He's ninety years old, ex-army.
He's slipped on the ice coming out of his house, we are sent to the call as 'Fallen over, leg is at a funny angle'.
We get there, he's broken his leg all right. He's lovely, the family are lovely.
He has waited one and a half hours for an ambulance.
I am furious. He has been laying on the ice for that long without an ambulance. I've just come from the hospital – the police have been bringing in patients with possibly broken ankles because there are not enough ambulances.
Apparently it doesn't matter, as the 'public perception' of the service is high.
That doesn't mean we provide a good service – it just means that our PR department is good at making us look good.
It's not a hard problem to solve, I can see what it is and I'm on the bottom rung of the ladder.
We do not have enough ambulances to meet demand
It's that simple.
We don't need 'initiatives' where a driver and an ECP go around to a house to see if the call really needs an ambulance.
We don't need 'smarter ways of working' – because it won't work, the reasons are many and varied – but it won't work.
What we need are more ambulances and more road staff.
You don't have to be a genius to work that out.
Year on year the increase of our calls is around 12%.
Our Boss, Peter Bradley seems proud that we will soon be dealing with one million calls in a calendar year.
The number of calls increase but the number of ambulances, the number of hospital beds don't.
“But there are 400 students being trained at the moment”, our PR department will say, “It will all be fine”.
Ask how many leave the course, ask how many finish the course and then leave because they are already disillusioned with the job, ask how many regular road staff are leaving the service, retiring, getting the sack, or changing careers?
Is it really a 'huge influx' of staff once you take all that into account?
Even if we have the staff we don't have the vehicles.
The other day my colleagues at my station were waiting five hours for an ambulance. This is not unusual.
We've ordered more, but it takes too long – we spent too long without getting new ambulances.
There aren't enough ambulances on the road.
The population of London is increasing, a large amount of this increase comes from immigration, or the expanding of immigrant populations.
Immigrant populations tend to be both poor and under-educated.
Can you tell what the two big causes of poor health are?
Poverty and a lack of education.
We aren't doing too well at getting these populations out of poverty, so it's no wonder that the number of people wanting an ambulance is increasing.
We aren't going to get people not calling ambulances.
People want ambulances to take them to hospital for free, and no matter how much we tell people otherwise they will continue to call us when they should be using other modes of transport, or not going to hospital at all.
(Today a nurse made an announcement at one of our A&Es that the waiting time was four hours; more than a few people moaned that it was too long and went home – how much of an 'emergency' was their reason for being there in the first place?)
It's simple – More Calls Need More Ambulances.
It's not rocket science.
“Unusual weather conditions” the PR department will say, “Lessons will be learned” they will say when someone dies waiting for an ambulance.
Here is a lesson that seems to have escaped those way above my pay scale – In winter, demand for ambulances goes up. We should then provide more ambulances.
Not blokes on pushbikes, not community responders, not FRUs to stop the clock in order to keep the government happy.
More ambulances to take people to hospital.
If I screw up, I could lose my job.
If I say the wrong thing I could lose my job.
If I'm sick too much I could lose my job.
Apparently if I can't produce enough ambulances, if I can't ensure that they are equipped properly, if I can't promise to get an ambulance to an elderly person with a broken leg in the ice within a reasonable time – well, my job is safe.
I'll probably even get a promotion.
What is important? It's not the 'public perception' that management and the government go on about, it's not about meeting a pointless target.
It's about not leaving a ninety year old man freezing on ice for an hour and a half.