To whom it may concern,

I wish to resign from my post as an EMT-3 in the London Ambulance Service. If possible I would like to go onto a bank contract so that I may work the occasional shift.

I would appreciate it if you could tell me my last working day as soon as possible as I am moving elsewhere in the NHS and they would like to know the earliest date that I can start.

Many thanks in advance.

Brian Kellett

—–

I handed this letter to my immediate boss today.

People who follow me on Twitter will have already heard that I have a new job, one that I'm due to start in approximately one month. In one month's time I shall be going back to nursing where I am taking a post as an Urgent Care Nurse Practitioner at Newham hospital.

I've been led to this by a number of factors, a majority of things that have pulled me towards a career change as well as more than a few things that have pushed me away from the LAS.

My AOM described it best when she gave me my reference, she said that I was bored and that I needed new challenges. We both agree that in most cases the job that we do turns our brain to mush.

So, I'm going back to nursing because I want to develop my clinical skills, I want to learn new things, I want to be more responsible for providing people with the best healthcare that I can.

It's pretty much impossible to do this within the LAS because, for example, our ECP (Emergency Care Practitioner – our top clinically trained people) programme is effectively being shut down. There is nowhere to progress to and… well… you have been reading all about it on this blog for the past few years.

—–

So, some big changes – one of which being that I'm going to go to writing under my real name, Brian Kellett, rather than the helpful pseudonym of Tom Reynolds. At the moment I'm in the process of changing this on all the social network profiles that I can remember belonging to.

If you take a look at the top of this very blogpost you should see that it no longer says 'By Reynolds'.

As for this blog… well… I'm unsure of what form it's going to take in the future. WIll I be still writing about ambulance stuff? Will I be documenting my journey into urgent care? Will I just natter about whatever interests me at that moment in time? I'm not quite sure. Certainly I'm not going to stop writing and in fact, later today, I'm heading into town to have drinks and a chat with a friend about something we are planning together.

So I'll keep blogging, but I'll no longer be the 'ambulance blogger', I'll be 'that annoyingly nerdy blogger', which I think puts me in good company.

—–

So there you go, a change in career, a change in direction, a change (of sorts) of name. I'm looking forward to it and will be writing about it in the coming weeks.

It would be a lie to say that I'm not at least a little bit nervous about this, but nervousness is just a form of excitement – and while this is a big step for me it's one I'm looking forward to taking.

Comrades!

Feel glory in the wonderful opportunity that central government has given you. Your inability to reach the required number of 'Amber' calls in the mandatory time has resulted in a new and innovative plan to allow intellectuals to shine.

We are to cut your budget by £1.6 million, thus allowing you to 'think smarter' in order to reach these same goals in time for next year's auditing.

As that cute white kitty says 'hang in there baby' for while some of the proletariat may see this as a 'punishment' rest assured that this is no such thing. By cutting your budget we will enable innovative practice to flourish. By placing this obstacle in the path of providing world class healthcare we will be 'evolutioning out' poor ideas and this burning of the forest of old ideas will enable new sprouts of innovative innovation to sprout sproutlike from the bed of innovation.

True, the valued, committed, diverse and hard-working staff of the organisation may suggest that the nineteen minute target to reach these 'Amber' calls is not based on any clinical or scientific evidence – however we leave it to LAS management to design some eye-catching and diverse posters explaining that it is the public's perception of the service that is more important than anything approaching clinical need.

May we suggest that any roadstaff that suffer a break in morale should be moved to East London where the constant influx of deeply sub-healthy and not-up-to-standard education patients will remind the staff that they are truly lucky to be working for such an innovative, forward thinking and diversely diverse organisation.

Those who complain about a lack of blankets and blood sugar machines should be shot as an example to the others.

We look forward to seeing the innovation that your staff create – might I suggest hiring a few new managers at £70k salaries a shot to facilitate the innovation?

Yours faithfully (and innovationingly),

The government.

—–

Seriously, we've just had our budget cut by £1.6 million (it was supposed to be £3 million but the fine was reduced after some begging negotiation) over our inability to hit the 'Amber 19' target. That is reaching a certain percentage of our 'Amber' calls in nineteen minutes or less. Again this target number is not based on any sort of, I dunno, evidence. Instead it is based around what the public demand.

