Sunday, 6 December 2015

Does NHS 111 Work?

NHS 111 services sit in the eye of a nationwide healthcare storm.

Amidst a chaotic vortex of hospitals in special measures, funding and resource concerns, escalating demand, demoralised healthcare staff and belligerent health ministers, the public continues to need treatment - and it is to the 24/7 medical helpline to which they often turn.

As a paramedic who has recently taken up a position as a clinical advisor in Hertfordshire's 111 service (run by Herts Urgent Care), it has given me an opportunity to see first hand the efforts to mitigate the unprecedented pressure on wider NHS services.

Sadly, the impression given by recent press coverage paints a bleak picture of those efforts (Daily Mail: 'NHS 111 Whistleblower Speaks Out', Independent: 'Most people told to go to hospital after calling NHS 111 did not need emergency treatment'). I'd like to take this opportunity to offer an alternative, more informed viewpoint than the kind of fearmongering anecdotes which have been the focus of much mainstream media coverage.

I am all too aware of the intolerable workload faced by my colleagues delivering 999 emergency care and the related challenges faced by A&E departments. GP services are also in crisis as are other community-based services. So it is absolutely imperative that whatever can be done to alleviate the pressure of relentless demand on primary care services (that being the umbrella term for any 'first point of contact' to healthcare, including GP surgeries, A&E departments and ambulance services, amongst others) whilst maintaining the standard of patient care people expect from the NHS. This is no small task and is fraught with risk.

It is vital to recognise that 111 does not exist to replace any of those services. It cannot. It is a supporting service which should enable its users to get the right care in the right timeframe. However, primary care is a minefield for the uninitiated. To expect the layman to know the urgency of their need and which point of access would get them the care they require is a huge assumption.

Risk Aversity Versus Safe Practice

Sourced from the internet - unkind and incorrect
Much has been made of the scripted process of assessment, provided by NHS Pathways, and its use by the non-clinical health advisors who take the majority of initial 111 calls. While the health advisors do not generally have an extensive clinical grounding, I have found them to be knowledgeable and passionate about the service they are providing. It is evident that the experience of dealing with the healthcare-seeking public dozens of times in a single shift soon gives them insight and understanding of the vast majority of the calls they field.  Of course, as non-clinicians, they are required to stay strictly within the constraints of the Pathways assessment, with any complex or concerning issues being transferred through to a clinical advisor.

The point of the Pathways assessment itself is to attempt to leave no stone unturned when ruling out medical problems which are not appropriate to be dealt with over the phone. It's a robust system which formalises the process which any clinician would be instinctively doing the moment they laid eyes on their patient. Using the system, there is no reason why an experienced non-clinical health advisor cannot provide as safe and thorough an assessment over the phone as a clinician. For the most part, the limitations lay not with their ability or training, but with the obvious restrictions of being on the other end of the phone, unable to physically assess the patient.

In an ideal world, every member of public would know the difference between a sleeping patient and an unconscious one, or a minor wound and a potentially catastrophic one. But that is simply not the case, so before any attempt can be made to address the problem at hand, those risks need to be identified and ruled out.

It's fair to say that, prior to my training, I had my reservations about the idea of being able to make any kind of reliable assessment of an unwell patient without actually being in the same room as them. But my experience over the last few months has given me plenty of reason to be assured that the process works for the most part.

Room For Improvement

Having undertaken the health advisor training as a precursor to my clinical induction, I spent a number of shifts working in that role. I did experience a degree of frustration as I was required to switch my paramedic brain off, relying purely on Pathways to identify areas of clinical concern. Despite that, as I worked through the assessment with my caller, I would be mentally noting what information I would have sought and almost without fail, the Pathways assessment would cover it (and often far more besides). Indeed, as I progressed on to my clinical advisor role, I found that, with transferred calls requiring further clinical consideration, the brief handovers health advisors provided would often show they had a good grasp of the underlying clinical concerns, even if they couldn't qualify them.

