Tuesday, 10 December 2013

Unacceptable Ambulance Delays and Struggling A&Es "Providing Pretty Good Service" Says FTN Chief Executive


Following recent BBC coverage of unacceptable ambulance waiting times outside A&E departments (Ambulances 'face long delays at A&E' - BBC figures reveal), I was invited by BBC Radio 5 live to go on air to discuss the situation.

You can listen to the full 10 minute segment below.



I had hoped we would have enough time to discuss the concerns that have been raised in the past on this blog and particularly the recent contributors on the Broken Paramedic Facebook page, but sadly the segment was all too brief. In any case, thanks to all those who pitched in. I hope there will be further opportunity to raise awareness.

It was disappointing that we did not have the opportunity to further discuss the relationship between frontline ambulance services and Accident & Emergency departments or the increasing pressure caused by more and more A&E closures, but most frustrating was the attempts by a man of some influence - the chief executive of the Foundation Trust Network no less - to brush the issues back under the carpet and claim that things are all right really. This seems to be a message which Mr Hopson has delivered in the past from the safety of a boardroom environment filled with charts and graphs. As I discovered last year with the former EEAS board, the capacity for detachment and delusion seems rife at this rareified level; a comfortable bubble of carefully engineered alternate reality in which executives can pat each other on the backs for jobs well done.

Take it from somebody who has worked in the pre-hospital trenches for over a decade and still has regular contact with those who continue to struggle against strangled resources, draconian government policy and the kind of detached 'I'm sure everything's fine' leadership that Mr Hopson exemplified: the situation is nowhere near as rosy as he would have you believe.

Why else would Jeremy Hunt, the Secretary of State for Health, write a message to NHS staff which essentially says:
"Healthcare workers, I know you've had it rough lately, but I expect - as always - for NHS staff make the unworkable work and do more with less. Thanks for that by the way, I really don't know how you manage it year on year, but I thought I'd up the ante. Brace yourselves, things are about to get even worse, I've closed some more A&Es, removed some care pathways, messed with various established processes and provided funding for some nebulous private organisations.
Please enjoy these meaningless waiting time figures which I'm using to make everything look fine and I'll raise a glass of expensive sherry to you all this Christmas. Cheer up though, we can all look forward to 2015, by which time my policies will have killed off the vulnerable old people who are ruining the healthcare system. Then you can all vote us back in and we'll make everything better for whoever's left by privatising it and making money from the declining health of the NHS workers we crippled to make this all possible. Thanks again, toodlepip."*  
Like Mr Hunt, Mr Hopson may be able to find some comfort in the current healthcare climate but that is because he doesn't really know what he is talking about when it comes to the day-to-day realities of patient care. He may be able to recite statistics and figures and I'm sure he's very good at leading his organisation, but it is unlikely that he'll be the one struggling this Winter.


*some paraphrasing may have occurred.

Tuesday, 7 May 2013

Economy of Blood: Are Private Ambulance Organisations the Problem or the Solution?


Rod of Asclepius = Healing and Medicine     Caduceus (Hermes) = Commerce
*


Over the weekend I was challenged on the Broken Paramedic Facebook page by some individuals who had taken umbrage at my stance on private ambulance firms.

One commenter expressed relief that my views hadn't been given the opportunity to be aired on BBC 5 Live Investigates as planned. He claimed that concerns I had raised regarding the capabilities and standards of private ambulance crews (as encountered and reported by active members of the NHS ambulance community) were “rubbish”. I have heard many genuine accounts from reliable and respectable sources of some very worrying practices concerning private ambulance organisations—some as recently as the last week—so I know the fears about private services are far from “rubbish”.

However, the ensuing debate gave me pause. Here was a fellow paramedic who felt the need to call me out on my views and defend not just his, but all private ambulance operators. This seemed like an odd decision on his part, given that he cannot possibly have intimate knowledge of the working practices of every other private ambulance organisation as well as his own. He was also (understandably) critical of NHS ambulance services. I can only assume he had not read any other articles on this blog, or he would have realised I am in complete agreement.

But I want to make one thing very clear:

Anyone who has chosen to pursue a career providing healthcare to patients has nothing to be ashamed of, no matter what pathway they use to deliver that care. Individuals with the desire to help others deserve respect, no matter what uniform they wear or what their level of clinical skill is.

