Tuesday, 26 February 2013

Blame, Private Ambulances and the Cost of Lives


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

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

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

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

Total: £12,815,702 over 17 months

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

Are Private Ambulance Services Worth the Money?

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

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

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

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

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

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

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

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

Illusion and Delusion

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

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

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

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

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

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

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

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

The Political Shadow

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

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

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

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

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

The future is money.

I am ashamed to be part of it.

25 comments:

  1. Is it only front line troops that are in touch with the real world ??
    What happened to common sense and logic !!!!

    ReplyDelete
  2. The main problems with employing private ambulance resources are, NHS money going to fund private profit, unknown qualifications, experience and resources. Some of the private ambulances have crews who are not qualified, hence not insured, to drive on blue lights resulting in the ludicrous situation of EEAST FRV paramedics attending critical patients in the back of a private ambulance (sometimes not even equipped with a cardiac monitor) while sitting and queuing in rush hour traffic.

    There are stories of private response car paramedics attending patients, giving a cursory assessment and then leaving them on scene to deteriorate and when a EEAST paramedic or EMT later attends the very unwell patient, treats and rushes them to hospital and reports the paramedic to the Trust the Trust covers it up because they don't want the bad publicity. If this has happened to you then if they are a paramedic report them direct to the HCPC, you can be sure the Trust will not, they only use the HCPC as a whipping stick to report Trust staff they do not like or want to get rid of, that is if they fail to get you with their own disciplinary. Hopefully these piss poor paramedics are small in number, I'm sure many private providers are very good and are as embarrassed as we are.

    ReplyDelete
    Replies
    1. I worked for the NHS trust as a Paramedic for many years and worked in an extremely busy district. I mentored new staff from the universities and had additional responsibilies in a supervisory role. In all the years I never had one complaint which was unusual considering the number of patients I attended.
      I decided to leave the Ambulance trust so that I was free to work without restriction in other areas of healthcare which are now available to Paramedics but previously were off limits.
      I gained some additional qualifications at my own time and expense to enable me to work in a different medical field. I did however continue working on a regular basis privately for several ambulance trusts both on ambulances and FRVs.
      In my opinion the standard of knowledge, skills and patient care displayed by the private sector paramedics was equally as good as the ones I had worked with in the trust. They were postive about their work and conditions and were not constantly complaining about pay, being busy and late jobs etc unlike trust paramedics.
      The paramedics also tended to be more experienced as most had left the Trusts to make the job fit around their lifestyles and not the other way round.
      I did sadly though find that on a very regular basis, resentment and animosity was shown from both trust paramedics and A&E staff. I can recall numerous times patients even noticing this and simply because I wasnt wearing a trust uniform. Quite incredible and certainly very unprofessional.

      As freelancers day rates are higher but we do not get sick pay, do not get a private pension, holidays, pay our own training and are not guaranteed regular work. This is very attractive to employers as they can use us as and when they chose when demand is high.

      I actually found that the trust control centres dispatched the private Paramedics to a greater number of jobs during an average shift than their NHS counterparts, not less. They were constantly asking for a clearance status both at scene and hospital to maximise their resources.

      I do agree that some of the job titles displayed on certain agency uniforms are ridiculous but not once have I seen the Title' Paramedic' displayed when the person is not State registered and trained to the high standard that is to be expected.

      In my opinion the private sector involvement in front line emergency care has only just begun and like it or not, its here to stay.



      .


      .

      Delete
  3. Refent press publications cited that the reason the extra vehicles were not beingbmanned was due to the staffs unwillingness to do the overtime. The glaring fact is that crews are exhausted, and we can not even cover the core shifts we drop. What incentive is there for staff to work extra hours when we are abused from pillar to post, our fears ignored and sidelined and our morale crushed by a bunch of sycophantic cronies who are under the delusion we are all happy working for this trust. I strongly believe that the trust board and management team are complicet in negligence with current changes and stratergies and i fear the day when some dies due to our failed ambulance service.

