Will government proposals to ease the strain on hospital accident and emergency units by creating a new breed of paramedic improve the quality of the service?
Under new plans people may be dealt with over the phone, or treated at home by "super paramedics", trained to the same level as a senior nurse.
It is hoped the changes could mean around one million fewer people going to A&E but ambulance staff are concerned that some more serious cases could be missed.
Do you think the plans put patients at risk? Or will it mean that more serious emergencies will be seen quicker? Will it make the ambulance service more efficient?
This debate is now closed. Read your comments below.
The following comments reflect the balance of opinion we have received so far:
It all sounds a good idea but how much more training are these 'super paramedics' receiving compared to the 3 years plus for a registered general nurse and the five years plus for a doctor? Why not utilise these resources more effectively than waste more money on training a paramedic whose original training was for a matter of weeks!
Will they work? Will they save money should be the question, because that is the ultimate aim of the changes. Was this in the manifesto, Tony???
Roger, Whitwick, England
This idea is a fantastic one which needs to be heralded for the future of an ever increasingly demanded health service. The costs will lower, the medics will arrive quicker, and this will reap major benefits to society as a whole. The more serious cases would not be missed as there would be more ambulances and space in A&Es to deal with them.
Jamie Prouse, Barnstaple, Devon
Why don't we provide better education to prevent these idiots from calling 999 in the first place? A few compulsory first aid and health sessions for everyone would put things into perspective. This whole fiasco is another reason I'd like to leave this ailing country before it finally does go to the dogs!
Sarah, Guildford, UK
How long will it take for someone to die while giving symptoms over phone? It may take only a few minutes for the operator to decide if the ambulance should be sent but those few minutes can mean the difference between life or death.
Kevin Weston, Westbury, Wiltshire
It's not a question of ambulance drivers performing open heart surgery on your kitchen table. It's realising that not all conditions are life threatening and that some people can be treated where they are. It will mean that A&E units will more likely treat trauma victims, and not drama queens.
Alan Davidson, London
Excellent idea - can't see how anyone can object to it. An additional benefit not immediately obvious is for those in more rural areas where better on the spot treatment could increase survival chances rather than facing an immediate long drive before receiving good first line attention.
Jennifer, Chester, UK
My wife fell on a glass the other week and neither of us could drive to the hospital as we were both 'over the limit'. We rang 999 for advice and they sent an ambulance. Are you telling me the new process will involve me getting out my sewing kit to do the job myself with careful telephonic instructions?
Ian Josling, Cheshunt, Herts
How can you possibly make an official judgement on an ill patient over the telephone as to whether an ambulance is sent or not? Are we turning into a Third World nation? I wouldn't be surprised if we farm out the call centre to India.
Chris Gower, Rayleigh, Essex
A sensible measure. There are a lot of truly stupid calls to ambulances. However a fair proportion of the calls for ambulances and visits to A&E units happen because of the degraded service availability from GP's. The GP's new contract means that they provide less service for more money and other NHS services are having to take the strain as a result.
Chris Stevens, London, UK
Given the number of (comparatively) trivial things that ambulances seem to be required for these days it seems reasonable to only send an ambulance out when the patient actually needs one, rather than when what they actually need is some medical advice or a few pills.
Ellie, Edinburgh, UK
As a nurse on an accident and emergency unit, I am shocked at the reasons why people call for an ambulance. Just the other day someone called 999 because they had a toothache. This meant wasting our time on a busy unit.
As long as it's done sensibly, every strategy has its place. Sprains, cuts, bruises and other minor injuries don't need a trip to A&E and that's what's going to be tackled with this scheme. Anything to prevent timewasters abusing the system.
Tom, Reading, UK
If you arrive at hospital in an ambulance you are more likely to be admitted and kept in, is this the government's way of reducing hospital admissions and freeing up beds?
Chris, Telford, UK
There is no attempt to offer medical care by telephone - it's a device to ensure that only real patients are emergencies. Mothers whose children graze a knee do not need to ring emergency numbers!
I have nothing but respect for paramedics and ambulance technicians, but I see this as the thin end of the wedge. Slowly but surely, "rationalisation" is knocking the wind out of the NHS, and the UK is slowly becoming America. My sister has been treated at home by paramedics and they were great, all well and good, but this is not about helping, it is about trying to save money. Read between the lines, it's all there. So I have mixed feelings about it.
Jennifer Hynes, Plymouth, UK
I'm a serving paramedic with quite a few years experience. These plans won't put anyone at risk, in fact ambulance trusts will more than likely err on the side of caution to such an extent that it will make very little difference. You can reduce the number of A&E admissions by charging people for minor injury transportation (injuries that could have gone in a car) and also for people who misuse (GPs included) the service. then you will see a drop in A&E admissions. There is a national non emergency helpline - NHS Direct, but unfortunately they end up telling the caller to call an ambulance more often than not.
What worries me is that from what I've seen of the proposals, these paramedics will be attending a call alone. What about the safety of these men and women? Ambulance crew already often face violence when attending to an incident. Who is going to help the paramedic who arrives at the scene to find a crowd of drugged-up yobs who've called him out because they think it fun to place a 999 call and then attack him?
