Thursday, 22 November 2012

Discussing Ambulance Service Failings with BBC Look East


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

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

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

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

On Effecting Change

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

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

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

Responsibility

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

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

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

Speak out.

35 comments:

  1. Good on yer matey - keep up the good work even if it means occasional reflective/cool-down moments..
    BB

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  2. Looking at the latest EEAST board meeting minutes (available online - but difficult to trawl through you have to access each item separately). It appears they have received several emails and letters from the Care Quality Commission reporting that several of you naughty employees have whistleblown concerns about resources, backup delays, response categorising and quality of response reporting figures. In addition the Clinical Commissioning Groups have expressed concerns about increasing complaints from GP's and patients about emergency response and the complaints directly to EEAST have increased significantly.

    The only worry would be if the CQC have only reported the concerns back to EEAST to investigate themselves and not ordered an enquiry considering the level of complaints from everyone about response.

    The reason for all the delays and complaints, inadequate numbers of qualified staff and double crewed ambulances, in fact one of the reports in the minutes mentions lack of double crewed ambulances impacting standards.

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  3. On Wednesday the Eastern Daily Press reported it was publishing a report of its "Ambulance Watch" over three days but the results don't appear to be available online.

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    Replies
    1. Silver surfer in North Norfolk27 November 2012 at 23:44

      I have just spent an hour on the EDP24 web site looking for the link to three published articles by Kim Briscoe - the results of her Ambulance Watch survey but without success. I am hoping that Mat will be able to find the links for you, but will give you a brief synopsis below.

      However, more importantly today there was an additional article – “GP’s concern over delays to patients’ transport”. There was much made of ”the service being below par for five of the last seven months and requires significant action to bring performance back on track”. There was quite a lot on staff sickness and a new management policy to better support staff. This made me grit my teeth since my daughter paramedic constantly does 2 hours extra on each shift!

      In a side article today on “Target is Not Being Met”, the paper states the EEAS is having to respond to three letters and several emails from the Care Quality Commission, following whistle-blowing concerns from staff. It lists the concerns raised and then states that there were 81 complaints relating to delays in October.

      Back to the survey results: The first article published on Thursday 22.11.12 was “What you told the EDP about ambulance service”. There were no surprises here: pats on the back for all the front line staff and shock, horror at all the delays, long waiting times for ambulances etc.

      The second article was published on Friday 23.11.12 - “Waits for ambulances and good services – your views”. This article looked at how long readers said they waited for a response, where they think the EEAS has a problem to provide cover and what the service does well. Again, there was nothing but praise for the front line staff. There was a pie chart entitled “Response: how would you rate ambulance response time?” Scores were on a scale of one to five, where one is poor and five is excellent.

      1. 34% (dark blue)
      2. 12% (yellow)
      3. 15% (green)
      4. 14% (red)
      5. 43% (light blue)

      I was a bit surprised at the results as I fully expected “poor” to be the highest rating. There was also a map from the North Norfolk coast down to the A120 in Essex, across westward taking in M11, A142 and A141. The map was covered in coloured balloons, referencing the colours in the pie chart and I found this totally baffling!

      Throughout the Norfolk part of the map were a large predominance of red balloons! However over the area names – ESSEX, SUFFOLK, CAMBRIDGESHIRE, N.CAMBS and NORFOLK – were dark blue balloons with Norfolk’s balloon showing 10 and Suffolk 2.

      The third and final article was actually published on Monday 26.11.12 – “Front-line staff have their say” – looking at concerns raised by the front-line paramedics and ambulance staff who responded. It seems you didn’t pull your punches. You highlighted long trips on blue lights, the increased use of ECA’s with problems caused, clinical support desk’s call backs and downgrading of calls, training cuts, culture of bullying and lack of support from management.

      I really hope somebody powerful is reading all this stuff before all of you end up totally broken and defeated!

      Delete
  4. Maybe the "independent senior ambulance clinician" WAS given a suitcase with £50m but diverted to the Cayman Islands.

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  5. All you staff in the "North and South East Sectors" (wherever that is) the board minutes also report the result of all your "Datix's". The result being that you have the highest level of incidents reported but in their opinion "only 9% resulted in negative impact on the patient".

