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AMBULANCE SERVICE ASSOCIATION
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME

DEVELOPING EFFECTIVE CLINICAL PRACTICE
IN UK AMBULANCE SERVICES

Annual Report
to the
National Institute for Clinical Excellence

May 2000

Stuart Nicholls
Manager, ASA National Clinical Effectiveness Programme

Click HERE for Contents

AMBULANCE SERVICE ASSOCIATION
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME

ANNUAL REPORT 1999/2000

Contents

1. Background

2. Progress since April 1999

2.1 National Developments

2.2 Programme Base

3. Finance

4. Agenda to March 2001

5. Future Developments within the UK Ambulance Service

Appendix:

A: Financial Statement

AMBULANCE SERVICE ASSOCIATION
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME

ANNUAL REPORT 1999/2000

1. Background

1.1 The Ambulance Service Association National Clinical Effectiveness Programme (referred to hereafter as either ASANCEP or the Programme) promotes and supports effective clinical practice within all UK public sector ambulance services.

1.2 The original work programme and objectives of the ASANCEP were laid out in the proposal submitted to the NHS Executive (1998) and are steered by the Joint ASA/ JRCALC (Joint Royal Colleges Ambulance Liaison Committee) Clinical Effectiveness Committee.

1.3 The Programme (ASANCEP) was initiated in December 1998 with funding received directly from the Department of Health as part of the NHS ‘Core Audit Funding’. This was for an eighteen month Project to develop and support clinical audit in the UK’s ambulance services.

1.4 In April 1999 the National Institute for Clinical Excellence (NICE) was established and took over the funding arrangements for ‘Core Audit Funding’ within the NHS.

1.5 The agenda for 1999/2000 had previously been outlined in the last annual report for 1998/1999 covering the initial few months of the Project. Progress against this agenda was also discussed with NICE at an annual review meeting in October 1999.

1.6 This annual report for the year 1999/2000 covers the work of the ASANCEP over the last twelve months of the initial eighteen month project.

1.7 Following the review meeting with NICE it was agreed that the ASA would receive the support of NICE in developing clinical effectiveness in line with other professions within the NHS. To reflect this continued commitment the Project changed it’s name to the ASA National Clinical Effectiveness Programme.

1.8 The objectives of the ASANCEP for the period 2000/2001 are outlined in the current Business Plan .

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2. Progress since April 1999

2.1 National Developments

2.1.1 Regional Clinical Audit Groups. These have been developed to facilitate the sharing of information on clinical audit at a local and regional level. Groups have been established in the south west, south east, midlands, north west, and north. Scotland, Northern Ireland and Wales each stand alone as national groups in their own right. Each regional group is represented on the national Joint ASA/JRCALC Clinical Effectiveness Committee to allow for local initiatives to be shared at a national level and for national initiatives to be fed back effectively to a regional and local level . They will form the basis for implementing many of the objectives of the ASANCEP 2000/2001 Business Plan.

2.1.2 Recommended Minimum Data Set. This has been developed jointly with JRCALC to ensure all UK ambulance services are collecting the same information, from their patient report forms, to allow for comparative and collaborative clinical audit . The data set was launched at the ASA’s annual conference and exhibition – Ambex International 1999.

2.1.3 Evidence for Change III Survey of Clinical Audit. This annual survey was conducted in January 2000. It looked at issues of data collection as well as documenting clinical improvement projects from all UK ambulance services. Once again there was an increase in the number of clinical improvement projects submitted over the previous survey .

2.1.4 Candour Newsletter. This continues to appear in Ambulance UK the official publication of the ASA. It informs the ambulance service and its staff of local, regional and national initiatives surrounding clinical audit and clinical effectiveness.

2.1.5 Project Information Leaflets. These were designed to highlight to clinical audit leads within the UK ambulance services the resources available and objectives of the ASANCEP.

2.1.6 ASA/ JRCALC Conference May 1999. The conference ‘Clinical Effectiveness & Governance: Creating the link’ was a resounding success with many eminent speakers and an audience representative of the majority UK ambulance services. A further national conference is to be held on 3rd November 2000.

2.1.7 ASA NCEP Website (www.asancep.org.uk). This was developed during the year and was officially launched in March 2000. It allows access to all the publications produced by the ASANCEP and provides links to other clinical effectiveness information. It also allows for feedback between users and the Programme itself.