That's not to say the system works perfectly every time. Of course it has its limitations and there is most certainly room for improvement (something which I hope to discuss in subsequent articles), but in my experience, the sheer volume of calls which are dealt with and result in a positive outcome unequivocally prove that NHS 111 provides a useful service and does much to protect the public and the interconnected primary care services.

There is of course pressure not to send ambulances inappropriately, just as there is clear guidance on the use of other primary care services, and this is something which any regular reader of this blog will know I feel strongly about. It is guidance which is entirely appropriate. The idea – as suggested in some media coverage - that patients are being wilfully denied ambulances when they need them is ridiculous and would be unethical.

I have dealt with a few cases where I know the ambulance crew despatched would probably be cursing me, and if I could call them to justify my decision, I would. But the limitations of telephone triage make it impossible as a clinician to take the risk based on the information provided by the caller.

But the number calls I've dealt with which have ended with the caller happy to deal with their problem at home who might otherwise have called an ambulance or taken themselves to A&E comprise the vast majority of my workload. Those kinds of calls vastly outweigh the occasional ones in which the need for immediate care cannot be completely ruled out I have no doubt that NHS 111 is a net positive both for professional healthcare services and for the general public.

The Real Problem is Lack of Education and Resources

Broadly speaking, I suspect any perceived pressure coming from NHS 111 arises from ever increasing public demand,  not inappropriate referrals. NHS 111 provides a wide and accessible safety net which may well be accurately highlighting that increase in demand. In its absence, I have little doubt that the increase in pressure on other services would be far greater.

I wish we had more ambulances so the occasional over-cautious referral didn't punish crews so much. I wish so many A&Es hadn't been closed and GP services weren't in such dire straits that I feel a twang of guilt every time I choose to err on the side of caution by sending the individual for assessment when my gut suggests it might not be necessary.

But I certainly don’t see the concept of NHS 111 as an appropriate target for attack by various media outlets and even some healthcare professionals. Without it, things would be far worse.

In any case, I'm glad there are employment alternatives for staff who have been fed through the front-line meatgrinder and  I won’t be compromising on my goal of endeavouring to provide the best and most appropriate care for every individual I deal with.

While the healthcare storm continues to rage around us and the NHS suffers the ongoing assault of the government’s misguided efficiency savings programme, I am grateful, despite the adverse conditions, to be able to provide clinical guidance and for the opportunity to work alongside health advisors and fellow clinicians who work hard to do the same.

The primary care sector and public should be grateful too - things would be worse without 111.

[Disclaimer: The views and opinions in this article are solely those of the author and are not representative of Herts Urgent Care or its partners.]

Thursday, 23 July 2015

Mission to Parliament: What Has Anthony Marsh Ever Done For Us?

Chloe Smith (Con), Norman Lamb (Lib Dem) and Daniel Zeichner (Lab) accept the petition from Fraer Stevenson
Earlier this week, a group of East of England ambulance staff travelled to Westminster to deliver a petition appealing for better working conditions for road staff and to retain the services of the chief executive who supports them. Their hopes were to gain ministerial support to help persuade the Secretary of State for Health to intervene and allow them to retain Anthony Marsh longer term as their Chief Executive.

I was fortunate enough to be able to travel with them to get a better understanding of the issues.

As I sat on the minibus heading for Parliament, I listened to the conversations of the ambulance staff who had taken time out from their home lives to maintain the push for positive change within East of England Ambulance Service (EEAS). The group exchanged stories about their front line experiences and the organisation that facilitates them with all of the disgruntled passion I recall from the crew rooms of old. It was this kind of cathartic debrief which allowed under pressure ambulance personnel to offload and vent. I knew how valuable these conversations were, despite often seeming critical or negative, as a way for ambulance clinicians to feel their concerns were being heard, even if only by each other. It was how they coped with the burden of their work.

