David Nicholson (Chief Executive NHS)

"The ambulance service is not close to breaking point. It's tough, there is pressure on them, but I think they are responding fantastically well. Staff are absolutely responding to provide a fantastic service to our patients"

Peter Bradley (Chief of the London Ambulance Service)

"The increase that has come this winter has been far more dramatic than normal. It has been the most difficult ten days I have seen in the last ten years. It is absolutely horrendous. Hospitals are full and A&E departments are struggling. We have got ambulances having to wait longer to offload patients and that is causing difficulties."

Who do you think has the better idea of the state of the ambulance service at the moment? I know who my money is on and it's not on Nicholson.

On Monday the London ambulance service went to REAP 4. The REAP system runs from REAP 1 (no problems with the service) to REAP 5 (the sort of problems you get after all the power stations blow up and there are plague rats running on the streets of London).

We have never been at REAP 4, and if you ask the road crews in London they would probably say that we should have been at REAP 4 a couple of months ago.

From the official London Ambulance website

"Ambulance staff responded to 20,939 emergency incidents across the capital in the seven days up to last Sunday (14 December) – an increase of nearly eight per cent on the average of the previous four weeks. The pressure has been compounded by high percentages of calls initially treated as being Category A (immediately life threatening), and delays caused to staff at hospitals while waiting to hand over patients.
As a result of these ongoing issues, the Service today raised the declared pressure level at which it is operating from ‘severe pressure’ to ‘critical’ – the first time that it has reached this level since the capacity levels were introduced in late 2005."

The national news has been full of this story and there has been constant coverage that the 999 service is to be used for only 'genuine' emergencies...

...and obviously it has worked because five out of my nine calls today were to simple chest infections that could have been treated at home, seen a GP, or just sit and wait for it to go on it's own. None of them were sick enough to need an ambulance - but they called and we responded. I suspect it will be a similar story tomorrow.

We also had two hoax calls.

But I'm preaching to the choir.

It doesn't help that we had an outbreak of Norovirus at one of our local nursing homes, something that has led to a local hospital opening an isolation ward in order to safely cope with the influx. I'll tell you the full story of that night in a later posting.

Today, like many others of late, there were multiple calls being held waiting for ambulances - some of these calls would have been covered were it not for people picking up a phone and using the same number you dial if someone has dropped dead in front of you for their case of a 'nasty cough for the past three days'.

There are too many patients, 80% of whom don't require an ambulance, and not enough ambulances.

What doesn't help is that the politicians are ignoring the problem and trying to pretend that it hasn't all gone to the dogs. The politicians are being dishonest (yet again) and so, it would seem, are the executives of the NHS. Rather than admit a problem and make some sort of plan to improve it they lie and spin and lie some more. Just notice how they call a massive (30%) increase in calls a 'pressure' rather than a bloody disaster that we have seen coming from twelve months away - it's not like Winter just sneaks up on us does it?

And on Friday it's 'office piss-up' day.

Bloody great.

The only good thing about today has been a group of us stretcher monkeys getting a good result from a cardiac arrest. If this post reads a little weird it's because I haven't slept a wink in the last 36 hours and have just completed a 12 hour shift. At least the hallucinations haven't started yet...

I'm a bit busy at the moment (although my lurgy has mostly cleared up and my Measles blood test has come back negative, so I can return to work tomorrow starting at 'Oh my God o'clock').

I just want to draw your attention to this newstory - it's something I'm currently researching by trawling through official papers.

The short version is that in a few years time the people who 'buy' health services in the UK will be required to contract out some of the 999 A&E ambulance services to private companies.

I happen to think that this is a bad idea, and the BBC has picked up on it recently as well.

More on this once I've had a chance to research it properly.

BBC Links here.

Utterly unconnected, but there is an interesting Guardian article about how the government might deal with internet and social networking communication during a terrorist attack - I'd hope that this has no basis in fact as to do what is suggested would (a) probably not work (b) cause more problems than it solves and (c) almost certainly be illegal.

Yet more reasons why large scale IT projects containing sensitive data are prone to failure. IT projects like the NHS Database.

Firstly the BNP had their membership list published on the internet, and this has led to some nastiness. While some people may think that publishing a list of these odious people is some sort of 'justice', I happen to think that data security should apply to everyone, no matter how nasty their legal views are.

It's though that this was an inside job from a disgruntled former employee. It's hard to protect against such things, and with the NHS being such a large employer, it will only be a matter of time before one person decides to open the floodgates and open up the system to abuse.

The second example is the virus infecting the Royal London Hospital. This was the Mytob worm that disables anti-virus software, shuts down firewalls and allows remote access. It's been around since early 2005.