2.1.8 Clinical Governance Reference Pack. This was developed by a special working group of the ASA with input from the ASANCEP to ensure the issues surrounding the development of clinical audit and clinical effectiveness were at the forefront. It was distributed to all UK ambulance services in August 1999 with copies circulated to Chief Executives and to Clinical Governance Leads.

2.1.9 NICE Conference – Clinical Excellence 1999. The ASANCEP exhibited at the first annual conference of NICE, in December 1999, gaining many contacts outside the ambulance service. The success of the conference and exhibition was beyond all expectations and raised the profile of both the ASA and individual ambulance services through their work in the areas of clinical audit and clinical effectiveness. The ASANCEP will again be present at Clinical Excellence 2000.

2.1.10 Other conferences and presentations. The ASANCEP presented its work to many ambulance services through the Regional Clinical Audit Group network but was also invited to speak at specific events such as Bedfordshire & Hertfordshire Ambulance & Paramedic Service NHS Trust’s annual clinical audit presentation evening (June 1999), and Welsh Ambulance Service NHS Trust’s national clinical effectiveness training day (March 2000).

2.1.11 Prehospital clinical audit databases. The ASANCEP continues to act as a resource centre for clinical effectiveness within UK ambulance services fielding many requests for information from latest research results to identifying others working in similar fields and assistance in selecting data collection and analysis tools for clinical audit. Reference material has been sourced and catalogued to assist in providing clinically effective prehospital information to all UK ambulance services.

2.1.12 Development of evidence based standards. A set of draft prehospital standards were presented to JRCALC in December 1999. JRCALC recognised further work was required and in March 2000 made moves to establish a National Clinical Guidelines Sub-Committee (JRCALC-CGC) . This sub-committee will agree a strategic direction for the development of prehospital clinical guidelines, develop an implementation plan, write evidence based clinical guidelines for use by ambulance services, develop performance indicators for each guideline and develop a framework for clinical audit activity covered by each guideline. The work of the JRCALC-CGC will be co-ordinated through the ASANCEP.

2.1.13 Clinical Audit Training. In line with the new direction for NHS Effective Clinical Practice Programmes overseen by NICE, the development of clinical audit training for ambulance staff will use existing packages available from other professional bodies and be tailored to the needs of the UK’s ambulance service.

2.1.14 Development of pathways of care. The work of the JRCALC-CGC as described above will ensure prehospital clinical guidelines ‘fit’ with existing guidelines used in other health care areas to ensure a ‘seamless’ pathway of care for the patient.

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2.2 Programme Base

2.2.1 The Ambulance Service Association National Clinical Effectiveness Programme continues to be based at premises of Kent Ambulance NHS Trust in Maidstone.

2.2.2 Following an initial delay a part-time Administrative Assistant to the Programme Manager was appointed in July 1999. However, the post was vacated in January 2000.

2.2.3 The job description was changed during February 2000 to reflect the developing objectives of the ASANCEP, and an Information and Administration Assistant was appointed. The new post will commence in May 2000.

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3. Finance

3.1 A financial statement on income and expenditure for the period 1st April 1999 to 31st March 2000 is attached in Appendix A. This has been provided by the Director of Finance for Kent Ambulance NHS Trust, in his capacity as both the nominated grant-holder for the ASANCEP and the National Treasurer of the ASA.

3.2 There is a small underspend which can be attributed to the delay in the employment of the Assistant to the Programme Manager in July 1999, and the subsequent vacancy for the same position which arose in January 2000.

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4. Agenda to March 2001

The following list provides brief details of the objectives of the ASANCEP as outlined in the current Business Plan . These may be subject to change throughout the year as NICE redefines the arrangements for funding and supporting NHS Effective Clinical Practice Programmes following their Board meeting in June 2000 .

4.1 Develop further the regional clinical audit group structure
4.2 Develop a Code of Practice for prehospital record keeping and data collection
4.3 ASA/JRCALC Minimum Data Set – Review of Compliance
4.4 Establish an effective communication strategy with interested bodies
4.5 Develop a rolling programme of audit
4.6 Maintain databases developed in previous work programme (1999/2000)
4.7 Develop a clinical audit training package
4.8 Conduct and disseminate ‘Evidence for Change IV’ – Survey
4.9 Exhibit at relevant conferences
4.10 Develop audit tools around agreed standards

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5. Future Developments within the UK Ambulance Service

5.1 Since the inception of the Ambulance Service Association’s National Clinical Effectiveness Programme in December 1998 significant progress has been made to support and develop clinical audit and associated issues within the UK’s ambulance services.