    ReplyDelete
  4. http://www.edp24.co.uk/news/health/graphic_ambulance_response_time_targets_missed_1_1954683

    ReplyDelete
  5. This Andrew Morgan chap's a strange fella. At the same time as he's trying to reintroduce a few clapped out old ambulances in Norfolk, he's about to almost halve the ambulance fleet in Hertfordshire.
    How's that going to help with the already severe delays in getting patients to hospital Andrew?

    It seems as if he actually likes being interviewed on Look East and being given a grilling by MPs.

    Let's hope he is only an "interim" chief for everyone's sakes.

    Oh and btw - what sort of idiots left us running with vacany levels at nearly 300 for so long? No wonder we need to recruit "extra" staff.

    ReplyDelete
  6. It's a shame that this has been your experience of private crews. There are some really good ones out there, working for reputable companies that care about standards and training.

    Unfortunately there are also the cowboys, and the reputable operators are trying their hardest to see the industry improve (with organisations like the IAA, and the vain hope that the CQC will shut down some of the poorer ones). But it is hard to manage within the cost envelope - I know what some of the private companies charge, and the total cost is actually cheaper per call (if the private crews are utilised properly) once you factor in capital expenditure on vehicles etc. than the trust doing it itself.

    Some crews are evasive because their qualifications are patchy (and if you think this is the case, you should report them to the CQC - which you can do anonymously - as well as through your trust incident reporting sytem). However, please bear in mind that some crews are evasive because they take a lot of undeserved abuse from trust crews (i've had a trust crew tell me in front of a patient that they didn't want my handover having never met me before) and qualifications is easy pickings sometimes (with quals like IHCD tech having been jealously guarded by the trusts for years with a deliberate policy of not letting anyone else get them).

    ReplyDelete
  7. I accept that not all private ambulance crews are going to be suspect and they are only doing their jobs, but it is the principle that is the key issue here. Private ambulance services represent a mercenary culture being applied to a healthcare environment. Private enterprise by its very nature introduces profit, which will unavoidably influence equipment, training and the type of services provided.

    EEAST have woefully mismanaged the situation and are at fault for leaving the door open for private business to pitch in. I can't help but wonder if there is a conflict of interests somewhere in the decision-making process. It is quite evident from the amount EEAST has admitted to spending that they are not getting good value for money - paying for private services is draining what little money the Trust has available.

    The government and the CQC have already shown they are unable to ensure a publicly-run ambulance service is policed and managed appropriately, what hope would there be if it was a privately controlled enterprise? There would be even less accountability motivated in part by the pursuit of profit.

    You say "some crews are evasive because their qualifications are patchy" and should be reported to the CQC, but why should this even need to be a concern for qualified personnel? Emergency crews shouldn't have to be worrying about possible cowboys. But because they do exist, the presence of any non-Trust crews instantly creates suspicion.

    The only way a private business can compete with a publicly-funded non-profit service is if they minimise costs through cheaper, less-skilled staff and reducing equipment costs.

    The truth is, when the public see an ambulance, they expect a paramedic. If a private ambulance service cannot deliver a paramedic standard service, they've got no business masquerading as such in the pre-hospital emergency care environment. And if they could deliver a paramedic service, they'd be too expensive.

    ReplyDelete
  8. Sadly the above report is not just limited to EEAST, I work in another trust on the front line and our trust is also relying heavily on the private ambulance sector.
    From a front line point of view your heart sinks when these guys turn up, mainly because the general public think we are all one service, and therefore all of one standard, I wish I could say that this is the case, from experience it isn't!!!!
    They aren't all bad, and some of them work for other trusts around the country, but this then implies another problem, if it's their day off from the same job, how tired are they??
    This current system that we work in is failing, failing the staff and most importantly the public, how far can we go down this spiral before it becomes untenable?
    I wish I could say there's an easy answer but if there is I'm struggling to see it.
    My colleagues and I have such low morale that we have the attitude that we go to work, do the best that we can for the pt's in our care, and just wait for the next pile of poo dolloped out by management, sadly it is dolloped out on a frequent basis, and guess what, it's ALWAYS road crews fault!!!!!!!

