Falling Apart

David Nicholson (Chief Executive NHS)

The ambulance service is not close to breaking point. It's tough, there is pressure on them, but I think they are responding fantastically well. Staff are absolutely responding to provide a fantastic service to our patients

Peter Bradley (Chief of the London Ambulance Service)

The increase that has come this winter has been far more dramatic than normal. It has been the most difficult ten days I have seen in the last ten years. It is absolutely horrendous. Hospitals are full and A&E departments are struggling. We have got ambulances having to wait longer to offload patients and that is causing difficulties.

Who do you think has the better idea of the state of the ambulance service at the moment? I know who my money is on and it's not on Nicholson.

On Monday the London ambulance service went to REAP 4. The REAP system runs from REAP 1 (no problems with the service) to REAP 5 (the sort of problems you get after all the power stations blow up and there are plague rats running on the streets of London).

We have never been at REAP 4, and if you ask the road crews in London they would probably say that we should have been at REAP 4 a couple of months ago.

From the official London Ambulance website

Ambulance staff responded to 20,939 emergency incidents across the capital in the seven days up to last Sunday (14 December) – an increase of nearly eight per cent on the average of the previous four weeks. The pressure has been compounded by high percentages of calls initially treated as being Category A (immediately life threatening), and delays caused to staff at hospitals while waiting to hand over patients.

As a result of these ongoing issues, the Service today raised the declared pressure level at which it is operating from ‘severe pressure’ to ‘critical’ – the first time that it has reached this level since the capacity levels were introduced in late 2005.

The national news has been full of this story and there has been constant coverage that the 999 service is to be used for only 'genuine' emergencies...

…and obviously it has worked because five out of my nine calls today were to simple chest infections that could have been treated at home, seen a GP, or just sit and wait for it to go on it's own. None of them were sick enough to need an ambulance – but they called and we responded. I suspect it will be a similar story tomorrow.

We also had two hoax calls.

But I'm preaching to the choir.

It doesn't help that we had an outbreak of Norovirus at one of our local nursing homes, something that has led to a local hospital opening an isolation ward in order to safely cope with the influx. I'll tell you the full story of that night in a later posting.

Today, like many others of late, there were multiple calls being held waiting for ambulances – some of these calls would have been covered were it not for people picking up a phone and using the same number you dial if someone has dropped dead in front of you for their case of a 'nasty cough for the past three days'.

There are too many patients, 80% of whom don't require an ambulance, and not enough ambulances.

What doesn't help is that the politicians are ignoring the problem and trying to pretend that it hasn't all gone to the dogs. The politicians are being dishonest (yet again) and so, it would seem, are the executives of the NHS. Rather than admit a problem and make some sort of plan to improve it they lie and spin and lie some more. Just notice how they call a massive (30%) increase in calls a 'pressure' rather than a bloody disaster that we have seen coming from twelve months away – it's not like Winter just sneaks up on us does it?

And on Friday it's 'office piss-up' day.

Bloody great.

The only good thing about today has been a group of us stretcher monkeys getting a good result from a cardiac arrest. If this post reads a little weird it's because I haven't slept a wink in the last 36 hours and have just completed a 12 hour shift. At least the hallucinations haven't started yet…

25 thoughts on “Falling Apart”

  1. today i saw the worst case i have ever seen a vf arrest from the street came in and the crew had to carry out als and cpr in the corridor out side resus as there are no beds because as usual the high demand on ourselves and the hospital yet the public believe we should be there for them at all hours without meal breaks and a paramedic has been struck off recently because he apparently refused a three nines call whilst being out of the system but thats ok because its just a pressure not a meltdown were do the the managment and polititians get off

  2. I've been reading for about 2 years now and decided it really was time to sign up so I could comment, so hello.I agree with the previous poster who said the triage system needs to be overhauled, along with changes to NHS Direct and the local systems.

