Professor Niro Siriwardena from CaHRU and Dr Adele Langlois from the School of Social and Political Sciences at the University of Lincoln have been awarded a seed award in humanities and social science from the Wellcome Trust to develop a Network exploring the Ethics of Ambulance Trials (NEAT). Dr Langlois is a social scientist who is an expert in biomedical ethics and governance. The network also includes leading prehospital researchers: Profs Philip Bath (Nottingham University), Jonathan Benger (University of West of England), Gavin Perkins (Warwick), Tom Quinn (University of Surrey), Helen Snooks (Swansea University) and Drs Chris Price (Newcastle University) and Sarah Voss (University of West of England).
Randomised controlled trials in ambulance settings are a relatively recent but growing area of research which poses particular challenges, including urgency of conditions and treatment, and difficulties with recruitment, randomisation and informed consent where time may be limited or patient capacity impaired. NEAT will involve interviews with researchers, health professionals and patients involved in ambulance trials together with the legal and systematic reviews and networking activities bringing together national experts in the ethical issues and design of prehospital clinical trials.
The team seek to raise awareness among researchers, practitioners, ethics committees and the public of developments in the ethics and conduct of ambulance trials and provide the basis for much needed research to inform recommendations for best ethical practice in future trials. Prof Siriwardena and Dr Langlois are currently recruiting a research assistant to join them to work on the study in 2016.
A new book, Ambulance Services: Leadership and Management Perspectives by Professors Paresh Wankhade and Kevin Mackway-Jones, features a chapter on equality and diversity in prehospital care, co-authored by Viet-Hai Phung and Prof Niro Siriwardena of CaHRU together with Dr Karen Windle of the School of Health and Social Care. The new volume also refers to CaHRU’s work in developing indicators and processes for measuring and improving the quality of care provided by ambulance services.
The chapter, Responding to diversity and delivering equality in prehospital care: statutory responsibilities, best practice and recommendations, explores the impact of increasing diversity in the UK population and NHS workforce on prehospital care delivery. As public sector organisations, ambulance services are bound by The Equality Act 2010, which obliges them to promote equality and outlaw discrimination, harassment and victimisation of people with protected characteristics such as age, disability, race, gender and sexual orientation. Ambulance services use the Equality Delivery System (EDS), a voluntary toolkit that provides guidance about how they can achieve their duties set out in The Equality Act 2010. Building on the original EDS, the new EDS2 framework encourages organisations to flexibly reflect local sensitivities.
There are still significant variations in the quality of data that ambulance services possess for different protected characteristic groups, which also makes progress towards greater equality difficult to measure. The chapter summarises the current policy, problems in delivering this and potential solutions to overcome these.
A new study ‘What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review‘ was published this month, and included CaHRU’s Viet-Hai Phung as one of the report co-authors. Over the last 15 years, The NHS has undertaken many reviews of urgent care. It has also recommended service delivery changes to improve access to, and the quality of, urgent care. Despite this, rising demand continues to strain the emergency and urgent care system.
In response, the National Institute for Health Research’s (NIHR) Health Services and Delivery Research (HSDR) programme commissioned this report from the University of Sheffield’s ScHARR as part of a wider series of evidence syntheses. The report contains five separate reviews linked to themes in the NHS England review – demand for urgent and emergency care; telephone triage and advice; ambulance clinicians managing patients with urgent conditions; delivering Emergency Department (ED) services; and emergency and urgent care networks. Alongside this, the team conducted systematic reviews and quality assessed additional primary research papers.
The key findings for each review were:
There is little empirical evidence to explain increases in demand for urgent care;
Telephone triage services provide appropriate and safe decision making with high patient satisfaction but the required clinical skill mix and effectiveness in a system is unclear;
Extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transport to hospital;
There is potential for GP services co-located within the ED to improve care;
No empirical evidence exists to support the design and development of urgent care networks.
The rapid review assessed the existing evidence base on delivering emergency and urgent care services. The research also identified two major gaps that further research needs to investigate. Firstly, we need to assess the current state of the urgent care. Secondly, we need to have a better understanding of the nature of demand, which can then be used to inform service delivery improvements.
CaHRU members, Viet-Hai Phung, Ana Godoy and Dr Jo Middlemass all presented posters at the recent College of Social Science Summer Conference, held at the University of Lincoln Business School on Thursday 2nd July. The purpose of the Conference was to showcase a range of work from across the College of Social Science that had been funded by its small grants scheme.
Ana was busiest as she presented four posters: Resources for Effective Sleep Treatment utilising Community Pharmacists (REST-UP), bisphosphonates and stroke and two for Quality and Costs of Primary Care in Europe (QUALICOPC)! Jo and Viet-Hai presented their work on dementia and ethnic inequalities in prehospital care respectively. All six posters generated considerable interest from attendees. Research from the wider School of Health and Social Care was also very well represented. Alongside the poster sessions were three sessions with 20 oral presentations from PhD students and staff. As with the posters, the oral presentations captured the diversity of the College’s work: from the work of the Red Cross to the future of Christmas markets; from gender identities and football through to the psychology of decision-making; from empathy in nursing to branding cities.
It is sometimes felt that students and academics rarely know what research colleagues in other parts of a School or College do. If the university is serious about raising awareness about the work of different departments, schools and colleges, then events such as this should become a permanent fixture in the academic calendar.
A new briefing paper, ‘Ethnicity and prehospital emergency care provided by ambulance services‘, was published today by The Race Equality Foundation. The paper was co-authored by Viet-Hai Phung, Professor Niro Siriwardena, and Dr Zahid Asghar from CaHRU and Dr Karen Windle from the School of Health and Social Care.
It builds on work that CaHRU is undertaking on people from minority groups and their prehospital care. The briefing paper describes the inequalities in access to, as well as treatment and outcomes from, prehospital care for minority ethnic groups in the UK. It discusses how inequalities are driven by factors that include limited cultural awareness among service providers, as well as limited language proficiency and understanding of the healthcare system among these patients groups and how these inequalities manifest themselves in differences in treatment and outcomes.
The paper goes on to examine the implications arising from these inequalities for service delivery, especially since increasing ethnic diversity is raising issues of equality and equity higher up the legislative and policy agendas. It concludes by exploring potential solutions, which include: a more integrated approach to collecting patient ethnicity data; interventions that target at-risk groups in particular locations; and better cultural competency training for service providers.