From the BBC (and thanks to everyone who pointed this story out to me)

A woman who drunkenly abused doctors, nurses and ambulance staff in Leeds has been banned from calling the ambulance service in England and Wales.

Kathryn Gummery, 28, received the Asbo, which also bans her from the two main hospitals in Leeds, at the city's magistrates' court on Thursday.

Great, about time - people like these are a terrible drain on the NHS*.

An exception to the terms would be made if she had a genuine medical emergency.

Which will make this ASBO pretty much useless for the ambulance service. You see (and if there are any crews that know her, please let me know if I'm wrong) I would imagine that most calls to her are 'female collapsed in street'. Or even 'female with chest pain'. Either of these are emergency calls. Maybe she phones herself, in which case I'm sure that she has realised that saying yes to the question 'have you got chest pain' means that she has an immediate ambulance.

So ambulance Control will no doubt continue sending to her, crews will continue running to her and they will probably keep taking her to hospital.

Why will they keep taking her to hospital? Because they don't want to be the crew who leaves her at home only for her to choke on her vomit or fall over and break her neck. Coroners can ask some awkward questions and in the normal run of things the ambulance crew would probably lose their job.

They don't want to be the crew who leaves her in the street only for someone else to call. And if they call the police because she has breached her ASBO, the police won't want her either because you can't have drunks in police cells in case they die.

And I find it hard to imagine a magistrate locking her up for the breach (if only because she is the 'victim of a disease'*).

What did strike me as funny (and all emphasis is mine).

Police, hospital chiefs and the council applied for the Asbo due to Gummery's catalogue of aggressive behaviour.

"We're absolutely committed to working towards the policy of zero tolerance when it comes to violence and aggression towards our staff."

'Zero tolerance' indeed, if it needs a 'catalogue' of aggressive behaviour to force legal action of some kind.

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*OK, here is the thing - I'm wondering where we draw the line on medicalising bad behaviour. It seems that everyone is 'ill' these days rather than 'bad'. Alcoholism is a disease, heroin addiction is a disease, beating grannies up to feed an addiction is a disease and being violent towards people is a disease.

Very seldom does the thought that some people may have become alcoholics or heroin addicts just because they were chasing a bit of fun at other peoples expense come into view. There is always some 'reason' behind it, some reason why they are the 'victim'.

There is a continuum of behaviour from 'ill' stretching all the way to 'just plain nasty'. At what point do we draw the line on the continuum where we say that the person isn't 'diseased', but is just a nasty person to know?

An alcoholic who refuses treatment, keeps drinking and is a drain on the NHS. Well aren't they just 'diseased'? If so, why the ASBO?

This is definitely a topic for a post on it's own.

Once again, patients are waiting for ambulances rather than ambulances waiting for patients.

What is interesting is the reported tone of the Derry Mayor (and I may just be paranoid here), when he says about finding out what the other ambulances in the area were doing,

"Were they on emergency services, were they on emergency duty, were they transferring people and stuff like that," he said.

"I think that is something that needs to be addressed."

Which sounds very much to me like he wants to know if they were on a break, skiving or otherwise not 'working'.

Or it could be very interesting to see if they were dealing with people who were demanding an ambulance for a wart they'd had for the last three weeks. But I doubt that this particular follow-up story would make national news.

So it would seem that I'll be taking an effective pay cut this year as inflation outraces my pay packet. Unison (which, for better or worse is the main ambulance union) as agreed to a below inflation pay rise, staggered over the year.

I don't belong to a union because I begrudge giving them my subscription dues when they agree to stuff like this, so I don't get a vote. Much like I didn't get a vote to decide this current Prime Minister.

Still, what do I expect when our Prime Minister has cosy little chats with the Milk-thief.

It's an incredibly cheery thought, as I get ready for a run of twelve hour night shifts this Friday, Saturday and Sunday that the government values me so much. I'll bear it in mind as I destroy my body through shift work and unhealthy eating that, in order to protect inflation, I have to suffer a reduction in my quality of life by getting paid less in real terms than I did last year. I'll think of this as my back starts to ache from being stuck in an ambulance for twelve hours straight, only getting exercise as I carry people younger than myself down several flights of stairs.

