Our overstretched ambulance service

[classic33]

Even paramedics are entitled to a break during their shift.

Never said they didn't.

They were the first two I've ever seen doing that, sitting at the rear of the station on the grass, in all the times I've gone past one, ambulance station.

Even sat outside, on breaks, they seem to be doing something. Three "insurance payments" made in the the first two months of this year. Nine in total this year.

 

[Stephenite]

The only time I've needed an ambulance myself I was given a quick assessment and carted off to the A+E. (It was a stab wound to the side incurred during a mugging in Oslo). I was basically frog-marched through the waiting room to be looked at by a doctor and stitched up. The paramedics didn't have to wait around. That sounds stupid.

 

[Brains]

Various personal ambulance stories where I've made that call:

In Snowdonia; with a fatality, 90 minutes from call to collection

In remote Cornwall; with a diabetic coma, 18 minutes from call to collection, 2 ambulances attended as the other one had nothing to do!

In Central London; with a stabbing. After 50 minutes and multiple calls, we gave up, and loaded the guy into a chauffeur driven Rolls!
No idea if the Ambulance ever turned up, but it certainly did not arrive within 90 minutes.

In Central London: Two people with broken limbs. Told ambulance waiting time was over an hour, and A&E was also full.
15-20 major hospitals within 5 miles!
Got a private estate car, loaded both people into it, drove out to an A&E in Kent 20 miles away and they were both admitted immediately.
Pick up to Admittance in Kent was under 45 mins!

In a very remote mountain area of Switzerland: 45 minutes for a 4x4 Unimog Ambulance to make its way up 10 miles of forest track and 1,000m of ascent to pick up a coma case. (It's the equivalent of driving up Ben Nevis). The guy was in hospital 2 hours from the initial call!

Amazon Rain Forest of Bolivia; Broken collar bone, 2 hr walk to the river, 9 hours in a motorised canoe, 2 hrs in the back of a 4x4 along very rough tracks. But superb service once admitted.

Peru; Broken wrist, 2 days drive south to the nearest big town. But once admitted, great service (at a price most locals could not have afforded)

Central London; with a epilepsy case. Paramedic arrived in around 3 minutes! Ambulance in under 10!

 

[Hicky]

The pod is monitored, how many jobs l do, how long they take etc Little old lady wants a chair ride? Some med pro needs something urgent "Sorry it's not on the system"...well to help them I'll be rated as "ldle", thats what the system shows and l'd be assessed negatively, should l help?

On general duties, l used to do something obvious. Taking a patient back on a trolley to a ward, meant that l'd match up another job, that is I'd pick up another patient on said trolley from somewhere and move them, 2 jobs per trip.

Now l cannot, l am at the mercy of a system that sends inappropriate/random jobs to me, so its usually 1 trip = 1 job, even manipulating it I reckon my productivity has fallen 30-40%.

We now have a "command centre" and a "wall of analytics" that might improve matters, we'll see.

What seems to be the key to managers more recently is the ability to see or check how hard them below are working and checkup/cajole them into being more productive for those above them.
In my eyes a true manager trains them below to do the job as efficiently as poss and let’s them get on with it with a view to pushing back against upper managements unrealistic expectations rather than “yes men”. Too often too much work and too few people.

 

[tom73]

IT and technology is not the issue. It's the trying to do it on the cheep which due a combo of political nits , poor public sector management and suppliers seeing them as fair game and cashing in never turns out that way.

The one's who think it up never have need of it. So don't see the limits or the lack of practical use. Politician's love shiny stuff so if it look's nice it must be good. Portable often means having to lump around a PC on wheel's with one hand and the drug's trolley with the other. That's when they are not plugged in as the battery life is a joke or just don't charge at all. Many system's just don't talk to each other. Labours NHS digital program was a mess lack of national standard they left GP's to pick which system to use. So which ever one a practice got cheapest or the one who's rep had the best freebies won. Each trust was left do it's own thing even NHS email ended up with 2 system's.

Slowly this is changing but still they keep getting all wrong and get sold a pup over and over again. One ward Mrs 73 worked on got some handheld tablets to hand to patients to recored patient feedback. Mrs 73 as a ward sister got the job of managing them. Only one PC could download the data , they had to be plugged in one by one ,they never worked , weighed a ton and had a battery life not worth bothering with. Then once she had the data she had to upload them and email it to management as one thought about a simple one stop joined up process.

The same trust went over to electric keys for the drug cupboard. Each nurse got a personal key that needed charging every 12 hours, a simple process using a charger next cupboard within seconds the key charged.

In case of issue eg chargers went down , keys stopped working etc, ect. The ward had a master key only ward mangers and sisters had access. Told it always worked never needed charging ect, ect. One night shift the whole thing went down no keys worked or charged. Off Mrs 73 go's for the master key guess what it did need charging. Getting maintenance in the early hours of morning to break into the drugs cupboard sure was fun. The bill to fix it was on joke though.

