UK ambulance service pre-registration programmes · ambulance services. The review focused on the series of approval visits undertaken by the Education Department to UK public ambulance

Review of approval and monitoring 2007–10

UK ambulanceservice pre-registrationprogrammes

64677 Ambulance Trust ReportV3:63630 AnnualMon 27/1/11 16:34 Page A

Introduction 2

About us (the Health Professions Council) 2

Our main functions 2

Brief overview of the approval and monitoring processes 2

About this document 3

Review of approval activities 5

Background to the programme of visits 5

Preparation for the programme of visits 6

Outcomes of visits 6

The evidence base 6

The impact on resources and timeframes for the approval process 7

Feedback from ambulance services 10

Time taken to complete approval process 11

Communication and information 11

Pre-visit stage 12

The visit 14

The post-visit stage 14

Education provider feedback conclusions 15

Standards of education and training 15

Standards of proficiency 19

Standards of proficiency: further analysis 21

Conclusions on SOPs data 24

Conclusions from the review of visits 24

IHCD as a curriculum-setting body 25

Contents

64677 Ambulance Trust ReportV3:63630 AnnualMon 27/1/11 16:34 Page B

Review of annual monitoring activities 26

The history leading to the annual monitoring of pre-registration education andtraining delivered by UK ambulance services 26

Brief overview of the annual monitoring process 26

Outcomes from the UK ambulance service annual monitoring process 27

Evidence base 27

The impact on resources and timeframes for the annual monitoring process 27

Standards of education and training 29

Analysis of Visitor comments 30

Summation of trends 30

Conclusions from annual monitoring activities 31

Conclusions from review of the approval and monitoring activities 31

Distinctiveness of each programme 32

Application of standards and approval and monitoring processes 32

Appendix A – Final outcomes from approval process 33

Appendix B – Ambulance Service Feedback Form 34

Appendix C – SOPs numbering 37

Appendix D – Final outcomes from annual monitoring 49

List of graphs 50

64677 Ambulance Trust ReportV3:63630 AnnualMon 27/1/11 16:34 Page 1

Introduction

UK ambulance service pre-registration programmes 2

About us (the HealthProfessions Council)

We are the Health Professions Council (HPC)and we were set up to protect the public. Todo this, we keep a register of professionalswho meet our standards for their training,professional skills, behaviour and health.

Professionals on our Register are called‘registrants’. We currently regulate members of15 professions.

– Arts therapists

– Biomedical scientists

– Chiropodists / podiatrists

– Clinical scientists

– Dietitians

– Hearing aid dispensers

– Occupational therapists

– Operating department practitioners

– Orthoptists

– Paramedics

– Physiotherapists

– Practitioner psychologists

– Prosthetists / orthotists

– Radiographers

– Speech and language therapists

We may regulate other professions in thefuture. For an up-to-date list of the professionswe regulate, please visit our website atwww.hpc-uk.org

Our main functions

To protect the public, we:

– set standards for registrants’ educationand training, professional skills, conduct,performance, ethics and health;

– keep a register of professionals whomeet those standards;

– approve programmes whichprofessionals must complete to registerwith us; and

– take action when professionals on ourRegister do not meet our standards.

The Health Professions Order 2001 says thatwe must set standards which are necessaryfor safe and effective practice. This is why ourstandards are set at a ‘threshold’ level (theminimum level of safe and effective practice toprotect the public).

Brief overview of the approvaland monitoring processes

We visit all the programmes we approve tomake sure that:

– the education programme meets orcontinues to meet our standards ofeducation and training (SETs);

– those who complete the programme areable to meet or continue to meet ourstandards of proficiency (SOPs) for theirpart of the Register; and

– all programmes and education providersare assessed fairly and consistently.



When we carry out an approval visit, we arerepresented by what we refer to as the HPCPanel. The HPC Panel is normally made up oftwo Visitors, at least one of whom is from thesame part of the Register as the profession towhich the programme relates, and an HPCrepresentative from the Education Department.It is the role of the Education Departmentrepresentative to support both the Visitors andthe education provider. Throughout the visit,we will ask questions of the staff, students,senior managers and practice-placementproviders. We relate all our discussions back toour standards. At the end of the approval visit,the Visitors will make a recommendation as towhether, or to what extent, the programmemeets or continues to meet our standards.Their recommendation is sent to our Educationand Training Committee (ETC) which makesthe final decision.

If we approve an education programme, it isnormally given ‘open-ended approval’ and isthen subject to monitoring. Annual monitoringis a retrospective, documentary, process. Weconsider whether a programme continues tomeet our standards of education and training(SETs) and deliver the standards of proficiency(SOPs). We try to build on the educationprovider’s own documents and processes formonitoring to remove the need for regularvisits. The annual monitoring process operatesin conjunction with the major change andapproval processes. Information on theseprocesses can be found in the supplementaryinformation documents available on ourwebsite.

About this document

This report details the work conducted toreview the programme of visits and annualmonitoring activities for pre-registrationeducation and training delivered by UK publicambulance services.

The review focused on the series of approvalvisits undertaken by the Education Departmentto UK public ambulance services. The reviewalso focused on the outcomes of the annualmonitoring activities and the implications forthe future approval and monitoring of pre-registration education and training delivered byUK ambulance services.

In particular the review focused on:

– the methodolgy the HPC applied indeciding to undertake a programme ofvisits to UK public ambulance services;

– how the HPC plan for the visitprogramme was formulated;

– the impact of the implementation of theapproval visit on the ambulance servicesand the HPC;

– the outcomes of the approval visits andany trends identified from this;

– how the HPC plan for the amendedannual monitoring process wasformulated; and

– the outcomes of the annual monitoringactivities, any identifiable trends and theimplications for the future approval andmonitoring of pre-registration educationand training delivered by UK ambulanceservices.

Introduction


Introduction

The paper draws on:

– a qualitative review of EducationDepartment records of the amendedapproval process used for theprogramme of visits and a structuredinterview with the lead Education Officerfor the project;

– quantitative data, drawn from EducationDepartment records, describing some ofthe key features of the implementation ofthe approval process;

– a quantitative and, to a limited extent,qualitative review of the reportsproduced after each visit;

– a qualitative review of EducationDepartment records of the amendedannual monitoring process used for pre-registration education and trainingdelivered by UK ambulance services;

– structured interviews with members ofthe Education Department who havebeen leading operationally on the annualmonitoring of those education andtraining services; and

– a quantitative and, to a limited extent,qualitative review of the reportsproduced after the amended annualmonitoring assessment.




Review of approval activities

Background to the programmeof visits

At the meeting held in February 2004, theEducation and Training Committee decided toconduct approval visits to all approvedprogrammes which had not been subject to avisit since the publication of the QualityAssurance Agency’s Subject BenchmarkStatement for each profession. This led to aperiod of activity for the Education Departmentin which programmes that had not received avisit were contacted and visits arranged.The Benchmark Statement for paramedicprogrammes was published in 2004.

In the paramedic profession, many of theHPC-approved programmes are delivered byUK public ambulance services and follow theInstitute of Health and Care Development(IHCD – part of Edexcel) rules for delivery andassessment of the programme. At the time, itwas anticipated that a visit was required toapprove the IHCD model of training generallyrather than visits to specific sites of delivery.Information available indicated that the IHCDmodel was due to be phased out as theprofession made the transition to highereducation. Additionally, the ambulance servicein England was subject to restructuring in July2006 with the merger of services into a smallernumber of larger NHS Trusts.

Given the uncertainty surrounding the future ofthe programmes, alongside the significantresource impact of 34 visits being added to theschedule, the decision was made that the UKpublic ambulance services had first to beentered into the annual monitoring auditprocess before visits would be undertaken.This process enabled the department toprioritise visits appropriately in the schedule forthe following academic year.

In the 2005–06 academic year all UK publicambulance services submitted an audit whichwas assessed by Visitors. Of the 34 auditssubmitted, only three resulted in arecommendation that an approval visit wasrequired. A paper to the Education andTraining Committee on 5 September 2006reported the outcomes of annual monitoringfor the UK public ambulance services. Thispaper stated that the distinctiveness of thearrangements for delivery and assessment ofthe IHCD programmes at each ambulanceservice warranted site-specific visits.

Owing to the continuing uncertainty about thefuture of the IHCD programmes and the recentmerger of English ambulance services, theCommittee directed the Education Departmentto contact all UK public ambulance services todetermine whether they intended to continueto deliver an IHCD programme. Where aservice indicated that it intended to continue todeliver a programme, the EducationDepartment was directed to organise anappropriate visit. At this time it was anticipatedthat, following site visits, a visit to the IHCDwould also be needed to addressgeneric issues.

On 12 June 2007 the findings of the initialcontact exercise with the UK public ambulanceservices were reported to the Education andTraining Committee. That report stated that,although there was a clear intention to moveparamedic training into higher education, thetime required for the transition meant thatIHCD programmes would continue to run untilat least 2008. The Committee decided thatapproval visits should take place at all UKambulance services other than those whichconfirmed that they would cease to enrolstudents after 1 September 2008.


