Race Week – The Ambulance Service

(But before the race stuff – apparently NHS Direct are referring too many calls. What have us ambulance people been saying since it started?).

Before working for the ambulance service I was a nurse in North London. Where I worked there was a large Turkish and Greek community. But I've never met a Turkish or Greek nurse.

Where I work now there is a huge Bangladeshi population. I know of three ambulance staff on the road in my area who ethnically come from that vague area of the world. We also have one North African and one 'Black British' ambulance staff. If you were to look at the ethnic make-up of my patch of London (and here is the link for the other half of my patch) you would see that this is a massive under-representation of 'visible minority ethnic' people.

So why is this the case?

(I would suggest that they aren't daft enough to work for the NHS – but that may be seen as being snide).

I'm honestly not sure. I have a theory, and again – if people have other ideas please do educate me.

Some cultures have traditionally had to look after their own families, probably because the ambulance and health services in their country of origin are poor. I don't think that you get ambulances out in the Bangladesh countryside, so you would have to look after each other and the ambulance service isn't seen as an important job.

I have a colleague who lives in India for half of the year and she tells me that the patients relatives have to supply the food and sheets when that person enters a hospital.

Is this why certain populations in London don't consider the ambulance service for a career?

Given the amount of Eastern Europeans that are working in London at the moment it does surprise me that none of them want to join the ambulance service, although I suspect that being a plumber pays better, and why would you want to retrain when you already have a skill that transports easily.

But it goes the other way – I believe that nursing is seen as a worthwhile career in the Philippines and that is the reason there are so many nurses from there (coupled with our willingness to 'poach' nurses from other countries in a cyclical boom and bust fashion…)

The question that I haven't got an answer to is if there needs to be a change in this situation, and if so how to go about it. Beyond the normal tired 'roadshows' that tend to pop up when a committee discusses such ideas.

There is one thing that I do believe is that all the 'VME's' that work in my area in the ambulance service have been accepted by an overwhelmingly white English workforce. Of course I may be wrong, not having the same perspective that they have but I honestly think that we save our energies for our real enemies.

…Alcoholics, the government, ambulance management, St John ambulance, drug addicts, people who try to assault us, people who make frivolous claims against us, heavy people who want us to carry them downstairs, GPs, the press, nursing homes, hospitals, hospital management, hoax callers…*

This blogpost was delayed by playing Civilisation IV until the sun came up.

*Joke. Obviously. Well… mostly. I'm serious about the government.

25 thoughts on “Race Week – The Ambulance Service”

  1. I suspect that being a plumber pays better, and why would you want to retrain when you already have a skill that transports easilyBut surely ambulance driving is a skill that transports quickly?


  2. I worry when all this blame rears it's ugly head. GP's are getting flack for big wages, opting out of out of hours, poor accesss to in hours appointments etc etc etc… I know lets shift the blame and use the reliable back up of the smoke screen that is Blame NHS Direct. Surely there has to be some common sense engaged here.IF In hours GP surgeries had better access to the patients.. If patients actually listened and did as they were advised … Took some responisbility for themselves when minor ailments hit. that would take the pressure off some area..

    But as one who works in OOH telephone triaging calls I can vouch for the fact many many caller tell lies to get access to the service and on occasions they may oversell themselves ” yes I have gripping central chest pain, it is going to my left arm and neck, I feel sick and sweaty!!!” when actually when the paramedics arrive they profess to have only had a slight pain a few hours before the call..

    Why oh why are we in the NHS insistant in slagging off each other… why don't they get together and sod the politicians.. let us work out a reasonable strategy to hand all such problems..

    GP surgeries during the day often orchastrated by the rockwieller receptionist tell patients to call NHSD for assessment during the day to see if they really need an appointmenty. or as I often hear direct the patients either to call 999 who redirect category C calls to NHSD. Or tell them to wait until after 18.00 to call ooh and tell them they need an appointment.. Who is abusing the service here then??

