Thursday, 22 November 2012

Discussing Ambulance Service Failings with BBC Look East

Firstly, an apology. I appreciate that this blog has been a little too quiet of late. As I explained in a comment on the previous article, although I remain as passionate as ever about the struggling UK Ambulance Services, no longer being employed by them means I have other responsibilities to which I must attend. However I will take the opportunity to keep getting the message out when I can. After all, my family will suffer as much as anyone's if local ambulance services continue to circle the drain.

To that end, I've just spent the afternoon with BBC Look East's Nikki Fox, where we discussed many of the issues already covered elsewhere on this site. The footage is not for any particular feature, but on a number of occasions when stories have broken in the East Anglia region, Nikki had approached me for an interview, but it was often difficult to fit in during the time-frame before the story aired. At least this way, they've got something “in the can” for any future coverage. Further interviews are a possibility, should the need arise.

Not being particularly media-savvy, it was a challenge covering the key issues succinctly and accessibly, but I hope at least some of the footage will be of use and the general message is clear. We talked about the unsustainable pressure on crews, the policy of attempting to have just enough resources to cover probable demand and the misguided target-obsessed culture behind the scenes. We touched on the demands made by the public and other services, such as the police and GPs.

We also discussed what possible effect the recently announced “independent senior ambulance clinician” may have in conducting a review of EEAST's Norfolk operations. In my opinion, it just feels like a PR stunt to “restore confidence” and I cannot see how a single individual can reverse the fortunes of the ailing service unless he's bringing with him a fleet of crewed ambulances and a suitcase of £50m. However, if this individual can effect a cultural change, then maybe - eventually - there is some hope to be found.

On Effecting Change

Of course, a lengthy inquiry will make no difference this winter as under-resourced crews continue to get brutalised attempting to deal with the hypothermic elderly, increasing road accidents and the many other pressures that further challenge the ambulance service during this inclement period. But, come spring, at least the EEAST Board will have a nice document to show off which will probably say that they're doing quite well all things considered, irrespective of overwhelming evidence to the contrary.

Perhaps I'm being a little cynical and I should give the process a chance. Therein lies part of the reason this blog fell quiet for a time. The failures of the ambulance service are a very emotive topic and, despite my best intentions to remain neutral and even-handed as stated in my Mission Statement, I found a degree of impassioned anger to be creeping into my writing. Apportioning blame and creating scapegoats will not solve anything, but I succumbed to exactly that, so I walked away to reflect and cool off.

I'm grateful for the sheer volume of open opinion found in the comments sections of articles throughout this blog and the advice and feedback I've received from many former colleagues has been invaluable and influential. I really feel for the crews still being abused out on the road, I completely empathise with them and I want to help, however it is a difficult task to discuss the issues openly and honestly without a degree of emotional involvement. As an experienced paramedic, I know things aren't going wrong, they've already gone wrong and, frustratingly, there is no solution in sight. Certainly not from one man and his independent review.


Writing this blog is a burden which has weighed heavily on me. But the truth is, I am no longer central to the fight. It's not through choice, but I'm watching from the sidelines now. I'm not sure I am in a position to do any more than I already have, no matter how much I might want to. The changes need to come from within the government and the ambulance service itself. It is quite clear to me that fundamental cultural changes need to take place, both within ambulance organisations and from the society in general, for ambulance services to return to being as effective as it should be.

EEAST staff need to make sure this Mystery Inquiry Man has the full facts at his disposal. They mustn't hold back and let The Board make out it's just a Norfolk problem - the entire EEAST service is failing and other regions throughout the UK are likely little better. But that's the Mystery Inquiry Man's burden now and he needs to deal with it appropriately and not paper over the cracks once again. The opportunity is there to plant the seeds for a future service that looks after its staff so they in turn can look after the patients. That way lies a successful, effective service, not squeezing diminishing resources in the vain hope of better results.

I will endeavour to continue delivering what support I can and I hope that more people will step up to champion the cause. I'm grateful that Nikki Fox and other media professionals I have been in touch with are aware of the issues, but they can only report it to the public if they hear about it. It is this communication and coverage that has pressurised EEAST to take a long hard look at itself. The opportunity for change may be within grasp, but not if the people who know the truth fall silent now.

