Safely Reducing Avoidable Conveyance Programme

Joint Response Unit

Brief Description of Initiative

The Joint Response Unit (JRU) was launched as an initial six-month pilot in March 2018 as the direct result of staff innovation and close partnership working with Kent Police.

The concept came about because frontline crews recognised too much response time was wasted waiting for blue light colleagues to arrive separately to call-outs where a dual emergency response was required, and vice versa, e.g. mental health crises, vehicle collisions, alcohol and drug-related incidents, domestic abuse or complex cases where vulnerable people are in need of medical and policing assistance.

The dedicated JRU team is made up of experienced, proactive Band 6 Paramedics that crew with a Police Officer or Special Constable, working on a dedicated fleet of JRU SRVs responding to incidents where there is a need for both police and ambulance services.

Date Initiative was introduced in Trust

March 2018.

Date of upload or review

Uploaded to Repository 15 April 2021.

Background Context

SECAmb and Kent Police call each other around 15,000 times a year on average, highlighting the need to work more collaboratively whenever possible. In the operational areas of Medway and Swale, where the JRU was first developed, data identified around 1,000 such incidents a year are recorded where dual emergency services need to attend, and that an average 40% of such call-outs presented between the hours of 6pm and 2am, mostly at weekends.

By August 2019 the pilot was a fully-fledged programme and SECAmb commissioned and rolled-out a purpose-built Skoda Kodiaq, featuring combined blue and green ‘Battenberg’ paintwork to represent the dual forces, touch-screen access to SECAmb’s Terrafix mobile data system, medical supplies and equipment and security equipment.

The project was originally launched with the Kent Special Constabulary, operational on Friday and Saturday evenings with one vehicle, and has since grown to work alongside the local police team with regular officers, seven days a week, 365 days a year with two vehicles.

JR-01 covers North Kent (Dartford and Gravesend) and JR-04 covers Medway & Swale.  In October this year, JR-07 is now live covering East Kent, focusing response on Thanet & Canterbury.

During the six-month pilot the JRU responded to almost 1,000 calls, recording a very low conveyance rate, successfully resolving numerous domestic violence, assault or mental health issues through swift assessment, effective safeguarding and treatment at initial point of contact. This has also positively impacted on operational performance for both Kent Police and SECAmb.

Over the subsequent 12 months the JRU expanded across all of North Kent, West Surrey and then the whole of Surrey, increasing response times from two days a week to seven days a week over peak hours.

Staff have demonstrated their commitment to their original idea by volunteering to do additional shifts, undertaking officer safety training, improving key skills and going above and beyond in terms of partnership communication and engagement, thereby enhancing educational standards and relationships between the police and paramedics.

The JRU has been backed by Health Education England and The Darzi Fellowship, who funded research into additional ways Surrey Police and SECAmb could work better together.

In their September 2019 inspection of SECAmb, the CQC highly commended the introduction of the JRU as an example of outstanding best practice.

In their 2020 business case for continued funding and expansion of the JRU, Kent Police highlighted the increased demand placed on them as a result of the rising number of mental health related calls – they forecast a 66% increase in these calls by 2022.

During 2019/20 the JRU attended 75 suicide risk calls, as well as 155 incidents in the ‘concern’ categories, often MH related.

Which specific patient group or presenting need is this response targeted at?

The JRU responds to all patients, where there is a medical need, and requirement for police, either due to a scene safety concern, or because an alleged crime has taken place.

When a standard 999 response from a double-crewed ambulance (DCA) costs approximately £419 per person, including conveyance to A&E, and a PC presence at a typical CAT3 incident costs £107.50 per officer, it became clear that too much time and money was being spent – for SECAmb, in taking DCAs off the road or waiting at scene for prolonged periods for police back-up to arrive, impacting negatively on Trust performance and our ability to provide safe, timely care to all our patients.

Similarly, trained police officers were finding themselves providing hours of pastoral care to citizens while waiting for ambulance support, instead of responding to emergencies or reports of criminal activity.

Geographical area or location covered by this response model

The JRU project was initially trialed in North Kent & Medway. It has since become full time 7 days a week in these areas, and has been expanded to other parts of Kent such as Thanet & Canterbury. The model has also been replicated in other areas of the trust with Surrey and Sussex Police Constabularies and operate on Friday and Saturday nights in Brighton, Worthing and Guildford.

Key Aims

The vision of the JRU was to establish dedicated response vehicles comprising one SECAmb paramedic and two police officers or special (volunteer) constables, which could attend up to seven call-outs during an eight-hour weekend shift, thus freeing up frontline resources and vehicles from both organisations to respond to more calls faster, improve experience and outcomes for each patient and improve safety for paramedics by preventing drug and alcohol-fuelled incidents, in particular, from escalating into disorder.

