#142 Decision to treat at home with paramedic Tom Pullen

“Decision to treat at home”, five small words but a huge impact. Listen in to hear how a shift in language can shape person centred care with paramedic Tom Pullen.

Key messages

• The shift from the term “non conveyance” to “decision to treat at home” changes the framing from negative to positive, recognising the proactive and person-centred nature of keeping people safely at home.

• Shared decision-making is fundamental, understanding what matters most to patients and their families guides appropriate care decisions.

• Advance Care Planning empowers individuals to have a voice in their future care, not just at the end of life but at any stage of illness.

• Risks of hospital admission, particularly for older or frail patients, include loss of independence and potential for complications; home can often be a safer and more dignified option when well supported.

• The Urgent Community Response team provides rapid interventions and coordinates care to support people staying at home and foster confidence among families.

• Advance Care Planning is an ongoing process, often initiated at moments of crisis but more effectively used at ‘trigger points’ such as diagnosis or change in condition.

• Collaboration between ambulance and community teams, and mutual respect among professionals, are the keys to success in home-based care.

• Language and culture within healthcare shape practice and perceptions; shifting language can normalise and legitimise home-based treatment.

• Empowering clinicians and patients is vital; robust policy and investment in community care infrastructure is needed for the “home first” model to succeed.

• Tom encourages clinicians to have proactive, compassionate conversations, and advocates for normalising Advance care planning for all – including themselves.

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Bio

Tom is an Advanced Clinical Practitioner working in Urgent Community Response with Sussex Community NHS Foundation Trust, and a Practice Development Lead with South East Coast Ambulance Service. With a background as a paramedic, Tom has built his career across urgent and emergency care, helping to shape services that enable patients to receive high-quality care in the most appropriate setting. He is passionate about how language, culture, and mindset influence clinical decision-making - particularly around the concept of a “decision to treat at home.” Tom is dedicated to advancing clinical practice, supporting colleagues in their development, and improving patient-centred care across both ambulance and community services.