Then the blood glucose machines for safety went high tech on the face of it nothing wrong with it and made sense. Each ward has it's own machine each staff member has a pincode only works with that machine. Each patient has bar code. So enter pin, scan bar code and check reading and act as needed. Less drug errors , ect. That's until the machine brakes and you have a diabetic emergency now along with legging it to next ward for a machine you have to leg in back with member of staff of the other ward so you can use the machine. No one thought about an emergency fail safe.

We all know the US private care system is bad and on one want's it over here. But the need to save money has meant they know how to use IT and technology. One hospital rolled out iPads access the hospital for a total paperless system. A thought out, planned , joined up, and workable one.
When it came to writing up a report on cost's the guy who looked into it was worried about presenting it thinking no-one would believe him. It turned out they made the money back in savings in a week.

 

[classic33]

What seems to be the key to managers more recently is the ability to see or check how hard them below are working and checkup/cajole them into being more productive for those above them.
In my eyes a true manager trains them below to do the job as efficiently as poss and let’s them get on with it with a view to pushing back against upper managements unrealistic expectations rather than “yes men”. Too often too much work and too few people.

I've said it to the sister in charge(that still correct?) at the time, they're ducks. Visibly they are calm, but what you can't often see is the work going on underneath just to get things done.

The new department manager disagreed, none of those within earshot did. They were having a gander at the "insurance payment", wondering which to have. As they passed by.

 

[si_c]

If the masses did not miss use A and E. They'd have the room and staff to deal with ambulance hand overs.
Equally if they did not miss use Ambulances they'd have more to deal with real call out's.
On a side note many front line Abmo's are now staffed by ECA's cheep option but not always the best/suitable one

The problem is much larger than that in respect to ED waiting times and the impact that people with minor injuries have on the flow of patients is minimal. the larger problem is the capacity within the wider healthcare economy - and by that I mean not just ED but care homes, residential care and in-home support services, particularly for elderly or vulnerable patients.

This manifests itself in ED as ambulances waiting outside and people complaining about wait times but in reality it stems from hospitals being unable to discharge patients without sufficient care in place to ensure their safety. Because there are no care services for patients they stay in hospital for far longer than necessary and take up beds which could otherwise be used for someone waiting in ED.

It's a frustrating situation resulting from cuts across the board and is mostly out of the control of NHS providers.

Never having used an ambulance I had no idea crews had to wait in reception with their passengers. That's insane. What a staggering waste of resources.

Yes. It is.

I've always remembered John Harvey Jones on one of those investigative programmes saying the NHS's fundamental problem was that it couldn't afford to compete with the private sector for the managers it needed. Paying peanuts, it ended up with monkeys, so already inadequate resources were incompetently used. That was 20 years ago. Sounds like nothing's changed.

Most of the managers in the NHS that I know are competent and use the resources they have available in the best way that they can. Of course there are those who aren't but they are few and far between and tend not to last long these days there are too many people who are capable wanting the jobs, especially younger people on the graduate schemes.

Paper-cut morons don't help, nor do austerity budgets. But the systems, the management: they're the killer.

Not really.

 

[tom73]

The problem is much larger than that in respect to ED waiting times and the impact that people with minor injuries have on the flow of patients is minimal. the larger problem is the capacity within the wider healthcare economy - and by that I mean not just ED but care homes, residential care and in-home support services, particularly for elderly or vulnerable patients.

This manifests itself in ED as ambulances waiting outside and people complaining about wait times but in reality it stems from hospitals being unable to discharge patients without sufficient care in place to ensure their safety. Because there are no care services for patients they stay in hospital for far longer than necessary and take up beds which could otherwise be used for someone waiting in ED.

It's a frustrating situation resulting from cuts across the board and is mostly out of the control of NHS providers.



Yes. It is.



Most of the managers in the NHS that I know are competent and use the resources they have available in the best way that they can. Of course there are those who aren't but they are few and far between and tend not to last long these days there are too many people who are capable wanting the jobs, especially younger people on the graduate schemes.



Not really.

Of course it's much wider and more complex than it looks. Attitudes to seeing GP's , A and E as some service at our beck and call for even the silly things and treating ambulances as nothing more than a taxi service. Have to change and will go some way to helping with over work front line services. We also need to wake up and understand good services cost and we have to be willing to fund them.

Capacity access the board is a growing issue and no quick fix. One thing that can change and costs little is the ending of inflexible working and thinking access the sector. The silo's need to come down and quickly we still have to much Empire building and no real push for better MDT working and thinking as one to fix the problem. It's not just all down to funding the system is often not fit for purpose and change can often only come from the inside. Too many services don't foster a culture of sharing best practice and willingness to see they have it wrong.

Too much money is wasted on stuff that really is not the best way to deal with things. The push for Physician associates is a current one. Yet again a cheep option to a problem. Greater push for ANP would be better use of money but that's a sensible option so that would never do. Then we have the nursing associates again costly and pointless.

 

[Richard A Thackeray]

Great post D.

Working in A&E, a medical professional would say "" Mark do this/that please" and l'd do it. I also had a pc screen showing who who was in each cubicle, name, DOB, sex and why they were there. That was important to me, it'd help me prepare to meet them, suicidal or off their head violent wackos need different approaches.