Benefits for Patients

Vulnerable patients experiencing mental health crises, domestic abuse, or other complex social health problems, or those involved in vehicle collisions, alcohol or drug-related incidents have benefitted from specialist response crews arriving on site sooner, equipped to deliver medical and policing services at point of contact, without incurring unnecessary delays.

Saving time in situations that are often very distressing for family members or friends on scene has done much to improve the patient experience.

Data shows the JRU attends CAT3 incidents in 36 minutes on average, compared to 1hr 52 minutes for a conventional SECAmb response. JRU call-outs are also resolved in an average of 34 minutes, compared to 64 minutes for a conventional response.

Benefits for Trust or System

Far fewer patients are being conveyed to hospital than through a standard solo police or ambulance response, positively impacting the wider system and our acute health service partners, and patients experiencing CAT1 or 2 potentially life-threatening symptoms are also receiving a faster response because more DCA resources are available to attend.

Kent Police are achieving cost savings by deploying special constables to the JRU, freeing up substantive officers to attend other high priority calls. For the year 2019/2021 a cost avoidance of £65,466 was achieved for Medway & Swale, equating to 2,091 hours of PC time saved.

SECAmb staff responsible for getting the JRU implemented were recognised in the 2019 Annual Staff Awards, winning the Clinical Excellence Award. Their successes have also been shared through internal comms channels including newsletters, social media, Chief’s bulletins and our membership magazine.

Morale is higher than average among the JRU team because their combined achievements are fed back to them through strong leadership, good internal and external communications, the CQC’s commendation and public feedback. As a result, staff commitment to improving the JRU is high, sickness levels are exceptionally low and we’ve been able to provide a consistently effective service, even during a pandemic.

Testimony from Chris Treves, SECAmb Paramedic:

“Since September 2019 I’ve been a full-time paramedic on the JRU. I’ve attended a combination of ambulance and police calls, which have proved exciting and different to our normal day-to-day work on a DCA. These range from RTCs, unexpected deaths, welfare calls to find the person collapsed behind their front doors, immediate graded calls for suicide risks in a public area to assaults and Saturday night drunks. There’s a great team effort on every shift and every day is different.”

Implementation

The project was trialed in March 2018, and it was quickly found to be a success. The project was then made business as usual for both SECAmb and Kent Police quickly expanding to one vehicle 7 days a week with two full time band 6 paramedics. The project then expanded further to a second full time vehicle for Medway & Swale 7 days a week, which led to two more band 6 paramedics joining the team. As this expansion was occurring in Kent, the JRU model was being replicated in other parts of the South East such as Brighton, Worthing and Guilford.

The full time vehicles work Monday – Thursday & Sundays and match the local response policing teams ‘late turn’ shifts, which Friday & Saturday nights are still resourced by the Kent Specials Constabulary, who have been integral to the team since its inception.

In Kent, funding is mutual between SECAmb and Kent Police. The dedicated fleet of JRU SRVs was purchased by SECAmb, and is maintained and serviced by Kent Police.

Evaluation & Monitoring

The Success of the JRU is being monitored in a multifaceted approach. Our response times are being reported inline with ARP, but we also monitor the job cycle time of the JRU. Patient feedback is also very important to monitoring the success, which is managed inline with the trust wide patient experience and feedback process by our patient experience team.

Patient feedback has been excellent and the JRU has received numerous compliments from grateful patients who have described the service as “absolutely amazing”, with one patient remarking, “couldn’t ask for a better response, the JRU went out of their way to help”.

A relative of a patient suffering a mental health crisis who benefitted from a JRU response said, “I don’t feel my daughter would be here now if it wasn’t for their help”.

We are in the process of analysing the JRU data in more depth alongside our business intelligence team and hope to be able to present this data soon.

Sustainability

The benefits of the JRU model have been widely appreciated, and as mentioned, the model has been implemented into other areas in the South East with other Police Constabularies. We have also had visits from other ambulance services and police constabularies such as Metropolitan Police, Sussex Police and the Welsh Ambulance Service and have been asked to provide consultancy to support similar models being implemented around the county.

In depth risk assessments have been completed for the JRU. The biggest risk is exposing paramedics to potentially volatile police scenes. To mitigate this risk, paramedics receive officer safety training delivered by Kent Police which teaches conflict resolution, basic self defence and restraint techniques.

All paramedics also carry a police airwave handset so they are aware of any important communications and can request assistance if needed. Since the inception no incident reports via our Datix system relating to JRU have been received.

Sharing & Learning

This model has assisted with the development of other collaborative projects across the trust. Most recently the principles of joint working have been used to implement a short trial project of a Falls SRV consisting of a paramedic and physiotherapist.

The JRU has also led to improved working relationships between police and ambulance.

Additional Information

Examples of positive media coverage for the SECAmb JRU can be found here.

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