Sunday, 26 April 2015

Meeting Edmund Daly: So Long and Thanks for All the Fish

On Friday, I had the opportunity to meet Edmund Daly, the former LAS paramedic at the centre of the controversy which has triggered a national outcry about the treatment of ambulance clinicians. He told me the details of his story.

In 2005, Eddie Daly won 'Accident & Emergency Person of the Year'
But more than that, we chatted about many things; his welfare, his interests and life after the ambulance service. Even now, after all he's been put through, he was clearly a polite, gentle and caring professional. It was quite evident from my time with Eddie that he was every bit the man that had been described so effusively by his many former colleagues who have reached out to me.

It is for those people - and for Eddie - that I write this blogpost.

A chief concern, and part of the reason I wanted to meet Eddie, was to ensure that he was okay. With his name appearing in national press and the storm that has followed, reports of Eddie's frailty gave cause to be worried about his well-being. Was our use of his name causing him distress? Could we be damaging whatever solace he had found for himself since his rejection by the service which had been his life for three decades?

Thankfully, he was quick to express his gratitude for all the efforts being made in his name. He explained that he had been moved to learn that he hasn't just been forgotten and that there are those who empathise and support him. He is happy for us to carry on and recognises that how he has been treated will happen to others unless that culture is challenged. He has even given me permission to tell his story in full, and I will just as soon as I've worked through my copious notes and approached other relevant parties for balance.

It was my initial impression that Eddie was more frustrated and confused by his treatment than angry and bitter, although the full spectrum of those emotions were undoubtedly in there too. Despite it all, he still retained a warm, amiable manner even while relating some truly horrendous details which have had a terrible, lasting impact on his life. He is still troubled by those. This gave me some insight into how I imagine his demeanour would have been on even the most demanding of attendances. I've been fortunate to have worked with a few paramedics with similar traits, the kind everyone respects and tries to emulate. But they are rare. The rest of us just do the best we can.

As Eddie and I sat on a bench outside King's Cross Station, drinking coffee and eating a MacDonalds, he told me about his career. He started working for the ambulance service in 1984 and was among the first generation of paramedics in the early 1990s. His passion for the job and his desire to help people was apparent and genuine. It was little wonder he became a team leader responsible for the tutelage and welfare of junior clinicians. Even now, as he tries to come to terms with life after his career, he is putting himself back into the service of others as a care assistant (after a brief period doing security work which he didn't take to).

He misses many aspects of his paramedic life and still spoke fondly of many work colleagues and of his sideline as 'the guy who looked after the fish'. As an avid keeper of marine life at home, Eddie enjoyed maintaining the fish tanks at a number of LAS stations (if anyone could report that they are still healthy, I'm sure Eddie would be glad to read it).

He misses it, but assures me he has moved on and wouldn't go back if he could. He would, however, like to clear his name.

To summarise our encounter, Eddie Daly came across as a thoroughly decent man. He is quite clearly a credit to the paramedic name and was so to the London Ambulance Service. Any service would be lucky to have him. It is my opinion that his career coming to an end in the manner that it did is a travesty and a miscarriage of justice. Everything I have learned from Eddie and a number of other sources makes it very difficult to grasp how it could have come to this.

But it did.

Many questions remain and I intend to find answers, for the good of the paramedic profession and most importantly, for Eddie.


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Thursday, 23 April 2015

Campaign Update: Contact with the College of Paramedics

The strength of feeling among operational ambulance staff that has been made evident by the Edmund Daly case has been polarising. It is painfully clear that the precedent the case sets applies further intolerable pressure on front line clinicians and that it desperately needed to be addressed.

Annelies van Wamel and I have discussed the many options, whom to approach and what to steps to take next. We had one overriding tenet - we need to approach the problem positively and professionally. As paramedics, it is vital that we seek unity and work toward a resolution in a manner befitting our station. There is little to be gained from vilifying individuals or trying to kick down fortified doors and there is far more to be gained by getting appropriate organisations and individuals on side. Although many intense emotions are shared by us, we feel that the best results can be obtained by playing the game by the rules given and change them in the process to our benefit.

