Redesigning ambulance services

In Yorkshire, centres in Middlesbrough and Leeds can perform an angioplasty. Alison’s team set out guidelines for paramedics which, under certain circumstances, allowed them to take patients straight to one of these. ‘That’s been very successful, both in terms of people being brought quickly and appropriately from outlying areas and also in terms of the outcomes for patients,’ she says.

Facing challenges

One challenge involved taking ambulances out of one hospital catchment area and into another. ‘If you take a 999 ambulance out of an area for a period of time, which could be up to an hour and a half, you need to still cover the 999 service in that area,’ Alison comments.

Another was that paramedics were used to working with national guidelines, which still recommend clot-busting drugs. ‘We were asking them to make a judgment call about whether the patient was able to get to the centre that could give the angioplasty’, Alison says.

‘That was a situation the paramedics hadn’t had before, and one of the important things for us was to say that either option was right. It was entirely down to their clinical judgment. It’s now acknowledged nationally that either treatment is fine, it just depends on the circumstances.’

Finally, the team had to ensure that they involved patients and local communities. ‘People were used to a local paramedic turning up, giving them some treatment and taking them to the local A&E department,’ Alison explains. ‘We went to our patient forum and explained why it was better overall to go further for a newer treatment. They were actually really receptive to it.’

Support from The Health Foundation

Alison highlights the chance to discuss her project with a multiprofessional group of fellows. ‘We had people from all areas of healthcare,’ she comments. ‘They presented views and ideas from angles that wouldn’t have occurred to me because I’ve got a very ambulance-service view of things.’

‘Some people also had a lot of experience of public and patient involvement,’ she adds. ‘Their input helped in terms of getting quicker buy in from different groups.’

The leadership training and support came in very useful when Alison was unexpectedly asked to take over as Acting Chief Executive of Yorkshire Ambulance Service part way through the project. ‘There was a lot of support for taking on a role for which I had little training or experience,’ she explains. ‘I also learnt how to delegate effectively and manage a project at arms length.’

Sharing the learning

The project has been an enormous success, and local hospitals are showing increased survival rates from heart attacks. Plus the learning will be used to inform an upcoming stroke management initiative in Yorkshire. ‘Clot busting drugs for stroke are different but the principles are the same,’ Alison says.

The team is also sharing their learning with ambulance services that are coordinating similar schemes elsewhere, such as in London.

On a personal level, Alison’s Health Foundation fellowship has now ended, but she’ll continue meeting the other participants and supporting each other informally. ‘We’ve agreed to meet twice a year and continue the work that we’ve been doing,’ she says. ‘Everyone felt so strongly that the information support and encouragement was too valuable to lose.’