Tuesday, 10 December 2013

Unacceptable Ambulance Delays and Struggling A&Es "Providing Pretty Good Service" Says FTN Chief Executive


Following recent BBC coverage of unacceptable ambulance waiting times outside A&E departments (Ambulances 'face long delays at A&E' - BBC figures reveal), I was invited by BBC Radio 5 live to go on air to discuss the situation.

You can listen to the full 10 minute segment below.



I had hoped we would have enough time to discuss the concerns that have been raised in the past on this blog and particularly the recent contributors on the Broken Paramedic Facebook page, but sadly the segment was all too brief. In any case, thanks to all those who pitched in. I hope there will be further opportunity to raise awareness.

It was disappointing that we did not have the opportunity to further discuss the relationship between frontline ambulance services and Accident & Emergency departments or the increasing pressure caused by more and more A&E closures, but most frustrating was the attempts by a man of some influence - the chief executive of the Foundation Trust Network no less - to brush the issues back under the carpet and claim that things are all right really. This seems to be a message which Mr Hopson has delivered in the past from the safety of a boardroom environment filled with charts and graphs. As I discovered last year with the former EEAS board, the capacity for detachment and delusion seems rife at this rareified level; a comfortable bubble of carefully engineered alternate reality in which executives can pat each other on the backs for jobs well done.

Take it from somebody who has worked in the pre-hospital trenches for over a decade and still has regular contact with those who continue to struggle against strangled resources, draconian government policy and the kind of detached 'I'm sure everything's fine' leadership that Mr Hopson exemplified: the situation is nowhere near as rosy as he would have you believe.

Why else would Jeremy Hunt, the Secretary of State for Health, write a message to NHS staff which essentially says:
"Healthcare workers, I know you've had it rough lately, but I expect - as always - for NHS staff make the unworkable work and do more with less. Thanks for that by the way, I really don't know how you manage it year on year, but I thought I'd up the ante. Brace yourselves, things are about to get even worse, I've closed some more A&Es, removed some care pathways, messed with various established processes and provided funding for some nebulous private organisations.
Please enjoy these meaningless waiting time figures which I'm using to make everything look fine and I'll raise a glass of expensive sherry to you all this Christmas. Cheer up though, we can all look forward to 2015, by which time my policies will have killed off the vulnerable old people who are ruining the healthcare system. Then you can all vote us back in and we'll make everything better for whoever's left by privatising it and making money from the declining health of the NHS workers we crippled to make this all possible. Thanks again, toodlepip."*  
Like Mr Hunt, Mr Hopson may be able to find some comfort in the current healthcare climate but that is because he doesn't really know what he is talking about when it comes to the day-to-day realities of patient care. He may be able to recite statistics and figures and I'm sure he's very good at leading his organisation, but it is unlikely that he'll be the one struggling this Winter.


*some paraphrasing may have occurred.

23 comments:

  1. Once again well written by you mate, and another prime example of higher up whitewashing !!!!

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  2. For anyone reading this that is not in the ambulance service....I have over 25 years experience working as a front-line paramedic. The situation regarding people's lives being at risk due to government cuts and their complete ignorance of how serious this is has never been worse. People are dying now and Winter hasn't even started. It is an absolute disgrace. Pray it doesn't affect you.

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  3. oh, I was listening to the soundcloud and was going to share to my friend, and it seems the file is gone? it loads up a blank page now.

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    1. oh wait, it works now. some temporary outage I guess. it works fine now.

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    2. That's odd, it still works for me. Here's a direct link: https://soundcloud.com/freebooted/bbcradio5live-drive-discussion

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  4. Mr Westhorpe, we need more honest mirrors such as your good self to temper the overly positive spin some employ to gain their short term bonus' they need to expedite their retirement. Keep it up fella!

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  5. After a month of putting your post up Matt it has provoked about 4 comments. This would suggest to me that despite your good intentions to 'tell it like it is' and expose the shameful practices that exist in East of England Ambulance Service you are wasting your time. No-one is up for a fight. They are ALL broken paramedics.... beaten into submission. Just a load of moaners who can't muster a squeak of protest between them. You played a blinder Matt and I salute you for your valiant efforts but you are now flogging a very dead horse and I think you are starting to realise this.