Preparation for the programmeof visits

It was recognised that the IHCD modeldelivered by ambulance services wassignificantly different from the majority ofapproved programmes that are based inhigher education institutes.

As a result, the Education Departmentcommenced work to review and amend theapproval process to ensure it was appropriatefor the visits. This work commenced byholding a meeting with a group of experiencedHPC paramedic Visitors. At this meeting eachstandard was discussed to determine whattypes of evidence for the SETs an ambulanceservice might be able to provide. Thisinformation was then used to tailorcorrespondence and other documents andprepare an appropriate agenda for each visit.It was also decided that wherever possible,the HPC panel would comprise twoparamedic Visitors and a third Visitorfrom a different profession.

A programme of visits was then arranged.The first visit took place on 11 March 2008and the last visit took place on20 January 2009.

Outcomes of visits

All the Visitors’ reports have been producedand considered by the Education and TrainingCommittee. The majority of the programmeswere granted continued approval. There werefour programmes that had approval withdrawn.

Outcomes of all visits, departmental recordsand feedback from the ambulance servicesinvolved meant that there was now sufficientdata to begin identifying trends. All the Visitors’reports can be found online in the EducationDepartment section of the HPC website.

Appendix A summarises the approvaloutcomes reached in the case of each of the15 UK public ambulance services.

As South Central Ambulance Service NHSTrust indicated that they did not intend tocontinue delivering a programme after1 September 2008, only 14 visitswere conducted.

The evidence base

The evidence used to review the visits wasgathered from the Visitor reports, theexperience of a key member of the EducationDepartment responsible for planning andoverseeing the implementation of the approvalprocess, and from feedback sought from the14 ambulance services who were subject toapproval visits.

Visitor reports

Visitor reports are produced after an approvalvisit has been conducted. A report makesrecommendations about whether aprogramme should receive open-endedapproval or re-approval of that status. TheVisitors’ recommendations are based onwhether a programme meets all of thestandards of education and training.

Visitors can make one of threerecommendations.

1. To approve / reapprove the programme.

2. To approve / reapprove the programmesubject to conditions being met.

3. To not approve / withdraw approval froma programme.

When it is recommended that conditions areapplied to a programme, these are detailed inthe Visitors’ report. They always relate tospecific standards of education and trainingand are supported by reasons.






Agreed conditions can be met by theeducation provider submitting furtherdocumentation to the Visitors. The Visitorsmust be satisfied that the documentationsubmitted in response to the conditionsdemonstrates how the programme meets theSET. Education providers are given twoopportunities to meet conditions prior to a finalrecommendation being made to theEducation and Training Committee.

Ambulance Service Feedback Form

A feedback form was distributed in November2009 to all ambulance services involved in theapproval process. The form was designed togather experiences of the approval processand asked for feedback on a range of pre-visit,visit and post-visit issues.

Issues explored included:

– the appropriateness of publications andcommunications to inform the service ofthe purpose and requirements of a visit;

– the appropriateness of the suggestedagenda and the groups of people to bemet at the visit;

– the documentation required prior tothe visit;

– the role and remit of the HPC and thevisiting panel at the visit; and

– the appropriateness of the report and itsusefulness in clarifying the requirementsfor conditions to be met.

Six ambulance services responded to thisfeedback request. Of the six respondents,five services received reconfirmation of open-ended approval and one trust had approvalwithdrawn. A copy of the feedback form canbe found at Appendix B.

The impact on resourcesand timeframes for theapproval process

From an operational perspective, the workundertaken to visit each of the programmeswas significant. Graphs 1, 2 and 3 show thelengths of some of the stages of the approvalprocess. Graph 1 illustrates the length of thewhole approval process from the date onwhich a visit request was received to the datethe Education and Training Committee madethe final decision.


The approval process for most programmes isnormally completed within six to nine months.It is apparent that the duration of the processwas significantly longer for ambulance serviceprogrammes. This is representative of thecomplexity of each of the approval visits andthe associated impact of time spent workingon these visits. In some cases the process hastaken in excess of two and a half years fromthe date the visit request was received.

This extended duration can be attributed to avariety of reasons, including:

– education providers suggesting thelatest possible dates for their visit to beundertaken to maximise the time topresent documentation;

– extenuating circumstances leading torescheduled visits;

– documentation deadlines being missedleading to cancelled visits;

– the time taken to produce reports; or

– the time required for education providersto meet conditions.

Graph 2 shows the time taken to produceVisitors’ reports after each of the visits.



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Graph 1 Time between visit request received and final decision by Education andTraining Committee




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Graph 2 Time between visit date and report sent to education provider

All the reports took one month or more toproduce and in some cases more than threemonths. This is much longer than usual incomparison to other programmes: overall 69per cent of reports are submitted to educationproviders within 28 days of the visit date asindicated in the Education annual report 2009.The length of time taken can be attributed tothe complexity of some of the cases and thenumbers of conditions required.

Another resource-intensive period in theapproval process is the post-visit stage.Graph 3 shows the duration of the post-visit stage from the visit date throughto the date the Education and TrainingCommittee made the final decision foreach programme.



Previous education annual reports for 2008and 2009 have indicated that the post-visitprocess is completed, in the majority of cases(67% in 2008, 76% in 2009) within fourmonths of the visit date. Only eleven per centof cases in the 2006–07 academic yearrequired more than six months to meetconditions. In all but one case, the post-visitprocess for the ambulance service visitsexceeded six months. The one case in whichthe post-visit process was resolved in less thansix months was a result of a decision by theEducation and Training Committee to withdrawapproval without the education providersubmitting a response to the conditions.

In some cases, the length of the post-visitprocess was affected by the time it took toproduce reports. However, in the majority ofcases it was the result of the time theambulance services required to respond tothe conditions placed on continued approval.

In some cases, education providers submittedobservations on the Visitors’ report to contestissues of accuracy and also to requestextended deadlines or split deadlines formeeting conditions.

Extended or split deadlines were granted bythe Education and Training Committee. Thesewere cases where specific conditions couldnot be met within the normal time frame owingto extenuating circumstances, such as aparticular service waiting for publication ofcurriculum information by the IHCD.

Feedback fromambulance services

Information regarding the ambulance servicessatisfaction with the approval process wassought in the feedback and the results arediscussed below.


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Graph 3 Time between visit date and Education and Training Committee decision



Time taken to completeapproval process

Of the six ambulance services to respond tothe feedback request, four found the timetaken to be satisfactory. The two services thatwere dissatisfied cited the feedback fromVisitors as the part of the process with whichthey were most dissatisfied.

The time taken by Visitors to decide whetheran IHCD programme had met the conditionsset was longer than the time usually taken inrelation to other programmes. The complexissues arising from each visit affected theduration of the decision-making process forthe post-visit stage. In particular, it took longerthan usual to consider the documentationsubmitted. Respondents acknowledged thechallenges faced as this was the first time theapproval process was being applied toambulance service programmes. These issuesare explored further in this report.

We also sought feedback on the three stagesof the approval process – the pre-visit, visitand post-visit stages. The tables andinformation which follow detail the responsesfrom the services.

Communication and information

The services agreed that communication andinformation in the pre-visit stage was deliveredin a timely manner. This suggests the time andresource committed to adapting the approvalprocess and communicating with serviceswas sufficient.

Graph 4 Responses to the feedbackquestionnaire regarding timeliness ofcommunication from HPC throughouteach stage of the approval process

Most services also agreed information andcommunication was delivered in a timelymanner at the visit itself. Our decision toinclude an additional Visitor from anotherprofession may have assisted this processand ensured consistency in the applicationof standards.

One ambulance service disagreed and twospecific issues were seen as contributing tothis. Firstly, the service cited the lack ofcollaboration from the HPC in comparison tothat from a panel at another HPC approvalevent the respondent had observed. Secondly,the respondent indicated that the panelappeared unprepared and seemed to have notread the documentation submitted prior to thevisit. This particular programme was one of thefirst to be visited. The final outcome of thevisit was the reconfirmation of approval ofthe programme.


Communication

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NoYes

Post-visit

Visit

Pre-visit



The panel, although fully trained, did includeparamedic Visitors who had not previouslyundertaken an approval visit. It is thereforelikely that the combination of these factors mayhave influenced the experience of theambulance service in this instance. Theplanning, communication and implementationof the approval process aimed to apply a fairand equitable process. The lessons learnt fromthis early visit were fed into future visits andthis is reflected in the responses of the otherambulance services.

Most services found communication waseffective and information was delivered in atimely manner in the post-visit stage. Somenoted the time taken to receive the Visitors’report, and the decision from the Visitors’regarding responses to conditions, exceededthe timeframes communicated in HPCpublications and at the visit itself. However,the programmes of these serviceswere reapproved.

Pre-visit stage

To further explore the application of theapproval process, ambulance services alsoresponded to more detailed aspects of thepre-visit, visit and post-visit stages.

