HB Q&A: North West Ambulance Service

Following their success at the 2020 Health Business Awards, we speak to Daren J Mochrie, Chief Executive Officer at North West Ambulance Service

HB: NWAS and East Lancashire Hospitals NHS Trust has seen almost 5,000 treated by the East Lancashire Falls Response Service Team. Given the current unprecedented pressures on the hospital, how important is it that patients can be treated at the scene? And what role does the initiative have to play in this?

DM: Patients are far better placed when they remain in their own home, an environment they are used to and feel safe in where they are less likely to pick up hospital acquired infections.

By enabling people to remain at home, our Falls Response Service (FRS) is helping to maintain capacity within hospitals, which is particularly important during this busy and challenging time. It is also much more beneficial to patients, particularly older people or those living with dementia, to stay in a familiar environment wherever possible.

If a patient does need to go to A&E for further assessment such as an x-ray, the hospital can be contacted by the FRS who can provide information beforehand to enable a quicker turnaround for discharge home, hopefully the same day.

By working together to form the FRS, a paramedic and occupational therapist can offer patients specialised care in the community. The paramedic assesses the patient from a medical perspective to determine whether treatment at home is appropriate. The occupational therapist, trained in both physical and mental health, can then complete a holistic assessment taking into account the person’s physical and psychological needs. Where appropriate, patients can safely remain at home with additional support; this could be through provision of equipment, request for crisis carers or referral to other relevant services.

HB: What is the partnership doing to ensure that the right balance is achieved between a better patient experience and the right patient care?

DM: Working in partnership, the team allows a balance to be achieved for a better patient care experience and outcome. By putting the patient at the centre of their care and ensuring that their needs are met, the team supports them both medically and holistically.

Occupational therapists possess the critical skills needed to address fall prevention with older adults. Research finds that falls are often a result of multiple factors such as individual conditions, their environment, or as a result of the interaction between the two. The most successful falls prevention initiatives are those that use a varied approach.

Following a medical assessment from the paramedic, the occupational therapist evaluates lifestyle factors such as the patient’s daily routines and environment as well as their individual goals and priorities. They can then make suggestions such as modifications and adaptations aimed at maximising independence for older adults.

By providing wrap around care and support, not only at the point of crisis but also for the future, the team can ensure that the patient receives the right care for their needs. Another benefit of this taking place in the community is that family members can also be involved, again particularly important during the pandemic due to visitor restrictions in hospitals.

HB: The most effective form of care, especially when treating the elderly and frail, is not only to respond to incidents but also to help ensure they are prevented from happening again. How is this implemented in the work of the Falls Response Service Team?

DM: The FRS team takes into account multiple factors to form the falls assessment. A patient-centred approach is used to try and reduce their risk of future falls by helping to prevent some of the causes whilst at scene. This could include onward referral to specialist community teams such as physiotherapists, medicine management, Parkinson’s nurses or additional support such equipment and carers.

Another benefit of the FRS is that referrals can be made by paramedic crews to try and prevent future falls occurring. These referrals are triaged by the team and information is gathered to consider whether an urgent response is required or if a referral to the community therapy team to support their ongoing needs is more appropriate. The team receives 120-140 of these referrals per month and is used as a point of contact for ambulance crews for telephone advice and any further needs they may have. They communicate with a wide number of organisations to assist with reducing the number of falls.

Occupational therapists work with patients and their caregivers to review the home environment for hazards and evaluate individuals for limitations that contribute to falls. Recommendations often include a combination of interventions that target improving the patient’s physical ability to safely perform daily tasks. This may include modifying the home or changing activity patterns and behaviours to support these initiatives to prevent falls in the future.

The fear of falling can be both a risk factor for falls and a consequence of falling. It can lead to individuals avoiding activities that they are capable of and need to complete in order to remain as independent as possible. The FRS team assists older adults in recognising and addressing their fear of falling by focusing on individual and specific concerns.

HB: Unaddressed fall hazards in the home are estimated to cost NHS England a staggering £435 million. With lockdown causing more people to become isolated and socially distant, how has the team adapted to ensure this doesn’t worsen?

DM: Falls information is given verbally and by written documentation. Falls hazards and risks are discussed with each patient and a joint plan of intervention and action is documented to confirm the information given.

The team can supply a basic exercise programme for patients to do in their home with either a referral to a physiotherapist for a follow up or, where appropriate, information for the patient to complete a self-referral. For those with access to a computer there are online programmes available to maintain social interaction.

Age UK has provided vital support during the pandemic and the team is able to refer patients there for further support as well as other local services available to help those who are becoming more isolated due to the pandemic.

The East Lancashire Falls Response Service Team

HB: The model incorporated by the team five years ago has since been replicated elsewhere across the country. In the healthcare sector, how important is sharing best practice, especially when the issue is not restricted to region or hospital?

DM: Sharing good practice has enabled other teams to develop more efficient, cost effective methods helping to develop a better service all round. This benefits the wider NHS and supports as many patients as possible to maintain as much independence and wellness for as long as possible.

HB: Given the unprecedented pressures facing the trust this Winter, how has the ambulance service worked to continue providing a safe service, both across the 999 emergency service, but also the 111 and Patient Transport services?

DM: Winter is always a busy time for the ambulance service, but this year is like no other. We have been experiencing extremely high levels of activity throughout the North West alongside a number of staff isolating or shielding as well as increased pressure on local hospitals.

In response to this, we have maximised our resources in a number of ways. All clinically trained staff have been supporting on the frontline, we have increased our use of private providers and are working with our healthcare partners to safely help us guide patients who don’t require urgent assistance to more appropriate healthcare services. Staff from our patient transport service and volunteers have also been assisting our 999 service, receiving additional training to do so.

We have also been heavily involved in the national roll out of NHS 111 First which encourages people to contact 111 for urgent care needs rather than turning up at A&E. Where appropriate, we’re able to book people in to be seen quickly and safely or direct them to the care they need. To support this we’ve undertaken a largescale recruitment drive within our 111 contact centres to help us manage the extra demand.

As always, the public can help us by only calling 999 in serious or life-threatening emergencies, checking their symptoms on 111 online when they need urgent care and acting within government Covid-19 guidelines.