to engage with mental health providers, and rarely have direct access to services outside of the acute trust. This has inevitably led to high levels of inappropriate ED admission or engagement with police colleagues, and overuse of section 136.
Ambulance crews also have no access to care plans, and as such manage each patient ‘blind’ to any supportive documentation or past medical history. This leads, on a number of occasions, to high levels of inappropriate ED conveyance and sub-standard care.
I have worked in the ambulance service for nearly 20 years, and have experienced the very real frustration shared by my colleagues. As a Paramedic, my aim is to reduce the suffering of my patients and feel in control when dealing with physical illness. I can see the damage and I know how to start the process of repair. But mental illness is not something I have been prepared for, nor is it something I feel competent in managing. I’d do my best, but is that enough and can I really make the difference I want to?
I think this sense of frustration and inadequacy is worrying many among my colleagues. Not having that essential knowledge base to appreciate what a patient is going through and what ‘I can do to help’, not having access to professional advice and referral and not having access to patients care plans, all combine to prevent me delivering the care I so want to provide.
But there is finally a light at the end of what has been a very long tunnel.
The Crisis Care Concordat has provided a real catalyst for change. It has empowered organisations and individuals to reflect on the care they provide and to work together to identify the barriers to the high-quality care we all want to deliver. By focusing on the areas where care provision has been poor, we have been able to understand the difficulties that we all face and to develop action plans to improve the way we work.
Within SWASFT we have developed a number of initiatives, including enhanced guidance and education for operational staff, regional protocols to support inter-agency working particularly with our police colleagues, and we are developing systems to support future electronic integration to enable access to patient information.
We are also working with mental health colleagues to develop systems to ensure that specialist mental health advice is available through 999 and 111 Clinical Hubs, both for patients and operational crews, reducing the burden placed on emergency departments.
The Crisis Care Concordat has given us all an opportunity to reflect on the care we have traditionally provided. It continues to be a driver for organisational change (especially now all local action plans are set across England), but more importantly, it has brought together parochial organisations and created a real network committed to delivering national changes at a local level. I, for one, look forward to the future with a far greater degree of optimism and truly believe that the future provision of care for those in mental health crisis will be greatly improved.