State of Emergency

The present pre-hospital healthcare environment is far from ideal. Collectively, the appropriate level of clinical care is not getting to the right patients in the right time-frame. Undoubtedly, the failings of NHS organisations—and ultimately the Department of Health—are key to this. This is not something that rank-and-file practitioners from any discipline are responsible for.

Poor management decisions and failure to provide sufficient resources has left the publicly funded ambulance organisations unable to deliver the service expected of them. Meanwhile, private organisations have capitalised on this, feeding on the chaos and claiming a moral high ground they have no right to.

As a result, pressure on NHS front-line staff has increased: they are expected to do more and more with less and less. Working conditions have deteriorated and experienced personnel are increasingly looking for a way out of this soul-crushing treadmill. Good men and women continue to bleed over to the private sector, further weakening front-line NHS forces. Years of experience are lost as valued staff are driven away by mismanagement or injury. Many of them migrate over to private firms who can offer better rates of pay and more reasonable working conditions.

Who can blame them?

But they are pawns in the rich man's game.

It is my perception that, as the NHS-provided services continue to be wilfully eroded by under-funding and mismanagement, private firms wait in the wings, hungry for the business. In both sectors, the clinicians on the front line are likely cut from the exact same cloth, but the motives behind the organisations supporting them are very different.

Unhealthy Competition

For all its modern-day failings, the NHS is built on the laudable principles of providing healthcare to those who need it rather than those who can afford it. Fundamentally, this is what medical care and first aid has always been about and should never need to change. If you need a reminder of the history of this vocation, go read The Charge of the Ambulance Brigade elsewhere on this blog. You really should, this article can wait.

All things being equal – imagine, for simplicity's sake that both private and publicly-funded ambulance organisations start with equal staffing, skill-sets and resources – then the defining difference is that, whilst the public organisation can use all of its resources to further its ability to better deliver its services, the private organisation needs make a profit to justify its existence. This means that in order to create a profit margin, they will either be the more expensive option, or they must reduce costs by relying on lower-skilled staff or less equipment, thereby comprising clinical effectiveness. They might then be tempted to obfuscate these facts in order to remain competitive. Quite clearly, the private sector solution is the less attractive option than the publicly-funded, more cost-effective, more honest organisation.

This is without taking into account the phenomenal buying power of the NHS, who can buy in such bulk that they can command a much better price for consumables and equipment than competing private firms can ever hope to.

Of course, this is an imaginary ideal in which both types of organisations are managed efficiently and logically. In reality, we have seen that this has been far from the case. Instead, what we are seeing is a scenario where NHS ambulance services have been throttled into ineffectiveness by the government. This has been compounded by inexplicable management decisions. Yet, even with the most effective management and resource use, they were—and remain—destined to fail.

Private sector ambulance services seem to have become the only viable solution. They have the manpower and the resources on standby, ready to save the day. These resources will be a blessed relief when they are effectively utilised to bail out their struggling public sector comrades. But these are resources that have been built up by steadily siphoning money out of NHS coffers. The aforementioned “inexplicable decisions” have often been to the benefit of private enterprise. There is evidence readily available that millions of pounds of NHS funds have been inappropriately spent on private contracts, money which could have been better used to bolster NHS resources rather than allow private firms to build up their 'rescue package' capability.

To me, this seems like saving someone from a mugging by tearing the victim's own arm off to use as a weapon to fight off the attackers (and then expecting a reward).

Standing Together, Maintaining Principles

I have no doubt that the front-line clinicians who work for private ambulance firms mean well, but surely they must be aware that they are being manipulated to work against a far more philanthropic cause that underpins the best of what their chosen vocation represents.

Why support private organisations which aim to make a profit from the ill health of others, when there is a viable, ethical, publicly-funded alternative which could and should be the better option?

You will get no argument from me that public sector ambulance services have been poorly managed, but this does not have to remain the case. Certainly the NHS doesn't have a monopoly on ineffective leadership - privately-led companies have the capacity to be just as incompetent (banking springs to mind), but also have the temptation to be malevolent, with the added need to look for the most profitable type of work at the expense of the patient. Should the legitimate healthcare professional really be supporting that kind of working practice in the healthcare environment?