Sadly, these days the growing pressure for ambulance Trusts to perform with ever dwindling resources leaves road crews with little opportunity for such informal confessionals as they are rarely on station to meet each other. Back to back emergency calls, aggressively enforced hospital turnarounds and soul-sapping late finishes mean that individual crews are often ships passing in the night.

But hopefully today their concerns would be heard by a far more influential audience.

Given their discussions, I was a little worried that their message might get lost under a deluge of anecdotes about inappropriate emergency calls and internal politics. Fortunately, as we arrived in central London, the spokeswoman of their merry band said a few words to ensure that everyone was clear on the matters in hand. Fraer Stevenson, ambulance clinician and UNISON Branch Secretary, underlined the importance of focusing on the key issues of the petition they carried; supporting moves to offer staff greater protection from late finishes and backing incumbent Chief Executive Dr Anthony Marsh to stay in post despite pressure from the board for him to be replaced.

On first impression, Fraer cut an unusual figure as the individual at the epicentre of the struggle for staff welfare. A diminutive blonde woman with a small voice who, while having the bedside manner of Florence Nightingale, you might think would be out of her depth dealing with headstrong and determined executives. Apparently not; a steely determination to fight for what is right, whatever the cost, hides just beneath the surface.

I had only spoken with Fraer once before today, a lengthy phone conversation (after weeks of missed calls) had revealed she and I had been walking a parallel path for a long time. Concerns about East of England Ambulance had prompted me to start this blog back in 2012 after I became aware of a growing outcry among North Norfolk residents at the poor service they were getting from EEAS. Fraer was involved in much of what I went on to write about on The Broken Paramedic during that period: campaigning when staff grievances were ignored and seeking support from concerned Norfolk politicians including Norman Lamb (Lib Dem) to the battle for EEAS’s soul against a misguided executive board which eventually stepped down. The catalyst for much of that was a brave and candid stand made by staff at Cromer Ambulance station on the North Norfolk coast. I believe that the corner which EEAS is perceived to have turned is very much something for which Cromer staff deserve no small amount of credit.

Is Anthony Marsh the Right Man for the Job?

Dr. Anthony Marsh, EEAS & WMAS Chief Executive
After piecing together our shared history, I took the opportunity to air some niggling concerns I had about the purpose of her mission to Parliament. Nationally, ambulance staff are in a desperate situation and I’m unequivocally behind anything that will give crews a better chance of surviving their own careers, but why is she so convinced Anthony Marsh is worth fighting for? Since publishing my previous article backing the petition to retain his services, I’d been contacted by various parties who expressed concerns about the move, from decisions he made at West Midlands Ambulance Service to his failure to address a bullying culture allegedly present within East of England. It seemed that not everyone was as convinced as she was that he was the right man for the job.

Her reasons were manifold. Now she is UNISON branch secretary, she has a good ‘partnership’ relationship with Anthony Marsh, enabling her to push for positive changes which benefit staff, pushing for improvements to the diabolical conditions they labour under and ultimately bolstering their ability to provide a good service to the public. She believes that Mr Marsh is a good man making brave decisions to right a listing ship. She identified some of the supportive measures he’d brought into EEAS include upskilling paramedic and EMTs to band 6 and 5 respectively, saving about 100 staff from having to leave the Trust after the loss of Patient Transfer contracts (under TUPE [Transfer of Undertakings (Protection of Employment) Regulations 2006] legislation they would have been absorbed by private providers) by bringing in a new tier of health care referral teams undertaking urgent work.

It is fair to say the role of any ambulance trust chief executive (or indeed any other senior management position) is a poison chalice. In the current target-obsessed, resource-starved climate, it is an impossible mission for anyone, but Fraer presented plenty of evidence to suggest that Mr Marsh is at least willing to factor staff needs into his strategies. The same may not be said of any replacement waiting in the wings, especially given that, due to the current period of uncertainty, many positive proposals under Anthony Marsh have already stalled and current changes threatened with reversal. Any incoming chief executive will surely be expected by the board to continue down that line.

