David Cameron is to announce plans to scrap many of the government's health targets including those on waiting times, the BBC has learned.

Of course not - but one can live in hope...

(...Or At Least Means He'll Never Get A Promotion).

Let me start with a few assumptions.

(1) Ambulance workers are human beings, human beings require food.
(2) The government wants the NHS to spend less money.
(3) People who use the NHS have high expectations.

The problem.

There have been a lot of stories in the news about people dying because of 'Crews on rest breaks' and even one where the proliferation of solo response FRUs are questioned as well.

To answer the first story - it was unfortunate that the people running Control put two crews on a break at once, I'll suggest why this may have happened later in this post. To quote the LAS response to the death,

An LAS spokesman said: “We dispatched a rapid-response car, which arrived at the shopping centre within eight minutes at 1.30pm, the member of staff being able to start treatment immediately. An ambulance was sent at 1.32pm after it became available from attending another incident and, according to our records, arrived at the shopping centre at 1.41pm and at the patient a few minutes later.

So, within eight minutes a solo paramedic arrived and nine minutes later there was an ambulance, so the maximum time the patient waited was seventeen minutes. Without knowing the circumstances I would imagine that even if a crew had been sent from Edmonton station they would have shaved only three or four minutes off that time.

The crews on the meal break wouldn't have even known that there was a call, Control are under orders not to disturb crews except in the last 10 minutes of the break.

Here is the thing - The press love this story because it points blame at the crews, our management or even EU legislation. Here is the story that you don't hear every day, but would be much more common.

'Man dies waiting for ambulance because they were all out dealing with idiots who call up for a stubbed toe that happened two days ago'

But it is harder for the press to prove that the reason why there wasn't an ambulance there in minutes was because they were run ragged chasing after mis-users of the service.

On the breaks themselves - in a 12 hour shift we are paid for 11 1/2 hours, we have half an hour unpaid break and 10 minutes that are interruptible. If our break is interrupted in those last 10 minutes then we receive a payment of £10. This replaces the old system of having our breaks 'bought' off us for £7.10 and while we would often be able to 'sneak' a meal, it was actually a disciplinary offence to do so. With increasing work pressures this was getting harder to do. These breaks must be completed within certain hours.

Why mealbreaks are impossible.

So - what is the problem with providing workers with mealbreaks?

Year after year the ambulance service has been put under increasing pressure. We have increasing numbers of calls. We are expected to provide services that were once the domain of GPs. More people are calling us for non-ambulance work, the recent stories about some of the rubbish we go to on a daily basis are just skimming the surface of what we do every day. If we look to reduce the numbers of inappropriate callers then, as Magwitch notes, the press is up in arms.

We do not sit on station playing pool or sitting with out feet up - we tend to go out in the morning and not stop until the end of our shift.

Then we have the pressure from the government, first they tell us that we have to get to Cat A calls in eight minutes, then they change the goalposts (Now we'll have eight minutes to get to the patient from our Control picking up the phone, rather than from knowing where we are sending the ambulance). Then the government tell us that the NHS needs to 'make a profit', whatever *that* means. Despite the increasing number of calls and our increasing roles we have less money than last year to cope.

Patient care is going to suffer as we seek to please the government.

The government therefore want us to do more calls, with wider roles but with a lot less money.

They sit in their ivory tower dictating what they want and the ambulance service bosses say, "Yes we can do that". If we don't do it then the money is cut even more. You never hear the government suggest that maybe we need more ambulances to cope with the increased roles.

Due to the budget pressures we have been put under recently there was essentially no overtime available. While we are supposedly fully manned it still meant that there were plenty of ambulances unstaffed. This situation was brought about by the government cutting our money, all at the risk of patient care.

When we have to provide the government with our response time figures we'll flood the area with ambulances so that we can make it in a 'big push'. Budget be damned. It used to be if we didn't make the target then our budget would be cut - now they cut it regardless of us making our targets.

And so we flip-flop, from saving money to providing more ambulances and back again. Our management are on the government leash and are being pulled in two directions.

This may explain why two crews were put on break at once - because management are under pressure from the government to save money wherever possible they are trying to get us our full breaks (in limited time windows) because we can't afford the £10 for an interrupted break.

So the short version - We don't have enough ambulances to to provide the care that the public and the government want and the introduction of meal breaks has just shown up how stretched we are.

And for some reason our bosses won't admit it.

A solution?

So what can we do? People are not happy with the service so there are three ways to deal with this. One way is to lower the expectations of the public toward ambulance care (and perhaps the NHS in general). If the public considered themselves lucky to get an ambulance, then they wouldn't complain so much, this is the attitude I often get from people who weren't born and raised in the UK. But there is no way to do this, and we shouldn't - we should expect, and get, top service from the NHS.

The second way is to reduce the number of calls we get by streaming out the 'crap' or by educating people about the misuse of ambulances. This isn't simple and would take twenty years or more to implement. Fines or paying the cost of the ambulance would sit in this camp and, as I've mentioned before, I don't like the idea of paying for ambulances because it would frighten off the poor.

