Launching his party’s 10-year plan for the NHS on Tuesday ahead of the general election in May, Andy Burnham said integrated ambulance and out-of-hours services would reduce demand on A&E and provide more care out of hospital.
Out-of-hours care and the ambulance service have been a 'missing piece in the jigsaw' of integration, said Mr Burnham. The ambulance service should be an 'integrated provider of emergency and out-of-hours care, able to treat people where they find them, rather than carry them to hospital.'
The plans, he said, were a 'substantial answer' to relieving the pressure on A&E.
Lack of integration
'It is the lack of integration in out-of-hours care which often results in carrying to hospital as the default option,' he said.
Mr Burnham said Labour would not set out a preferred model for integrating the services. This would be left to local health economies to decide in line with wider plans for health and social care integration into a single service, with single budgets.
NHS 111 contracts would be given to ambulance providers as they expire. ‘This will mean more experienced staff on the phones and better classification of calls,’ the shadow health secretary argued.
Treatment at home
The service would work from a default presumption of treatment in the home, in line with the rest of the health and care service. Services would be able to call on wider, integrated teams of professionals, including GPs, OTs, physios and care assistants, around the patient, in the same way as new local integrated care organisations will do around hospital and primary care, he said.
‘Building a sense of a local team with GP out-of-hours services is essential, all with a financial incentive to keep people out of A&E,' said Mr Burnham.
Mr Burnham said he was open-minded about how integration might work and would consult on the best ways to do it.
‘This will allow us to build a high-quality, highly co-ordinated response behind the NHS 111 number that commands better public confidence than it does today,' he added.
'The principle is the same as the principle when we are dealing with more routine local care. The principle being, we need to create one team around the person. A highly integrated team. So that in the out of hours moment, a paramedic can, with confidence, say that if they decide not to carry somebody to hospital a GP will arrive in a specified time. Or district nurse will arrive in a specified time. Or a physio.
'That is what we have to achieve: where out of hours providers are incentivised to leave and support people in their own homes if that is clinically right.
'At the moment they can't do that, they don't have that confidence, because they can't be sure, because they are working in a fragmented way. They can't be sure that somebody will turn up and look after that person. '