Letter to the College of Paramedics
Already, our efforts have borne some fruit. A letter, written by Annelies, was sent to the Chair of the College of Paramedics (CoP), Professor Andy Newton, last Monday (see image to the right for the full letter). Today, the Executive Director of the CoP, Gerry Egan, contacted Annelies to have a chat about the letter and its contents.

Encouragingly, the overall message was a supportive and positive one; the letter was deemed appropriate and relevant to the profession and, consequently, to the CoP. As a result of the nature of the CoP (they are not a trade union therefore they cannot represent or intervene in individual cases like Ed Daly’s), they are seeking other ways to influence employers. Gerry mentioned the difference in fatigue management between Scottish and English Ambulance Trusts. Although we have not seen it, there seems to be a Fatigue Policy in Scotland which is applied when [on-call] staff are run beyond their capabilities (view the Scottish Fatigue policy document here). It was developed to distinguish between ‘sickness’ and fatigue and has driven down sickness levels among Scottish Ambulance staff since. It would be very helpful if a reader of this blog with access to that policy could forward it to us!

The CoP is actively seeking to get a copy of this policy and, after scrutiny, potentially include it in its newly established Library of Best Practice Documents. In its desire to help influence the working conditions for paramedics, the CoP has also sought contact with Unison.

Although it is still early stages and the CoP has not been able to issue clear guidance or advice just yet, we think this is a positive step and we will be following it up in the next few weeks.

We have also been in contact with various other parties, including the LAS, so it is clear that our concerns are far-reaching and noted. I am hoping to arrange an audience with many of those parties in order to gain more clarity and further our cause.

We will continue to push forward and keep everyone updated on any new developments. Thank you all for your continued support.

Tuesday, 21 April 2015

They're Killing Us

A year ago today, I watched my mother die.

An otherwise healthy woman, she unexpectedly started to suffer a decline in health early last year and by March, she was immobile, confused and emotionally volatile. I, along with my two younger sisters, cared for her at home. We did what we could, watching helplessly as she continued to deteriorate. The last 10 days were especially traumatic as her body refused to give up despite her inability to eat or drink due to her brain being decimated by the incredibly rare (1.4 in a million) sporadic Creutzfeldt Jakob Disease (sCJD).

It was last year today when I held her emaciated hand, watched her breathing slow and felt the last palpable beats of her heart. The woman who had given birth to me, had loved and cared for me for my entire life and who had become my close friend and confidant, finally ended.

I didn't - and still don't - know how to feel.

I feel compelled to share this here, not because I seek sympathy, but because how it affected me in subsequent months is relevant to the discussion currently raging on this blog and elsewhere. My Mum encouraged me to start this blog when she became concerned about ambulance cover in North Norfolk. I think that she would have been happy to help me make a point now.

Coping with Trauma

Due to the healthcare background shared by me and my sisters (a paramedic and a former care worker), we felt we could take responsibility for Mum at home in her last weeks. With superb support from the district nursing team, the GP and others, we did exactly that and I believe we provided Mum with a level of care that no hospice in the world could compete with.

But it left me tortured by the experience and constantly questioning the decisions I had made. For the last year, no amount of support or condolence was able to penetrate the darkest corners of my thoughts - I even found irrational cause to despise many of those closest to me. Compounding this, I found myself unwillingly mentally reviewing countless events from my ambulance career. Watching my baby daughters sleep triggered vivid, unwelcome images of ambulance attendances I'd previously been able to suppress.

I became inert, useless and negative. People made excuses for me, 'he's grieving, give him time'. I have been lucky to have a fantastically caring and patient wife and small children who are an uncompromisingly positive influence. I also benefited from a close relationship with my sisters - who also continue to struggle with the experience - and a network of tolerant friends. The birth of my second daughter last November was perhaps a real catalyst for my recovery (although it continues to sadden me that she and my Mum never met).

But not everyone is so lucky.

PTSD: Cautionary Tales Ignored

My point is this: although undiagnosed, I am fairly certain I was (and perhaps still am) suffering from PTSD. It impacted my ability to think objectively or contribute constructively to many aspects of my life for a long while.

