Challenges Facing London Ambulance Service

1.0 Introduction

London Ambulance service is one of the busiest as well as the largest ambulance service that is operating in the United Kingdom. It provides free emergency as well as urgent healthcare services to the patients at an accurate time. It is the only NHS based trust that is performing in London and having more than 6000 staff working in it. It had served almost more than eight million people all over the area in London. The organization also delivers 24 hours of 111 Integrated Urgent-care services in the region of South East Asia and North-East London. The primary task of it is to respond to any of the emergency 999 calls and then provide medical care to that patient each and every time. The other services which they offered also include providing the facilities of pre-arranged facilities of transport and also finding the accurate bed in the hospital for that patient. The organization is ready to deal with any incidents in the capital as they collaborated with polices and the majority of fire services. The organization spends almost £58 million each year on the supply of a wide number of goods or materials. However the trust faced issues regarding the political disruption with Brexit which results in leaving the part of the EU. The trust also had issues related to the recruitment deficit which creates a negative impact on the retention rate as most of the staff is leaving because of health and wellbeing issues in the organization. It is also found that the trust also had to face critical issues regarding public engagement in minor urban areas. The primary goal for the organization is to deliver a world-class ambulance service and becomes a primary integrator of access to any urgent as well as emergency healthcare.

2.0 Discussion

2.1 Three strategic issues of organization

Lack of consistency in staffing level and unreliable Rota system even after increase in the number of staff in Emergency operation centers by NHS trust: The NHS trust assumed that the work performance can be improved after increasing the staffing level in emergency operation centers. But it is found that the strategy creates a lack of staffing-levels which impacted the ability of staff to respond to any incoming number of calls in emergency-operation centers. The temporary agency staff that is hired for IUC identified to have insufficient skills to handle any responsive calls of the caller (cqc.org.uk, 2020).

Potential disruption with the Brexit that can result in harming the care of patients and also finance of trust: One of the biggest ambulance services that are located in London is creating a strategy to safeguard suppliers and also spares for the ambulances. It also aims to reduce the consumption of fuels as much as possible. But the chief of London Ambulance service had added the Brexit as one of the risks or red alert and therefore finalized a discussion to leave EU. According to the report of the board of LAS the organization is not that prepared for handling that risk. The potential disruption with the Brexit might harm the level of care provided to the patients and also the financial implementation of Trust. Thus the political unrest can be created with Brexit and to recover from it the military help must be taken to prevent it (standard.co.uk, 2020).

NHS is unable to improve the level of care to the patients in terms of getting optimal responses, easy contact to services due to the high recruitment deficit in the frontline: The NHS trust creates a strategy to recruit more people at the frontline so that the patients can easily get optimal responses to the queries and also can be transported immediately to the required hospital. But because of the higher deficit in the number of staff at the frontline the NHS failed to manage such a large population. These results in creating tremendous pressure on those staff that is currently working on another position or doing their core jobs. The staff is getting tremendous work pressure due to the deficit number of staff at the frontline which impacts the retention percentage of London Ambulance Service (londonambulance.nhs.uk, 2020).

2.2 Three challenges faced by an organization

The demand or the number of care for critically ill patients or aging patients is growing at a higher rate which results in decreasing care for other patients with mild or moderate conditions: In the United Kingdom there is an almost large population of people who are suffering from aging and have older ages. This increases the complexity of the London Ambulance services as more number of the aging population increases overall demands and also lengthening the time for treatments. The rate of transportation for all the particular ages in the United Kingdom is increased by a total of 75% from the last 14 year period of study. The patients whose age is more than or equal to 85 is transported eight times more than the people age 45-69 according to the forecast model. Thus the study of researchers confirmed that the accelerated rate of care for older patients creates a major impact on the performance of London Ambulance services (londonambulance.nhs.uk, 2020).