    For example, I have phoned my doctor plenty of times, but I was not aware until earlier this year of the Out of Hours GP service run by my local hospital. I had vaguely heard the phrase before, but phoning my doctors' surgery out of hours gives you a recorded message telling you to phone 999 if it is an emergency, with no mention of the out of hours GP clinic, which is situated next to A&E under a sign reading “fracture clinic”. I wouldn't have had any idea of its existence if an A&E receptionist hadn't one day directed me to it, but why did nobody redirect us a year or two previously when my partner arrived complaining of a cracked rib from a motorcycle accident which had happened some days previously? It obviously wasn't an emergency but an unsympathetic employer meant he couldn't see a doctor during normal hours and being unaware of the out of hours clinic he assumed A&E was the appropriate choice.

    And NHS Direct don't seem particularly helpful, they seem to suggest going to A&E every time I phone them… I suppose they would be useful to weed out the people with man flu though!

  3. Urgh…office piss up…when will people learn to stop relying on the NHS to solve their overindulgence so they can deal with some real calls!

  4. From the Telegraph Mr Johnson is qouted as saying about the ambulance service”What Peter Bradley has pointed out is that every year we have pressure on the system. It used to be a crisis every year. Thanks to better planning it's not now……..”

    “……….It's working very hard and very successfully to cope with very difficult circumstances, but it's not the annual crisis that we used to know.”

    What a prat. Maybe Mr.Johnson would like to spend a 12 hour shift or 3 on a front line ambulance, with out a break and then see if he still holds the same opinion. Or maybe it's just a simple case of him living in opposite land as I'm sure he was heard saying of Woolworths, “Business is booming and the lead up to christmas has put Woolies in its strongest ever financial position”

  5. The politicians need to back up the “Don't call if it isn't an emergency” with laws with teeth to arrest and charge the idle idiots with obstruction and public hazard and wasting EMT time. Make them pay through the nose for the ambulance time and crew wages and any other use of goods. Got a cold? Call an ambulance? Go to jail overnight and pay for the privilege.

  6. I read your blog & smiled as nothing will ever change in that country, I emigrated last year & I strongly recommend it!! its the same issues every winter & management expect you to give 100% when they dont even give you time to eat. They wonder why morale is so low??!!

  7. The value of 80% is going off the genuine statistics that we have, it's not a number I've plucked out of the air.Of course, at this time of the year it wouldn't surprise me if it *is* 95%…

  8. Oh blimey…I've done resuses in the main area because there is no room in resus, but never in the corridor outside it.

    Keith05kate – can you link to the HPC disciplinary result page for that Paramedic?

  9. Not sure about other services' protocols but in the last couple if months mine had started doing 'general broadcasts' for A calls in the hope that if theres a crew closer than the response being sent they can offer themselves up. These general broadcasts used to be very rare and used as a last resort, but we were averaging 4 an hour the other day usually the transmission finished with “currently no resources to send”.That same day i went to a call for an MI and as i walked through the door the man took his last agonal breath and promptly arrested on me. I got an output back after each shock but even after full ALS he died at hospital. It took us 30 minutes to reach the man as we were the nearest resource due to nearer crews being tied up elsewhere.

    Im convinced a quicker response to this would have had a better outcome. I really felt sorry for the wife and community responder who were on scene helpless to do anything.

    At the hospital i spoke to a crew who just before the time the call came to us, cut short their stand down to respond to chest pains which turned out to be a cold.

  10. hi not been able to link to the hpc for a couple of days now have read a few stories in papers about it and somthing does not ring true apparently they were on way back to station whilst being out of the system secondly it then states they had had 15 minutes of there meal which suggest they were on station it is not a postition i wish to be in because if this is true to form then this wouls set a precedent for controls across england and there would be no breaks

  11. in reply to your comment up here inthe north west (not sure where you are) we have a couple of controllers who sound like taxi radio operators shouting out “any vehicles clear for emergencies in …., then …. and …. and …. and…. etc the other day i went to an red call query mi and was stood down for a Purple which should be not concious not breathing or at least ineffective breathing 21yof in and office block yest you guessed it she had a cold and sniffle

  12. We have 24 hour shopping for that tin of beans we fancy at 2 in the morning, we have 24 hour banking for that transfer of funds to cover our credit card bill at 3am and we have 999 and NHS direct for that cold which we've had for the last five days but has got really annoying and is now stopping us from sleeping at 4am. We are not prepared to wait for anything, especially if we feel ill. Meanwhile, in a different part of town, that chest pain thats been coming and going all day is ignored in the hope that it will, given time, simply go away….strange old world isn't it.