Graph 5 Responses to pre-visit stagefeedback questions

The majority of respondents found thepublication Approval process – supplementaryinformation for education providers to beuseful. However, one service found theinformation difficult to understand.Respondents were asked whether they feltwell-informed of the HPC’s purpose inconducting an approval visit. Five services feltthey were well-informed and one did not. Thatservice did not understand why the HPC werevisiting individual ambulance services insteadof the IHCD body itself. The evidence withinthis report supports the view that all theprogrammes were based on the IHCDcurriculum, but delivered in differing ways.This same viewpoint was held by theEducation and Training Committee and wasa key factor in deciding to visit individualsites of delivery.

The majority of respondents felt well-informedduring the organisation of the visit. The datasuggests the significant resources committedby the HPC to communicate key messageswere expended successfully. This view issupported by the fact that all respondentswere satisfied with the information andcommunication received at the pre-visit stageof the process.

All ambulance services were satisfied with theagenda for the visit and were content that itwas negotiable and could accommodate otherstakeholder requirements. The agenda wastailored for the purposes of these visits andensured the meetings were appropriate andcould be accommodated by each service. Wealso used terminology which reflected theprofessional titles used within the programmes.


Pre-visit

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NoYes

Q6.

Q5.

Q4.

Q3.

Q2.

Q1.




Five services felt they understood who theHPC needed to meet. Confusion arose withone service regarding this issue. In thisparticular case, the ambulance service hadrepresentatives fulfilling multiple roles within theprogramme and therefore, they had to attenddifferent meetings at the visit. This is notunusual when conducting visits to educationprogrammes for other professions. It is oftenthe case that members of the programmeteam are also present at meetings with seniorteam members. The most confusion centredon the roles and titles used within ambulanceservices and further clarification of these roleswas sought at the visit itself.

The submission of documentation is a keymilestone in the pre-visit approval process.Four of the services indicated they were clearabout these requirements. Of these, one notedthat the HPC did not account for additionalmapping documentation which was suppliedby them. That documentation related to howthe programme met the requirements of otherstakeholders. The HPC appoints Visitors toassess how the programme meets the SETsand will consider evidence relating specificallyto these. The regulatory role of the HPC andthat of other external bodies (eg The QualityAssurance Agency for Higher Education,professional bodies, funding bodies) may nothave been communicated effectively inthis instance.

The remaining two respondents were not clearabout the documentation requirements.One indicated that they were unprepared forthe specific documentation requirements.Particular reference was made to the approvalprocess being traditionally applied tostakeholders within higher education who arebetter placed to meet the documentaryrequirements. The final outcome for thisprogramme was to have approval withdrawn.The challenges highlighted by this particularservice regarding documentation wereidentified by the HPC as challenges commonto all sites of delivery. These challenges havealready been addressed within this report.

The second service suggested the publicationApproval process – supplementary informationfor education providers could be interpreted indifferent ways. This issue was recognised bythe HPC at the beginning of the approvalprocess and requires attention since weapprove programmes which vary significantlyin terms of methodology and delivery. Thepublications which detail our standards andapproval and monitoring processes aredesigned to communicate with a range ofeducation providers who operate in a variety ofsettings. As mentioned previously, significantresources were committed to ensuring thatissues of terminology and process wereclarified.




The visit

Graph 6 Responses to visit stagefeedback questions

Most services agreed that the role and remit ofthe HPC were made clear at the visit.All services agreed that the roles and remits ofthe Education Department representative andthe Visitors was also made clear. One servicedisagreed and commented that the HPC paneldid not engage in collaborative discussion withthe rest of the members of the joint panel. TheHPC panel need to arrive at decisionsindependent of any other stakeholders. Privatemeetings are held at the visit and a separateVisitors’ report is produced to ensure this. Asthis was a new process, this may have beenperceived as not being collaborative.

Feedback was sought on whether the post-visit procedures were made clear to theambulance services. Due to the complexityand number of conditions, feedback to thepanel was limited to information aboutoperational timeframes for the post-visit stage.One service commented that although thepost-visit timeframes were communicated,they were not adhered to (28-day turnaroundfor report and Visitor feedback). In practice itwas these post-visit procedures and thetraditional timeframes which proved mostchallenging to the HPC, Visitors and theambulance service.

The post-visit stage

Graph 7 Responses to post-visit stagefeedback questions

Most services agreed the Visitors’ reports wereclear and easy to understand. One disagreedand cited the practice of listing each standardof proficiency (SOP) not met under SET 4.1 asthe reason. The listing of particular SOPs notbeing met for conditions relating to SET 4 isnot a standard practice but is applied where itis deemed useful for the education provider toaddress the condition. Individual SOPs werelisted in 12 of the 14 reports. In the two caseswhere the SOPs were not listed, bothprogrammes were approved. However, sevenother programmes also received approvalwith SOPs listed.

Most services understood exactly what wasrequired of them in order to address theconditions set for the programme. Twoservices did not understand the requirementsto meet conditions. One respondent did statethey required further clarification to gain a fullunderstanding of the conditions set. This wasan expected response given this was the firstHPC Visitors’ report each service received.The Education Department provided additionalsupport to services to clarify the conditionsset. The extra time taken to produce reportsmay have assisted services’ understanding ofthe conditions still to be met. Telephone andemail support may also have proved useful.These measures, although not normal to thepost-visit stage, were necessary.

Visit

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Q9.

Q8.

Q7.

Post-visit

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NoYes

Q12.

Q11.

Q10.




Education providerfeedback conclusions

The feedback indicates that this was achallenging process for the services to engagewith. Although they were not familiar with sucha process being applied to their programmes,the majority of services were satisfied with theapproach adopted by the HPC. Commonchallenges highlighted from their feedbackincluded:

– gaining a clear understanding of whyvisits were taking place;

– gaining a clear understanding of how theapproval process was applied and thepotential outcomes;

– understanding the terminology used bythe HPC in publications,correspondence and Visitor reports;

– identifying the groups of people whowere to be present at the visit itself; and

– the time taken to receive Visitorfeedback on responses to conditions.

Despite these challenges, the view widely heldby the services that responded to the requestfor feedback was that the HPC andVisitors were contactable, approachable and well-informed.

Standards of educationand training

As mentioned previously, the time spentproducing reports during this programme ofvisits was greater than usual. This was due tothe high number of conditions applied. Graph4 shows the number of conditions applied toeach programme.

Graph 8 Number of conditions applied to each programme

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There is considerable variation between thenumber of conditions applied across theprogrammes. In some instances, the numberof conditions is significantly higher thancommonly found in cases of visits toprogrammes that already have approval. Incontrast, a number of the programmes haveless than 20 conditions applied to ongoingapproval, which is relatively typical of aprogramme visited for the first time by theHPC, following the publication of the QAABenchmark Statement. The variance betweenthe number of conditions supports the viewthat the individual ambulance servicesimplemented the IHCD model of paramediceducation in distinctive ways and therefore adelivery site visit was required.

Notably, in the case of the programme whichreceived the highest number of conditions(over 50), an eventual decision for withdrawalof approval was reached by the Education andTraining Committee. The two programmeswhich received 40–50 conditions alsosubsequently had approval withdrawn.

These three programmes took varying times tocomplete the approval process (8.5–30.6months). Therefore, the high number ofconditions applied did not necessarily relate tothe length of the approval process.These programmes tended to haveextenuating circumstances related to keyprogramme team members as the maincause for the extended duration.

Many programmes had more than 30conditions, but less than 40. Programmeswithin this range of conditions reached a finaloutcome within a wide variance of time from14.8 to 20.6 months taken to complete theapproval process. A selection of programmeshad more than ten conditions, but less than30. These programmes took between 15.2and 24.7 months to reach a final outcome andcomplete the approval process. Again, thissupports the view that the number ofconditions does not necessarily relate to anextended duration for the approval process.However, these do further highlight thecomplexities of each ambulance service andprogramme visited, and further support thedecision to visit each site separately.

One consequence to the number of conditionsapplied to each programme is that it made itchallenging to provide useful informal feedbackat the end of the approval visit. In many cases,it was decided that it would be inappropriate tolist the proposed conditions that were beingplaced on continued approval. This made theproduction of the Visitors’ report more crucialfor the ambulance services, as it was the firstopportunity to determine the full nature of theoutcome related to the approval visit andbegin the work of responding to proposedconditions.

Graphs 9, 10 and 11 provide more detail onthe nature of the conditions that were appliedto the ongoing approval of the programmes.




This graph illustrates which areas of the SETswere subject to conditions at each of theambulance services. There is significantvariance between each programme in terms ofapplication of conditions to a particular type ofstandard. For example, in relation to SET three(management and resource standards), oneprogramme received no conditions whilst otherprogrammes received up to 13.

