For those in the UK Panorama tonight has a programme on violent patients in the NHS (BBC One 20:30).

Us ambulance crews are verbally and physically abused on an almost daily basis – it has gotten that we tend to ignore the verbal abuse that we get.  It’s only with the increasingly common physical assaults that we fill in the required forms.

Let me give you an example from my last night shift, a not unusual job.

We were called to ‘woman collapsed in the street’ at gone midnight.  We arrived to discover our ‘patient’ lying under a bus stop with what appeared to be her worldly possessions in a plastic bag.  There was no-one else around except for the minicab driver who had called us from hi office that she had ‘collapsed’ in front of.  While my nose can no longer detect alcohol my crewmate for the shift was able to tell me that the patient smelt as if she had been dunked in a brewery sewer.

A quick check in her bag revealed nothing obviously medically wrong with her (medicalert bracelets or ‘I am an epileptic’ cards).  It did however reveal that the woman had been released from custody earlier in the day.

I tried to wake her, but she screwed her eyes tight and refused to talk to us.  The problem is that we can’t leave her on the street; someone else would call us and we would be back and forth all night.  Likewise if she froze to death we would be to blame and, if she were stabbed later in the night we’d also probably be to blame.  The police also wouldn’t be interested, they have stopped taking people who are drunk, one too many deaths in custody is to blame for this.  So, as she refused to go home or to her hostel, the only place that we could take her was to hospital. 

I was in a good mood, so I explained all this to her, that we couldn’t leave her here, and that if she didn’t come with us the police would probably be called and that they might take a dim view of her drunkenness (a bit of a bluff, but it sometimes works).

So she started to swear at us, she threatened to hit me and she was generally rather rude…

Again, this is all water off a ducks back to me.  At one point she tried to kick me, but I’m an old hand at drunks in the street and by the cunning tactic of stepping out the way managed to avoid a scuffed shin.

Eventually we managed to hoik her up and into the back of the ambulance where, after a bit more swearing, she settled down.

She did give me a dirty look at the end of the journey though.

I would say that I get a patient who is verbally abusive at least once or twice in a shift.  I don’t mind violence from people who are medically unwell (e.g. diabetics with low blood sugars, post seizure epileptics).  But can I really count ‘drunk’ as a medical problem?

I also count myself lucky that I work where I do – unlike the hospitals where people become frustrated by long waiting times and percieved injustice I’m often seen as a friendly stranger who makes everything better.

For further stories of assaults you can look here, here, here and here. Unfortunately these won’t be the last.

You know that you have arrived when you start getting press releases. Especially when they are actually things that you care about...

DRINKERS are being encouraged to cut their booze consumption during Alcohol-Free Week.

The week will be launched Wednesday 21 February 2007 to coincide with the season of Lent when, traditionally, observers abstain from some indulgence such as drinking alcohol.

During Alcohol-Free Week people are being encouraged to give up alcohol for one day, a weekend or for a full week.

The event is sponsored by The Alcohol-Free Shop and is supported by the NHS Drinking Responsibly Project, the national charity FAS Aware that highlights the dangers of alcohol in pregnancy, Manchester City Council, and Manchester Drug and Alcohol Strategy Team.

A new website to promote the campaign www.alcoholfreeweek.co.uk has been set up where visitors can find information about the health impact of excess alcohol consumption and enter a competition to win a supply of alcohol-free beer. The web site also has links to support groups for those worried about their own or someone else's drinking.

In its first year, Alcohol-Free Week has been adopted by Manchester City Council as part of its 100 Day Challenge to tackle anti-social behaviour. It is intended to make Alcohol-Free Week an annual event involving health organisations and local authorities across the UK.

John Risby, who launched The Alcohol-Free Shop in May 2006, said: "A lot of people make new year's resolutions to reduce their alcohol intake, lose weight and improve their fitness but after a few weeks, often their good intentions fail. Lent is a good time to give it another go.

"Alcohol-Free Week is intended to encourage people to become more conscious of their own drinking and the impact it may be having on their health and the well being of those close to them.

"Health experts say that even moderate drinkers should have one or two alcohol- free days a week. We're hoping that, during Alcohol-free Week, people will avoid alcohol on at least one day and that avoiding alcohol at least some of the time will become a lifestyle choice."

