Dear Lord Darzi,

You are saying that the experiences of patients will affect the funding of NHS Trusts, does this include the experiences of the patient who has to wait four hours in A&E before being told that they don't deal with verrucas there? Will it include the patients who turn waiting rooms into boxing rings, or who call ambulances for a cheap taxi ride home?
If I go to a patient and they want me to carry them downstairs for their cut finger, putting my spine at risk - will I have to do it in order to keep the 'patient satisfaction' high?

And if we don't do this, either due to good sense, or because we have already stretched our current resources to the limit, then you will cut our money.

What about those patients who don't like their GP because their GP isn't 'English'?

Such people exist, and in greater numbers than you might expect. But then the view is a bit limited from that ivory tower of yours.

It is really quite simple - the expectations of the public are rising faster and higher than can be reasonably met. They want everything and they want it now, but are not willing to pay for it. They do not understand that there is rationing in the NHS, but then the government has been unwilling to mention this.

And why stop at 'dashboards' inside hospitals showing their 'quality', why not have a scrolling marquee around the outside of the hospital, it would be just as tacky.

Giving patients choice is a fine idea in principle, but for many of the patients that I deal with they just don't have the knowledge to make an informed choice on their treatment.

-Tom Reynolds
Just another ambulance man.

UPDATE: I'm not the only person to think this way.

I often joke with parents that their children enjoy scaring them.

When they are a few weeks old, they hold their breath and go blue.
When they are a year old they get high temperatures and have febrile convulsions.
When they are two years old they fall over and cut their head.
When they are seven they fall and break a bone.
When they are fourteen they either get pregnant, or make someone pregnant.

One of our commonest calls for children is the 'traditional', two year old who has fallen over and cut their head on a wall/radiator/stone/passing dog. The mother is often panicking because 'it's a lot of blood!' (even though it isn't) and we pop them down the hospital for patching up.

Sometimes a child will fall over and get a bump on the head. I take them to hospital because it's an easy job and they get to sit there for a few hours before being sent home by the A&E doctor. Simple.

Sometimes however the parents just want the child 'checked out', they don't want to wait at the hospital so they will call an ambulance and not go to hospital.

Occasionally the ambulance crew will feel kind to the parents and child and suggest that they don't need to go to hospital.

I don't know what scenario played out in this story, but unfortunately the child died. Now the father is aiming to sue the service.

I have no details of this job, or what happened - but I can talk in generalities.

If, on examining a child, they are happy, alert and interested in what is going on around them and there is no history of a loss of consciousness, then they are almost certainly going to be fine. If you take them to hospital they will be sent home most likely without an x-ray or CT scan.

I can imagine that in this instance, even if the ambulance crew had taken the child to hospital the outcome would have been the same. Only the headline would be 'Hospital in probe over boy's death'. I don't think that the child would have been examined differently by a hospital doctor than by the ambulance crew.

There is a saying among those of us at the bottom of the medical hierarchy - 'always leave another medical professional between you and the patient', or 'don't be the last medical professional to see the patient alive'. If I take a patient to the hospital, then it's the hospital's fault if something goes wrong. If the patient wants to stay at home, then I'l try and arrange the GP - so if something goes wrong it's the GP's fault.

It's medical arse covering at it's worst.

In part it's due to the media - in this story above, do you imagine that the BBC would print a story following the investigation where the ambulance staff are found to be without fault? I doubt it.

We ambulance folk are being subtly encouraged to leave people at home, and most of us are blatantly ignoring this hinting for the exact reason above. We don't want to be the last people to see a patient alive.

If I go to a patient with a sore toe I'll still take them to hospital - because if they die of an unconnected heart attack, I'll be the one to blame.

And soon, with the 'front end' model, solo responders will be expected to leave patients at home, somewhere in the vicinity of 60% of patients should be left at home, or have 'alternate pathways' for care.

I can't see many ambulance people being happy doing that.

The plan that was supposed to happen for the next two weeks is that I wander around the UK (on your recommendations), unfortunately for the last two days I have been suffering from a bout of diarrhoea and being stuck on a motorway with while desperate to visit the loo is a thought that doesn't fill me with joy.

So I'm postponing it until I feel better. The good news is that it isn't happening while I am supposed to be working, otherwise I would be up before the 'competency hearing' that I've been threatened with. That or rustling while I walk around in incontinence pads...

Good news though as I have a piece I wrote for the Guardian up at Comment is Free. Getting some interesting comments as well, which is lovely.

UPDATE: It would seem that whoever posted the article edited the final paragraph for reasons unknown. It should read

Due to public concern and the opinions of experts the government is seeking to reduce the amount of alcohol drunk, especially by the young. However until we have a change in culture of a similar magnitude to that which made 'drinking until you fall down vomiting' popular these problems will only get worse.

Perhaps in the future the fashion may be to drink sensibly.

I live in hope.

This is interesting,

The Scottish Ambulance Service has been given a month to bring forward plans to end the single-staffing of its emergency ambulances.

"I have made it clear to the Scottish Ambulance Service that it must take action to eliminate rostered single-manning," Ms Sturgeon told MSPs, making it clear the use of rapid response vehicles, designed to be manned by a single-paramedic, was also being looked at.

In London there is an increasing move to have solo responder RRVs going to calls (it helps with the eight minute target), in fact the move is to reduce the number of double manned ambulances and instead have many more solo cars.

In London a lot of the RRVs are manned staffed by ambulance technicians rather than paramedics, and ambulance techs don't have the same drugs available as paramedics.

When I was working on the RRV if I arrived at someone who was having a seizure there I couldn't give the drugs that a paramedic would use to stop the fit.

This plan, the 'front end' model, where a RRV is first sent to a job to decide if a double-crewed ambulance should be sent is due to be rolled out in London in the near future. This story would mean that at least one person in government is unhappy with this plan. Along with a lot of on-the-floor ambulance staff.

So I wonder if the Health secretary will be looking at other ambulance trusts?