I'm reliably informed that this job came out as 'Man knocked down'. It's a big fear that we all have that we get attacked while going about our work and it is for this reason that we will hold back and wait for the police if a job seems 'dodgy'. The problem is that sometimes you have no idea that there is a danger in the area.

My thoughts are with those affected by this, both the man who was killed, and the others who have been hurt. I hope the crew involved aren't badly hurt and I wish everyone a speedy recovery.

The health secretary admitted there would be difficult decisions to be taken on staffing, because "some parts of the NHS in England have taken on too many doctors and nurses".

Good grief, Hewitt is bonkers.

I'm beginning to think that 'Care in the Community' for our mentally ill has gone a bit too far when one of them has become Secretary for Health.

NHSBlogDoc is as incredulous as I am.

The BBC are very nice people.

A little walk down a few canal paths took me from the hotel in which I was staying to the hotel where the 'Medical Day' talk was taking place. Along the way I took a few pictures of swans and boats and the like. I am such a tourist.

There were around thirty writers/producers there and we were to listen to a number of talkers, myself being one of them.

The first talker was presenting a piece of BBC research, it was the distillation of a number of focus groups about what the people of the UK were most worried about. Some interesting views that were obviously media led, but in my experience have little basis in reality.

The second talk was from a Bristol psychiatric liaison nurse explaining his role. For those that are familiar with Casualty, this is the role taken by the character 'Abs'. It was a very entertaining and useful talk, and would be something that I'd like the local hospitals in London to be able to see. He highlighted a lot of the problems that psychiatric services have with A&E departments and wasn't afraid to criticise others when warranted.

Then it was time for my chat - while the others had Powerpoint presentations for their talks, I had a scrap of paper - I have a distinct dislike of Powerpoint unless it is full of pictures of flying dogs and kittens in chocolate boxes. The session was a bit of a two-way conversation between myself and the audience, which was something I was hoping for. For the writers to get the most out of the session I thought it important that they could ask the questions that they wanted answering, while at the same time I could bring new aspects of ambulance care to their attention.

Then lunch where I had a very enjoyable chat with a high-up producer and some writers. While aware that they are producing a drama, rather than a purely accurate recreation of life in A&E, I told them about some of the things that make us people who do it in real life groan. It was a good chat because I learnt a little about how the TV programme is written and produced, and how it differs from the American way of doing things. All very interesting and I appreciated them taking the time to explain things to me. Then I was given a stack of my books to sign, the department had bought twenty copies of my book. My bank manager thanks all you TV license payers.

Then a taxi to the Casualty studios which is situated in an industrial estate and doesn't look at all how you would expect it from the outside. Taken under the wing of a lovely PA, I had a period of disconnect when I walked in and saw the extras sitting around. Here were large numbers of people dressed as nurses and paramedics, but they were all actors! The costumes, hair and similar were all extremely convincing, even the two police officer leading someone off in cuffs during the scene had the same tired look as all the real police I know. I felt like I wanted to talk to the paramedics sitting at the table to ask them what the work was like in Bristol...

The set itself is superb, it really does look real. The ceiling tiles are the same, the equipment is the same and there is even the little bits of detritus that gather in real A&E departments. The trollies (probably disused trollies taken from a real A&E) were, while old, the exact trollies I used to use. They were also bashed around in the same way that real trollies are. The only real difference is that the fake department has more blankets and pillows than a real A&E.

Unfortunately I wasn't allowed to take any pictures... perhaps if they were to invite me back in an 'official blogger' role (hint, hint)...

I sat quietly while they rehearsed and shot a scene several times from different angles. It was interesting to see all the work that goes into a section of filming that will only last two minutes on screen. They make 48 episodes a year, which means they work much harder than I do.. Filming the scene were the actors James Redmond and Janine Mellor who play the parts of 'Abs' and 'Kelsey'. I don't think I could do their jobs, to much standing around and then repeating yourself... There was also an actor who has been in loads of programmes, but whose name I don't know. Again the costumes and the way they carried themselves reminded me of people whom I have worked with in the past.

After leaving (with the fun goodie pack pictured above) I had a meal in a local pub and then caught the train home (where I wrote this post).

Now to sleep before work tomorrow. Seven evening shifts - my favourites...

The video thing yesterday was purely a bit of fun. It's in Quicktime .mov format for those that had trouble viewing it. If I ever do it again, I don't think it'll be on this blog. It was my attempt to do a 'ze Frank' when I had a spare hour. It only took two takes and I think that speaks for itself. It is also viewble on Youtube.

Loads of stuff, including twelve hour shifts has meant a slight slacking of the blog.  Time for some catch-up.