Liz Burns from the NHS Drinking Responsibly project said, "We know that people want reliable information and environments that support responsible drinking.

"There is more to drinking responsibly than just soft drinks, so whether you own a pub or off-licence or you're in your own home, stock up on a range of quality alcohol-free drinks to help pace your drinks or for that alcohol free day.

"Unless our drinking habits change, liver disease may overtake coronary heart disease as the major cause of early death in the next decade".

Councillor Pat Karney, who heads Manchester City Council's Social Strategy Committee, said: "Like a lot of people I have enjoyed drinking so it's not a question of moralising or being judgmental. It's good from time to time for everybody to check their alcohol intake to see if there are any problems. This week provides a great opportunity to do that."

Once more a shortage of ambulances makes the news...

A man stabbed outside a pub was taken to hospital in a fire engine because the area's three ambulances were busy...

...An ambulance service spokesman said: "The three vehicles on duty in the Maesteg area were already committed.
"The nearest available ambulance was at the Royal Glamorgan Hospital and this was dispatched but was stood down when police responders informed control that they would convey the patient in a fire brigade vehicle

Full article here.

What strikes me as amusing is that I heard of a fire engine bringing a traffic accident in my local hospital only a few days ago - once more because of a lack of ambulances, and this is in London, not Maesteg. Once more the demand for ambulances far outstrips the actual number of ambulances we have available.

At the moment the London Ambulance Service is at 'level 3' in our 5 point scale of how busy we are. So, despite not having the money for it (thanks to the government taking a large chunk of our budget away from us to pay another hospital trusts bills), we are having to pay people for overtime in order to keep the service running to the standard that the government and the public expect.

It's long been known that the ambulance service runs on it's overtime, and our ORCON times have been dropping through the floor because until now we haven't had the funds to pay for overtime (due to the aforementioned government taking money away from us). Now it is reaching a crisis it seems that we have found the money for overtime somewhere - I suspect by 'robbing Peter to pay Paul'.

It's a simple formula, 'Too many calls (often for rubbish) + not enough ambulances + high expectations from the public of the service we provide + demoralised staff = long waiting times for ambulances, delays getting to genuine life-threatening calls and an unhappy public/government'.

Large swathes of the population expect an ambulance for every cough, cold and sniffle - the government is unwilling to pay for this expectation and so the ambulance service gets squeezed from both sides.

In April we tell the government if we have made our targets. I hope that we don't make them this year. If we make the targets after the government has cut our budget, then what incentive do they have for giving us our pre-cut budget back?

If we make our targets, then we will have made a rod for our own backs.

UPDATE: Edited to correct my mistake - we are actually at level 3, not level 4 as originally written.

To be honest, today I'm kind of ashamed to be English.

So overnight and this morning it snowed, the snow lay and as I write this we have about two inches of it all on the streets.

(Rather amusingly, as I don't watch the weather reports I only found out it was going to snow because of my Twitter cloud).

I'd planned to visit my mum, so I had a careful drive to her house - my car felt as if it had power steering and as I opened the front door I was greeted by my brother.

I may have mentioned before how my brother is a teacher, he'd gone to school and had been sent home. Apparently half the teachers hadn't turned up to work and a similar number of children were absent. A cleaner had slipped over in the hall (and then a trampoline had fell on her) breaking her leg. The headmaster then decided to send everyone home.

Cue much phoning of parents and writing of letters. Now the streets of Dagenham are more dangerous than normal, not because of of the snow, but because there are gangs of teenage thugs roaming the place.

So everything shuts down - snow is headline news (although as I'm writing this the BBC is showing pictures of puppies in the snow. No dumbing down there...) Why is it I can remember winters like this, but without all the fuss that this current fall is making.

Ernest Shackleton nailed planks from his ship to his feet to trek across hundreds of miles of frozen tundra, but a bit of snow and everything grinds to a halt. That is why today I'm ashamed to be English.

I *am* however looking to racing around icy streets in a big, heavy yellow van tomorrow (although I'm not looking forward to getting up at 5am to do it).

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)