  13. Sorry there's so many idiots in the world. If you could only eliminate one group of idiots, would it be the idiot service abusers, or the idiot politicians and upper management who refuse to see, hear, or speak the side of the crews?But, also, a little perspective… if the only good thing that happened to me all day was me and my coworkers saving the life of someone who'd gone into cardiac arrest, that would still count as a Fucking Good Day, really. Even for your job – from what you've said, it's pretty rare to get a good result.

  14. Just checked it out on the HPC website. It states he was on a 6-6 shift which would mean his stand down window would be between 10 and 2 so at 12:14 he wouldn't have been at liberty to refuse as he was't actually on his stand down. If it was at 2:15 that would have been different.Could count the amount of times in the last month on one hand that ive had a stand down inside my 4 hour window…

  15. As a call-taker I find it incredibly frustrating that even though I know a caller is blatantly taking the piss and his/her bad cold is in no way life threatening, I still end up triaging it as Cat A because we're not allowed to use our common sense, lest the powers that be discipline us for not following protocol.Rather than expecting the public to use their brains and only call in emergencies (which they will never do, it's much too convenient to just pick up the phone and let us do the work for them), the entire triage system needs to be overhauled; this would then prevent crews being sent on calls that could better be dealt with by a GP. Either that or we start charging the time-wasters and the office party drunks.

  16. well further to these comments i had a rare treat the other day a relative of a patient (who actually warranted a trip to a + e) was amazed and finally understood why we are having problems after quickly explaining that once we arrive at hospital there is a black hole of time where the patient falls into and the hospital accept the patient we have to wait to handover it dawned on the relative we are being held to ransom by hospitals trying to massage there 4 hour targets and not breaching patients and the stress levels are getting higher my best comment yesterday was from the triage sister at one of our lesser visited a+e first words out of her mouth were yes i have seen you twice but i have patients in the waiting room to be seen to first at which point she walked one through infront of our low o2 sats patient sob who had several bouts of vaso vagel oh forgot to mention ca lung once finally triaged 15 minutes later she wandered off into the distance and shouted you will have to make your own bed if you dont want to be stood in the corridor all night yeeeheee happy christmas sister

  17. For what it's worth, I just had my appendix out, and I didn't take an ambulance.I might call one now though and see if they can give me some morphine….It bloody hurts! Lol

  18. We usually have to find and make our own beds anyway. Is it wrong that we thank the care assistants like they are doing it as a special favour when they make the trolleys up for us??On 4 nights over the weekend; let the fallout and onslaught of the last friday before xmas office parties begin…yeehaa

  19. it's just as bad with the walking wounded, most of em think they've got flu if they got a sniffle or pneumonia if they've got a cough. Some GP surgeries are allowing receptionists to do the triage before booking appointments, how long before there's a real problem with an unqualified diagnosis? And never mind NHS Direct, I've got patients whose GP examination and diagnosis were conducted entirely over the phone. No wonder the people are coming up to A&E in the hope they'll actually get to speak to a human face……

  20. Ah, but if the politicians put out a strong message “don't call unless it's a realy emergency”, then the public might think that the service is in trouble. Which they have already said it isn't.I'm not a medical person, but I would imagine that if someone called for an ambulance with “difficulty breathing” that they should be intubated as soon as the ambulance arrives – just to be on the safe side. Maybe catheterized as well.

  21. I rang NHS Direct when my son thought he had broken his ankle. I had to insist to them that there was a minor injuries clinic in Leeds with X-ray facilities – I just needed them to give me the phone number and location so that I could take him there in my car (wouldn't even have dreamt of calling an ambulance!). After having told me that it didn't exist, they went away to check it, and lo and behold it did exist and I was given the phone number to call to check when I could take him in. If NHS direct don't know about these facilties then how are we supposed to use them??? End result was one (22y old) son without a broken ankle – Mum does know best but he had to have it proven by x-ray poor thing!

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