• Mac Expo – Fun, and I met Magwitch, who’s blog you should definitely read.  I do dearly love my Mac (and my Windows box, and Xbox360 and…)  The problem with the Mac Expo was that there was a lot of nice software, just priced way out of my range.  £576 for a software backup solution?  No thanks!  I did buy one bit of software, and I’m training it now.  There were some good demonstrations and the general ‘vibe’ made it worth goig.
• Laura is, as always, lovely and somehow is managing to put up with me and my personality.  She is obviously a saint.
• I was in the Metro last week – I’m not sure if I should be happy though…  Allow me to explain.  I was approached by a PR company handling the new ‘Saved’ series.  They asked if I would do an interview with an online site and I agreed.  Then, without my permission, they reprinted some of my blog in the Metro as pretty much a full page advert for ‘Saved’.  While the blog is Creative Commons licensed, it is licensed under a non-commercial license, meaning that you cannot use it for commerical use without my permission.  So I’m not really happy that it got used without them even asking.  I may give them a little phone on Monday – or they could phone me…
• What would you say if you had a chance to have a chat with the writers and producers of ‘Casualty’? On Tuesday I get a chance to have a chat with them and *ahem* put them right.  I understand that they must make the programme interesting, but it just seems a bit like the writing is lazy.  I think it would be for the best if I stick to the medical side of things.  Still, I’ll be enjoying their hospitality and will blog about what happens later.
• I have a shiny new Bluetooth GPS receiver which, when coupled with my phone, means I’ll never get lost again.  Superb!
• (Too busy to answer loads of emails #1) Loads of people offered me hosting for a Wordpress blog, they are all very kind and I’ll be making my mind up about such things next week.
• (Too busy to answer loads of emails #2) If you have sent me a ‘Thanks, I like your blog/book’ email, I will answer them, but it takes time for me to do so.  Sorry.
• (Too busy to answer loads of emails #3) If you have emailed me about something important, it’s probably dropped off the face of my world, if you want to be sure I got it, please send it again.
• Couple of medical stories are in the ‘vault’ ready to be written, normal service will be resumed soon, etc, etc…

I'm heading off to the Mac Expo today. I've got to say I'm looking forward to it, it's been quite some time since I've been to a computer trade show of any sort. If anyone wants to meet up my mobile phone number is in the 'Contact me' section of the site.

I'm going to try my best to not return with an empty wallet.

Thanks to everyone who commented on my previous three posts - I try to stay a bit clear of politics on this blog but everything seems to be happening at once in the LAS.

Here is a question. Describe an ambulance.

For most people it would be a big white (or yellow) box with blue flashing lights, when you dial 999 it turns up and two ambulance people put you in the back of it and it trundles (or rushes if you are sick) off to hospital.

Not for much longer.

In the near future the LAS will send a lone person in a car to anything that doesn't obviously need an ambulance (I'm not sure about the exact policy for who gets a big ambulance as well, I think it's being worked out). That person on the car will then decide if a 'big' ambulance is needed or if the patient can be treated by a GP/ECP/Walk-in centre.

The numbers I have been given by one of our managers is that the number of 'cars' will increase from 70 to 210 across London while the number of 'big' ambulances will be reduced from 350 to around 250.

I can understand what our management are thinking, as anyone who has read this blog for any time will be able to see, a lot of our calls don't require ambulance treatment. In an LAS report half of our patients don't need hospital treatment and in fact only 10% of our calls are life threatening.

As I've mentioned in Monday's post we are getting our budget cut so we need to 'think smart'.

There are problems with this approach though. I (and many others) are of the belief that everything goes to hospital, it only needs one person to die at home (even of an unrelated cause) and if you are the last healthcare person to see them then it is 'your fault'. We will no longer be able to do that, the expectation will be that the people on the cars will be refusing ambulances to people. Refusing an ambulance, especially if you are on your own may well increase the number of assaults on crews, not to mention the (governments) 'Patient's Charter' says that if you demand an ambulance, then you get an ambulance...

I would assume that those going on the cars will get extra training, which costs time and money and will be a slow process.

I also wonder if going on the car will be a volunteer position, because if so I doubt that the cars will be fully manned resourced. A lot of people (myself included) would go insane working on our own for any length of time.

It could work - I hope it does because we don't have the government support to provide more ambulances. I have a sneaking feeling that it won't.

I just wish I had a better (quick fix*) idea.

Magwitch has already touched on this subject.

*My long-term fix would be to hugely increase health education in schools, but the results of that would take a generation to come into effect, no good for a government looking for re-election.

The Healthcare commission assesses and rates all NHS trusts.

The LAS got a 'Quality of Service' of 'weak'.

The reason?

We failed "All ambulance trusts to respond to 95% of category B calls within 14 minutes (urban)" - Possibly because we are chasing after Category A calls with not enough ambulances.

We also 'underachieved' at "Deliver a ten percentage point increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help." - Is this because we don't do thrombolysis in London, instead we take the patient to an angioplasty centre, which is much better for the patient.

So, once more we are punished for not having adequate resources and punished again for providing a service superior to that normally expected.

We are getting used to be valued by the government.