The NHS White Paper is out and I've read pages and pages of analysis, although I'm yet to read the White Paper myself. It's sitting in my reading queue waiting to be read.

The big change is the PCTs who currently 'purchase' healthcare will go the way of the dodo to be replaced by 'consortia' of GPs. The thought being that GPs know better the needs of their community.

While I am sure that there are plenty of conscientious, well trained, thoughtful and management minded GPs out there, certainly in my part of London they seem a bit few and far between.

As an example, my crewmate and I were sent to a patient who had seen the GP who had thought that she might need hospital treatment. The patient was described as 'ambulant'.

She was 'ambulant', in that she had walked to the GP surgery – at least one mile away, and the GP had sent her home to await the ambulance.

As soon as I walked into the room I knew that we would be wheeling the patient out on our chair. She was so short of breath she was breathing forty times a minute, her oxygen levels were way below what they should have been (86% – even with someone with chronic lung disease, this would be a worry), her pulse was racing at over 120 beats per minute.

She was a very sick lady – and yet the GP had sent her to walk home.

Similarly I've been to patients in the later stages of shock who have been sat out in the waiting room for the ambulance and I've had patients who the doctor has, correctly, diagnosed a heart attack sitting on the wall outside the surgery.

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Now, I understand that not every GP is like this and that I only tend to go to the patients that are seen by these worryingly poor GPs, but how many of them will be holding onto the public's purse strings in the future.

In some places they can't even arrange decent out-of-hours coverage with GPs who are able to speak English.

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The other worry is what happens if a GP consortia decide that they don't want the LAS handling emergency calls in a certain postcode? Will we be refusing calls because privateambulanceservicecompany will hold that contract? Will we no longer be London-wide, but tasked to only cover certain areas.

Given yesterday's announcement about 'Big Society', will the ambulance service be broken up to be replaced by volunteer services? I heard rumours that the Olympic planning people wanted LAS staff to volunteer to cover the Olympics as they didn't want to pay them, was that just the start of this?

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Still, lets wait and see what happens in the consultations before we start panicking. After all it's not like consultations in the past have ignored all the good points in opposition to what the government want to do…

You would think that it is pretty obvious what us ambulance people do; pick up sick people, treat them and then take them to hospital.

If you've read this blog over the last few years you will have realised that we do much more than that.

It's why I carry a Swiss army knife, because more than once I've been called to fix something.

The other day I had one of the weirder calls, it was sent to us as 'Having heart attack because of two boxes'.

Needless to say this piqued our interest.

We arrived as scene quickly, after all it was a 'Cat A' call and so be there in eight minutes or be a failure – but we were also the quickly as the address was just around the corner to the station.

Once the patient opened the door we recognised her, I'd say all LAS and half of the Police force in the area would have recognised her as well…

She is elderly and lives alone. She is also probably schizophrenic, or at least has some form of dementia. She has daily carers who are good, but they aren't there all day so she gets worried and scared easily.

The last time I was sent there was because she hadn't had her morning cup of tea and was worried that she would faint.

This time we were there because some delivery pillock had picked her address, out of all possible addresses to mis-deliver two large boxes.

These boxes turning up on her doorstep had, as she described it, 'given her a heart attack'. She'd phoned the police, and they had directed her to us.

And here we were.

The two boxes were lurking in the corner of her living room, staring at her with malicious intent.

Well, not really, but she was acting as if they were the most evil things in existence. There was no way that we could leave the boxes here because she would just keep phoning us, or the police, back.

So it was time for our problem solving skills to get a bit of exercise.

I phoned Control to get the phone number of the address on the box. This was not that easy as our radio kept cutting out, I would guess that we were in a b it of a dead spot as there wasn't any rain…

Control then looked up the p-hone number and relayed the number to me – I then phoned the person who was supposed to have the boxes (he only lived around the corner).

He was greatly surprised to hear from the ambulance service about his mislaid parcels, but was more than happy to come and pick up the bosses himself.

I suggested that this wasn't a good idea, and that we would come and drop the boxes up to him – after all if he turned up after we left our patient would probably call out the coastguard as well as us and the police.

So, as I knew the address I threw (ahem, rather I 'placed carefully') the parcels in the back of the ambulance and drove them around to him.

He was both exceptionally happy and very grateful.

Parcels delivered I returned to my cremate (and FRU, did I mention they were sent as well?) and picked her up after she finished assessing the patient.

Problem solved, and no need to drag our woman off to hospital.

It would appear that the radio system that the LAS uses has been in the news of late – claims that it doesn't work in the rain, or that vehicles are without radios.

Or vehicles use the 'Airwave' standard, a digital network shared by, amongst others, the police. We have a main set that is fixed to the ambulance and should have two handsets that we carry everywhere with us.