Ho-hum. That'll help with the shortage of blankets, vehicles and other rather useful kit that I find missing from my ambulance whenever I start a shift.

Here we go…

Ambulance service gets £38 for every patient they don't take to hospital

Patients' groups expressed horror at the “sick experiment” in which NHS managers have agreed to pay £38 for every casualty that ambulance staff “keep out of Accident and Emergency” (A&E) departments after a 999 call has been made. The tactic is part of an attempt to manage increasing demand for emergency care amid failings in the GP out-of-hours system.

Documents seen by The Sunday Telegraph disclose that staff at Britain's largest ambulance service have been encouraged to maximise the organisation's income, by securing payments for diverting patients to telephone helplines. The bonuses are among dozens of schemes being tried out by ambulance trusts across the country as they attempt to improve their emergency response times and help A&E departments meet controversial targets to treat all patients within four hours of arrival. Another plan uncovered would see thousands of 999 calls currently classed as urgent downgraded so that callers receive telephone advice instead of an ambulance response.

I suspect that, once again the journalist writing this has no idea on the sorts of pressures any ambulance service is dealing with.

Our own figures show that only 10% of calls are 'life-threatening', (Taking healthcare to the patient: Transforming NHS ambulance services p8 3.4).

That is why our calltakers prioritise calls by using a computer system. We simply do not have enough ambulances to deal with the 4,000-5,000 calls we get per day.

80% of the calls to us do not require hospital treatment. Eight out of ten calls to us are for things like coughs and colds, vomiting once in a day, hangovers, headaches, period pains, cut fingers, sprained ankles, feeling hot, feeling cold and of course the plethora of 'drunk and asleep in the street'.

Now, I'm not saying that the process is perfect – far from it, there are plenty of failings of which I've written about in the past. Grannies with broken femurs are a lower priority than a drunk asleep in the street – and the main claim to fame about the computer triage system that we use is that 'it has never been successfully sued in America', and that is, sadly, a large part of the problem.

(That and the calltakers are not trained, or allowed, to vary from the script the computer gives them to read).

In the past two shifts I have been sent on numerous 'blue light' calls to drunks asleep in the street ('unconscious/not alert'), some people with colds ('difficulty in breathing'), Can't sleep ('Not alert'), Drank alcohol ('Overdose – not alert') and Fallen – bruise on thumb ('Fall – not alert'). In the last two shifts I can't think of one patient that actually required my attendance, or hospital treatment. Needless to say all the 'not alert' people were very much alert when I walked into the room and had to try and pick my patient out of a family group of the twelve people crowding into the living room.

So, why did I take them to hospital? It's because I'm not trained to leave people at home and I know that I won't get any support should that person die. I'm far from the only ambulance person with this point of view.

So, the people who commission ambulance services are looking to save the money that is currently spent on treating these non-emergency cases in hospitals. I'm not against this, after all it's my tax money that goes towards treating these non-emergency calls, and A&E treatment is expensive. It's why the government is intent on shutting down as many A&E departments as it thinks it can get away with.

So the PCTs have taken the decision that, rather than spend £100-200 per A&E hospital visit, it would be cheaper to reward the ambulance service they commission with £38 if we can either leave such cases at home, or direct them to a better place to deal with their 'illness'.

It seems sensible when 80% of our calls don't need emergency hospital treatment.

—–

Now, I'm going to take a quick break to admit that this isn't ideal. The infrastructure for people with sub-acute chronic conditions to be treated at home isn't there at the moment. That is, for example, the ability to be treating people with long term heart failure or emphysema at home is not, in my opinion, up to scratch.

In this blog post I'm talking purely about 'emergency' cases – the coughs and colds brigade as it were.

—–

With road staff unwilling to leave people at home in all but the most minor cases due to lack of support/training and a general culture of 'I won't lose my job or get sued if I take someone to hospital' it fell to Control to do a large part of the triage.

And so it was the 'Clinical Telephone Advice' desk came into being.

This is a desk with specially trained road staff who, when passed a call that is a low priority (in other words it has been through the normal computer triage system and therefore we aren't going to get sued), will ring back the patient and will talk to them and use some clinical judgement as to the best course of action for that patient.

So, for example, Mr. 'I've had a runny nose for three days, I can't get a GP appointment please send me a wahmbulance because I've run out of tissues' (and yes, I do get sent to those calls) will be triaged as not having chest pain, difficulty in breathing or any other priority symptom, and so the CTA desk will phone him back, determine that he has a cold and will advise him to suck it up and act like a man for a change.