If respectable clinicians who set out to help those in need are now single-mindedly chasing the dollar, then the cause is already lost. We may as well shut down what’s left of the NHS, let the poorest and hardest to treat die, and just provide a service for those who remain. It will be far more cost-effective and a much more sustainable business model. It'll certainly take a lot of the pressure off of front-line medical services, improve working conditions and cause a boom in the funeral trade.

Fortunately, I don't believe this is a future that any right-minded individual wants. I think the altruistic drive instinctive to every healthcare professional is being subverted by those with far more selfish agendas. Every medical clinician in the land has a duty of care to stand in the way of this opportunistic tide of mercenary healthcare.

Watching or supporting ultra-capitalist forces slowly throttle the life out of the NHS is not an option.

Do not let the government float the economy on blood.




[*The title image shows the Rod of Asclepius, an ancient Greek symbol used to represent healing and medicine often found in modern ambulance livery and the ironically similar Cadaceus, or Staff of Hermes, the Greek god of Commerce and guide to the underworld.]

Sunday, 5 May 2013

Is the EEAS Turnaround Plan Just a Fantasy?




Earlier today, BBC Radio Five Live covered the ongoing crisis at East of England Ambulance Service. The programme is well worth a listen whilst it is available on BBC iPlayer, with accounts from an anonymous whistle-blowing paramedic (my hat is off to this gentleman for his very professional and earnest delivery), the bereaved mother of a baby who died allegedly as the result of ambulance delays, and an interview with EEAS chief executive Andrew Morgan.

I had been scheduled to appear on the show but was dropped at the last minute (I had spoken briefly on 5 live’s Weekend Breakfast at 0640 - 41m 45s in). I was deeply disappointed by my eleventh hour exclusion - this felt like an opportunity missed to offer an honest and informed overview as well as the chance to discuss how the general public and the government need to take some responsibility rather than just scapegoating the ambulance services whilst absolving themselves.

A Brighter Future?

However, the silver lining was that my preparations did give me cause to read through the recently released East of England “turnaround plan”. Mr. Morgan 's document, entitled 'Delivering better services for our patients' made for a thought-provoking and inspirational read.

I can honestly say that my first read of the document gave me a sense of vindication and of hope.

Vindication because there is a refreshing candour to the opening segments, in which many of the problems which I have written about previously on this blog are identified; lack of resources, untenable working conditions, misdirected priorities, leadership which is either delusional, arrogant or absent and many other sins are all laid bare.
“We are not delivering our 999 service, which is our core business, well enough.”
“We need to provide more front line resources, particularly double staffed ambulances...”
“An insufficient focus on the health of the organisation, in pursuit of performance response targets.”
I felt hope because, if all these sins are addressed and if Mr. Morgan's vision of EEAS's future can be realised, then I will be living in a part of the country in which I can have confidence in the emergency pre-hospital healthcare services.

A confidence which is currently not deserved.

Over the Top?

Andrew Morgan's concluding statement is so inspiring and aspirational it almost makes me sad that I no longer work for EEAS (rather than the usual emotion of thankful relief). He wrote;
“We need to make progress on all areas of this turnaround plan in order to recover the health of the organisation and deliver sustainable performance and high quality services for our patients. We know we work in changed times, we know that this is having an impact on the lives of our staff and we know that we are failing some of our patients. We have to change. We have to demonstrate better leadership. We have to support Staff better. We have to provide more resources for front line service delivery. We have to deliver good clinical outcomes for our patients. We have to ensure we make better decisions about how we use our valuable emergency response vehicles. We have to use our clinical skills better to guide patients to access the health service in a way that will support their long term health. We believe that by doing this we can keep more people at home, when it is appropriate to do so.
We must push for investment in the service when this has been proved to be justified and we must create a service that delivers what our patients need. We must support staff to make changes locally and we must listen to patients more. 
The future of this organisation is in our hands. As a Board we know we need to do a better job at leading the organisation. We hope that staff will work with us to implement the changes that are necessary to restore our collective pride and passion in what we do.”

Powerful, stirring words indeed. The kind spoken by a leader who can perhaps rally dispirited troops and give them belief in the cause once again. Right before he sends them over the top and into the enemy guns he secretly knows they cannot defeat.

