Increasing Calls

It has been in the news recently that the BBC has hold of documents showing a large increase in the number of 999 ambulance calls. This is the reason why my phone hardly stopped ringing yesterday as various BBC radio stations wanted interviews. (I had to turn two of them down because I was going to be spending a rare evening with Laura).

One of the reasons given for the increase in calls was the recent British Heart Foundation urging people to call for ambulances if they get chest pain. In my own experience there hasn't been a huge increase in calls due to this, I suspect that the LAS has the official figures, but in my area people don't need any encouragement to call us out.

When I started working for the ambulance service we would get around 2,500 calls across London each day – now it isn't unusual to get 4000+. While a government spokesperson says that there are more ambulance staff than in the past (which is true), it doesn't follow that there are more ambulances. Ambulances which were covered by staff on overtime now staffed by reliefs.

I don't think that there has been an increase in the actual number of ambulances in the last fifteen years; yet we have increasing call numbers and our ever expanding role.

I would say that there are a number of reason why there is an increase in calls.

  • The lack of GP services 'Out of hours', since GPs were allowed to stop covering out of hour services the quality of primary care during the hours of darkness have plummeted. Due to decreased GP cover we are going to more and more 'primary care' situations, jobs that would normally be under a GP remit.
  • The increasing 'I have the right' brigade – people who know that they have a 'right' to an ambulance as a free taxi to hospital. All thanks to the 'Patient's Charter'
  • People want healthcare when they want, rather than when it is available. Waiting for an appointment to have your foot wart removed is such a chore, you want it off now? Call an ambulance to take you to hospital.
  • A general lack of education – a simple chest infection in an otherwise healthy person isn't going to kill you; but some people do believe that a cough is something life-threatening.
  • A lack of magic cures – I've lost count of the number of people I've been to recently who have seen their GP for a chest infection, have taken two of the prescribed antibiotics and yet they aren't feeling better. Then they call an ambulance. Here is a hint – there is a reason why there are 28 tablets in the pack…
  • Increased population, more and more people are living in smaller places, buildings are being thrown up all over London, yet there isn't a corresponding increase in healthcare provision. And the government is closing two A&E departments in our area, because, you know, they are full all the time.
  • 24 hour licensing, I know it's an unpopular view in some circles, but we are going to more drunks, and alcohol related calls than ever before.

One of the problems is that we are trying to solve all these problems by throwing ambulances at them. We are covering for reduced GPs by implementing ECPs (Emergency Care Practitioners, GPs on the cheap). Who is going to want to get an appointment for a GP when you can dial 999 and have someone turn up at your door when you want. We aren't refusing ambulances to people who don't need them, partly for fear of being sued or making a mistake. As a whole, health education in this country is dreadful – barely going beyond 'safe sex' and 'stop smoking' messages. Drunks in the street are going to a nice friendly A&E department rather than a less comfortable police cell where they are charged with an offence.

Part of it is that we are mollycoddling people for fear of being sued, and having bad press. If the ambulance service continue this way then I can't see things getting any better. Because of the lack of funding from the government we are having to change the way we work in order to meet those useless targets; this will lead to problems with patient and crew safety – but that is a post for another day.

Without a sea change in society as a whole and in the funding and measurement of targets in the ambulance service, despite the LAS' best intentions, things aren't going to get any better.

The BBC news forum has some hilarious comments (and it does point out some of the weird ideas that people have about the ambulance service).

As I type this there is an *awful* segment on blogging on the BBC breakfast news.

37 thoughts on “Increasing Calls”

  1. Glad I found your blog; liked it so much I added it to the sidebar on mine. Anyway, I just started at a volunteer amb. co. in upstate New York and already I have seen a little bit of what you are talking about. I have a lot to learn: culture, protocol, and of course, practice.But in the short time I have been there, I have already seen that even here in the States the burden on EMS is going up. The number of calls in our area is very high and vol. companies are understaffed throughout the area, even with many standing up three crews at all times (or trying to anyway), even when paying paramedics and senior sub-paramedic grade personnel hourly wages. Our area is also considered well-covered if you can believe it; other parts of the state don't have a paramedic-level provider within 100 miles of them, and an ED anywhere near? Nearest is three hours away for some communities. And we don't even have nationalized healthcare in the US so people are calling for EMS help even though they know they are going to carry the burden for the cost, or some part of it, with their private health insurance carrier (if they have one, which many do not) footing the rest.