(OK, OK, they'll probably advise he phones NHS direct or a trip to the pharmacist for some over the counter meds, but you get my drift).

Meanwhile, on the road, I'll have been sent a mobile phone mast to start driving towards (in case it turns into a 'Cat A' call) , then get sent the address I'm actually needed at, then get cancelled as the call goes to the CTA desk.

If you ever see an ambulance doing perpetual U-turns in the street, this is the reason why.

By saving the NHS £400 by not sending an ambulance who then cart him off to an A&E department, the ambulance service will receive £38 to spend on, I don't know, blankets or something.

This all makes sense, right?

—–

It all comes down to the question of, how much taxes would you like to pay for what degree of service?

If you want an ambulance on every street, well, that's £40,000+ for the ambulance, plus a couple of thousand for the kit inside it, £26,000 for me to sit in it for 37.5 hours a week, multiply that wage by at least six for 24 hour coverage, add in money for fuel, insurance, training of staff, the wages of those to take your phone call, etc, etc, etc…

—–

Moving on to the 'Another plan uncovered would see thousands of 999 calls currently classed as urgent downgraded so that callers receive telephone advice instead of an ambulance response.'

Yes.

Hell yes.

We massively over-prioritise our calls. It's why drunks in the street get a priority just short of 'dad's stopped breathing, help us please!'. All calls that we get from the police – often 'person has small cut / person needs to be checked out / person 'in shock') are automatically 'amber calls'. That's a blue light response every time.

Small cut to the head, that's a Red call as it is 'bleeding to potentially dangerous area'.

Period pain? Amber response please as it is 'Serious bleeding'.

Crying because you are upset? – Red call as you obviously have 'difficulty in breathing'.

Twenty year old with a pain in his chest from coughing too much – Red call 'Chest pain'.

Blocked nose? – Red call as you have 'difficulty in breathing'.

None if these need an ambulance, but because of the triage system that is forced upon us we have no choice.

(Meanwhile granny with 'broken leg, after a fall' is a Green call – we'll get to you when we have finished dealing with all of the above… or if one of our sensible allocators is working and upgrades the call.)

We need, as a priority, to juggle the priorities that we give calls – based on the evidence that we have collected from 4,000+ calls a day over a number of years, otherwise we just aren't able to cope with the influx of 'can't get a GP' calls.

In fact recently, Peter Bradley, our CEO chaired a meeting that proposed this – and he still got turned down.

(The government seems to adore ignoring evidence and just going it's own way – so I chose to ignore the bullshit they tell me.)

So downgrading 'puncture wound, peripheral artery' seems reasonable to me – because that, right there, is your 'I cut my finger on a lid of a cat food tin', it's not someone getting stabbed and dying in the street.

—–

Needless to say I don't get to see any of these £38 'bonuses', and that is almost certainly for the better, otherwise road staff would take more risks at leaving patient's at home.

—–

The problem simply boils down to this – like it says on the side of the ambulance we are an 'Accident and emergency' service, we should not be a replacement for GPs, we should not be used because someone can't be bothered to wait for a GP appointment, we should not be called at 1am in the morning because someone has had a 'high blood pressure for the last week'.

But people will use us like that because they want 'things' to be 'sorted out immediately with no waiting'.

Our ' core business' is A&E work, and yet we are being forced to be a medical everyman, without the funding, the infrastructure and the training – and a large part of this is based around the government not understanding that because someone has an apparently minor illness like a headache, a minimally trained ambulance worker can rule out the sorts of things that doctors train for eight years to rule out. Am I a neurologist? Can I tell the difference between a migraine, meningitis or a brain tumour?

—–

And tomorrow I'll tell you why our funding has been cut by £1.6 million.

—–

As I don't work up in Control, I'd be exceptionally happy to have any comments from Control room staff on this story – for one, I can't see how anything that is a 'collapse with difficulty in breathing' could end up going to the CTA desk as stated in that story.

When we are called to a drunk in the street we have a number of options open to us. Well, we have four options, but realistically we only have two.

Option One

Leave them where they are – either they aren't that drunk, or they have friends who will look after them. We don't do this that often as it will only take one of them to then waltz out into traffic and get their fool arse killed to lose you your job.

