It all appears to have gone crazy in Newham. The hospital is full, they have no beds for admission and the A&E department is nearly overflowing. It's getting close to standing room only in the waiting room.
The ambulances here are pretty much fully staffed, yet the police are bringing in 'blue call' motorbike crashes because there are no ambulances to send to them.
West Ham football club is playing at home later this afternoon, so that will mean more work.

Apparently the other hospitals in the area are in a similar position.

Whatever happened to Sundays being quiet?

I'm scribbling this while my crewmate quickly does paperwork before we return to the fray.

-=-=-=-=-
Sent from a mobile phone, probably from the cab of an ambulance.
-=-=-=-=-

NeeNaw gives a description of a job very similar to one I went to today.  I may have been a trifle rude to the drunk I found laying on the couch…

Loads of stuff, including twelve hour shifts has meant a slight slacking of the blog.  Time for some catch-up.

• Mac Expo – Fun, and I met Magwitch, who’s blog you should definitely read.  I do dearly love my Mac (and my Windows box, and Xbox360 and…)  The problem with the Mac Expo was that there was a lot of nice software, just priced way out of my range.  £576 for a software backup solution?  No thanks!  I did buy one bit of software, and I’m training it now.  There were some good demonstrations and the general ‘vibe’ made it worth goig.
• Laura is, as always, lovely and somehow is managing to put up with me and my personality.  She is obviously a saint.
• I was in the Metro last week – I’m not sure if I should be happy though…  Allow me to explain.  I was approached by a PR company handling the new ‘Saved’ series.  They asked if I would do an interview with an online site and I agreed.  Then, without my permission, they reprinted some of my blog in the Metro as pretty much a full page advert for ‘Saved’.  While the blog is Creative Commons licensed, it is licensed under a non-commercial license, meaning that you cannot use it for commerical use without my permission.  So I’m not really happy that it got used without them even asking.  I may give them a little phone on Monday – or they could phone me…
• What would you say if you had a chance to have a chat with the writers and producers of ‘Casualty’? On Tuesday I get a chance to have a chat with them and *ahem* put them right.  I understand that they must make the programme interesting, but it just seems a bit like the writing is lazy.  I think it would be for the best if I stick to the medical side of things.  Still, I’ll be enjoying their hospitality and will blog about what happens later.
• I have a shiny new Bluetooth GPS receiver which, when coupled with my phone, means I’ll never get lost again.  Superb!
• (Too busy to answer loads of emails #1) Loads of people offered me hosting for a Wordpress blog, they are all very kind and I’ll be making my mind up about such things next week.
• (Too busy to answer loads of emails #2) If you have sent me a ‘Thanks, I like your blog/book’ email, I will answer them, but it takes time for me to do so.  Sorry.
• (Too busy to answer loads of emails #3) If you have emailed me about something important, it’s probably dropped off the face of my world, if you want to be sure I got it, please send it again.
• Couple of medical stories are in the ‘vault’ ready to be written, normal service will be resumed soon, etc, etc…

I'm heading off to the Mac Expo today. I've got to say I'm looking forward to it, it's been quite some time since I've been to a computer trade show of any sort. If anyone wants to meet up my mobile phone number is in the 'Contact me' section of the site.

I'm going to try my best to not return with an empty wallet.

Thanks to everyone who commented on my previous three posts - I try to stay a bit clear of politics on this blog but everything seems to be happening at once in the LAS.

Here is a question. Describe an ambulance.

For most people it would be a big white (or yellow) box with blue flashing lights, when you dial 999 it turns up and two ambulance people put you in the back of it and it trundles (or rushes if you are sick) off to hospital.

Not for much longer.

In the near future the LAS will send a lone person in a car to anything that doesn't obviously need an ambulance (I'm not sure about the exact policy for who gets a big ambulance as well, I think it's being worked out). That person on the car will then decide if a 'big' ambulance is needed or if the patient can be treated by a GP/ECP/Walk-in centre.

The numbers I have been given by one of our managers is that the number of 'cars' will increase from 70 to 210 across London while the number of 'big' ambulances will be reduced from 350 to around 250.