The most significant proportion of conditionsthat applied to each programme generally fellunder SET five (practice placement standards).This is relatively typical of all programmes ofstudy subject to approval visits and is arecorded trend in previous annual reports.Some programmes, such as the one deliveredby the London Ambulance Service NHS Trust,stand out as exceptions to this, havingreceived just one condition related to thepractice placements and proportionallyreceiving more conditions related toassessment standards.

The range and duration of placementexperience is commonly an area for furtherdevelopment in the programmes. Eachambulance service has responded individuallyto the conditions, but the IHCD have alsorecently amended the Rules that dictate howtraining is delivered, to increase the requiredrange and duration of placement education.

For one programme that reached a finaldecision for withdrawal of approval, there werea significant number of conditions applied to allareas of the standards. However, conditionsfor SET 5 came in highest for three otherprogrammes which also reached a finaldecision for withdrawal of approval. There areno clear trends for significant conditions acrossall other SETs.

Graph 9 Conditions applied by standard of education and training

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SET 2 SET 3 SET 4 SET 5 SET 6

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The following graph provides an illustration ofthe nature of the conditions applied.The conditions have been broken intothree categories:

– Resource based – requires changes toresource allocation for the programmefor the standard to be met;

– Documentary based – there isevidence to show that the standard ismet, but documentation requiresupdating to reflect this evidence; and

– Curriculum or assessment based –requires review of the curriculum orassessment procedures to ensure thestandard is met.

Graph 10 Types of condition applied

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As is common in many approval visits, a trendemerges which shows that Visitors havereceived verbal confirmation or demonstrationthat a standard is met, but do not receivedocumentary evidence to support this. In 11out of the 14 cases, this type of condition ismost common. This type of condition isindicative that, in terms of student experienceor attainment of the standards of proficiency,the standard is in effect met, but notadequately documented.

Resource based conditions appear in relativelyhigh proportion in the four programmes whichreached a final outcome of withdrawal ofapproval. However, other programmes whichreceived a similar number of resource-relatedconditions secured continued approval.

Curriculum or assessment based conditionsalso appear in a relatively high proportion

across all programmes (excluding EastMidlands Ambulance Service NHS Trust andNorth West Ambulance Service NHS Trust).There is a general trend, demonstrated inprevious Education annual reports, ofconditions being imposed where significantnumbers of standards of proficiency have notbeen adequately mapped against learningoutcomes for the programme.

Standards of proficiency

Graph 11 shows the number of timesconditions were applied which requirededucation providers to articulate particularstandards of proficiency (SOPs). Thedistribution of conditions related to individualSOPs illustrates variance across theambulance services.


Graph 11 Number of instances where conditions were applied to SOPs and theirdelivery in a programme

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3a.33a.23a.12c.22c.12b.52b.42b.32b.22b.12a.42a.32a.22a.11b.41b.31b.21b.11a.81a.71a.61a.51a.41a.31a.21a.1




In relation to this variance, there is no standard of proficiency common to all of the 14 programmeswhich required greater description. There are, however, four standards which were outlined inconditions placed on ten of the 14 programmes. The highest occurrences are to the SOPs 2b.1,2c.1, 2c.2 and 3a.1. It is important to note that this analysis does not take into account theindividual standards under each SOP heading.

Further analysis was undertaken under each of the SOP headings, to ascertain whether theseinstances were related to specific individual standards within the SOPs, or whether a significantvariance of individual standards within these could be found.

The standards of proficiency which required conditions in 50% or more of the visited programmes are:

SOP heading number SOP wording

1a.1 be able to practise within the legal and ethical boundaries of theirprofession

1a.6 be able to practise as an autonomous professional, exercising their ownprofessional judgement

1b.3 be able to demonstrate effective and appropriate skills incommunicating information, advice, instruction and professional opinionto colleagues, service users, their relatives and carers

2b.1 be able to use research, reasoning and problem-solving skills todetermine appropriate actions

2b.3 to be able to formulate specific and appropriate management plansincluding the setting of timescales

2c.1 be able to monitor and review the ongoing effectiveness of plannedactivity and modify it accordingly

2c.2 be able to audit, reflect on and review practice

3a.1 know and understand the key concepts of the bodies of knowledgewhich are relevant to their profession specific practice

In the majority of cases, it is apparent that the above SOPs fall into a category of professional skillsrather than technical competencies.

Each ambulance service responded individually to the conditions, but the IHCD also amended therules that dictate how training is delivered to include the addition of Module J, which is entitled“Professional Paramedic Practice” and includes explicit delivery of learning outcomes related toprofessional skills, rather than technical competencies. Some ambulance services made thedecision in responding to the conditions to incorporate the IHCD Module J, whilst others took adifferent approach by either including a service-designed module J or amending the programme inother ways. Again, this reflects the significant variance between the individual programmes.




Standards of proficiency: further analysis

The tables below provide further analysis of the SOPs which were most commonly identifiedacross the Visitor reports. Each table is grouped according to the three overarching areas ofpractice as illustrated in the HPC standards of proficiency for paramedics. These are then furtherclassified according to the applicable sub-areas of practice. For the purposes of further analysis,each individual standard SOP is allocated a specific number in order to identify each easily. A copyof this numbering system can be found in Appendix C.

Expectations of a health professional

– 1a – Professional autonomy and accountability

1a.1 Sub Level 1a.6 Sub Level 1b.3 Sub Level

1a.1.i 4 1a.6.i 5 1b.3.i 6

1a.1.ii 6 1a.6.ii 6 1b.3.ii 8

1a.1.iii 5 1a.6.iii 5 1b.3.iii 8

1a.1.iv 6 1a.6.iv 6 1b.3.iv 8

1a.1.v 2 1a.6.v 6 1b.3.v 7

1b.3.vi 7

1b.3.vii 7

1b.3.viii 7

Where SOP 1a.1 and 1a.6 appeared in Visitors reports’, their individual standards (excluding1a.1.v) were referenced in at least half. All sub-standards for SOP 1b.3 were referenced in at leastsix Visitors’ reports. Three individual standards were present in all eight reports in which SOP 1b.3was referenced. These SOPs detail professional skills which are generically applied to allprofessions regulated by the HPC. However, SOP 1b.3.viii is specific to the paramedicprofession and requires paramedics to be able to identify anxiety and stress in patients,carers and others and recognise the potential impact upon communication.

These results suggest that most areas of practice in SOPs 1a.1, 1a.6 and 1b.3 were not clearlydescribed in the programme documentation. Common factors influencing this trend couldpotentially relate to the design and delivery of the individual programme and also the articulation ofthese professional skills within the IHCD curriculum. However, these results are not conclusive andonly suggestive, and would indicate that there was a variance in design and delivery ofprogrammes across each service.




The skills required for the application of practice

– 2b – Formulation and delivery of plans and strategies for meeting health and social careneeds

– 2c – Critical evaluation of the impact of, or response to, the registrant’s actions

2b.1 Sub Level 2b.3 Sub Level 2c.1 Sub Level 2c.2 Sub Level

2b.1.i 10 2b.3.i 7 2c.1.i 9 2c.2.i 10

2b.1.ii 9 2b.3.ii 7 2c.1.ii 6 2c.2.ii 9

2b.1.iii 10 2c.1.iii 8 2c.2.iii 9

2b.1.iv 8 2c.1.iv 5 2c.2.iv 9

2b.1.v 10 2c.2.v 10

2c.2.vi 8

SOP 2b.1 individual standards are generic to all professions regulated by the HPC. Three of theindividual standards were not met in all ten reports. The remaining two individual standards werereferenced in at least eight reports.

2b.3.i is generic to all professions and 2b.3.ii is specific to the paramedic profession. Once againthe data illustrates that this SOP was applied in its entirety to half the programmes visited.

The distribution is varied with regards to SOP 2c.1. Individual standard 2c.1.i was referenced ninetimes and 2c.1.iii was referenced eight times. These individual standards both relate to professionalskills for the gathering of evidence to influence practice, which are generic across all professions.

Similar to the trends identified in SOP 2b.1, the individual standards for SOP 2c.2 were found inmost reports. This SOP, generic to all professions, requires registrants to “be able to audit, reflecton and review practice”.

Again, the distribution of data suggests the IHCD curriculum upon which these programmes werebased may not have clearly described the proficiencies encompassed by this SOP. Alternatively,the ambulance services may not have clearly demonstrated how this SOP was delivered from theprogramme documentation submitted.




Knowledge, understanding and skills

– 3a – know and understand the key concepts of the bodies of knowledge which are relevantto their profession-specific practice.

3a.1 Sub Level 3a.1.viii Sub Level 3a.1.ix Sub Level

3a.1.i 0 3a.1.viii.a 9 3a.1.ix.a 3

3a.1.ii 7 3a.1.viii.b 9 3a.1.ix.b 2

3a.1.iii 2 3a.1.viii.c 8 3a.1.ix.c 4

3a.1.iv 3 3a.1.ix.d 8

3a.1.v 1 3a.1.ix.e 7

3a.1.vi 4

3a.1.vii 1

3a.1.viii 9

3a.1.ix 8

3a.1.x 2

SOP 3a.1 relates to technical competencies a registrant must possess. Most competencies withinthis SOP are specific to the paramedic profession. Standard 3a.1.viiii was referenced nine timesand 3a.1.ix was referenced eight times. SOP 3a.1.viiii relates to the understanding of variousaspects of behavioural science. The data suggests the psychological and social aspectsunderpinning the knowledge, understanding and skills delivered on most programmes was notdemonstrated clearly.