The destination for some of the patients who are suffering from any trauma, stroke and other cardiology related patients have been shifted to the excellent center rather than just to any of the local hospital resulting in the performance problem of the ambulance crew as a long journey: As the population of the United Kingdom is mostly having older peoples and they are highly suffered from strokes, trauma, heart disease, and many others. Thus the complication of the London ambulance service increases as they have to transfer or shift them to some center of excellence where they can easily get treated and not to any local hospital (Edwards et al. 2019). Most of the ambulance crew have been assigned the responsibility to transport patients till their core areas and in most cases they have to go far from their core area. This results in increasing work pressure and they might get tired and often felt sick and unhealthy. At last, to prevent them from such incidents the staffs leave the job and it is because the turnover rate of employees is increased in the London Ambulance Service at a higher rate. [Referred to Appendix 2]

The elevation in the vacancies of the frontline of the London Ambulance Service creates a high level of operational pressure and also increases the rate of sickness. It also results in creating the issues of staff retention as call-taking staff and frontline staff is getting tremendous workload and stressful working conditions which results in an increased number of staff turnover and urgent requirement or training of new staff that is costly: According to the theory of HRM in an organization the staff turnover depends on various factors like job satisfaction, health safety, work responsibilities, and other more factors. Thus the staff of the London Ambulance Service feels tremendous work pressure because of a lack of people in frontlines. The staff gets sick and unable to handle such critical conditions. Therefore, at last they resigned and it increases complications for the company. The poor retention rate of employee impact the performance of the company and thus the level of service gets distracted because of the lack of attendants in the frontline services. It is found from the annual report of London Ambulance service of the year 2018-19 that it continues to have a higher turnover rate of 11.5 percent which is extreme as compared to that of the other trusts. The 2018 survey of staff organized by NHS concluded that there is a great challenge of the company related to the health and wellbeing of staff and it is the most important reason for high turnover (london.gov.uk, 2020). [Referred to Appendix 1]

2.3 Three solutions to the challenges occurring in the organization

NHS planning to increase the use of “hear and treat” and “see and treat” services and also working with the London’s five sustainability and transformation partnership to manage and take care of critically ill patients: The concept of an approach like "see and treat" can be used to treat the patient who called on the emergency number and healthcare specialists can suggest them appropriate medical advice. This will reduce the number of attendants for the emergency services in London Hospitals because and also decrease the complexity of ambulance services. The patent burden can only be reduced through this strategy and it will also improve the retention rate of the organization. The clinical audit and proper patient feedback collection strategy can also be useful as it helps in checking whether the approaches are working properly or not and does it needs to be changed. Even there are various technologies that can be used to improve the care provided to that of patients. The integration of the ambulance services with that of the high community teams of the health department can be useful in providing robust or high-quality services (Snooks et al. 2019). The service will be useful in providing clinical advice to the patient as well to the own attending staff and health professionals who are also working in the community. The method of access can be improved by including video calls directly from the home and also by web-chat.

The ICAT London has the capability of multichannel access and with the help of it the photographs can be received and the assessment with external clinicians can be done. Thus this strategy can be useful in improving the facilities of care and burden at emergency departments of hospitals, the clinicians can be able to prescribed prescriptions in an electronic mode and then patients can collect medicine from a local pharmacy. It will also create a better patient experience and also prevention from unnecessary referrals to that of GPs (londonambulance.nhs.uk, 2020). [Referred to Appendix 3]

The NHS trust in order to reduce recruitment deficit issues must improve offers given to the new as well as existing staff: According to the HRM theory, the best way to attract new talents and improve recruitment is to improve the benefits and facilities offered to the existing or new employee. This can ultimately result in attracting wide range of talents all over the country and reduce issues like turnover or recruitment deficiency. The support that is provided to the existing or new staff must be accurate and they must be rewarded for better performance.

ICAT model can be useful in supporting the on-scene crew to determine which most appropriate hospital is for patients and thus the transportation gets assigned to the crew who used to transport patients to that hospital as a regular activity: The ICAT model can perform early detection of the patient's health and prescribed appropriate hospital or any other level of care to them. The crew of London Ambulance Trust mainly has issues as sometime they have to take older patients suffering from cardiac arrest or stroke to center of excellence from local hospital and it results in increasing the travelling distance which is not their core area and creates health issues like sickness. Thus because of this complicated conditions related to health and wellbeing the maximum number of crews left the job. Therefore, ICAT model is an improved model which has the capability to perform multichannel communication between patients and clinicians can help organization to get recover from such critical condition (Shaw et al. 2018). The model can also decrease the number of patients who needs to be transported to the emergency department by direct video conference and online assessment of clinical staffs that electronically transfer the prescription to patient so that they can collect medicine. So if maximum of the older patients gets treatment at home using ICAT model, then there will be no need to transport them to some emergency department of hospital (londonambulance.nhs.uk, 2020).

