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Emergency Services: Paramedics

Volume 745: debated on Wednesday 15 May 2013


Asked by

To ask Her Majesty’s Government under what circumstances unsupervised, unqualified paramedics may be sent to respond to an emergency call.

My Lords, ambulance trusts have a range of staff with different skill levels who are able to respond to patients depending on the severity of their illness or injury. It is the responsibility of individual ambulance trusts to determine how best to deploy those resources, ensuring that suitably qualified, skilled and experienced staff are sent to respond to calls.

Will the Minister tell me, therefore, whether he thinks that it was just an individual case or whether a general principle was at fault in the case of Sarah Mulenga, which has been widely publicised? The coroner ruled that neglect contributed to her death and found,

“a gross failure to provide basic medical attention”.

That was when two unqualified paramedics went to her call and, apparently, did not take her to hospital or even register her normal condition. How often does that sort of thing happen? Is it necessary to change the training system so that there will be more people qualified and trained?

My Lords, the London Ambulance Service has advised that the article in the Sunday Times was slightly misleading, in that the two members of staff who attended that particular patient were student paramedics in their third and final year of training and so were sufficiently qualified to work unsupervised. It is inaccurate to call them “unqualified”. The issue in this case was that, despite their qualifications and experience, the crew did not act in accordance with their training or the procedures that were laid down. That has been acknowledged by the London Ambulance Service, which has said that it believes that the failings are not reflective of the hundreds of ambulance staff who provide a high level of patient care to Londoners every day.

My Lords, the Minister has suggested that, on the issue raised by the noble Baroness, Lady Gardner of Parkes, it is really down to the management of ambulance trusts to make all those decisions. There is widespread concern around the country about the delays in ambulances reaching emergency cases. For example, I am told that the police now find that they are the first responders and end up having to take people to hospital. Is this a problem with the management of ambulance trusts or is it about the level of resources being made available by commissioners for emergency services and ambulance services?

The noble Lord is quite right that certain areas of the country have seen unacceptable delays in ambulance response times—I am aware of two trusts in that regard. However, this is not an issue around a lack of trained paramedics. Projections by the Centre for Workforce Intelligence show that there is a secure supply of paramedics until 2016. The College of Paramedics has stated that training posts on courses are always filled and, currently, 900 ambulance technicians are training to become paramedics. We are seeing an increase in paramedic numbers, which is encouraging.

My Lords, does the noble Earl agree that first aid ought to be taught in all schools mandatorily, so that as many people as possible in the community can learn first aid, help when there is an emergency and save lives?

I agree with the general thesis that the noble Baroness has advanced. As many people as possible should know first aid. That is how we will ensure that we can save more lives, particularly among those who suffer heart attacks in public places.

Will the Minister address the question asked by the noble Baroness, Lady Gardner? It has been said quite clearly that there are circumstances in which unqualified paramedics attend an emergency call. Does he believe that any unqualified paramedic should be responding to an emergency call?

My Lords, the issue here is that they were not unqualified, as I tried to convey. All ambulance trusts in the UK allow student paramedics to work unsupervised, but only after they have had nine months’ operational experience and have passed both a written exam and a clinical practice observation by a qualified assessor. In this case, the London Ambulance Service accepts that, despite their qualifications and experience, the crew did not act in accordance with their training.

My Lords, there are also volunteer first responders, trained with a minimum skill set and working with ambulance trusts across England. Will my noble friend tell the House who keeps the information about their deployment and how they are monitored for quality outcomes?

I think that my noble friend is referring to first responders, who should be integrated into the clinical governance structure of all ambulance trusts. The outcomes will be assessed for all calls regardless of who attended the calls in the first instance. A first responder is just that—further ambulance staff would always be sent to a call. In rural areas, these staff can often get there first and provide immediate help, so the use of those people is a matter for local decision.

My Lords, how often are fully trained paramedics and those in the training process evaluated as being fit to practise?

My Lords, it is up to the employer—in this case, the ambulance trust—to ensure that it has a body of suitably trained and experienced staff. That depends on regular monitoring and ensuring that training is kept up to date. Equally, it is up to commissioners to ensure that the service that they are receiving is delivered by suitably experienced and qualified people. The CQC will also have a role in this regard.

My Lords, I refer noble Lords to my health interests in the register. To follow on from the noble Earl’s final comment, is this not an example of staff such as nurses being trained to be practitioners in the health service but finding that they have not been given enough practical training when they come to treat people on the front line? The noble Earl will know that Health Education England is being established as a non-departmental public body in the Care Bill. Can we ensure that that body has much more control over the curriculum of those being trained to fill these very important posts?

The noble Lord makes a series of very important points about training. The answer to his final question is that, yes, Health Education England will certainly be looking at the degree of training required to fulfil specific professional tasks across the piece in the health service, including the ambulance service. However, I do not think that this case reflects a lack of appropriate training on the part of the individuals involved. They were appropriately trained; they were just incompetent. That is the point.