Tuesday, 7 May 2013

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.]

35 comments:

  1. Ken Jones in Norfolk.7 May 2013 at 21:51

    I have followed this blog since it began last September. There has been great support for the front line staff and great condemnation for the antics of those who lead what is fast becoming a total fiasco. We all know where we hope to get to but I now have to ask IS ANYBODY LISTENING? It makes no sense to cut resources in the face of increasing demand keep on with the effort to get the right result for the service, we all have a vested interest as we may need urgent medical attention some day. I pray that that attention will be available when that day comes.

    ReplyDelete
  2. This is a good piece, but you are missing a couple of bits of information.

    The first is that there are a lot of private companies that are not really in it for the money. Sound odd? Not really, a lot of the private firms were started by ambulance personnel, who do need to make some money to live (as we all do) but plow most of their income tax back in to their business. There are a couple I know of that are distinctly non-profit in motive, and this doesn't even begin to cover some of the possibilities behind formal non-profit status.

    The second is that your assumption about private and public services performing the same given the same resources just isn't true. Private firms have an inherently lower cost base as they don't have the same residual liabilities like paying out old style NHS pensions and dealing with some elements of A4C. In truth this means that they can probably deliver the service cheaper than the NHS and still deliver a healthy profit.

    Fears of excessive profit are almost certainly unfounded as the market is so competitive, and I'd be surprised if any operator was making more than 5% on their contracts, and if any NHS service thinks they aren't wasting at least 5% of their money, I think they're misguided.

    Lastly, is private provision inherently 'less NHS' than direct provision? GP surgeries are all private providers to the NHS (and mostly making a pretty healthy profit), yet are seen as part of the system. Is that wrong? If not, then why isn't the same true of ambulance services?

    ReplyDelete
    Replies
    1. Owain, in your argument you say;

      "Private firms have an inherently lower cost base as they don't have the same residual liabilities like paying out old style NHS pensions and dealing with some elements of A4C. In truth this means that they can probably deliver the service cheaper than the NHS and still deliver a healthy profit".

      So you are arguing for worse terms and conditions for NHS staff in order to run a cheaper ambulance service?

      Yes you have given one of the reasons why private providers can provide a cheaper service (worse terms and conditions for employees). In my neck of the woods there was recently a dispute between private employees and the private company subcontracted to the NHS due to their terms and conditions meaning the ambulance contract was not fulfilled so no ambulances to respond for NHS patients.

      Other reasons (you don't mention)
      a private provider can run a cheaper operation is to crew most of their vehicles with ECA's or an ECA and a "Technician" also not provide a cardiac monitor or provide a cheaper old "van" with blue lights (and awful suspension), provide little training (certainly you can save money there) and a crew unable to drive on blue lights.

      Far fetched? All the private crews who have backed me up have been ECA's or an ECA and a "Tech" only on two occasions (out of about 40) have the crews been authorised to drive on blue lights and only on two occasions have they carried a cardiac monitor, other than an AED.
      If you are required to travel with the patient you have to take your cardiac monitor, leaving it on the floor somewhere, your drugs and your response bag that is after you have made the decision should you wait for a 'real' ambulance or drive to hospital without blue lights and sit in traffic, no it is not safe. The end of last year Thames ambulance failed to achieve CQC standards in "training and management" (see CQC website) subsequently they have been taken over by a Spanish company and some of their management team has left.

      Your last argument about GP's being private providers (they are salaried and pensioned by the NHS at a far higher rate than Paramedics) is contradictory to your first argument about cheaper terms and conditions enabling private providers to run a cheaper operation.

      Delete
    2. As a correction and update to my comment on Thames Ambulance they were not meeting CQC national standards in the area of staffing and standards of quality and suitability of management in October 2012. Their latest CQC inspection (April 2013) shows they have improved and are now achieving national standards.