    I symathise with the NHSD staff.. if they direct to self care and a patient dies…. they are heading for a FAI inquest with no support from their own employer on the otherhand when referring the patients are targetted by the GP's Who incidenlty were the ones the service was set up to cover their backsides since the new GMS contracts were in the offing…

  3. NHS MisDirect (or ReDirect) are bloody useless. Their latest trick is calling amulances for people who DO NOT want them. I have had several occasions of late where crews have called up on the radio saying “Err, Can you tell me who called the ambulance to this address – No-one here has vcalled an ambulance.” I say: “The call came from NHSD, via the location (from the caller identifier)” and the crew say “OK – Point taken – bear with us, get back to you shortly.” Later on I get the full story. Most recent was a call in W6, so close to Charing Cross hospital you can spit on it. Six year old child been diagnosed with Chicken Pox by the GP few days earlier. Not surprisingly, the pox hasn't yet run it's course. The mother rang up NHSD, and – knowing that Charing Cross Hospital doesn't deal with paeds – asked if it was OK to take the child by car to Chelsea and Westminster, which does do kids. Apparently, ther moter stated CATEGORICALLY she did not want or need an ambulance, and was stunned when we turned up. Another complete waste of everyone's time.

  4. did you actually get to listen to the call made ? there are many occassions when people tell lies to try and ensure an appointment with a gp and are as stated before over selling themselves then backdown or deny knowledge of why ambulances are sent.I think by the sounds of all this the most important lesson so far is all parts of the health service need to get together and understand each others roles and responsibilities to always ensue the best and most appropriate outcome is reached in the majority of cases..

    I am sure there are many stories you may have of NHSD referals as they will have of the Ambulance and GP directed calls to them.. but surely this this sniping and picking holes is keeping the real problem out of the news… patricia Hewit and central government!!

  5. You can pick your headline really.”NHSDirect are wasting millions in NHS resources by referring too many callers to OOH services and emergency ambulances!”


    “Child dies after NHSDirect failed to recognise signs of Evil Fatal Lurgy! Distraught parents say “we were told to take her to our GP in the morning…”

  6. Well there is one answer, it's too bloody difficult to get in to the ambulance service! As you know, my daughter is itching to get in but the goal posts keep getting moved.Telephone triage is dodgy, it's so much better if you can see the patient. I'm sure that's one of the reasons that you have problems about who is sent where. eg emergency care practitioner or fast response or ambulance. At least when I triage house call requests I often know the patient and I have their notes. Your control have a very limited time to decide which ridiculous target they are aiming for!

    As for ethnic minorities it seems the better educated opt for jobs as accountants, doctors,lawyers, pharmacists etc. possibly because these are considered to be suitable professions by their parents.

    I still don't think the general public have a clue what an EMT does. It goes back to an earlier discussion on how the ambulance service has evolved from the pick up and run era.

    Sadly, those who have not been so well educated would not get through the selection especially now there's no EMT training so you are expected to go to university to become a paramedic.

    If we brought back some form of apprenticeship we might get more diverse applicants to jobs such as yours and nursing and many others.

    I'm not a huge fan of all this university stuff. Sure if you're really academic and want to study in depth, fine,but soon you'll have to go to university to work in a pub or a chip shop.

  7. Short answer here is: If someone DOES NOT want an ambulance (regardless of the circs), why should I send one, when I can send it to someone who actually wants it?? I lose count of the genuine, decent people who want to help us out “because I know how busy you are”, to whom I end up sending an ambulance,. On arrival, the family are happily getting into the family Volvo. Tom – Been There?

  8. Blame all the uni stuff on Blair (that's what I like to do)It's a fine route if you can get in, but my biggest wonder is that a large amount of people I work with came in a long time ago and don't have anything like A levels and sometimes GCSEs. These people do, however, know how to deal with pissed up council estate people because that's how they grew up. This is something that I and other uni people will have to learn as we go along. I just feel that the profession will be deprived of a certain type of people who are very valuable!!

