In my last post I was asked in a comment why I don’t fear death, what brought me to that attitude towards it.

I would guess that due to the amount of death, ‘near death’, and ‘about to die’ that I have seen due to my work it has driven me to think about it a bit more than a ‘normal’ person would.

The two things that influence my thoughts about death would be my atheism, and my grasp, tenuous as it may be at some times, of logic.

Firstly, my atheism, means that I have no fear of a Heaven, or Hell, no Limbo (and sadly no Valhalla). So I don’t think that there is anything after death. You die, and you stop. Stop thinking, stop feeling, stop worrying about work, or family, or why the cat keeps scratching your sofa.

And if I stop thinking, then there is no consciousness, and therefore no experiencing of anything, including time.

So when I am dead, that’s it – I won’t feel anything because I won’t exist anymore. When I sleep I have no experience of time, no feelings of pain, no nothing. I don’t worry about if I am going to wake up because my conscious mind ceases to exist for the time I’m asleep.

(I know that with the different phases of sleep and with dreams the analogy breaks down somewhat, but I think the general point is made).

So, logically, why should I be scared of death? Even if I die in a horrible and painful fashion, I’ll not remember any of it, because I will no longer exist. So ultimately it won’t matter how I die, because even with a long drawn out death it will end eventually.

And I don’t plan on having a long, drawn out death. If I become terminally ill then I shall scream for the really good medications, and when I’m fed up of that – well, there are ways out of the situation.

As I have no sense of self before I was concieved, I will have no sense of self once I have ceased to exist. All of which, in my mind, is comforting, that no matter how bad things get, in the end all worries, all pain, will cease.

Of course, if I’m wrong? Well won’t I look foolish as Anubis weighs my heart against a feather.

But that’s a bridge I’ll worry about when I reach it.

I’m not massively scared of anything. In part because I’ve seen a lot of bad stuff, in part because once you are not scared of dying a lot of fear goes away.

So when my brain wants to try and scare me with a nightmare it has to get a bit ‘creative’.

So it tries to frustrate me – Last night I dreamt that there was an older Star Wars ‘sequel’, it made no plot sense, the lightsabers were plastic toys doused in lighter fuel, and David Cameron had a guest role.
Bad enough, but my dream went further, the creators of the film had managed to hijack IMDB, so when I looked up the film (in order to avoid any other films the director had made) it loaded malware onto my computer.
And then every time I tried to delete it, it would reinstall.

Nightmare.

Taps mike
Is this thing on?

There is a reason why I tend to keep off the internet when the 7/7 bombings anniversary rolls around, it’s not because of any traumatic memories (I did nothing more than turn up to cover my colleagues who dealt with it all, while I had one ‘Maternataxi’ job).

My thoughts on the days around it can be found here

What makes me angry is that on the anniversary there is a big hoo-ha about how ‘London stood as one’, with no hate but just a determination to keep on living and muddling along as we did before the bombing.

And it’s true – we did.

But then the media realised that they would sell more papers, get more eyeballs, and have a bigger influence by villifying muslims. By causing hatred and fear. And now we end up with groups like the EDL and ‘Britain First’. Two organisations that came into being based on the lies that the media has spun.

So something that should have unified us has, instead, just divided us. And it seems it’s going to continue that way – all for the benefit of media mogals and shareholders.

I’m not a fan of conspiracy theories, while there is often a certain elegance to them I have been on this planet far too long to believe that great secrets can be kept. Humans are dreadfully inefficient creatures and a conspiracy needs a more perfect operation than can be handled by bunches of jumped up primates.

What I do see however is A leading to B which leads to C.

On Monday I wrote about the explosion in the use of private ambulances (and a good comment was left, one I shall revisit later), in that post I linked to my piece about the cutting of London ambulance staff by one sixth. A few days later, after the news story had been featured on the BBC, it was announced that London ambulance would be recruiting more staff.

Obviously I was interested, and as I keep an eye on such things, I looked as to who the LAS was looking to recruit. Their only job vacancies at the moment are for ‘Ambulance Support Staff’.

Ambulance support staff are not trained to the same standard as what the public would call ‘Paramedics’, and the plan is to team up one paramedic with a ‘support staff’. So when you call an ambulance only one of the people present will be trained to deal with your medical emergency. The other will essentially be a driver and equipment carrier.