Option Two

Call the police. If there is nothing wrong with them then surely we should call the police, after all it's not a medical problem really is it? Realistically, it's the police who call us to get rid of the drunks and one too many death in custody cases means that custody sergeants are loathe to have drunk in their cells. I can't really blame them.

Option Three

The commonest one – take the drunken idiot to hospital, then we have been seen to have done our job in removing them to a place of safety. Of course, in many of these cases the A&E department isn't the place for them. Where we should be taking them is to a cot in a tent where minimally trained (and therefore cheap) people can look after them until they sober up.

As these places don't exist (except on special occasions like New Year's Eve in central London) the 'patient' ends up in A&E where they can cause a load of trouble for the staff and other patients.

Option Four

We take them home, we leave them with someone who is at least a little bit responsible and then make ready for our next job. It works if we know where they live and that they aren't too drunk to stand. This gets us clear of the patient quicker than if we were to take them to hospital, it frees the hospital from having to look after the person concerned, and the drunkard is safe in their own bed.

As mentioned, we don't do options One and Two, we often use option Three and we can also, at our discretion, end up using option Four a fair bit as well.

—–

Paramedic who gave drunk girls a lift suspended

The on-duty paramedic was caught on camera dropping five women, who were swigging from a bottle of wine, at a train station. One of his passengers even kissed him farewell as they stumbled out of the emergency vehicle in full view of hundreds of people celebrating St Patrick's Day.

“I was absolutely gobsmacked and couldn't believe what I was seeing,” said Paul King, a photographer who saw the scene. “I am sure taxpayers would be delighted to know that they are paying for paramedics to operate as a free taxi service for drunken women. “It is absolutely disgusting and what worries me is the number of real emergencies that were kept waiting while this was going on.” The paramedic, who has not been identified, works for private ambulance company MediForce and was contracted by the South Central Ambulance Service to provide ambulance cover in Reading on Wednesday night.

…..

“Our responder was informed by a member of the public that one of the members of a group of females was having difficulty and kept falling over around the corner from his location,” he said. “He responded at normal speed to the location and found four females, one of whom was lying on the floor. He inquired if assistance was required and, after assessing that there was no injury or illness that required hospital intervention, he took the four females at normal speed without turning on his emergency lights or sirens to Reading train station so that they could make their way home safely.

—–

Now, like most ambulance stories in the newspapers, I'm sure there are several details missing – however, going on what has been written this 'Paramedic' (the private company only refer to him as a 'responder', not a Paramedic), seems to have done nothing different than what regular ambulance crews, certainly across London, do every night.

I'd like to direct Mr King to the years of archive material in this blog to show him that I am often used as a 'free taxi', by drunks and non-drunks alike.

It seems to me that the responder did nothing wrong, and in fact acted with full duty of care. Certainly I would have done much the same in the same situation.

(Well… Actually I'm not brave enough to have drunk women alone in a car with me – just in case one of them makes an allegation against me. It's happened to crews in the past and I've been threatened with it myself. It's one of the many reasons why I'm glad I've got a female crewmate).

What were his other options? Leave them in the street – then the headline would be 'Paramedic leaves my injured daughter in the street'.

Take her to hospital, despite not needing to go?

Wait for an ambulance to come and take her to hospital? Thereby tying him and the ambulance up with a rubbish job when they could be going to see one of those 'real emergencies' that I've heard about but haven't personally seen in the last four months.

I'm no fan of private ambulance services doing 999/A&E work – and if I had the motivation I'd do an exposé on what the coming privatisation of the ambulance service will mean for patient care. But in this case the responder did a sensible thing, his company even say he did things for the drunk's safety.

…and still ends up suspended.

(I suspect he wouldn't have been suspended if the newspapers hadn't got a hold of this non-story).

I always though I had to watch out for being punched, stabbed or run over – looks like the biggest danger to my career is someone talking to a newspaper.

It's getting harder for me to blog because I'm trying to not lose my sanity.

You see, this blog has been a place for me to tell stories but it has also been a place for me to get angry – to shout about crappy social care, uncaring and criminal nursing homes, the misuse of our service and, indeed, the mistakes that I think the government and our own management have made.

But of late I've come to realise that getting angry about things doesn't matter, not really.