  9. Just a thought – is there a “cooling down period” needed by new arrivals en masse before they feel comfortable getting involved in any kind of civil service/public service jobs?Is there a point at which new arrivals feel it's safe to abandon either low-level service jobs or single entrepreneurship, and really engage with the ongoing life of their new country? A point at which the individual feels secure in their place, enough to offer their skills for the good of people outside their immediate cultural group/community?

    Anyone hoping to “go home” as soon as possible, may not see the benefits to them of taking a RELATIVELY low paid job if their own family business, which supports people they love at home, prospers.

    And likewise if someone feels so left out of any chances of bettering their own position that the best they can aim for, is the lower end of the service market, a job saving lives may not occur to them.

    I cannot imagine being transplanted to Peru or Rwanda, for life, and immediately assuming that a place in public services was totally right for me – most of the gap year UK kids who do overseas aid work don't engage on an everyday level with local public service workers, they do their charitable fly-by (and I'm not knocking it) for a UK-based charity or NGO, and with a ticket home to an NHS/welfare state country constantly in their pocket.

    Final thought: when I trained a young Indian student to take over a job I was leaving, he told me that in his area (if not country – I can't say) corruption in the form of bribery – and more often, favours done for cousins of friends of uncles – was endemic.

    And so, he was amazed at the ease with which he could walk into a job without needing someone “on the inside” to grease a few palms, pull a few favours, and generally ease the way.

    I will venture to suggest that any nation without a considerable and established middle-class – that group of people who make comfortable incomes, have no immediate life/death subsistance struggle, and so feel secure enough to contribute to their communities and countries in the social and political spheres – suffers from bribery and corruption we can't really grasp, as the mass of desperate poor struggle to achieve the lifestyle of the few mega rich.

    But I'm no sociologist and these are just my observations, and I'm ready for them to be just plain wrong – only offered for what it's worth.

  10. First of all, Tom I loved your book, I have recomended it to anyone who asks me what working in the ambulance service is like (or say “Ooh I bet you see some sights).On the subject of whether people lie about their problems to get an ambulance – of course they do! In WMAS we have a paramedic in the control room, if a call taker feels that a person does not need an ambulance they will transfer the call to the paramedic who will give advice over the phone.

    Often you will start running on a job and will be stood down as the case is 'going to the Paramedic in the room'. 5 minutes later you will be running on the job again, but now it won't be itchy teeth…nooo it will be itchy teeth with chest pain!

    People know that if they complain of chest pain or difficulty in breathing they will get an ambulance. And they will (maybe) get it very quickly.

  11. Oh and just to add, As much as NHS redirect annoy me I wouldn't fancy trying to triage over the phone. It's much easier to tell if a person is lying face to face.

  12. how about some policing where if people blatantly lie they get fined.it's disgusting how people will do this to elevate their problems above other's genuine ones.

  13. Yeah, coz fines and laws solve everything. I hear what you're saying but look at the history books, and look at Nulabour's attempts to turn everything into a no-trial, fineable “Crime-lite”…Who administers this, the Ambu crew at the scene, who may see the reason the person called if not agreeing? Some remote civil servant who doesn't know the facts?

  14. At a rough guess NHSD telephone staff are using the same guided triage system online users have to wade through. If that's the case then I can see why so many spurious 999 calls result.A few months back I was fixing a light switch and shut off the wrong circuit breaker. As a result I got a bit of a belt off the mains resulting in being somewhat shaken up and a tiny blister on one finger. Thinking better safe than sorry I went online and ended up in the 'Burns' section (there's nothing specific on electrical shock). Was there damage to the skin? (yes – a small blister), was the heart racing? (yes, like I said I was pretty shaken) – “CALL 999 IMMEDIATELY!”. Now I have more sense than that so went and made myself a cuppa, stuck a plaster on the burn and had a sit-down for half an hour after which all was back to normal and I could get on and fix that &!$** switch. If I'd phoned instead of going online I'm sure I'd have had an ambo outside my door and spent the next 4 hours kicking my heels in A&E (with no tea). Obviously whoever put the triage system together had one thing in mind (shock due to a significant burn) but the way the questions led me through the system I had no way to qualify my answers or apply common sense.

