We have detected that you are using Internet Explorer to visit this website. Internet Explorer is now being phased out by Microsoft. As a result, NHS Digital no longer supports any version of Internet Explorer for our web-based products, as it involves considerable extra effort and expense, which cannot be justified from public funds. Some features on this site will not work. You should use a modern browser such as Edge, Chrome, Firefox, or Safari. If you have difficulty installing or accessing a different browser, contact your IT support team.
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 requiring better support
I recall the first time I was called out to a patient who had suicidal thoughts and having a sense of helplessness as the patient did not want to attend accident and emergency (A&E). We did not have access to their crisis team or crisis plan. This meant we had a real struggle to persuade them that it was in their best interests to go to A&E. If the patient had not agreed, we would have been left in a really difficult situation of having to assess their capacity to make such a decision and possibly requiring police involvement.
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.
Access to mental health crisis plan
The development of the National Record Locator is crucial in allowing clinicians and other NHS staff to more easily contact the mental health crisis teams.
Ambulance clinicians can now see when a patient has a mental health crisis plan, who is responsible for the plan, and how they can be contacted for further information.
During the first phase, we worked with organisations that had a wide range of digital maturity. This meant that our delivery approach was less consistent than we had anticipated and we had to be flexible in working through the different constraints that organisations were facing. For example, the mental health trusts were trying to connect to the NRL from a variety of different platforms. We had to work with them to overcome the barriers in being able to perform all the API interactions, which help integrate application software. Another constraint was understanding the complexity of the trusts’ different admission and discharge processes.
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.
Making a wider range of records accessible
We are also using new NHS digital capabilities to provide better access to the National Record Locator for ambulance clinicians.
For example, using the NHS Identity system means ambulance clinicians can authenticate themselves using biometrics such as a fingerprint instead of using a Smartcard, which isn’t always a practical solution in a mobile setting.
We are also making a wider range of records accessible to clinicians, including child health and maternity records, plus further types of care plans in collaboration with the Local Health and Care Records (LCHR) initiative. For each record we bring on, we have to work out how it is best technically represented so that it can be easily searched for and viewed by a clinician. We also need to ensure that the correct access controls are in place so that it is only viewed appropriately. Although this can be challenging, knowing the benefits it will bring to the frontline makes it all worthwhile.
You can keep up-to-date with the progress on the second phase on the NHS Digital website.
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.
Learn more about the benefits of the National Record Locator (NRL).