      Delete
  3. Get a load of this, WOW!

    http://www.edp24.co.uk/news/health/ambulance_watch_concerns_raised_over_appointment_of_private_sector_ambulance_chief_to_top_nhs_role_at_east_of_england_ambulance_service_trust_1_2196636

    ReplyDelete
    Replies
    1. The EDP 'Ambulance Watch' article expresses concerns raised by Unison and health minister Norman Lamb about the cosy relationship with and spending on hiring private ambulances from Thames Group and then employing their Chief Executive at £100,000 a year.
      Similar concerns were raised on this website by anonymous in November 2012;



      "Anonymous5 November 2012 01:05
      The latest Care Quality Commission report on Thames Ambulance Service (October 2012) shows they were not meeting CQC national standards and they required improvements, specifically in standards of staffing and standards of quality and suitability of management.

      So why is East of England Ambulance Service NHS Trust utilising a company not achieving national standards? Is there any connection between senior managers or directors and Thames Ambulance?

      Yes, Director of operations Neil Storey has declared a personal friendship with Thames chief executive Rob Ashford and Rob Ashford was formerly Locality Chief Operating Officer for East of England Ambulance and must know most if not all the Trust board and senior managers.

      Strangely the minutes of an Essex County Council meeting 15th November 2010 show that a "Brad Lane" from East of England Ambulance Service attended the meeting along with Rob Ashford from Thames Ambulance. Mr Lane gave a presentation and in response to a question about dealings with other ambulance services stated that East of England Ambulance Service contracts directly with Thames Ambulance Service by tender. There is no explanation as to why it had been pre-arranged for Rob Ashford from Thames Ambulance to attend the meeting with a representative from East of England Ambulance Service.

      One thing is for sure, the plans to reduce the number of double crewed NHS ambulances and qualified staff and increase the number of cars will certainly contract more work to private providers such as Thames Ambulance."



      I don't know if any explanation was given as to why Rob Ashford was prearranged to be at the council meeting with East of England Ambulance or who asked the question?

      Delete
  4. The minutes of the council meeting are available online here are the relevant bits:


    MINUTES OF A MEETING OF THE SOUTH ESSEX AREA FORUM HELD AT 2.00 PM
    ON TUESDAY 15 NOVEMBER 2010 AT BENFLEET METHODIST CHURCH
    Membership
    County Councillors:
    * R C Howard (Chairman) * D Abrahall
    J Dornan D W Morris
    * Mrs T Sargent * R A Pearson
    S C Castle Mrs I Pummell
    * Mrs T Chapman Mrs J M Reeves
    W J C Dick C G Riley
    * Mrs E M Hart * J M Schofield
    * A M Hedley * K Twitchen
    * S Hillier * Mrs M J Webster
    * B Wood
    * present
    Present
    Cllr R Chambers and Cllr J Jowers – Essex County Council
    (in order of signing the attendance book – and as there described).
    Adrian Roper – representing Rebecca Harris MP, Rod Bishop – Canvey Island
    TC, Janice Payne – Borough Council, Brian Dallas and Tony Brockwell – Brockwell
    & Sons, George Whatley – PAM, John Buchanan – EALC, Brian Efde – Essex
    Flood Forum, Glenn Caton – Essex Police, Keith Garnish, Paul Howell – Essex
    Police, Adam Acott, Steve Rogers – Castle Point BC, Bill Dudbridge and Rob
    Ashford – Thames Ambulances,.........

    ....................In response to a question about whether they had dealings with other
    ambulance services, Mr Lane confirmed that they had adopted a policy of
    mutual aid, so were always prepared to move to wherever the need arose.
    They did use other services, such as Kent, as well as St John’s
    Ambulance; and they contracted directly with Thames Ambulance Service,
    by tender.....

    ReplyDelete
  5. Why has Andrew Morgan not dealt with the managers who left us in the shit we are in?

    To place the "25 additional ambulances" into context against the number lost in the rota redesign here is a clip from the "performance and finance committee" quoting Neil Storey who devised the plan along with a few others:

    "The main change in the strategy relates to the number and type of vehicles we will operate, derived from the Trust‟s increased understanding of the requirements of the Integrated Service Model, an operational demand analysis and the output of the rota redesign programme which determines the number and mix of vehicles required to deliver services to patients. These changes include:
     A planned reduction of double-staffed ambulances from 275 to 184. (- 91 DSAs)
    Page 14 of 24
     A planned reduction of response cars from 235 to 209. (- 26 RRVs)
     A planned increase in Intermediate Tier Vehicles from 23 to 67. (+ 44 ITVs)"

    http://www.eastamb.nhs.uk/Downloads/Board%20papers/2013/March%202013/27%2003%2013%20Trust%20Brd%20Pub%20Sess%20Agenda%20Item%2016a%20PAFC%20Rpt%20of%2013%2003%2013%20Minutes%20of%2019%2012%2012-16%2001%2013.pdf

    What's 25 minus 91?