The final way is for the government to give us more money and to stop pulling us in two directions at once. This isn't going to happen, the motive behind Patricia Hewitt's desire to 'make a profit' is that they want to invest less in the NHS. I'm not suggesting that we need to throw money at bad services, but there does need to be an increase in funds. If you were running a business you wouldn't expect to be able to expand your company without some form of investment.

But what can we do to force the government to listen to us?

Here is my solution. When the government asks for response figures we refuse. We stop recording and collating them. We spend the money that we have on improving patient care, not on fanciful imaginary 'performance indicators'. We make a stand against the utter idiocy that is the Department of Health. What could they do? Sack us all? It needs to be countrywide and across every level of the ambulance service. We need to be bloody-minded about making the government concentrate on Patient Care and not fulfilling their seeming desire to run the NHS into the ground.

We need to take a rolled up newspaper, strike across the dog's nose and in a firm and clear voice say , "No!".

It may be simplistic, but it's the only language they understand.

Paramedics in Kent dealt with more than 350 calls in six hours from midnight on New Year's Eve - the equivalent of an average day for the emergency teams.
Kent's ambulance service said the calls were mainly drink-related incidents and road accidents.
On an average day, Kent crews deal with about 400 calls.

BBC News

I'm guessing that they have a lot less staff in Kent, as London deals with around ten times that call rate every day (3,500-4,000 calls a day), it just goes to show how different various ambulance services are. Anyone in the LAS care to tell me what the CAD numbers got up to last night and tonight?

(Spotted in the new section in the sidebar of this blog - the results of searching for 'ambulance' on BBC News)

For the first time *ever*, ambulance crews are going to have rest breaks.

For too long we have been working 12 hours a day without a break.  Sure, we may be able to sneak a cup of tea at hospital, but if you take longer than half an hour to unload patient, handover to nurse, clean and restock the ambulance and finish your paperwork so that the patient can’t sue you, then we often get asked if we could ‘green up’ for another call.  Trust me when I say that it can easily take longer than half an hour to do all the above.

We rarely get to see our station, too many people call us and we simply don’t have enough ambulances to deal with all the drunks, cut fingers and coughs and colds that we get sent to.

European legislation means that we should all get a short ‘rest break’.  If you work for 12 hours, is it really too much to ask for a half hour break at some point?

Apparently it is too much to ask for ‘The Sun’.

Some journalist, who can no doubt have plenty of cups of tea during her day, decides to attack our service for (a) following the law, and (b) treating it’s staff like human beings who need feeding and watering.

It can be hard work on an ambulance, while a lot of our work is fairly simple, there are days when, not only are you run ragged, but you also have a string of tricky jobs.  Why shouldn’t we be like everyone else and get a break.  The police have meal-breaks, nurses have meal-breaks, doctors have meal-breaks and the fire service have meal-breaks (if I were being uncharitable I say that the fire service have occasional breaks in their meals for work).

So why should we be any different?

We make enough sacrifices for this job – shift work knocks years off your life, wrecks your health and social life.  We go into dangerous situations on a daily basis, get beaten up and sit in enclosed spaces with infectious patients.  We also don’t get paid enough considering how the government keeps expecting us to hold together the tatters of the NHS.  Until we got breaks we would also be eating unhealthily, wolfing down fast food between jobs, so physical fitness is a concern for us – gym memberships are a waste of money when you work half the time they are open.

So ‘The Sun’, rag that it is, wants us to work like robots.  Instead they should ask why, despite meeting targets,despite an annual increase in calls, despite being told we should cover the shortfall in GPs and A&Es the government has taken money away from us.  Ask why we can’t have more ambulances?  Ask why we have to go to people who have stubbed their toe, got a wart on their foot or have ‘man-flu’?  Ask why, after dark, it’s us and the A&E departments against the world as all the psychiatric teams, social workers and care home staff vanish along with the sun.

Maybe that would be proper journalism.

I’m already hearing about crews getting abused due to this article, one person reports being shouted at while having a sandwich, while another received abuse from a patient with a cut finger (needing only a plaster) – all because they think we should be running around ‘saving lives’.  It only needs someone to abuse me on this subject and they would get a lecture on how you shouldn't believe everything that you read in your chip wrapper.

In reality meal-breaks won’t make much difference in responding to emergency calls, it just means that the ‘stubbed toe brigade’ will have to wait half an hour for their free taxi to hospital, while true emergency calls will be covered as well as they are at present.  Being able to have a protected break may also mean crews will  be refreshed, meaning that they will ‘green up’ that bit faster, improving our response to those genuine calls.

I’ve been using Twitter a fair bit these days, it’s an interesting web-app that may well have…

Well, why tell you here when I have my shiny new blog to fill.

However, this belies the beauty of it. Once you have added a few friends (and more and more people are signing up as this meme spreads), then the inflow of short messages become like a Zen cloud of how people are feeling.

Here is the deal – on this blog I shall continue to write about ambulance work and the like.  I’ll keep up the normal posting frequency (when I have inspiration).  ‘Mental Kipple’ will be for anything that isn’t connected to ambulance work.  It’s somewhere for me to fool around, write about the things that interest me outside of the ambulance world and to let me practice different forms of writing.

It will let me keep this site ‘pure’, so that folks can’t moan when I post about things unrelated to ambulance work.

Lets see if I get bored after three months.

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.