Whatever your thoughts on Anthony Marsh’s tenure, the ground made in EEAS under his watch is at stake and I’m inclined to give him the benefit of the doubt, largely because Fraer is. I am convinced she is absolutely a force for good, someone who is prepared to stand up for staff and stand up to the less savoury aspects of ambulance culture, even to her own detriment.

Parliamentary Friends

Clive Lewis (Lab) and Gavin Shuker (Lab) listen to staff concerns.
When we arrived in Westminster, the meeting itself went well, with some encouraging dialogue taking place between the assembled ambulance personnel and the MPs who found time to escape the halls of power on the day of the Welfare Bill debate.

Gathering on the green often used by the reporting media outside Parliament, we were met by Chloe Smith (Conservative MP for Norwich North), Daniel Zeichner (Labour MP for Cambridge), Norman Lamb (Liberal Democrat MP for North Norfolk), and later by Clive Lewis (Labour MP for Norwich South) and Gavin Shuker (Labour MP for Luton South) all of whom were attentive and supportive, listening to concerns and supporting the petition. It was fantastic to see such positive cross-party support.

Norman Lamb talking to BBC Look East
I was particularly impressed with Norman Lamb, who I’ve always viewed as sort of a kindly uncle, but in person was far more steely. His commanding performance in front of the BBC Look East camera showed that he was a very capable man able to marshal facts from conversations he’d had moments before into what sounded like a polished, pre-prepared speech. His comments were insightful and had weight, asking ‘is it wise to lose a chief executive who has the confidence of staff and has made real progress.’ Certainly, it’s worth considering that, in light of concerns about Anthony Marsh’s other role as West Midlands Ambulance Service chief, he has still had successes, where his full-time predecessors had failed.

Thankfully, all of the MPs pledged to do what they could for the cause, with promises to write to Jeremy Hunt, Secretary of State for Health, to bring the matter to his attention. I hope it’s a matter which Mr Hunt feels is worthy of his time. After all, now more than ever, he is a man who could do with the opportunity to appear supportive toward the needs of NHS staff.

Perhaps more importantly, I hope that the East of England executive board are able to see whatever influences are driving the decision to oust Anthony Marsh and to make the right choice to support the staff that make their organisation work.

Wednesday, 15 July 2015

The Fight for Positive Change in Ambulance Trust Culture Needs You

In a country of beleaguered ambulance Trusts facing staffing shortages, pay freezes and dwindling resources, things are looking bleak right now for employees and the public alike.

But there is a glimmer of hope.

After a desperate few years, East of England Ambulance Service has been experiencing the beginnings of a positive shift in culture and attitude. A change which, if successful, could show the way for other Trusts and prove to be the template for the much needed shot in the arm ambulance services nationwide need. Among other things, this grassroots initiative led to the production of the powerful and incisive video below about pressure and late finishes and accompanying petition, which solicited this encouraging response from the Association of Ambulance Chief Executives. But it's an initiative that needs your support, wherever you are in the country.

Although this blog's recent focus has been on London Ambulance Service's institutionalised abuse of its workforce - a conclusion borne out by the recently published, damning independent investigation into bullying and harassment - LAS's current culture echoes that of EEAS' in the past. With the recently announced departure of LAS Director of Operations, Jason Killens, it seems every bit as plausible that London staff could hope for a positive shift in their fortunes in the future. It just takes the right kind of bold and positive influence and leadership.

The kind which Dr Anthony Marsh is providing for EEAS in his role as Chief Executive.

During his tenure, Dr Marsh has proven to have an ear for staff and public concern, supporting moves to address late finishes, stopping the practise of fudging response time figures through the use of single-manned rapid response vehicles where a double-staffed ambulance is more appropriate. He has encouraged increased transparency and communication. He has backed a push to support wage increases for low paid Trust staff. He has started to build a belief that the workforce is valued. In his Clinical Governance Report of 2013. he challenged the kind of negative culture which brought EEAS to its knees in the past and has more recently seen LAS fall from grace. But there is much more which still needs to be addressed - his work is far from done.

