As has been previously reported, the Trust and UNISON have been continuing to have detailed discussions and negotiations in respect of finalising the scope of practice for the role of Emergency Care Assistant (ECA) within YAS. Following the completion of these extensive discussions and negotiations, both the Trust and UNISON have now reached agreement upon the contents of the scope of practice of the role of ECA and a measure to support the effective implementation and embedding of the role of ECA into the operational service delivery of the Trust.

In arriving at this agreed scope of practice, both the Trust and UNISON were very clear about the feedback received from staff to ensure that not only clinical decision making and empowerment of clinicians was achieved, but equally that opportunities would skill exist for staff, particularly former Assistant Practitioners/Intermediate Care Assistants, to practice their patient skills and ensure they were best placed to succeed through the ECA to Paramedic conversion programme over the next 5 years, in-line with the Workforce Plan for A&E.  Consequently, agreement has beenreached that it will be the responsibility and accountability of the Clinician that works alongside an ECA to determine whether or not the Clinician or the ECA will ride in the back of the ambulance with a patient during conveyance.  This agreement has been reflected in a revision to the agreed scope of practice, which is separately attached to this staff notice and will be reflected in all education and conversion training for ECAs.  It should be noted that where an ECA is with a patient during conveyance, that they may only operate within the ECA scope of practice and may not apply clinical skills outside the parameters of that role.  This is to ensure consistency of practice across the Trust and will also ensure that clinical decision making is based upon a clear understanding of the role.

The second key element of the agreed position relating to ECAs is in respect of two ECA crew members working together.  Whilst there may be occasions where this could occur in the future, both the Trust and UNISON recognise that to enable this role to fully embed within the A&E operational workforce, it is first important that ECAs work alongside and receive clinical supervision from a clinician.  Consequently, it has been agreed that two ECAs will not be deployed together and, should the occasion arise where an ECA is unable to be paired with their normal partner, then they will be paired with another clinician for that shift.  Where this could necessitate the ‘splitting’ of a current pair to ensure that all staff can be deployed on a shift, then this is considered not only a reasonable step, but is in the best interests of both patients and staff by ensuring that clinicians and ECAs become used to working together at an early stage.  The period during which no ECAs can be deployed together will be for 6 months, following which this will be reviewed by both the Trust and UNISON.  On that basis, the element of the scope of practice thatrefers to ECAs working together is withdrawn for the next 6 months, i.e. until 1stOctober 2013, by which point this will have be reconsidered and staff updated accordingly.

In arriving at these decisions and agreements, both the Trust and UNISON recognise that A&E staff have been extremely supportive and have engaged wellwith the implementation of the new A&E workforce model. Both the Trust and UNISON believe that these decisions will not only support the implementation of the A&E workforce model, but will enable clinical decision making and will create the opportunity to appropriately engage with patient care for all clinical support workers.