I can understand what our management are thinking, as anyone who has read this blog for any time will be able to see, a lot of our calls don't require ambulance treatment. In an LAS report half of our patients don't need hospital treatment and in fact only 10% of our calls are life threatening.

As I've mentioned in Monday's post we are getting our budget cut so we need to 'think smart'.

There are problems with this approach though. I (and many others) are of the belief that everything goes to hospital, it only needs one person to die at home (even of an unrelated cause) and if you are the last healthcare person to see them then it is 'your fault'. We will no longer be able to do that, the expectation will be that the people on the cars will be refusing ambulances to people. Refusing an ambulance, especially if you are on your own may well increase the number of assaults on crews, not to mention the (governments) 'Patient's Charter' says that if you demand an ambulance, then you get an ambulance...

I would assume that those going on the cars will get extra training, which costs time and money and will be a slow process.

I also wonder if going on the car will be a volunteer position, because if so I doubt that the cars will be fully manned resourced. A lot of people (myself included) would go insane working on our own for any length of time.

It could work - I hope it does because we don't have the government support to provide more ambulances. I have a sneaking feeling that it won't.

I just wish I had a better (quick fix*) idea.

Magwitch has already touched on this subject.

*My long-term fix would be to hugely increase health education in schools, but the results of that would take a generation to come into effect, no good for a government looking for re-election.

The Healthcare commission assesses and rates all NHS trusts.

The LAS got a 'Quality of Service' of 'weak'.

The reason?

We failed "All ambulance trusts to respond to 95% of category B calls within 14 minutes (urban)" - Possibly because we are chasing after Category A calls with not enough ambulances.

We also 'underachieved' at "Deliver a ten percentage point increase per year in the proportion of people suffering from a heart attack who receive thrombolysis within 60 minutes of calling for professional help." - Is this because we don't do thrombolysis in London, instead we take the patient to an angioplasty centre, which is much better for the patient.

So, once more we are punished for not having adequate resources and punished again for providing a service superior to that normally expected.

We are getting used to be valued by the government.

Our boss gives his response here.

Right, a bit of a moan.

When us ambulance people signed up for Agenda for Change, we realised that while we would be taking a cut in our basic pay, the deficit would be made up by our 'unsocial hours' payments.

It works like this - I am paid a basic wage. If I work 'unsocial hours' then I get paid more for those hours. 'Unsocial hours' are currently between 7pm and 7am in the morning.

The government is changing the boundaries of the unsocial hours to 8pm to 6am. That's two hours less a day.

I'm hoping that our pay will remain protected (i.e. not drop below the amount I was getting paid before Agenda for change started).

Secondly, more crap from the government. We, and other healthcare workers are going to get a pay rise pegged at 1.5% as opposed to the rate of inflation which is 3.6%. I'm looking forward to that extra 2p per hour given that our role keeps expanding.

Is it any wonder that workers keep leaving the NHS?

Finally, the London Ambulance Service ended up financially 'in the black'. So our budget is being cut by £3 million and is being given to a failing department. This has meant a reduction in overtime, which again has reduced some people's take-home pay. Given that our trainees are paid 75% of the basic wage and many of them rely on the overtime, now there isn't enough to go around. While manning is at an all time high, there are plenty of rumours that large numbers of ambulances are going un-resourced*.

So we are being 'punished' for saving money, we are going to get paid less and our pay-rise is lower than inflation.

If it wasn't for the government it'd be a nice job.

I'm glad I'm not the boss of the LAS.

Maybe Dr. Rant has the right idea.

*I was told off for not being politically correct when calling the staffing of motors 'manning', hence 'resourced'.

Here is a fragment of an e-mail I received the other day. It makes me more than happy to have released the book under a CC license.

I'm an occasional reader of your blog and have just
downloaded the CC version of your book (I would've
bought the book itself but I'm in Nigeria at the
moment and Amazon refuse to deliver here - can't think
why!).

How superb is that?

I'm feeling better now, thanks for all your kind words. For some reason I got a load of 'flu-like' symptoms for 48 hours, aching joints, lack of sleep, headache the whole nine yards. Maybe it was some nasty mouth bacteria that got into my tooth-hole. The worst thing was that I had to cancel a day with Laura. Something that made me feel even more wretched.