And then our Health minister comes out with garbage like this,

"What is important is that we build on this, involving the workforce in the key decisions about the future of the NHS as we modernise patient care. Involving staff in this way is the key to boosting morale."

I can picture him smirking inside as he spouts this bullshit.

It seems that more and more often I think about getting out of this job and instead do something more reasonable, like writing for a living or working with computers. Unfortunately my computing 'A' level dates back to the years of the 8086 processor, and while I'm fairly smart about computers, I have nothing formally useful on my CV. That and starting on the bottom of the ladder (again) is just too depressing to consider.

And if I'm depressed now, I can imagine how I'll feel after my run of nights...

Job offers to the usual email address.

At least one of the Lib Dems has had a reasonable idea. Nothing will come of it of course, but it is a nice idea that gets him some news coverage.

UPDATE : Mousethinks points out an even better way of looking at the problem. One that in my blaise acceptance of abuse I'd completely forgotten about.

First off go and read this. Some of the comments are pretty good as well.

The article has changed somewhat from when I first read it, but it still seems to place a large part of the blame on the ambulance service. The last section tends to stick in the mind, especially the paragraph that reads.

It had failed to meet response time targets and was branded "appalling" and "unacceptable" in a report by a committee of AMs in March this year.

If things are unchanged since I was a nurse on a Medical ward and a Care of the Elderly ward then I can explain exactly why patients are waiting on ambulances for A&E trolleys.

The routine for a patient who needs a trolley and then admission to the hospital goes something like this.

1. Patient calls 999, ambulance turns up, does clever medical stuff and drives them to hospital.
2. Ambulance gives patient to A&E department by putting them on an A&E trolley.
3. A&E department doctor sees the patient, does even cleverer medical stuff, and decides they need admitting.
4. A&E nurse calls the bed manager, bed manager finds the patient a bed on an appropriate ward.
5. A&E transfer the patient to the ward.
6. Patient gets treated on the ward and either goes home or, if unable to return home, is referred to the social workers who arrange a care home/warden controlled place/home care package.

So where is the most common delay? It's at step 6, and this trickles back all the way to step 2.

When a patient cannot return home (for example following a stroke) the social workers need to sort out who is going to fund the care home, they need physiotherapy reports, they need occupational therapy reports, they need to run 'Multidisciplinary team' meetings and they need to do all the other arcane and hidden things that they get paid to do.

Then there needs to be an available place at a care home that the patient and family are happy with. And this all takes time, and so the patient becomes a 'bed-blocker'.

(The record for me when I was a nurse was a patient staying on the ward unnecessarily for six months while funding was sorted out)

Even if the patient can return home but needs assistance, be that daily carers or just a stairlift installation, the delays are much the same.

If the ward beds are full there is no place for a new patient, so the patient stays in A&E taking up a trolley that could have been used by the next patient rolling in by ambulance.

Which means that the A&E department turns into a medical/surgical/psychiatric ward by knocking the wheels off some trolleys and hiring and expensive agency nurse to look after the patients for a few days.

There are other delays, like ward nurses 'not being ready' for a patient even though they have an empty bed, or A&E departments being reluctant to accept new patients because it would impact on their four hour government target. But generally I would say that these are fairly minor and can be fixed by a Matron with a big stick. Or an angry A&E nurse threatening ward nurses with bloody murder...Ahem...

I think that when Mike Cassidy says, "We've experienced some difficulties, maybe one or two days every couple of weeks just when the system overheats a bit and when demand is extremely high for us.", he is highlighting that this is a cyclical thing, and perhaps people should look into why it is a cycle. Is it because in the hospital social workers and the like vanish at the weekend, leading to a Monday/Tuesday backlog of patients?

However - both the hospital trust and the ambulance service blame the number of 'inappropriate attenders', people who should have gone to their GP for their minor illness. 'Inappropriate attenders' don't block beds - they tend to slow down the transit of people through A&E, but as they seldom need trolleys to lie on they can't really be blamed for making ambulances wait with their patients for trolleys. What 'inappropriate attenders' do is make other minor injury people wait to be seen.

We can blame 'inappropriate attenders' for a lot, I know I do, but in this case their influence is tiny.

What is needed is more social workers, more care homes and more hospital beds with the nurses to staff them. There needs to be a way to move people who no longer need hospital treatment into appropriate placements much faster and there needs to be a streamlining of the discharge into care process.