Sadly, the remaining proponents of EEAS' former, negative culture are understandably not happy with the threat Anthony Marsh poses to the status quo and are making moves to oust him, already preparing his replacement in the wings. Dr Marsh's departure would be a regressive move for the Trust and the public it serves. It would endanger any hope of continued positive change and threatens to see a return to the blinkered and damaging practises of old.

If ambulance Trusts around the country are to find a way to evolve past the archaic 'command & control' management structure which has proven to grind staff into the ground, if they are to mature into a public service which supports its staff and delivers the world class service the country expects, then we need to stand with progressive leaders like Dr Anthony Marsh, who is also chair of the Association of Ambulance Chief Executives.

It is for these reasons that East of England staff have been running a petition to the Secretary of State for Health asking for support to keep Dr Marsh in their Ambulance Trust. Hundreds of staff have signed the petition, which says, ‘We believe that without Dr Marsh things will again quickly start to unravel in our Ambulance Trust; there are already discussions to remove some of the supportive changes we have seen, and this is severely impacting morale. We feel we need to petition you [Jeremy Hunt], as we do not believe our Board is acting in our best interests.’

Frontline staff are traveling to Parliament on 20th July (next Monday) with the support of former Minister of State for Care and Support Norman Lamb and other MPs. I will be travelling with the group and hope that they will be listened to and supported by MPs and the Secretary of State for Health. I’ll post details of our mission both on this blog and in other social media.

They, and I, would be most grateful for your support and help. This could be a tipping point for ambulance culture nationwide.

Please follow this link to sign the petition.

Tuesday, 23 June 2015

Saturday's #EndAusterityNow March in Pictures

My thoughts on and reasons for attending the protest against the current government ideology can be read in my previous post, but as I spent much of my time taking snaps of the assembled masses (until my battery died), I thought I'd share some here.

As I exited Bank tube station, it was immediately clear I was in the right place.
The Socialist Party were clearly well-prepared to get their message out.
I wasn't quite expecting the carnival atmosphere. Or a giant balloon hand. I idly wondered if the NUT operators planned to attempt a few gestures at the Houses of Parliament.
Judging by their level of preparedness, the Fire Brigades Union must have done this sort of thing before. I bet they've got a hammock in there.
That's unfortunate. I really need to learn to take more than one shot.
As people gathered, the streets filled with colour and noise...
... well, some streets. In my historical re-enactment days I learned the hard way not to mess with charging horses. Evidently most people didn't need such a painful lesson.
The Essex Feminist Collective and Southend's UNISON representing.
Co-ordination and inspiration came in the form of a series of speeches from organisers and key individuals like Green Party leader Natalie Bennett and activist Dr Jacky Davies.
As I explored the growing throng, I was slightly concerned to see a group who felt the need to hide their identities, but they were a tiny minority.
A mobile rock band with their drummer on a rickshaw entertained the crowds.
Quite possibly the march's youngest protester?
One of the more colourful banners. I suspect a Blue Peter badge was involved. ;)
The butterfly supporting immigration made me smile. There was something poetic about it being nestled among the more militant signage.
As I ducked down a side street, a squad of police with riot gear rushed the other way. I hoped nothing untoward was occurring.
My detour to get to the head of the march before it started made me stumble across this sinister lot. I moved on quickly.
... the police were aware of the group and were quietly monitoring their activity.
In stark contrast, just around the corner at St. Paul's Cathedral, the Salvation Army played a dainty tune as some kind of St John Ambulance presentation took place.
I got to the head of the protest as it set out and the diversity of the protesters soon became clear as they marched toward me up Ludgate Hill.
Bankers masturbate while Vesus saves. Or something.
I was disappointed by the lack of close harmony singing from the Welsh contingent.
Caravans Against Austerity? Um, okay.
The Norfolk contingent. This lady was giving me a smile and a friendly wave, not trying to hide from the camera as it appears.
Apathy Schmapathy!
I admire his candour, but I'm not sure that's a sound economic policy.
Go on little fella!
Still not singing, but at least they brought their dragons.
What the hell ARE you doing, Dave?
No, I don't know what 'unanquishable' means either. I think they missed out a 'V'. Maybe it's a subtle reference to V for Vendetta.
'Over 200 dead women in 18 months [due to] domestic violence.'
Here comes the scene-stealing FBU battle bus, with 'unity in strength' emblazoned on the side.
Rumour has it that David Dickenson was so enraged by government policy that he spontaneously combusted half-way along the route.
This street performer treated us to a very funny satirical number about Ian Duncan Smith's welfare policies.
Approaching Parliament Square, the positive vibe continues (and passing tourists look bemused).
As we pass the war memorial in Whitehall, it strikes me that it is a shame that it is necessary for the police to take these measures to protect a monument to those who fought and died for our right to peaceful demonstration.
Approaching Parliament Square, we are greeted with a big screen for those who can't get close enough to see the stage.
I chuckled. Her boyfriend can shower, but I think a more 'industrial solution' would be necessary for the other problem.
The first few thousand already in place, eagerly awaiting for the speakers to appear on the stage.