Speak out.

Friday, 19 October 2012

No A&E, No Ambulance, No Chance

In my ongoing efforts to banish the veil of misinformation that confounds the general public when it comes to their local Ambulance Service, I was recently given the opportunity to write a piece for the Welwyn Hatfield Times. Sadly, for space reasons, they were unable to fit it in. They did quote me, although those quotes did not come from my submission. It is possible they were alluding to something I said on the phone, but I'm not entirely comfortable with the tone of the quotes and I'm disappointed with myself if I ever used the word "speedy" (unless I was talking about a Mexican cartoon mouse).

I certainly did not intend for ambulance crews to sound like they're a liability - only to underline that the constantly exhausted and overworked road staff would be less capable and less efficient. From personal experience I'm pretty sure I was of fairly sound mind for the first 8 or 9 hours of a non-stop shift. It was only after that things would start to get woolly.

In any case, the Welwyn Hatfield Times are at least getting the message out to the public that things are not in good shape. I hope they can step up their focus in the manner the Eastern Daily Press has. The EDP has been providing almost daily coverage of local ambulance issues and have been really getting the drains up on East of England Ambulance Service, setting up a survey, gathering patient accounts and reporting ongoing issues. I appreciate that they are a regional newspaper with far greater resources, but I'm really impressed with the way that Kim Briscoe and her colleagues are attacking the issue. It's certainly having some impact. I hope more local journalists take up the cause.

Wednesday, 17 October 2012

“I don't see the problem.”

"Everyone counts" ...except staff. And patients.

When Neil Storey, East of England Ambulance Trust Director of Operations, presented his new rota system, road staff tried to point out the obvious flaws. The entire plan, now public knowledge, was predicated on the idea that existing resources had enough wiggle room to allow for a reduction in ambulances. Every operational staff member in the room knew from bitter daily experience that that was not the case. Sadly, Mr Storey was clearly not looking for advice, he simply wished to inform the staff of what was going to happen. His parting words were reported to be: “I don't see the problem.”

Those five words highlight the very issue with Ambulance Trust leadership today. No doubt Mr. Storey knows his figures and has studied the “demand profiles” which the EEAST Board are so fond of exhorting. Everything that he has worked on is singularly focused on the ORCON model we discussed last week in The Cult of ORCON. But that laser-like focus simply underlines his flawed logic process. He is working on the precept that achievement of ORCON targets has real meaning which, in the current culture of achieving them by any means necessary, they evidently don't.

Despite road crews speaking to him in an overwhelming, singular voice of dissent, he was content to dismiss that room full of know-nothings with the departing statement which damns his kind. Directors do not – cannot - see the problem. That problem is reality. But reality apparently just gets in the way of target achievement and therefore should be ignored. It is not productive to consider reality – instead The Board has incontrovertible evidence in the form of statistics and demand profiles which are far more useful than the daily experiences of everyone who is actually doing the job.

If nothing else, this proves that whistleblowing to the Care Quality Commission is the only way to get through to The Board. Direct communication from staff members has already been tried and fallen on deaf ears. Links to further information on contacting the CQC can be found on the right. --->

Tuesday, 9 October 2012

The Cult of ORCON

Yesterday, East of England Ambulance Service chief executive Hayden Newton announced his decision to take early retirement. On the same day, North East Ambulance Service tweeted that their chief executive, Tony Dell, has taken the same decision. There will likely be many theories as to their motivation to step down from their positions, but in the current climate, the chief executive role is undoubtedly a poisoned chalice. Their departures certainly won’t solve anything and whomever replaces them will be confronted with the same insurmountable challenges and cultural problems.

The Ambulance Service is about providing good pre-hospital healthcare where it is needed. It is the responsibility of the paramedics to provide the good healthcare. The “where it is needed” part is dealt with by the supporting organisation. Those two key components of effective ambulance care should work in tandem, but somewhere along the line they have become opposing forces. The primary task of remaining and future chief executives should be to put an end to this clash.

Monday, 8 October 2012

The EDP's Ambulance Watch Campaign

In response to public concern, last week the Eastern Daily Press regional newspaper launched its Ambulance Watch campaign, focusing on the plight of the emergency ambulance service in East Anglia.