The reason I say this is because, sadly, I do not believe that Mr Morgan's well-meaning turnaround plan can possibly work. This is no reflection on him - he can only work with the tools and resources he is given, but I believe the government taskmasters to whom he answers have set him up for failure.

Not Enough Funding

The need to make £50m savings remains, yet despite stating that “the cost of implementing this turnaround plan is predominantly going to be found from within existing budgets”, Andrew Morgan somehow feels able to conjure “the equivalent of an additional 25 24/7 DSAs provided directly by the Trust.”

This will apparently be achieved by “recruiting to our vacancies, reducing staff sickness and reducing our spend on private ambulances” and “recruitment to our additional posts” but I am concerned that the funding figures don't add up.

In September last year, public outcry regarding reduced ambulance coverage in North Norfolk resulted in £3m being found which enable 2 (nearly) full-time Double-Staffed Ambulances to be reinstated. So going by that, a single full-time DSA costs just over £1.5m to staff and run for a year.

The turnaround plan states that approximately £5m can be found from elsewhere to fund this initiative, leaving only the private ambulance spend and the nebulous concept of reducing staff sickness (overtime cover costs?) as the source for the remainder of the total £37.5m (£1.5m per ambulance x 25) bill for these proposed additional vehicles. Even if the entire monthly private ambulance bill (an average of £750k) was redirected, that will still total less than £15m. As bad as staff sickness may be, I doubt the very optimistic plan to aggressively reduce this over a six month period will result in saving the remaining £20m.

My scepticism is further compounded by the fact that earlier this year Mr. Morgan promised the “additional resources” of 15 ambulances and 200 staff, which turned out to be recycled old ambulances left unused due to staff shortages, and the promised staff (which did not appear in the timescale promised) were simply replacements for existing unfilled roles. It was all empty spin.

That is not to say that Mr Morgan is attempting the same trick again and I genuinely believe that the reality check has finally reached the top. This is a broad and noble plan which promises fundamental cultural change—including repeated oblique references to addressing a senior management problem some might refer to as the 'Essex Mafia'-- as well as a significant uptick in available resources for the “core business” of 999 responses, and a greater respect for the front line staff.

The problem is, it seems too good to be true, so it probably is.

Reverse Psychology?

Perhaps Andrew Morgan's plan is prove to the Department of Health that more funding is desperately needed to avert further disaster. This could certainly be inferred from the statement;
“Any new funding requirements identified as a result of the actions in this plan, will be discussed by the Board with a view to identifying the potential sources of this funding. This may involve seeking transitional funding from elsewhere in the wider NHS.”
There will undoubtedly be “new funding requirements” if the plan is to succeed and I hope Andrew Morgan is setting the stage to make a watertight case for exactly that. I eagerly await the results of the “clinical capacity review” they have commissioned, which “will determine how much of any gap in resources can be filled by internal efficiencies and changing working practices and how much will need to be discussed with external stakeholders and commissioners.” The results are due “late May 2013”.

My greatest fear is that this plan will be attempted without the resources necessary to see it through. Without backing from the DoH and a government willing to do what is necessary to stop the rot, we will see partial implementation, leading to greater demand on dwindling staff already stretched far beyond reasonable levels. The fantasy will become a nightmare as we simply end up with another post-Bradley Report attempt to fulfil lofty ambitions using only the existing personnel, which will break them.

How many broken paramedics do you need Mr Morgan?

Wednesday, 20 March 2013

Will the CQC Report on EEAS Trigger a Positive Change or Just More Excuses and Cover Ups?


Last Autumn, when I spoke to the Care Quality Commission about East of England Ambulance Service's (EEAS) failings, I was told that they could not act on my information as I was no longer an employee and therefore not a whistleblower, just a “concerned citizen”.

However the rising tide of concerns from active staff was evident – just reading through the hundreds of comments elsewhere on this blog is a sobering experience – and I'm grateful so many have shared their thoughts. But anonymous confessions on an internet blog were never going to effect a change and full credit to the many staff who were brave enough to speak out and give the CQC the information they needed to hear.

As a result, the Care Quality Commission investigated EEAS and published a report on 15 March 2013 which highlighted the need for improvement and hopefully will be the official voice which will force government ministers to re-evaluate their treatment of emergency ambulance services.