I can shout all I like, rant and rave, fill in paperwork and publicise things on this blog – and the net result of all that energy, strain and anger is precisely nil.

So I've been working on not getting angry anymore about things that I cannot change.

No blankets on my ambulance – not my fault.

No essential medical kit on my ambulance – I'll muddle along without, but it's not my fault.

Being sent on 'active area cover' 800 yards from the station – So what if it's almost certainly against the policy I'll meekly go there like a lamb.

Someone dials 999 because they've had a blocked nose for three hours? – Fine, come on to my ambulance and I'll drive you to A&E where you can wait for hours.

I'll try not to listen to the desperate calls for ambulances to go to a fitting child.

You dialled 999 because you want 'treatment' for the headache you've had for the past hour – sure, I'll point out that it says 'Emergency' on the side of the ambulance and not 'GP', 'Pharmacy', or 'Most things get better left alone'. Then I'll take you to hospital and you can sit in a noisy, brightly lit waiting room for three hours and fifty minutes.

When the drunk with the cut to his head turns violent, or walks off, I'm not going to struggle with them to get them into my ambulance.

Basically I'm worn – nothing I do has any wider effect than the comfort that I can give to the patient in front of me and their relatives. If I keep worrying and getting angry I'm going to lose my head.

—–

So, I shall continue to treat my patients to the best of my ability with the equipment that I have to hand and the training that I have been given – and to stop worrying about the big picture.

The only downside to this is that, without the passionate hatred of where things are going so obviously wrong, I'm finding it hard to be motivated to write blog posts.

After all it's a bit tricky to write something interesting about a young man calling an ambulance because he vomited once.

And so this is my 'excuse' as it were as to why my blogging has been light of late.

—–

I'm also somewhat fed up about double standards.

A paramedic who lied about his failure to try to revive a collapsed heart attack victim on a 999 call was jailed for a year today.

That's lied about something – still very wrong, but really? A year in jail?

Especially when you look at this,

A Rotherhithe woman received a suspended sentence after attacking a paramedic and police officer who tried to assist her. Kate Ibrahim, 30, of Tawny Way, pleaded guilty, having changed her plea since a previous appearance, to two counts of assault.

Or even this little charmer – who, if I met in the course of my work I'd have to call sir…

A joyrider has walked free from court after killing a police dog and injuring two officers in a road smash while three times over the drink-drive limit. As his 12-month prison sentence was suspended at Newcastle Crown Court, Sean Lawson, 20, shouted ‘Get in!’

I don't know – I just feel like buggering off to a remote island somewhere and letting people get on with it.

—–

My comment on the paramedic jailed for lying, because a lot of people have asked is simple – if he'd said that he couldn't start resuscitation because of the size of the patient and the cramped environment he'd probably have been fine. I don't really see the point of lying about it, at the end of the day the police and the coroner would have understood (and this is why I suspect he's been jailed for lying rather than for manslaughter or similar.

Still, he's got a year to think about it.

I really like I.T – Information Technology, after all I've been using it since I was around eight years old. However, in those thirty years of using computers I'm also fully aware of some of the problems that I.T can make manifest.

Especially when you bring in the cheapest contractors, don't supervise them properly, don't consult properly with the people to be using the system and then start cutting budgets halfway through the project.

*cough* NHS *cough*

I mean, if you can't get contractors who are skilled enough to stick linoleum to the floor, how can you trust your commissioning people to find someone good enough to do invisible and arcane things with computers.

Therefore you end up doing daft things like sending letters with confidential information to the wrong people – as, despite what the 'Connecting for Health' person says, without serious thinking I can imagine two ways of a member of the public getting confidential and potentially damaging information because of these letters.

(And notice how the CoH speaks as faceless unit – the spokesperson doesn't have a name in that article)

Actually this is perhaps why we stick with outdated software – official web browser of the NHS? Internet Explorer 6.

—–

But I'm no Luddite – when a system works well, it works well.

Take my mum – she's currently under the care of a consultant and the consultant is juggling her medication for her. Slowly increasing the medication while looking for improvement or side effects.

Does my mum need an appointment to do this? No. The Consultant has an email address that we can send updates to, and the Consultant can suggest dose changes.

It works really well.

The problem only occurred when my mum went to the GP surgery (that has been there for some years) in order to get a refill of the prescription.