As the likes of Jeremy Corbyn, Len McCluskey, Charlotte Church and Russell Brand spoke earnestly about the state of society and what could be done, people continued to flood in. Half way through the speeches it was announced that the final protesters had just departed the starting point.

Joining the Anti-Austerity March: Can it Make a Difference?

I maintain this blog because I feel strongly that ambulance clinicians are increasingly being mistreated and taken for granted by the organisations they work for, by the public and ultimately by the government.

The intolerable impact of of this growing disregard is heartbreaking to witness as we ever more frequently read about patients who have been needlessly failed by struggling services and of dedicated staff who have had their ability to continue flogged out of them. The former circumstance is frequently the fodder of the mainstream media, but the latter rarely finds it way past sterile data on staff attrition and sickness.

Banging the drum for hard-working and undervalued ambulance folk has been a fairly solitary occupation and often it seems as I'm only ever preaching to the choir (a readership for whom I am very grateful). Many times I have wondered if the public even care, or if they remain oblivious and apathetic until the bubbles of their healthy existences are popped by unexpected illness or injury (at which point many who felt the service was inadequate would just point the finger of blame at the attending clinicians or their Trust).

After attending the End Austerity Now march in London on Saturday (20 June 2015), I feel buoyed by the evidence that clearly not all are so removed from the harsh realities suffered by a health service under siege (and indeed I know from experience that not all service users are unsympathetic to the challenges road staff face). An unconfirmed estimated 250,000* people marched from the Bank of England to Parliament Square to express their ire and frustration at government policies which are negatively impacting the lives of millions. And I am grateful for that.

*more conservative estimates state closer to 80,000

The march was so law-abiding, we even stayed on the correct side of the road (mostly)
Having never attended such an event before, I had some trepidation. Demonstrations rarely make the headlines unless there's trouble, and that was something I did not want to be part of. But I did want to be part of a movement which is pushing for positive change which could provide some relief to my fellow clinicians. I wanted to know that folk existed who were thinking about people beyond their own closeted existences. I needed my faith in humanity restored after our nation was plunged into a 5-year orgy of selfishness and greed by the general election results.

I felt it important to attend because the core principle of the campaign was to end austerity, a government-inflicted stranglehold on society which lies at the heart of the reason why ambulance services are struggling. The ongoing NHS 'efficiency savings' demanded by the austerity drive impact pre-hospital emergency services both directly and indirectly. As well as ambulance trust funding continually failing to meet rising demand year after year, leaving an inadequate amount of clinicians to deal with an impossible workload, healthcare cuts elsewhere inevitably filter back into the demand for ambulance services as local A&Es are closed, GP services buckle, patients are discharged too early to resolve bed shortages.