The kind of emotionally traumatic experiences dealt with by front line ambulance staff undoubtedly has a long-term psychological impact, even if they successfully compartmentalise the memories in order to carry on. Only after my medical retirement due to injury did parts of my mind start to 'unwind' and release previously buried trauma. I know from personal experience that the damage caused can lay in wait and be triggered long after the actual events. This 'drip-drip' effect and any debilitating impact it has is largely ignored by current ambulance culture and even actively exacerbates it by forcing staff to work in such a relentless environment which allows no time to decompress or reflect.

Furthermore, a number of cases I have been made aware of recently which have resulted in staff suspension and an edict of 'no contact' enforced on colleagues can leave the individuals bereft of the support network they so desperately need. In many cases suicide becomes a very real concern.

It is heartbreaking to hear about the breakdowns and suicides of ambulance personnel who, having chosen to dedicate their working lives to helping others, are unable to help themselves.

Del Rutter-Wilton 'took his life in 2013 whilst suffering from work-related depression and PTSD.'
If compassion is truly at the core of healthcare, then those who govern and manage it need to be reminded of the fact. If they cannot find the means to provide a compassionate, supportive working environment to protect their own staff then they are failing in their role and should get out.

Because they're killing us.

Saturday, 18 April 2015

Fear and Loathing in LAS Ambulance

It is painfully evident from the outcry caused by the case of Edmund Daly, a beleaguered paramedic who could take no more and was thrown to the wolves for it, that things are horribly wrong within the practise of emergency pre-hospital care.

After reading about the case on various news outlets and offering an alternative (read: more accurate) interpretation of proceedings, I was taken aback by the response. My blogpost has, at time of writing, been viewed nearly 80,000 times and the discussion has reached in excess of 150,000 people across various social media. As I result, I was given the opportunity to write a more sympathetic view for Metro.

Concurrently, similarly concerned paramedic Annelies van Wamel working in another Ambulance Trust, instigated an online petition entitled, 'HCPC this time you got it wrong!', in which she identifies,

'The HCPC is there to protect the public against malpractice. That is good. However, the HCPC did not realize and/or recognize that this paramedic was not the problem; it was his employer who disregarded staff welfare in its pursuit of targets. The blatant lack of support for a senior member of operational staff is an indication of the real problem and should be taken into account.'

In less than two days, her initial target was far exceeded and she closed the petition at 2,000 signatures. I have no doubt it would have accrued many more had she let it run.

Quite clearly, the response from both ambulance clinicians and the general public shows that we were not alone in our concerns.

A Dangerous Precedent

Chief among these issues is the fact that Daly’s case sends a clear message to all operational personnel that their health and 'fitness to practise' is a secondary concern to the employing ambulance trust's ability to meet targets. The HCPC can be used by employers as a blunt instrument to fuel a culture of fear which leaves individual staff, already expected to do the work of many, trapped between the devil and the deep blue sea.

There are urgent questions that need an answer: where would paramedics stand if they were NOT to indicate their limits? That would lead to unsafe, irresponsible and even illegal situations with potentially far worse consequences for staff, patients and the general public (think of driving while exhausted).

Where should clinicians turn if they feel they are being abused? The London Ambulance Service chose to 'make an example' of Edmund Daly and sack him after an internal investigation, so clearly LAS staff can expect no support from their employer. The HCPC chose to pile on and point the finger of blame at Daly rather than the organisation who pushed him off the cliff. Union involvement in proceedings evidently made little difference to the outcome.

Year on year, staff have to listen to promises that things will improve as new recruits are pumped into the meat grinder, all the while more and more staff are leaving, voluntarily or otherwise. The daily reality is that, in the current environment, many staff - new or old - will only last a short while before they are also broken by a system more willing to replace them than ensure that they are fit to continue.

This has to end.

Helping Ourselves to Help Everyone Else

Annelies and I have spoken at length to discuss what next steps to take. We have resolved to push back in the hope that we can change this poisonous culture. We're hoping for your support and input.

We will be contacting the College of Paramedics for their advice and guidance and we will be taking the 2,000 signature petition to the HCPC headquarters in London prior to the end of their consultation period on 'revised Standards of conduct, performance and ethics' (period ends 26th June 2015). The precise date of our visit is yet to be decided, but your involvement and attendance would be most welcome.

We are determined to create a better working culture for front line clinicians and the staff who support them.

There is no reason for this to even be a debate. There is no one who benefits from the current situation; not the operational staff, not the ambulance trusts, not regulatory bodies, not the Department of Health and certainly not the patients.

