2. (Military) (esp in the ancient Roman army) to kill every tenth man of (a mutinous section)
When I heard the news that the London Ambulance Service was going to reduce it’s frontline staff by 560 people my first thought was that this would meet the true definition of ‘decimate’, to remove one in ten men.
I was wrong.
They will be removing a sixth of frontline staff.
From the LAS own press release – 3433 staff provide direct patient care, 560 posts will go. That’s 16%.
This physically makes me sick.
I’m going to, for the sake of brevity, ignore the way in which staff will be removed from post – let us just assume that it will all be from natural wastage and that no-one who wants to keep their job will be made redundant.
Let me remind you that for every year in living memory the number of people calling for ambulances increases – last year the LAS attended 4.5% more calls than the year before, and this rise is typical. I suspect that this rate of change will only increase faster because poverty is a big cause of poor health – and more people are going to be poor in the future.
I’d also like to say that next year there is going to be a little sporting event called the Olympics – and I suspect that the LAS is already in panic mode without these ‘cost improvements’.
Let’s look at that number of 16% frontline staff being cut, that is roughly equivalent to one ambulance removed from each and every one of the 70 ambulance stations around London.
Or it may be that of the 70 ambulance stations the
cost savings cuts will close 11 of them, leaving just 59 stations untouched.
However, I think that these cuts will go much deeper than this – there are going to be far fewer ambulances on the road than this 16% figure would suggest, and this will be because there will be a ‘new way of working’.
When you call an ambulance at the moment you get a big yellow van that can take you to hospital, if it sounds serious then they also send a little yellow car in order to (a)stop the government mandated target time clock, and (b)start treatment before the big yellow van arrives.
This will change. In the future, when you call for an ambulance, a big yellow van will not be sent. Instead the little yellow car will arrive and see if you really are sick enough to need a proper ambulance to take you to hospital.
But where will the increased need for people to drive the little yellow cars come from? Well, they will be taken off of the big yellow vans to be put on a little yellow car. This will reduce the number of ‘proper’ ambulances on the road even further.
The danger in this is twofold.
(1) Will there be the training, support and education for ambulance staff to ‘medically discharge’ while in the patient’s home?
(2) Will these solo staff responders be safe when they either refuse to send a proper ambulance, or have to keep apologising for there not being an ambulance to send when surrounded by upset and possibly angry patients and relatives?
Taking the training and support point first – even as an ex-nurse with sixteen years working in various medical emergency fields, until I started working as a nurse practitioner, I would still be nervous about leaving patients at home and I have had more training then most of the people who drive ambulances. Also, in my experience, the in-service training and updating of skills was very poor.
This is without wondering if of the 330 ‘management and support’ roles that are going, a sizeable chunk of them will be in the training department.
The LAS will be looking to sack many of the staff that have been working there the longest – they cost more than an inexperienced new person. Sacking people for making a clinical error after being forced to work outside their scope will be a booming business.
(I have heard a rumour that ‘Untoward Clinical Incidents’ doubled last year – if I were a journalist it might make for an interesting Freedom of Information request…)
So, you will have staff working outside their scope of experience, worried for their jobs, being sent to decide if you really do need an ambulance – anyone who has been in the job for any length of time will decide that everyone will need to go to hospital in order to protect their own career as well as the life of the patient.
So you will need the same number of ambulances.
Secondly – imagine yourself surrounded by a large, noisy, scared and potentially violent group of relatives, maybe you are in a crack-house, maybe you are attending a case of domestic violence, maybe you are at the house of a child who is dead. You are on your own. You are trying to tell the people present that either they do not ‘deserve’ an ambulance, or that there just isn’t an ambulance to send because they are all too busy.
How do you think those people will react?
All the interpersonal training skills in the world will not save you from that one person wanting to take their frustration out on you.
So, expect to see ambulance crew assault on the rise – and remember, if you are assaulted and off sick they can still discipline and sack you for taking too much time off sick – I know because I was threatened with it myself.
One part of the LAS that won’t be cut will be the PR and communications department – they are going to be spending more and more time responding to reporters asking for information of patients being ‘left to die’, as well as sending out the following template press release.
The London Ambulance Service would like to express their condolences to all those affected by the circumstances surrounding the death of _______________. As a service we have taken the comments of the coroner’s office very seriously and believe important lessons have been learned.
So, what is the solution?
If I were Peter Bradley I would stop pretending that everything was going to be ‘just fine’. I would not call these cuts ‘cost improvements’, I would publicly call Dave Cameron the lying bastard that he is. I would do that every day as loudly as I could to as many people as possible. I would encourage the unions to take ‘work to rule’ action in order to embarrass the government. At the bottom of every ‘condolences’ press release I would add ‘Unfortunately the government have forced us to cut services and while we are trying the best we can we are not being funded enough to provide the service that people expect‘.
If I were CEO I would resign, while trying to cause as big a fuss as possible, because these cuts will make any CEO responsible for more deaths than all the serial killers of the UK combined.
And that’s not how I’d like to be remembered.
If I were a member of road staff right now, and I had another trade, I’d be looking to get out of ambulance work as soon as possible – the pay is poor, conditions are going to get worse and the right wing press will paint you as feckless and lazy. Get out while you can because, no matter how bad things are now, it’s only going to get worse over the next five years.
And MPs? Just remember this, the next time one of you is stabbed – there might not be an ambulance to come and save you.