RCN Congress iii 2025 - Accountability for patients in ambulances

The resolution (with a reading list) on Accountability for patients in ambulances

- drew attention to language once again (yes, well there's a truism: what do you expect!). This time highlighting how corridor care is now variegated. In addition, politically you can circumvent addressing an issue, by referring to 'never events', and 'zero tolerance' as we read:

'This agenda item addresses the urgent issue of accountability, for both registered nurses and the organisations they work for, when patients are cared for in ambulances waiting to access emergency departments.

The resolution comes at a time when, across all four countries, there are unprecedented ambulance handover delays with patients left in vehicles which are neither appropriately staffed nor resourced outside overwhelmed emergency departments. Despite the prolific nature of this practice, there is no clear guidance on accountability. Who is responsible for the care and safety of those patients - the ambulance service, the hospital, the emergency department, or the individual registered nurse providing care?

These delays accessing care and the lack of guidance on who is accountable for the waiting patients, compromises the ability of health care staff to provide good quality care and risks patient safety. It also exposes registered nurses and other health care professionals to professionally, ethically and legally ambiguous situations. It could also contribute to the crisis in nursing wellbeing, raising issues such as moral distress and professional, emotional and physical burnout. It may, therefore, also impact the already perilous recruitment and retention.'

Student nurses, paramedics ... please take note: There is a paper to be written on Hodges' model and the gaps we encounter in health and social care. For Brian Hodges this started with the theory-practice gap; one of four original stimuli for the creation of the model. 

As the idealised standards, quality and safety of care being delivered are surrendered; this gap stands out as the virtual keystone.

individual

|

INTERPERSONAL : SCIENCES

humanistic ------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group

individual - PURPOSES patient safety - distress nurse wellbeing emotional burnout moral distress personal ethics individual responsibilities	procedure delivered care - observation mattress, trolley .. ambulance design instrumentation, noise time - duration logistics - PROCESSES - handover physical resources - beds
communities of PRACTICE team working - coherence team experience - students THE DAMAGE - that is 'BOOK-PASSING' The public's - carer's experience (wither friends and family)	law - guidance - ambiguity POLICY professional accountability risk management organisational responsibility workforce recruitment & retention

Previously: 'RCN' : 'gap' : 'accountability' : 4Ps

'ABCD' mapped to '1234'*

For context [UK politics and policy] please see below ...

INDIVIDUAL

|

 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

BACKLOGS Person-centred: "Am I there yet?" Service-centred: "Are we there yet?"	AMBULANCES 'Just in TI:ME' [not] Hand-me-over-why-don't-you?
(Social) CARE	DOCTORS DENTISTS

"Sally Warren, director of policy at The King’s Fund,
said that Our Plan for Patients ‘amounts to little more
than tinkering at the edges’ despite containing some
‘sensible’ policies."     https://www.nursinginpractice.com/

Whether tinkering or not, don't forget and do take care around all the edges.
Do 'C' the low-hanging fruit.

[Just to be clear: This isn't about ✔ in boxes.
It's about integrating care, values, quality and safety. ]

https://www.nursinginpractice.com/latest-news/therese-coffeys-plan-for-social-care-only-short-term-solution/

^ and '5' the Spiritual too.

Context:

"Thérèse Anne Coffey is a British politician who has been Deputy Prime Minister of the United Kingdom and Secretary of State for Health and Social Care since 6 September 2022." Wikipedia.

"For Coffey, 'ABCD' stands for ambulances, backlogs, care, doctors and dentists – and rightly so." The Guardian

See also: c/o The Health Foundation

What are the public’s priorities for the NHS? And is the government listening?

Person-Centredness and Safety: 25st / 350lb / 159kg

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

	https://www.bariquins.com/ ... doors and doorways, entrances, exits, passages, chairs, stretchers, hoists ... moving - handling ...

