The millions of interactions that paramedics and ambulance staff have with patients and the public provide a valuable opportunity to improve health and wellbeing among the most vulnerable people in society.
This makes them a great potential partner for local public health teams, and so PHE has committed to work more closely with ambulance services and their partners to maximise opportunities for health promotion.
A new consensus statement published this week outlines this commitment by NHS England, Public Health England, Health Education England, the Association of Ambulance Chief Executives, the Royal Society for Public Health, the College of Paramedics, the Local Government Association, St John Ambulance and the British Red Cross.
This blog highlights how partners outside traditional health services can make a real difference to the health and wellbeing of local people, how one local ambulance trust is leading the way and what the next steps are in our national work to facilitate closer working with ambulance services at local level to deliver preventive interventions.
Spotting the signs
An increase in the number of people with long term conditions, alongside an ageing population, means demand for health and social care is rising. There are many common underlying factors behind this, such as mental health problems, cognitive impairment, smoking, drugs or substance misuse, physical inactivity, poor diet, obesity, cold or poor housing, loneliness and social isolation.
Addressing these risk factors early on can help to prevent more early deaths and years spent in ill health, and reduce costs to the health and care system. Strengthening the focus on preventing ill health is a top public health priority and one where our partners outside core health services can make a significant contribution.
The ability to engage with people in their own home setting, at an unplanned time, puts ambulance staff in a unique position to play an important role in the public health agenda.
By identifying people with these risk factors and spotting opportunities to provide information and signpost people to locally provided services, they can work more closely with partners across the health and care system to make every contact count with vulnerable people to help improve or maintain their physical and mental health and wellbeing.
Local services leading the way
We recognise that ambulance services are already working at full capacity, and it is important that we make the most of opportunities for health promotion as part of the work that the service is already doing.
There are some great examples of collaboration between local ambulance services and public health teams that could be replicated elsewhere across the country to improve health outcomes.
For example, in 2013 the Yorkshire Ambulance Service and PHE Yorkshire and Humber developed a referral pathway into local alcohol services, allowing ambulance clinicians to refer patients with potential alcohol misuse problems to specialist alcohol services and getting help for those most in need.
PHE’s recent evidence review into the public health burden of alcohol revealed over 10 million people are drinking at levels which increase their risk of health harm. The pathway is a great example of the Making Every Contact Count approach, as paramedics can raise a conversation regarding drinking regardless of whether or not alcohol is the reason for their attendance.
It also demonstrates the potential for collaborative working across the health service, as good relationships with each of the local alcohol misuse services across Yorkshire and Humber have enabled a robust pathway to be formed, taking referrals 24/7 and ensuring that patients are receiving the most appropriate care for their needs.
Early data for October 2014 to September 2016 shows that 92% of people referred via the pathway were not currently in treatment at the time of referral and 62% of those referred entered into treatment as a result.
Other opportunities are also being explored, such as more effective use of blood pressure data recorded by paramedics and the development of a regional ambulance service dataset, linked to key local authority public health work streams including falls prevention, alcohol misuse and self-harm.
Nationally, a working group of representatives from each of the consensus partners are putting together an action plan to outline what can be done at national level to support local initiatives and care pathways to deliver preventive interventions. For example, this might be developing training for the ambulance service workforce or enabling better sharing of data and best practice case studies.
Importantly, we’ll be incorporating what we’ve learned from similar work we are doing with local fire crews and police forces.
For example, a recent PHE evaluation of the impact of fire and rescue service interventions to reduce the risk of winter related ill-health highlighted some promising practice developments and some key opportunities for further action.
The evaluation showed that that fire crews were identifying people who needed specialist support, such as falls prevention services, without overloading services or identifying people who were already receiving interventions.
It also highlighted the need to:
- engage partners at every stage;
- use available data as much as possible to target those in need and avoid duplication;
- develop a standard method for evaluation and benchmarking; and
- show strong leadership to support front line staff to understand the benefits of a new approach and feel confident to undertake brief interventions.
We will keep everyone updated on our work with NHS ambulance services and their partners through this blog. For now, the key message for local public health teams is that ambulance trusts are committed to improving the health and wellbeing of local people and ready and willing to have conversations about how they can contribute to the prevention agenda. We urge teams to make the most of this valuable opportunity.