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

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

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

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

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

But I want to make one thing very clear:

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

State of Emergency

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

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

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

Who can blame them?

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

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

Unhealthy Competition

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

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

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

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

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

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

Standing Together, Maintaining Principles

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

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

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

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

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

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

Do not let the government float the economy on blood.

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