The campaign was launched with a questionnaire asking for feedback from the public and continues with regular articles focusing on related stories from the local area. They have summarised the questionnaire responses so far, with response times and delays being chief amongst the concerns of the public.

I am grateful that the EDP has given some consideration to the road staff who are under extreme pressure to continue delivering good clinical care in an increasingly challenging working environment.

Today, I had the opportunity to present the paramedic perspective in a piece the EDP entitled “Paramedic says ambulance service in East Anglia is ‘broken’.” In it, I attempted to convey the hardships that face ambulance personnel as they are continually squeezed to the point of exhaustion in an attempt to achieve targets.

Friday, 5 October 2012

An Appeal to Ambulance Staff: Make a Stand and Expose Failings

It is becoming increasingly evident that the desperate pursuit of government set targets has led to a misguided culture of subterfuge and misdirection within the ambulance 999 system. Under-resourced Ambulance Trusts so pressured to achieve impossible targets may be resorting to massaging the system to meet demands set by the government.

Beyond the simple failure to provide appropriate ambulance responses, of great concern is the alleged practice of inappropriate call categorisation. Rather than admit that Ambulance Trust’s inability to meet current demand, there is evidence to suggest that 999 call-handlers and clinicians in despatch are being encouraged to find ways to downgrade potential Red 1 calls that cannot be attended in 8 minutes. It has also been suggested that single responders in Rapid Response Vehicles are being reclassified as vehicles capable of transporting a patient in order to avoid sending an ambulance. If those practices are taking place, that undermines the already questionable validity of the present target-driven system of monitoring Ambulance Trust effectiveness. If dispatch staff are under pressure from a sinister culture of prioritising targets over genuine patient care, this is unacceptable and they need to speak out.

If these practices are evident to front line staff or from patient experience, this needs to be made known too. The culture in HEOC may be too pervasive to draw out concerned call-handlers and dispatchers without front line support. Concerned staff need to stand together and stand up.

Wednesday, 3 October 2012

How the Public Could Save Their Doomed Ambulance Service

So far on this blog, I think we've established that the "ambulance problem" is huge. Every opinion I have heard - from the public to paramedics to chief executives - has underlined the many intolerable issues that beset patients, crews and the service as a whole. The problems are so vast and manifold, it seems as if those in charge are incapable of addressing them, choosing instead to skirt around the problem, chipping away at minor contributing issues instead of tackling the core cause head-on.

Part of the problem is the vast differences between how various key parties perceive the ambulance service. In an effort to address the "ambulance problem" constructively, far more needs to be done by these parties to agree on what the ambulance service is for and then to execute that single purpose with efficiency and professionalism.

The Public Perception

Ultimately, the ambulance service is there to serve the public. But does this mean that the public knows best? Not at all. Few members of public give any thought to the ambulance service until they find themselves in a situation they cannot deal with, without outside help. The convenience of the 999 service means that for many, it is a catch-all solution. From their perspective, dialling 999 is the instant answer to a broad range of unmanageable problems. In some respects, this is good thing. It means that the UK public have faith in the emergency services provided. But the public demand on ambulance services lies at the core of the problem and the current inability to meet it is already eroding that faith.

Sunday, 30 September 2012

Writing for The Mail on Sunday

Earlier this week I was contacted by The Mail on Sunday and offered an opportunity to raise awareness on a national platform of my concerns about the ambulance service cuts. For some time, The Mail has been campaigning against A&E closures around the country and was interested in the impact the cuts were having on the ambulance service. It goes without saying that the simultaneous depletion of two key emergency services are linked.

Presented with the opportunity to write in a national newspaper, I was conflicted. I wrestled with my conscience - was it the right thing to do? Would giving account of my morale and health-destroying experiences and the tremendous pressure my former colleagues continue to face be constructive and lead to a better ambulance service for patients and staff? I know many ambulance personnel would have come forward already, but for fear of their jobs. Because of my back injury, as of August this year I am no longer employed, so there is no such fear remaining for me. My attempts earlier in the week to appeal to the EEAST chief executive, Hayden Newton, had seemingly fallen on deaf ears.  Perhaps this is the last service I can do for my former colleagues.

I had to try.

