NHS medical director, Sir Bruce Keogh, is suggesting that heart attack and stroke patients could be treated in their homes rather than in hospital to ease the burden on A&E units. He suggests that ambulance staff should be charged with administering drugs to treat heart attacks, strokes and severe asthma attacks.
Sir Bruce disclosed these proposals as Health Secretary, Jeremy Hunt, warned that the NHS faced a 'very tough winter'. He admitted that A&E departments may miss their waiting time targets of four hours, prompting a review of emergency care aimed at identifying ways of cutting the number of people going to A&E.
One option being considered is to treat people at home instead of taking them straight to hospital, with Sir Bruce commenting that some paramedics are already treating patients at home and the practice could become widespread. There are calls for moves towards more home treatment for acute cases which, it is hoped, would reverse recent trends in medical practice. For instance, over the past decade, paramedics have provided less treatment to heart attack victims in the home preferring to take patients directly to specialist heart attack centres to undergo treatment to open up the blocked artery. One option to bypass A & E would be for paramedics to administer anti-clotting drugs to heart attack victims at home to stabilise them before taking them to a specialist clinic to recover.
The Telegraph reported Sir Bruce’s comments that: “Increasingly we have seen ambulances treating people in their own home, delivering clot-busting drugs in the ambulance, treating heart attacks and delivering the early stages of stroke treatment… There is more that ambulance services can do to provide A&E treatment to patients rather than just transferring people.”
Lucie Prothero, associate in the Penningtons’ clinical negligence team, said: “We would not disagree with Sir Bruce’s comments that there is expertise amongst the ambulance services that can be utilised efficiently for the management of acute cardiac and stroke patients. However, concerns have been raised by Britain’s leading stroke expert, Dr Anthony Rudd, that clot-busting treatment for stroke patients cannot be provided in an ambulance - they have to be in hospital. While it is clear that urgent steps need to be taken to reduce A&E waiting times, this must not be done at the expense of providing proper acute care to the patients most in need. Patient safety must be a priority to ensure not only prompt treatment but also a good standard of care is provided by medical practitioners in a safe and appropriate environment.”