The CQC's overall view was as follows:
Our judgement
Since our last inspection the trust‘s performance in relation to its ambulance response times had deteriorated and people could not be assured they would receive care in a timely and effective manner.”
This seems like a succinct and understated version of some of the concerns that have been stated vociferously here on this blog, in the mainstream media and in crew rooms around the country. I am sure that any of the other regional ambulance Trusts put under the same scrutiny would be found wanting in similar fashion.

The Good

According to the report, EEAS operations were visited on three occasions, on 30th January 2013, 31st January 2013 and a “routine inspection” on 5th February 2013. The locations visited are not made clear in the report, but it can be inferred that the inspectors experienced some conditions out in the field as references are made to “30 interactions between ambulance staff and people using its service during our visit” and that it was a “cold and windy day”. Reference to witnessed trolley transfers and fully completed patient records suggests a visit to an Accident and Emergency department.

The report identifies that road staff are, as we already knew, doing their best providing a service which is “consistently good, with staff showing genuine concern, respect and care for people they assisted”.

The inspection team also spent some time in one of the HEOCs (Health and Emergency Operations Centre – ie. The Control Room). The report mentions two days in the Norwich HEOC, although it is unclear if one of those days was the routine inspection which took place on 5th February or if they were additional visits.

It appears that it was here that the fabled “big picture” became evident to the inspectors. It was not all bad though. The despatch system was rightly seen as effective and professionally run;
“During our time in the communications centre we spoke with managers, call takers and dispatchers. We listened to calls being taken and watched as deployment decisions were made by staff. Emergency calls were answered promptly and resources were allocated by one of five dispatchers according to the location of the call. A responding resource was allocated quickly to emergency calls as soon as the location of the incident was known. Further details concerning the call were passed to staff en route.”
The Bad

However, the CQC were forewarned of the struggle to reach many calls and back up first responders.
“Response times to emergency calls were an area of concern following our previous inspection in March 2012. We were also aware prior to this inspection, that the trust’s performance had deteriorated during 2012 and that this was particularly evident in the Norfolk area. There also continued to be a significant inequity of service between rural and urban areas of the trust. For example, although the trust achieved its response times in places like Luton and Peterborough, it regularly failed to meet them in Norfolk and Suffolk. Furthermore, we knew that the trust had not been able to reduce the length of time single paramedic responders waited for a back up vehicle to take people to hospital.”
The report goes on to examine deteriorating response times (a 4% fall in target achievement in Norfolk since Sep 2012). Reasons cited for this included a 9% increase in the past 12 months, hospital handover delays and “not enough extra staff to match the increase in calls”.

Despite this, the report states that “Managers were unable to give us sufficient explanation as to why performance had fallen.”

This is a worrying statement which not only suggests that the explanation has been missed despite clear evidence, but also seems to disingenuously finger "managers" as lacking the knowledge or competence to explain the situation. This is unfair. It is painfully, fatally apparent that the reason for ever decreasing performance is a lack of resources. That is it. No new chief executive or re-worked deployment strategy is going to squeeze any more out of resources already overstretched. Any individual arrogant enough to claim otherwise will just add to the culture of delusion that has been cultivated by the fanatical pursuit of government targets by fair means or foul.

The frontline staff are already giving more than they can sustain just trying to cover the shortfall. Experienced staff are leaving or looking for a way out as a result, further depleting a highly-skilled but shattered workforce.

I doubt the managers were “unable to give sufficient explanation”, rather they either felt it was patently obvious and already in plain view or they were unwilling to speak up due to the pointlessness of repeating themselves. No one in the ambulance service at any level is there trying to do a bad job and there is no sense searching for a scapegoat when it is a solution that is required.

The Solution

That simple solution is: MORE DEMAND REQUIRES MORE RESOURCES.

There is no sense in trying to manipulate the targets and statistics to make the demand appear less. The population is increasing, the elderly demographic especially. This means more demand for the ambulance service. Trying to split hairs because some calls might not be emergencies has only become so desperately important because REDUCTION IN GOVERNMENT FUNDING CAUSED A REDUCTION IN RESOURCES.

There is no magic deployment system, no superhuman director that will change EEAST's fortunes.  It is imperative that this is understood. The CQC report is evidence of this. Interim chief executive Andrew Morgan was powerless to do anything when the Department of Health had already dealt his cards.  Sadly, if history is anything to go by, all that will occur as a result of this report will be a few new faces at the top and another new broom to be introduced. Lord Howe's involvement might bolster board room morale, but unless he comes with a suitcase of bailout cash from his banking background then they will just be continuing to fiddle whilst Rome burns.