My phone rang that morning…

'Hello, it's the GP surgery, you mum has come in asking for more pills but we have no record of this – but she has told us about the emails from the consultant – can you fax the email to us please'.

Well, I haven't owned a fax machine for quite some time.

'Could I not forward the email to you? I have it on the machine I'm sitting in front of right now'.

'Sorry, no – our email isn't working yet'.

So I had to print it out and drive down to my mum's place (only five minutes and I did get a cup of tea for my trouble) with a printed out email in my hand. All because their email wasn't working yet.

—–

So, you can see how it works – someone embracing technology as an option (I know that email isn't hugely secure, but the important thing is that we had a choice about whether to use it or not), while another part of the NHS can't get it's email working.

Situation normal then – the luck of the draw.

“I know you like doing that sort of thing”, my crewmate said, “but I can do it this time seeing as you are getting old and fat”.

—–

It was 3am in the morning (as it always seems to be) and we were being sent out of our area, although quite close to where I live, to go and see an elderly woman who had called for an ambulance and seemed a bit confused.

Knocking on the front door I could see a hunched shape moving around in the hallway. It came to the door, fiddled around a bit and then wandered away.

It's more normal that when people call for an ambulance they open the front door for us.*

I tried knocking again – this time the living room window opened and I was suddenly face to face with a little old lady.

“I can't let you in, the door is locked and I can't find a key”, she waved her arm at me – even in the dark I could see that it looked like she was sporting a broken wrist. “I know what”, she said, “I'll try the back door”.

My crewmate and I walked around to the back door where the same event played out. This time she opened the kitchen window.

“Oh dear, this one is locked as well”, she said, “Maybe the front door is unlocked”.

I explained that she had already tried the front door.

I eyed the kitchen window. It opened pretty wide, I was certain I could climb through it.

“Can you climb in through the window?”, asked our patient. Behind me I could hear my crewmate groan. She knows I love climbing over, through and into things.

“I know you like doing that sort of thing”, my crewmate said, “but I can do it this time seeing as you are getting old and fat”.

Well, that was a red flag to a bull. I had to climb through the window now.

My plan was simple – the patient was obviously mildly confused, I'd nip through the window, find the keys and open the front door to let my crewmate in.

Climbing through the window was fairly easy, and if my crewmate leaves a comment saying that I barely squeezed through and was panting and red faced by the end of it then I would trust you all to ignore her.

Once I was in the kitchen I could give our patient a look over – my suspicions were right in that it looked like she had broken her wrist while climbing out of bed, although my patient couldn't remember falling, her obvious dementia meant that she couldn't remember much.

But she was a nice old stick and we had a nice chat while I searched the house for the front door keys.

I looked everywhere, from where you would expect to find keys to the more inventive places that someone with dementia can hide something (ovens, fridges, teapots) – but no keys were found.

My crewmate had gone to sit in the cab, there was nothing she could do standing around in the cold.

I'd noticed, because I'm funny like that, that there was a 'keysafe' on the outside of the house – this is a little combination lock box that holds a spare set of keys, it's normally used when a person has carers but isn't always able to open the door for them.

“Do you know the code to the keysafe”, I asked hopefully, “the little box outside that holds the keys for your carers?”

“I have a keysafe?”, she answered, “Sorry love, I've no idea”.

I looked in the care notes for an out of hours phone number – surely they would know.

But, of course, the sun had gone down and the 'out of hours' phone number just went through to the normal office phone.

“Our hours are between nine am and five pm…. please leave a message”. Considering my shift ended at 7am I didn't fancy waiting that long to get an answer.

So I called up Control on my radio and asked them to try and get in contact with the care suppliers – maybe they could find a different number and ask what the code to the keysafe was.

—–

A little while later Control got back to me – the care provider didn't have the slightest clue about the lady.

So I set about a bit of detective work and found the phone number for our patient's daughter. I didn't really want to ring them (it was about 3:45 by now), but she was my last hope if I didn't want to be stuck in the house all night. While the company was lovely, her wrist really needed looking at by a doctor.

The first ring went to an answerphone, but I know how difficult it is to find your phone when you've been woken from your sleep, so I hung up and dialled again.

This time success!

—–

Now, one thing I learnt when I was a nurse and was ringing relatives all the time, is that you need to keep them calm and relaxed, otherwise they can think the worst.