2.4 Practical implementation of one solution

Specific Objectives

The objective of the solution is to improve the level of care that is provided to the patients of any age from the organization and also at the same time to improve health and wellbeing of staff working in the organization. The aim is to treat the patients through the approach of “hear and treat Model” where the patients are referred directly to the specialized nursing teams and it can prevent hospital from unnecessary admissions of patients.

Approach

The HRM and the operational approach can be used related to the improvement in recruitment percentage and also to make ambulance services less stressful. The approach is to decrease the number of patients at emergency care in hospital by proper technological or digital assessment from the staff and also generation of electronically advised prescription of medicine. It can improves the patient engagement with London Ambulance service and also reduce the excess burden of emergency wards in hospitals at London.

Stage 1: Inputs

The input which can be used for practical implementation of solution can be ICAT which is a useful technology that can allow digitalized interaction between clinicians and patients.

Stage 2: Action and Timelines

The ICAT will be staffed by most of the truly multi-disciplinary team that includes GPs, Paramedics, pharmacists, dental nurses and also mental health practitioners. The air ambulance dispatch-desk will also include at the time of services.

Stage 3: Delivery and Evaluation

The service will work when the patients gets accessed to the video call, web chats, online self care advice or channel for communication with specialists and clinicians. The clinicians after evaluating the video assessment and also received photographs related to assessments generate electronic prescription and share it with patient to take medicine from local pharmacy. The patients receive prescription and then further guidance is also provided through it in timely manner.

Models Description

The most critical issues that is occurring in the London Ambulance trust is the high demands of care for aging people which results in increasing complication for the London Ambulance service. The ICAT approach can be helpful in reducing the unnecessary admission of the patients in the emergency departments and thus the ambulance can also able to manage the patients as per the demands. As per the analysis the ICAT model can also improve the working technique of frontlines and support them through proper instructions and guidance to treat any customer at any situation. The model can allow improving or releasing the complex routine of many crew by proper direction on which hospital is preferable to the patient according to their health situation. The model also can increase the patient engagement and they do not have to face any complicated situations or wait longer for getting the treatment in hospitals. The optimal responses can be ensured through this model and it also reduces the time and resources that can be required for the patient to reach or get the right service appropriately. The physical responses team like clinicians and ambulance crew can get improved information related to patients and it also enhances the data capture capability of system.

3.0 Conclusion

The increase in the population of people creates high level of difficulties for the organization like London Ambulance services of NHS trust. It is found that the population of United Kingdom mostly has older peoples. Thus there is a continuous demand of ambulance services to transport them to urgent care or emergency department. The higher demands because of aging in population and increased level of complicated health issues like stroke, cardiac arrest arises many challenges for the trust to manage. Even it is analyzed that NHS trust is facing the complicated issue of the recruitment deficit as due to high turnover mainly because of the poor health and wellbeing of staff as per the annual report of the organization. The London Ambulance services also had an issues related to potential disruption with Brexit and its impact the supply of organization. The company plans to take military help to prevent from such political unrest with Brexit. This impact the strategy that is assumed by the organization with an aim to enhance the level of care and service provided to people all over the London. Some employee is not skilled to handle large number of emergency calls and thus it reduces the flow of organization. The ICAT is one of the useful technological approaches which can be used to reduce the flow of patient or unnecessary attendants in emergency departments of hospitals. The clinicians with the team of nurse, pharmacy can solve the health issues of patient through video conference and then after analyzing the situation can prescribed the correct medicine to them. The patient do not needs to visit any emergency department and this model also provides better support to the ambulance crew and other staffs of organization. The NHS trust is including this strategy with an objective to improve the level of care and service that is provided to the people of London. The ICAT model can work to provide optimal response and also help trust to treat more number of patients remotely.

Reference List

Edwards, T., Williams, J. and Cottee, M., 2019. Influence of prehospital airway management on neurological outcome in patients transferred to a heart attack centre following out‐of‐hospital cardiac arrest. Emergency medicine australasia, 31(1), pp.76-82.

Shaw, J., Murphy-Jones, B. and Fothergill, R., 2018. 69 Pre-hospital paediatric pain management in the london ambulance service.

Snooks, H.A., Khanom, A., Cole, R., Edwards, A., Edwards, B.M., Evans, B.A., Foster, T., Fothergill, R.T., Gripper, C.P., Hampton, C. and John, A., 2019. What are emergency ambulance services doing to meet the needs of people who call frequently? A national survey of current practice in the United Kingdom. BMC Emergency Medicine, 19(1), pp.1-8.