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  6. I see EEAST has a new interim chief executive (Andrew Morgan). I thought Hayden Newton was still chief exec for another 3 months? does this mean he has been sacked/left early by mutual agreement?

    Welcome to Mr Morgan.

    Sorry to start negative, but some problems you have been left:

    1. Insufficient double crewed ambulances with qualified crews to transport the patients who require transporting.

    2. Years of unfilled vacancies of qualified staff.

    3. Skyrocketing complaints from patients and concerns from staff about delays and lack of double crewed ambulances able to convey patients.

    4. More qualified staff leaving than the number of unqualified staff being recruited.

    5. Most (if not all) of your road staff severely stressed, overworked and suffering various levels of Post Traumatic Stress Disorder.

    6. Very poor training levels, with employees being expected to undertake training with their own money in their own time, with no regard to how difficult this is for stressed employees working shifts. No effort to provide protected finance and downtime for staff training.

    7. A management culture that achieving the A8 and A19 response targets with a car equates to good patient care. With staff frustrated that their poorly patients are required to wait until a response car has arrived and requested a "Hot 1" or "Hot 2" backup before there is any chance of an ambulance being dispatched (when available).

    8. A computer triage system (AMPDS) that fails to recognise life threatening conditions and is made pointless and incredibly dangerous by further downgrading of category A calls if they are more than 8 minutes away.

    9. A management culture of intimidation, bullying and a biased disciplinary process.

    10. Ill and injured staff being treated to a disciplinary process.

    11. Increasing costs employing private ambulances with unqualified staff or staff with questionable qualifications or contracting a company that has failed to achieve Care Quality Commission standards. Many private crews unauthorised to drive on blue lights (so why the hell are they attending calls?)

    12. A management culture that thinks partnership working and consultation means "this is the reduction in qualified staff and double crewed ambulances we require in order to save money, now design new rotas and we will implement it".

    13. A perception that there are more managers (most of them with a lease car) than road staff.

    14. A coalition government who think it is more important to be seen saving money than providing sufficient emergency ambulance cover.

    15. An incident reporting system that staff now see as a meaningless process with no feedback action.

    16. A Trust board that can't see a problem with any of the above.

    ReplyDelete
    Replies
    1. Yet another (interim) Chief who wants to spend 3 months going around meeting the staff to "listen" to their concerns.

      Blah, blah, blah. We've heard it all so many times before. Do these people copy and paste this stuff from a website somewhere?

      Hayden Newton spent 4 years doing that and what happened? Neil Storey was allowed to plough on with policies that are a danger to patients and staff alike. So much for listening Hayden.

      This service is in an absolute mess and the main reason for this is so that a very few people at the top can cling onto their jobs by introducing more and more dangerous "initiatives" in order to help us manipulate our performance figures.

      When these rota changes come in and we are left with very few DSAs and the inevitable chaos and suffering takes place, those who didn't stand up and register their concerns beforehand should be sacked.

      Has anyone heard or read Pam Chrispin or Neil Storey express any concerns about having so few ambulances when we can't cope with the number we currently have?

      I haven't.

      Delete
  7. Has anyone else noticed just how poor our performance is at the moment?

    Have things actually got so much worse or have we been told to stop fiddling the times?

    ReplyDelete
  8. Is it a bird ? Is it a plane ? No......it's the demoralised, battered to near exhaustion front-line ambulance staff ROARING with laughter that despite beating us all year with their 'all stick no carrot policies' and fiddling the figures to suit this clueless load of tossers got turned down for foundation status. Happy Christmas boys and girls !!!

    ReplyDelete
    Replies
    1. Fear not.

      In order to make sure we get that hallowed status, the Trust will move heaven and earth to make sure we hit the 19 minute target.

      Despite the fact they are due to slash the number of DSAs and constantly remind us that we HAVE to save £50million, they have just announced the reintroduction of double time and £100 bonuses on top of that for some staff.

      Where on earth did that extra lolly come from? Has Hayden decided not to take his £1.2 million pension pot after all?

      Let's hope they aren't spunking a whole load of cash they don't have in order to ensure we get Foundation status at any cost.