It goes without saying that when there is a serious job, for example a ‘proper’ car accident, then you need all the hands you can get, and in the future you will arrive on a scene and half the people wearing green will be undertrained and underpaid staff.

Needless to say ambulance support staff are paid less than the person that they are sitting next to for twelve hours of the day.

So instead of the old ‘one day drive, one day look after the patient’ that we had always had, the paramedic will be looking after patients for twelve hours a day constantly with no break and no support. Given the unique pressures of ambulance work this is not in the best interests of the health of the paramedic.

Money will be saved, patients will initially not know the difference and paramedics will burn out even faster. These burnouts will be replaced by ‘apprentice paramedics’ who will also be cheaper than those who have been in the job for a longer period of time. What impact do you think that losing all your experienced members of staff will have on morale and, more importantly, patient care?

So we have a cutting of staff, followed by increasing private contractors and now followed by recruiting more staff. These staff are to be paid less than the staff originally lost. And apparently this will have no impact on patient care. The expensive staff will burn out quicker and be replaced by cheaper staff and this will mean patient care will fall.

This is similar to the government’s plan of student nurses working for a year as a HCA – it’s a blatant way of getting free (or certainly very cheap) health care assistants.

A leads to B which leads to C.

An apparent increase in the use of private ambulances in the NHS is a risk to patient safety, Labour has warned.
It says freedom of information requests show spending on private vehicles by three English ambulance services rose by millions over two years.

This is amusing to me as it was Labour who started the privatisation of the ambulance service whne they were in power. I remember the LAS losing a lot of patient transport contracts as private companies could ‘do it better and cheaper’. At one hospital I remember the private ambulance company lost their contract because none of their staff had been through criminal record checks…

I had reason to need an ambulance to transport a patient to hospital as an urgent case a little while ago. We booked the private ambulance to do the job and thought that was that. Later that day I had a phone call from the company saying that they wouldn’t do the job as it wasn’t booked with 24 hours notice. I told them that they should go ahead and book it for the next day, to which they replied that they still needed twenty four hours notice – I explained that they were actually getting twenty-six hours notice.

In the end we decided that as the patient needed to be in hospital we should use the LAS urgent service.
I was waiting at the house so that the crew could gain entry and was less than surprised to see a private ambulance turn up.

The figures showed an increase in spending of (in London) more then £3.8m, from less than £400,000, in 2010/2011, to £4.2m, in 2012/2013.

When I was still working in the hospital I was surprised that, when I went outside the A&E doors (normally looking for a member of staff who’d gone outside for a crafty cigarette), I would often see more private emergency ambulances than LAS ones.

As for the increase in private ambulances – could it have anything to do with something I wrote about previously – the decimation of the LAS?

While I am ideologically against the privatisation of the NHS (and the evidence would seem to back me up), the more practical concerns with respect to private ambulance services are, how well are they trained and kitted? Do they have clinical updates, CRB checks? Who does their staf training? What are the legal issues of them driving on blue lights and claiming the excemptions that the NHS services claim? In the effort to cut costs (and thereby increase profits for shareholders and owners) are they compromising patient safety?

I know that private ambulance services are monitored by the CQC, but we know how well staffed and effective they are.

The quality of the work of ambulance services are hard to track, it’s why the main gauge of ‘efficiency’ is ‘how fast did they get there’ – so I wonder how well the private services are being monitored.

My guess would be ‘not very well’.

The interrogator sat opposite the interviewee, his machinery sat on the table between them. He checked his screens with care, watching the pupil dilation of the woman he was addressing.

“Miss Jones”, he said, “You are walking in the desert and you come across a tortoise that is laying on it’s back in the baking sun. What do you do?”

“I pick it up and turn it over – poor thing”, she replied.

The interrogator made a few notes and asked her his follow up question, “And once you have completed your training and gained your degree?”

“Easy – fuck it, let it die”.

The interrogator stood and reached across the table to shake her hand, “Congratulations, welcome to nurse training”

The government has said that there is a problem with compassion in nursing, that nurses don’t ‘care’ enough. So today they released their plan on making nurses work as Healthcare assistants (HCAs) for up to a year before they start their training. Apparently this will teach prospective nurses how to care for people – something that I seem to remember from my own nurse training which didn’t include the HCA component. Obviously all nurses are horrible bastards while all HCAs are paragons of compassion and are never lazy or arrogant.

