(…Or At Least Means He'll Never Get A Promotion).
Let me start with a few assumptions.
(1) Ambulance workers are human beings, human beings require food.
(2) The government wants the NHS to spend less money.
(3) People who use the NHS have high expectations.
To answer the first story – it was unfortunate that the people running Control put two crews on a break at once, I'll suggest why this may have happened later in this post. To quote the LAS response to the death,
An LAS spokesman said: “We dispatched a rapid-response car, which arrived at the shopping centre within eight minutes at 1.30pm, the member of staff being able to start treatment immediately. An ambulance was sent at 1.32pm after it became available from attending another incident and, according to our records, arrived at the shopping centre at 1.41pm and at the patient a few minutes later.
So, within eight minutes a solo paramedic arrived and nine minutes later there was an ambulance, so the maximum time the patient waited was seventeen minutes. Without knowing the circumstances I would imagine that even if a crew had been sent from Edmonton station they would have shaved only three or four minutes off that time.
The crews on the meal break wouldn't have even known that there was a call, Control are under orders not to disturb crews except in the last 10 minutes of the break.
Here is the thing – The press love this story because it points blame at the crews, our management or even EU legislation. Here is the story that you don't hear every day, but would be much more common.
'Man dies waiting for ambulance because they were all out dealing with idiots who call up for a stubbed toe that happened two days ago'
But it is harder for the press to prove that the reason why there wasn't an ambulance there in minutes was because they were run ragged chasing after mis-users of the service.
On the breaks themselves – in a 12 hour shift we are paid for 11 1/2 hours, we have half an hour unpaid break and 10 minutes that are interruptible. If our break is interrupted in those last 10 minutes then we receive a payment of £10. This replaces the old system of having our breaks 'bought' off us for £7.10 and while we would often be able to 'sneak' a meal, it was actually a disciplinary offence to do so. With increasing work pressures this was getting harder to do. These breaks must be completed within certain hours.
Why mealbreaks are impossible.
So – what is the problem with providing workers with mealbreaks?
Year after year the ambulance service has been put under increasing pressure. We have increasing numbers of calls. We are expected to provide services that were once the domain of GPs. More people are calling us for non-ambulance work, the recent stories about some of the rubbish we go to on a daily basis are just skimming the surface of what we do every day. If we look to reduce the numbers of inappropriate callers then, as Magwitch notes, the press is up in arms.
We do not sit on station playing pool or sitting with out feet up – we tend to go out in the morning and not stop until the end of our shift.
Then we have the pressure from the government, first they tell us that we have to get to Cat A calls in eight minutes, then they change the goalposts (Now we'll have eight minutes to get to the patient from our Control picking up the phone, rather than from knowing where we are sending the ambulance). Then the government tell us that the NHS needs to 'make a profit', whatever *that* means. Despite the increasing number of calls and our increasing roles we have less money than last year to cope.
Patient care is going to suffer as we seek to please the government.
The government therefore want us to do more calls, with wider roles but with a lot less money.
They sit in their ivory tower dictating what they want and the ambulance service bosses say, “Yes we can do that”. If we don't do it then the money is cut even more. You never hear the government suggest that maybe we need more ambulances to cope with the increased roles.
Due to the budget pressures we have been put under recently there was essentially no overtime available. While we are supposedly fully manned it still meant that there were plenty of ambulances unstaffed. This situation was brought about by the government cutting our money, all at the risk of patient care.
When we have to provide the government with our response time figures we'll flood the area with ambulances so that we can make it in a 'big push'. Budget be damned. It used to be if we didn't make the target then our budget would be cut – now they cut it regardless of us making our targets.
And so we flip-flop, from saving money to providing more ambulances and back again. Our management are on the government leash and are being pulled in two directions.
This may explain why two crews were put on break at once – because management are under pressure from the government to save money wherever possible they are trying to get us our full breaks (in limited time windows) because we can't afford the £10 for an interrupted break.
So the short version – We don't have enough ambulances to to provide the care that the public and the government want and the introduction of meal breaks has just shown up how stretched we are.
And for some reason our bosses won't admit it.
So what can we do? People are not happy with the service so there are three ways to deal with this. One way is to lower the expectations of the public toward ambulance care (and perhaps the NHS in general). If the public considered themselves lucky to get an ambulance, then they wouldn't complain so much, this is the attitude I often get from people who weren't born and raised in the UK. But there is no way to do this, and we shouldn't – we should expect, and get, top service from the NHS.
The second way is to reduce the number of calls we get by streaming out the 'crap' or by educating people about the misuse of ambulances. This isn't simple and would take twenty years or more to implement. Fines or paying the cost of the ambulance would sit in this camp and, as I've mentioned before, I don't like the idea of paying for ambulances because it would frighten off the poor.
The final way is for the government to give us more money and to stop pulling us in two directions at once. This isn't going to happen, the motive behind Patricia Hewitt's desire to 'make a profit' is that they want to invest less in the NHS. I'm not suggesting that we need to throw money at bad services, but there does need to be an increase in funds. If you were running a business you wouldn't expect to be able to expand your company without some form of investment.
But what can we do to force the government to listen to us?
Here is my solution. When the government asks for response figures we refuse. We stop recording and collating them. We spend the money that we have on improving patient care, not on fanciful imaginary 'performance indicators'. We make a stand against the utter idiocy that is the Department of Health. What could they do? Sack us all? It needs to be countrywide and across every level of the ambulance service. We need to be bloody-minded about making the government concentrate on Patient Care and not fulfilling their seeming desire to run the NHS into the ground.
We need to take a rolled up newspaper, strike across the dog's nose and in a firm and clear voice say , “No!“.
It may be simplistic, but it's the only language they understand.