5.2 The foundations have been laid to ensure the quality of prehospital care is continually improved and clinically effective. Amongst other initiatives, the regional clinical audit group structure ensures close collaboration and the sharing of best practice at local and regional levels , whilst the introduction of the ASA/JRCALC Minimum Data Set ensures data is comparable allowing for the future development of regional and national audits .

5.3 However, there is still a way to go. There are many seeds of change which are about to take root in the UK’s ambulance services as we move into the new century, all of which will impact upon the quality of patient care provided.

5.4 Aside from the new response time performance standards set for April 2001 there are several additional key developments which will shape the way in which the ASANCEP continues to develop and support effective clinical practice in the UK’s ambulance service.

5.5 The development of prehospital paramedic care as a Profession continues since the announcement at Ambex in 1999 of Registration of Ambulance Paramedics . This introduces concepts of clinical accountability and self-regulation on top of national initiatives such as clinical governance. Whereas in the past clinical audit training has been aimed primarily at the staff directly involved in audit, more is required to ensure all staff are aware of its use and value, and the part it plays in self-regulation and continued professional development.

5.6 The continued development of the profession itself poses important questions. The changing role of paramedics is under discussion given the changing face of the NHS with the introduction of Primary Care Groups/ Trusts and NHS Direct amongst other initiatives . It is foreseen that the further education of paramedics will impact widely on both prehospital care and care provided in the wider NHS.

5.7 The increased use of technology and the development of clinical decision support systems and electronic patient records are as vital to ambulance services as they are to in-hospital electronic health records. With the diverse nature of patients seen by ambulance staff it is almost impossible to allow for every event on a paper based patient report form. Similarly, the ease and accuracy with which electronic data can be collected, analysed and reported means that the development of electronic clinical audit tools are a necessity.

5.8 The implementation of National Service Frameworks will mean targets are imposed upon ambulance service performance with specific clinical audits developed to ensure progress is made. A prehospital clinical audit database to fulfil the requirements of the Coronary Heart Disease National Service Framework is currently under development.

5.9 The development of national pre-hospital clinical guidelines is a vital component to the progress of ambulance services. The ASA and JRCALC are working on a set of guidelines with associated audit tools which will both improve the quality of care provided and reduce variation in clinical practice . Being evidence based the guidelines will ensure that prehospital care is clinically effective.

5.10 As part of the NHS Effective Clinical Practice Programme the ASA will increasingly collaborate with NICE and other professional bodies within the NHS. This will ensure there is no duplication of work and that where appropriate prehospital care is included in wider pathways of care, guidelines and national audits.

5.11 The ASANCEP is already re-evaluating it’s priorities for the coming year 2000/2001 in light of the Clinical Audit Workshop held by NICE in March 2000.

5.12 With all of these initiatives in place the ASA hope to establish effective clinical practice in the UK’s ambulance services building on national prehospital clinical guidelines, using electronic information, developing regional and national clinical audits, feeding into National Service Frameworks and collaborating with the wider NHS to ensure an integrated approach.

5.13 In order to achieve all of the above, strong working relationships need to be maintained between the Ambulance Service Association and the National Institute for Clinical Excellence.

5.14 Further information about the Ambulance Service Association National Clinical Effectiveness Programme, together with details of all the publications cited here, can be found on the Programme’s website at http://www.asancep.org.uk.

Stuart Nicholls
Manager, ASA National Clinical Effectiveness Programme
May 2000

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APPENDIX A

FINANCIAL STATEMENT

AMBULANCE SERVICE ASSOCIATION
NATIONAL CLINICAL EFFECTIVENESS PROGRAMME

1st April 1999 to 31st March 2000 Inclusive

INCOME AND EXPENDITURE ACCOUNT

As at 31st March 2000

INCOME  
NICE Allocation 1999/2000 46,229.00
EXPENDITURE  
Salaries (including employer’s on costs) 26,885.94
Training 3,394.04
Travel & Subsistence 1,509.76
Telephone Rental & Calls 1,624.92
Computer & Officer Equipment 519.98
Printing, Stationery & Postage 2,556.08
Petrol & Diesel 1,641.10
Staff Lease Car 3,860.88
Rent & Rates 1,200.00
TOTAL 43,192.70
   
SURPLUS 3,026.30
   
Salary underspend (including employer’s on costs) 3,032.96
Actual Surplus

3.9400

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