I can only talk personally, but in my experience the radios are often a bit flaky (but remember that this is a system that was forced on us by the government), but not any flakier than any digital phone network.

The problem is that they are digital, if they have a poor signal then they just refuse to work, unlike the old VHF analogue radios that would transmit, although over a load of static. With analogue though the human brain is a great signal filter, and so you could make yourself understood. With a digital system you just have silence.

So it's not perfect, but it's not bad – at least we have handsets now, it's been something we've been wanting for crew safety for quite some time.

As for not having radios on vehicles – I suspect that the spokesperson for the LAS is counting the main set in the vehicle as a radio (quite rightly as that is all we have had for years), but the HSE are also counting the portable handsets.

These do go missing, but there is normally at least one handset on a vehicle. When we were trained in the use of the radios we were told about the system for replacing them if one should go missing – sadly this seems to have gone out of the window.

Oh well, no change there.

The switch to digital has meant some changes. For example you can no longer hear everyone on the radio talk group, so you have no idea where your workmates are or what they are doing – this results in much less awareness at street level of the situation across your sector. I can't tell if a hospital is full or not just by listening to the radio, nor can I hear if any crew needs assistance. This makes you feel a lot more isolated on the road.

The other side effect of not hearing the rest of the talk group is that, when it is busy, you 'buzz in' to talk to Control, but you don't get an answer, all you have is what seems like an empty channel while Control seemingly ignore you. With the old system you would hear them talking to the other crews, and so you would know that they were busy so you knew you weren't being ignored.

Overall, the provision of handsets has made crews safer, although I can't comment on the panic button as I've never had to use it. Some things are better, some things are worse. But at least the LAS has made the effort and the problems are with the design of the system rather than with the LAS.

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Can I also take a moment to mention one thing that I forget to write about in the last 'Transplant' post – that you should also discuss your being on the donor list with your family, so that they are prepared should the worst happen and that they know your wishes and don't overturn them. You might also be able to persuade some of them to sign up as well.

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Finally, big changes coming up, but it's something that I need to sit and write with plenty of time, not fire out in the half hour before I leave for work. And I'm not just talking about the NHS White Paper.

So… What is it that makes an ambulance?

What sort of equipment do you think needs to be on a vehicle for it to be classed as an 'ambulance'.

You'd probably think that it would need a stretcher, a carry chair and some sort of medical equipment. Perhaps something to take blood sugars, blood pressures and tracings of your heart.

Maybe it would need something to deal with broken limbs, a board to strap you to if the crew thought that you had a broken neck and maybe even some drugs to treat conditions such as asthma, heart problems and allergic reactions.

You might also expect bandages.

You would, of course, be wrong.

We have had the official memo from one of our Assistant Director of Operations.

To be a working ambulance you need…

1) A vehicle which passes the legal requirement of basic roadworthiness – decent tyres, has a windscreen, has working lights and is taxed.

2) A Bag-valve-mask and a defibrillator.

3) That is all.

That is all you need to have a working ambulance – or rather an ambulance that will stop that all 'important' (and utterly bloody pointless) ORCON target.

This level of equipment means that you can perform pretty basic life-support – no drugs, no clever airway management.

If you have asthma, you will be wheezing like a wheezy thing with not a thing I can give you.

If you are having a heart attack I won't be giving you the aspirin that vastly increases your survival rate.

If you have a broken leg, I'll have no way to splint it. And I may not even have a stretcher to put you on anyway.

But I will have 'stopped the ORCON clock', and so the job will be a 'success'.

And this is happening – a friend of mine was sent out on an ambulance with this level of equipment. He was concerned by this and wrote a letter to our medical director who replied that this is a good policy.

Over 50% of the time I'm sent out on a vehicle without a blood sugar kit, and without other equipment like Scissors or a Paediatric Advanced Life Support Kit.

The London Ambulance Service calls itself a 'world class service' – but I think it's a bit rich to refer to yourself as this when ambulances are being sent out with this level of kit.

But who am I to complain that I don't have the right amount of kit? After all, the people who make these decisions are paid a heck of a lot more than me, so they must be smarter.

It is, as regular readers will no doubt have guessed, all because of the frankly dangerous ORCON target – dangerous because our ceaseless chasing of this clinically worthless target means that patient care is suffering.

The government has decreed that a number of targets will be dropped – the four hour A&E wait, the Police Pledge, Literacy (well… they haven't specifically said that literacy must be cut, but if you are cutting the education budget by 25% then that is the sort of thing you are going to get).

Sadly, no, tragically, it would seem that the ORCON target will remain. And so resources that could be spent on, oh I don't know, fully equipped ambulances, are instead being spent on beating that damn clock.

However I think that there are those in management who probably like this – after all they can understand how to chase this target as opposed to being capable of setting a standard of excellent patient care.