How much does the government value combatting the horrors of Mid Staffordshire? I their own words it must be ‘budget neutral’, in other words it must not cost anything. Which I think shows how seriously they take the care of the <strike>plebs</strike> public.

There seems to be the thought that, in the process of doing a degree, a prospective nurse has all human compassion removed from them. The person applying for a nursing degree may initially do so due to compassion for their fellow human, but sitting in classrooms, writing essays and going on placements somehow strips them of their empathy.

I also think that there is element of sexism in this anti-intellectual approach – nursing is still seen as a ‘woman’s job’, and the impression I get is that if we teach these women to a degree level then their wombs harden over and they lose their feminine caring. The discussion also seems to be around whether nurses really need a degree, after all can’t they just be taught on the job?

(The answer to that is no by the way)

However, it would seem that the government is sending a mixed message, first that educating nurses makes them into empathy-free robots, while they also want nurses to become mini-GPs (as I was) in order to provide primary care on the cheap. And if you think about it, if Cameron broke his ankle would he see a nurse practitioner, or would he see a doctor?

I think that this is also a way to get HCAs on the cheap – making students work on a ward in order to gain a bursary rather than ‘employ’ them with employment rights and pensions and all that sort of thing the government seems desperate to get rid of.

I wonder if further traction might be made of this idea. MPs lost their humanity years ago, probably as they start in a public school, go to a red brick university and then become MPs via a stream of ‘think tanks’, and consultancies. Perhaps they should spend a year as an HCA in order to remind them that voters are people and not just dots on a demographic graph. If you look at Jeremy Hunt and his actions, do you think that he cares for the person on the street?

I shall tell you why nurses appear ‘uncaring’, it’s because of the paperwork, the constant pressures, the cuts in pay and jobs. It’s because unless you are a nurse or similar then you don’t understand the stresses you are under. Patients think that the nurse is being dismissive of them specifically – not because she has seen patients like you for twelve hours a day for the past five years and really, you aren’t that different from those that came before you and eventually it can wear you down.

Obviously something needs to improve, For example Schwartz Rounds. But attacking nurses for being over educated rather than addressing the root causes is not helping anyone. (Although these attacks are presumably ‘budget neutral’).

This just continues the attacks on nursing that are happening on a regular basis and a cynical person (i.e. me) would suggest that this is the government continuing to soften up the NHS in order to make it easier to sell it for their mates because obviously the solution for uncaring nurses is to employ private companies to provide care. After all if there is one thing that we know is that an unfettered capitalist system looks after the weakest members of society.

Anyway – I apologise for the rant, I had a tiring day today as a nurse and that sometimes makes me grumpy and a bit incoherent.

My name is Brian Kellett and I used to write a blog under the name Tom Reynolds. The old blog went down when the company hosting it stopped running their blogging platform. I moved my old blog ‘Random acts of Reality’ to here. All of it is here but at some point I lost the commentors names. Sorry about that.

I used to work on the ambulances, then I worked as a nurse practitioner in an urgent care centre. Now I’m a community nurse, looking after adults.

This means things like giving eye-drops and insulin, dressing leg ulcers, and doing supportive visits for people with chronic health problems. It gets a bit more complicated on occasion but that is it in a nutshell. I do not give people baths or feed them as that is the role of social services and home carers.

Since changing my job, I plan on writing a lot more. This is because I’m working eight hour shifts rather than twelve hour ones.

I wrote two books – Blood, sweat and tea, More blood, Sweat and Tea and these were collected into one volume – Sirens. These books were the basis of the TV series ‘Sirens‘. It got cancelled after one series – sorry.

I have back problems, bowel problems and depression, along with other pains and failures. This makes life sometimes annoying by which I cope by being angry at things.

I’m in the process of working on a new book and on a secret project codenamed ‘Truth Bastards’ that may or may not see the light of day.

I spend too much time gaming and can often be found on Steam as bkellett. I am also spending a large amount of time playing Guild Wars 2 on the Piken Square server – mostly as Tom Weylan.

I tweet a lot as @Reynolds and I don’t use Facebook if I can help it.  I am too old to use Tumblr.

The best way to reach me is through email, or via twitter.