Hello all, I suspect that I'm not going to at all popular by saying what I'm about to say, but I just wanted to give this another perspective. I have exactly the same background as Tom, ED nursing and then the Ambulance Service. However, I didn't join the LAS but went to the Netherlands. We know know no different here than a driver and a healthcare professional that it responsible for the patient. I do have days when I'd like to be driving, but can't. I also get fed up of listening to the same stories in the back of the moter. But, you know what? It's my job as attendant. Some of the points Tom made are valid, but there are usually solutions. As far as clinical competence is concerned, if Tom does his job as well as he writes (something about his prose suggests he does) then I'm sure he has nothing to worry about. I bet he never double signed every single drug dose in the ED whilst working there (with the exception of opiates). If a job is particularly sticky then there's always the option of a single truck, isn't there? This will be a big change for the LAS, and nobody likes change. However I find it difficult to believe that this will be to the detriment of direct patient care. I don't have the idea that we give substandard care here in the Netherlands compared to an average NHS ambulance trust. Just my 2(euro)cents worth, The Welsh Medic.