    Our aging population is without a doubt a major factor. It seems like 4 of 5 people an ambulance is dispatched to is elderly. No surprise there, but if you consider that in the US (and UK, and Germany, and Spain, and Italy, etc., etc.) the pop'n continues to get older on average, there is a tilt factor– fewer younger people to act as EMS workers with more and more elderly people in need of EMS workers to save them from some condition. You could say the same thing about other related fields, of course: hospital workers, nursing home workers, any number of other professions as well. Here in the U.S. our “Boomer” generation is just beginning to enter the part of their lives where they are going to need or demand substantially more healthcare/EMS resources. If we are already overstretched now, what will it be like in five years? In ten? Dare I even think 20 or 30? On top of that, legal liability issues as well as pay issues, politics, stress from multiple sources and of multiple kinds, training demands, crazy hours and all the rest put the pressure downward on both recruitment and retention.

    More to consider: all over the place, public funding for healthcare institutions is actually being reduced; currently just here in NY state, for example, our governor wants to cut $40 million from the state budget for healthcare, and he probably will succeed. On top of all this, we (i.e., we in the U.S.) are in a long, protracted war in the middle east that arguably hasn't even begun to get serious (a few thousand casualties is nothing compared to what it could or will be if it continues, which I am 99.99% sure it will). All those wounded, physically and psychologically, will need a large number of healthcare resources, and on top of that, eventually civilian healthcare workers will get tapped to handle military casualties. [Most Americans don't know this, but the legal apparatus for a drafting particular types of specialists and workers, including healthcare workers at all levels of skill and training, is already in place; a general draft need not be enacted by Congress. The president merely has to sign the paperwork to activate this system.]

    So, just WTF is the civilized world going to do about this issue? It can't do nothing, but it seems unwilling to do anything. I dunno what it will all add up to, but eventually, “the system” has got to break down. There is no escaping cause and effect.

  2. Its the same in my patch…increase in calls, GP out of hours useless and as you say some people call 999 for the slightest cough.But the public arnt aware of our crap AMPDS system so we are responding code red cat A to daft jobs…someone is going to get injured or killed whilst we chase more targets.

  3. I have to agree with KingMagic “…increase in calls, GP out of hours useless and as you say some people call 999 for the slightest cough”If our AMPDS system triaged pts correctly then we would be able to deal with some calls more effectively than sending a blue light flying through the streets of town putting other people in danger!

    Whoever made 999 so easy to dial just wasn't thinking…i just wish someone would educate people on when to and when not to dial 999!

  4. But how do you educate those who wont listen?If you have campaigns along the lines Is this ambulance really necessary? the folk who pay attention, and who then dont call an ambulance, are the likes of little old ladies who have had central chest pain for 5 hours and didnt want to bother any one!

    They wait till the GP surgery opens, then they wait again because the lines are engaged with folk trying to get an appointment for the same day (because they cant book one in advance for a routine check)

    Humpphhh I am getting all grumpy now.

  5. You missed NHS Redirect from your list or reasons for increased 999 calls.I've been to a call which turned out to be a broken finger nail. Admittedly it was down to the quick and hurt but …….

  6. I'm glad I wasn't the only reader who recommended your blog on the BBC forum: a lot of very stupid people on there with a 'gimme gimme gimme' attitude who need a smack round the head with a wet fish.I would also agree that NHSDirect needs to be blamed: each time I have been on the receiving end of an ambulance visit has been because they have called them for me. The last time I had reflux, which always presents as high chest pain. I was in a town I didn't know, it was gone midnight on a Saturday, and I just called them up to see if they could advise me on where I might get my usual remedy. It didn't matter how much I insisted that I just needed to know where to buy Gaviscon, as soon as they heard 'chest pain', the call was made.