      I wouldn't be surprised to find out soon that we need to save £51million.

      Desperate or what?

      Delete
    2. Don't knock it mate, whatever the reason for reintroduction of enhanced rates over Christmas.

      I was disgusted when we lost enhanced rates for bank holiday working. The Trust was treating Christmas day as any other day working for a normal days pay and yet I was not allowed to book the day off! Yes miss the family Christmas meal and the kids opening their presents - of course its a normal day.

      Delete
  9. ***Freedom Of Information Christmas Present***

    The Trust has replied to a Freedom of Information request about backup delays on website whatdotheyknow.com

    http://www.whatdotheyknow.com/request/excessive_wait_times_for_ambulan#incoming-342959

    Interesting reading. You can see how the backup delays have increased significantly since the Trust has "worked smarter", "adjusted" response times (?used cars for A19 transport time?) and "downgraded" calls since Nov 2011.

    These are only the calls that received a responder first, if you included the patients who received a transporting ambulance as the first response then the number of patients waiting for transport will be far greater.

    Now we have a new Chief Exec they would do better to come clean now. Hopefully we will see some mass board "resignations" soon.

    If the link above doesn't work then google foi east of england ambulance and click on the whatdotheyknow.com link.

    Merry Christmas.




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  10. I have been working for an air ambulance company for the last 6 years and there have been so many miracles. Just the other day we airlifted someone off of a mountain and got them safely to a hospital. There is no more rewarding feeling than saving someones life!

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    Replies
    1. Heart warming story Bill.

      Unfortunately in our ambulance service, patients die as we haven't got enough ambulances to get them to hospital and we like to downgrade hundreds of life-threatening calls so the Trust can get Foundation status (then really cut our current terms and conditions).

      Apparently having even fewer ambulances in the New Year will help things dramatically. Mr Storey said so himself.

      Can't see it myself.

      Delete
  11. So after presiding over collapsing morale, worsening response times, soaring numbers of complaints, the introduction of staff with less training and a culture that tolerates bullying (by Managers only mind you), Hayden gets a medal from the Queen.

    Blimey.

    ReplyDelete
  12. I see the number of patients suffering Norovirus reached over a million over Christmas. I think that is the number I personally have attended. I bet these patients don't realise that when they pass it on to staff in East of England Ambulance Service they are also 'giving' a disciplinary, (yes we are disciplined for being sick).

    Nice to see EEAST looking after our health and wellbeing, forcing staff to go to work and pass it on to other staff and patients. Well at least we have the "I respect, we respect" bullshit campaign to bolster our morale.

    "Everybody Counts", except staff and patients.

    Happy New Year.

    ReplyDelete
  13. So lets get this right about the A19 response time. If a car attends a patient with chest pain, gets there within 19 minutes but waits 3 hours for an ambulance to transport the patient, in which time the patient suffers a cardiac arrest (twice) then it is deemed a success because the car 'achieved' the A19 transport time - but did not transport the patient? On top of that it may be a double success if some useless, unprofessional, corrupt paramedic sitting in the control room 'downgraded' the call because it was more than 8 minutes away?

    When you consider that patients, staff, unions or elected representatives (MPs) knew nothing about this underhand 'fiddle' until recently just proves how underhand, thoroughly dishonest and corrupt this fiddle is.

    There is only one reason for this fiddle and that is to allow ambulance services to 'achieve' response time targets without 'achieving' anything but poor patient care.

    Former Health Secretary Andrew Lansley, this 'money saving fiddle' happened on your watch. Was this another way of making the NHS ambulance service untenable in order to privatise?


    ReplyDelete
  14. Workers are being offered the incentive to divert 999 callers to a GP, NHS Direct or other medical services.
    Control room workers will each receive £250 if the service dramatically reduces the number of ambulances sent to 999 calls.

    Link ~ http://www.telegraph.co.uk/health/healthnews/9798554/Control-room-staff-receiving-bonuses-for-not-sending-ambulances-to-emergencies.html

    Your thoughts?