    I'd hate to be in the shoes of an operator who saw that “CALL 999 IMMEDIATELY” on the screen and had to make a judgement call based on what they were being told rather than what they could see. Personally I too would probably err on the side of caution.

    Fix the cause, not the symptom.

  15. Plenty of ambulances would be a good start – that way when people slip up or take the mick by abusing the service, at least there's enough nice big yellow taxis left for the real cases.Any system so pared down that it only works if everyone is perfect is designed to fail – even our brains have multiple redundancy, because nature realised long ago, sh1t happens and you'd better have backups in place.

    Smoke detectors, insurance, the prison service, even most medical treatments acknowledge by their very existance that people screw up, make bad judgement calls, and are sometimes just plain lairy, yet this one essential piece of our lives is being stripped down to only work in a perfect society.

    That is just plain stooopid beyond belief.

    JMO. :o)

  16. Right behind you on that one playdoh!I am a student nurse (names a bit of a give away, no?) about to finish my uni course. Do I think that the uni course teaches me what I need to know to go into the big wide scary world of the RGN? No. Its provided me with basics, yes, but I know my real training will come after I qualify and start working as an RGN, alongside people that never went to uni, but by god, do they know their stuff.

    A prime example is that of my sister in law who is a modern matron, and who qualified over 20 years ago. Her Trust is now saying that she does not have the necessary qualification and are putting her through a part time uni course!

    I firmly believe that you get some people that are very academic but a bit duff with patients, and you get others that are brilliant with patients and duff academically, or you may be lucky and be a combination of the 2. Does being a bit rubbish academically make you a bad nurse? No. Does being brilliant academically make you a good nurse? No. You need both skills to do this, and alot more besides.

    The university route, although basically sound, could be doing alot of people out of a job that they would be good at and really want to do, all because the government want us to be able to wave pieces of paper around.

    At the end of the day, is my patient going to care what percentage I got on an assignment?? NO, what they are going to be concerned about is whether I can provide them with good quality patient care and support and help them to get better, adjust to an illness or, in some cases, to have a good death.

  17. Yes NHS (re)direct are a pain in the posterior but if you look at it from their point of view then they have to err on the side of caution. The increasingly litigeous nature of medical work unfortunatley makes it that way. If you don't see the patient all you can do really is guess whats wrong with them. I have been to people with “Chest pain” that turned out to be everything from renal colic to back ache (anterior chest pain apparently). So what do you do? I would suggest scrapping it

  18. if you look at from NHSdirect side you would listen to the clls the patients make to them..I have just done the same for SAS calls from NHS24. e.g. having listened to the recording the patient clearly stated on the call of 22.30 monday night had gripping central chest pain . going through to his left arm and up left side of neck.. and yes he was nauseated and sweaty +++ 999 ambulance requested rightly by the nurse advisor. However, when SAS arrived and report the patient stated no nausea or central chest pain NIL ecg changes on arrival denied agreeing to ambulance dispatch. And apparently stated to SAS crew though had indigestion,

    Do you notice the trend here…. PATIENTS LIE !!

    Incidently it turned out on follow up with a Glasgow Hospital the following day ( after SAS had felt transport to hospital not neccessary and NHS24 over reacting!!. A GP had arranged admission and the said patient had had undergone ANGIOPLASTY and 3 Stents had been inserted at the W.I.G. ) think on!!!

  19. its good to read the positive support for NHS direct, its an innovative service thats has huge demand from the public. Are you telling me that you've never known ambulance staff taking a patient in to be checked on the safe side. I'm aware sometimes ambulances may be called unnecessarily but can NHS staff work together. I notice you didn't comment on the BBC news story reported the following day where a child was waiting to be seen in A and E for 90 minutes for a head injury he got so distressed the parents took him home, they rang NHS direct for advice who told them to return to A and E because of his symptoms. He was diagnosed with a skull fracture and swelling of the brain. We all cover each others back, can we stop this blame culture as its the patient who comes first.

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