Medicine and the paramedical sciences are constantly developing, there is new research and new products that we need to learn about. We also need to refresh skills that we might not have used in some time. For example, I don't believe many babies, other crews deliver loads. I don't have many calls that could be classed as 'trauma' other crews are 'trauma magnets'. Meanwhile there are crews that perhaps don't have the same number of 'social care' issues that I do.
So it is essential that we have continuing training in order to learn new stuff, and refresh ourselves on the stuff we don't do that often.
Until very recently there were essentially no continuing training courses for road staff, at least none that I have ever been made aware of (and in this instance, not knowing about something is as bad, if not worse, than there not being any provision in the first place.
There is a 'training prospectus' on our internal website – let me give you a flavour.
Applying for Promotion, Communicating Assertively and with Self Respect, Effective Verbal Communications, Effective Written Communications, Equality & Inclusion, Getting the Most from Your Job in the Service, Giving and Receiving Feedback, Making the Most of Meetings, Minute Taking, Office Suite Training, Presentation Skills, Report Writing, Time and Workload Management.
You will note that lack of clinical skills.
It is a part of the Agenda for Change that we are continually learning, yet this doesn't happen.
However, things are changing slightly.
Our station now has five days a year set aside for training. So far this has mostly been for things like the new 'trauma tree', a new (and vaguely pointless) new bit of kit we are getting and my Personal Development Review. Nothing on delivering babies, CPR and ALS, trauma treatment, social care pathways, mental health issues….
The list goes on.
It is supposed to be 'protected', but already on one of those days I have been told to man up on a vehicle because there is no-one to train us (although the day was postponed, not cancelled).
This training is provided by our Team Leaders, who aren't actually trained to give training (although on our group of stations our AOM has put them through an instructors course – I wonder how widespread that will be).
So it is a fair bit of a shambles at the moment as there are many groups of stations that will not have any set training days.
My crewmate's instruction on the administration of Morphine? A sheet of A4 that had to be read, signed and returned.
Mandated training days, outside inspection of our training programmes, specific trainers who are educated to be trainers. A yearly prospectus of what each role in the ambulance service must have a refresher on each year. Standards that are set and must be reached.
Clinical governance is, at it's simplest form, a way of making sure that your staff are doing the right thing. It is a way to make sure that I'm not wrapping BP cuffs around someone's throat. It is a way to make sure that I'm following the latest medical evidence and guidelines and it is basically a way of making sure that I'm not doing anything wrong.
At the moment this is done by looking at my paperwork and 'marking' it in comparison to an ideal.
What my managers don't know is that I could make up everything on that paperwork and they would never know. As long as there is a tick or number in a box on my paperwork then I'm doing the job fine.
At the end of your first year on the road you have a 'ride-out', where an officer does a shift with you to make sure that you are doing things right.
Seven years ago I had this ride-out. It was the last time I was ever supervised in my work by anyone other than my crewmate.
(And crewmates will cover for crewmates – it's in out culture, not least fostered by an 'us vs. them' attitude towards management).
It's obvious really, regular ride-outs, regular checking of skills during refresher courses and a 'no-blame' culture. A person that a road staff can go to to ask questions or check their own skills without be judged or without fear of being disciplined.
Unfortunately with both of these problems, in fact the problem with everything that I have written so far, it's not in the LAS best interest to squander our few resources on them. Instead we panic about hitting the eight minute target (and the 19 minute target for amber calls) and so all the focus is on that rather than on a well-motivated and well-trained workforce.
For example, a nearby complex has no training days. Yet their AOM has seen fit to install time tracking devices into local hospitals so that crews are under more pressure to 'turn around' jobs quicker.
i.e. We don't have enough ambulances, so we need you to see more patients, so don't spend as long at hospital as you have been doing.
This is where the resources are going, into trying to eek as much performance out of existing staff as possible. No extra ambulances, no extra staff, ignore training. All that matters is the time targets.
For this I blame the government – although there are some mumbles that some of these time targets are going to be scrapped. Hopefully the ambulance service will be one of these.
But there also needs to be blame laid at the feet of the ambulance trusts, there seems to have been a severe lack of action in trying to get these (clinically inappropriate) targets flagged as clinically inappropriate and instead bring in standards that actually reflect on patient care rather than on how quickly we drive.
What we need is for all our Chief Executives to band together and say 'No'. We need them to stand up and say, 'This is where we fail our patients, and it's all because of this target – no more. We refuse to having you harm our patients any more'.
We need people to fight for what is right in the media so that the public can see that we have their best interests at heart, rather than follow an illogical, outdated and irrelevant target. Instead that we need targets and standards that result in better patient care.
But I can't see that happening any time soon.