SOP 3a.1.ix concerns the understanding of various aspects of clinical science. Of the five individualstandards related to this SOP, two sub-standards were referenced at least seven times with SOP3a.1.ix.d referenced eight times. These two sub-level SOPs detail:

– the principles of evaluation and research methodologies which enable the integration oftheoretical perspectives and research evidence into the design and implementation ofeffective paramedic practice; and

– the theories supporting problem solving and clinical reasoning.

This data suggests each services’ approach to delivering both generic professional skills andprofession specific competencies differed and the documentation produced for each visit variedaccordingly. The variance found across all the individual standards relating to this SOP stronglysuggests its delivery was dependant on factors concerning the site of delivery.




Conclusions on SOPs data

Further analysis conducted into the mostcommon SOPs contained within the Visitorreports highlight many issues. Firstly, the datacontinues to suggest that the IHCD curriculumguidance, upon which these programmeswere traditionally based, may have notarticulated the standards of proficiency relatedto generic professional skills and professionspecific technical competencies. However, thevariance of SOPs applied to programmes atthe first, second and, where applicable, thirdlevels indicate each service delivered theirprogramme in their own way. The factorsinfluencing the common trends and also thevariance within each SOP could be furtherexplored. In particular, a gap analysis could beconducted within the IHCD curriculum toascertain if any elements relating to theprofessional skills and technical competenciesidentified in the Visitors’ reports could beattributed to the curriculum itself. However, thistype of research is outside the scope andpurpose of this report. The SOPs datasuggests the model of education adoptedwithin each ambulance service differedsignificantly and therefore, the decision tovisit each site and programme accordinglywas appropriate.

Analysis has also highlighted all theprofessional skills which were common to theVisitor reports relate to generic professionalskills applicable to registrants of all professionsregulated by the HPC. This suggests thatthese aspects of practice, which may be foundwithin the education programmes of otherprofessions, are continuing to be developedand embedded within models of paramediceducation. This is certainly not conclusivegiven the size of the data set, however it is stillworth noting as the HPC continues to engagewith paramedic education.

The data also suggests that the technicalcompetencies which related to the professionspecific understanding of aspects ofbehavioural and clinical science were notarticulated clearly.

It is important to note at this stage that thedata above does not correlate directly towhether or not individuals who havecompleted one of these programmes haveattained the standards of proficiency, only thatthe programme documentation did not clearlyindicate how learning outcomes were linked tothese standards of proficiency.

Conclusions from the reviewof visits

It is clear from the data and analysis in thisreport that the normal time frames for theapproval process were exceeded for theprogramme of visits to ambulance trustservices. This appears to have been theresult of:

– the differences between the type ofeducation and training delivered byambulance services and othereducation programmes; and

– the individual complexity ofconducting the approval processat particular services.

These factors were acknowledged andconfirmed by the ambulance services as partof feedback sought from each delivery site onthe implementation of the approvals process.Furthermore, the feedback clearlydemonstrated satisfaction from those serviceswhich responded with the process which wasadopted in light of these issues. The reflectionsreceived from the ambulance services confirmthe additional resource allocated by theEducation Department to implement theapproval process was appropriate, andcontributed to the successful implementationof the approval process.




The data and analysis supports the view thatthe approval process is robust and flexible andcan be applied to programmes which use avariety of educational models. There are areasfor further development, relating particularly tothe communication activities at the post-visitstage, which have been highlighted in thisreport and will prove useful to futureundertakings of a similar nature.

The final outcomes from each approval visitindicate that there is significant variancebetween each site of delivery and this supportsthe decision to visit each site. Trends haveemerged in relation to the conditions applied tocontinued approval, but within the samplesize it is difficult to determine theirstatistical relevance.

Trends have also emerged in relation to theSOPs applied to the programmes. ParticularSOPs relating to professional skills, applicableto all professions regulated by the HPC andtechnical competencies specific to theparamedic profession were consistentlyapplied across most programmes. The datasuggests there is also significant variance inhow programmes evidenced these SOPs.These trends further support the importance ofcontinually assessing the site of delivery ofparamedic programmes.

IHCD as a curriculum-setting body

The range of responses to conditions alsodemonstrates that the IHCD curriculum hasbeen an important element to the programmesthat have been visited, but also thatambulance services have made differentdecisions about how closely to follow IHCDguidance, in the process of meeting conditionsplaced on continued approval. This reflects thestatus of the IHCD curriculum in theseprogrammes as being similar to that of othercurriculum guidance documents for theprofessions regulated by the HPC.

In the case of programmes that have receiveda final outcome of continued approval, it isdifficult to state that they are only comprised ofelements from the IHCD curriculum. In manycases, the programmes incorporate elementsderived from:

– the IHCD curriculum;

– the College of Paramedics’ curriculumguidance document;

– ambulance service-specific initiatives; or

– procedures from higher educationpartner institutions.

In effect, this has meant that whilst many of theprogrammes still contain the programme title“IHCD paramedic award”, it is challenging todefine these programmes as being solely IHCDmodels of education and training. Curriculumguidance documents form an important part ofan education provider’s reference tools in thedevelopment and implementation of anapproved programme of study. However, asthe standards of education and training andthe standards of proficiency are the thresholdstandards required for approval of aprogramme, curriculum guidance documentsare not critical to the decision-making processto grant approval to a programme. This meansthat education providers must be mindful ofthe curriculum guidance available to aprofession, but that each education providermust make an individual decision about themost appropriate way to meet HPC standards.

Accordingly, in conducting visits to each site ofdelivery, this has effectively reviewed all theambulance services and no specific visit isrequired to review the IHCD as a curriculumauthority. Despite the distinctive nature of eachvisit, further analysis of the conditionshighlighted common areas, within theIHCD curriculum, which may not havebeen clearly articulated.



Review of annual monitoring activities

The history leading to the annualmonitoring of pre-registrationeducation and training deliveredby UK ambulance services

As a result of the review of approval visits, theEducation and Training Committee agreed ona variation to the normal annual monitoringprocess for all pre-registration education andtraining delivered by UK ambulance services,to allow additional areas of these programmesto be monitored.

Brief overview of the annualmonitoring process

When we approve an education programme itobtains what we refer to as 'open-endedapproval' and is then subject to our monitoringprocesses. Annual monitoring is aretrospective documentary process where weconsider whether a programme continues tomeet our standards of education and training(SETs) and continues to effectively deliver andassess the standards of proficiency (SOPs).

From the review of the programme of visits topre-registration education and training,delivered by UK ambulance services, theEducation and Training Committee decidedthat the annual monitoring process should beadapted to reflect the outcomes of the review.In particular the three areas highlighted forfurther monitoring were:

– implementing and embeddingprofessional skills into the delivery of theprogramme;

– implementing the range of appropriateplacements; and

– the availability of resources andconfirming the ongoing provision.

The Education Department adapted the annualmonitoring process to reflect this and askedUK ambulance services delivering pre-registered education and training to submitadditional documentation.

When we carry out an annual monitoring audit,it is normally reviewed by two HPC Visitors.At least one Visitor will be from the relevantprofession and all Visitors undergo a conflict ofinterest process. The documentation isreviewed by the Visitors, along with previousreports from the approval, annual monitoringand major change processes.

The Visitors make recommendations to theEducation and Training Committee. They eitheroutline that there is sufficient evidence to showthat the programme continues to meet thestandards or outline that there is insufficientevidence to show how the programmecontinues to meet our standards. The Visitorscan ask the education provider for furtherdocumentation before making arecommendation to Education and TrainingCommittee. If the Education and TrainingCommittee agrees that there is insufficientevidence to show how the programmecontinues to meet our standards, a visitwould be required to gather that evidenceand, if required, to place conditions onongoing approval.

In the amended UK ambulance service annualmonitoring review, the Visitors were asked tomake a recommendation on both the standardannual monitoring submission that all HPCapproved programmes go through, and also aseparate recommendation on the additionalannual monitoring requirements previouslyoutlined. For ongoing approval to berecommended the Visitors need to be contentthat both elements were evidenced.




Outcomes from the UKambulance service annualmonitoring process

All the Visitor reports have been produced andapproved by the Education and TrainingCommittee and all pre-registration educationand training programmes delivered byUK ambulance services were grantedcontinued approval.

All the reports can be found online in theeducation section of our website and in theEducation and Training Committee papers.Appendix D summarises the outcomesreached in the case of the eight UK ambulanceservices who deliver pre-registration educationand training.

