How we are integrating urgent and emergency care

Video launched to explain services

Our population is changing. People are living longer and have multiple long term conditions, resulting in emergency departments being unable to cope, hospitals being overwhelmed and a knock on effect for our crews and patients.

To avoid patients facing long waits and unnecessary hospital admissions, we’re transforming from a transport to a treatment service that ensures patients are treated by the right person and in the right place, first time.

We are doing this through our Integrated Urgent Care Clinical Assessment Service (IUCCAS) in the Emergency Operations Centre, providing access to an ever expanding team of nurses, paramedics, advanced practitioners and GPs to help our call handlers in identifying the medical need of each patient.

And with the integration of the emergency care and patient transport services into our newly aligned Clinical Care and Transport service, our dispatch team have the ability to send a more appropriate vehicle type and staff member, depending on each patient’s clinical need.

As well as being able to improve patient outcomes, working in this way enables us to utilise our resources more efficiently and provide a real career development for staff from Band 2 through to Band 7.

You can watch an animation explaining the changes here:

The following case studies show how the CAS works in practice:

Stacey

Stacey calls 999 because her 78-year-old mum, Anne, has slurred speech, facial drooping and right arm weakness. It is determined she is likely to have had a stroke.

Our dispatch team know Anne needs to get to hospital as soon as possible but that she doesn’t necessarily need a paramedic, and are able to dispatch an ambulance with a technician-led crew. Following a positive FAST test, they transport Anne in the ambulance to the nearest specialist stroke unit, to ensure she receives the best possible care straight away.

Amir

Amir’s carer calls 111 and explains Amir’s acute confusion, incontinence and reduced fluid intake has resulted in him taking to bed and she is no longer able to cope with him at home.

Our call handler is able to refer to a nurse within the Clinical Assessment Service, who determines Amir has a urinary tract infection and arranges Amir’s admission to hospital. With more choice open to our dispatch team, we are able to dispatch an ambulance care assistance vehicle that can transport Amir in his wheelchair.

Pete

Pete, an ex-miner and long term smoker, calls 111 reporting breathlessness and feeling feverish.

Our dispatch team are able to dispatch an advanced practitioner, who determines Pete has a chest infection and prescribes him medication. After chatting with Pete and his wife, they agree he can be managed at home and a referral is made to community services to follow up Pete’s care.

Joanne

Joanne rings 999 for her friend Bob, who has collapsed. It is clear to the call handler immediately that Bob is in cardiac arrest and provides CPR advice and support to Joanne whilst an ambulance is dispatched.

On arrival the paramedic crew take over CPR and shock Bob with a defibrillator. After obtaining a return of spontaneous circulation (ROSC), the crew transport Bob to hospital.

Juan

Juan calls NHS111 as he is suffering from diarrhoea and vomiting following a trip abroad.

The call handler carries out an assessment of his symptoms on NHS Pathways and transfers Juan to a clinician in the Clinical Assessment Service, who is able to offer care and worsening advice to Juan without the need for an ambulance to attend.

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