    ReplyDelete
  9. I see the results of the NHS staff survey are out. EEAST are at or near the bottom of the league in just about everything except equality and diversity and our acting chief exec describes it as "disappointing"

    What with the complaints, long waits, poor response times (in spite of fiddling the figures by downgrading calls and using cars for the 19 minute transport time without transporting and spending over a million pounds a month on private ambulances ) failure to achieve foundation status and insistence that more cars and less ambulances will magically provide a better service. Isn't it time for the whole board and senior management to stand down. The staff survey shows staff are not listened to, they have been telling you for years you need less suits and more qualified staff and NHS ambulances.

    ReplyDelete
  10. Charlie Chucklebrother4 March 2013 at 22:42

    Why would they stand down ? As long as their gravy train keeps chugging along they are more than happy. When it finally hits the buffers they'll just look for another one. The last chief at EEAST presided over a service that doubled the workload of frontline staff whilst stealing money from them in every way possible. His bullying tactics destroyed morale and left the public with a standard of service that is a national disgrace. Now we hear he has been awarded a medal from HRH the Queen. What a joke. No wonder the old girl's guts are playing up.

    ReplyDelete
  11. More publicity from the EDP 24 Ambulance Watch. Norfolk crews say they are the worst performing county for back-up delays with paramedics waiting for up to 3 hours for back-up. Now I don't want to play "Top Trumps" but we Essex Boys beat you hands down on that one!

    Also, if you read the comments on the article one Ex-Paramedic has been blocked from EEAST facebook site for daring to ask about backup delays and number and training levels of ECAs, his comments have been removed and he has been prevented from making any more!

    ReplyDelete
    Replies
    1. Here is the link :
      http://www.edp24.co.uk/news/health/ambulance_watch_paramedics_waiting_for_up_to_three_hours_for_back_up_from_their_own_crews_with_norfolk_the_worst_performing_county_in_the_east_of_england_1_1965178








      Delete
  12. Can you trust the Trust?

    A Royal College of Nursing report shows NHS staff are reluctant to whistleblow or report colleagues poor care standards for fear of being seen as a troublemaker. I thought some of the comments and investigations by the GMB about bullying and intimidation in the EEAST may be a bit far fetched until I read this site and the freedom of information website what do they know. Please read the request for information about the cost of investigation ordered by EEAS.

    http://www.whatdotheyknow.com/request/cost_of_investigation_ordered_by#incoming-363253

    To sum it up, it appears a paramedic whistleblew or reported concerns about a colleague and instead of investigating the concerns EEAST treated the whistleblower as a troublemaker, disciplined them then reported them to the HPC (who dismissed the case). It then transpired someone in EEAST Human Resources had withheld evidence at the disciplinary hearings and the Trust fraudulently altered the findings of reports and investigations for disciplinary hearings in effect to pervert or pre-ordain the outcome. When the paramedic obtained two different versions of the investigations Hayden Newton ordered a further investigation to find out who and how many managers were involved in perverting its own procedures. This further investigation took 15 months to complete and cost an unknown several thousand pounds but with no known outcome except that most of the senior managers, directors and human resources personnel involved are still working for the Trust or have not been disciplined as far as we know.

    Presumably then this is how the Trust currently runs its disciplinary and grievance proceedings, the outcome pre-determined.

    I wonder if they also blocked this paramedic from their facebook site?

    ReplyDelete
    Replies
    1. If the Trust reported the paramedic to the HPC and the HPC hearing was based on the fraudulently altered investigation reports does this mean the Trust managers concerned attempted to pervert the course of the HPC hearing?

      Delete
    2. That's a very good point. You'd hope they would report their own managers to the HPC for doing this.
      Bet they don't though.

      Delete
  13. According to Andrew Morton, it's cheaper to employ private staff AND put them up in 4 star hotels than it is to use his own staff.
    Now I don't know about the rest of you but I certainly don't feel like I receive an excessive wage.