    ReplyDelete
    Replies
    1. I agree with your disappointment that those responsible have not been dealt with. Mr Morgan has been making the right noises recently and most of us are giving him some time but some of the management appointments have been questionable.

      When they interviewed for the General Manager appointments they needed 6 General Managers but were "so impressed by the candidates" they created a new post here in Essex and made it 7, (at what cost?). There is now a rumour that this new GM appointee was responsible for doing the computer modelling on behalf of Neil Storey which led to the rota redesign and the cut of 91 DSA's you mention?

      The worrying thing about the performance and finance meeting you quote is that it was as late as December 19th 2012 at the height of "the shit we are in" with complaints about delays at a record high, hundreds of unfilled frontline vacancies, patients deteriorating left in agony and dying waiting, money was pouring into private ambulance cover to fill the holes and yet "they" were still planning to slash DSA's further with the rota redesign (and what were the rest of the board doing, sitting with their heads in a trough and fingers in their ears saying la la la?) and later Andrew Morgan went ahead with it! I will give him the benefit of doubt as he had literally just arrived but it wasn't a good start.

      You may have thought that when every crew member and most managers were saying we need more DSA's common sense would prevail but was there another reason we were giving money to provide private cover while reducing ours?

      All I can say is some of these appointees must be fucking incredible at interviews because their track record isn't very good, some of them have demonstrated they certainly have no fucking common sense! (computer says no mentality). Maybe they should apply for "The Apprentice" and see how Lord Sugar deals with them.

      Delete
    2. "What's 25 minus 91?"

      Neil Storey's IQ?

      Delete
  6. So Pam Chrispin is the latest one to leave the Trust.

    Maybe Mr "front-loaded model" Neil Storey should be the next to go.
    All those meetings Neil where you were told you couldn't go slashing the number of DSAs without disastrous effects. You stood there with that smug, defiant look - you just couldn't be told could you?

    Well done you.

    ReplyDelete
  7. Charlie Chucklebrother28 May 2013 at 10:53

    All these people leaving and receiving glowing tributes saying what a wonderful job they did. Get real....they have been disastrous when measured in patient care. the only true indicator of performance in this industry. The fact they've been turfed out encourages me that Andrew Morgan is a doer and not so full of bullshit as his predecessors. Neil Storey will be history and soon as the next gravy train comes chugging along and good riddance. Perhaps then we can get back to looking after patients and staff properly which all road staff have ever asked for.

    ReplyDelete
    Replies
    1. Don't count your chickens Charlie. Who interviewed and appointed the new locality chiefs, GM's and AGM's with Mr Morgan? and who is on the "listening into action team? Also who was mates with Mr Marsh from West Midlands, the national ambulance advisor who reviewed the Trust for the government? Yes he has lost confidence of staff (if he ever had any) and his position is untenable, but it doesn't mean he will leave any time soon.

      I have heard there is a job going at Thames Ambulance though.

      Delete
  8. Find yourself with at least 200 vacancies and having to save £50million?

    Then why not offer nearly £100k to get rid of just 6 staff then immediately offer £500 "thank you" payments to anyone who can come up with names of potential replacements for those you just paid to go.

    https://www.whatdotheyknow.com/request/referral_thank_you_payments#outgoing-276566

    Wow! Just wow!

    ReplyDelete
  9. In response to a question about the use of untrained private crews Neil Storey said;

    "However, they did not attend serious 999 calls without NHS back-up".

    What NHS back-up? I thought the reason for using private resources was because we don't have enough NHS ambulances. Even our own FRV's wait hours for backup so what NHS resource is available to back-up a private crew and when? Presumably they would have been sent because there wasn't an NHS resource, so good luck with that one!

