Money, Money, Money…

We have an internal monthly 'magazine' called LAS News, and to be honest it's fairly awful (sorry communications department). But in this month's issue there are two interesting tit-bits of connected news.

'Savings to be made to ease the financial pressure'



Savings of nearly £11.5 million will need to be found to balance the Service’s books this year. Increased costs – including £14 million for staff pay as a result of the introduction of Agenda for Change – means that the Service’s £219 million budget will not cover outgoings over the next 12 months.

As approximately 80 per cent of costs relate to staff, it is possible that some posts will no longer be funded. Although no decisions have been made on how many jobs and which areas of the organisation will be affected, some reductions on posts will be achieved through not recruiting to vacant posts.

It is also hoped that some savings will be able to be made through more cost-effective purchasing of resources such as uniforms, vehicles and fuel.

Which I read as we are in danger of going bankrupt due to changes forced on us by the government. It's also the first time I've known how large our budget is – £219 million pounds to run a 4,000 jobs a day 24 hour service and civil emergency planning service.

Which, if my 'back of the envelope calculations' are right (£219,000,000 / 365 days in the year / 4,000 calls a day) equals £150 per job. That is to pay everyone, get new vehicles, new stock, petrol, uniforms and so on and so forth. Around £30 of that £150 goes to my crewmate and I, of which our bank balances see around £10 each.

And then it looks like we are going to lose some posts – probably starting with the training department as we can't afford to hire new staff. Then some people will leave the job due to retirement and the total number of staff will decrease as they won't be replaced.

But I'm not budget minded, so it's a bit hard for me to comment on such things.

However…

'Boost for alternative patient treatments'



A payment of £38 is to be made to the Service for every patient who receives appropriate care that sees them not needing to be taken to an A&E department for treatment. In a bid to reduce inappropriate A&E admissions, London’s primary care trusts have set aside £800,000 this year as an incentive for the Service to provide alternative treatment for patients who do not need to go to hospital.

So – every person who we go to, and don't take to hospital means we 'earn' £38. Which is a fair chunk of the £150 that I mention above. To be able to claim the full £800,000 we just need to leave 21,000 patients at home (sorry – refer to alternative care pathways), which is 57 patients a day. Out of 4,000 calls this means we only have to refer a shade over 1% of patients.

This is easy – I refer far more than this number and I'm a 'nervous nelly' when it comes to leaving people at home. So it's not really an incentive if we are doing it already is it?

Now for the complicated part – We supposedly refer 32% of patients via our telephone advice service, or they are attended to by an ambulance crew but not transported (data from the same story), yet we are looking to double the amount of telephone advice staff. I have no problem with this if it means that more people are given appropriate advice and an ambulance isn't sent. But, given our budget pressures mentioned in the first story, where are these staff going to come from?

Off the road? If we are going to less calls then we need less ambulances don't we?

Yet I still hear Controllers on the radio asking for any free ambulances to attend to emergency calls because we are all busy.

I don't know – I'm just a bloke with a big yellow van; I'll leave it up to people brighter than me to work out if I'm missing something obvious. As always if someone from management wants to email me corrections I'm more than happy to print it.

(Apart from the magazine being poo – I'm sticking by that. Also the internal website makes my eyes bleed and is completely unfit for purpose).

26 thoughts on “Money, Money, Money…”

  1. Can't you just grab some money back from trusts that have a defecit? I know our trust bailed out two local PCT's, so surely LAS can do the same?!Wonder is LAS can become a foundation trust? That way they would get to play with their money on their own.

    And finally (!), I know a friend who was the guilty party in a relatively RTA a few years back got charged for the amulance that was called?