My source:
Twitter:
https://twitter.com/Bariquins

3rd Healthcare Digital Technology Congress: Manchester

I greatly enjoyed Convenzis's Congress in Manchester at etc.venues. The early train journey (as 'us' Northerner's know very well) was not pleasant. Upon arrival I worried I might behave like a sardine in the lift up to the 8th floor. The venue is very convenient near Oxford Road and Piccadilly (I got off early at O. Rd). Manchester and Liverpool are well served for conference venues.

The journey was quickly forgotten, with a welcome coffee and breakfast. Networking started immediately thanks to a 'clear' twitter profile picture and some 'homework' with tweets the night before. Despite breakfast the exhibitor stands whetted the appetite for information at the breaks to follow.

These events are not just a help keep up-to-date #HealthIT #DigitalHealth wise, but a way to try to maintain some sense of balance as things are read while not experienced first-hand. Digital health is diverse and a reference during the day to juggling and its architecture was quite apt.The balance comes in countering the social media bubbles that (as users) we inhabit and are influenced by.

I'm not going to do a blow-by-blow account but Richard Price set the digital tone referring to technology development through the course of NHS's history:

- and The Topol Review (February 2019) and the digital future through Dr Eric Topol and a video:

As a scholar of literacy in its many forms I appreciated Richard's slide on the digital form. (Is this the same as 'information', or informatics' even?) This is interesting in being person-centred which at an individual level is not necessarily the same thing. Hopefully any e-careplan is formulated and constructed based on this, with time for data entry and practitioner-patient(person) engagement?

My thoughts or social media concerns here are based on tweets I have read which are often politicised and tied to related policy and the NHS Long Terms Plan. Health and Healthcare IS political, as previous posts have indicated. In contrast days like this and technical evangelism are a great experience for the optimism, technology, skills, problems solved and ongoing progress.

There was a question at the end of the day about AI artificial intelligence and how perhaps its role can be proven in less clinically applications. I was going to reply with the case of 'robotic process automation' which is gathering pace in other 'industries' such as insurance, recruitment and document management. Having experienced in the past new starters from universities have to retro-learn old applications and operating systems I was surprised to hear mention of 'Windows XP'. History - future all rolled up together.

In March I noticed a tweet andwell before I attended RCN Congress for the first time:

1 in 40 doctors participating in research compared to 1in 1, 000 nurses says Lord Willis @councilofdeans @JessicaCorner @KingsNursing @theRCN what can we do /enhance access and participation?

— anne marie rafferty (@annemarieraffer) March 13, 2019

Also on twitter I've wondered about wards, clinical teams having a 'research question' sitting on the shelf, if not a 'live' research project. Perhaps a ward could have three proposed questions that are revisited and even picked up by students. This could be part of the introduction to the placement and help raise awareness on several levels. At this event I spoke to InPhase and within the 'single assurance system' which was demonstrated to me there would be scope to incorporate such an initiative. Beyond this though ward managers, matrons and senior managers can have the tools such that 'data' about wards and even individual practitioners is available. While crucial (think CQC), this data turned into information and intelligence should not just be inspection fodder. There must be a clinical and research dividend to routine records. Also noted previously is the need for practitioners to manage their cases, their caseload.

A representative for Checkware explained their approach of patient involvement through self-reporting, self-management and long-distance follow-up. In terms of low-hanging fruit for computerisation this has long been one of them. The original box-ticking exercise that now seems to define the success or otherwise (mere completion?) of activities that it really shouldn't. After discussing copyright, patient engagement and the company's background I thought of Hodges' model (of course). I wanted to ask "What is the most general assessment tool you have?" There are many possible responses, but I didn't.

As a registered nurse I've always been defensive about patient data and what happens to it (IT). Consequently I've paid interest to data protection and public initiatives for e-records over the decades. It may be me, but I picked up a sense that a consensus within the public may be emerging? It's not even that the public were represented as such, just a sense from what was said. I may be wrong... and any optimism regards the maturity of the public's attitude to health e-record, does not equate to the maturity of the technology?