Evidence base

The evidence used to review the annualmonitoring process for pre-registrationeducation and training delivered by UKambulance services was gathered from Visitorreports produced from the review of eightannual monitoring audits, EducationDepartment records and from the experienceof Education Department representativesresponsible for planning and overseeing theimplementation of the annual monitoringprocess. Ten pre-registration education andtraining programmes are currently beingdelivered by UK ambulance services, howeverwithin the annual monitoring process, it isusual to review full time and part timeprogrammes within the same audit and forthese to be represented in the same report.The graphs that follow within this reporttherefore only represent the eight UKambulance services and the eight audits(as full and part time are usually submittedas one audit).

It is important to also note that the East ofEngland Ambulance Service NHS Trustsubmitted a major change to the HPC inSeptember 2009, which initiated an approvalvisit as an increase to student numbers wasplanned. The visit took place in March 2010and took account of all standards of educationand training. As is normally the case, when aprogramme is subject to the full scrutiny of anapproval visit, it is removed from the next twocycles of the annual monitoring process.

The impact on resources andtimeframes for the annualmonitoring process

From an operational perspective, the work tomonitor each UK ambulance serviceprogramme required an increased resourceprovision at various stages of the annualmonitoring process. However, the overallduration of the annual monitoring process wasnot significantly extended.

Graph 12 Duration between annualmonitoring submission being received andeducation provider informed of outcome

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East Midlands Ambulance Service NHS Trustsubmitted ten weeks earlier than the other UKambulance services and as such, this hasaffected this submissions overall duration.

Graph 12 illustrates the individual durations forthe UK ambulance services to complete the fullannual monitoring process, from the date onwhich the submission was received to the datethe ambulance service was informed of theoutcome. The average duration for the fullannual monitoring process for pre-registrationeducation and training delivered by UKambulance services was 3.3 months. Theaverage duration for the full annual monitoringprocess for all other HPC approved educationand training for the academic year 2009 –10was also 3.3 months.

217 annual monitoring audits were reviewed inthe academic year 2009–10. On average theEducation Department was able to submit anaudit to an annual monitoring assessment daywithin five weeks of receipt. UK ambulanceservice programmes went to an assessmentday on average within six weeks of receipt.Although this is not a significant delay, it hadoriginally been planned that all eight UKambulance service audits would be reviewed inone assessment day, and that the time toreview the UK ambulance service audits at anassessment day would be significantly lessthan five weeks. On 15 June 2010, five UKambulance service audits were reviewed.A second assessment day was requiredand this was undertaken on 3 August 2010.Graph 13 reflects this split between the twoassessment days.

Graph 13 Duration between ambulanceservice annual monitoring auditsreceived and review at assessment day

The main factor that caused the UKambulance service annual monitoring processto be delayed was that the EducationDepartment undertook a second unplannedassessment day. This was needed for a varietyof reasons including:

– the comprehensive nature of thesubmissions and some of thedocumentation not relating to thestandards of education and training;

– documentation being inaccuratelyreferenced with Visitors unable to findwhat the education provider had statedas being submitted;

– apparent confusion about theretrospective nature of annualmonitoring, with documents beingsubmitted well outside of the requiredtime frames, including informationregarding changes that had been lookedat during the approval visit and thosewhich had taken place since; and

– the submission of major changes withinthe documentation.

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The outcomes from the UK ambulance serviceannual monitoring assessment days differ incomparison to the outcomes from all the otherannual monitoring assessment days in the2009–10 academic year. Seventy-five per centof the UK ambulance service annualmonitoring audits required additionaldocumentation. This compares to twenty-fiveper cent of audits requiring additionaldocumentation for all other pre-registrationeducation and training going through theannual monitoring process that year. Therequirement to seek additional documentationdoes have a small impact on the resourceprovision within the Education Department, assome post assessment day action is required.All the UK ambulance services that wereasked for additional documentationprovided this on time and in line with ouroperational requirements.

Standards of educationand training

If Visitors request further documentation theyframe requests around specific standards ofeducation and training. Graph 14 gives anindication of the areas where the Visitorsrequested further information.

Graph 14 Standards of educationand training that requiredadditional documentation

Six of the eight UK ambulance services wererequired to submit additional documentationlinked to the management and resourcing ofthe programmes. From the issues identified,all but one was based around SET 3.2, whichrefers to the effective management of theprogramme. The recurring issue around SET3.2 was that the Visitors were not providedwith evidence that the programmes continuedto be effectively managed because incompleteannual monitoring submissions weresubmitted. In particular, several programmesdid not include internal quality documents andexternal examiner reports and some includedinformation relating to different programmes.In one submission, the Visitors noted a changeto the programme leadership, by reviewing anexternal examiner’s report.

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Two of the UK ambulance services requiredadditional documentation linked to thecurriculum. In one submission the Visitorsrequired additional documentation to clarifyissues around the implementation andembedding of professional skills into thedelivery of the programme (the first additionalrequirement in the amended ambulanceservice annual monitoring assessment).

Three UK ambulance services requiredadditional documentation linked toassessment. From the issues identified twowere specific to standard 6.1 (which is linkedto assessment strategy and meeting thestandards of proficiency). In one submission,a comment in the external examiner’s reportindicated a lack of clarity around theassessment strategy. The Visitors thereforeasked for additional documentation to clarifythe assessment design and procedure.Another area addressed under assessmentrelated to a change in external examiner. TheVisitors required clarification that the externalexaminer was on the appropriate part of theRegister. In one review the Visitors notedchanges to the practical assessmentguidelines and required further information.

Analysis of Visitor comments

As part of the annual monitoring process theVisitors have the opportunity to add commentsto a Visitor’s report. A comment would notrequire any direct response from the educationprovider, however, it gives the Visitors theopportunity to offer advice on areas theeducation provider may want to consideraddressing for future annualmonitoring submissions.

Two main areas were raised by the Visitorswithin the eight UK ambulance service annualmonitoring reports. Three of the reports hadcomments around issues with confidentiality.The Visitors noted that education providershad submitted information about individualstudents, including results and individualcomments in minutes. The second issue raisedin the Visitors’ comments in 75 per cent of thereports was around the comprehensive natureof the submissions, as discussed previously.

Summation of trends

Analysis of the UK ambulance trust annualmonitoring Visitors’ reports shows that UKambulance services did not understand thepurpose of the annual monitoring process. Inparticular, a number of UK ambulance servicessubmitted audits which addressed many areasof their programme rather than focusing on thelast two years of delivery.

However, analysis also shows that whilst thisengagement with the annual monitoringprocess was consistent across many of theambulance services, where additionaldocumentation was required, each programmewas asked to submit additional documentationfor individual programme-specific reasons.

All UK ambulance services running pre-registration education and training havesuccessfully completed the HPC annualmonitoring for 2009–10.




Conclusions from annualmonitoring activities

It is clear from the data and analysis in thisreport, that the annual monitoring activities ofpre-registration education and trainingdelivered by UK ambulance services has takenlonger than usually expected. This appears tohave been the result of:

– the need to undertake a second UKambulance service annual monitoringassessment day due to the individualcomplexity and comprehensive nature ofaudit submissions; and

– ambulance services not alwaysunderstanding the retrospectivenature of annual monitoring.

All UK ambulance service pre-registrationeducation and training programmes have beenable to provide additional documentation whenrequired and have been able to do this withinoperational deadlines. Additionally, allprogrammes have been able to meet theadditional requirements for annual monitoringrequested by the Education and TrainingCommittee. Data and analysis also indicatesthat the outcomes of the annual monitoringactivities of pre-registration education andtraining delivered by UK ambulance servicesdo not significantly differ from those of otherHPC pre-registration education and training.

The report concludes that:

– each programme is distinct;

– UK ambulance services are able toconform to the requirements of annualmonitoring (though at the next auditcycle for ambulance services it will besensible to ensure that copies of theannual monitoring supplementaryinformation are enclosed in initialcorrespondence);

– all UK ambulance services programmeshave been granted continued approvalby the Education and TrainingCommittee; and

– no further amended annual monitoringprocess will be required and the UKambulance service programmes are ableto fit into the normal annual monitoringschedule.

Conclusions from review of theapproval and monitoring activities

The review of the approval and monitoringactivities conducted for pre-registrationeducation and training delivered by UKambulance services highlights trends whichhave been discussed consistently thoughoutthis report.




Distinctiveness ofeach programme

The review of the approval and monitoringactivities demonstrates that approvedprogrammes delivered by UK ambulanceservices are each designed and delivered indifferent ways. The review of approval visitsidentified significant variance between eachprogramme and the decision to visit each sitewas supported. The issues arising from eachmonitoring submission were in most casesspecific to each programme and additionaldocumentation was required to addressindividual programme specific issues.

Each programme has demonstrated itsdistinctive nature and analysis of Visitor reportsacross all programmes further supports this.Although common trends were identified, eachprogramme has demonstrated how ourstandards were met in different ways. Thereview also supports the HPC position that theIHCD act as a curriculum setting body and thateach ambulance service programme deliversthis curriculum uniquely.