I think that it sounds like a good idea but even this service will be abused if something isn't done to sort out the chaos which currently prevails in the appointments systems at most GP surgeries.
Melanie, London, UK
This is a good move for all. Waiting times in A&E's should in effect be reduced by this new proposal which is good news for those with more serious conditions. Ambulance response times should also improve as they will no longer have to wait with as many patients to "hand over" to medical staff. Paramedics are trained well enough to distinguish between minor medical problems and those requiring a doctor's assessment.
Richard K Leah, Chesterfield, England
This sort of proposal might work quite well. As long as, that is, the politicians stay well out of it. Leave the decision making to people who know something about emergency medicine. As soon as politicians get involved, then decisions get made without any background knowledge at all. This could cost lives.
N Rhodes, Leicestershire, UK
This is pointless. Simply deal with the timewasters. If someone calls for a stupid reason, fine them.
Cynical GP has a valid point. My wife worked in an A&E department and the stories she told of 'patients' who turn up at A&E and wasted staff time for clearly trivial reasons was astonishing. Maybe it's time to bring about prosecutions for such people as already happens with joke 999 calls.
Adrian, Grantham, UK
One potential problem is not the LEVEL of expertise - a paramedic is just as much a specialist as a doctor - but the precise AREA of that expertise. If I have been injured in an accident or taken suddenly ill I'd rather have a paramedic during the 'golden hour'. Many doctors are not skilled in emergency care and can do more harm than good. This change to the ambulance service may take skilled paramedics away from this to more secondary care roles which would suit the skills of a doctor better.
Megan, Crewe, Cheshire
It is only a matter of time before someone dies as a result of misdiagnosis by telephone. A safer alternative would be to introduce on-the-spot fines for people who misuse the 999 system.
Kim Watkins, Cardiff
Health, safety and the capacity to deal with emergencies are not state provisions that should be subjected to the bureaucrats' measures for "value for money" and "cost effectiveness." Please stop this rot, before we have to rely on charities to provide this emergency cover.
Steven G Auld, Glasgow, UK
As long as these super paramedics are trained properly to deal with minor ailments I think this is a sensible plan. I hope these new units will not be sent out to life-threatening emergencies and that financial penalties are used against those who call out a paramedic in non-emergency situations. This will prevent the abuse of this new "treatment in the comfort of your own home" service.
A series of government information films on TV ought to be used to educate the public as to when and when not to call for an ambulance. An easy-to-understand illustration of examples getting the message across should work eg heart attack, unconsciousness or extreme blood loss being genuine reasons to call versus sprained ankles, coughs and toothache. The stop smoking and anti drink-drive messages have been effectively got across using this method, excepting the people whose attitudes you will never change.
Oliver Wright, Cambs UK
As long as the initial contact clearly establishes that the problem doesn't require hospital treatment then I think it's a great idea. Simply fining people for wasting time wouldn't work. It'd just become yet another issue where deserved punishment was claimed to be fundraising for political capital.
What a lot of doctors do not appreciate is that when you are ill you are often scared and want reassurance. It is only in this country with its precious NHS that it is extremely difficult to get that reassurance (even if you are willing to pay for it!) because that is "not how the system works".
Jeremy Glover, United Kingdom
As long as the super paramedics and the staff receiving the emergency calls in the control centre are well trained, I think this is a good idea - many people call ambulances unnecessarily. Maybe we should consider giving everyone in the country basic first aid training - this could help unnecessary callouts for minor burns, cuts etc.
I work for an ambulance service that already has implemented some of the changes mentioned in the report. We have desk-based paramedics who speak to callers with probable non life-threatening problems and advise them of the best course of action. Ambulances are always dispatched but if the paramedic determines beyond doubt that there is a more appropriate alternative the ambulance is stood down and is therefore available for another call. With our workload increasing year-on-year these changes are vital. We simply do not have the resources to deal with broken fingernails which in the past we would have been required to attend - with blue lights and sirens! Our system is definitely improving the quality of service we can offer to the public and as we aren't doing quite as much blue light driving we are not risking as many lives. I don't believe that any of our staff are worried about serious cases being missed - the desk paramedics have years of experience behind them and if they are in any doubt the ambulance is left to run.
I think this is a really positive move and patients have nothing to fear. When I have been to casualty for relatively minor injuries, I have often had to wait to see a hard-pressed doctor just to get the OK to go. Things like cuts and bruises, stitches, etc can easily be dealt with in the comfort of your own home. People seem to be afraid of change without thinking about the positives.
It is only a matter of time before someone dies as a result of misdiagnosis by telephone. A safer alternative would be to introduce on the spot fines for people who misuse the 999 system.
Tim Watkins, Cardiff
These motorbike super-paramedics are an excellent resource. Medically skilled with a surprising amount of life-saving equipment on board and able to stabilise the patient on the spot. And there's nothing to stop them calling in the full-size ambulance if hospitalisation is then necessary. In an emergency it's speed that counts.