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    1. In response to 'Anonymous 8 January 2014 18:07'

      This particular post was more for my own benefit, having left the BBC studio frustrated by the oblivious and condescending attitude of Mr. Hopson, who I think is sadly representative of many in his line of work. Whilst this piece hasn't had the impact of earlier Broken Paramedic articles, it was more a matter of record and I didn't expect a huge response after such a long quiet period.

      That said, I believe there is still a fight worth fighting and my silence in recent months has been more to do with the necessity for me to do work which will pay the bills, along with coping with being a new parent than any dead horse related realisations.

      If anything, my path and purpose seems clearer now, so I fully intend to redouble my efforts this year. Although the 100,000 or so page views this blog received in the past year is relatively small in the scheme of things, it is enough of an indicator to me that it is possible to get a voice heard and I feel we did have an impact at EEAS.

      On reflection, I think EEAS's woes are a symptom of a much larger problem and no amount of card-shuffling at the top is going to produce results. I believe focusing my efforts more broadly will enable me to reach a correspondingly larger audience. Whilst discussing issues with fellow healthcare professionals (the majority of my readership) is encouraging and a vital part of the debate, it is preaching to the choir.

      Ultimately, it is the public and the politicians I need to reach.

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    2. Re 'anonymous 8 January 2014 18:07'

      I understand your comment but disagree. Yes, broken but certainly not beaten. I think you vastly underestimate the effect Mat's blog has had, and still has.

      I ensure I visit this site regularly for updates, even the news links are useful. The posts themselves are well written, to the point and accurate. Most comments and predictions have also been factual and unavailable elsewhere.

      As well as visiting this site, I regularly visit the Eastern Daily Press 'ambulance watch' site, the Unison East of England Ambulance site and the freedom of information site 'what do they know?' (google edp24 ambulance watch or East of England Ambulance Service what do they know) to find.

      This particular article of Mats was more a national issue than just EEAST, that's one of the reasons I haven't commented.

      There are times I have personally wanted to post comments, but have been wary of possibly being identified by my comments.

      If you think I am paranoid and the management at EEAST are not vindictive against whistleblowers and don't run corrupt bullying disciplinary and grievance procedures then I suggest you have a look at all the comments on this site and visit the 'what do they know' site. Of particular interest is the freedom of information request 'cost of investigation ordered by EEAST', 'Altering investigation reports', 'taped conversation', 'legal witness orders', withholding evidence', 'inappropriate emails', 'payments to external organisations', 'external investigation costs'......

      The Trust has a new Chief Executive in Anthony Marsh. Staff are understandably wary as commenters have linked him to what has been termed 'The Essex Mafia'. As a new arrival he has the unique opportunity to get rid of the managers who have left us in this 'sense of helplessness'. Personally I don't think he can do it and we will be further down the toilet (if that is possible). Perhaps some suggestions for fixing things from other commenters may help?

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  6. Reply comment yesterday sent to spam folder?

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    1. It was indeed, I'm not sure why. Sorry about that, it's restored now.

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  7. I notice on the Unison website there's reference to a freedom of information commissioner decision notice against EEAST requiring they release management documents relating to a planned rota review. The Commissioner required EEAST to disclose the information withheld within 35 days from 13 November 2013 or risk contempt of court. I believe the Trust is appealing the decision. The original FOI request for information was made on 28th August 2012! The full notice is available here;

    http://www.ico.org.uk/~/media/documents/decisionnotices/2013/fs_50497760%20%20.ashx

    There must be something in the document EEAST really don't want anyone to see!

    If you follow the trail, the Trust told the complainant they did not hold the information requested, the complainant then requested a specific document - a letter (or letters) of concern about the planned rota review sent from managers to the trust's Associate Director - Special Operations.

    I don't think the trust has heard of the 'Streisand effect'. The Streisand effect is where an attempt to hide, remove or censor information has the unintended consequence of publicising the information more widely. Now I am sure there are several copies of these 'letters of concern' that may suddenly become available.

    As for the reasons for such secrecy, I have my suspicion - watch this space.

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  8. The EEAST don't like answering FOI requests do they?

    Maybe they have something to hide!!!

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  9. Couple of news items of interest. Anthony Marsh's 'top performing' West Midlands Ambulance has......failed to perform and is also having funding withheld by an NHS Clinical Commissioning Group after failing to achieve response targets.

    Maybe he is required full time there to sort their own mess out instead of part time in both Trusts.