  2. Brian If you read the LAS news of about two months ago, the one where the FRU was parked on it's roof on page three, top right hand corner it tells us what our leaders have got planned for us leading up to the Olympics. Basically they want to cock it up for all of us. they are planning more paramedics and EMT 4's but are binning all EMT 2 & 3's so that is how a large chunk of money should be saved, but they have bought in the brand new A&E support , as far as I am aware A&E support courses will continue to run in to next year, plus they are half the length of the tech course so are cheaper to run, and on top of that are only in band c of the agenda for change the only problem is no one seems to know how to progress internally through the ranks from A&E support up to paramedic. There are rumours of a bridging course up to EMT in which case why not just start us off as EMT 2's in the first place or the other option is through paramedic degree courses however Greenwich had something like 800 applicants for 17 positions on the course. there are not many universities in Britain which run the course, so this idea may lead to a drop in paramedics, also some of these students are buggering off to Oz as soon as they have passed, for a new life in the sun.On top of that management are binning some trucks on the road in favour of the cars (orcon targets) so instead of our punters dying because no bystander started doing CPR, they are dying on the street after a FRU driver has been bagging them for 40 minutes and managed to get a copper to do the CPR, where they are too knackered to continue to do it themselves. all that because there are no trucks available to take them to hospital.

  3. yes, i agree about LASNews – its full of sycophantic back slapping. you could cut that out and save a bob or two

  4. I reckon they could save some dosh by sacking everyone in ambulance control. I mean, they allow those guys to use their common sense even less than they do you frontline guys. It seems like calltakers are treated like data entry clerks whose job it is to read out the prescribed questions, type in the answers, then let the computer decide the priority level of the call. Now, excuse me if this is being cynical, but if they're going to be treated like that, why not just have a computer system that says “Press 1 if you are having difficulty breathing, press 2 if you have pain in your chest, press 3 to hear more options, press hash to return to the main menu, or press star to hear these options again.”

  5. Why don't they just scrap the magazine and free up all the money they put into its publication? I know it wont free a great deal but its a start.

  6. Interesting statistic the 150 quid a job one. I wonder, in comparison, what the average taxi fare would be for each of the jobs would be?Also I would be very surprised if you get paid 30 pounds per job. At one job per day that would be about 11,000 a year!

    It strikes me that there must be some large overhead somewhere.

  7. 30 between 2 crews pre tax and pension, taking that a job takes one hour that would be 15 per hour per person, then tax takes 5 that would be 10 per hour per person.a bit rough but you get the idea.

    Save money get rid of the deputy managers

  8. More bums on seats in Vehicles.. not sat behind telephones.. Our Chief Executive says that we're adequately staffed to cover the calls we get.. so how is it we had 2 ambulances covering ( according to the 2001 census) 119292 people from midnight last night..?

  9. The car insurance of the guilty party should've paid out to the ambulance service (and, i think Fire & Rescue), Fimb.Management somewhat c*cked up across the country.

    With the A4C approaching, i am led to believe, all trusts were asked how much it was going to cost. Focusing on EMS,say, the figures were estimated around EMTs = band 4 and Paras = 5. Whilst many services have gone with this undervaluing their primary personnel quite a few other services have managed to get advanced EMTs in to band 5 which has thrown all their figures out of the window. And that's only one area where the figures have not added up. If the service bosses had calculated the figures correctly in the first place alot less corner-cutting and penalising would be going on now.

    Having said that, ALL the bosses of the UK services (ambulance trusts) should be marchin up to Westminster and telling that lot how it really is and not doffing their caps and tugging their forelocks. It's time our bosses sided with us and valued the people who work in the sector of why the ems ambulance service exists in the first place.

    Anyone else like to borrow my soap box? 😉

  10. Another take on it is companies doing things by the book to avoid liability.A couple of weeks back I walked rather rapidly into a glass door which resulted in a few bruises, a suspected broken nose and because my glasses broke and scraped across my nose loads of the red stuff (didn't go well with my yellow shirt). To stop the blood dripping down my shirt even more I sat down and then the building supervisor came to me and said he had called an ambulance. Having played Rugby for many years, broken my nose at least three times and had more than a few concussions I knew an ambulance was probably gross overkill and asked him to cancel it. He wouldn't saying it was company policy and the insurers insisted on it. My choice was to just walk off and really piss off the LAS or to stay and just slightly piss them off. I stayed, they arrived about 5 minutes later, we quickly established that a trip to casualty was not required (though it was offered just in case) and that I would not be alone overnight if things did go pear shaped. I said my thanks, apologies and goodbyes and wandered off down New Oxford Street to the Tube.

    I was grateful for the ambulance turning up but I think all the parties there knew it was not a medical need being satisfied. Ifit hadn't been “policy” then precious resources would not have been wasted. The only upsides were the ambulance crew got a toilet break in a civilised environment and in the future you would get your 38.