    /rant

  7. I think my favourite comments on there so far are the ones who are along the approximate lines of “I have a car and I could drive to the A&E, but then I'd have to pay the congestion charge, and that isn't fair, so I call an ambulance instead, because I'm a taxpayer so I've already paid for it.”

  8. I really don't understand this “lack of education” problem. Why is it so difficult for people to understand when to call and when not to call? It's quite simple really…1. do you have a car? yes – go to question 3, or no – go to question 2.

    2. do you know someone with a car? yes – go to question 3, or no – I don't believe you, go to question 3 anyway.

    3. can the person walk? (PLEASE NOTE: unconcious would be “no”, broken leg or hip would be “no”, injured foot would probably be “yes”, early stages of labour would be “yes” but babies head appearing would probably be “no”) yes – go to question 4, or no – call an ambulance.

    4. will the person die during the trip to the hospital without medical help? yes – call an ambulance, or no – make your own way there.

    Half the problem is that people are such wimps these days.

  9. Tom, I allways enjoy reading your blog, and I would be interested to read your views on the new role of the ECA's and the demise of the EMT role. To date I have very little confidence in it. What do you think?

  10. I know NHSD may not be flavour of the month to many people. but surely you cannot blame them for hearing chest pain and acting on that. Wouldn't you have been one sorry bunny if in fact it wasn't reflux..I hope now you have made a conscious effort to make sure you have supplies of Gaviscon at home or at least know where your nearest all night supermarket/garage are.

    I think the main problem leading to the increased calls is as previously stated the lack of simple education and the selfish and irresponsible attitude of many people.

    I have worked in Acute care through PCT's and in recieving units and many of the people I have dealt with who have turned out to have very minor problems cite the reason for not contacting their GP is they are too busy during the day to go to the Dr and it is their right to see a GP/doctor when they want.

  11. People just need to be educated, I recently went to my GP after falling down the stairs as I didn't want to waste peoples precious time in A and E. I ended up there anyway after an x-ray discovered I had a broken ankle! Whilst waiting a woman arrived with her young son, when asked the problem she stated “He has an ingrowing toenail!”. These kind of people need to be educated!!

  12. I agree.. There is not much hope however of educating the genetically stupid. I think the stun gun idea is the best for most of these people. Either that or compulsary sterilisation to prevent yet another generation of idiots abusing the system.

  13. I often look out for you at one of those A&E's on your patch which is closing. Its ridiculous, and I fail entirely to see how Queens is going to be able to take the people from the two closed / closing. And, I'm sure it will cause an increase in 999 calls, as its really quite a treck on public transport for some people.They've already moved our occupational health there.. along with the subsidised accupuncture *rolls eyes*

  14. About 24 hour licensing. I have seen the research that is being done by certain influential bodies about the introduction of extended licensing hours, and it entirely revolves around alcohol related crime and disorder. In terms of that, the change in licensing has been a very good policy, but no one influential seems to be looking into the impact it has had on healthcare services. Might be worth a bit of a campaign.

  15. Hiya, I agree with most of these points but have to say, regarding 2., I don't know anyone with a car who would be able to pick me up say at 2am with serious symptoms.My friends/acquaintances are either carless, single mums who can't just drag themselves out (or wouldn't even answer a late phone call) or not people I know well enough to ask – eg the guy I say hello to 3 doors down.

    Taxis are fine but occasionally, as I'm self-employed, I have cash-flow hitches and simply don't have the 30 – 40 cash available it would take to reach my nearest A&E.

    The assumption everyone has access to a car has caused me serious problems in the past, and while I may be in a minority I don't think anyone deserves to die for being without a motor – esp. since cars are such destructive things to the planet as a whole. Just my two bob on that issue – like I say, totally agree with the rest.

  16. Back to my Grandmother again. Man rings front door demanding to be let in, GM has common sense to not do anything. Creeps upstairs and sees three men wandering round house, shed and garage. GM does nothing more except lies down in the dark and worries.When questioned as to why she didn't dial 999 for the police, the response was “Well they wouldn't come would they, and anyway when I rang last year to tell them my shed had been broken into, the woman told me off because it wasn't an emergency”.