Application of standards andapproval and monitoringprocesses

The outcomes from each process support theview that the HPC standards and approval andmonitoring processes are robust, flexible andcan be successfully applied to programmeswith different models of education. Feedbackfrom ambulance service representatives clearlyhighlights the difficulties experienced inattempting to engage with our standards andprocesses. As this was the first time theseprocesses were applied, further support wasprovided by the HPC where necessary. Theimpact to expected time frames has also beendiscussed resulting from this. Any futureimpact should be reduced as theseprogrammes continue to engage with thesestandards and processes.

Programmes which were approved and havecompleted the annual monitoring process havedemonstrated how standards were met andcontinue to be met. The programmesapproved by the HPC will continue to besubject to our routine approval andmonitoring processes.



Appendix A – Final outcomes fromapproval process

Service Programme Modes of study Status

East Midlands Ambulance IHCD Paramedic Award FT and PT ReconfirmedService NHS Trust approval

East of England Ambulance Certificate of Higher PT Reconfirmed Service NHS Trust Education in Emergency approval

Medical Care (incorporatingthe IHCD paramedic award)

Great Western Ambulance IHCD Paramedic Award FT ClosedService NHS Trust

Isle of Wight NHS IHCD Paramedic Award FT Approval withdrawnPrimary Care Trust

London Ambulance IHCD Paramedic Award Block Release Reconfirmed Service NHS Trust approval

North East Ambulance IHCD Paramedic FT Approval withdrawnService NHS Trust Programme

North West Ambulance IHCD Paramedic Award Block Release ReconfirmedService NHS Trust approval

Northern Ireland Ambulance Paramedic-in-training FT Reconfirmed Service Health and Social approvalCare Trust

Scottish Ambulance College IHCD Paramedic Award FT Reconfirmed approval

South Central Ambulance IHCD Paramedic Award PT ClosedService NHS Trust

South East Coast Early Registration FT Approval withdrawnAmbulance Service ProgrammeNHS Trust (IHCD Modules)

South Western Ambulance IHCD Paramedic Award FT Reconfirmed Service NHS Trust approval

Welsh Ambulance IHCD Paramedic Award FT ReconfirmedService NHS Trust approval

West Midlands Ambulance IHCD Paramedic FT Approval withdrawnService NHS Trust

Yorkshire Ambulance IHCD Paramedic Award FT and PT Reconfirmed Service NHS Trust approval



Appendix B – Ambulance Service Feedback Form

Ambulance Service Feedback Form

Education Provider: ____________________________________________________________________

Name: ________________________________________________________________________________

Position: ______________________________________________________________________________

The Education Department undertook approval visits to paramedic pre-registration education andtraining programmes delivered by UK ambulance services in the 2007– 08 academic year. Thisquestionnaire is designed to gather your feedback on the approval process adopted for these visits. Your thoughts, experiences and feedback on the process will be used to report to ourEducation and Training Committee in March 2010. The report produced will not reference specificnames or bodies, just trends found across the data gathered from this form. Also your responseswill have no affect on the outcome of the approval process conducted for your programme.

Approval Process: Pre-visit, Visit and Post-Visit

Pre-Visit

Q1 – Did you find our publication the ‘Approval process – supplementary information for educationproviders’ useful to prepare for your visit?

Yes No

If no, please use the box below to provide further comments:

________________________________________________________________________________________

Q2 – Did you feel well informed regarding the HPC’s purpose for conducting an approval visit?

Yes No


________________________________________________________________________________________

Q3 – Did you feel well informed during the organisation of the visit?

Yes No


________________________________________________________________________________________

Q4 – Did you feel the suggested agenda for the visit was easy to accommodate and negotiate?

Yes No


________________________________________________________________________________________




Q5 – Was it clear what groups/people the HPC needed to meet with as part of the suggestedagenda?

Yes No


________________________________________________________________________________________

Q6 – Was it clear what documentation we needed from you once a visit date had been suggested?

Yes No


________________________________________________________________________________________

Visit

Q7 – At the visit was the role and remit of the HPC made clear?

Yes No


________________________________________________________________________________________

Q8 – At the visit was the role of the Visitors and the HPC executive made clear?

Yes No


________________________________________________________________________________________

Post-Visit

Q9 – During the approval process were the post visit procedures made clear to you?

Yes No


________________________________________________________________________________________

Q10 – Was the function and format of the Visitors’ report clear and easy to understand?

Yes No


________________________________________________________________________________________




Q11 – Did you understand exactly what was required of you in order to address the conditions setas outlined in the Visitors’ report?

Yes No


________________________________________________________________________________________

Q12– Did you find the time taken to complete the process satisfactory (from submission date ofvisit request form to receipt of official outcome of the approval process)?

Yes No


________________________________________________________________________________________

Overall

Q13 – Did you find communication and information was delivered in a timely manner throughoutthe approval process?

Pre-Visit Yes No

Visit Yes No

Post-Visit Yes No


________________________________________________________________________________________

Q14 – Do you have any further comments regarding the approval process?

________________________________________________________________________________________

Thank you for completing this form.

Please return electronic forms to us at [email protected]

Alternatively if you would like to complete the form by hand please send completed forms to:

Education DepartmentHealth Professions Council Park House184 Kennington Park RoadLondonSE11 4BU

Please send all completed forms back to us by 18 December 2009.



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a r

ange

of

2b.1

.iii

rele

vant

phy

siol

ogic

al

3a.1

.vi.f

reso

lutio

n of

pro

blem

s an

d re

sear

ch m

etho

dolo

gies

para

met

ers

and

how

to

be a

ble

to e

xerc

ise

inte

rpre

t cha

nges

from

pe

rson

al in

itiat

ive

the

norm

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know

the

limits

of t

heir

1a.6

.iii

be a

ble

to d

emon

stra

te a

2b.

1.iv

dise

ase

and

trau

ma

3a.1

.vi.g

prac

tice

and

whe

n to

see

k lo

gica

l and

sys

tem

atic

pr

oces

ses

and

how

to

advi

ce o

r re

fer

to a

noth

er

appr

oach

to p

robl

em

appl

y th

is k

now

ledg

e to

prof

essi

onal

solv

ing

the

plan

ning

of t

he p

atie

nt’s

pr

e-ho

spita

l car

e

reco

gnis

e th

at th

ey a

re1a

.6.iv

be a

ble

to e

valu

ate

2b.1

.vth

e fa

ctor

s in

fluen

cing

3a

.1.v

i.hpe

rson

ally

resp

onsi

ble

for

rese

arch

and

oth

er

indi

vidu

al v

aria

tions

in

and

mus

t be

able

to ju

stify

ev

iden

ce to

info

rm th

eir

hum

an fu

nctio

nth

eir

deci

sion

sow

n pr

actic

e

be a

ble

to u

se a

ran

ge o

f 1a

.6.v

2b.2

be

able

to

dra

w o

n2b

.2un

ders

tand

the

follo

win

g3a

.1.v

iiin

tegr

ated

ski

lls a

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app

rop

riate

kno

wle

dge

as

pect

s of

phy

sica

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lf-aw

aren

ess

to m

anag

e an

d s

kills

in o

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to

mak

esc

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ecl

inic

al c

halle

nges

p

rofe

ssio

nal j

udge

men

tsef

fect

ivel

y in

unf

amilia

r ci

rcum

stan

ces

or s

ituat

ions

1a.7

reco

gnis

e th

e 1a

.7be

abl

e to

cha

nge

thei

r 2b

.2 i

prin

cipl

es a

nd th

eorie

s 3a

.1.v

ii.a

need

for

effe

ctiv

e pr

actic

e as

nee

ded

to

of p

hysi

cs, b

iom

echa

nics

,se

lf-m

anag

emen

t of

take

acc

ount

of n

ew

elec

tron

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and

wor

kloa

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d be

abl

e to

de

velo

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at c

an b

epr

actis

e ac

cord

ingl

yap

plie

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par

amed

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1a.8

und

erst

and

the

1a

.8be

abl

e to

dem

onst

rate

a2b

.2 ii

the

mea

ns b

y w

hich

the

3a.1

.vii.

bob

ligat

ion

to m

aint

ain

leve

l of s

kill

in th

e us

e of

ph

ysic

al s

cien

ces

can

fitne

ss t

o p

ract

ise

info

rmat

ion

tech

nolo

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info

rm th

e un

ders

tand

ing

appr

opria

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thei

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alys

is o

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form

atio

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unde

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1a

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2b.3

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ulat

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e pr

inci

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and

3a

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prac

tise

safe

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ific

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ap

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ctiv

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with

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man

agem

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mea

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men

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ctic

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clud

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the

sett

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bio

mec

hani

cs

of t

imes

cale

sor

ele

ctro

phys

iolo

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e ne

ed to

1a

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unde

rsta

nd th

e 2b

.3 i

unde

rsta

nd th

e fo

llow

ing

3a.1

.viii

mai

ntai

n hi

gh s

tand

ards

re

quire

men

t to

adap

t as

pect

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beh

avio

ural

of

per

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l con

duct

prac

tice

to m

eet t

he

scie

nce

need

s of

diff

eren

t gro

ups

dist

ingu

ishe

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, for

ex

ampl

e, p

hysi

cal,

psyc

holo

gica

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viro

nmen

tal,

cultu

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or s

ocio

-eco

nom

ic fa

ctor

s

unde

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nd th

e 1a

.8.ii

iun

ders

tand

the

need

to

2b.3

iips

ycho

logi

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ocai

l 3a

.1.v

iii.a

impo

rtan

ce o

f mai

ntai

ning

de

mon

stra

te s

ensi

tivity

to

fact

ors

that

influ

ence

an

thei

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n he

alth

the

fact

ors

whi

ch s

hape

in

divi

dual

in h

ealth

and

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esty

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at m

ay im

pact

illn

ess

on th

e in

divi

dual

’s h

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d af

fect

the

inte

ract

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patie

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unde

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oth

the

need

1a.