Lorraine, St Albans, UK
In many cases now a lone paramedic attends an incident, so what will change? One of the reasons the 999 system gets so many nuisance calls is that there is not a national non emergency number. A new number such as 888 should be set up so that people can be routed to police, fire and medical in non emergency situations. This would improve matters dramatically.
C Parker, Padbury
This makes good sense, there are number of 999 cases where A&E admission is unnecessary. With trained practitioners and medics treating people at home in their own environment is not only good for the patient but as this policy aims will relieve the strain on hospitals. Well done.
Ravin Ginige, Cork, Ireland
If people were made more aware (though heaven knows why they aren't) that fainting, splinters and head lice are not reasons to call an ambulance, important calls would get through and reduce waiting time. My close friend works in the Avon and Somerset ambulance call centre and he wishes that the public were also aware that there isn't an ambulance on every corner. Perhaps more would be available if doctors didn't upgrade ambulance requests to emergencies when they aren't just to keep things sweet when they are face-to-face with the patient who is waiting to travel - not urgently, just as a private bus!
I work for an ambulance trust, as an emergency medical technician. We have had ECPs for six months now and this has made no difference to the amount of people we transport to hospital. A service will always be abused whilst it is free. A nominal charge that costs more than a taxi would cut out a lot of the abuse. Obviously emergency call would be exempt, but most 999 calls are not emergencies. Ambulances do not sit on station waiting for jobs to come in, we also do transfers, urgent and planned journeys and take people home.
Not a bad idea, but why are these people calling 999 at all? Mainly because the politicians don't have the courage to tackle abuse of the system except in the most extreme cases. It is not unusual for our patients to dial 999 if we will not fit them in immediately or at their convenience for what are clearly trivial problems. Now they will get attention in the comfort of their own homes. So a system introduced to cope with pressures on the system caused by misuse of the system will still be abused by those who can get away with it. I bet there will be plenty told to see their GP, too, and demanding to jump the wait to see us "because the paramedic said I had to be seen". This already happens with NHS direct.
Cynical GP, West Yorkshire
Dealt with over the phone? "Press 1" for advice on heart attacks. "Press 2" for advice on stab wounds. "Press 3" for advice on mending broken bones.
Alfie Noakes, North of England
I used to work as an operator handling 999 calls and was astounded by the amount of time-wasters that called for an ambulance - most had no real need for an emergency ambulance, often kids with sprained arms, ankles and one cheeky young couple who wanted an ambulance to take them to an out-patients appointment as they did not have any money a taxi! People who genuinely need an ambulance should not be forced to wait whilst paramedics are sent out to these people I am all for this kind of service, I am sure it will help save a lot more lives
There used to be a service dedicated to seeing, treating and trying to keep people at home where appropriate. They were called out of hours GPs.
JR, Sheffield, UK
Last year, when unable to get an emergency GP appointment, I was 'treated' over the phone by a nurse at my GP clinic. I was told to make an appointment in 5 days time if I was still in pain or had particular symptoms. These symptoms were actually present at the time of the call but I was unable to detect them without a simple test, which the nurse could have offered if I'd been seen in person. I was forced to pay £60 later that day to see a private GP because I had a fever and was still in great pain. In light of this incident I would worry about diagnosis conducted over the phone as it could put lives at risk. Although for some conditions treatment at home could be a better option - especially with hospital beds being in demand and MRSA being a threat.
R Webster, London
As long as these "super paramedics" are trained properly to deal with minor ailments I think this is a sensible plan. I hope these new units will not be sent out to life-threatening emergencies and that financial penalties are used against those who call out a paramedic in non-emergency situations. This will prevent the abuse of this new "treatment in the comfort of your own home" service.
It depends really doesn't it? On one hand it could be a good idea, but on the other hand it could be absolutely catastrophic. A "senior nurse" style paramedic won't have the knowledge that a consultant or qualified doctor will have, so this could cause so many problems. I'm divided here, I think we will have to wait until "positive results" are seen.
Maxine, March, UK
The current Ambulance Service is excellent but must reform if it is to give patients an improved level of care. Many medical emergencies can easily be treated by well trained paramedics at home or on the scene every bit as well as patients transported to hospital at huge cost without any improved level of care.
Eddie Espie, Cookstown N Ireland
This seems to be a sensible and logical change. If it's possible to treat people in their own home, clearly there is no point transporting them to A&E departments. If it was not necessary to take me to hospital, I know where I'd rather be treated.
David, Cornwall, UK
Another cost saving measure, which will be under-funded and will be scrapped within a couple of years. Then they will dream up another plan to replace that one, etc
Bumble, Dartford, Kent
It seems like a sensible idea to me, assuming proper safeguards and practices are put in place.
Andy, Reading, UK
In other words, instead of being attended by a doctor after your heart attack you'll be looked after by an ambulance driver who's had a course in first-aid. This, according to the government, is an improvement.
Seems sensible - a lot of ambulance calls are for things that don't need rushing to hospital. But it mustn't end up as a way to cut costs - like dentists, and 'care in the community'. We know where that leads.
Mike, London, UK