Tuesday, 27 July 2010


Cuts need to be made. We knew they were coming. The NHS, like all other government departments, is facing some major changes to help it through these financially unstable times. Ambulance Driver is using this piece of news to the tunes of "I told you so" in reference to the changes being proposed over in the States - the so-called "ObamaCare".

So whilst over the other side of the pond they're trying to change public health care to be a little more like the UK, we over here are travelling in the opposite direction. Surely there must be some sort of middle ground, although I'm not sure where it is. A socialist health system in a capitalist society are always going to clash.

I don't profess, or pretend for that matter, to understand all the ins and outs of the NHS, but I do know a little about the very tiny corner of it that I occupy. The NHS, to a certain degree, has been a victim of its own success.

People live longer, healthier lives. That costs money.

Chronic conditions are better treated than ever before. Sometimes they are cured, other times merely managed long-term. That costs money.

Some prescriptions, at least in England and Wales, have a minimum charge. The rest of the cost is covered by the state. That costs money.
Trauma victims have a better chance of survival. Then they need rehab. That costs money.

Operations cost money.

Drugs cost money.

Staffing the NHS costs money.

Everything costs money. And slowly but surely, we're running out of it. The promise that there would be no front line cutbacks is proving to be another of the broken promises that has become the norm for any political party seeking to seize or retain power at general elections.

Read that linked article at the top, and have a glance through the threatened cuts. One in particular caught my eye. The one that has most relevance to my little corner. They want to reduce the number of people using Accident and Emergency departments, whether through GP referrals, or at a guess, also by self-admission. Only having the newspaper article to go on, I can't be certain what that means for the ambulance world. I'd love there to have been something in there about reducing the number of inappropriate ambulance calls.

Sometimes, to save money, like the NHS needs to, there's a need to spend some money. Money spent on education, for starters.

Education on when to use the NHS. Can you manage your symptoms at home? Does your child really need to go to the doctor? Do you really need to go to A&E at 3am for something that has been bugging you for a fortnight?

Education on how to use the NHS. How do you access the most appropriate care? How do you ensure that you get the follow up you need? How do you call an ambulance, and what for?

As ambulance staff, we are front-line providers. And also have the chance to be front-line advisors and educators. But to do this effectively, we need back up. From the state, from our employers, from the system. Even from our colleagues. There are too many who opt either for one extreme or the other.

Too many who turn up to calls that are a totally inappropriate use of the NHS in general and the ambulance service in particular, and yet do nothing but transport to A&E. It's an opportunity missed.

Then there are too many who get so angry about that same call, that all they do is rant and rave at the patient. The chances of said patient paying attention to a telling off are slim to none.

We trialled a system of not sending ambulances, but unless the pressure on the ambulance service is so severe that it is on the verge, or possibly past the point of collapse, it's not utilised. So for now, we need to take it down one level, and give that responsibility to the crews on scene. If only we could devise a system where we can legally refuse to transport someone to A&E, and at the same time use our skills and knowledge to educate them about all the things I've mentioned. As things stand, we're not allowed to refuse to send an ambulance, and we're not allowed to refuse to convey to A&E. And that's money we could be saving.

Instead of employing managers at astronomical salaries who are paid for nothing more than concentrating on fictitious targets, spend that money on educating both the public and the front-line staff. There seems to be a culture shift in the ambulance service at the moment of taking decision-making and skills away from the staff, leaving those decisions to faceless, albeit trained, phone operators. There seems to be a train of thought that cost-cutting can only be done by employing lower grade staff for the front-line on lower wages, whilst maintaining staff on high wages just to hold clip boards and tick boxes.

Cost cutting within the NHS has to be brutal, but it has to be honest too.

It cannot be that the top few percent hold on to their precious jobs, whether necessary or not, whilst those at the coal-face have their jobs threatened.

It cannot be that those who most rely on the NHS, bear the full brunt of its savings.

At the same time, the general population must accept that they need to help the system, if they still want the system to be there to help them.


Chris M said...

Wow what a great post!

Very true well done that man!

Fee said...

I second everything that you say!

The Fire Brigade hereabouts run regular campaigns with the schools about hoax calls (especially in the run up to the long summer holidays). Having qualified NHS staff add on to that wouldn't be a huge financial burden, and could save a heck of a lot of money. If kids can be taught from an early enough age that dialling 999 is something you do only in a dire emergency, then it works its way into the rest of the population.

peter m said...

unfortunately, i suspect that if you reduce the number of patients you convey to a+e ,the NHS will use it as an excuse to make further cutbacks in much needed staff in the emergency sector because they will view it as , less patients needs less staff = greater savings......peter transplant team driver

Anonymous said...

Normally after reading this sort of blog, I'd have a go at you for being miserable and grumpy. But, I won't as I agree with everything you've said!! Dr Abuse

Rhiannon said...

In Manitoba Canada it costs about $250 CAD to take an ambulance to the hospital. I wonder if a system similar to ours would work.

InsomniacMedic said...

ChrisM - Thanks!
Fee - at risk of sounding like an old UK gov't - Education, Education, Education...
PeterM - I hadn't thought of it like to be honest. I hope you're wrong... The emergency sector, however, needs to go back to being an emergency sector - and not a "I have a cold and don't know what to do" sector.
DrA - Ha!
Rhiannon - It's a hot topic of conversation over here quite regularly. However, the NHS being what it is, is free at the point of delivery. End of story. I wrote a piece about charging drunks - always an emotive discussion amongst frustrated ambulance staff - and the answer just isn't as straightforward as people seem to think...
Thanks all for your comments!

Ambulance Amateur said...

Couldn't we make more use of different types of people?

Many calls to the ambulance seem to be for people who need either reassurance or advice - or a simple dressing.

Obviously we'd need to train these people reasonably well but not to paramedic standards. They could also call control if they thought something was going off that was beyond their skills.

We should also train more of the public in basic first aid. I'm not talking about the 4-day FAW course, but a simple awareness course.

About 15 years ago, I was working for a well-known company. As well as my normal job, I did First Aid. Some of us, myself included, were trained as First Aid trainers.

For each person on shift, so many hours per year were set aside for training. With two trainers on each shift, we could then train everyone - absolutely everyone - on our shift in "first aid awareness", similar to the EFAW course (but before that was being offered).

We not only had someone always on hand in an emergency, but the accident rate went down too!