    Ninety year old, angina, breast cancer, lives on her own. Are we you helping the wrong people?

  17. I read some of the comments on the BBC site, gave up after a while, some right idiotic comments in there, probably due to lack of education.But, yes, you are right, good points in there.

  18. Increasing workload has been affecting other parts of the NHS. My Mum has worked in the Pathology department in one of the SW's hospitals for just over 25 years. When she started, they'd have about 300 samples per day, now they have 2,500. In the past year, their workload has increased by 20%.Coupled with that, they are no longer allowed to replace staff due to costs. Whereas in fact it would apparently save money if they did employ more people.

    I read your book about a month ago. Practically glued to it, I was.

  19. It was my wedding night, knowing where to get Gaviscon was hardly high on my list of priorities! Great fun speaking to NHSD on that though: 'Have you done anything stressful today?'

    'Er, yes, actually, I got married.'

    '…. I'm sorry, I have to ask, have you eaten or drunk anything unusual today?'

    'Did you hear my first answer?'

    'Yes, sorry, I just have to follow the auto-prompt on screen…'

  20. Education is one thing, but is too much knowledge a bad thing? One of the problems is that people know what to say to get an Ambulance now, I have been to several calls over the last year or so that was put through on AMPDS as either breathing problems or chest pain and when we have got there it has been nothing of the sort, but on asking why they said that they had chest pain, the reply was so that they got an ambulance, and then wonder why we told them off, explaining that they would have still got an ambulance regardless, just not one arriving at x mph with all the bells and whistles going. Will we ever be able to educate these people? I doubt that very much….Maybe a system in place involving the crews, A&E nursing staff and doctors might work. One tick from the crew to agree that an ambulance was necessary, one from a nurse and so on and it is agreed that indeed an Ambulance was a necessity, those who don't get any ticks get a warning and/or fine?

    Or alternatively (which is what will happen) nothing will be done and we will just get busier year in year out.

  21. Another fine post – I'm sure the reasons for increased ambulance call-outs overlaps with similar increases in A&E attendences.Ours numbers are up by over 30% in less than 10 years.How long before we have a more robust system so that crews and triage nurses can refer non-urgent problems to other providers.In my experience front line staff are finding it increasingly difficult to keep up with current demand and expectations.

  22. Move her to sarf London where guns are mandatory, and she could pack a pistol and get “respek”?Or, talk to her about Darwin, who would also have something to say, which I wouldn't agree with and so think she should be able to have one-press panic button access to police – as shelters for abused/fearing death women do.

  23. How does the ageing, legal and legitimately needy population Vs. the junkies and bumheads fit in to a right wing person's view of how the emergency services should be managed?Surely a successful whiner who happens to have a great education and well-piad job should have more right to an ambulance, in a “meritocracy”, than some old poor person who can't afford it and who's going to die anyway?

    I am neither left nor right nor am I trying to be problematic, but I am seriously hoping to learn something here, and apologies in advance if my post is out of line, I support healthcare for all but cannot get my head round any system that could offer that.

  24. Maybe this is part of the answer? No one co-ordinated a special public awareness campaign which educated the system abusers about how 999 react to “chest pain”, it just spread about. So maybe if fines for really inappropriate use of the ambulance service were simply introduced, quietly, then knowledge of that would just spread about – without scaring elderly/vulnerable genuine callers with a “hard-hitting” series of adverts to which the service abusers won't pay any attention.

  25. I always forget which wing is “right” and which is “left”… and I haven't the foggiest which I am.I don't think being lucky enough to get a great education has much to do with whether a person should be prioritised for emergency healthcare, and I can't see ambulance dispatchers tapping your NI number into the computer to see which tax band you're in before sending a crew.

    How non-emergency care gets shuffled about is another thing entirely, any amount of arguments can be made for and against private healthcare, helping those who help themselves first, walk-in clinics, on-call GPs, prescription charges, long-term care, and a million other facets of debate.

    But for emergency ambulances, it should only be about the nature of the emergency – saving life or limb of a person who, regardless of status, tax contributions, age, hobbies, etc, is a fellow human being.