    Presumably Neil Storey will say "I don't see what the problem is" because that was his attitude when everyone was stunned by the cuts in DSA's in the rota changes.

    ReplyDelete
  10. A prediction -

    Andrew Morgan, who's been sweating blood and tears trying to turn this sinking ship around, gets the boot to be replaced by Anthony Marsh (anyone else notice the dig about non-ambulance staff appearing on TV wearing ambulance uniform?)

    Mr Storey also gets the push, basically for not being very good at his job and is replaced by his "friend" Rob Ashford, who is a well known lapdog of Mr Marsh.

    Watch this space folks....

    ReplyDelete
    Replies
    1. I agree with your comment regarding the dig about "civilian staff wearing Officer Uniform whilst undertaking a Television interview when they are not a career Officer" having an "unforeseen adverse effect". This was totally out of place in a Governance Review, in fact placing the comment in the review will have a "foreseen adverse effect" (it makes Anthony Marsh look spiteful). "Handbags at dawn" anyone?

      On the "people in glass houses" theme Mr Marsh was awarded an "Honorary" Degree of Doctor of Science by the University of Wolverhampton in 2012 and it is rather frowned upon in academia (especially by "real" Doctors who have earned the title through academic work) to prefix the title "Doctor" to your name when it is an "Honorary" Doctorate. Most universities inform the recipient of this, apparently not the University of Wolverhampton.

      Regarding "Mr Storey being replaced by Rob Ashford", Mr Storey is also a friend of Mr Marsh, he was a senior manager under him in Essex.

      Delete
  11. Who supplied Marsh with the bullshit average backup figures (table, page 11), anyone believe those figures?

    Answer is on page 30 ("Average Back up times Tables Received from Neil Storey")

    Say no more!

    ReplyDelete
    Replies
    1. Actually the figures given are appalling, at first sight they don't look too bad because the times given are "averages". In this context averages are almost meaningless but when you are getting "average" backup times over 24 minutes for hot1 backups, 35mins for hot2 backups and "average" backups over 2hrs 23mins for other calls you know there is a terrible transportable resource problem someone is trying to conceal by supplying only "average" figures. Imagine how bad the "real" backup delay figures are.

      Delete
  12. Personally I think Neil Storey is far more culpable than any of the non-execs who've resigned.

    He's the one who should shoulder the blame for deciding to drastically cut our DSAs when every member of staff was telling him it was the wrong thing to do. Can't believe he's still here to be honest.

    ReplyDelete
  13. Anyone know where we can sign this vote of no confidence in Neil Storey? There are a few of us, or should I say everyone I speak to want to sign it.

    ReplyDelete
    Replies
    1. According to this Dr Harris chap, "Neil has been a substantive board member only since last October.

      "During that short period of time he has helped develop our turnaround plan and started implementing actions to improve services to patients.

      "Neil has been driving forward improvements like working hard to get more staff and ambulances onto the front line."

      Funny that as I remember him completely failing to listen to staff prior to last October when they told him HIS plans were madness and would lead to chaos and suffering.

      Wake up Dr Harris. Either you're being very naive or you take us for naive fools.

      Delete
    2. Well apparently instead of "driving forward improvements", Neil Storey has just announced he is to seek "opportunites" elsewhere.

      I'll have a large fries with mine please Neil

      Delete
  14. I don't know about the rest of you in EEAST but I am getting milghty fedup with the constant propaganda regarding the increasing number of ambulances and recruitment drive. Since Neil Storey reduced the number of DSA's (and couldn't see why that was a problem) I have seen ZERO, ZILCH, DIDDLY SQUAT more DSA's on the road to transport patients. Also, now he has gone are we not still left with his mates (the rest of the "TOWIE Mafia") and others who have a questionable disciplinary history?

    When we recruited Rob Ashford from Thames Ambulance, bearing in mind he had negotiated the Thames contract with East of England Ambulance Service (including presumably his mate Neil Storey) now that Rob Ashford is working for us, exactly how long does the Thames contract last for? Is this allowable under the Public Service tender regulations, to negotiate a contract with a company then employ the Chief Executive of the same company?

