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View from the frontline: Dealing with mental health as a paramedic
The next phase of the National Record Locator launches soon, allowing ambulance trusts to access mental health information at the point of care. Business analyst and former paramedic Philip Radford talks about what this means for people on the frontline.
10 October 2019
The scale of the mental health crisis facing the NHS and social care system cannot be underestimated.
I previously worked for the London Ambulance Service. As I trained to be a paramedic, mental health issues became part of my working life. Day in, day out, I would respond to 999 calls relating to mental health. It wasn’t long before I began to appreciate how seriously such problems affect individuals and our society.
Poor mental health doesn’t discriminate. It can affect anyone of any age or background. Our mental health training was limited, so, although I would always endeavour to provide the best possible support to a patient, I didn’t always feel equipped to do so effectively.
That is why I understand the importance of the National Record Locator project (NRL). This has been a two-year effort to help develop the sharing of mental health information with ambulance trusts for the patients they treat.
Patients would not be able to recall the details of their crisis team. Sometimes they didn’t want to tell you.
With experience, I learned to better manage these situations and communicate more effectively with patients, but our access to resources to support them remained minimal. Often, our only option would be to take patients to A&E as a safe place of care. This rarely seemed to be the best outcome for the patient or a busy A&E.
Many patients have access to a mental health crisis team who can help them and provide support away from A&E. If we could contact the crisis team, we could potentially provide a better outcome, but this was not an easy task. Patients would not be able to recall the details of their crisis team. Sometimes they didn’t want to tell you. If their phone had died, it was difficult for them to access those details even if they wanted to retrieve them.
Using the NHS Identity system means ambulance clinicians can authenticate themselves using biometrics such as a fingerprint instead of using a Smartcard.
Introducing a new clinical system into the workflows of already busy clinicians was also challenging. We had to make sure they could really understand the benefits to them to ensure uptake. We needed to help them see a longer-term view of what the National Record Locator would provide.
For instance, the first phase, which went live in November last year, solved some problems for the ambulance clinicians, but not all. The crisis team couldn’t always pick up the phone and the clinicians weren’t always able to extract the extra information they needed.
The second phase, which is about to go live imminently, enables the clinicians to instantly access the mental health crisis plans of the patient, without having to go to the crisis team to share them. This will enable crews to make better informed decisions more quickly.
This sharing of records across organisational and regional boundaries helps the organisations and their clinicians to meet their targets of providing more integrated care.
After the first phase went live a year ago, we were able to prove that the technical functionality worked in a live clinical environment.
The second phase will involve us trying to get greater uptake by working with more mental health trusts to make their mental health crisis plans available via the NRL.
National Record Locator (NRL) will be able to alert you to patients under your care who have certain records, for example a crisis care plan, created for them. This is done by your local health care system searching the NRL for pointers (or bookmarks) to patient records indicating that a specific type of record now exists for the patient.
The National Record Locator (NRL) will bring many benefits to patients, organisations within the NHS and social care landscape as well as NHS frontline staff such as paramedics. This can be broken down in to three main groups.