Thursday, 27 September 2012

An Encounter with the EEAST Board of Directors

...except front line crews.
Your feedback from my previous article, Why the Public Should Care About the Institutionalised Abuse of Their Ambulance Workers, has been overwhelming and emotive. It is patently clear from the comments left anonymously by many practicing frontline ambulance personnel that the UK ambulance workforce is beleaguered, demoralised and pushed to breaking point.

The deluge of comments left in the last few days make for powerful and poignant reading. In review, there were a number of common themes and all were in agreement of the intolerable bleakness of the current situation:

"The workload is relentless...Many workers are over 50... and are expected to keep going at this pace ' til they reach the age of 68."

"The ambulance service is broken. The staff are tired, demoralised and miserable."

" load is up, sickness is up, but rather than cover for this the management drop the shifts to save money, this only puts more strain on those few on shift, because the call volume does not decrease when we are crews down."

"Staff are not cared for as they should be..I have lost several colleagues over the years due to the job..."

"I will not stay in this job for much longer. It is killing me. It is killing my friends and my crewmate."

"It won't be long now before the 'shock horror' headlines will be relating to stories of ambulance staff dropping dead when attending the public."

Thursday, 20 September 2012

Why the Public Should Care About the Institutionalised Abuse of Their Ambulance Workers

Regional Ambulance Trusts in England

In conference rooms and administrative buildings around the country, statisticians and logistics experts pore over figures, maps and budgets in an effort to squeeze maximum efficiency from available ambulance resources. Like every business in the UK, the era of austerity has meant even the emergency services are required to tighten their belts.

The problem of how to cope with rising ambulance calls in the face of budgetary reductions seems an impossible task.  According to Hayden Newton, East of England Ambulance Service chief executive, closer analysis of population distribution, social behaviours and trends in call history are "paving the way for the rota review and revisions which, using sophisticated modelling technology, tell us where and when vehicles are needed and what type." Assuming this miraculous technology is capable of what Mr. Newton says, this will lead to "ambulances not being cut overall, but matched to where the demand lies.”

Aside from the flippant thought that - if the "sophisticated modelling" is so accurate as to know where the emergencies will be before they happen, why don't they use it to stop the accidents in the first place - there seems to be a touch of messianic delusion at work here. With the government-stated requirement of East of England Ambulance Service to reduce expenditure by £50m over five years, Hayden Newton is essentially proposing to perform the ambulance equivalent of feeding the five-thousand with a few loaves and a couple of fish.

As far as we know, the EEAST chief exec does not have access to divine powers, so with £50m-worth of resources disappearing from his coffers, where does he think the ability to continue delivering pre-hospital healthcare worthy of a first-world nation is going to come from? Fortunately, like every ambulance service figurehead in the country, Hayden Newton believes he has access to a miraculous fountain of endless resources.

The front-line workforce.

Tuesday, 18 September 2012

North Norfolk's Hollow Victory

North Norfolk are celebrating making East of England Ambulance Service “rethink” their new deployment strategy which proposed the removal of full-time ambulance cover from the towns of Cromer and North Walsham. According to the Eastern Daily Press “they are taking another look at the controversial shake-up of cover and they have already agreed to amend heavily-criticised proposals.”

The “efficiency” proposals announced earlier this year were met with public outcry which gained momentum as MP for North Norfolk Norman Lamb and some notable celebrities added their voices to the cause. Now the decision-makers at East of England Ambulance Service have apparently U-turned after rising demand “triggered a clause in their contract”, leading to an extra £3m in funding which has allowed the provision of 2 (almost) full-time ambulances at Cromer and North Walsham.

Sorry North Norfolk, but it's not nearly enough - at best, you've been given a sugar-coated excrement sandwich. For a start, if it has suddenly come to the attention of the decision-makers that demand was on the increase, how could they justify any kind of withdrawal of cover in the first place without checking the figures first? Why did it take a public outcry for anything more than fuzzy logic and assumption based on old figures to be applied?

Saturday, 15 September 2012

The Charge of the Ambulance Brigade

Since the dawn of civilisation, time has been a critical factor in the treatment of the infirm. Even before modern medicine, those caring for the badly injured and the seriously ill would be acutely aware of the urgency of the situation. There are no qualifications required to recognise pain and suffering. The only thing that has really changed is how those circumstances are managed.

