This is a post about how chasing government targets impacts directly on patient care.
I've often written about our chasing of our 'Cat A' targets – that we are tasked by the government to reach 75% of these calls within eight minutes. I've also written about how I think our senior management have put this priority above many others.
There is another target that we should be hitting – calls that are given 'Cat B' (serious but not immediately life threatening), we should be reaching these calls within 19 minutes.
In my part of the LAS we have been failing in this second 'Cat B' target.
One of the things that really surprises me is that someone having a CVA, also known as a stroke is normally given a 'Cat B' priority. Given that the move is for better treatment for strokes – going so far as to rename them 'brain attacks' to put them on a par with 'heart attacks'.
It is a good thing that we are starting to treat strokes more seriously – I can remember when I was a nurse that we would essentially put people who had just had a stroke into a bed and arrange for physiotherapy – there was no treatment then, only rehabilitation.
Things have changed a little but there is still an amazingly long journey before we can start offering the same level of treatment as we do to people having heart attacks.
Due to our poor performance in 'Cat B' our senior managers have decided that we should have 'Amber Ambulances', these are ambulances that are to be tasked with bringing our 'Cat B' response times up.
These are extra ambulances that are staffed with the same skill level as our 'regular' ambulances, but they are only supposed to attend to 'Cat B' calls.
All in order to meet that government target.
We were sent on a possible CVA/Stroke – a 'Cat B' call. So I put on our lights and sirens and headed off to the call.
Partway there were were canceled for a nearer vehicle, so I turned off the lights and sat in the normal traffic. I got stopped by a set of red lights.
As the house we were going to was on our way back to station We would drive past it and see who had been given the job.
As I drew up to the street it was obvious that there was no ambulance there.
I called up Control and let them know that we had beaten the 'nearer' ambulance and that we were more than happy to take the job. After all if someone had suffered a stroke they needed to be in hospital, not waiting for another ambulance.
I was told that I should continue driving and not attend to the patient as 'the amber ambulance is nearly there'.
Four minutes later the 'amber ambulance' arrived.
An identical ambulance, with an identical skill level, but four minutes behind us – even though we had travelled most of the way observing the speed limit.
Needless to say, I was absolutely fuming. Here we were, already on scene and yet being told not to enter the house because it was more important that the target-busting 'amber ambulance' would do the call.
An identical ambulance, but one that is to be used to hit this other government target.
Why were we canceled? We were canceled because it is not good enough to have an ambulance, it has to be the right ambulance in order to reach that government target. Because they are only to go to 'Cat B' calls, and if we attended then what would happen if there was a 'Cat A' around the corner? They couldn't send the 'amber ambulance' because then they wouldn't be free to hit the target.
And the government would be unhappy.
I reported this through our clinical incident reporting procedure.
We managed to return to station where I saw one of my Station Officers, I told him about the situation and he phoned the top person in Control for that day. Top person in Control agreed that it shouldn't have happened and would look into it.
To be fair , this was the first day that the 'amber ambulances' were being run and this was probably just teething problems, but I still think it highlights how fixated on chasing these targets we have become.
Every person in the ambulance service who works out on the road understands the simple fact that, if you want to get ambulances to patients quicker you need more ambulances. It's not rocket science, there is no way that we are going to make any appreciable difference in the number of people calling for an ambulance, so we need more ambulances to deal with the year on year growth in demand.
What doesn't help is bringing in more ambulances (in itself a good idea), but then limiting the flexibility of those ambulances over an artificial target that, I suspect, has no basis in science.
This is one of the worst cases of government targets directly impacting patient care that I have personally witnessed. And it shames me to think that actual patient care comes after pleasing the government.
However, sadly, it doesn't surprise me.
Thanks to Lordneil for reminding me that the 'Cat B' target is destined to be scrapped and that better clinical indicators are to be put in it's place. This was supposed to be done in 2009 but has been put back to April 2010 for some reason. (It's here on page 40). This is something that I suggested in this blogpost although I am yet to hear what clinical indicators will be put in it's place.