    Regarding the recruitment drive this also means nothing in practical terms if the number of Paramedics leaving is more than the number being recruited, I notice those figures aren't published. It looks like the only number that has increased is the number of managers, including three sector leads at £100,000+ per annum each, big saving to be made there. What happened to all the previous managers who didn't get a sector lead, GM or AGM position? Are we still employing/paying them?

    ReplyDelete
  15. AMBULANCE SERVICES RUN BY “MATES DOWN THE PUB”

    I have been reading this blog and the comments for some time and have been impressed at the accuracy of most of the articles and comments, many of the comments and predictions have been vindicated by action (resignations) press reports and freedom of information requests.

    It is evident that control and road staff (I have spent half my career in ‘control’) have been continually lied to in the past. Some of the lies have been about “employing extra staff”, “reduction in management costs” and “double staffed ambulance cover”. Freedom of information requests on website whatdotheyknow.com have shown up these lies, and more. So why are things no better?

    The comment from “Anonymous” above @ 23:42;

    “Also, now he has gone are we not still left with his mates (the rest of the “TOWIE Mafia”) and others who have a questionable disciplinary history?”

    Along with other information on this blog, this comment may point to the answer.It has been suggested that many (if not all) of the appointees to the Sector Lead, GM and AGM positions were regular “mates down the pub” with each other and with Neil Storey. The question is did Neil Storey declare any close ‘friendships’ with the Sector Lead, GM or AGM candidates before interviewing for the positions. If he did, why was he allowed to interview and appoint them? If he didn't why didn't he admit his friendships? You may ask what difference it makes (especially now he has gone) if he appointed all his mates into senior manager positions, (apart from taking Cronyism to a new level). Well again some comments on this site and freedom of information requests about the costs of the Trust investigating the conduct of its own managers (and human resources department) in disciplinary matters points to why it is important.

    You can bury your head in the sand if you like, but an open culture and unbiased disciplinary and grievance procedure is vital, otherwise Unison or the GMB are wasting their time trying to represent you at disciplinary hearings and taking out grievances will also be a waste of time.

    What if one of your managers did something inappropriate, are you going to even report the incident if his manager is “his mate down the pub” or the AGM, GM and Sector Lead are all “mates down the pub” if you did report it what do you think the outcome will be?

    You face disciplinary action and one of the “mates” doesn't like you, what do you think the outcome will be? Unconvinced? Try reading whatdotheyknow.com about the “cost of investigation ordered by EEAS”, where the Trust “altered reports” and “withheld information” during a disciplinary in order to try and sack a member of staff, it still didn't work so they tried to get the HPC to do it for them by trying to pervert their disciplinary hearings, then when found out, having spent thousands to investigate the conduct of its managers, they now appear to have covered up the investigation. No manager has been disciplined.

    Contrast that with some of “the mates down the pub” (Anonymous 23 March 2013 23:53) and how they were dealt with.

    I don’t know about all the sectors, but here in Essex the only people who don’t think we need more DSA’s are some of these senior appointees (incredible) but are you going to suggest to them that they are wrong?

    I see no one has answered “Anonymous 18 May 2013” above as to why Rob Ashford from Thames Ambulance was prearranged to be at a council meeting with East of England Ambulance or who asked the question?

    Is the answer “mates down the pub”?

    ReplyDelete
  16. So Andrew Morgan applied for his own job but wasn't good enough?

    Great. So now we're stuck with him until someone better comes along. Is this car crash of a "service" ever going to recover?

    ReplyDelete
  17. Wasn't sure if my comment last night about the "ambulance service run by mates culture" was not posted or if it was removed as a 'comment too far' or because I unknowingly mentioned an ongoing investigation?
    I don't want to spoil a good site so if it was removed by Mat I respect whatever the reason was but it would be nice to know? If it wasn't removed should I try and repost? Maybe attempt to tone it down?
    Don't agree with the comment about Andrew Morgan above. We have been "led by Donkeys" for a long time and the result is we have all been treading in Donkey Shite, it will take time to get rid of it.

    ReplyDelete
    Replies
    1. That's odd. Nothing has been moderated or removed and I know the comment you mean - I read it via my email notification. I'm not sure why it's not shown up in the comments thread. Apologies, I'll look into it.