  26. 0315 in the morning a couple of days ago I was phoned by someone wanting assistance with bathing a skin complaint. This was on my private number. I don't work for the health service. I am just a member of a VAS. Needless to say, I was not impressed.

  27. TomAgree with you on most of these points. However, the increase in Ambulance call outs was a national figure, and although the population of London is increasing and likely to increase further, the population of the country overall has remained stable (unless there is a large unregistered underground population which is possible).

    Your point about lack of education is interesting. Arguably there is more education as the Internet and other sources of information become increasingly available. Maybe when people were more ignorant they panicked less about health issues!

    Your point about alcohol definitely seems spot on though. Not only does it make people ill when consumed in excess but it also impairs their judgement when considerig whether an ambulance is required or not.

  28. god I hate BBC have your say, I don't think they should be allowed to get away with publishing some of that stuff.people find a way to blame everything on the forrins.

  29. That would be my ideal…I'm fascinated that our society bends over backwards to give free housing, free money etc to people who do nothing or who choose to destroy their lives, yet I can't see what the alternative would be that wouldn't be – well, just awful.

    I'm just posting my Q really because I gather people with all kinds of views post here, and those people are sensible enough not to get shirty.

  30. LOL that's been going on since before the Roman empire though! I think HYS is compelling reading, there are occasionally a few thought-provoking posts, and some have me in stitches of laughter through their stupidity. It's educational to realise that those people have the exact same vote as me, as you, and it casts light on how politicians can actually get away with some of the nonsense they pull.

  31. But my husband was told to go to minor accidents when he awoke with fever becuase his ingrown toenial had gone green – nhs direct told us to go there and even suggested an ambulence.

  32. I think lots of people have gone really nurotic as well – my baby drank the cats milk jhust two spoonfuls – I thought this was funny and posted it on a forum and everyone told me to ring for an ambulence and take her to hospital with the ingredients of the milk.They were saying she would throw up and be really ill and stuff. I checked the ingredients and its all stuff thats in humans food. I was just suprised by that sort of reaction.But at the same time I went to casualty on the bus as the doctor hadnt thought to check weather my husband could drive! And there was a bit of a walk to the bus stop.

  33. I hope that Tom's comments about Ambulances being called for mere foot warts was a joke… sadly i think it probably isn't.The “emergency” health care in the UK is sadly abused. Mainly by the same people who then complain about waiting times in ED. They probably even tutt at the stories in newspapers about people who are ill being kept waiting.

    I hope to goodness i will never again have to call for an ambulance for my baby- and if i did that it would not be tied up taking one of those timewasters.

    I don't think it is for Ambulances to police who uses the service, but perhaps a few hefty bills aimed at those abusing the system might just get the message across!

  34. I have actually just had a brainwave and hit upon the exact, perfect solution to this – one that won't frighten the many vulnerable elderly out of calling when they need an ambulance, but which will take care of the foot-wart crew in no time at all.Ladies and gentlemen, it is this:

    Give the patient the full conventional medical treatment for the problem they complain of. In its most serious form.

    Think about it – someone calls in with a cough (“chest pain”) wanting antibiotics they can't be bothered to get from their GP – ambulance crew gives them a full course of defibrillation, and perhaps an open-chest heart massage.

    Person calls in with a sniffle (“difficulty breathing”) and gets stuck into an iron lung for 3 months.

    Person calls in with a wart of their foot – super, field amputation, quarantine them for having that necrotising flesh-eating bug thing, and then give them the treatment for leprosy just to round stuff off.

    Maternataxis could get off lightly with an emergency caesarian, while all drug abusers could be shot into space in special life-support capsules to detox for a few weeks, since “getting high” is the aim of the game after all.

    Stupid, I know, but the idea makes me happy! :o)

  35. I was listening to a debate on BBC radio today about car parking charges at NHS hospitals. Apparently some trusts are actually making millions from charges. I must admit that I have been a bit miffed at having to shell out when taking my baby sons to hospital. One caller claimed that the increase in ambulance call outs were partially attributable to these costs. Rather than pay out, they call for an ambulance and get someone to pick them up later.

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