I've mentioned before how the ambulance service and the A&E department is often seen as a "safety net" by other healthcare providers. Both yesterday and today we had perfect examples of this.

Yesterday we were called by a 70 year old man with a urinary catheter which had blocked. This is a fairly simple thing to solve as it just needs a flush of water up the catheter to clear the blockage. It's a five minute job that we, as ambulance crews, aren't allowed to do - however it is the sort of job that District nurses are supposed to do.

So why hadn't a district nurse been to see the patient, so that she could flush the catheter and prevent the patient from having to attend A&E? Why was the patient, who had phoned up the nurse himself, and told her exactly what he needed doing, forced to call an ambulance?

Because the nurse didn't have any water to actually flush the catheter.

It's a bit like if I turned up to someone having an asthma attack, and didn't have any oxygen to give them.

So the district nurse told the patient to dial 999 for an ambulance. We arrived and found him with a bladder so full it was causing him severe pain. We took him into Newham hospital, who, within minutes had cleared his catheter, and eased his pain - then they gave him a 'takeaway' bottle of water so that the district nurse wouldn't have an excuse the next time she needed to visit him.

Today, we were called to a patient who needed his anti-Parkinsons disease medication. He had a carer, who was supposed to visit him once a day to clean, and arrange his medication. But for the last two days, because the 'carer' couldn't get in touch with the patient's GP, had just left him without his medication. We turned up, not knowing what we could do to help. The flat in which the patient was living is brand new, and yet was already very untidy. The patient told me that he was lucky if the carer spent longer than 5 minutes with him (the carer is contracted to work with him for an hour a day).

This poor man was left, alone and shaking, with a carer who seemed to think that if he ignored this 'problem' it would soon go away.

So we did the only thing that we could - we took him to hospital, so that they could sort out his medication for him. Meanwhile I filled in an 'LA260' which is a 'vulnerable adults' form, and allows the LAS to bring situations of abuse, and potential abuse to the attention of the local social services. They now have the name of the care agency, and this problem can solved before it repeats itself in a months time.

Hopefully someone will get a bollocking, and our patient will get a carer that actually cares for him.

It often feels that we, and the local A&E departments, are left to do the jobs that other people should be doing, but because we are there, these other agencies don't seem to care about doing a competent job. I'm aware that there are probably loads of health visitors/social workers/district nurse/CPN's and GPs who do actually give a damn about their patients - it's just that we never seem to meet them.