Now the medical professionals are data inputters and have to enter it onto the system via a terminal. Then hope it arrives on my handheld pod, but it might not, because l often don't have a wireless signal, also the system doesn't know the med pro wants me to do job, so it might arrive on another's porters device! And l now have no idea about anything at all when l pull back the curtain to face a patient.

The pod is monitored, how many jobs l do, how long they take etc Little old lady wants a chair ride? Some med pro needs something urgent "Sorry it's not on the system"...well to help them I'll be rated as "ldle", thats what the system shows and l'd be assessed negatively, should l help?

On general duties, l used to do something obvious. Taking a patient back on a trolley to a ward, meant that l'd match up another job, that is I'd pick up another patient on said trolley from somewhere and move them, 2 jobs per trip.

Now l cannot, l am at the mercy of a system that sends inappropriate/random jobs to me, so its usually 1 trip = 1 job, even manipulating it I reckon my productivity has fallen 30-40%.

It's the 2nd highly expensive IT portering system in 3 years, neither of which are as good as the old tech controller & radios. The controller " knew", the systems do not.

We now have a "command centre" and a "wall of analytics" that might improve matters, we'll see.

We were going to try that kind of technology
Our 'Landlords' use a derivative of it (PFI building) for their staff on the 'dark-side'
Out Porters are on radios, controlled by knowledgeable staff
Theatres & AE, porters are answerable/controlled by the Sisters in charge of those units
Radiography lads (& lasses) are fairly autonomous, so long as they get the relevant patients, but still have to log where they're collecting from/delivering to

my son works for the north west ambulance service and gets frustrated at the time spent hanging around hospitals to hand over

Sadly true, but if the A&E can't send patients into the Hospital because all beds are full, it acts as a log-jam

EG; I think we have 28 cubicles/trollies (without doubling up the bigger rooms, plus 7 Resus bays) - if we have the staff, as 8 are on another corridor, in the department

We're one of the 5 busiest in the country, as due to restructuring/re-organisation, we get a lot of patients that previously attended the other two A&Es in our Trust
As of my leaving today. @ 16:00, our A&E had seen almost 82,500 patie

 

[MarkF]

We were going to try that kind of technology
Our 'Landlords' use a derivative of it (PFI building) for their staff on the 'dark-side'
Out Porters are on radios, controlled by knowledgeable staff
Theatres & AE, porters are answerable/controlled by the Sisters in charge of those units
Radiography lads (& lasses) are fairly autonomous, so long as they get the relevant patients, but still have to log where they're collecting from/delivering to

It was sold to me as a system that would send tasks to the most appropriate porter. I assumed it would be an intelligent system and that I'd be tracked, it'd know where I was, where I was going and what I was doing, then match up a following task.

It's dumb, it's not even a system, it's just a facility to load tasks, but instead of the phone, it's via a keyboard. Then it's just random, so nothing matches up, so I can take patient on a trolley to one far side of the hospital, then the system will tell me to go to the other far side and change some oxygen, and so it goes on, every day. Miles and miles of wasted walking resulting in me doing much less actual productive work than I did before.

It could only, IMO, work with a controller, constantly viewing the listings and trying to match up jobs, but then that sounds just like previous controller who would radio out requests! It has a load of entirely predictable and negative consequences for everybody, one of my favourites involving the devices themselves, they are ipods, 75 were missing at the last count last week.......................mindnumbing.

 

[classic33]

Any time I've been picked up by ambulance and taken to an A&E, part of life I've never got used to, and I'm able to walk/leave under my own steam. I feel I've wasted the time of the crew that brought me there.

I've seen too many that never got that chance, to leave A&E. And that is counting those who may have got admitted.

It gives you a chance, if you want, to see a load of what many, Paramedics and A&E staff, deal with day after day. A lot of black humour may be heard, and mistaking it as them not caring, but if they didn't use it I don't think they'd last long in the job.

walj/leave corrected to walk/leave in edit.

 

[Richard A Thackeray]

I've seen too many that never got that chance, to leave A&E. And that is counting those who may have got admitted.

It gives you a chance, if you want, to see a load of what many, Paramedics and A&E staff, deal with day after day. A lot of black humour may be heard, and mistaking it as them not caring, but if they didn't use it I don't think they'd last long in the job.

True, so have I

Can we call it that now?
Somewhere there'll be a NHS manager suffering apoplexy, at it being called 'black humour

Oh yes!!!, it happens, be it Nursing staff/Doctors/Ambo-crews/Police - if they attend for any reason

 

[Hicky]

Black humour.....found amongst every uniformed service as a coping mechanism.....along with booze however that's becoming more of a thing of the past.

 

[classic33]

Black humour.....found amongst every uniformed service as a coping mechanism.....along with booze however that's becoming more of a thing of the past.

Booze a thing of the past!!

 

[Hicky]

Booze a thing of the past!!

As in it's encouraged to avoid drinking problems away....often. Does that read better ?