    ReplyDelete
    Replies
    1. Apparently our lot have introduced their own incentive scheme:

      £5 for everytime you can leave a single responder waiting an hour for back up.
      £10 if you can make that 2 hours.
      £1.38 for every late finish you make the crews endure.
      £15 if someone (anyone) gets to a cardiac arrest within 19 minutes (Used to be 8 minutes but we've decided that doesn't matter).
      £12 for every life-threatening call our completely inexperienced "co-ordinators" manage to downgrade regardless of whether that patient is at death's door.

      Mind you, they get docked £20 for everytime they manage to get the right response to the right patient at the right time. (Fear not, this seldom happens)

      Delete
  15. Now that the snow has arrived aren't we all glad that EEAST has prepared for the conditions by supplying de-icer?

    What about winter tyres? Oh of course these "exceptional" conditions couldn't have been predicted, it never snows here in Norfolk - or anywhere else in the East of England. At least they can blame "exceptional circumstances" (snow in winter). Strangely enough ambulances and response cars have to attend patients down minor roads and drive up and down hills.

    How much do we spend on "resilience" and yet the most likely event to seriously disrupt operations (snow) is not prepared for.

    ReplyDelete
    Replies
    1. Sadly patients will probably freeze to death waiting for ambulances in the East of England this winter (if they haven't already). Saving money (except for private ambulances) is more important than saving lives. Our response times are measured in hours rather than minutes in good weather, what will be the response times in snow and ice without winter tyres. I see they are talking about snow and ice lasting a few months (well it is winter).

      Delete
  16. It amazes me that after all the staff at EEAST have gone through, the long 12 hour shifts short on staff, vehicles and time delayed at A&E departments due to there being "no space at the inn" that there are still the brainless out there that land a portion of the blame at the door of "Control Staff". Are those of you so short sighted or stupid to realise that they are just as overworked and stressed as you?? Ill thought out polices, the lack of qualified staff and double staffed vehciles has its effect not only out on the road?? how much down time away from the job do you think these members of staff get in a 12 hour shift? 100% of control staffs attention goes into patient and staff care, whether you believe it or not having someone wait on scene requesting backup that we simply do not have isnt taken lightly, having staff finish their shift late therefore missing much needed time with their families and time away from the job is cared about. We also miss the time with our families, we also are stressed throughout our days off between shifts, we also are close to breaking point with the workload, not being able to take a break as its so busy. My point, please direct your frustrations towards the people that deserve it and not the people who are trying to do their best, like you with the resources they are given!

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    Replies
    1. How often do you finish late?

      How cold and wet do you get waiting for a resource to turn up?

      How late do you have your mealbreak?

      When did you last put your back out lifting a patient?

      How often do you have to sit and watch a patient deteriorate in front of your eyes?

      How often do you face the aggressive wrath of relatives because we can't get their loved ones to hospital?

      Have you ever been physically attacked in the course of your work?

      How often do you REALLY speak up and tell the powers that be that what they are doing is wrong?


      Not very often I imagine.

      BTW - What is your view on some of your colleagues (maybe you do it as well) downgarding potentially life-threatening calls just so your "team" can try and demonstrate you have hit the Trust's targets for the day?

      Delete
  17. The brainless mentioned above,

    Again I go back to the point of my initial post above, how can control staff be held accountable for any of your points?

    Do you think we have a choice but to send you out towards the end of your shift? would you pay my mortgage following my dismissal when a patient dies because i havent sent a resource as it would make them late off??

    Mealbreak? is this when you have time away from your job to eat and relax before commencing work revitilised, energetic and no longer hungry?? you dont know how well you have it, it may be 30 minutes and it may not be on your base station but how do you think mealbreaks work in a control environment?? the reality is that staff eat at their desks as it is too busy to leave the area short and leave your colleagues to pick up the slack, so you eat answer radios, phone and dispatch all at the same time.

    My view on Enhanced Triage of calls and subsequent downgrading is irrelevent, again going back to my initial post how have control staff any say on this?

    I was initially going to reply to each point above but ultimatelky I would be wasting my time as no matter what my reply it will never be appreciated that Control staff are there to do a job, they dont write the policies they are governed by them, we have very different jobs with very different pressures and stresses.

    At the end of the day (personal view) the service is screwed, its not going to improve so before the job completely kills you vote with your feet and leave.