Fortunately, for the most part, things have improved.

The Common Miracle

Hippocrates: The Father of Western Medicine
The evolution of medicine itself spans thousands of years, with the Ancient Greeks being responsible for the Hippocratic Oath which, even today, underpins the ethical and honest practice of medical treatment. The Greeks also did much to advance the understanding of human anatomy and physiology and the names of most of the organs and structures in the body are Greek in origin. Physicians through the ages have built on this, expanding the biological sciences and developing new skills, all contributing to phenomenal wealth of medical knowledge no single person could ever hope to absorb.

We are all extremely fortunate to be living in today's enlightened age, where there are specialist treatments and life-saving procedures for many conditions which would previously have killed. With access to the right equipment in a hospital environment, the modern doctor's ability to diagnose and treat would, in the past, have been viewed as miraculous. For some, it still is.

But for those who cannot get to that hospital, it is irrelevant. This is why the ambulance service was born.

Friday, 14 September 2012

Mission Statement

Today's UK Ambulance Service is something of which this nation should be proud. The ability to bring a professional standard of healthcare to homes, streets and fields nationwide is a privilege not found everywhere in the world. To be able to take comfort in the knowledge that our health and our lives - and those of our elderly and our children - are championed by a national service of dedicated individuals trained and equipped to cope with almost any emergency is something we should not take for granted.

Yet many people do.

With that comfort comes a complacency that the necessary help will be available whenever it is needed; should a parent have a heart attack, or if a child is knocked down in the street. Many people assume that an ambulance equipped to deal with an emergency is minutes away and it will bring with it skilled and alert individuals qualified to fix the problem or quickly take the patient to a hospital where they can be treated.

But what if that was not the case?

As a paramedic with a decade of experience in front-line emergency care but who has now been forced to cease practicing due to a debilitating back condition, I can only watch as services are re-organised in a manner I am concerned will be detrimental to the emergency cover the general public needs.

The principles underpinning the Ambulance Service are something I firmly believe in and those colleagues who remain on the front-line have my utmost respect and support as they attempt to do their jobs in the face of impossible pressure. They are swimming upstream with their hands tied as resources are withdrawn, skillsets are diluted and conditions in which they work are worsened by the erosion of common sense. They are certainly not to blame for the falling standard of ambulance care. In fact, they are the an immeasurable resource that is relied upon to keep things working in spite of everything. But they are only human. Eventually, even they will break.

The Aim of This Blog

In an effort to continue contributing something to the ambulance cause, I aim to use this blog as a platform to discuss this faltering service and to highlight the concerns that an employed Paramedic could not, for fear of employer reprisals.

To be clear, it is not my intent to be defamatory or unnecessarily negative. The opposite in fact - I will continue to honour the principles of the Ambulance Service and the professionalism of the Paramedic workforce and those that work alongside them and support them. I will uphold the standards of patient confidentiality to which all healthcare professionals must adhere. I intend to be constructive, but I will not shy from hard truths and I will do my best to see through the weasel tactics used to confound the public into thinking that all is well. I have seen first hand that this is far from the truth.

I aim to weigh up the pressures which today's Ambulance Services face and to provide an honest overview of how problems might be addressed. Over the coming months I will explore the various challenges that face patients, individual crews, support staff and the service as a whole. Expect recurring themes like public accountability, resource management concerns, the role of the public, and institutionalised abuse. I will offer my thoughts on possible resolutions and lessons to be learned.

The Critical Patient

Any healthcare professional will tell you that the human body is a complex system of organs whose vital functions can only operate if the cardio-vascular system is healthy. Blood is needed to transport vital oxygen and nutrients to every part of the body and to remove toxins and waste products. Blood contains the means to fight disease, repair injuries and sustain life. Just like the ambulance service.

If skills can be diluted, stations can be closed and the means of transporting patients can be reduced, then surely the human body can survive with less and weaker blood. You do not have to be a medical practitioner to know that this is the recipe for ill-health and eventual death, both for the human body and for the NHS.

Ambulance Services are the blood of the National Health Service and right now it's bleeding out.

This is my call for help.