Sadly, this was the closest I ever got the the National Health Action Party group.
So I headed into London and kept my fingers crossed that I wasn't heading into an angry mass of violence and kettling, but something more life-affirming.

I was glad that I took the chance. What I experienced was like a carnival, a mobile Glastonbury festival, but with added politics. It was more a celebration than a confrontation. The overwhelming majority of people were just ordinary folk that you'd see in a supermarket or down the street. There were families, children, senior citizens, working-age adults of all varieties. It's fair to say that there were also some colourful characters, and some intimidating ones, but even menacing thugs have rights. Thankfully, I witnessed no trouble and the BBC report I saw subsequently suggested there was nothing more than a small bonfire of placards and a gang of potential troublemakers who had the temerity to move some barriers a bit. The police were stern but approachable and I was grateful for their presence. I stopped and thanked a few. After all, we were marching for them too.

The march itself was punctuated at the beginning and the end by public addresses from numerous figures; activists, politicians and celebrities. Although the hovering helicopters often made it hard to hear every speech clearly, I caught much of what was said by the likes of Natalie Bennett (Green Party leader), Dr Jacky Davis (consultant radiologist, NHAP and Keep Our NHS Public member, co-author of NHS For Sale), Len McCluskey (general secretary of trade union Unite), Martin McGuinness (Deputy First Minister of Northern Ireland), Jeremy Corbyn (Labour Party leadership candidate, whose rousing speech was very well-received) as well as celebrities like Shappi Korsandi, Francesca Martinez, Mark Steel (sharp and sarcastic), Charlotte Church (whose words were compelling) and Russell Brand (who was, well, Russell Brand - perhaps with a dash of extra deference, offering himself as a servant to the cause 'in whatever manner you see fit').

Dr Jacky Davies addresses (some of) the crowd before they set off.
Overall it was an immensely positive experience and full credit should be afforded to the organisers, The People's Assembly. The rally has given me a sliver of hope that at least some people have a conscience and a sense of social responsibility to stand up for ambulance staff, other public sector professionals and the vulnerable people they serve.

Even though none of the quarter-of-a-million attendees hold the reigns of power, they all are constituents of those who do. Members of Parliament on both sides of the green benches must surely take note of such a loud call for social compassion and decency when it comes time for them to vote for or against a policy. If nothing else, I can at least take some solace in the fact that there were hundreds of thousands who do feel things are going wrong and need to be righted, even if their particular agendas varied from mine. There were blocs of marchers for womens' rights, students, immigrants, racial tolerance, the disabled, public sector workers, animal rights activists, even caravan owners(!) and many more, all united by the understanding that austerity is cruel and unnecessary and that we should find a better, more positive way to improve our society.

Various signs were handed out by attending groups.
At least I hope so, because the one quote that stuck in my mind was from one of the activist speakers whose name I didn't catch. With suggestions of general strikes already finding their way onto placards and into many trade union speeches, I found the message to David Cameron from the unknown speaker of 'If you make our lives unbearable, we will make this society ungovernable' quite chilling. That's not what anyone wants, any more than austerity. But I can also see that other options are becoming increasingly thin on the ground.

I can only hope that this march woke up some compassion both across the land and in the halls of power. This is still a democracy right? Not a 5-year dictatorship. Surely the population can still influence those who serve them in government?

Otherwise, either under the oppressive yoke of Tory policy or because of increasingly militant opposition, things are going to get worse for everyone.

Parliament Square full of people less than pleased with the usual residents of the nearby buildings.
This video by WellRedFilms gives a great overview of the event, showing the diversity and the sentiments of the participants. Well worth your time (even though the figures quotes regarding incoming cuts are vastly understated - the £12bn mentioned is for welfare alone, a further £22bn is hitting the NHS).