All I know is that for a large part of Tuesday, the Royal London Hospital wasn't accepting ambulance patients into A&E. While I wasn't there, I can't see how the failure of a computer system meant that they couldn't deal with emergency patients. Even worse, this came a day after all the local hospitals were inundated with patients. At my local hospital there were no beds available at half past six and there were nine ambulances waiting to handover their patients into the packed out A&E.

Therefore, hospitals that were still recovering after an exceptionally busy Monday had more pressure put on them because the Royal London went on divert.

I know of one critically injured patient who should have gone to the Royal London, as it's a trauma centre, but instead had to go to another hospital. So, despite the official statement, I would suggest that "By using back-up systems, manual procedures and working flexibly, we have continued to provide high quality care to our patients.", isn't true for all patients.

All this was caused by an old worm that should be fully protected against - imagine if it were something specifically written to take advantage of the NHS computer systems. Imagine if the whole computer system was linked and the worm had access to the entirety of the NHS via a joined up database?

If you have been to the Barts and London Trust can you be sure that the remote access feature of this worm hasn't been used and that your medical details aren't now out there?

But of course the NHS IT programme won't be doomed to failure, because they are using the best of the best to design the system, not the cheapest or most politically expedient...

Today was supposed to be my 'getting things done' day, but instead I have the lurgy (which may explain some things if this post is utterly unreadable).

Pondering - I wonder if there is a market for insulated and waterproofed Burkhas? I imagine that they'd be quite nice in the worst of the English weather. A cross between a Parka and a Burkha - but what would I call it?

Jacqui Smith says public demand means people will be able to pre-register for an ID card within the next few months.
The cards will be available for all from 2012 but she said: "I regularly have people coming up to me and saying they don't want to wait that long."

The fuck!?

"Please Jacqui - let me pay you £30 or more so that you can store my data on a huge database that will almost certainly not go missing (unlike many, many other cases of dataloss) all so that you can catch those nasty, nasty terrorists. I'm more than happy to have £50.1 billion of my tax money going into this scheme rather than into, I dunno, the NHS".

When is it we can get to vote this shower of fools out of government?

Here is my statement of intent :

I refuse to carry any national ID card that is based around a national database and would rather go to prison than submit to this attack on my privacy and security. They will have to get my biometric data* by force and I will shred any ID card of this type that I am sent.

I would rather emigrate (And I love London and the UK) than be forced into this scheme of waste and evil. I will vote for any political party that guarantees scrapping this white elephant.

*Which is still hideously flawed and throws up too many false positives and negatives. To be fully informed please visit No 2 ID.

(You can click through to Flickr to see the notes that I've added to my notes)

Just some notes that I made before going on Radio 5 Live to talk about this story.

Donal MacIntyre devoted part of his radio programme to it (and you can download and listen to it here, I don't know how long it will last).

So I got on the radio and said a few words (here for a few days - the section starts 1:03 in and again I suspect it only lasts a few days and won't let nasty foreign types listen to it).

But I didn't get a chance to say as much as I wanted to. But I have an audience here - so here goes...

Sadly we don't tend to flag addresses for people who are just verbally abusive to us, as I said in the radio segment, I'm working next Friday, Saturday and Sunday nights and I fully expect to be sworn at on every one of those shifts. If I were to fill in forms for that sort of abuse I'd never get any work done. Instead we fill in the forms for those people who have either physically abused us, or have acted in such a way that there is a high chance of them physically abusing people in the future.

We fill out the form, explaining why we are flagging it as a dangerous address and then fax it off to Control (using the hospital fax machine, our station doesn't have anything so high tech as a fax machine...)

So the dangerous addresses are flagged by people who have actually been there. And trust me, if someone dies as a result of a delay by us waiting for the police, the person initially flagging the address will get some serious questions asked.

The flagged address system is a warning system, it informs and compliments our 'at scene' risk assessment. Sometimes we ignore it, sometimes we wait for the police. It all depends on the situation. If someone is reported as not breathing then we'll probably go in, if they are calling because someone in the house is drunk then we are more likely to wait for the police. An example of when it was right to enter the address is this one, while in this example it was right for me to wait outside for police assistance.

It's that sort of risk assessment that we make all the time, often without consciously thinking about it.

The address is reviewed every six months, taken off the register if there have been no further reports, at least that is how it was explained to me.

So why are people violent towards us? Obviously drink and drugs play a huge part, mostly drink. But I think that there is a more subtle thing in action here.

When I wear my uniform people do as I say, they don't see me as a slightly overweight bloke - they see me as a figure of authority, that I know what I'm doing and that it is in that person's best interests to do as I suggest. Conversely, the uniform dehumanises me - it makes me a 'thing' rather than a person and it's much easier to hit someone if you think about them as just being a 'uniform' rather than a living, thinking, feeling human being.