    ReplyDelete
    Replies
    1. "Brainless"?

      Ooh get you.

      "eat and relax before commencing work revitilised, energetic and no longer hungry?? you dont know how well you have it"

      Priceless mate.

      In your original post you were intimatding that things are just as tough for you as those on the road. I disagree.

      You mention about losing your job if you don't send an ambulance out. What about all those really dodgy calls that are down graded as we clearly wouldn't hit the hallowed 8 minute response time? Is that acceptable, because someone as sure as hell is ensuring ill patients are having to wait even longer for an ambulance?

      BTW - these people who do the downgrading. You talk as if they're on a different planet and nothing to do with Disptach. Where are they based exactly?

      Do you lot still get 3 breaks in 12 hours or has that got knocked down to only 2 now?

      Delete
  18. I will start by saying this will be my final reply as its becoming tedious putting forward the same point and it being missed.

    My intention was to highlight the fact that control staff are merely following the same policies and procedures as road staff and have no control over these. This has been missed unfortunately and has turned into a game of top trumps about who has it worse.

    Again as far as Enhanced Triage of calls is concerned i'm sure your aware that this is carried out by clinical roadside staff and not call handlers, dispatchers etc. Im sure if you wanted further information/clarification on this process you would be able to come into control and see exactly what it is about.

    ReplyDelete
    Replies
    1. Well next time you have a crew who have been hammered all shift and they finally get the tiniest chance to sit down / restock / recharge their batteries / catch up with paperwork / fill out just one of the many DATIX that need doing, imagine just how hacked off they are when the opportunity disappears because they are required to go and sit in some God foresaken layby in the rain and the cold.

      I know you'll say you're "only following orders" but not all disptach staff insist on it. Some (not all) actually seem to care. Thanks to those that do.

      Delete
  19. More good publicity for the EEAS.

    "Fire Brigades Union concern over east of England ambulance delays"

    http://www.bbc.co.uk/news/uk-england-essex-21242912

    Just wait until they realise we are doing away with loads of ambulances in the very near future. Are we going to have roof racks fitted so we can transport patients on spinal boards on all these extra cars we haven't actually got yet?

    How many times do the idiots at the top need to be told before they realise that what they are about to do will end in more delays, suffering, frustration, anger, pain and death?

    Hold them to account, then sack them (and without a fancy pension pot)

    ReplyDelete
  20. I see EEAST has finally replied (several months late) to a freedom of information request about the cost of subcontracting work to private ambulance services between April 2011 and August 2012,

    Over several of the months the cost was OVER ONE MILLION POUNDS PER MONTH!

    UNBELIEVABLE!!!!!!!!!

    That's why we have to make savings, so that someone can make a profit out of the patient's (and our) misfortune.

    The cost (and profit) has probably increased since then. I see why they avoided answering the freedom of information request for several months.

    http://www.whatdotheyknow.com/request/cost_of_hiring_in_private_ambula#incoming-359201

    ReplyDelete
  21. Here are the figures - cost of private ambulance cover per month, credit freedom of information site What Do They Know;

    Apr-11 310,733
    May-11 363,945
    Jun-11 1,062,006
    Jul-11 348,630
    Aug-11 735,142
    Sep-11 863,450
    Oct-11 623,676
    Nov-11 889,098
    Dec-11 758,754
    Jan-12 980,042
    Feb-12 908,579
    Mar-12 1,016,571
    Apr-12 539,169
    May-12 788,091
    Jun-12 604,922
    Jul-12 932,795
    Aug-12 1,090,099

    ReplyDelete
    Replies
    1. That's an average of over a three-quarters of a million per month.

      If that practice were stopped they would save £45m over five years - almost the sum the Government have required they save. Obviously some expense would be required to run and expand replacement Trust services, but it is still an inexplicable moneypit.

      Instead, EEAST penny-pinches from existing front line services and is even forcing relief-rota staff to audit themselves to ensure they are doing the required anti-social hours or they'll have their 25% removed.

      Appalling mismanagement or something more calculated?

      Delete
  22. Dont give the plight.... The staff that work relentlessly need HOPE that they are heard via your brillant blogs.. I thank you..

    ReplyDelete
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