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CFOA proposes a new approach to emergency ambulance response


Some 12 months ago in the context of an impending change of government and a bleak financial climate, internal discussion was initiated within the Chief Fire Officers’ Association (CFOA) around the future role of the fire and rescue service (FRS). One of the proposals CFOA has since put to government is that the issue of fire and emergency medical services (EMS) should be examined in an open and objective way.


Since those initial discussions, debate has been wide-ranging and has culminated in a series of papers which have been submitted to the Fire Minister which were intended to inform the Strategic Review, which was urgently called for by the Coalition Government given the financial crisis in the public sector. This work has been carried out independently by CFOA and is separate from the Communities and Local Government (CLG) Fire Futures project.


The association has called for a review to be jointly commissioned by CLG and the Department of Health (DH) to fully explore whether emergency services could be better delivered with a different approach. CFOA has considered how elements of the ambulance service and the FRS could work more closely together, or indeed potentially be combined, in order to realise significant benefits consistent with the Government’s concept of Big Society. There is a real opportunity to realise financial savings estimated to be in the order of £250m while at the same time creating a better performing, more efficient, locally based service that meets local community needs.


“CFOA believes that there is the potential for a combined ambulance and fire and rescue service provision using a High Performance model to increase the number of lives saved.”


In developing this proposal, the experience across North America and in much of mainland Europe was considered, where the FRS provides the emergency medical response. Indeed there are similarities to the position in many areas of England prior to 1974. In towns and cities across England, fire stations are located next to, or in very close proximity to, ambulance stations. Despite the obvious synergies however, the two organisations remain distinctly separate other than in the case of a small number of co-location schemes.


Exploring options With the Government’s reform of the NHS and the responsibility for public health services passing to local authorities, an ideal opportunity exists to explore


options for providing a service designed to meet the Government’s stated aims of ‘putting patients and public first’ and ‘improving healthcare outcomes’ by way of a new approach to emergency response. CFOA believes that there is the potential for a combined ambulance and fire and rescue service provision using a High Performance model to increase the number of lives saved. It is anticipated that over 420 lives would be saved every year. This would be delivered on a locality basis taking into account District General Hospital provision and population density. The emphasis is on a local service meeting local needs and is consistent with government’s concept of Big Society. We fully accept that any joint arrangement would still require a high degree of clinical oversight, with a national clinical ambulance committee and local ambulance clinical structures if it is to maintain political and public confidence. Such reassurances would also come with oversight from the Care Quality Commission (CQC), which would provide independent quality assurance. CFOA and the Audit Commission have previously raised the possibility of integrating emergency ambulance response with the FRS. The NHS itself recognises that an element of emergency response (specifically HART and other USAR/CBRN trained responders) could be transferred out to either a combined civil contingency service or local FRSs. Using the US model of High Performance Ambulance Services (HPAS), the following outcomes should become the benchmark for performance: 90 percent response times for all life threatening emergencies in eight minutes; 20 percent cardiac arrest survival rates for all cardiac arrests; and a service that meets public satisfaction and at a cost which is publicly acceptable.


These services are based on a population of 300,000 to 1.1 million and utilise systems engineering concepts based on a demand analysis on a temporal and geographical basis, restructuring shifts, fleet standardisation, investment in IT and streamlining logistics and vehicle preparation. Productivity measures include costs per Unit Hour (UH: 1 hour of ambulance time, available to be tasked) and Unit Hour Utilisation (UHU).


Reduction in costs


Staffordshire Ambulance Service, prior to regionalisation, adopted this method of working, with a major reduction in costs, reduction in Whole Time Equivalents (WTE) and meeting the standards listed above. We understand that the changes CFOA is proposing are likely to produce concerns and opposition but it is our belief that engaging fire, health and ambulance professionals in the debate around benefits to the public is essential. www.cfoa.org.uk


Photos courtesy of Hampshire and Cheshire fire and rescue services.


Author: Peter Holland, President, Chief Fire Officers’ Association (CFOA).


Emergency Services Times November 2010


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