A lot of arguments are started because of the raised expectations of people to be looked after by the state, they don't want to wait for their treatment and they want an instant cure - this is why I would suggest that actual violence against staff is higher in A&E departments, although they do have security guards posted there now.

The dangers for ambulance staff have only increased - there are more solo responders now, and they go into situations where the police would turn up mob-handed. While solo's aren't supposed to be sent to assault cases on their own, I know that I attended a fair share of such things - often waiting ages for a proper ambulance to arrive. I remember one stabbing I was sent on and it took forty minutes for the ambulance to arrive. I'm just glad that the assailant didn't return to finish off the job he'd started.

The other huge danger is Call Connect.

Due to "call connect", the government's new way of measuring the "success" of ambulance trusts, we are finding ourselves going into houses without any idea of the possible dangers. Once we are out of the ambulance, there is no way for control to contact the crew.

The new 'Airwave' radios have been delayed, so there is still no way for Control to contact us once we are out of the ambulance. We are often sent calls that just give the address.

An example,

I'm sent a call to a house I'm just driving up to - no further information is given. If I'd got out of the vehicle then I would have been met by a house full of drunks, one of whom had been cutting herself open with a kitchen knife and was arguing with the other occupants. Thankfully I don't give a damn about the government's ORCON target so I waited until more information came down - then waited for the police. If I hadn't done that there was a good chance that I wouldn't be here today writing this post.

To be honest, I would be very surprised if an ambulance person isn't killed in service before the end of next year.

Edited to add that I found the Unison's comments in the original BBC story particularly unhelpful, seeming to care more for the people who hit us than the members of their own union, then realising that there was a fence that they had to go and sit on.

I've spoken before on the 'Connecting for Health' IT project, its something that frankly gives me the willies; a huge database of all your medical details that has shockingly bad security measures.

(I've spoken to people working on the system, and trust me, it's horrendously insecure).

They are having a consultation process on the use of your medical information, which you can take part in on-line.

NHS Connecting for Health (NHS CFH) is conducting a consultation with the public and healthcare professionals on the use of patient information for purposes such as health research and managing and planning care.

The health and well-being of the population can be improved by activities such as medical research, disease surveillance, screening, needs assessment and preventative activities.

NHS CFH is keen to obtain the views of the general public, patients and other interested parties on how patient information held by the NHS should be used for additional purposes such as research.

I suggest that everyone in the UK has a look at it.

From the Open Rights Group mailing list I'm part of, someone has made the following point.

Note that the survey more than once claims that patients have no legal right to control information they have given the NHS about themselves once it has been anonymised.

As a matter of law this is nonsense.

Information given in confidence may not be used or disclosed except for the purpose for which it was supplied unless the supplier consents, and this is not changed by removing the supplier's name. So I hope responders will challenge this (and perhaps also the blithe claim that
anonymisation only fails in the case of people with very rare diseases, which greatly understates the risk that an aggregation of conditions,
dates and places will identify someone just as plainly as a name and address).

This is just exactly the sort of function creep that I mentioned in the previous post, please go and have your own say about your data being used in this fashion.

Oh, and you folks do me proud. If anyone else wants to join up (I do recommend it, I'm a proud supporter, and you can see the sorts of bright people we have involved) you can find out more here. These folks do good work that you can help support for less than the price of two pints of lager.

A paramedic who tackled a wheelchair-bound gunman has been hailed a hero.
Garry Perkins was honoured for his bravery by a crown court judge after he and a colleague came face-to-face with the armed man during a routine call-out.
But when they arrived at the house the two paramedics found Ian Wilson, who has no legs, sitting in his wheelchair asking for morphine.
But while Mr Perkins called the man’s GP, he noticed a gun on a radiator.
He said: “We both saw it and looked at each other, then the man produced a gun from down the side of his wheelchair and pointed it at John, smiling.

Myself? I would have either thrown him the drugs and told him to take them all at once - then call out the armed police, or just run.

That the man was in a wheelchair is neither here nor there, you can shoot from a wheelchair as numerous paralympic medal-winners have shown. I've also known wheelchair users who have run quite successful drug dealing businesses.

I particularly like one of the comments left on the site that says,

I have had the dubious 'pleasure' of having met Mr Wilson as a result of my job, and although on the face of it, it is hard to believe that a man with no legs, and confined to his wheelchair could be a threat to anyone,believe me he is a very threatening, aggressive and thoroughly odious little man. Good work from the Paramedics.

Just a snapshot of the sorts of things we can walk into.

Many thanks to the reader who sent me this story.