The CQC report quite clearly shows that THE EMERGENCY AMBULANCE SYSTEM WORKS WHEN IT IS NOT STARVED OF RESOURCES.

The only place these resources will come from is the Department of Health. Jeremy Hunt, Norman Lamb, Lord Howe et al are the people who can empower Trust staff to effect a positive change. If instead, the government ministers conduct a witch hunt and an organisational vivisection, or simply encourage The Board fudge the figures and tweak the system again, then the continued failure of East of England Ambulance Service and the blood of those whom it fails, is on their hands.

And don't for a minute think that this problem is isolated to Norfolk, or even the East of England Region. I'm sure there are a number of Ambulance Trust chief executives who are breathing a sigh of relief that East of England is getting all the heat. At least those who haven't resigned, retired or left the country in the last year or so.

This is a national problem and concerned staff from other regions should also consider contacting the CQC if things are quietly failing behind closed doors.

The time for silence is over.

Tuesday, 26 February 2013

Blame, Private Ambulances and the Cost of Lives


Last Summer, a diligent individual documented as “P. Holmes” made a Freedom of Information request for East of England Ambulance Service to release a breakdown of payments for private ambulance contracts in 2011 and 2012.

According to this website, earlier this month the figures were finally released [with thanks to Anonymous for the tip-off].

2011
Apr  £310,733
May £363,945
Jun £1,062,006
Jul £348,630
Aug £735,142
Sep £863,450
Oct £623,676
Nov £889,098
Dec £758,754

2012
Jan £980,042
Feb £908,579
Mar £1,016,571
Apr £539,169
May £788,091
Jun £604,922
Jul £932,795
Aug £1,090,099

Total: £12,815,702 over 17 months

This works out to an average of three-quarters of a million pounds (£753,864) every month. That's £9 million every year. It is interesting to note that, over 5 years, that expenditure makes up most of the £50m the Government require the Trust to save over the same period.

Are Private Ambulance Services Worth the Money?

Is having private ambulance firms waiting in the wings an efficient use of limited Trust funds? If there was some logic to the application of these private services then perhaps. If calling in private ambulances was a temporary measure whilst the publicly-funded Ambulance service bolstered its own cover then it would be more agreeable. Or if they were being used for routine transport to free up front line emergency resources. But there is evidence to suggest that none of these possibilities are the reality.

If these nebulous private services were being used appropriately and accountably, there might be less cause for concern, but that is not the case. According to the correspondence provided by EEAST, this is the “total monthly PAS [Private Ambulance Service] spend on Emergency & Non-Emergency services”.

What is the most worrying about this is that accounts from front line paramedics who have encountered private ambulance staff at the scene of emergencies, have found them to be evasive when challenged on their skill sets. (An example of questionable private ambulance professionalism can be found at the Trying My Patients blog.)

The title of Paramedic is protected by law and can only be worn by those who are registered with the Health Professions Council - a regulatory body who enforce stringent standards of  “training, professional skills, behaviour and health”. As such, ambulance attendants with lesser skill sets, as usually found on private ambulances, have vague titles on their otherwise similar uniforms that will confuse the general public. One account from front line staff even found a solo private ambulance attendant first on scene at a serious emergency to have a limited command of the English language.

A lack of clear skills and ability to communicate is dangerous – if a front line professional cannot be clear on the abilities of those attendants around him, then there is increased risk to the patient, especially as the struggling system is relying on these individuals to replace the service currently provided by registered professionals.

The cost of these private ambulance crews is reported to be more than three times that of the Trust equivalent – a Trust paramedic crew on triple time would apparently still be cheaper. Yet elsewhere, Trust paramedics working permanent relief – where they get very little notice of when and where they will be working – are now being made to audit their shifts and if they are not assigned 60% antisocial hours by the admin staff then they will have their pay incrementally reduced by up to 25%.

Even more frustrating to Trust front line staff is the knowledge that these private crews are paid for an entire shift but are only called upon if Trust resources are unavailable, meaning that while Trust crews are repeatedly denied a break, somewhere an expensive private crew is probably sitting idle.