    Perhaps it's because we have a legion of "support" staff all sitting around doing very little that makes us so expensive in comparison.

    How about cutting these staff / roles rather than front-line services?

    Just a thought.

    ReplyDelete
  14. EEAS have finally admitted that they "downgraded" 10% of red calls last year, (Is it now 20% - 50%?)

    http://www.edp24.co.uk/news/health/ambulance_service_downgrades_10pc_of_life_threatening_calls_1_1972654

    They admit that they can even downgrade red calls to patients complaining of "chest pain" to "green calls" requiring a one hour response, (but only if they are more than 8 minutes away, eh ?).

    I wonder what miraculous training they undertook to enable them to exclude cardiac chest pain over the phone? We should all undertake this training and save thousands of pounds on cardiac monitors and taking patients to hospital for blood tests, or administering Aspirin GTN Metoclopramide and IV Morphine.

    So first you have your red call downgraded to fit the convenience of the response targets, then they send a car and achieve the A19 minute transport time without transporting you! You then wait God knows how long for the non existent double crewed ambulance to transport you because they have already achieved the target. If you suffer a cardiac arrest while waiting they have probably achieved another target! This whole target system is open to abuse and based on lies. Know wonder staff are frustrated, its like running a third world ambulance service.

    ReplyDelete
  15. Did anyone else notice the Trust's latest bid to save £50million?

    Apparently they needed 6 General managers but were so "impressed" by the candidates they decided to give jobs to 7 of them! You honestly couldn't make this shit up.

    You have to assume these "outstanding" candidates are also partly responsible for the absolute mess we are currently in.

    The sooner these clowns are given the sack the better.

    ReplyDelete
  16. I was 'backed up' by a private crew when I responded to a critically injured patient. It was a 30 minute run for me to get there on the RRV, the privates were 10 minutes away (and asleep) when the call came in, but weren't sent. It only took 40 minutes of me hitting priority to get them there; HEOC had forgotten they were on duty.

    The Nurse (!) on the private crew later admitted to me that she was grateful I was there as she wouldn't have known what to do if first on scene (why are you on an ambulance then?!!)

    Raised a DATIX but when it was acknowledged 8 months later no one could explain what had gone wrong - quel surprise!

    Shower of s**t. Will be glad to not be associated, VERY soon.

    ReplyDelete
  17. All these comments about "private ambulance staff" make me very sad. It borders on an "ism", treating someone differently because "they" are different, or you once met someone who was "the same" as you and caused you to be concerned. If we replace the words "private ambulance staff" with the words "black people", these comments would be deemed (quite rightly) to be racist.

    So, a lot of people are being "privatist".....

    Most people do a job to earn money to put food on the family table and generally try to provide a decent lifestyle for their family.

    Every comment I have ever read on these forums about "private ambulance staff" equally apply to trust staff.

    I do both, trust and private. As a private Para, I am always being backed up by double ECA trust crews, so therefore have to travel to hospital.

    As a trust para, I am always being backed up by double ECA private crews and can not praise their skill and professionalism highly enough.

    One private ECA who backed me up (a guy in his early 50's) was an ex army air core Lynx helicopter pilot with over 4000 logged hours, many in war zones.

    Treat people as you find them, not pre judge them by the name on their sliders.

    ReplyDelete
  18. Hi there, just wanted to tell you, I liked this blog post.
    It was inspiring. Keep on posting!

    Also visit my site; Link Building for Reputation Management

    ReplyDelete
  19. Private ambulances should realise that their importance and activeness can save lots of life. They should concentrate on saving life rather than money making. Government officials should also see this matter and can discuss with these private companies to make the human safety much better.

    ReplyDelete
  20. This comment has been removed by the author.

    ReplyDelete
  21. Any paramedic wanting the opportunity to live off grid with 20 other people for a year? There is lot more to it but i would like to know if anyone is interested in knowing more?

    ReplyDelete