    The other item of interest is the EDP 'Ambulance Watch' campaign where EEAST has been accused of 'distorting response time statistics' by using volunteer first aiders to 'stop the clock' on thousands of 999 calls.

    I thought the idea of the community responder scheme was to get someone local with a defibrillator and CPR skills to a cardiac arrest, but it appears they are sent to virtually any 'emergency' and achieve the 8 minute cat A target! Exactly what they do when their neighbour is having a PV bleed, seizure, exacerbation of COPD, heart failure or anaphylaxis I don't know but at least they achieved the response time so the ambulance that used to be based local can now come from further away!

    Don't get me wrong, the idea is good, but if it is purely for the benefit of the patient then let's not include them in the ambulance response times otherwise there is no incentive to provide ambulances in a timely manner. I am sure the vast majority of first responders would not like to think they have made it worse for patients they have attended and not been able to do anything for just because they achieved the response time that an ambulance should have achieved.

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  10. A similar logic to the first responder 'achieving' the response time can also be applied to response cars. Although the paramedic can obviously do more, what exactly are they 'achieving' or going to do for some patients - such as suffering a stroke? Are they, by 'achieving' the response time (including the 19 minute transport time - without being able to transport the patient) actually delaying care.

    EEAST standing orders state that an ambulance should also be dispatched to cat A calls - when does that ever happen? HEOC will request you to assess and let them know if you require a 'Hot 1 or 'Hot 2 backup, before sending an ambulance in the hope that you will be able to deal with the call - or are stupid enough to convey in the car. No they don't want to tie up 2 resources (they don't have because the cars are 'achieving' the times) on one patient. Is this not what the 'front loaded model' is about? There is also a standing order that the response car will be automatically backed up as a 'hot 1' after 30 minutes, when does that happen? This results in the response car being on scene for hours waiting for a transporting ambulance. Defeats the benefit of cars as they can't now get to any more calls. In addition, if the transporting vehicle is crewed by 2 ECA's then the paramedic will often have to travel with the patient, delaying them further.

    Let's not pretend that first responders and response cars 'achieving' response times are benefiting patient care - they are actually making it worse for the patient by delaying transport and reducing the number of transporting ambulances.

    See A19.org for further information.

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    1. correction, should have been changeA19.org

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    2. Aye, the over-emphasis on achieving meaningless targets over focusing on providing good, prompt clinical care and transport is an ongoing problem. Tragically, explaining how the system has lost its way to those who could change it is no easy task.

      I discussed it in The Cult of ORCON, but it seems the misguided fanaticism continues.

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  11. Anyone know the name of the trust's Associate Director - Special Operations who is mentioned in the FOI request as the recipient of the 'letters of concern from managers', about the rota review?
    The reason I ask is because if it is who I think it may be one of the reasons, if not the main reason, the trust have refused to answer the FOI request. Because they don't want the name to be public knowledge. If someone can confirm the name and it is who I believe, I will tell you why.

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    1. According to his LinkedIn profile, Oskan Edwardson has been Associate Director of Special Operations at East of England Ambulance Trust since 2009.

      It already is public knowledge, but I'm curious as to why you think that might be linked to EEAS's reluctance to honour an FOI. Do tell.

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    2. Unfortunately there have been a number of managers who have held the position of Associate Director - Special Operations. What is required is the name of the individual who was in receipt of the letters of concern at the time. Maybe have to wait until the foi information is finally published.

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  12. If it was Oskan Edwardson at the time (Linkedin can be wrong), then I was mistaken. The person I thought it was must have held a similar named (special operations) position and is linked to others.
    Let us see if the foi information is ever released. Another strange result of the foi request was the answer the trust gave that they did not hold the data that the rota review was based on.

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  13. EEAST have finally released the information requested (Unison newsletter)
    I can confirm the Associate Director written to was Oskan Edwardson. No online version available yet. I can't find any mention of the letter in the board minutes for 2012 .

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  14. Can anyone confirm whether this is the same Oskan Edwardson who allegedly reported a previous CEO, Dr Carney over the "incorrect" recording of response times? I think that led to disciplinary action being taken against Dr Carney.

    If so this would be the same Oskan Edwardson who was recently said to have been involved in an action described by an independent investigator as "totally inappropriate and unprofessional". See the relevant FOI request on the What Do They Know site.

    "Let he who is without sin cast the first stone"

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