      Delete
    2. There ya go - it had been automatically flagged as spam (not sure why).

      Delete
  18. I've always wondered where the private ambulance firms get their staff - I have a choice to work for the NHS, get paid OK get a decent pension and the T&C's are reasonable. OK there is a lot of crap falling on you from above, but the NHS is not an awful employer.

    Or...

    I join a private firm who save money by not paying the staff as much as in the NHS with a worse pension and likely worse kit. The T&Cs are also likely to be slanted in the firm's favour all in a way to squeeze more profit.

    So why would any sensible clinician join a private firm? Given some of my experiences with private crews maybe they won't be employed by the NHS because clinically they are, erm, crap.

    (Trying to think of something other than 'crap' but it's late and my brain is on shutdown - apologies).

    OK, so they save money on employing ECA's or similarly undertrained staff, but I do see a fair few walking around with paramedic epaulettes and it makes me wonder why they aren't in the NHS.

    Just my tuppence worth about the scores of private ambulances rolling around my local patch.

    ReplyDelete
  19. I see Andrew Morgan's "Turnaround Plan" including the recruitment of an "extra" 231 paramedics is going well.

    So far they have recruited an extra 4 (that's FOUR,) this year!

    https://www.whatdotheyknow.com/request/recruiting_paramedics#incoming-440738

    Keep up the great work Andrew

    ReplyDelete
    Replies
    1. Actually, the figure is minus 48 since 2012! Yes, 48 more paramedics have left than have joined since January 2012! But does this also include paramedics who have come off the road to transfer to HART or HEOC?

      I hear that many potential recruits change their mind at the last minute when they find they are going to be permanent relief staff, run ragged, treated like shite and receive no ongoing paid training (unless they are willing and available to come in on their days off).

      "Sense of helplessness" is a bit of an understatement.

      Now, if the Trust scrapped relief, provided paid ongoing training (without having to jump through hoops to apply so you can come in on your rest days, to enable them to achieve their CQUIN targets), placed more ambulances on the road, stopped expecting everyone to single attend in an ambulance and generally stopped treating those of us left like shite, we may start getting somewhere.

      Unfortunately, the above is unlikely to happen and the only way forward for the near future is to use agency staff, privates and significant overtime incentives. To use a euphemism from 'Game of Thrones', "winter is coming" to East of England. Patients and staff alike are going to deteriorate or freeze to death waiting for ambulances. Let's have a public enquiry and get it over with.

      The job is just not worth the adverse health effects anymore, personally I am hoping that shortly it will be minus 49 recruited.

      Delete
    2. They told the EDP on 31st August that they had "recruited 160 emergency care assitants and paramedics".

      Now their "Turnaround Plan" stated they wanted to recruit 96 ECAs (even though Anthony Marsh advised them not to).

      So does this mean that they actually recruited 153 ECAs to go with the 7 paramedics / specialist paramedics, or are their claims more, complete b*ll*cks?

      Who on earth would believe anything they say?

      Delete
  20. I see the Eastern Daily Press (EDP) have published an article titled "999 trust slashes private ambulance costs"

    Is that an accurate description? The article quotes figures released by the trust under a freedom of information request, the figures show the trust spent £1.9m in March and £1.3m in April compared with £990,484 in August and £757,999 in September. The article goes on to quote Rob Ashford, acting director of service delivery suggesting money is now going to pay agency staff as well.

    Why I question if "slashing private ambulance costs" is an accurate description is twofold. Firstly Mat published an article on this blog on Tuesday, 26 February 2013 titled "Blame, Private Ambulances and the Cost of Lives" in which he published the private ambulance costs over a 17 month period from April 2011 to August 2012. The highest monthly cost then was £1,090,099, but the average monthly cost was £753,864. The current costs are still much higher. Secondly, if the trust is now also spending money on "agency staff" which is in addition to the private ambulance cover, it is still NHS money going to a private "agency". Yes, I accept it may be better than paying a private ambulance provider who may be competing for our PTS contracts, but we are still using more private ambulances as well, also are any of the private ambulance services running the agencies or providing the agency staff?

    ReplyDelete
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