“Hello there, this is the London Ambulance Service, I'm with your mother and she's absolutely fine, just a bit of a fall….”

All absolutely true – and it's best to get the 'absolutely fine' bit out of the way before their imagination jumps in with “…and she's dead as a dodo”.

I apologised for ringing at that time of the morning and I told her my situation. I was very thankful that she didn't laugh down the phone at me.

Happily the daughter knew the combination to the keysafe, and wasn't bothered by me waking her up at the crack of sparrowfart.

So my crewmate was able to open the box, retrieve the key and then fail horribly at trying to open the front door.

One of the keys fit, but it just didn't turn in the lock…

Thankfully one of the keys fit the back door and we could soon get our patient off to hospital where she was well looked after.

—–

I'm glad that we managed to get the door open, because otherwise it would have needed the police to arrive and rescue me by kicking down the door. Something I could do without…

Sadly, although not unusually, I was let down by the lack of coordination and information from the care team. It really does seem that once the sun goes down and the firefighters all go to bed** it really is just us and the police out there to keep people safe.

But of course, all that will soon change – what with Labour's plans. Why, I fully expect every carer to be bright, determined and committed. Not underpaid, undereducated and uncaring – that would never happen, and certainly never be the norm. I'll tell you what Gordon, Andy, and whoever the Conservatives will have as health secretary – let me come and explain why ambulances count as social care, it was something that your predecessor was surprised to hear from me.

Never mind, I'm sure that the numbers will show that there is more social care – but I bet they won't show the increased ambulance usage because the social care is so slipshod.

What is really sad is that I sometimes see superb social and residential care – it's just that it is increasingly rare.

—–

*However, I could not count the number of times someone has called for an ambulance, we've turned up four minutes later and on knocking at the door the occupants have asked who it is…

**I do of course jest – they don't go to sleep. They watch porn instead***.

***I love 'em really – mostly because a lot of them look like they box for a hobby and could take me in a fair fight.****

****Especially the women.

Queen's Hospital in Romford is closed

King Georges Hospital, a bit closer to my station is closed.

Whipps Cross hospital remains open for more of the day, but then closes.

Newham, Homerton and the Royal London are now the only hospitals in East London accepting patients.

—–

Queen's and King Georges being closed in the east means that ambulances local to them are bringing patients to Newham.

Crews local to Newham (i.e. me) are being told to take patients to either the Homerton or to the Royal London.

I don't know what crews local to the Homerton or Royal London are being to to do.

—–

I pick up a patient a stone's throw from Newham hospital, he has chest pain that could be cardiac in nature. I have a bit of job persuading him to come to hospital, but he finally agrees that the only definitive test is some blood tests.

As directed I contact Control to see where I should take him. They tell me to go to the Royal London hospital.

I tell the patient – he gets off the trolley and walks out of the ambulance, he doesn't want to go to that hospital and I had a hard enough time getting him to agree to go to the local hospital.

I complete my paperwork and then fill out a clinical incident form. If he drops dead it'll be me in front o the coroner, not my bosses.

—–

I spoke to one of the crews that is local to Queens hospital, they tell me that the A&E department is full of patients from last night. They are still waiting to go up to the wards to get the treatment that they need.

But there aren't enough beds.

Queen's hospital was only built in the last two years – you'd assume that it would have been designed and funded to meet the needs of the local people.

I can understand why the A&E closes, it's a clinical risk to be so overcrowded.

—–

But it's also a clinical risk to be driving patients across London, it's a clinical risk to have patients decide that they want to stay at work rather than be driven miles to a strange hospital.

It's a clinical risk that I can't take a patient who has multiple problems that the local hospital knows all about to that hospital (although in that case I successfully argue my case with Control, at least I think I do, they don't reply after I tell them why I'm going to the local hospital instead of one unfamiliar with my patient).

I'd say that it's a clinical risk that ambulances are tied up with longer than normal transports – this means it takes us longer to go clear at hospital to get to our next patient. And it's normal for us to be holding calls for ambulances to come clear – how many more calls were we holding today?

—–

Once more, a lack of capacity means that those of us on the bottom of the pile get the most crap – and in this case it's not the ambulance service, it's the patients.

The answer is simple, but it costs money. Money 'better' spent on keeping bankers in jobs and fighting wars that don't concern us.

But of course, I'm just a stretcher monkey, what do I know?