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“2020health is an important and thoughtful contributor to the health debate”

Dr Sarah Wollaston MP, Chairman, Health Select Committee


Pre-hospital care Fringe Event CPC 2010

Oct 03. till Oct 03.

Pre-hospital care - Why the NHS is not fit for purpose

THis event was chaired by Gail Beer, 2020health Consultant Director

October 3, 20102010-10-03T05:45:00 - October 3, 2010 2010-10-03T07:00:00
5:45 PM 2010-10-03T05:45:00 - 7:00 PM 2010-10-03T07:00:00
ICC Hall 7

Conservative Party Conference 2010

Lois Rogers (Correspondent, Sunday Times),
Dr Phil Hyde (Consultant Paediatric Intensivist, Birmingham),
Gail Beer (Consultant Director, 2020health),
Nadine Dorries MP (Health Select Committee), 
Barry Johns (EMS Consultant, CranmerLawrence)
Lois Rogers (Correspondent, Sunday Times), Dr Phil Hyde (Consultant Paediatric Intensivist, Birmingham), Gail Beer (Consultant Director, 2020health), Nadine Dorries MP (Health Select Committee), Barry Johns (EMS Consultant, CranmerLawrence)
Fringe Event Speakers



Image Summary
  • Pre-hospital critical care is known as an area for improvement
  • The emphasis is on pre-hospital critical care and not just pre-hospital care. The latter term would encompass all that occurs to a patient outside of hospital, whereas the former is provided only to patients who need it (as they are critically ill) and can only be provided by a doctor and skilled assistant.
  • Ensuring the professional transfer of life saving skills that patients need for their journey.
  • London is the only region where good quality pre-hospital care is commissioned and funded by the NHS. Other regions need to put in place provision based on their population.
  • We should address the culture of cover-up within the NHS, acknowledging that it is a complex subject which requires careful and open discussion.
  • Pre-hospital critical care impacts on time taken for rehabilitation
  • There is international evidence supporting reduced intensive care bed stays for patients who have received pre-hosptial critical care.

Pre-hospital critical care is one of the known areas of deficit in the NHS. Outside of London, many critical injuries are not dealt with until the patient arrives in hospital. In March 2010 the department of health produced guidance about how improvements could be made in this area, however this guidance has not been widely implemented. Although the lack of improvement could be due to the major changes occurring in the NHS at this time, this could be a future field of inquiry for the health select committee.
International best practice for critical injuries

  • Access to emergency service
  • Quality of response, quality of care taken to patient
  • Projecting skills of A&E doctor and registered paramedic to incident to deliver care immediately, ensuring that a hospital standard treatment is brought to the patient.
  • Taking patients to centres of excellence
  • Less rehabilitation and a quicker return to normal life

Describing pre-hospital care as taking skills from A and E makes it sound like we are removing doctors from the hospital. Rather it is hospital standard treatment which is brought to the patient. It is projecting the life saving skills that patients need forward in their journey. The military already achieve this very effectively in Afghanistan and consequently their survival figures eclipse those within the NHS.

The Clinical Advisory Group on Trauma highlighted the obvious skills overlap between MERIT requirements and provision of accessible pre-hospital critical care. One solution to the current absence of pre-hospital critical care provision may be to combine funding streams for MERIT (Major Emergency Response and Incident Team ) and pre-hospital ‘enhanced care’ provision to ensure a regional 24/7 pre-hospital critical care support capability. MERIT’s stated remit encompasses any incident with critically ill or injured patients whose care requirements exceed the capability of the ambulance service. This would meet day to day ambulance demand while also acting as the first medical component of a response to a disaster. Innovative integration of our national need for pre-hospital critical care and major incident provision could provide the economic efficiency required for development of the pre-hospital ‘enhanced care’ component of our newly developing trauma systems.

There is an inequity of care provision across the country and London is best served, but their model would not suit every region. The principle of improving care is based around the patient and not the region. Critically injured and ill patients deserve life saving care that begins as soon as possible and London has achieved that for their particular social and physical geography. In London, the best served region for pre-hospital critical care, a team of a doctor and a paramedic attend the patient by the roadside. In the case of a head injury an anaesthetic can be administered to reduce the metabolic rate, and a tube used to facilitate breathing. These interventions can be done before the patient reaches hospital, thus providing early treatment.

Every day throughout the UK, ambulance services seek medical assistance in providing critically ill or injured patients with pre-hospital care. There is wide geographical and diurnal variability in availability and utilisation of physician based pre-hospital critical care support. Only London Ambulance Service has access to NHS commissioned 24 hour physician based pre-hospital critical care support. Throughout the rest of the UK, extensive use is made of volunteer doctors and charity sector providers of varying availability and capability.

We should also not forget the cost-effectiveness arguments. Since there may be an extended recovery through the delay in care, it could be more cost-effective to provide treatment at the roadside where necessary.

The culture of cover-up of malpractice was discussed. To encourage change, we need to complain publically about problems with the health service and have an open dialogue. The media can assist with publicity of adverse events.

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2020health at CPC 2010 (PDF, 1449 KB)

2020health at CPC 2010

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