There should be no debate. But sadly there has to be to effect a positive change.

The time for suffering in silence is over.

Co-written by Mathew Westhorpe & Annelies van Wamel

We can be contacted via the Broken Paramedic Facebook page or at m[underscore]westhorpe[at]hotmail[dot]com.


Like the NHS, this blog is free at the point of use, but I really need your help with funding. If you feel that what you've read here is of value, please consider supporting these efforts by following THIS LINK to become a Patron of The Broken Paramedic.

Monday, 13 April 2015

30-Year Veteran Paramedic with Unblemished Record Finally Broken by Institutionalised Abuse

In this past week, many major news outlets have covered a story about a London Ambulance Service paramedic who refused to attend a 999 call on the grounds that he and his crewmate were dangerously tired after 11 hours overnight without a break.

Across the mainstream media, the tone of the headlines used invariably focused on the public perspective.

On 7 April 2015, The Guardian reported 'Paramedic refused to help sick woman as crew were tired, tribunal told'. As subsequent news outlets picked up on the story, the Evening Standard went with a more outrage-inducing 'London paramedic "refused to answer 999 call because he was about to finish shift"'. The Mirror chose 'Paramedic suspended after refusing to attend 999 call because he was '"tired"' and the Metro opted for 'Paramedic suspended for refusing to pick up patient because he hadn’t had a break on 11-hour shift'. ITV weighed in with 'Paramedic who refused to help sick woman because crew were 'too tired' is suspended' and even the Belfast Telegraph got involved with 'Paramedic suspended for 12 months over 999 call snub'.

It has most likely been covered elsewhere too, but I think the theme - and the bias - is clear.

The facts which were cherry-picked from the publicly available Health and Care Professions Council (HCPC) hearing documentation are mostly consistent throughout the coverage. Due to his actions on 29th May 2013, Edmund Daly, a paramedic and team leader of 30 years service, was found to have 'seriously undermine[d] public confidence in the profession' by refusing to attend a call to a 43-year-old woman who was 'feeling faint, dizzy and vomiting'.

The HCPC panel chairman, Julian Weinberg, is quoted as saying, 'As a paramedic and as a team leader, he failed to make service users his main concern. (Daly) has also not demonstrated any remorse for his actions and such misconduct seriously undermines public confidence in the profession. However, the panel has taken into account that this was an isolated incident in the registrant's 30-year unblemished history of service as a paramedic and that it occurred after an 11-hour shift without a rest break.'

According to the London Ambulance Service, Edmund Daly's contract had already been terminated following an internal investigation of the matter and the HCPC notes state that he was no longer working as a paramedic. The final outcome of the HCPC hearing was a 12-month Suspension Order. A Striking Off order was considered but thought disproportionate given Daly's 'otherwise unblemished 30-year career'.

Treating the Symptom, Not the Cause

I know I am not alone in thinking that the broader concern has been entirely missed here, hence the provocative choice of headline for this article.

Although we are not privy to the underlying history of this particular case or Edmund Daly's general working practises, it is safe to assume from repeated reference to his 'unblemished record' that he had conducted himself in an appropriately professional manner for the past 30 years. So what drove this veteran to engage in the kind of brinkmanship which was likely to have a poor outcome for him?

I think it's important to recognise that Daly’s actions gave his employers, control room staff and the HCPC little choice but to act in the manner they did, but a man of Edmund Daly's experience would have known this. Yet still he drew his line in the sand and said 'no more'. Whether it was a calculated decision or just the poor judgement of an exhausted mind is a matter of speculation.

Like many current ambulance crews, I empathise with Mr Daly, having many times in the past been exhausted and emotional myself after yet another gruelling, endless shift. I know from first-hand experience how hard it is to think clearly through that haze of fatigue. I am still haunted by attendances gone awry due to fatigue-induced oversights and mistakes, near misses and lapses in professionalism both on the road and when dealing with patients or co-workers. The system forgets paramedics are still only human and it has no regard for the kind of pressure under which the current, brutally under-resourced emergency clinicians are expected to perform flawlessly.

Not one of the previously mentioned articles nor the HCPC panel addressed the implications of the fact that '[a]s a result of the Registrant’s refusal to attend the call, there was a delay of approximately 90 minutes before another crew was able to attend the service user.'