I'd like to be clear: this is not the fault of the crews on either side of the line, but the poor decisions that created the line in the first place. The questionable deals and arrangements that allow this siphoning of funds to take place need to be thoroughly investigated.

Illusion and Delusion

The expenses listed above date back almost two years and gradually increase up to the most recent entry in August 2012. This suggests a pattern of growing reliance on external private resources. All the while the Trust have been building a case for reducing ambulance cover.

EEAST Interim Chief Exec. Andrew Morgan
Of course, it is also important to note that the Trust delayed releasing these figures for several months and they are conveniently old enough for the current Chief Executive to blame the previous incumbent. I'm sure that they have an explanation waiting in the wings to detail how they are no longer spending this much and how things are now much rosier.

But the new regime has already shown its colours with their truth-distorting claims of 15 “extra ambulances” and “a recruitment drive for 75 new paramedics and 124 emergency care assistants”.

As those of us watching quietly from the sidelines already knew, this turned out to be smoke and mirrors. Old vehicles left unmanned due to staff shortages were requisitioned from other areas also struggling for cover, then refurbished and relocated. The incoming staff are to fill existing vacancies as more experienced staff leave for roles that won't lead to an early grave. The entire press statement was spin engineered to placate the public and the press.

EEAST's motive was to stem the recent tide of bad publicity which they seem convinced is the root cause of poor staff morale. In their press statement of 5 February 2013, which they released in response to coverage on BBC Look East, the Trust claimed that “...one of those key issues raised by crews was low staff morale directly because of recent adverse press...” 

What an appalling attempt to sidestep responsibility for looking after their own staff.

They blame not the fact that the staff are routinely abused by their employer and the general public, not the disruptive, gruelling nature of a job made worse by inadequate resources and poor management and flawed policy, instead they blame "adverse press" coverage – the fact that the failings of the service, ergo their management, have become public knowledge. They think that's why entire ambulance workforce is buckling? Seriously? If the people in charge are really this deluded, the problem is even worse than previously feared.

For the benefit of those senior personnel who seem to be struggling with unfamiliar concepts: what you are experiencing is shame. Front line staff are well versed in dealing with the ignominy of having to publicly apologise for a failing service, it's something they've been doing for some time in their daily dealings with real people.  Their morale hasn't suddenly dropped, it's been steadily drained over years. Perhaps what ambulance leadership has started to become aware of is a sudden decline in their own morale as the propaganda bubble burst and reality started to creep into the board rooms and conferences. Shame is likely an unfamiliar sensation to them and they should be advised to reflect upon it and consider taking some responsibility rather than blaming the media/public/staff/other scapegoat.

The Political Shadow

The sad truth is that all this evidence suggests there are forces at work with agendas that place profit and bonuses above patient care and ethics. I don't for a minute expect the East of England Ambulance Trust to suddenly reform and deliver a "high-quality cost-effective" emergency ambulance service - those are just buzzwords they'll fire out in press releases to convince those who are not experiencing the opposite on a daily basis. EEAST just don't have the resources, even if they were spending more sensibly. The only thing that will change is the direction of the spin.

But EEAST's position is just a symptom of a far greater disease. I don't care for politics – but there is no escaping that this is a problem of government policy. Ambulance Trusts around the country are all facing the same decline; just as EEAST tried to convince their region the problem was exclusive to Norfolk rather than face the truth that the failure to deliver was region-wide, it is in the government's interests for the country to believe this is only an East of England problem rather than a national one. It is all a public image damage limitation exercise and was the only thing EEAST still had any real control over, but now they're losing that battle too. However, the government will still claim black is white and there is no cause for alarm.

It is the direction of the current government which dictates the policies and purse-strings to which NHS Trusts must adhere. In the current climate of economic austerity, it seems that we are also making savings on morals and ethics. The message from the Prime Minister at the Conservative Party Conference in October was very much a case of “every man for himself”. The concept of helping others is anathema to their agenda of helping people to help themselves.

Whilst society does have its parasites and those who would take more than they give, it seems that those individuals exist at both ends of the fiscal spectrum. But does this mean we should just accept that we now exist in a society where we abandon the weak?

Ethics? Morals? Health? Lives? Only if we can afford them.

The future is money.

I am ashamed to be part of it.