But that requires money.

And I'm not the minister for health.

A big thanks to Dr Crippen for writing about what I was going to post about today. It means I can go back to sleep.

The short version is that there are some pillocks that don't want to have to look at the injured servicemen coming back from Iraq and Afghanistan.

It was drawn to my attention on one of the ambulance forums, partly because we have a fair number of ex-forces people in the ambulance service and partly because, while some of us may disagree with the purpose behind the wars, we do respect and honour the people on the ground actually doing the fighting for our political masters.

the other thing to post about is that, as you are probably aware, there is wide flooding around the UK at the moment. The British Red Cross have set up an appeal fund. If you have a spare couple of quid please head over there and donate to that or one of their other causes.

(...and now I head over to PC World to get something for my brother, then to Homebase to get a tonne of stone for my mother. Then I shall collapse back to sleep).

From TheyWorkForYou.

Sandra Gidley (Romsey, Liberal Democrat)

"To ask the Secretary of State for Health how many (a) male and (b) female teenagers were admitted to accident and emergency departments on grounds related to drunkenness in each month of (i) 2007 and (ii) the last five years, broken down by NHS trust; and what treatments they required, broken down by category."

Dawn Primarolo (Minister of State (Public Health), Department of Health)

"We do not collect data relating to alcohol-related attendances at accident and emergency departments." [Emphasis mine]

Tables have been placed in the Library which supply data for teenagers admitted to hospital [Emphasis mine] via accident and emergency with a primary diagnosis of T51 toxic effect of alcohol (i.e. more severe than general drunkenness and loss of inhibitions) for the last five years, broken down by gender and health care provider. The information provided in the tables does not include instances of the toxic effects of alcohol as secondary diagnosis."

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From the BBC

"The introduction of 24-hour drinking laws may have trebled alcohol-related admissions to A&E departments in inner city areas at night, a study claims.
Researchers at London's St Thomas' Hospital compared overnight visits before and after the 2005 law change.
There were 80 alcohol-related visits in March 2005. This hit 250 in 2006, the Emergency Medicine Journal said. "

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We 'code out' all our calls. There are two or three numbers to write down that represent what has happened to our patient. The first number is the 'type of injury' code. So (from memory) - Code 01 is 'Illness known', 02 is 'illness unknown', 03 is 'fall', 14 is 'assault' and so on.

Then comes the injury code. 01 is 'abdominal pain', 75 is 'minor head injury', 69 is 'vomiting', 23 is 'epileptic seizure'.

'62' is alcohol related.

The small problem is that where someone has two types of injury, for example they had a seizure due to alcoholism and cracked their head open, there are only two boxes to write numbers. For the fitting head injury mentioned that would be as 57/75 ('fitting - other cause', 'head injury - minor'). There would be no place to write down the '62' - alcohol related.

Couple that with the problem that the boxes are very small and easily forgotten and are therefore are occasionally not filled in and you have an obvious lack of data on how alcohol affects A&E attendance.

There are some vague figures mentioned in parliament. But these are only for people admitted to hospital - not for that much more common breed of people who are treated and discharged or are allowed to sober up and make their own way home. Or for those that attend, are violent and are thrown out.

So the St Thomas' Hospital study is incredibly important, and should be going on nationwide. During nightshifts alcohol probably accounts for 40-60% of my work, half that during dayshifts. Yet it would seem that no-one is recording or studying the numbers and types of people using the NHS for this reason.

Again from the BBC

"Both the Department of Health and the Department of Culture, Media and Sport, which was behind the legislation [to increase licensing hours], were dismissive of the findings, noting that the study only related to one hospital in one particular month."

So why isn't there a more widespread counting of the number of alcohol related attendance? Something done all year in all hospitals, something involving ambulance service trusts. Just a simple tickbox asking if we considered alcohol the cause of the injury or illness.

If it were recorded and studied, might it not make a difference in how we provision care, fund hospitals, amend licensing laws and tax alcohol?

Or is that why it's not done?

Because this sort of thing happens.

And because I noticed it because Rachel 'twittered' it.

(Yes - I'm paying a bit more attention to my other blog now - there may be reasons behind this...)