    (Nose was broken – not worth fixing as it was straight enough given all the previous breaks. Main damage was the embarrassment especially as I was stone cold sober and couldn't blame alcohol)

  11. not just companies, but individual workers too. I used to have the sort of job where we were all required to have a First Aid At Work certification renewed yearly, and the (not connected to our company) trainers' big thing was “no one ever got sued for calling an ambulance”.

  12. 14 million for staff pay as a result of the introduction of Agenda for ChangeHow much of this 14m actually made it to your bank account?

  13. Then who is getting this 14m. The overworked and under-appreciated managers?Incidentally, it would be interesting to know the ratio and pay rates of admin staff to those who actually do the work. The figures for 10 years ago and today would make interesting reading.

  14. Tom,Am quite new to reading your blog and find it fascinating, am a nurse who is considering joining our local ambulance service, do you think i am mad and should stick to nursing?! Any good tips for my application form?

    Our PCT has huge debts and we have just merged to become one huge debt forcing my managers to become redundant, i think all the NHS is in a state finacially and it will just continue…

  15. Do it do it do it. Its the best and worst job in the world.Re the application form, get the job description and profile. On it there will be a list of requirements. Some will be essential, some will be desirable. If you don't clearly document evidence that you meet each and every one of the essential requirements you wont get shortlisted, even if you've other qualifications which exceed them. If that's the case, draw attention to it in your application. eg Whilst I don't have a btec in learning to blog 1, I do have an HNC in blogging for beginners which exceeds this qalification. Please do not fail to shortlist me on this basis as I am qualified beyond this. Make sure you also document that you meet as many as possible of the desirable qualities.

    Go on the BBC website to practice maths and english skills and also get someone to take you out for a few lessons in driving a transit van. Only 20% of people pass the driving assessment. oh. and make sure you've relearnt your highway code before the driving assessment. Loads get caught out by that……..and start going to the gym now. The fitness test is as hard as it sounds. Good luck.

  16. Thanks for your comments, i have the application form and completed it earlier so fingers crossed!The driving assessment sounds scarey and i have the extra hassle of having to get C1 on my licence provisionally first, which includes me having a medical from my GP who wants to charge me 80 to tell the DVLA i am healthy, Unbelievable!

  17. so if the Agenda for Change which was introduced by the government is costing 14m, shouldn't the government be stumping up that extra 14m?Or am I missing something?

  18. As one of the useless types in Control, perhaps you can tell me who will:a. warn an amb crew about a hazardous situation, which becomes apparent when they are already on way to a call;

    b. be the human voice that the crews speak to, when they need something done, a favour, some time out after a nasty job;

    c. take the call from the crew, who have been assaulted and want urgent police, because the all-seeing computer didn't tell them about the bloke with the knife, on the automated police call, where all of the info doesn't appear on the crews' screen.

    d. be the contact on the radio, who is there to give crews any and all info they need…

    I coud go on…….

  19. Correct me if I'm wrong, but I think Daniel was probobly batting your corner here? You, like us get a “feeling” about a job that comes from experience and that golden quality called common sense which they are trying harder and harder to beat out of us. I'm an ambulance tech (you know, cool, calm, controlled, dependable in an emergency……..) but when I woke in the night to find someone trying to break into my house it took me 3 attempts to press the buttons on my phone in the right order to make the 999 call connect!!I can only imagine the type of calls we'd be dispatched to if it were dependent on a push button method. Actually guys, I reckon people wittier than me could kick off an entertaining run of comments here speculating?

  20. Wait, so… someone, somewhere will be getting kickbacks for not treating patients? Or do they want that you become GPs?And as for the Agenda for Change… I thought most of the crew got screwed over with that, pay-wise. Where did this extra 14m come from? And why would that have to come from NHS when the government was the one that spent it for the sake of NHS in trying to save money for it? What?

    I don't understand a damned thing about how the government does their finances. All I know is, if I did the same, I'd have been kicked out of my apartment and sleeping in a box within the week.

  21. No, unfortunately has to be GP so i think i will just wait and see if i'm shortlisted first otherwise it will be a complete waste of money!

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