8.iv

2b.4

be

able

to

cond

uct

2b.4

how

psy

chol

ogy

and

3a.1

.viii.

bto

kee

p sk

ills a

nd

app

rop

riate

dia

gnos

tic o

rso

ciol

ogy

can

info

rm a

n kn

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dge

up to

dat

e m

onito

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pro

ced

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, un

ders

tand

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and

the

impo

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eatm

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the

rap

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ph

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nd m

enta

l ca

reer

-long

lear

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r ac

tions

saf

ely

and

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alth

, illn

ess

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heal

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ilful

lyca

re in

the

cont

ext o

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ram

edic

pra

ctic

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d th

e in

corp

orat

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of th

is

know

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to

para

med

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ract

ice

be a

ble

to m

aint

ain

a hi

gh1a

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unde

rsta

nd th

e ne

ed to

2b

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how

asp

ects

of

3a.1

.viii.

cst

anda

rd o

f pro

fess

iona

l m

aint

ain

the

safe

ty o

f ps

ycho

logy

and

ef

fect

iven

ess

by a

dopt

ing

both

ser

vice

use

rs, a

nd

soci

olog

y ar

e st

rate

gies

for

phys

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and

th

ose

invo

lved

in th

eir

fund

amen

tal t

o th

e ro

leps

chol

ogic

al s

lef-

care

, ca

reof

the

para

med

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cr

itica

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f-aw

aren

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de

velo

ping

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an

d by

bei

ng a

ble

to

mai

ntai

ning

effe

ctiv

e m

aint

ain

a sa

fe w

orki

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rela

tions

hips

envi

ronm

ent

1b.1

be

able

to

wor

k,

1b.1

ensu

re s

ervi

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sers

are

2b

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unde

rsta

nd th

e fo

llow

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3a.1

.ixw

here

ap

pro

pria

te, i

n po

sitio

ned

(and

if

aspe

cts

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par

tner

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mob

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unde

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1b

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know

the

indi

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2.b.

4.iii

path

olog

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cha

nges

3a

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.abu

ild a

nd s

usta

in

cont

ra-in

dica

tions

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and

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ofes

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latio

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atur

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oth

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depe

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chni

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ncou

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actit

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colla

bora

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am

embe

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a te

am

unde

rsta

nd th

e ne

ed to

1b

.1.ii

be a

ble

to m

odify

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2.

b.4.

ivth

e ch

ange

s th

at c

an

3a.1

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enga

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ervi

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sers

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ad

apt p

ract

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to

resu

lt fro

m p

aram

edic

ca

rers

in p

lann

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and

emer

genc

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tuat

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prac

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g ev

alua

ting

diag

nost

ics,

ph

ysio

logi

cal,

trea

tmen

ts a

nd

phar

mac

olog

ical

, in

terv

entio

ns to

mee

t the

ir be

havi

oura

l and

ne

eds

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goal

sfu

nctio

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be a

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ake

1b.1

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2b.5

be

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mai

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e th

eore

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asis

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3a.1

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appr

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ific

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1b.1

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2b.5

.ipr

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valu

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.dlim

itatio

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f ope

ratio

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legi

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and

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re

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etw

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reco

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appl

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the

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take

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1b.3

be

able

to

1b.3

2c.1

be

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2c.1

3a.2

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1b.3

ivbe

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e re

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aw

are

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3a

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he

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the

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affe

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d be

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ith th

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unde

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ed to

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e to

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k sa

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ide

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udin

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lf) w

ith th

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n pr

oced

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haza

rd c

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ena

ble

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m

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to m

ake

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elim

inat

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tech

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ance

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ty le

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atio

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nd th

e ne

ed to

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ibe

abl

e to

use

qua

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ble

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t 3a

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qua

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ver

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lish

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hips

with

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re

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and

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ose

and

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ble

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ain

trea

ting

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gh s

tand

ards

of c

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othe

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even

in s

ituat

ions

of

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azar

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ntro

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onal

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ders

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and

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able

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of q

ualit

y co

ntro

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to

app

ly a

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rs a

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ther

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d qu

ality

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uran

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ovin

g an

d ha

ndlin

g re

cogn

ise

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ntia

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ques

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ct u

pon

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icat

ion

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1b. 4

und

erst

and

the

1b

.4be

aw

are

of th

e ro

le o

f 2c

.2.ii

unde

rsta

nd th

e na

ture

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.3 v

ine

ed fo

r ef

fect

ive

audi

t and

revi

ew in

qua

lity

and

purp

ose

of s

teril

e co

mm

unic

atio

n m

anag

emen

t, in

clud

ing

field

s an

d th

e pa

ram

edic

’s

thro

ugho

ut t

he c

are

of

qual

ity c

ontr

ol, q

ualit

y ro

le a

nd re

spon

sibi

lity

for

the

serv

ice

user

assu

ranc

e an

d th

e us

e of

m

aint

aini

ng th

emap

prop

riate

out

com

e m

easu

res

reco

gnis

e th

e ne

ed to

use

1b

.4.i

be a

ble

to m

aint

ain

an

2c.2

.iiin

terp

erso

nal s

kills

to

effe

ctiv

e au

dit t

rail

and

enco

urag

e th

e ac

tive

wor

k to

war

ds c

ontin

ual

part

icip

atio

n of

ser

vice

im

prov

emen

tus

ers

part

icip

ate

in q

ualit

y 2c

.2.iv

assu

ranc

e pr

ogra

mm

es,

whe

re a

ppro

pria

te

unde

rsta

nd th

e va

lue

of

2c.2

.vre

flect

ion

on p

ract

ice

and

the

need

to re

cord

the

outc

ome

of s

uch

refle

ctio

n

reco

gnis

e th

e va

lue

of

2c.2

.vi

case

con

fere

nces

and

ot

her

met

hods

of r

evie

w

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ndar

d o

f N

umb

er

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ndar

d o

f N

umb

er

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ndar

d o

f N

umb

erp

rofic

ienc

yp

rofic

ienc

yp

rofic

ienc

y



Appendix D – Final outcomes fromannual monitoring

Ambulance trust Program name Mode of study Status

East Midlands Ambulance IHCD Paramedic Award FT and PT Continues to meet Service NHS Trust the standards

London Ambulance Service IHCD Paramedic Award Block Continues to meet NHS Trust the standards

North West Ambulance IHCD Paramedic Award Block Continues to meet Service NHS Trust the standards

Northern Ireland Ambulance Paramedic-in-training FT Continues to meet Service Health and the standardsSocial Care Trust

Scottish Ambulance IHCD Paramedic Award FT Continues to meetCollege the standards

South Western Ambulance IHCD Paramedic Award FT Continues to meet Service NHS Trust the standards

Welsh Ambulance Services IHCD Paramedic Award FT Continues to meet NHS Trust the standards

Yorkshire Ambulance IHCD Paramedic Award FT and PT Continues to meet Service NHS Trust the standards



List of graphs

Graph 1 Time between visit request received and final decision by Education and TrainingCommittee 8

Graph 2 Time between visit date and report sent to education provider 9

Graph 3 Time between visit date and Education and Training Committee decision 10

Graph 4 Responses to the feedback questionnaire regarding timelines of communication fromHPC throughout each stage of the approval process 11

Graph 5 Responses to pre-visit stage feedback questions 12

Graph 6 Responses to visit stage feedback questions 14

Graph 7 Responses to post-visit stage feedback questions 14

Graph 8 Number of conditions applied to each programme 15

Graph 9 Conditions applied by standard of education and training 17

Graph 10 Types of condition applied 18

Graph 11 Number of instances where conditions were applied to SOPs and their delivery in aprogramme 19

Graph 12 Duration between annual monitoring submission being received and education providerinformed of outcome 27

Graph 13 Duration between ambulance trust annual monitoring audits received and review atassessment day 28

Graph 14 Standards of education and training that required additional documentation 29


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Documents

UK ambulance service pre-registration programmes · ambulance services. The review focused on the series of approval visits undertaken by the Education Department to UK public ambulance