Surely this highlights a much bigger cause for concern than the actions of one clinician. Why such a dearth of ambulances? Was there really not a single other vehicle available for 90 minutes? Or perhaps the call wasn't deemed to be that much of a priority after all. In either case, resources were clearly stretched too thin to provide adequate cover given that the sudden unavailability of a single ambulance caused such an apparent failure. The existing system has no overlap, no redundancy, no buffer. The few ambulance crews available are endlessly bounced from attendance to attendance until they can take no more.

Compounding this is the cultural disregard for crew welfare best exemplified by ITV’s quote, purportedly from the controller called as a witness in Edmund Daly's final hearing, which shows that providing any respite for exhausted staff is given little value,

The crews all know getting off on time is a bonus. If it happens it happens, and if an emergency call comes in it's a late shift. It is not a guaranteed nine to five job.

While it is accepted by all staff that responding to emergencies is the absolute priority, the comment is a bitter pill to swallow coming from a staff member whose role should also include protecting road crews. Considering that this is in the context of a crew who have already worked continuously overnight for longer than most people’s entire working days, the statement is a damning indictment of the emergency service culture and the prevailing attitude to road staff if ever there was one.

However, it’s not the fault of control room staff either. They too are under enormous pressure to perform in the ‘room of doom’. They cannot afford to see staff on the road as anything more than a vital mobile resource. If only dispatchers were provided adequate resources to distribute the calls in a manner that didn't dangerously overwork the few responding crews to hand, there would be far less acrimony and far more efficiency.

Bleeding Out?

But if the problem does not lie with operational staff, then where? Was anyone else’s competence called into question for the circumstances which drove an exasperated paramedic to willingly commit career suicide? Of course not, it's just business as usual. Targets to meet, et cetera, et cetera. Little wonder that sickness, recruitment and staff retention is such a huge problem for ambulance trusts. Edmund Daly, like every other emergency clinician, was expected to make up for the shortcomings of a collapsing, inadequate system being throttled by underfunding and misuse.

How many more staff need to physically or psychologically crumble before the problem is addressed? It is clearly a nationwide problem, with the Manchester Evening News reporting ‘Paramedics in Greater Manchester at breaking point due to stress, says union’. The article details the findings of a staff survey revealing ‘[m]ore than 90pc of the 153 staff surveyed reported suffering with stress with huge numbers of staff reportedly leaving the North West Ambulance Service.This summary of UNISON's national survey indicates the true scale of the problem.

Evidently, if more effort is not made to protect ambulance staff by providing them with tolerable working conditions, they can’t be expected to maintain the level of excellence demanded of them or even stay in their jobs.

There is some hope, at least. Parts of the establishment are aware of the problem and there is evidence that efforts are being made to address it. East of England Ambulance Service recently published a document focused on improving working conditions which identifies the need to tackle the problem. In it, the joint working group of EEAS managers and UNISON members identified key stressors impacting staff performance.

The group recognised that the existing policy around late finishes was not working. As new frontline staff continue to be recruited it will help ease the pressure on staff and reduce late finishes. There was joint agreement that implementing supportive changes over the issues identified will help retention, reduce sickness levels and make EEAST a more supportive, sustainable organisation.’ ~EEAS Trust update: improving working conditions

This is clearly a positive step and EEAS should be commended for attempting to stem the flow. But, as has long been the case, it will likely remain a well-intentioned dream until more deep-seated cultural changes - both within ambulance services nationwide and more broadly in government and the general public - take place.

Meanwhile, if the case of Edmund Daly is anything to go by, existing and future staff will continue to be wrung out, abused and discarded as organisational failings and public demand continue to brutally sacrifice the health and careers of those willing to prop it up until they can't - or won't - any more.

Edmund Daly, like every clinician and operative working to provide emergency care to the public, deserves better.

Addendum: In response to Edmund Daly's case, an iPetition has been set up.

Image credit: Daniel Sundahl, via EMSworld


Like the NHS, this blog is free at the point of use, but I really need your help with funding. If you feel that what you've read here is of value, please consider supporting these efforts by following THIS LINK to become a Patron of The Broken Paramedic.