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.