Hadleigh Stollar from NHSDigital explained the progress and plans of the National Record Locator Service, it’s success so far and benefits! This is pivotal for the experience of people with mental health problems in crisis and ambulance services. This is just the start. There was a phrase, LHCRE (which became 'lycra') that's "Local Health Care Records Exemplar" sites. There was a lot more with the Personal Health Record, a key example, as the event website indicates. The offerings of PureAV go far beyond the prompt for me to use video. Clinical Emergency Medicine Books - CEMbooks brought back some nursing memories. This was a very well organised, clearly well-planned Congress, informative, practical, with time for the exhibition and networking. Leaving at 1610 I even had a much better return journey.

Thanks to the Convenzis Team and etc.venues.

Patiala Health Foundation Launches SevaMobile Trauma Initiative

FOR IMMEDIATE RELEASE: Organization focuses on ways to combat traffic and provide critical and emergency trauma care to those in need.

(Weirton, WV / Patiala Punjab India) - The Patiala Health Foundation, a registered 501-C3 non-profit based in the United States, has started its second phase of providing critical health care services to those in need. Today the organization is announcing the launch of three “SevaMobiles”, or charity vehicles, that will bring trauma care to injured people instead of waiting for them to get to hospitals.

The SevaMobile Initiative is a major innovation in Indian healthcare because it will shorten the time from emergency call to treatment by 50 percent. For many, these precious minutes can be the difference between life and death. Traffic in major metropolitan areas is a two-pronged danger in India. Firstly, many trauma deaths are caused by automobile accidents and secondly, the traffic itself slows down the ability for care professionals to reach victims and transport them to hospitals.

Trauma-related deaths occur every 1.9 minutes in India, according to a 2004 report in the Indian Journal of Critical Care Medicine [IJCCM]. With traffic increasing, trauma will move from its current ninth position to become India’s third leading cause of death by 2020. The 10 percent increase in deaths from injuries in Punjab between 1983 and 1992 demonstrates the urgent need for trauma facilities in the region.

The SevaMobile Initiative will consist of a fully functional mobile trauma unit that also provides emergency critical care on site. In addition to this ambulance, two SevaMobile motorcycles will also be able to navigate through traffic and narrow roads to provide first response immediate care and stabilization. This first level of care will allow for victims to be quickly treated while more comprehensive care, via an ambulance, is on its way. The service will be offered free to those who cannot afford medical services and will be funded by the Patiala Health Foundation.

"In our analysis of urban healthcare, we found that there were many efforts underway to build new structures and hospitals, but there was still a real need to reach victims faster," said Patiala Health Foundation's Dr. Amrik S. Chattha. "We believe the SevaMobile Initiative will be a major innovation, impacting the lives of people by treating them quickly and more efficiently. We also believe that pre-hospital care, such as that offered by the SevaMobile, should be a right to all injured victims."

The organization is currently planning to partner with public and private hospitals in the area to transport patients to larger treatments centers. Patients who cannot afford the medical fees will be treated free of charge courtesy of the Patiala Health Foundation. Those who can afford the service will pay for their care, enabling the program to partially fund itself, while also creating a longer sustainability of operations.

"We want to help those in need, but also build a system that supports itself," noted Dr. Harish Sood, another Patiala Health Foundation board member who is spearheading the SevaMobile effort on the ground in India with a collection of local trustees. Additionally, fifteen retired alumni of Patiala Medical College are volunteering their services and time to assist with the project.

SevaMobiles are planning to commence operations this winter. The project is funded by the Patiala Health Foundation whose funds have been raised by Indian-Americans across the United States through six benefit events in Ohio, California, North Carolina, New York and, most recently, Virginia. The organization is also actively looking for additional donors, corporate partners and grant giving organizations interested in improving health care for low-income citizens within India.

For more information on the Patiala Health Foundation please contact:

Patiala Health Foundation at 304-723-4151 or amrikchattha AT yahoo.com.

Image source (Courtesy of Getty Images)
http://www.vscconsulting.com/dev/clients/MediaCenters/8/Ambulance%20Image_motorcycle.jpg

My source: Vijay Chattha, PHF PR Contact

Additional links:

Ideas Factory posts

DoH (2005). Taking healthcare to the patient: Transforming NHS ambulance services.