What next for our emergency services?

A crisis gives us permission.

When we don’t have the time to take baby steps we are forced into a position of innovation and creativity. Leaps we didn’t believe possible are just that.

The emergency services in Italy, in Spain, in China, in the USA and here in the UK have responded remarkably to the Covid pandemic. The challenge is immense – and in the same creative vein that we are seeing improvisation and huge leaps of faith around medical practice, the same is increasingly true around the more prosaic elements of delivering help in extraordinary circumstances.

If we had suggested a year ago that we would be able to manage 101 calls via remote working teams; that we would have major police investigations being effectively run from private homes that seemingly overnight GP’s would be able to accommodate staggering number of consultations via email, video calls and chat bots – if we had suggested this, it would have been considered reckless. Patients wouldn’t tolerate it. Primary care should only be delivered in person. Investigations are most successful on the ground. Emergency calls should be taken and managed within a team environment.

And yet we have been able to cast these tenants of faith aside. Police Services have used remote technology to protect senior officers and key staffto create Gold and Silver command cells to monitor and manage demands on policing. Greater Manchester Police has become the first force in the UK to take 101 calls from home. Calls are triaged centrally then placed appropriately – the majority into homes where trained staff continue to deliver exceptional public service. More and more emergency services across the UK and US are deploying live video streaming in their control rooms to more effectively triage incoming calls in order to ensure a proportionate response and evaluate the heightened risks at this time.

At the start of the pandemic, it was estimated that if just 5% of GP’s face to face appointments could be moved online there would be 300,000 fewer physical visits to a GP per week. This is crucial when each of these could be a potential coronavirus transmission and would allow the risk to GP’s and patients alike to be minimized.   In addition, this allows more flexibility in the system, increasing the capacity and reducing the disruption to normal life caused by a visit to a practice. Basic admin like sick notes and medical certificates have been automated via the 111 call service, and over 250,000 calls taken out of the system in the first ten days by the provision of online information and chat bots to reduce pressure on the system.

And in a crisis the definition of emergency services extends to encompass far more key public services. Utility companies from water to electricity to broadband are having to find ways to move their services online.  But with the provision of simple yet highly secure live streaming services that just use a combination of text and GPS location providers can deliver all sorts of services remotely. Take water companies. They can identify leaks, find stop taps, share information between engineers on the ground and supervisors to speed up time to resolution and reduce the number of visits through a simple live stream.  Electricity companies can do a large amount of pre-visit screening and triage of the situation again limiting unnecessary visits and reducing time on site.  Many are reporting up to 30% reduction in the need for actual visits after deploying these simple solutions.

The wider question is in fact – when this is over, why would we go back? The benefits – reduced costs, improved work life balance and flexibility, enhanced access to services, environmental impact etc etc will be hard to put back in the bottle even once the lockdown is over. While there’s no doubt that a great deal of provision will still need to be conducted face to face, and that managing a team remotely isn’t as simple as hooking up a good video streaming service, the ability to deliver at the point of real need, at significantly increased capacity and reduced cost will be attractive. And impossible to ignore.